“My name is Steve and I transitioned when I was seven” is how Steve describes his identity. “I’m not a girl with a boy’s name. I’m a boy with a girl’s body. Most people just get that and some people don’t.”
There is no simple answer to the question of what it is like to be a transgender person in Ireland in 2022. For Steve, the experience has been mostly positive, though he says he is "privileged" to have a really supportive family, school and friends. Now 13, he feels lucky that he transitioned when he was younger "and I got a lot of help with it." In his life, "I have more positivity than I do otherwise. I have a lot of people I can talk to."
Once he discovered support groups for children and teenagers like him, it was a huge relief. Before then, “I thought I was on my own. I thought I was the only one.”
Steve now has a passport in the correct name, but in the past had one with his old identity. For him, it was like giving a fake passport
Over the past decade, there has been much more visibility and discussion around transgender people. Young people like Steve – who showed signs of identifying as a boy from the age of 2½, according to his mother, Aisling – have more language to describe who they are. This means they are able to look for support.
The corollary of that visibility is that "there is much more spotlight", says Dr Vanessa Lacey, a consultant in the area of gender identity and a board member of the European Professional Association for Transgender Health (EPath). Increased spotlight has brought an increased demand for services, and more challenges.
If you were to consider the question of what it means to be transgender now from a purely legal perspective, you might conclude Ireland is one of the most progressive countries in which to be trans.
This once conservative Catholic society has been offering an administrative process for people over 18 to achieve full legal recognition of their preferred gender since 2015. This is due in part to the work over many years of activists in groups such as Trans Equality Network Ireland (Teni), BeLonGTo and LGBT Ireland, which have recently come together to form an umbrella group called Trans Equality Together.
“Ireland, while still remaining one of those countries that can hold itself up as being progressive and a leading light in gender recognition based on self-determination, is being surpassed slowly in that regard,” says a spokesperson for Trans Equality Together.
That's because Ireland doesn't offer gender recognition to under-16s or non-binary people. Sixteen- and 17-year-olds require the consent of a parent or guardian, two medical reports and an application to the High Court. The Government has committed to changing the law to allow this age group to self-declare with parental consent only.
“I think we should consult young trans people to hear their views. Many have endured unacceptable bullying in certain situations,” said Taoiseach Micheál Martin recently, pledging greater support for trans people.
A key part of that support, says the spokesperson, means “having documentation that fits with the gender you’re presenting as. That’s critical for all of us, whether you are 40 or 14. It’s probably more important the younger you are.”
Steve now has a passport in the correct name, but in the past had one with his old identity. For him, it was “like giving a fake passport. That’s not me. That’s not who I am.”
Dr Lacey is hopeful that in the future, we will move to a more decentralised model of healthcare for trans people, which will help ease the pressure on the adult service
Evan as the legal rights of trans people have advanced in recent years, healthcare has become increasingly difficult to access.
The spokesperson for Trans Equality Together outlines the issues. “The first is that child and adolescent services are currently non-existent.” Accessing adult services requires battling “long waiting lists and onerous assessments, [which] are having negative mental health outcomes for the community.”
"We don't have sufficient resources to provide the trans health care that we want to provide in this country," says Dr Karl Neff, head of the National Gender Service, bluntly. "That's a grandiose title because in reality we are 10 or 12 people in a prefab."
He describes the pressures on the system. It receives more than 300 referrals every year; there are now 863 people on the waiting list, and the waiting time is currently 2.5 years. By the end of 2022 it will be three years. The people who are referred to it “tend to have very complex needs that are not just related to gender”.
Sometimes this includes “really significant functional impairments … meaning that they don’t leave the house, they can’t access work or education”. Some of this may be attributable to the fact that as many as one in three people presenting at the service is suspected of or diagnosed with autism.
The link between autism and gender identity is “very consistent worldwide”, Dr Neff says, though the reasons for it are poorly understood. “Could it be a biological link? Could it be that the results of autism and gender are maybe biologically in the same part of the brain? Is it part of the social construction of gender? It’s really impossible to know.”
Dr Lacey is hopeful that, in the future, we will move to a more decentralised model of healthcare for trans people, which will help ease the pressure on the adult service. Supports around social transitioning could be offered in other settings, suggests Dr Neff.
Changes in the approach of the National Gender Service since 2018 means there is now more focus in assessments on the psycho-social aspects of transitioning and “finding out where a person is at in terms of readiness for transition,” says Dr Neff. Initially, “we spend most of the time talking about anything but gender”.
Some trans people who have undergone the four-hour assessment are publicly critical of the process, describing being asked deeply personal questions including about their sexuality.
“We ask about the entire person’s life,” says Dr Neff. “Psychosexual function is a critically important part of the assessment, especially for people going for genital surgery, because sexual function and reproductive function is going to be permanently changed. So we will ask about sex. When we focus just on gender dysphoria and mental health, we miss a huge section of the person’s needs and life.”
It’s important to understand that “a lot of trans people decide either not to start hormones or start hormones and stop them. And likewise, most trans people who come to our service don’t even have surgery. Neither of those things are necessary for a person to feel very well and very affirmed. There’s no one way to medically transition and there’s no one way to be trans or gender diverse. There’s one thousand million ways.”
Groups representing trans people argue that an “informed consent” model, in which people were asked if they understood the implications of surgery, would be “more positive and proactive rather than invasive”.
For those under 17, there is currently no healthcare at all since London’s Tavistock clinic ceased offering a gender identity adolescent service at Crumlin hospital a year ago. This followed a controversial ruling in the UK in late 2020 that children under the age of 16 considering gender reassignment were unlikely to be mature enough to give informed consent to puberty blockers. This was overturned last September on appeal, with the court finding that “it was for clinicians rather than the court to decide on competence”.
Dr Lacey points out that “the international protocol is very clear – six assessments need to be done before any decision can be made by a multidisciplinary team” to prescribe puberty suppression treatments to children.
Those working in the area are privately hopeful that a domestic paediatric service will resume. But currently, if you come out at 15, you have to wait until you are 17 before your GP has anywhere to refer you, and you’ll be 20 or older before you get an appointment. By then, young trans people have often come out to their family, begun trying to research information, and undergone a social transition – which can involve changing their name and pronouns.
The result is that trans teenagers are left to navigate what can be an extremely difficult and isolating period in their lives without access to healthcare or psycho-social supports.
Later in life, access to employment and housing are more difficult for trans people. Across society, transphobia, bullying and harassment continue
Beyond the healthcare realm, myriad challenges still face the trans community. “Steve’s overall experience in school is positive, particularly in secondary school, which is critical to his wellbeing,” says his mum, Aisling. But many students experience issues from “misgendering, misnaming ... staff prejudice, peer bullying, barriers to sports”, according to research carried out by the University of Limerick and Teni.
The situation is compounded “by the fact that we have quite a lot of single-sex schools, and religious-based schools,” says Trans Equality Together. However, “schools are more open to discussing issues. That conversation is now happening.”
Later in life, access to employment and housing are more difficult for trans people. Across society, transphobia, bullying and harassment continue.
The former chief executive of Teni, Éirénne Carroll, left Ireland to return to the US in August 2020 after just a year in her role. Announcing her departure on Twitter, she said that “living alone through Covid and with multiple threats on my life and daily harassment, along with no healthcare, was too much”.
The tweet came as a wake-up call to those who believed that Irish society had managed to avoid the polarised, often toxic debate that has characterised some of the conversation in Britain.
“Trans people are not as safe as they once were. It saddens me to say that about Ireland, which would have been seen as probably a beacon of hope. Around the world for trans people and LGBT people generally, things have deteriorated,” says the Trans Equality Together spokesperson.
The coalition is concerned about what it sees as negative commentary in the media and the fact that “trans people’s voices are not being platformed at the same level”.
The tone of the discussion online and in the media has become much more polarised in recent years, says Dr Lacey, who highlights the proliferation of disinformation online. Online commentary is an additional pressure on trans people, adds Dr Neff. “Trans people can be made to feel afraid online.”
Aspects of the coverage of trans issues in The Irish Times and other outlets have also come under criticism in recent months, with some in the community and their allies participating in a boycott of this newspaper. Those included in this article agreed to be interviewed on the basis that better understanding of the challenges facing the trans community can’t be achieved without hearing the voices of that community. Teni did not provide a spokesperson.
Dr Lacey believes progress can only come from “people talking to one another”, better training and policy supports. “My number one focus now is the same as it always was: a better quality of life for transgender people.”
Despite the difficulties, there are stories of hope. The experiences of Steve and his mother is that society is full of what she calls “hidden heroes”, “teachers, neighbours, friends, coaches on the side of the running track” who can help to “assist the respectful journey that I want for him”.
The advice she received early on, after Steve told her at aged seven that he was a boy and wanted to have a boy’s name and cut his hair, was that “adults should hear it from adults; adults should not have to hear it from this kid”. The people she told would invariably say, “Can you give me something to read about this? Can you help me? I want to be a support; I just haven’t come across this before.”
The reaction from most people is to say “if it was my kid, I hope I would do the same”. There have been bumps along the road, but Steve comes across as a mature, wise and happy teenager, excelling in sport and with a wide circle of friends.
Sweeney has also undergone two gender-affirmation surgeries. Despite rare but serious complications following surgery last summer, he has no regrets about his decision
With the support of their families, many young trans people are emerging into adulthood, happy, resilient and positive about the future. Cody Sweeney is one of those.
I first interviewed Sweeney in 2018, when he was 19. He had come out as trans to an aunt three years earlier, telling her that he felt “like a boy”. His parents were concerned but immediately supportive, and arranged for him to be seen by Child and Adolescent Mental Health Services (CAMHS), where he was diagnosed with gender dysphoria. (New WHO guidelines to be introduced by Government redefine gender incongruence as a sexual-health rather than mental-health issue, a move the community says will help to destigmatise it.)
Over three years later, we meet again for coffee in the coastal village where he grew up. Sweeney’s physical appearance has altered since we first met, but even more striking are the changes in his demeanour. The teenager who described himself as “shy” has been replaced by a confident, articulate man. He has a busy, fulfilling life – a job, a consultancy business giving talks to schools, two social media channels where he highlights trans issues and talks about his own life, and a packed schedule of sporting and musical activities.
Sweeney has also undergone two gender-affirmation surgeries. Despite rare but serious complications following surgery last summer, he has no regrets about his decision. “I’m glad I had it; I’m just not glad about the experience I put myself or my family through,” he says.
When he thinks back to the contrast between his life now and before he came out, “I find it quite unbelievable. Back then I was in such a horrible, dark space. People say, ‘how do you know you’ll be happy transitioning?’ But I just knew. If I hadn’t, I would be still in that dark place. Now I’m just so positive about my life.”
Sweeney sees himself as lucky – he has the support of his family, who were “just incredible since day one”, his real-life and online communities, and the college where he is studying social care. “The department head welcomed me with open arms. He had full knowledge of the trans experience, which made everything easier.”
He has encountered very little transphobia, although he has friends who have. “A lot of people have hate thrown at them or have been attacked just for being trans. You are who you are for a reason, and no one can change that, so for someone to attack you for it, it’s just beyond me, it’s just shocking.”
That’s one of the reasons he does his talks in schools – “there is not enough education”.
He was also, he realises, lucky with timing. He remembers getting the letter with a date for his first appointment with the gender service 10 months away “and that felt like a heck of a long time.” In the event, those months gave him time “to really think the process through. It’s tough process, and it takes a lot of talking to your family. If I’d been told the waiting list was five or six years, it would have been a lot harder.”
There are still challenges to be navigated, and maybe more surgery down the road, but keeping busy helps him to manage the uncertainty. “It’s been quite the journey. It’s ongoing, but I try to stay positive and keep my mind busy. Music and sport and just having a laugh is what’s important to me now.”
Steve wants trans children to know that “they’re not alone. There are other people out there that they can try reach out to and talk to.”
One of the high points of the past decade, says Dr Lacey, is a growing recognition by trans people and society that “your gender identity is only part of you. It’s not all of you. Be an engineer, be a politician, be a journalist. Trans people are starting to do all of that. It’s beautiful. We’re emerging out of the shadows of the awful past. In this emergence we are experiencing challenges, but we’ll overcome them.”
Cody Sweeney's website is codyjamie.squarespace.com
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