New staff for National Gender Service due to rapid growth in demand

Three appointments to the National Gender Service (NGS) will help address demand that has grown "exponentially" in recent years, one of the key clinicians involved has said.

However, the waiting list for the service will continue to grow as the increased capacity will still not be sufficient to deal with the "spectacular" growth in demand, according to psychiatrist Paul Moran.

The NGS, at St Columcille’s Hospital, Dublin, has a capacity to see approximately 150 new patients a year, but demand is running at more than twice that.

An exponential growth in the number of adults seeking help for gender dysphoria, or distress associated with their gender identity, is occurring in Ireland and internationally, said Dr Moran, chairman of the NGS Clinical Governance Committee. The service sees people who are seeking gender affirming medical or surgical interventions and assesses patients so as to decide what treatment they should receive.

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The approval for employing a senior psychologist, a senior occupational therapist and an administrator is a “significant development”, Dr Moran said.

Figures submitted to the HSE with the application for additional resources showed demand went from approximately 50 new patients in 2012, to approximately 275 last year. Demand is running at about 35 new cases a month.

The service developed gradually at St Columcille’s over the past 20 years before being formally commissioned in 2018.

Outline approval for further resources has been approved, but the need to ensure proper training for what is highly-specialised work means the service can only expand at a certain rate if it is to do so safely, Dr Moran said.

He said the NGS, which sees patients over the age of 18, has also seen a growing complexity in the type of patient seeking its services.

“In line with international trends, an increasing percentage of referrals have atypical gender dysphoria complicated by functional impairment, social adversity and mental health problems,” Dr Moran said. “The average age of referrals has declined significantly.”

The functional impairment being seen is mostly associated with autism spectrum disorder. The patients also frequently have difficulties with housing, employment or social isolation.

Historically many of these difficulties were attributed to the attitudes of society towards trans people, and certainly this is a part of it, Dr Moran said.

“What we have discovered, and other people are discovering, is that there is a much bigger cause of this, which is internal, not external,” he added. “The reasons why people emerge with dysphoria about their body and their social role are complex and they are different and it is not the same reason in each case.”

Changing gender

The range of patients that the NGS sees goes from people who are trans, to natal girls who were sexually abused and want to change gender, to people who lived in eastern European orphanages for their first number of years of their lives, before being adopted by Irish parents.

Dr Moran said some of the late adoptees have grown up with “hugely complicated problems with their identity attachment”. Historically, adults seeking the service were “far more” male-to-female than female-to-male, but the pattern is now almost equal, he said.

The recent increase in demand for the service involves more people who are less clear about their gender than was the case with previous referrals, he said. Previously, patients were more definite about what their gender was.

A separate service for children and adolescents with gender dysphoria, at Crumlin Childrens Hospital, Dublin, has also experienced a rapid growth in demand for its services over recent years.