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From their action: It’s time for us to transgress the boundaries the National Gender Service has built to prevent access to trans healthcare in Ireland. We are calling on the community to join us for a phone and email picket of the NGS to demand their public commitment to stop advising GPs against providing blood tests and prescribing HRT to trans patients. Throughout this week (8-12 May) between 9am and 5pm, we need you to: ☎️ CALL the NGS at 01 211 5045 ✉️ EMAIL the NGS at nationalgenderservice@hse.ie 📃 SCRIPT linked in our bio & story The NGS intimidates GPs into denying blood testing and prescriptions of gender-affirming hormone therapy to support their trans patients. Yet what alternative does the NGS provide? A decade-long waiting list to access a psychiatric model of care rife with invasive, damaging evaluations and inadequate treatment. We refuse to accept this. We will not rest until we have self-determined, informed consent trans healthcare in the community through our local GPs. The NGS will not stand in our way. NGS phone and email picket scriptPlease try to call first (using the script below) because this is more effective than an email. Call 01 211 5045 and ask to talk to any of the following:
If you are emailing, send the email to nationalgenderservice@hse.ie, karl.neff@hse.ie, paul.moran@sjog.ie, ian.schneider@sjog.ie & info@dosheaendo.ie. Please cc transharmreduction@gmail.com Please note, if you are a patient of the NGS you may wish to use a different phone or email address to contact them than the one they have on record. Script “Hi, I’m contacting you to support a campaign being coordinated by Trans Harm Reduction, a trans healthcare group that supports people who are self medicating in Ireland. Trans people in Ireland who wish to undergo medical transition are forced to take matters into their own hands due to the unacceptable standards of trans healthcare in this country, including the interminable waiting list for the NGS. For those who can afford to and wish to, they have the option to privately pay for their medication, but for many, they are left to self medicate due to financial restrictions or mistrust in both the public and private medical institutions. Trans people on HRT need to be able to access blood tests through their GPs as a basic safety check. However, we are aware that the NGS has a policy of advising GPs not to carry out these basic blood tests when trans folks in Ireland either self medicate or medicate through private health services. This situation is totally unacceptable. Trans people also often ask their GPs to prescribe HRT to them directly. There is no restriction on Irish GPs to do this and it would enable trans people in Ireland to shift to accessing prescription HRT medications from their local GPs, avoiding waiting periods. We are aware that the NGS also has a policy of advising GPs not to prescribe HRT. We refuse to accept this. Providing blood tests and prescribing HRT are both entirely within the remit and capabilities of GPs. The NGS’ policy of advising GPs not to provide them is putting trans people at serious risk. By preventing access to basic medical care, the NGS are attempting to force trans people onto a decade-long waiting list for their harmful system. The only thing the NGS is doing is stopping trans folks from accessing alternatives to their psychiatric model of care that is rife with invasive, damaging evaluations and inadequate treatment. Trans people should be able to self medicate or seek private alternatives safely if that’s something they wish to do. The NGS must stop interfering with people’s ability to access care through their GP. We are demanding that the NGS publicly state that it will no longer be advising GPs not to provide blood tests or HRT prescriptions. We want a statement to be made on this by May 21st or we will take further action to ensure our demands are met. Regards,” Source: Trans Harm Reduction 
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 I was first referred to what is now the National Gender Service in 2014, at the age of 14/15. At that time the service would accept 16/17 year old patients, and would allow 14/15 year olds onto the list. In this time before in-house assessments, I had to seek assessments. I received one from a private provider, who because of his level of respect and consideration for the trans community, rapidly became disliked by the NGS. He was seen as too willing to refer patients to the NGS, and as such even though he had provided a thorough assessment, I was advised by other trans people to seek a second, public assessment. I was assessed by CAMHS, by a clinician who was clearly inexperienced in working with transgender patients, and who in his formal assessment document described me as ‘androgynous dressing, overweight, and female-appearing’. He also used my deadname throughout despite my name being legally changed by this time. He asked me intrusive questions about my relationship at the time with a girl in my school year, and about my sexual orientation. He asked questions that reasserted binary gender roles, and showed that I was only going to be seen as legitimately trans in his eyes if I was traditionally masculine enough. I received my first appointment a few days before my 16th birthday. Upon my first appointment at the NGS, I was talked through by staff as though I wasn’t there. My parents were both present - although it is worth noting that 16 year olds in Ireland are legally able to make their own medical decisions, and while I was just short of my 16th birthday, they continued to require my parent’s presence until I turned 18. The endocrinologist played at being a psychologist, retracing the steps of the assessment I’d received in CAMHS, before leaving me and my parents to wait for hours for the consultant to see us.  When the consultant did eventually meet us, and prescribe my testosterone for the first time, there was one single thing he said that stood out to me: that it would have been better if I had been able to access care sooner, since I was still young and mid-puberty, I could have had blockers and HRT at a more typical age. This infuriated me - it would not have mattered if I knew I was trans sooner because that service was non-existent in the country at that time, and even when child and adolescent services were introduced, they would not have enabled me to start testosterone any sooner. Over the intervening years, I’ve experienced several issues with the NGS, which have only worsened as their system focuses more on gatekeeping and controlling the community. When I sought referral for top surgery, I was pressured into taking a consultation with a surgeon I did not want to attend and had heard very negative reviews of. I ultimately did not take this consultation, but it was a barrier put in front of my being referred for surgery. Around this time the NGS started to do their initial in-house assessments, but I did not require one for surgery. After top surgery, when discussing if I wished to be referred for bottom surgery at that time, I was told that I was right not to seek a referral at present because the results were ‘unsatisfactory’ and ‘poor’ - a judgment on the bodies of other trans men. When seeking a referral for a hysterectomy, I was told I must do a pre-surgical assessment with them in order to be referred. I argued against this - I had been assessed twice already to confirm my ‘diagnosis’, I had been out, socially, legally and medically transitioning for years, and ultimately there was nothing the assessment in the NGS could explore better than a conversation with the surgery providers in the NMH. I was refused any alternative to their assessment. I have also been on the receiving end of threats around missed appointments, reschedules or cancellations.  Ultimately, my early experience of the NGS in a time before in-house assessments was simpler, faster, and better than what I or other trans people experience today. While it was already a poor and flawed system, my experience over time demonstrates that it simply doesn’t have to be as bad as it is now, and that things can be changed in the interest of quality care and patient experiences. I do not have faith that the NGS can become an affirming, trustworthy service given the decline and increasing control the service attempts to exert.
The person I met with introduced herself but did not say what her profession was. To be honest I didn't want to rock the boat, so I didn't ask. She had my notes from my GP which I had never been told were being forwarded to the NGS, so I don't understand how that was allowed. I had brought up to my GP that I might be autistic, which has since been confirmed, so now the NGS know that too. I’m hoping that won't impact my care, but after seeing how others have been treated, I'm not too optimistic about it. They also know I'm non binary now, as my GP had told them. I had always thought the referral was just “here's my patient” and kind of a brief description of me, but she had my whole medical history since birth basically. No one ever asked if I was ok with that.  As a result, we spent a long time discussing my bullying from primary and then isolation in secondary school. It opened up a lot of stuff that I'd kind of hoped I had closed, so after the three and a half hour appointment, I was feeling pretty low. I was in CAMHS and she asked for access to my notes from them, and she was not impressed when I refused. She also wanted to know if my family was on board with my transition or not.  I monitor myself online quite heavily as I am worried if I say something even slightly critical of the NGS that I will not be granted the care I need.
We discussed sexuality a good bit and my dating history. She didn't ask if I was a virgin in so many words, but it was kind of obvious from the line of questioning that that's what she was trying to establish. We only talked briefly about gender because bullying and sexuality had taken so long and it very much felt like I had to be convincing and prove that I am indeed trans enough to 'deserve care'. All in all it was not the worst as I have heard much worse stories. I was offered a break after 2 hours. It is still based on an outdated model of care though and not best practice. It very much felt like an interrogation no matter how you try to dress it up. I came out as trans around 5 years ago, at which point I felt very isolated and uncertain about medical options for transitioning. I was aware of the situation with the NGS including endless wait times and the horrifying stories of interrogation by hostile psychiatrists. I wanted absolutely nothing to do with that system because I didn’t think my mental health would withstand it. I also wasn’t in a position to pay for private treatment because I was unemployed and the fees for Gender GP or one of the other private healthcare providers were out of my reach. Fortunately, I managed to get in touch with other trans people who were able to provide support and get me started with self-medicating, which I’ve been happily doing ever since. As a result, I’m not suffering in silence for years on the NGS wait list or putting myself under financial strain to pay for basic medical care from a private, for-profit enterprise. People call it self-medicating, or DIY HRT, which both suggest that it’s something you do on your own, totally in isolation, but that hasn’t been my experience at all. In reality, I have received a huge amount of support and advice from peers and friends who were in the same position, and together we have accumulated a massive volume of experience and knowledge. There is also an immense wealth of knowledge available on the internet that has been put together by dedicated members of our community in places like transfemscience.org or r/transdiy. In almost all cases now when I have to interact with medical professionals I’m aware that I have vastly more knowledge than they do and I also don’t have to rely on them for my healthcare, which is a fundamentally empowering experience.
In terms of the risks of self-medicating, there’s an enormous amount that even standard GPs could do to reduce these including doing blood tests to give an indication if my dosage is correct or to flag any other health issues. The first GP I went to and talked to about my situation refused to do blood tests to test my hormone levels, despite the fact that this would be a standard check they would do for any cis person who asked for it. She told me that doing blood tests would encourage me to continue with a practice they saw as risky and undesirable.  The ridiculousness of this situation is obvious if you compare it to drug or alcohol use or any other activity that involves risks to one’s health. If I had an addiction issue and went to the doctor because I was concerned about my health, basically everyone would acknowledge it would be totally irresponsible and unethical of them to say they wouldn’t treat me because it would enable or encourage me to keep drinking or taking drugs. Likewise, if I played a sport they thought was risky and injured myself, it would again be obviously ridiculous for them to say they wouldn’t treat me because it would allow me to continue. There’s clearly a double standard here where my GP treated me differently because I was trans and, even worse, because I was taking control of my own body and healthcare. Fortunately, I was able to find another GP who was totally fine with doing blood tests, rightly regarding it as his basic responsibility as a medical professional. This has been great for me but shows a bizarre level of variability in how trans patients are treated in the general medical system.
For anyone else who wants to get blood tests, Trans Harm Reduction (transharmreduction.org), a grassroots community group based in Ireland and Scotland that supports people who are self-medicating, keeps a list of GPs that should provide blood tests for people who are self-medicating, and you can email them to ask if they’re aware of any good GPs in your area. There are other important risks that I’m worried about including the quality of hormones that I’m using, because these are non-prescription and sourced online. Fortunately there are again community resources available for understanding the quality of hormones available online. Trans Harm Reduction have a hormone testing programme for assessing the quality of sources of HRT that are popular amongst people who are self-medicating. So far this has shown some variability in the concentration of estrogen medications, which means it’s important for me to get regular blood tests and monitor my hormone levels, but more importantly, there has been no evidence of dangerous contamination, which is a huge relief. It would be great if better funded organisations could take up this idea and do more comprehensive testing. I’m also concerned about losing access to HRT due to unforeseen circumstances, so I’ve since gotten a referral for the NGS. My plan is that if, one day in the distant future, I get to see a psychiatrist there, I’ll be in a position to refuse to cooperate with their questioning and general model of care if I decide to do so, because I’ll be aware I’m not totally dependent on them for my healthcare. I’ve found that people in general tend to emphasise the risks of self-medicating, without actually wanting to take any practical steps to reduce them or focusing as much on the very significant risks of any of the alternatives. As a recent article in GCN put it, trans people who are self-medicating are used as a ‘cautionary tale to underline the failures of the current system’ but our actual needs and voices are not listened to (https://gcn.ie/trans-healthcare-ireland-change/). I’ve had hostile reactions including from other trans people when I’ve told them about my situation, or in other cases they treat me as a victim who needs to be advised on a better or more responsible course of action. Fundamentally I understand my own situation the best and I’m in the best position to make decisions about my life and my body. Nobody should be trying to tell me otherwise. It’s a small step from advising someone not to self-medicate because it’s dangerous to telling someone they shouldn’t medically transition because they might regret it. Related to this, many of the mainstream trans and LGBT+ NGOs in Ireland shamefully do not offer any form of support for people who are self-medicating because they are terrified of being associated with them and potentially losing their funding. This is despite the fact that research from the UK shows that up to 25% of trans people are accessing HRT through self-medicating. The figures from elsewhere in the world are even higher, especially for trans women, and there’s no reason to think Ireland is any different. If mainstream NGOs can’t offer support for a very significant vulnerable section of our community and instead only provide for those who are being ‘responsible’ and ‘respectable’ in how they access healthcare, what are they good for?
Like many trans people, early in my life I knew there was something different about me; and like many trans people from my generation, I kept my thoughts to myself. I grew up in 90s rural Ireland, a time when a wave of conservatism swept over most of the country.
For me the worst part of being trans, was the loneliness. I was surrounded by people who loved me, but my life, until I finally told someone; was the loneliest time of my existence. I was watching, and participating in everyday life, but in my mind, I was a person that nobody knew. Thinking about the loneliness now, I see my little self and just want to tell her, 'Don't be scared, it will be ok, you're not alone'. No child should ever have to experience that intense loneliness.
After years of grappling with why I had this innate feeling that I was a girl, I finally came across the word Trans. It was from a story that was in one of the papers about a trans woman in the UK. Now I knew I was not alone, and more importantly I now knew what I needed to do.
Unfortunately, I never imagined that my family would ever accept me, I was convinced that I would need to run away, change my first and second name, so as they would never be able to find me. That was the plan I made when I was twelve years old. But of course, things did not work out exactly how I had naively imagined. In reality I spent several years going back and forth; from Ireland to England. Every time leaving Ireland with the intention of starting transition, and every time leaving England because, just maybe, for the love of my family; I could just go on as I was. Except it never goes away, in fact the older I got the worse the dysphoria got. The last time I went to England was different, I was able to tell someone, they were supportive, understanding and accepting. And I most certainly do not have enough words in this brief synopsis of my life to explain this extraordinary human being. I dread to think where I would be now without them. My experience in England was mostly positive. Admittedly it was a slow process that at times was infuriating, but I got the care I needed. Years into my transition I still never really truly contemplated moving back home to Ireland, but that all changed in 2015 when I watched the marriage equality referendum unfold, which sent a clear message that Ireland had moved forward. Hence, I moved home full time soon after. One of the first things I needed to do was acquire a doctor, as of course I still needed my medication. Additionally, as I have had numerous surgeries, as such it was important that I could comfortably discuss any issues with my doctor. Unfortunately, I accidentally came across my doctor's social media profile, and while I would not say they are a full blown transphobe, the accounts that they interact with most certainly are. I no longer felt comfortable going to that doctor, and to be honest, I was quite annoyed, not so much for myself, but what if a young trans person goes to that doctor. How can they give them the care they need? Sometime after this I found a lump on my breast which turned out to be lipoma, which is a harmless gathering of fatty tissue, which I had removed. However, when I went to another doctor in the same clinic about it, as I was concerned this could be a rupture, I was told I should go back to England where I had my breast surgery done. I had to arrange another appointment with another doctor at the same clinic, and thankfully this time they examined my breasts and sent me for an outpatient appointment to have the lipoma removed. It's important to also mention that when I had it removed as an outpatient, the person who done the procedure was an extremely nice person who understood transgender issues. I currently have no doctor that I can discuss anything trans related with. I have a clinic that I am registered at, I have my prescription on repeat, so I simply ring up to get that filled every month. I am looking for a trans friendly doctor but that is not an easy feat, considering the area that I live in. I frequently hear transphobes claim that trans people have mental health issues, that any depression we suffer is through our own fault. But I have lived this life now for nearly 20 years, and I can whole heartedly say, acceptance negates most all issues relating to being trans. 
A quote that reads: For me the worst part of being trans, was the loneliness. I was surrounded by people who loved me, but my life, until I finally told someone; was the loneliest time of my existence. I was watching, and participating in everyday life, but in my mind, I was a person that nobody knew. Thinking about the loneliness now, I see my little self and just want to tell her, 'Don't be scared, it will be ok, you're not alone'. No child should ever have to experience that intense loneliness.
I've been at my clinic for about six years or so. Back then, you only needed a referral from a clinical psychologist or psychiatrist to be taken into the clinic. I saw a clinical psychologist, who diagnosed and referred me there. I remember my first time there, feeling so worried and so scared, because I had heard the things that people had said about them. That wasn't my experience at all. After a year or so in their care, I was told that I could be referred for gender affirmation surgery with the NHS. I was blown away. I remember talking to people in support groups and hearing they had been waiting for years, and I couldn't understand why they had been waiting, and that I was being put forward. They told me to get a second opinion diagnosis from a psychiatrist, and that when I came back with this, I would be put straight on the waiting list. That didn't happen.
The next time I saw them, I had my two diagnoses, and I had all the other documents they had asked for. In this meeting, after being promised I would be put on the waiting list for surgery, they told me that they were no longer working with the NHS, and that they had no plans to refer to any other clinic in Europe. I felt like the ground disappeared beneath me. I broke down sobbing in the office in front of one of the senior staff and this poor junior consultant who had no idea what to say or do. I just sat there in the room and bawled my eyes out for I don't even know how long. Nothing happened for another two years. ​After two years, I got a phone call and was told that they were setting up a new waiting list that involved doing their own assessments in-house. I was confused, because I already had two diagnoses at this point, and I had been living full time for years. I asked why this was the case and was told they wanted to make it standardised, and it was actually really streamlined, and would be good in the long run. I was waiting another 18 months before I was contacted again and told I would have to see another psychiatrist and clinical psychologist.
I had to sit in a room with someone for almost four hours while they poked and prodded at every detail of my childhood looking for reasons why I might be lying about being trans. Instead of asking me "how has your life improved since you transitioned?", or "what would surgery mean for you?", I was asked about how I masturbate, what kind of porn I watch, how I have sex with my partner, and how I feel when I get an erection.
I remember sitting in that room, crying, feeling such intense shame and pain, barely able to speak, and rather than have them acknowledge that, I was forced to explicitly and verbally describe all of this in detail to them. No matter the amount of pain, agony, and humiliation this caused me, this was the only way they would give me access to the healthcare I need.
Later that year, I had to do a second assessment with another professional. I sat in that room and felt terrified that they would try and pick my words apart. Even though I had been honest in my first session, I was scared they would try to talk me into contradicting myself. It felt like an interrogation. They made me feel as though I had committed a crime by being trans, and that they were the authority in place to stop me. Since then, I no longer trust medical or mental health professionals. This has fundamentally changed how I think about the people there to help and protect us. In these sessions I was not helped or protected. I was needlessly harmed for the sake of ticking boxes that didn't need to be ticked. When this was done, I was finally referred for surgery, and I've been waiting almost two years.
I'm writing this now because not too long ago, I got a letter from the clinic I was on the waiting list with. They told me they have stopped doing gender affirming surgery, and I'm going to be transferred to another clinic. It's been five years since I was promised I'd be referred, I've had four separate diagnoses, and I've just been added to the back of another waiting list. I've wanted to talk openly about this, but I know what has happened to others that have spoken out.
If I put my name to this, then I will be denied healthcare, I'll be taken off all waiting lists, and potentially threatened with litigation, as has happened with others in my position. There is such a gross and unjust power imbalance, where services can take our inalienable right to healthcare and hold us hostage to it. Share this story
My local GP refused to prescribe my HRT, even though I transitioned many decades ago abroad28/11/2021
I told her that I had transitioned many decades before and that I needed a post-operative dose of IM estradiol valerate. Instead of giving me a prescription, any prescription, for HRT that any post-menopausal woman would take, she refused and said I would have to go through the National Gender Service.
I told her the medical and mental health risks of me going off estradiol and the waitlists and she said without the NGS, she could and would do nothing. "So, let me get this right? You're willing to risk my health because the NGS hasn't evaluated me over something that happened 25 years ago?"
At that point, knowing exactly the kind of treatment I'd get at the hands of the NGS, I began searching for some solution. Unable to find any source of the medication I have been on for years, I found someone who compounds the medication at a reasonable price. In her home.
So I began buying my injectables overseas and using the network of feminists who smuggled the abortion pill into Ireland in order to avail myself of a medication I've been on for close to three decades now.
I would like to not have to deal with this at my age. I would like to be able to go into a GP, tell them, I'm trans, here is the dosage I need of X and not have to go through the dehumanising treatment so common in Irish trans health "care". I would like the National Gender Service to actually implement an informed consent model instead of me having to repeatedly risk my health and wellbeing in order to avoid their mistreatment.
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I was referred to the NGS in 2017.
I did not hear from them until 2019, two years after referral, when I called to see if my referral was one of the ones lost and it was.
I received a letter in early 2021, nearly a year and a half after that, to give me the appointment for my initial assessment. This lasted 4.5 hours, with a ten-minute break during. It was at 9am and they did not take into account that I live 4.5 hours away from the hospital, and therefore had to drive up at 4:30am, and drive back home again after the appointment ended. It was a 620km round trip. When I called to confirm, I asked if it was possible to do it on video call due to the distance and COVID, and they said it was not.
The appointment was with a social worker and covered my mother's pregnancy with me, early childhood, family relationships, friendships, social life, education, and work. A lot of it was not relevant to my identity.
They did not like when I couldn't remember details, such as names of childhood friends or why we aren't still in contact. I don't think this is fair as no one has a perfect memory of everything that has ever happened to them, and the NGS expects us to remember every little detail. They spent some time talking about my relationship with my partner and family planning, mentioning their own children. They asked that he attend my second appointment.
My second appointment took place three months later and lasted approx 30 minutes. I was told it would take 90, but it began approx 40 minutes late and I was on break from work and had to get back on time. They ran through what to expect when starting HRT and clarified a few things from my previous appointment. They gave me a vague estimate of when I would return for my third appointment and that it would basically entail picking up my prescription and a quick chat with them.
I received a letter two months after that stating my third appointment will take place towards the end of this year. This appointment is one week shy of four years since referral. I received a call from the social worker shortly after this letter asking to arrange a family planning appointment with me and my partner over video call. They said this is something they like to do with couples who are long-term or live together. During my initial appointment with them, I stated that I was in a long-term relationship and that we are living together. They asked about future children and I stated that we had discussed it, but it wasn't going to be soon, and that we had no solid plans about how to go ahead with this. She asked if I intended to freeze eggs before I start HRT and I said that I did not, that I was not compelled to have biological children, that I would not be carrying any children myself, and that I could not afford this anyway. They wrote this down and said they would support me if I chose to have biological children, which I again said I had no intention to.
In my second appointment, they brought this up and asked me my stance on my relationship and future children. I restated the above, and they said they are supportive of if I wished to have biological children, and informed me to not expect to have children at all any other way, as surrogacy is illegal, foreign adoption for a gay couple is very complicated, and Irish adoption is very difficult. I said that I had no solid plans for children yet as I am still quite young, and we never know what changes may occur by the time I may choose to have any.
I had the family planning appointment with the social worker and my partner on video call. It lasted approx. 30 minutes and during that time they repeatedly asked me to consider "preserving my fertility", even though I stated I would not be doing this. My partner joined in on this after their third time asking to say that, like I had previously stated several times, this was not something we were considering. They insisted it was important to consider, and we both assured them we had discussed it and it would not be happening. They briefly mentioned the other options for having children, but spoke of them very negatively, and continued to bring the conversation back to the topic of biological children and me carrying a child, for the duration of the appointment. At the end, they asked if I had any questions, but when I asked them, they did not have any answers. Overall, it was thoroughly unhelpful and unnecessary, and I remain unsure as to why they insisted on it in the first place. They seemed to think that I was going to regret not "preserving my fertility" or having biological children, and did not listen to me repeat what I stated in my first two appointments, and in this one.
Regarding COVID, I have had to attend all appointments thus far in person, and have not been permitted to wear a mask during. They said that both of these are because they want to be able to accurately read body language and facial expressions, and the secretary confirmed this on the phone.
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