Dozens of Irish families with transgender children have been left in a state of major uncertainty after a UK court case stopped a London clinic which treats HSE patients from accepting referrals for under-16s.
Ireland does not yet have its own full child and adolescent transgender health service and for a number of years has been relying on the Tavistock Centre, the UK’s only gender-identity development service, to accept referrals under the Treatment Abroad Scheme.
This week, the English High Court said that under-16s attending Tavistock were “unlikely” to be able to give informed consent for puberty blockers. The clinic immediately suspended such referrals for under-16s.
“Emma”, a mother of two whose 16-year-old son Sean has been prescribed puberty blockers by Tavistock for a number of years, said she believed he would not be alive had it not been for the service.
“I know if he had had to go through puberty, I probably wouldn’t have Sean. He wouldn’t be here, he just wouldn’t survive it. I just know my own child,” Emma said.
According to the Trans Equality Network of Ireland (TENI), 13 Irish patients are currently going through puberty suppression at the clinic – when “blockers” are taken to stop hormones which cause puberty.
Another 40 Irish patients are being assessed by Tavistock, while 70 are on a waiting list. TENI said it was important to note that more than half of the young people who are assessed by Tavistock do not go on to have any medical intervention at the clinic.
Emma said Sean started to present as male from the age of three. By the time he was eight he was extremely distressed about having to wear girls clothes, and Emma realised he was trans.
“For his First Holy Communion, Sean wore a dress and that was just the most distressing day for everyone. It was then that I took my head out of the clouds and said, ‘this is not a phase, we need to get him some help’,” she said.
“Between his communion to when he went on the blockers was the most distressing time of all of our lives.
"Sean would have been self-harming. He was threatening to cut off his boobs. He was just in a really bad state.”
“There was constant aggravation in the house and frustration. He put a hurley through the wall. He was so upset and really distressed at the thought of puberty coming on.”
Sean was referred to the Child and Adult Mental Health Services (CAMHS) which diagnosed him with gender dysphoria. He was then referred to Tavistock. While the HSE’s Treatment Abroad Scheme covered the cost of the flights to London, Emma and her partner would have to cover the cost of travelling to the airport, overnight accommodation and childcare for their other son. Emma said when Sean was 12, he was finally put on puberty blockers and was “like a new child”.
“It was the difference between night and day,” she said.
In 2019, the HSE told Emma it would not cover the cost of her travelling to Tavistock because they were trying to set up a service in Dublin.
Emma said the Dublin appointments have been “very distressing” for Sean, because he’s seen a different endocrinologist every time – while in Tavistock it was always the same person.
At his last appointment, there was uncertainty over whether or not Sean would be allowed to move on to cross-sex hormone therapy – which would involve taking testosterone.
Sean has already had “intensive” appointments to consider what effect this could have on his fertility, and has spoken to a maternity hospital about freezing his eggs.
Emma said she was concerned that the UK court ruling could affect Sean’s ability to move on to cross-sex hormones. “The Tavistock case sent shockwaves for us, because we’re worried about where that will leave Sean. Does that mean they won’t prescribe cross-hormones? Everything is up in the air now,” Emma said.
The High Court case against Tavistock was taken by Keira Bell, a 23-year-old British woman who began taking puberty blockers when she was 16. Ms Bell started cross-sex hormones at 17.
She said she had made a “brash decision” as a teen and is now detransitioning. Ms Bell argued that puberty blockers should only be prescribed after a court order.
Emma said she believed there are a small number of people who do regret transitioning, but this case could now affect the majority of trans children who do not.
“I think for all the good Tavistock has done, there have been a very small number of people who haven’t been happy with their service. They were fantastic for us,” Emma said. “I don’t think Sean would be here without it.”
A number of years ago the HSE had agreed to fund referrals to Tavistock up to January 2021. It had been hoped that by then, Ireland would have its own multi-disciplinary child and adolescent transgender health service.
Vanessa Lacey, the health and education manager at TENI, said this has not been done and the HSE has failed to hire the staff required.
“The one-million dollar question is where do people go from next month. If we decide to end Tavistock’s involvement, we have nothing else there. Because we don’t have anything else,” Ms Lacey said.
“The adolescent service wasted years, and never used the money available to it. I think it is scandalous what has not happened. And I think we are in a worse position now than we were five years ago.”
Ms Lacey said her preference would be for Ireland to have its own child and adolescent transgender health service which would follow international best practice and require at least six assessments before a child is prescribed puberty blockers.
Ms Lacey added that there has been a recent roll-back and increased debate on transgender rights in the UK which meant Ireland should not be relying on it for services.
The Department of Health declined to comment on whether or not it believes Ireland should continue funding and referring patients to Tavistock.