What’s going on with Gender Affirming Care?

starting, with many tense and exhausting discussions between trans people and those leading the review. Many individuals, who joined with the best of intentions to give their all to the work, either resigned or dropped off. It was thankless work: I, like many of my fellow panel members, were sharing our views and expertise on the care that would best fit our community while we were unable to access that care ourselves, and while getting increasingly frustrated when our views were discarded or ignored.

Eventually, the Review produced a series of recommendations which were almost entirely unsupported by the service user panel, took account of very few of the issues we had raised and, frankly, wasn’t worth the paper it was written on. It made no recommendations to move in line with international best practice and depathologise our care - that is, move it out of a mental health framework and into sexual health, something supported by almost everyone on the service user panel. It barely considered young people’s care, and to our knowledge had consulted no young people in Knowing Our Identity, the under-18s service, in the process of developing those recommendations.

This document was never published, and the Review group ceased to meet for a long period following this. Nothing changed, the waiting list got longer, and trans people continued to be forced to seek care elsewhere to have any hope of making progress.

That brings us to this year, when the Review reconvened under new leadership, with many of the service user panel disengaged, and began work in earnest to deliver a new service. As someone who has invested my entire adult life into working to ensure trans people have access to gender affirming care, I was sceptical given my previous experience with the Review, but hopeful that we could actually start to make meaningful progress for our communities. We entered into this new stage in good faith and with hope that it would make a change. Has it? Well, the proof will be in the pudding.

Some of that pudding came out of the oven underbaked and smelling of rotten eggs when the Health Minister announced his ban on puberty blockers, joining the rest of the UK in their moral crusade against basic care for trans adolescents. The Review Group was consulted on this change, but the final decision was down to the Health Minister and the First and Deputy First Ministers, with the announcement of the ban seeming to take many clinicians as much by surprise as it did the community. This issue will not fade away - indeed, it’s quite likely that the British Secretary of State for Health and Social Care, Wes Streeting, will push hard to make the emergency ban permanent.

Regardless of this setback, and recognising the impact it’s having on young people across Northern Ireland and the fear it has generated across our communities, the Rainbow Project and others across the LGBTQIA+ sector are determined to keep pushing and provide some positive movement and some hope for the future for trans communities.

I believe the next six months will yield some positive change for trans people in Northern Ireland. We won’t get everything we want, we won’t get a best practice service transformation, not immediately, but I am hopeful that the crisis that has defined our services for the past six or seven years will begin to be addressed.

If that does happen, and I hope it will, we cannot rest on our laurels: we must keep pushing, fighting for the best possible standard of trans healthcare, fighting for bodily autonomy and self-determination, fighting for the basic respect and integrity that should be afforded to everyone in their access to healthcare. We deserve, and should accept, nothing less.