Fintan Warfield (Sinn Fein) | Oireachtas source

I thank the Minister of State for coming into the House to take this matter.

I commend the work of the Transgender Equality Network of Ireland, TENI, and the #ThisIsMe campaign which has been raising issues about a clinic for some time. I also commend the work of the Department and the HSE which have committed to the provision of additional resources for the clinic which should help to make an impact on waiting lists. However, there is currently only one full-time public endocrinologist who is based in St. Columcille’s Hospital, Loughlinstown with expertise in hormone replacement therapy, HRT, who serves the needs of adult transgender people in the State. The number of posts will soon be increased to two. There is also a part-time clinic in University College Hospital Galway, UCHG, with very limited hours. Owing to HSE policy, HRT is only administered to trans people at these two clinics, despite the fact that HRT prescribed for cisgender people or in any other instance can be administered and monitored by a local GP.

In the clinic in Loughlinstown there is a two-year waiting list. The waiting time has been attributed, not to service users but to the cancelling of clinics by consultants and the enforcement of the medical and diagnostic model by the HSE. The additional resources can be largely offset as the lead consultant within the clinic, Professor O’Shea, takes on the role of clinical lead for obesity. While I hope waiting times will improve, all of the indications point to the fact that the clinic will continue to be stretched beyond capacity. It is also worth noting that those aged 16 or 17 years who wish to apply for a gender recognition certificate must have supporting documentation from the clinic which will only accept referrals from certain psychiatrists who also have strained waiting times.

The model of a full-time Dublin-centric clinic meeting the needs of a community spread across the State is one that contravenes international best practice, namely, the World Professional Association for Transgender Healthcare, WPATH, guidelines which are the standard for most developed countries and also in keeping with the European Social Charter. It is not viable for a Dublin-centric clinic to support the needs of our island-wide trans community. It is fair to say the current position has led to a spike in mental health issues and the incidence of suicidal ideation among vulnerable persons and a rise in unmonitored self-treatment where individuals are forced or opt to buy hormones online.