The proportion of people for whom gender-affirming hormone treatment is a “greater risk than benefit” is increasing, a consultant from the National Gender Service has said.
Representative groups for the transgender community have said the current system is “failing our community” and have called for a new model of care.
Dr Yagoub Gader, consultant endocrinologist at St Columcilles Hospital Loughlinstown, where the national service is based, said the evidence base for transgender healthcare is “underdeveloped” and what does exist is “of poor quality”.
“Therefore, it is impossible to reliably quantify the potential for risk and benefit in transgender healthcare. This applies for all aspects of transgender healthcare, including hormone therapy,” he said.
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Gender-affirming hormone therapy involves people taking hormones such as oestrogen, testosterone or hormone blockers to help achieve physical characteristics that are more masculine or feminine.
“We do not recommend prescribing gender affirming hormone therapy in the absence of a comprehensive, holistic, multidisciplinary assessment, or if, after such an assessment, the apparent risks exceed the apparent benefits.”
Dr Gader said “clinical complexity is greater than it has ever been before”, with people presenting for assessment with multiple unaddressed clinical needs.
Therefore, he said, the proportion of people who are found to have “greater risk than benefit” at the time of assessment is “increasing”.
“When clinical risks and/or needs are identified, they are addressed either by referral to community services, other specialist services, or by the multidisciplinary team within the NGS,” he said.
His statement was made in response to a parliamentary question from Labour health spokeswoman Marie Sherlock, who said the lack of recruitment in the area since 2020 “speaks volumes about the lack of seriousness and paralysis” with which the Health Service Executive and Department of Health are treating the National Gender Service.
According to Dr Gader, the waiting time for a first appointment is four years, which the consultant described as “unacceptably long”.
“Further investment and service development is needed to shorten waiting times. Autism specific supports would also be needed,” he added.
Transgender Equality Network Ireland (TENI), an advocacy group, said its position is that transgender people who want to access transgender healthcare should be able to do so in a service that is safe, informed, and in their local area.
“While the service is currently seeing individuals who were referred four years ago, the wait-list has grown considerably since,” the organisation said. As of December 2024, there were more than 2,000 people on the wait-list, and the service only took 160 people off the wait-list last year, it added.
This means individuals being referred now are facing a wait of more than 10 years before their first appointment, TENI said, adding that there has been a “breakdown of trust” between the trans community and healthcare providers.
The group said the assessment process should be functioning to “identify additional needs so that those needs can be met”, but instead “those needs become barriers to accessing care”.
A spokeswoman for BelongTo, a charity for LGBTQ+ youth in Ireland, said there is “no active health service for trans young people”.
“Trans young people and their families cannot get the information, supports and referral pathways they need to understand whether accessing gender-affirming care is the right option for them or not,” the spokeswoman said.
The HSE is developing a new Model of Care for transgender healthcare.
