Inside Europe's Transgender Medicine System with Róisín Michaux
27 August 2026
With Róisín Michaux
Europe
Journalist Róisín Michaux, based in Brussels, went undercover as a fictitious autistic teenager to map how Irish young people reach gender medicalisation across Europe. The investigation exposes cross-border prescribing, online clinics operating outside Irish jurisdiction, and surgical providers in Madrid willing to perform mastectomies on minors. The episode examines the fragmented landscape left by Ireland's gender service changes and questions whether safeguarding frameworks are keeping pace with the market that has grown up around them.
Róisín Michaux is an Irish journalist based in Brussels who has spent time investigating how young people in Ireland and elsewhere in Europe navigate the gender medicine landscape. In this episode she brings that reporting directly to the podcast, describing her methods, her findings, and the specific providers and pathways she encountered. Her work sits at an intersection that rarely receives close scrutiny: the gap between what formal health services offer and the range of routes a determined or distressed teenager can actually take. One of the starting points for her investigation was what the episode identifies as Ireland's gender service split — the reorganisation of how the Health Service Executive provides or commissions gender-related care. That structural change left a vacuum that private providers, online clinics and cross-border services have moved to fill. Michaux traces how an Irish young person, particularly one who has been waiting months or years for an assessment, can relatively quickly find their way to hormones or surgery through channels that operate outside HSE oversight. Undercover, posing as a fictitious distressed and autistic teenage girl, Michaux accessed online spaces where transition options are discussed, and then tested several of the clinical services those communities point towards. These include Gender GP and Gender Plus, both of which operate online and are accessible from Ireland, as well as Imago, a provider she identifies as engaging in cross-border prescribing — issuing hormone prescriptions to patients in countries where they could not easily obtain them domestically. The investigation extended to in-person providers on the European continent. Michaux visited a youth gender clinic in Antwerp and probed clinics in Madrid that she found willing to perform mastectomies on minors. The Madrid findings are among the most striking in the episode: surgical interventions typically classified as irreversible being made available to children through pathways that do not appear to require the safeguarding steps that would be mandatory in an Irish or UK hospital setting. The episode also examines how suicide risk is deployed within these systems. The hosts and Michaux discuss the tension between affirmation-based protocols — which treat any questioning of a young person's stated identity as potentially harmful — and a therapeutic approach that would explore distress before moving to medical intervention. Also covered is the role the pandemic lockdown period played in accelerating online community engagement and, in some cases, the pathway toward medicalisation. For anyone trying to understand the current Irish landscape, this episode maps how formal and informal systems interact. The HSE's commissioned services are one part of the picture; online clinics based outside Ireland, cross-border prescribers and surgical providers in other EU member states are others. The episode raises clear questions about whether the information young people and their families receive is accurate, whether autism and other vulnerabilities are being adequately assessed, and whether Irish regulatory frameworks have any reach over the providers involved.
