The Clinical Lead of The National Gender Service (NGS) located at St Columcille’s Hospital in Loughlinstown has called for the immediate provision of all major ‘gender affirming surgical options’ including chest surgery, mastectomy or breast removal and mammoplasty or breast enhancement, as well as genital surgery including reconstructive surgery of the genitals to form a vagina or phallus.
Endocrinologist Dr Karl Neff made the call after the HSE confirmed the Service is seeing more than 300 new referrals each year with a current waiting list of up to two and a half years for 800 people over the age of 17.
According to The Chief Director of Nursing and Midwifery for the HSE, Paul Gallagher, “referrals received per year continue to exceed capacity.”
Mr Gallagher also stated that in order to address this deficit in capacity the NGS has submitted a number of business cases to the HSE for additional staff to bring down the waiting time. The NGS has spoken to the HSE Mental Health Division about establishing a Child and Adolescent Multidisciplinary Team so that the National Gender Service “can see people of all ages.”
The HSE had previously confirmed to Independent TD for Laois-Offaly Carol Nolan that the existing pathway in Ireland for pre-pubertal children generally begins with an approach by the child and family to their General Practitioner who may then refer to the local Child and Adolescent Mental Health Service (CAMHS).
At that stage, a social transition may be advised with management between the family, GP, CAMHS team and school services as well as an assessment and management of any co existing mental health or developmental disorders.
At present those who wish to pursue a surgical option usually travel to the UK or further afield with funding support from the Cross Border Directive for chest surgery or the Treatment Abroad Scheme for genital surgery.
Minister for Public Expenditure and Reform Michael McGrath recently confirmed that Cross-Border Directive costs have been increasing year on year and in 2020 were €15.4 million, although most of these costs are not related to gender related surgery.
Taoiseach Micheál Martin has already stated in late December 2021 that he is committed to delivering on the Programme for Government commitment to lower the legal age at which children can change their gender.
The existing self-declaration process only applies to those age 18 and over while children aged 16 must provide medical, psychiatric and parental consent.
This continuous lowering of the bar approach will come as no surprise to anyone who has been keeping an eye on the trajectory of the mainstream party’s ideological positioning on this issue.
Indeed, Fine Gael LGBT in its submission to the 2015 Gender Recognition Act Review Group had requested that any amendments which were to be made to the Act should permit children aged under 16 years of age to secure legal recognition of gender by removing the criterion relating to minimum age.
Amnesty International Ireland as part of its contribution to that Review claimed that “absolute denial of legal gender recognition to individuals under a given age is not consistent with existing international standards regarding the rights of children.”
While the LGBT advocacy group ShoutOut, whose Board of Directors included Fine Gael Senator, Jerry Buttimer, made the following point in its submission:
“Where a child under the age of 16 does not have parental or guardian consent then the state should be allowed intervene, subject to existing children’s rights legislation, to vindicate the best rights of the child where appropriate.”
One of the ten key recommendations that formed part of the Review Group Report was to effectively abolish all obstacles or delays to the process around obtaining a gender recognition certificate.
The Minister who was responsible for the issue at the time, Regina Doherty, said that this would only happen subject to parental consent with an appropriate legal process to address cases where there is not consent from both parents.
Writing on this at the time I made the point that while all of this had the appearances of prudent caution, it was anything but.
In fact, to see how ‘parental consent’ in this specific area will always be a dead letter you need only imagine what the reaction would be if it became known that certain parents had consistently refused to sanction a gender recognition change for their child.
Would they be seen as rational people concerned at the impacts that might follow for their child or would they be accused of transphobic bullying or ‘heteronormative’ coercion?
In fact, one of the very first things that the Gender Recognition Review Group Report mentioned was how they have heard from young people and teachers about children not being allowed to use their preferred name or pronoun at home.
This was highlight as a form of abuse.
In what real sense then can parents ever feel genuinely free to object to their child’s request to change gender?
This question has become far more urgent In light of the National Gender Services call for life altering surgical facilities of the kind identified above.