Tús Nua on Gender?
By Catherine Monaghan
Many people in Ireland are feeling tentatively hopeful right now as we witness significant change in the UK regarding sex-based rights. The UK Supreme Court has clarified that the protected characteristic of ‘sex’ in the Equality Act 2010 refers to biological sex, not gender identity. We watch with bated breath, barely believing that sanity has prevailed and women are back to being adult human females, and we hope that ripples will be felt here, across the water.
While it may seem that we are quietly submitting to the demand to keep up with “progress” when it comes to all things gender, there are many Irish women’s rights activists, parents, teachers, the odd politician, and a brave few in the medical profession who are speaking out and asking questions about women’s rights and child safeguarding.
Judicial Review
Two of Ireland’s leading medical professionals, Professor Donal O’Shea (consultant endocrinologist) and Dr Paul Moran (consultant psychiatrist) of the National Gender Service (NGS), are seeking a judicial review of the treatment of children in Ireland with gender identity issues.
The action has been taken against the Health Information and Quality Authority (HIQA), Ireland’s health watchdog, and is due to come before the High Court soon.
The doctors lodged a formal complaint to HIQA some 18 months ago regarding the Health Service Executive’s (HSE) treatment of children and young people with gender identity issues. In the complaint, Professor O’Shea and Dr Moran highlighted concerns over referrals of Irish children with gender identity issues to the NHS Tavistock Gender Identity Development Service (GIDS) in London. The clinic was closed to new referrals in 2022, but in the seven years prior to that, 229 Irish children were referred there by the HSE. The closure of the clinic followed a review by the UK Care Quality Commission and the Cass Review of gender identity services for children and young people.
The Cass Review was an independent review of gender identity services for children in the UK, commissioned by the NHS and carried out by paediatrician Dr Hilary Cass. It found that the Tavistock clinic’s approach to treating young people with gender issues lacked sufficient evidence and did not fully consider the long-term impact of medical treatments. The review concluded that the clinic rushed into prescribing puberty blockers, which prevent puberty, and cross-sex hormones, which masculinise or feminise appearance, despite little evidence that these improve wellbeing and without thorough psychological assessments.
It highlighted the potential long-term effects of these treatments on fertility and physical development and raised concerns about the lack of comprehensive information provided to young people and their families about the permanent consequences of these treatments, such as the impact on fertility and other aspects of development. The review stressed the need for more careful consideration of these irreversible changes before proceeding with such treatments, particularly for younger patients who may not fully understand the long-term implications. Dr Cass recommended a more cautious, holistic approach to care.
In 2019, the National Gender Service in Ireland carried out an internal audit of 18 young people who had been referred to the Tavistock clinic in the UK. The audit found that many of these patients were started on medical treatments, like puberty blockers, without thorough mental health assessments. Many also had complex psychological issues that were not properly addressed before treatment began. The NGS raised concerns that this approach was unsafe and could lead to harm, especially for vulnerable young people.
“What that audit told us was that… we were sending our young people to a very inadequate service,” Professor O’Shea told RTÉ Prime Time.
According to Dr Moran, the National Gender Service first raised concerns with the HSE in 2018 about its practice of referring Irish children to the Tavistock. However, Professor O’Shea said they were silenced and reprimanded, and the HSE continued to refer patients to the UK until the clinic closed to new referrals in 2022.
Following the closure of the Tavistock to new patients, the HSE advised children on their waiting list of a gender clinic in Belgium. While children were not actually referred there, they were advised how to access care at the clinic, which the HSE said was accepting patients under its public health system. The quality of the clinic was not assessed by the HSE, and in a statement to RTÉ Prime Time, the HSE claimed they have “no role in evaluating or otherwise approving a public healthcare service in another EU/EEA country”. Professor O’Shea told the Irish Independent that the HSE was directing a highly vulnerable group of patients towards a service that “is at least as bad as Tavistock, but most likely worse”.
Dr Moran and Professor O’Shea have also expressed concern over what they see as inappropriate influence of activist-driven ideology on gender services in Ireland. They say that the HSE is in thrall to the gender-affirming model of care promoted by transgender activists, an approach which focuses on affirming a patient’s gender identity rather than exploring the issue, and which often leads to the fast-tracking of medical interventions without adequate psychological assessment.
They claim that certain policies within the HSE and external providers are guided more by advocacy positions than by rigorous medical evidence or clinical consensus, and that this has created a culture in which clinicians can feel pressure to affirm gender identity without question or exploration of the complex psychological factors that may underlie a child’s distress.
The HSE has defended its approach, claiming that appropriate standards have been maintained and that there have been no formal complaints from families of children treated abroad. In a statement to RTÉ Prime Time, the HSE denied that it had succumbed to an activist agenda that was causing harm.
The dismissal of their concerns by the HSE was what prompted Professor O’Shea and Dr Moran to seek the intervention of HIQA 18 months ago. Now, having received a letter from HIQA effectively dismissing their complaint about the HSE, the doctors have taken a High Court action against HIQA and are looking for a judicial review of the State’s treatment of children seeking assistance with gender identity issues.
A judicial review would look at how and why decisions were made within the HSE regarding treatment of children and young people presenting with gender-related distress. The findings would inevitably shape future services and provision. This is timely, given the HSE is currently developing a new clinical program for gender healthcare, due to be up and running in 2026, with endocrinologist Dr Karl Neff as clinical lead.
What Lies Ahead for Gender Healthcare in Ireland?
What all of this means for the future of gender healthcare in Ireland remains to be seen. The number of children presenting with gender-related distress continues to grow, and thus far the service provided has been at best inadequate, at worst harmful.
The HSE says this new program will be informed by the best available evidence on clinical care and that an “…important part of the work will be to review emerging and evolving international evidence, including the just-published Cass report.”
The Cass report concluded that there was no solid evidence to support medical intervention, such as puberty blockers or hormones, and that even social transition (where one changes one’s name, pronouns, and appearance in an attempt to socially identify as the opposite sex) is a major psychosocial intervention, which can have long-term implications for children and should not be taken lightly.
Dr Moran has said, “…we are working somewhat in the dark, which means we have to prioritise being safe and careful,” a recommendation made all the more salient by his acknowledgement of the growing number of people contacting the National Gender Service in recent years seeking to detransition (to stop or reverse the process of gender transition).
Various transgender support and activist groups, such as TENI and Belong To, however, continue to campaign for children and young people experiencing gender distress to receive gender-affirming care, despite the mounting evidence that this is not best practice. Considering Dr Moran’s and Professor O’Shea’s assertion that such groups exert undue influence on gender healthcare services in Ireland, it would be reasonable to assume that investigation of services to date and planning for future services will carefully consider how much weight is given to the activist agenda.
Given what we now know, one would hope that we can ultimately expect a model of care that will encourage a non-medicalised and extremely cautious approach to this issue and which, at the very least, will do no harm. Meanwhile, we may prepare for a can of worms to be opened and for more contentious debate to follow.
Catherine Monaghan, Irish women’s rights activist and founding member of Wicklow Women 4 Women.
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