Youth gender medicine in Ireland

How were Irish children referred abroad for treatment, what did the Tavistock closure mean for Ireland, and what happens now?

Ireland did not have a dedicated multidisciplinary public gender-identity service for children and adolescents when referrals to England began. The National Gender Service at St Columcille’s Hospital, Loughlinstown, was an adult service. For younger patients, the route described in the HSE’s 2023 review was through general practice, CAMHS and/or paediatric endocrinology at Children’s Health Ireland, with specialist psychological or psychiatric assessment sought from the Tavistock and Portman NHS Foundation Trust in London.

Background

Ireland did not have a dedicated multidisciplinary public gender-identity service for children and adolescents when referrals to England began. The National Gender Service at St Columcille’s Hospital, Loughlinstown, was an adult service. For younger patients, the route described in the HSE’s 2023 review was through general practice, CAMHS and/or paediatric endocrinology at Children’s Health Ireland, with specialist psychological or psychiatric assessment sought from the Tavistock and Portman NHS Foundation Trust in London.

The relevant funding mechanism was the Treatment Abroad Scheme. It permits an Irish public-hospital consultant to refer a public patient abroad where a clinically necessary service is unavailable in Ireland. A separate Cross Border Directive route may allow a patient to obtain care in another EU state and seek reimbursement, subject to its conditions. Neither route means that a family simply self-refers a child for State-funded treatment: the public consultant, the HSE funding process and the receiving provider each have roles (Department of Health, 2024; HSE, 2023).

The HSE’s own account is important because it qualifies a common shorthand. Irish children were referred to Tavistock principally for specialist psychological and psychiatric assessment and support, not automatically sent abroad for medical treatment. The report states that the consultant paediatric endocrinologist at CHI, working with Tavistock psychological support, considered whether hormone treatment was appropriate. It also states that the endocrinologist held the decision to prescribe hormone therapy (HSE, 2023).

What the documents say

The Irish referral pathway

The HSE’s published pathway began with a GP consultation. A GP could provide initial screening, consider primary-care psychology and refer to CAMHS; GPs could also refer directly to CHI paediatric endocrinology. CAMHS was expected to address mental-health difficulties. Once co-occurring issues not regarded as central to the child’s gender distress had been addressed, a CAMHS consultant could refer to Tavistock and apply simultaneously for Treatment Abroad Scheme funding. Before the pandemic, Tavistock psychologists also travelled to CHI for assessments (HSE, 2023).

The record does not establish that every referred child received the same assessment, travelled to London or received medication. Indeed, the HSE found incomplete documentation in an administrative review of 18 people later referred from CHI to the adult service: eight had documentary evidence of CAMHS involvement and ten did not. The report expressly said this did not prove that assessment had not occurred, but it did mean that the available documentation could not show clearly whether a full assessment had been completed in all ten cases (HSE, 2023).

The Tavistock change

The Cass Review’s interim report concluded that the single-provider model for England was not safe or viable in the long term. The final report, published on 10 April 2024, described a weak evidence base for medical interventions, called for holistic assessment of mental health and neurodevelopmental needs, and advised that puberty blockers should be available only in a research setting. It also recommended extreme caution before prescribing masculinising or feminising hormones to 16- and 17-year-olds (Cass Review, 2024).

For Ireland, the first practical disruption came earlier. The HSE recorded that Tavistock stopped accepting direct referrals in November 2022; referrals to NHS England were then triaged by a board towards new services. The closure in March 2024 therefore did not simply end an otherwise stable Irish arrangement. It exposed that Ireland’s pathway depended on an English specialist service already being reconfigured because of capacity, governance and evidence concerns (HSE, 2023; NHS England, 2024).

The HSE reported that fewer than five Irish children or young people had used centres in Belgium and Germany in the preceding year through the Cross Border Directive and Treatment Abroad Scheme routes. It did not identify the providers or publish outcomes, citing the very small numbers involved. That is a significant limitation for public scrutiny (HSE, 2023).

Courts and legal context

The English case of Bell v Tavistock is sometimes presented as an Irish legal ruling. It was not. In September 2021, the Court of Appeal of England and Wales overturned the High Court’s earlier declaration concerning consent to puberty blockers, holding that clinicians, rather than the court, should decide Gillick competence in individual cases. The judgment did not govern Irish consent law or Irish HSE policy. Its relevance here is historical: it formed part of the English context in which Tavistock’s practices and oversight were being reconsidered (Court of Appeal of England and Wales, 2021).

The positions

Trans-rights and patient-advocacy organisations argue that Irish young people have been harmed by the absence of timely, local and properly resourced care. Their central concern is that long waits, fragmented pathways and reliance on foreign providers leave distressed adolescents and their families without support. Belong To’s Irish research documents substantial barriers reported by trans and non-binary people seeking gender-related healthcare and argues for a service designed around access and patient experience (Belong To, 2024).

Clinicians associated with the National Gender Service, including Professor Donal O’Shea and Dr Paul Moran, have argued that a gender-affirmative pathway can move vulnerable children too quickly towards medicalisation without adequate assessment of mental health, neurodevelopment, trauma, sexuality and family circumstances. In 2025, the High Court gave them leave to pursue judicial-review proceedings concerning HIQA’s alleged failure to review HSE care and overseas referrals. Leave to bring proceedings is not a court finding that their claims are correct.

The HSE’s published position is different again. Its 2023 review maintained that the Irish pathway mitigated some Tavistock risks because referrals came through consultants, children had local GP, CAMHS and/or endocrinology involvement, and the Irish endocrinologist retained prescribing responsibility. Yet the same report described the overall Irish provision as fragmented, suboptimal and high-risk, especially at transfer to adult services (HSE, 2023).

Interpretation

This site’s reading is that Ireland outsourced not merely appointments but clinical uncertainty. The State referred children into an overseas service precisely because Ireland had not built a transparent, specialist paediatric pathway of its own. Consultant involvement and formal funding approval were safeguards, but they were not substitutes for a nationally governed service that could assess, follow and audit every child over time.

The Tavistock closure should therefore not be treated as a foreign controversy with no Irish consequences. Ireland sent 233 children and young people into that service over a decade. The HSE’s own documentation shows gaps in records for a sample of later adult-service patients, prolonged waiting, unclear transition arrangements and use of multiple overseas routes. A finding of no reported Category 1 incident is not the same thing as evidence that all children had good outcomes; serious incident reporting is not a long-term outcomes audit.

A gender-critical approach does not require indifference to distressed children. It requires the opposite: careful differential assessment, support that does not predetermine an identity or medical pathway, full attention to co-existing difficulties, meaningful consent processes and long-term follow-up. Where interventions may affect fertility, sexual function, bone health and future treatment options, the evidential threshold should be high.

Open questions

What has happened to each of the 233 Irish referrals? The public record does not provide an anonymised audit of assessments completed, medications prescribed, discontinuation, adverse effects, detransition, mental-health outcomes, fertility counselling or adult-service transfer. Such an audit should distinguish referral from attendance and assessment from medical treatment.

What is the present overseas pathway? The HSE stated in December 2025 that it was developing an updated Model of Care for children, young people and adults, and that expert consideration of the final Cass Review had been completed. However, the public answer did not identify the current providers, referral criteria, governance arrangements, clinical protocols or publication date for the completed expert work (HSE, 2025).

Finally, who is accountable for the transition period? The Oireachtas, HIQA, the HSE, CHI, CAMHS and the National Gender Service each have part of the picture. Parents, clinicians and journalists need a single published account of the current pathway, the evidence standard for interventions, the safeguards for children and the outcome data by which the new Irish model will be judged.

On the Irish timeline

Episodes on this subject

Rethinking Youth Gender Medicine with Dr Louise Irvine

The Doctors Transitioned My Son at 13 - Here’s What Happened Next...

Psychiatry's Biggest Mistake? | Dr Kris Kaliebe