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Transitioning in Ireland
So you are thinking about transitioning but you are unsure where to start and how to approach it all?
Or you are not trans but you would like to learn more about transitioning because you want to understand and support somebody or the trans community as whole.
Please keep in mind that not everyboy's transition will be the same.
Social Transition
The social transition is the time during which you ask people to use your correct pronouns and name and where you (start to) live your life as your correct gender.
This can but doesn't have to be in stages.
For example you could come out to your family and live in your correct gender role only at home for a while. This would already be part of your social transition.
In Ireland however, you will be recommended, and often required, to live 24/7 as your correct gender for at least a year, before you are considered for a medical transition.
So what does 24/7 mean in this context?
You come out everywhere. Your family, friends, larger social circle, school, work, your sports club, etc. In short, every minute of every day, in every situation, you will be living as your correct gender, using your correct name and pronouns.
This time can be very challenging because while this is an important step for yourself and can be a little scary at first, the people around you are also getting used to what they perceive as the “new you”.
So be prepared that people might slip up, forget, or need to be reminded sometimes. You will have to keep reinforcing your wishes, gently but firmly. This can be frustrating, but things will normalise after a while and it will get easier both for you and everybody around you.
Medical Transition
Your medical transition basically includes everything, be it tablets, gels, injections, surgeries, or anything else that is given or performed by a medical professional.
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Puberty Blockers: These are typically given to those right before or in puberty to pause the puberty and give those children and teenagers more time. When the blockers are not being taken any more, the puberty resumes.
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Hormone Blockers: Some transgender people need to take hormone blockers along with their hormones. Generally MtF women will take Testosterone Blockers because Testosterone is a very strong hormone that can easily surpress Estrogene. Some FtM men will take Oestrogen Blockers to stop their menstrual cycles if they did not stop when taking Testosterone or if they do not wish to take testosterone.
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Hormones: Usually Oestrogen is taken by MtF women and Testosterone is taken by FtM men. Some NB people will also choose to take hormones. Hormones can be taken in various ways, for example as pills, gels, patches, or injections. Which one is chosen depends on the hormone itself, the prescribing doctor, and personal preference.
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MtF surgeries: From breast implants to shaving the adam’s apple to facial feminization to SRS (sexual reassignment surgery), many procedures can be done. You’ll want to have a conversation with your GP or the gender clinic when you decide to go for this.
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FtM surgeries: There are different types of breast removals and SRS procedures available. Additionally, other procedures, such as liposuction or some implants to alter the body shape can be done. You’ll want to have a conversation with your GP or the gender clinic when you decide to go for this.
Legal Transition
The legal transition is often being done at some point during the medical transition, but there is no rule as to when you can or should do it. You can do this whenever you are ready and only if you wish to.
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Here you are working on all the legalities.
Your legal transition generally starts with two steps:
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Gender marker:
You can get your sex changed on your birth certificate via a Gender Recognition Cert (GRC).
A Deedpoll is no longer required for a GRC. According to the Client Identity Services, a redesign of the GRC 1 form has been recently requested. In the meantime, you may ignore the part of the form that requires a deed poll. -
Name:
If you wish to to change you name on official documents, like your passport and drivers license, your bank account, PPSN, etc, you will need a deedpoll. Get your deedpoll witnessed by a trusted person and notarised by a lawyer. Then register it with the high court. Once this has been processed, you can go ahead and make all the changes within your documents and registrations.
Please be aware that name changes, registered by the high court, will be added to a list that is publicly accesible on the website of the high court.
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For details on how to transition legally, please refer to these pages:
Name change || Sex change
Order & Timeline
1. See your GP
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Tell your GP that you wish to transition and that you need a referral to the gender clinic. Depending on where you are located this will be Loughlinstown or Galway. If your GP is unsure which clinic is in charge in your area or they don’t quite know how to help you, have them check with the NGS (National Gender Service) and/or with the HSE. Both have a lot of useful information for your GP and should help them support you.
Here are two useful links you can give to the GP, if they seem unsure where to start or seem to be lacking knowledge:
HSE on Gender Dysphoria || Booklet and other information for the GP
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2. Come out / Social transition
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Public System:
Without having lived in your correct gender identity and with your correct name 24/7 for at least one year, the gender clinic might not approve you to move forward to a medical transition.
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Private:
Even going through private services, it is usually advised to have lived in your correct gender identity and with your correct name 24/7 for at least one year before moving on.
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Please don’t see this as a hurdle to jump through.
This is a great way for you to become more secure and confident in your gender identity.
If you are also still exploring yourself and your place on the gender spectrum, it gives you a chance to see how it feels to live in your gender identity before making medical changes that, for a large part, are irreversible.
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3. See the psychiatrist
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Here you will need to obtain a diagnosis for Gender Dysphoria as per the DSM 5.
Make sure to be patient and calm during your appointment and have a friend or another trusted person ready after the appointment, so you have support should you need any.
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Public System:
Your gender clinic (Galway or Loughlinstown) will give you a first appointment, which is to see the psychiatrist and be evaluated.
You will be told how long the appointment is - usually several hours. So make sure to take enough time off for that day or call in sick, because you might need time before / after, due to anxiety, travel time, or simply to take some time for yourself.
During the appointment, the psychiatrist will ask you questions about your live, your experiences, and your identity.
Be prepared that the questions asked may feel very intrusive and in-depth about topics you might not feel are connected to being transgender and a diagnosis for “Gender Dysphoria”.
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Private:
You will need to do some research as to which psychiatrist you would like to see for your diagnosis. Even though you chose to go private, you still need the diagnosis for “Gender Dysphoria” as per the DSM 5.
While doing your research, it is advised to look for psychiatrists who are specialised and experienced with transgender people.
Be advised that private psychiatrists can be quite expensive, so make sure you save up ahead of time if you have limited financial abilities.
Generally, the appointments with private specialists are a little bit shorter than in the public system (60-90 minutes) and the questions will feel more gender oriented.
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A while after your appointment, you should receive a letter from the psychiatrist via email or post and if everything went well, it will include your diagnosis.
Sometimes the language on the letter will not be exactly: "<name> has Gender Dysphoria as per the DSM 5".
It might say something like: "I see <name> as fitting for DSM-5 302.85 Geder Dysphoria in Adolescents and Adults....".
Essentially, what you are looking for is language that agrees with the diagnostic criteria.
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Two currently available services:
(Please note that Gender Care is currently not taking patients from outside the UK)
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4. See the Endocrinologist
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This is when you are hopefully getting your hormones.
Usually you need to get your bloodworks done ahead of time and either send them in advance or bring them on the day.
Be prepared that under some circumstances you might not get your hormones right away on the day. There are many reasons why this could be the case, for example other conditions that need to be managed first.
At the appointment, the endocrinologist, might do their own little assessment as well but it won’t be as in-depth as the one with the psychiatrist. Usually this will simply be a brief run-down of what’s already in your psychiatrist’s assessment, which you will have to bring or send ahead of time anyway.
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Public System:
Your gender clinic will assign you an endocrinologist, with who they work, and they will also give you an appointment.
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Private:
You will have to do some research to find an endocrinologist who works with transgender people.
While they all are technically qualified, not all of them feel confident in their ability to support you in the best way.
Should you not find one in Ireland, you may consider reaching out to a service outside the country. Make sure to speak to your GP about a good approach to this. For example will your GP be happy to work with the recommendations of the endocrinologist if they are not in Ireland and if yes, would they like to get emails / prescriptions sent to them?
You can also check with your pharmacy if they would accept a prescription from your chosen endocrinologist if they are not based in Ireland.
Two currently available services:
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5. Surgeries
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There will be an in depth page coming in the future, but here is a brief overview:
If you are Non-Binary, please be aware that you can definitely avail of transgender surgeries as well. Your process for approval is still the same.
There are very few surgeons in Ireland who perform gender reaffirming surgeries so make sure to do some research about whichever surgery you are looking for. Find out where you can receive it, learn about the surgeon, their approach, results, and requirements. Make sure you do this research before getting in touch with your point of contact.
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Public System:
Most gender affirming surgeries are not available in Ireland so you may have the option to be sent abroad by the HSE to avail of the care you need.
To get an idea of your options, make sure to contact both your GP as well as the NGS (National Gender Service) at nationalgenderservice@hse.ie or 01-2115045.
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Private:
Once you have found a surgeon, make an appointment with them and ask all your questions, tell them any worries you have, and make sure to understand their requirements. Best is to make a list with all your questions so you are prepared for your appointment. Check with your health insurance, if you have any, whether or not they might cover some of the costs and what the requirements are if they do.
Examples:
- Do they need your psychiatric assessment with the Gender Dysphoria diagnosis?
- Are there any limits concerning body weight or illnesses?
- When should you arrive at their office / are there any additional appointments before the surgery date?
- Tell them any complications you might have experienced in previous surgeries.
- Tell them what method you prefer and ask what their advice is on that front.
- Ask about any medications you are taking (do you have to stop taking something or add something?)
- Ask about your stay at the hospital and in the country.
- Ask about physical limitations after the surgery.
- Ask to see previous results!
- Ask about pricing and payment plans / payment options.
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Generally, the surgeon will now explain everything and make any further plans with you directly.
Ongoing
If you chose to take hormones:
You will need regular check-ups on your hormones to see if your levels are stable or if any adjustments are needed. So make sure to stay in touch with the endocrinologist.
Should you notice any reactions or symptoms to your hormones or around the time you take them, make sure to bring this up at your visits with the endocrinologist.
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Additional Services:
There are additional services, you might want to consider, such as vocal coaching, hair removal, therapy, etc.
You can find some of these services on Teni’s list.
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