‘Growing up here was hopeless’: trans voices from rural Ireland

In 2015, Ireland became the first country worldwide to legalise gay marriage by popular vote. Seven years later, this same land is ranked the worst country for transgender healthcare among the 27 EU member-states. 

TGEU's Trans Health Map research found that Ireland scored worse on waiting times, having longer delays than any other country, at between two and half years and ten years to see a specialist, which can be even more challenging for those seeking gender care in rural areas.

‘Getting trans healthcare in Ireland is a nightmare’

LGBTQIA+ experience is singular for each person but with intersections between: coming to terms with your identity, coming out, transitioning or in accessing health and mental care can be enormously challenging. 

“Getting trans healthcare in Ireland is a nightmare. It took years for me to get what I needed, even though I knew what I wanted. They [HSE] want you to take the most difficult route possible. Also, they make you wait for years. From when I came out, in 2013, to getting actual healthcare, it took until 2017”, says Meryl McGowan, 30, originally and based in Drumshanbo, Co. Leitrim and a member of Leitrim Pride. 

Meryl started transitioning when she moved to Dublin, away from home. At the time, she said the process was 'embarrassing' and 'very invasive'. Gender transition is different for each person - "some people may change their names, pronouns, style of dress etc., to express their gender identity. Others may feel that a medical Transition (e.g. hormone, replacement therapy, surgery, etc.) is the right route for them", explains BeLonG To LGBT+ Youth Ireland. 

Pictured: Meryl McGowan

According to the Health Service Executive (HSE), the gender dysphoria treatment in Ireland for adults includes changes in gender expression and role hormone treatment therapy; surgery to change primary and/or secondary sex characteristics; psychotherapy or counselling (individual, couple, family, or group) for purposes such as exploring gender identity, role, expression, and addressing the negative impact of gender dysphoria and stigma on mental health.

However, the current model of gender-affirming healthcare in Ireland has been widely criticised by trans people, activists and organisations. "It is all very invasive, and I am not sure if it has gotten much better since I transitioned, seven years ago. Prescriptions were very hard to come by, and it still is very difficult getting in contact with the National Gender Clinic (NGS) in Dublin. GPs are advised all the time to never give us blood tests or hormone therapy without consulting NGS, even though that is against the World [Professional Association for Transgender] Health best practices, and it is discriminatory", shares Meryl. 

WPATH recommends that most countries follow the 'informed consent' model, which is advised of both benefits and risks of treatment options for gender dysphoria, followed by appropriate and continuity care. According to HSE, Ireland follows this model; however, there is only one specialised clinic for gender care in Ireland, based in Dublin - which directly affects people living in rural areas - with their preferred method that dictates how all trans people are provided or denied healthcare.

It is all very invasive, and I am not sure if it has gotten much better since I transitioned, seven years ago. Prescriptions were very hard to come by, and it still is very difficult getting in contact with the National Gender Clinic (NGS) in Dublin.
- Meryl McGowan

The National Gender Service approach to gender care includes multidisciplinary assessments prior to any gender-affirming medical interventions (hormones), surgical interventions, or other care.
Its first step is to be referred by a GP, followed by triage, waitlist, initial assessments, clinic appointments and, for some, surgical assessment. NGS's last update says they are currently seeing people referred in the first quarter of 2020 - to see a specialist could take up to ten years. 

Harper Rooney, 22, a Sligo Inclusive Pride member, said she attended several protests regarding better healthcare access for trans people in Ireland. "I started my process with the National Gender Service in February 2023, and I don't expect to hear back from them until I am 32, in ten years' time. 

"I am not going to be putting my life on hold because of the failures of our healthcare system. So, that's why I've had to take other measures to continue my transition", she said. Due to the long waiting times, like many other trans and non-binary people across the country, Harper self-medicates her hormones by buying them off-prescription through online pharmacies, as they simply cannot face the wait.  

Pictured: Harper Rooney

Harper had to start her transition treatment at a private clinic in the UK, where she was able to get a gender dysphoria diagnosis, which only the appointment cost from her pocket about €140, plus €200-€300 to the hormone therapy set up. "I didn't have that money to spare. So, instead, I had to start self-medicating", she said. 

Unlike friends who had problems with their GP, she said: "My GP has been helpful, at the very least, providing me blood tests on request every three months. I can get checked and make sure that my hormone levels are ok. But I know countless trans people struggling with their GPS not referring patients or providing them with blood tests. There are many people in the trans community in a much worse space than I am". 

NGS policy advises GPs against providing prescriptions without an assessment and says that blood tests 'can be done by your GP or at St Columcille's Hospital, then bring the results to the clinic, or email them'. However, Trans Harm Reduction says that it has become increasingly common for trans people to be refused access to blood tests by their GPs in many areas across the country. 

"The waiting list here is unreal. First, you need to commute to Dublin to get any actual care, and the waiting time can affect the mental health of lots of people. I've given up, and I did my transition on my own", shares Carolyn Ann Willis, a 73 years old transgender woman who migrated to Ireland over ten years ago and currently lives in Manorhamilton, Co. Leitrim.

From Kentucky, United States of America, Carolyn did her final transition in 2016 and said: "I haven't looked back since". It was in Ireland that she began her transition process, which, in her case, also includes some surgeries. As many others paid for all the treatment herself and needed to resort to gender care services in Belgium - Carolyn estimates that all her costs are around €50,000. 

‘Waiting times just kills people’

In addition, trans people are disproportionately affected by poor mental health outcomes - Transgender Equality Network Ireland (TENI) Speaking from the Margins: Trans Mental Health and Wellbeing research, published in 2016, found high levels of stress (83%), depression (82%) and anxiety (73%) among trans people than who are not trans. With the social barriers plus the long waiting times to get an appointment in the NGS for, as she calls, 'life-saving treatment', it is unacceptable and causes a lot of damage to mental health. 

"Waiting times just kill people. But they seem to think we are depressed because we are trans, not because we are treated poorly. I couldn't get proper mental health support for a long time. In 2017, I was trying to see a psychiatrist regarding depression back in Sligo, and the first thing she said to me was, 'How much do you regret trying to be a woman?' At that point, I was like there was no hope, and I was completely on my own.

"If the people you are supposed to go to for help make things worse, then you are better off without. If you're treated like an outsider and a problem, like you've committed a crime, even though you're innocent, everywhere you go, no matter who you talk to, you're going to feel bad", she added.

LGBT Ireland report (2019) found that over 75% of trans people had considered taking their life compared to lesbian/gay females (56.4%) and gay males (52.4%), and over 48% had self-harmed. It also highlights that these long waiting times negatively impact the mental health of trans youth and can put them at higher risk of suicide ideation or self-harm.

"I didn't really get much mental health support. Being honest, the internalised transphobia was a big struggle for me, and I had to overcome my mental health. There is a lot of misinformation about being trans out there. Before I came out as trans, I was hyper-fixating on my gender identity every single day. I was stressing about it constantly because it was causing me so much dysphoria that it caused a lot of pressure and misery in my life. Since coming out as transgender, I generally don't think about it anymore", said Harper.

Transgender Identity Survey: A Measure of Internalised Transphobia explains this phenomenon that trans, nonbinary and gender nonconforming individuals experience after internalising society's normative gender expectations, which may cause them potential health effects, such as "higher rates of depression, anxiety, low self-esteem, delays in seeking healthcare because of shame or concerns about discrimination, lower quality of life, difficulties coming out as trans or seeking gender-affirming care".

Pictured: Carolyn Ann Willians

‘Growing up here was hopeless’

Stigma and discrimination, in addition to family support, have a significant impact on trans people's mental health, especially those living in rural areas where they feel there is little or no access to support or from experiencing a sense of community or acceptance. "Growing up here, it was hopeless. There was nothing, no one to talk to or get help from. No allies, no friends, no family", says Meryl about her experience growing up as queer in Drumshanbo. 

"When I was younger, it was brutal. I didn't feel like I could trust anybody, which is one of the problems growing up where you might have some kind of connection to people, but you always know it is conditional on how they expect you to present, not how you truly are. It is not everyone that is accepting, it is quite isolating", Meryl shared.  

Meryl moved from her hometown to Dublin for a couple of years and decided to come back asb says now life there is not as bad as it was when she was growing up. "But there is no community really. Aside from one other person, I don't know anyone who is queer or openly queer. To feel integrated, you must commute to Dublin", she added.

Harper grew up in a standard Roman Catholic family in the Sligo countryside - as a child, she said there was no mention of the LGBTQIA+ community. "None of my friends or my parents talked about it. So it was a completely alien world for me while I was growing up, and this caused a lot of confusion for me in terms of my gender identity and my sexual orientation. I was in autopilot mode for over six years of my life because of that. When I was 18, I started coming out more to people, but not to my immediate family, because I struggled with anxiety and depression". 

In terms of discrimination, Harper says the most common situation to happen is to "get dirty looking over the streets as if you

If you are feeling vulnerable or different, it's hard to blend in a small community. So it must be easier in big cities to mix with the crowd and not be seen as different. 
- Bernie Linnane

have two heads". As she is involved in community projects and a member of the Sligo Inclusive Pride, she says that people are generally quite accepting, even the older generations. 

Bernie Linnane, a member of the Leitrim community and Labour's new Local Area Representative for the Manorhamilton Electoral Area, said that with the marriage equality referendum, Ireland made huge steps in letting the LGBTQIA+ community know that they are accepted as a community in Ireland. 

"If you are feeling vulnerable or different, it's hard to blend in a small community. So it must be easier in big cities to mix with the crowd and not be seen as different. Whereas if you're in a small community, you may stand out a bit more. Because in small communities, everybody knows everybody else's business quite often. I just support anybody in being themselves and being their authentic self. That's why I believe they should have what they need regarding health care and support, " Bernie said. 

Living in Manorhamilton, Carolyn shared that, at first, coming out as trans was scary. "I did not know how people would take it. It is a small farming community, but they gave me the benefit of the doubt. So, I figured out what works, and my job is to be and become invisible. I have my local friends, and today I am just a normal person that happens to be transgender".