THE NATIONAL GENDER Service has been contacted by GPs seeking advice on prescribing hormones, after transgender patients were started on this treatment by private providers, a consultant has said.
Writing in The Journal, Paul Moran, a consultant psychiatrist at the National Gender Service (NGS) said “many Irish GPs” had contacted the service seeking advice becaues they felt under pressure to prescribe hormones after this course of treatment was initiated for patients by private providers.
The NGS, based at St Colmcille’s Hospital in Dublin, is a HSE service that works with people who need specialised medical support to affirm their gender.
The Irish Council of General Practitioners, the professional body for GPs, said it was not aware of GPs seeking advice from the NGS and had no comment to make.
Irish patients are turning to private providers for gender care because of the inaccessibility of public care here. There are long waiting lists for the NGS for adults, while children and adolescents are currently referred for treatment abroad in the absence of specialised paediatric staff and services in Ireland.
The HSE said it does not have figures for private patients receiving gender treatment. It said it “sincerely regrets” the delays people are experiencing in accessing the care they need, and acknowledged that both adult and children’s gender healthcare in Ireland were underdeveloped.
In his opinion article, Moran said the NGS has advised GPs against getting involved in shared care arrangements with private providers who are unregulated and based outside Ireland, and called for clearer guidance on the issue from the ICGP and the Medical Council.
He also called on Irish pharmacists to “stop dispensing foreign gender healthcare hormone prescriptions”.
Moran was writing in the wake of a landmark report on gender services for children in the UK published last week, which highlighted significant failings, including a lack of evidence for the benefit of prescribing puberty blocker medication to kids.
The Cass Review’s final report also raised concerns over privately provided care, flagging the difficulties faced by families “trying to balance the risks of obtaining unregulated and potentially dangerous hormone supplies over the internet with the ongoing trauma of prolonged waits for assessment”.
The review said GPs expressed concern about being pressurised to prescribe puberty blockers or masculinising or feminising hormones after these were initiated by private providers. It also identified a lack of clarity about GPs’ responsibilities in relation to monitoring on these medications, for example of bone density, which can be compromised by puberty blockers.
The review found that GPs should not be expected to enter into shared care arrangements with provider providers, and no clinician should prescribe outside their competence.
The review also recommended that the British government and pharmacies regulator should define the responsibilities of pharmacists in relation to private prescriptions and consider statutory solutions to prevent “inappropriate oversease prescribing”.
The Medical Council, the regulator of doctors, said its existing guidance to doctors “acknowledges and, where relevant, signposts to other sources of direction and guidance that should inform the practice of doctors”.
The Pharmaceutical Society of Ireland, the regulator, said that because the Cass review was conducted in the UK it was “not within [its] regulatory remit”. It said it had not issued any specific guidance to pharmacists on this topic, but said that prior to dispensing a medicine pharmacists must evaluate “safety, appropriateness and effectiveness”, adding that all pharmacists signed up to a code of ethics and conduct.
The Irish Pharmacies Union, the representative body for community pharmacies, said by law pharmacists can only dispense medicines which are licensed in Ireland and prescribed by doctors within the EU or European Economic Area.
Trans Equality Network Ireland (Teni), which advocates for equality and wellbeing for trans people, said it was aware that unfortunately people were having to use private providers for gender affirming care due to long waiting lists to access this acare in Ireland. It said transgender and non-binary young people should be able to access the correct care here in Ireland.
Teni is in favour of trans healthcare being delivered at primary care (GP and community) level. Next month, it will host a presentation in Leinster House from a gender service based in primary care in Manchester.
The HSE is currently developing a new clinical programme for gender healthcare, and will review emerging and evolving international evidence for this, including the Cass review.
The HSE told The Journal its new model of care will encompass services including “care locally in the community” as well as “more specialised and complex care”.
Moran has argued that the Cass review – which recommended that children’s gender care should be led by a child psychiatrist or paediatrician – has demonstrated that “the idea of GP or psychology-led gender healthcare is out”.
However, also writing in The Journal, University of Galway psychology lecturer Dr Chris Noone and psychotherapist Karen Sugrue have argued that Ireland should also take on board the positions of other expert bodies, including the American Academy of Paediatrics, which have backed a different approach to that set out in the Cass review, including in relation to puberty blockers.
Noone and Sugrue said Ireland should look to countries that have “de-pathologised transness” and which provide care in multiple primary care settings rather than through a centralised service.
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