More surgical procedures for transgender people could be available in Ireland if the number of people being referred to the national gender clinic increases.
The number of trans people in Ireland using online fundraisers to pay for private healthcare almost doubled within the space of a year, as waiting lists for public gender healthcare continue to grow.
Figures released to JOE show that 608 fundraisers for trans people in Ireland were set up on GoFundMe, one of the world’s largest crowdfunding websites, in the year to July 2018. This was almost double the 307 fundraisers set up by trans people in Ireland on the same website the year before.
The site told JOE that the vast majority of these fundraisers were trying to raise money to cover the cost of private trans healthcare in Ireland.
This weekend, trans rights activists will hold a rally outside Leinster House in protest against the failure to improve transgender healthcare in Ireland.
This Is Me, the Irish transgender healthcare campaign, said it wants the government to introduce “safe, accessible, best practice, person centred healthcare for all trans and non-binary people.”
At the moment, it takes over a year for a person to get their first visit with the National Gender Service, according to figures provided to JOE by the HSE.
While not all trans people will go on to have gender affirming surgery, it’s important to be able to access it within a reasonable timeframe for the ones who do. There are no medical staff in Ireland who are able to perform top surgery, which means trans people have to travel to other countries for surgery through the treatment abroad scheme or the cross border directive.
It can take three years to access top surgery through the public health service from the person’s first appointment, because patients need to go through pre-operative assessments and apply for state funding. There can then be waiting lists in clinics abroad. The National Gender Service described this as a “complex process with many steps,” and said that some parts of it were out of its control.
The length of the process means that some trans or non-binary people may choose to go privately, due to the damage to their mental and physical health while waiting for important procedures like top surgery. Female to male transgender people will often bind their chest for hours if not days in a row to flatten the appearance of their breasts. This can cause damage to their lungs, and scarring.
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Availing of private top surgery in the UK can cost over €8,000, which can be unaffordable for many trans people. Hundreds have instead asked friends, family, colleagues or even strangers online to donate to fundraising campaigns to help them raise the money.
Dr Karl Neff, a consultant endocrinologist and the clinical lead for the National Gender Service, told JOE that HSE waiting lists are “longer than we would like them to be.”
Dr Neff said that at the moment, there is no surgical service in Ireland that offers “a full suite of gender affirming procedures in Ireland.”
There is breast surgery available at St James' University Hospital and a gender affirming hysterectomy available at the National Maternity Hospital, but no other gender affirming procedures are available in Ireland at the moment.
“This is due to a lack of expertise in the area of gender affirming surgery. Gender affirming surgery is highly specialised," Dr Neff said.
"For a surgical team to offer a service that can deliver the best outcomes, a sufficiently high volume of surgical cases is needed per year.
"If a surgical team does not complete a sufficiently high number of cases per year, then quality drops and outcomes are suboptimal. At present, it is not thought that a specialised gender surgical service would be viable in Ireland, but this may change if referral rates to the National Gender Service continue to increase.”
