Accessing Gender Affirming Healthcare

The process of accessing gender affirming healthcare in Ireland has changed significantly over the last decade, and continues to change. This information is updated and maintained to ensure it is as accurate and current as possible.

People Under 18 Years of Age
Unfortunately at this time, there is no service in Ireland operating to provide gender affirming care to children and young people under 18 years old. Some transgender young people and their families have accessed care through remote private services such as Gender GP, which is discussed further below.

People Over 18 Years of Age
For adults seeking access to gender affirming healthcare in Ireland, they can choose to pursue public or private care. Public care is provided free at point of use, although prescriptions will still require full payment unless the individual has a medical card. The wait for public care is known to be extremely long, and the quality of care provided is not regarded highly by the community. Private care is expensive, but is generally much quicker to access, and mostly of a higher quality.

National Gender Service, St. Colmcille's Hospital, Loughlinstown, Co. Dublin
You need to be referred by your GP to the National Gender Service (NGS). You do not require any prior assessment or diagnosis of any kind to be referred. At this stage you will be put on a waiting list for your first appointment. According to the NGS, their waiting list is approximately 2.5 years long, however if patients continue to be seen at the current rate, new referrals will be waiting up to 9 years. The NGS have their own website where you can read more about the service. Please note that many patients and community members have found the information provided to be at best, a sanitised version of their experience of the service, and at worst, outright dishonest.

Initial Assessment
The NGS conduct an initial assessment, which comprises a minimum of two visits. These assessment visits are done by various members of the team in the NGS, but generally include a psychiatrist for at least one appointment. These appointments are often long, with the first being approximately three hours with a break in the middle. They can also be upsetting or difficult, as you may be required to discuss highly personal topics such as your sex life, sexuality, traumatic experiences, or previous experiences of abuse. Broadly, the appointment explores your life, physical and mental health, general wellbeing, your social network, and relationships. Once you have completed your initial assessment, most people are referred on to the endocrine clinic for HRT. Some patients have not been immediately referred on for HRT, with the NGS generally citing that the person is lacking in support or stability in some area, such as family or housing. When this happens, the person may be referred to another member of the NGS team to provide support such as a social worker. The NGS largely does not assist in rectifying the identified lack of support, and in some cases their reason for refusal are impossible to change, such as a diagnosis of autism.

Endocrine Appointments
Once a person is referred to the NGS endocrine clinic, they are generally required to complete blood tests in advance of their appointment to bring on the day or have sent in advance. Testosterone is prescribed by the NGS in three forms - testosterone gel, a short-cycle injection known as Sustanon, and a long-cycle injection known as Nebido. Usually, gel or Sustanon is used initially, moving to Sustanon or Nebido long term. Follow-up appointments are continued to fine-tune the correct dose for each person and check in regarding their overall experience. Over time, appointments can be spaced farther apart the right dose is found.

Surgical Assessments
The NGS requires individuals to undergo a surgical assessment before they will refer a person for surgery. It is important to note not all surgeons will require a referral from a service like the NGS, and therefore this may be avoidable for some people. However, their referrals are required to access services like the Cross Border Directive or Treatment Abroad Scheme, and potential to have surgeries covered by health insurance where coverage is available. The NGS requires that for top surgery (Double Mastectomy), a person has been on testosterone for six months prior, and for any other surgery a full year prior, with the NGS service. This means that any time on testosterone prior to accessing the NGS, via a private provider for example, is not included. Surgical assessments cover similar ground as the initial assessments, but with a focus on the surgery itself, the process, expectations and goals. Similar to the initial assessments, patients may not be immediately referred and instead sent for support to another member of the NGS team.

Dr Bell @ Galway University Hospital, Galway
''There had previously been concerns that other providers around Ireland were no longer taking patients, due to the NGS aiming to centralise all gender affirming healthcare into their service. As a result, we cannot guarantee that this provider is still accepting new patients.'' To be referred to Dr Bell, you need two separate diagnostic reports of Gender Dysphoria. These can be obtained publicly or privately from a psychiatrist or clinical psychologist. Reviews of Dr. Bell’s services are generally positive. Her waiting list appears to be 5 or more years publicly.

Dr Ahern @ Our Lady of Lourdes Hospital, Drogheda, Louth
''There had previously been concerns that other providers around Ireland were no longer taking patients, due to the NGS aiming to centralise all gender affirming healthcare into their service. As a result, we cannot guarantee that this provider is still accepting new patients.'' To be referred to Dr Ahern, you need one detailed diagnostic report of Gender dysphoria. This can be obtained publicly or privately from a psychiatrist or clinical psychologist. There are negative reviews of Dr Ahern in terms of his strict dosing that he enforces on patients, which includes mandatory blockers (where not necessary).

Private Gender Affirming Healthcare
There are a number of private options available, including private consultants who also operate public services, and remote services.

Dr Bell @ Galway University Hospital, Galway
To be referred to Dr Bell, you need two separate diagnostic reports of Gender Dysphoria. These can be obtained publicly or privately from a psychiatrist or clinical psychologist. These requirements are the same as for her public service. Reviews of Dr. Bell’s services are generally positive. It is unclear how long the wait for Dr. Bell is privately.

Dr Ahern @ Our Lady of Lourdes Hospital, Drogheda, Louth
To be referred to Dr Ahern, you need one detailed diagnostic report of Gender dysphoria. This can be obtained publicly or privately from a psychiatrist or clinical psychologist. These requirements are the same as for Dr. Ahern's public service. There are negative reviews of Dr Ahern in terms of his strict dosing that he enforces on patients, which includes mandatory blockers (where not necessary).

Gender GP
Gender GP is an online service based in the UK that provide gender affirming healthcare in the form of hormone replacement therapy for transgender people. Gender GP will conduct an initial assessment themselves, but are also willing to accept assessments from other healthcare providers if available. They can then prescribed testosterone. Gender GP are happy to work with your own GP (called 'shared care') or to transfer care to your own GP at a later point. This can be particularly beneficial if you are currently on a medical card, as your GP can rewrite the prescriptions as medical card prescriptions. Gender GP charge a once-off set up fee of £195, and then a recurring monthly fee of £30. Required follow-up sessions for regularly providing prescriptions cost £30. They provide additional services, such as counselling, or referrals for surgery. Gender GP have their own website where you can learn more about their service.