“It’s very complex! It’s something to be carefully considered! It’s something we should be afraid of! It’s dangerous!” – These are all things that the mainstream media will tell you about transgender healthcare.
And they’re correct! But not in the way that they meant to be correct.
For transgender people, it is a very complex area of healthcare to navigate. Our healthcare system needs to carefully consider their current practices, and yes, it’s something that much of the trans community are afraid of due to our negative experiences of trying to access services in Ireland.
In terms of being dangerous? Yes, it is dangerous for a trans person to have the healthcare that they need delayed or refused.
So, what is ‘Transgender Healthcare’? It’s quite simple really – it’s any form of healthcare that a trans person needs to survive, thrive and stay healthy. Be that Hormone Replacement Therapy (HRT), gender affirmation surgeries/procedures, mental health support, sexual health services etc. It’s nothing special, it’s basic healthcare that is needed, just like every other area of healthcare.
To put this into perspective, let’s look at some statistics from Speaking From The Margins, the only study of its kind ever undertaken in the country. Carried out by TENI (Trans Equality Network Ireland), it looks at trans mental health and wellbeing in Ireland.
The study found that 92 percent of respondents were more satisfied with their bodies after transition and 82 percent more satisfied with their lives. And if you didn’t before believe that adequate trans specific healthcare can be a matter of life or death, I invite you to read and think about the following statistics and then come back to me: 76 percent of respondents had self harmed prior to transition, this dropped to a whopping zero percent post transition. 81 percent had thought about or attempted suicide prior to transition. This dropped to just four percent after transition. These statistics may be shocking for you, but not for me. And not for the trans community.
This is an Ireland specific study, but any global study will read with almost identical results. Healthcare saves lives, trans healthcare is no different.
Unfortunately in Ireland, trans specific healthcare is one of the only areas of healthcare in the country that has regressed with time.
When I speak with older members of the trans community who first accessed HRT 15-20 years ago, the pathway seemed simpler, quicker and more seamless than it now is. There were no long waiting lists, endocrinologists didn’t solely demand a psychiatric diagnosis and trans people were believed as opposed to having to prove themselves.
But what happened? Fear. Fear amongst healthcare providers.
As our language grew and society became more aware of and accepting of trans identities, more trans people began to feel safer in living their authentic lives. This meant that more and more people were seeking the healthcare that they needed.
With the influx of people seeking services, more healthcare professionals began working in the central clinic, and thus, more opinions and ideologies of different individuals began to muddy the waters in terms of access for trans people, and as a result, an unofficial, outdated and incorrect psychiatric model of care was adopted and enforced by clinicians, out of fear and against the 2012 official model of care developed by the HSE in conjunction with TENI and signed off by the HSE in 2016. But although officially adopted, it never filtered down to clinical practice.
So what was this fear about? That trans people would have regret. But it’s an unwarranted fear. In Ireland, less than one percent of trans people have regretted any form of gender transition. Let’s break that down to a number: three people.
All of a sudden, over 99 percent of trans people seeking life-saving healthcare in Ireland were now being held back, not just because of those three people who regretted their transition (which they are perfectly entitled to) but because of an irrational fear by the clinic who provided healthcare to the entire community.
Healthcare for trans people in Ireland ‘inadequate’ – European reporthttps://t.co/tOTiFc7QEJ
— GenderGP (@GenderGP) February 4, 2020
This had a devastating impact on trans people.
In 2017, the waiting list to access HRT had jumped to 3.5 years. Every trans person was being bottlenecked into the one clinic at Loughlinstown Hospital -a clinic which now insisted that all people referred to the service go through a robust psychiatric evaluation to be diagnosed with gender dysphoria. But on their terms, by their liaison psychiatrist, with a diagnostic model created solely by the ideas of this one clinic, a model that went against international best practice standards of care, developed by WPATH (World Association for Transgender Health) which advises a model of informed consent.
Trans people were waiting years for this psychiatric assessment and once they reached the top of the list, they were put through an invasive, intrusive, three-hour-long session with a psychiatrist with the “diagnostic” questions bearing no relevance to a person’s gender identity.
I had this assessment in July 2018; it was exhausting and infuriating. I was asked how I pick up men for sex, I was asked the mechanics of how I have sex, I was asked about my parents’ relationship or any experiences of abuse in my childhood, as if any of this information changed the fact that I was born a transgender person.
The model wasn’t working, it wasn’t relevant and it was damaging those trying to access healthcare. People were suffering, and yes, some people were dying.
As healthcare for transgender people began to fall apart, TENI were doing trojan work in the background, they were at the table with the HSE and the Department of Health, trying to improve the care being provided to the trans community in Ireland. But on the part of the HSE, progress was slow.
From this, the This Is Me Campaign arose – a campaign that I was inspired to begin based on my own experiences of trying to access healthcare.
We were grassroots, we were loud, and we didn’t have to play political niceties. We formed in December 2017 and we began to shout about something that no one else was publicly shouting about. Transgender Healthcare.
And the storm began.
Suddenly, people were sharing their experiences, the media was, for once, giving attention to the issue and major pressure was being put on the Department of Health and the HSE. People were emerging from the ashes nationwide, wanting to tell their stories. The Irish trans community found their voice, they were no longer afraid. And together, as one community we pushed ourselves as hard as we could until it became impossible for the HSE and Department of Health to ignore us any longer. Negotiations began with Minister for Health Simon Harris, who subsequently, in June 2019, set up a steering committee to review the integration of healthcare services for transgender people in Ireland.
— Gay Community News (@GCNmag) December 30, 2019
Members of this committee mainly involve leading HSE clinicians and Department of Health officials with the exception of myself as a patient advocate and the Minister’s appointment, as well as two representatives from TENI. It wasn’t everything, it wasn’t exactly what we wanted, but it was a start. Although the improvement of service integration is positive, it is the model of care that we really need changed, and recent conversations with the Minister have me cautiously optimistic for future amendments.
There is a lot of focus on the negatives, of which there are many, but let’s take a look at some of the positives that have come from the trans community’s relentless work over the past few years:
The clinic at Loughlinstown Hospital, now under a new clinical lead, has been developed into The National Gender Service, the waiting list has been cut from 3.5 years to roughly 17 months. More personnel have been hired in areas such as psychiatry, social work, speech and language therapy, and nursing and admin.
From just a few months ago, when email and phone calls were going unanswered for months at a time, you can almost be sure to now get through on the same day. People are being discharged from the clinic to the care of their local GP’s and a virtual clinic has now been set up for repeat prescriptions and hormone monitoring.
How to better integrate paediatric services with adult services is currently being reviewed, and hopefully this year, the model of care will be examined. The change of the model of care is what will most benefit trans people accessing healthcare in Ireland. So this is our next big fight.
The World Health Organisation (WHO) last year declassified trans identities as mental health or behavioural disorders. They can no longer be considered as such, however, Ireland still treats us as a psychiatric disorder. We currently use a model that was developed by one clinic, based on non-evidential ideas of what it is to be trans. And unfortunately, it’s a model that is being used as a ‘tick the box’ exercise in allowing, delaying or refusing essential treatment to people who need it.
Included in our next big fight is access to gender affirmation surgeries. The only surgeon in the country providing ‘top surgery’ (chest surgery) to trans people, has now retired. And for ‘bottom surgery’ (self explanatory) we do not, nor have we ever, had any surgeons in Ireland that provide it. This means that that we are sending our trans community abroad for major, invasive surgeries with little to no aftercare when we return home, also leaving people paying thousands out of pocket.
In this issue of GCN, more than ever before, I go deeper into detail of how and why trans people have been failed so badly by the HSE and what’s coming next for us! https://t.co/zelcJ6HZOU
— Noah Halpin (@Noah_Halpin) January 24, 2020
I was one of those people. I had to travel to Poland and pay privately. Although one of the best things I have done, I wouldn’t wish the stress, financial burden, or pain and torment on my worst enemy. We have many surgeons in the country that can provide these surgeries. But why wont they? Fear.
It pains me to think that something as normal and boring as my gender is something to be so badly feared by apparently highly intellectual professionals.
So what’s next and what can you do to help?
Our gender identities don’t render us ill. Help us to end this stigma and bring the Irish transgender healthcare system into the modern day. The most important change that is needed is that we adopt an informed consent model of care in line with international best practice standards of care. This will save lives. I promise you.
Secondly, surgery options at home and/or access to the Treatment Abroad Scheme and/or Cross Boarder Directive for all trans people.
We don’t want anything extraordinary. We don’t want special treatment. We just want to be treated adequately, accurately and as the human beings that we are. We want to survive, we want to thrive, and we want to live.
We’re doing our best to achieve this, but we’re a small army. Change is slowly happening, but we need your help for progression. Help us to achieve this and I promise you, when you see the next generation of trans kids thriving personally, professionally, holistically, you’ll smile knowing that you were part of their happiness.
Because I think there’s one thing we can all agree on – that healthcare is a human right.
This story originally appeared in GCN Issue 362 released February 2020. You can read more here.
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