Ireland's Health Service Is Finally Asking Trans People What Better Care Looks Like

If you’ve spent any time around Ireland’s trans community, you’ve heard the waitlist numbers. Referrals to the National Gender Service that take years, not months. A single adult clinic trying to serve the whole country. People flying to other countries, paying out of pocket, because the public system can’t move fast enough for the care they need. Against that backdrop, a survey closing this week feels small — it’s a questionnaire, not a policy change — but it matters because of who it’s finally asking.

What the HSE survey actually did

The Health Service Executive commissioned RedC Research to run a survey gathering the experiences of transgender people who have tried to access, or attempted to access, gender-affirming healthcare in Ireland. The survey closed on August 21. It asked not just what people’s experiences of the current system have been, but how they think services should be organized going forward — a design question, not just a satisfaction check.

That distinction is the point. Ireland’s Trans Rights Index and Map gave the country a score of zero in the Health and Family categories this year, reflecting a system that has not depathologized gender-affirming care and where so-called conversion practices remain legal. Long waits, understaffing, and hard-to-access care have been the norm for so long that a survey asking trans people what they’d actually want feels overdue rather than premature.

Why now, and why it’s uncertain

The timing isn’t incidental. The HSE is in the process of developing a new model of gender-affirming care, and this comes at a genuinely unstable moment for that effort — Dr. Karl Neff, the HSE’s Gender Healthcare Clinical Lead, is stepping down at the end of the year, leaving a leadership gap in exactly the role that would normally steer a redesign like this.

Healthcare researchers and advocates have been pushing for a specific structural fix: an informed-consent, patient-centered model that would let trained GPs and clinics initiate and monitor hormone therapy directly, rather than routing every patient through a single overburdened specialist clinic. That’s roughly the model already used in parts of the US, Canada, and increasingly in the UK’s private sector — and it’s the model most likely to actually cut Ireland’s waiting times, since it doesn’t depend on hiring enough specialists to clear a backlog that keeps growing.

Whether the HSE’s new model will move in that direction is still an open question. A survey is an input, not a commitment. But it’s a different kind of input than Irish trans healthcare policy has historically had — this system has largely been designed and debated without the people using it in the room.

The bigger picture

Ireland’s TransCare conference, an academic gathering focused on trans, gender-diverse and intersex-inclusive healthcare research, ran again this year with a renewed focus on interdisciplinary approaches to exactly this problem. Between that and the HSE survey, there’s a case to be made that 2026 is the year Ireland starts building an evidence base for what its trans healthcare system should look like next — even if the system itself hasn’t caught up yet.

For a country that likes to point to its 2015 marriage equality referendum as proof of how far it’s come on LGBTQ+ rights, the state of trans healthcare has been an uncomfortable exception for years. A survey closing quietly in late August won’t fix that on its own. But it’s the first time in a while that fixing it has looked like it might actually start with the people who need the care, rather than around them.