The Health Service Executive (HSE) has paid for 29 people to undergo gender reassignment surgery in clinics outside the state during the past three years.
Figures obtained by the Irish Mirror reveal that nearly €131,000 was spent on treatment for the 29 individuals, who travelled abroad a total of 41 times for surgery, as well as pre- and post-operative care.
Gender reassignment surgery can include procedures involving the face, chest and genitalia to provide a transgender person with a body that aligns with their self-identified gender.
Facial reconstructive surgery is intended to make facial features more masculine or feminine, chest surgery either removes breast tissue or provides implants, while genital surgery transforms and reconstructs the genitalia.
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The HSE funds gender reassignment surgery under the Treatment Abroad Scheme (TAS), which allows patients to travel to certain countries and undergo treatments that cannot be readily accessed in Ireland.
A consultant must confirm that the treatment is medically necessary, a proven form of treatment, and provided in a recognised public hospital or other institution run by a registered medical practitioner.
Records released under freedom of information laws show that 11 patients underwent gender reassignment surgery abroad in 2020 at a cost of €49,438, making a total of 16 trips for treatment.
Another nine patients travelled abroad for the surgery in 2021, costing the HSE a total of €60,876 over the course of 14 visits, while nine more accessed the surgery last year at a cost of €20,613 during 11 visits.
The National Gender Service (NGS), which is based at St. Colmcille’s Hospital in Dublin, provides referrals for those seeking surgery, according to its website.
“The first step is to speak to one of the doctors or nurses at your Endocrine Appointment Clinic. At that stage, you can talk about your plans for surgery and we can refer you for a surgical assessment,” it says.
“You must be attending our Endocrine Clinic and on hormones for a minimum of six months for mastectomy and a minimum of one year for any other surgery before we can refer you for surgical assessment.
“If, following surgical assessment, it is clear that surgery will help you to affirm your gender and there are no outstanding risks to your health or well-being, then we will refer you for surgery.”
The NGS says “most surgeries” are not provided in Ireland but refers to “funding options” that are available to people who want surgery. “We can help you to apply for that funding,” it adds.
A spokesperson for the HSE said transgender services had been disjointed in Ireland, with some elements unavailable in the country.
"This is why the HSE is establishing a team, starting with the recruitment of a clinician for an essential new clinical role, to lead the development of an updated model of care for the treatment of gender dysphoria.
"What we are doing is moving forward to develop the best service possible for the health and social care of this group of patients or service users and their families, which takes into account the emerging international evidence.
"The HSE is committed to building a service based on experience and compassion with the service user at the centre. We aim to provide a wide range of services for all people with gender dysphoria, from care locally in the community to more specialised and complex care," they added.
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