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Achieving a caring consensus on gender issues requires a broad national discussion

Michael McDowell: I think most people feel sympathetic to anyone experiencing gender dysphoria

The Health Service Executive proposes to develop a new policy in relation to gender dysphoria, transgender issues and the availability and access to gender transitional counselling and medical treatment.

This raises the immediate question as to who or what the HSE is at present. It is an executive agency of the State with wide responsibilities in the provision of public health services. But it is by no means clear that the board of the HSE is competent to evolve national policy on gender issues.

There have been repeated calls for proper parliamentary consideration of these issues based on reflective debate. That seems more urgent than ever.

The great majority of Irish people are not activists in relation to gender issues. But the airwaves and newspaper columns seem to be dominated by activists who seek to frame the discussion in terms of the denial of human rights and discrimination against the small minority who have dysphoria or who consider themselves to be gender fluid or who argue that the conventional male/female binary gender distinctions in society are oppressive or unjust.


For my part, I am very sympathetic to anyone who is experiencing gender dysphoria. I think most people feel the same.

That does not mean discussion of these issues must be conducted only in the vocabulary or with the conceptual understanding of those activists. I have difficulty accepting that there are many genders; I readily accept that there are shades of gender.

Gender is important. Maleness and femaleness are realities for the great majority of people, including gay and lesbian people. The great majority is not obliged morally to simply discard fundamental social and psychological concepts such as masculinity or femininity because a minority find those concepts limiting, challenging or even offensive.

The linguistic chaos of using the plural pronoun to describe a single individual is, I think, contrived. Most people have no problem with addressing someone by their chosen name or dealing with them on the basis of their chosen gender identity. But using a plural pronoun with a single verb stretches, confuses and distorts meaning.

The idea of a broad LGBTQI+ coalition is fine. But I have been struck by the number of gay men and lesbian women who privately dissociate themselves from some of the demands of trans activists. One can readily appreciate a sense of mutual loyalty among members of the broad LGBTQI+ movement which has won out huge advances for equality for gay and lesbian people. One can sympathise with the idea that these successes should leave no one behind. But surely there is, at the same time, nothing wrong with straight, lesbian or bisexual women wanting to pursue feminist agendas on the basis of gender as they see it.

Particularly, as regards dysphoria among minors, we must be very careful and protective of children. Prepubescent, peri-pubescent and post-pubescent children are transitioning into adulthood. Adolescence is a psychologically challenging time for many children. We cannot simply expose children to a random lottery of ideologies or treatments in the light of what went wrong at the Tavistock clinic.

The emergence of transgender issues on social media in the last decade seems to have created a much greater interest among adolescent children in gender identity.

There is little evidence that there has been significant use of conversion therapy in Ireland for children with homosexual orientation, and all children must be legally protected from conversion therapy as we have seen it in the US.

At the same time, children may or may not be experiencing long-term gender dysphoria. They may be experiencing different temporary uncertainties about their gender orientation or about their own personalities or identities.

The Tavistock clinic experience highlights the risks and dangers of irreversible and inappropriate interventions, from puberty blockers to reconstructive surgery, for highly vulnerable minors and for their parents.

At a recent highly informative briefing in Leinster House, Irish experts from the National Gender Service reported a very high correlation between adolescents and young adults seeking to transition and autism. It is not simply good enough to dismiss that correlation by saying that young people with autism have the same rights as anyone else. Of course, they do. This correlation needs to be explored and understood.

In developing policy on transgender health services, we badly need a fact-based objective approach which is firmly rooted in care, consultation and counselling. We need a national, inclusive debate.

This is not just a matter for the HSE. Nor is it a matter only for activists. It is a matter for all citizens and all politicians to devise good policies.

For that to happen there must be a broadly based national discussion from which, hopefully, a caring and careful consensus emerges.