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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 [email protected] 📃 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 [email protected], [email protected], [email protected], [email protected] & [email protected]. Please cc [email protected] 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.
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