Three doctors have expressed concerns about the children's gender service being provided at Crumlin hospital. Are their concerns well-founded?
That depends on who you believe. All of the doctors work in the gender area, are well-respected and would not call for the immediate closure of the service lightly.
But the HSE has insisted that while it is aware of concerns expressed by individual consultants regarding the service, which is bought in from the Tavistock and Portman NHS Trust in London, these concerns are not representative of many consultants who refer patients there.
Why are we buying in the service in the first place?
The HSE says there is currently no dedicated mental health service in the State for children with gender-identity issues, so it turned to the Treatment Abroad Scheme.
Patients initially travelled to the UK, but as numbers grew it was decided, in the interests of patients, to fly in the clinicians. In 2019, €29,914 was spent on 17 patients.
The HSE says it is planning to have a fully Irish-based service "within the next year".
What treatment does the service provide?
According to the HSE, treatment for gender dysphoria aims to help people with the condition live the way they want to in their preferred gender identity.
If a child is diagnosed with transsexualism and has reached puberty, they may be treated with synthetic hormones that suppress the hormones naturally produced by the body.
The recommendation for endocrine treatment must come from a mental health professional, and they must continue to be part of the child's ongoing care.
If a child over 16 has been taking the hormone suppressors for several years and are still diagnosed as transsexual, they may be offered cross-sex hormones which can alter their body further to fit with their gender identity. The effects of these hormones are only partially reversible.
What is the main concern of the three doctors?
They say they have encountered children who were started on hormone treatment when they did not appear to be suitable.
What are the implications of this?
According to Professor Donal O'Shea, proceeding too quickly with a transition can be "disastrous" and leave the person as "upset and miserable as they were before".
Another emerging implication is potential lawsuits against the State.
In England, a case was recently initiated against the Tavistock trust. One of the claimants, Keira Bell (23), changed her mind about being a man after hormone treatment and surgery. She says the treatment needs to change and should not be offered to under-18s who may be emotionally vulnerable.