I had a better experience with the NGS nearly a decade ago than today

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. 

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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. 

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​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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