Irish National Gender Service closes waiting list due to chronic and deliberate underfunding

After the waiting list ballooned past 4.5 years, the state health service– run by a co-author of the UK's Cass Report- decided to close the list to new clients as of next March, leaving no formal access to trans healthcare.

By Artemis T. Douglas

After the waiting list ballooned past a decade, the state health service decided to close the list to new clients as of March 2026, leaving no formal access to trans healthcare.

With trans healthcare in Ireland being chronically underfunded for years– and only one national gender clinic on the entire island, the NGS has decided to close its waitlist. This comes a little over a week after a Labor Party-led resolution passed in the Irish legislature, indicating government support towards a move to a WPATH-based informed consent model in Ireland.

A letter released to RTE (the public broadcaster in Ireland) explains the decision. Drafted by Brian Cotter by the head of the NGS’s Clinical Oversight Team, it says that,

"it has been clear that the lack of resources would result in increasing waiting times and could compromise our ability to continue to provide a service.”

"Despite repeatedly highlighting this risk over the last number of years, we remain in a situation where we have neither the staff nor clinical space to safely and effectively provide a service."

In the letter Cotter also mentions a “chronic lack of resourcing" which "has been evident for some years, and is now at a critical point."

RTE’s coverage reports as if being trans is only gender dysphoria, saying “A transgender person is someone whose gender identity does not match their biological sex. This mismatch can cause extreme psychological distress, known as gender dysphoria.”

RTE’s explanation of transness also elides that trans people who medically transition do change their sex in terms of biology and medical needs.

It is also too credulous with reporting on Fianna Fail’s removal of the WPATH model from its 2025 program, as compared to their 2020 program.

Fianna Fail is a center-right party in Ireland that currently holds the largest share of the government, as of the 2024 general election.

Informed consent is a superior model to WPATH’s gender-affirming model in terms of bodily autonomy. Some people in Ireland are fighting for informed consent. 

The most recent movement towards a better model happened in Dail Eireann, the legislative body for Ireland, where a resolution towards an informed consent, GP-led model was passed without a vote by a Labor Party TD. In Ireland, a TD is a legislator. 

Editor’s Note: According to the Oireachtas’ (Irish national legislature’s) website, “The Dáil is the lower house of the Oireachtas. A Dáil Member's official Irish title is "Teachta Dála" (TD) which in English means "Deputy to the Dáil".”

However, the Irish National Gender Service- such as it is, operates on a transmedicalist model. 

According to the December 3rd transcript of the debate surrounding that Dail motion, as stated by TD Paul Murphy,

“It is no surprise that there were no trans voices involved in the creation of the NGS. Those running it do trans people a disservice by lobbying against any reform of this broken system that treats trans healthcare as something to be restricted and pathologised. In this clinic, transgender people must undergo a dehumanising and humiliating assessment process. They are asked inappropriate and invasive questions that have very little to do with gender identity or medical transition. In some instances, trans people have been denied important gender-affirming healthcare if they were diagnosed with ADHD or autism or for not answering inappropriate and sexualised questions in a way deemed correct by the clinic.”

Yesterday, ‘Transgress the NGS’ put online an interview, the existence of which I knew of, but had not seen until then. It is shocking how invasive and inappropriate the questions being asked are. This should not be happening in a proper national gender service. 

These are some of the questions asked of someone seeking bottom surgery:

“Can I ask you a bit about your mental illness?

When was the most serious episode of mental illness that you had?

Were you drinking at the time?

What type of drink do you like?

On Tinder, what was your profile then?

Were you experiencing a lot of erections?

What else did you experience in terms of sex drive?

Can you describe what it is about your penis and balls you notice or don't like?

Are you happy receiving as well as giving?

Are you capable of receiving an orgasm?

Would you use a strap-on or sex toys?”

TD Murphy finished his remarks with 

“This is not the type of approach we should have. We should have an informed, consent-based transgender healthcare model led by GPs and nursing staff in primary care. We should look to Catalonia, which has an informed consent model in primary care that has been successfully in use since 2012, with a 36-day waiting list and 71% of adults receiving HRT on the first appointment, compared with the decade-long waiting list trans people face in Ireland.”

Unfortunately, one of the National Gender Service’s top people, Dr. Moran, supports both the transmedicalism and the Cass Review– and was even involved in the Cass Review and learned "gender medicine" in London.

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Per RTE’s reporting,

Dr Moran of the NGS criticised the Labour Party motion as "significantly misinformed" in many regards, including the reference to WHO guidelines. "There are no WHO guidelines regarding Gender Healthcare, and there have never been," he said.

He also criticised WPATH, saying what he called "the most extensive and authoritative review of evidence in Gender Healthcare," by UK paediatrician Hilary Cass, "found that the WPATH Standards of Care (SOC8) were not evidence based and unfounded."

"The most unfortunate thing about this Labour Motion," he said, "is that it was brought to [Dáil Éireann] at a time when there is an ongoing review of Gender Healthcare and a comprehensive program to develop a new Model of Care."

"The HSE has established a National Lead, a Working Group, and a Clinical Advisory Committee who are working to develop new models of care for children and adults in Ireland," he said.

"It would have been more appropriate for the Labour Party to contribute its opinions on Gender Healthcare constructively via the ongoing [model of care] redevelopment process, than present an uninformed, and inappropriate motion."

However, RTE's coverage misses that Dr Moran was involved in the Cass report and also defended its applicability to the Irish system.

According to an op-ed Dr Moran got into The Journal, an Irish news publication, Dr Moran believes that,

"We have a lot of catching up to do, but with the new National Clinical Lead and the Cass Report, we now have the leadership and the roadmap. Hopefully, this will be matched by HSE and government support to develop a world class gender healthcare system for Irish people of all ages."

He was also "delighted and honored" to be a part of making the Cass Review happen, opening the same op-ed with,

"I was delighted and honoured to be invited to be part of this team and I thoroughly enjoyed collaborating with the dedicated and open-minded experts Dr Cass had assembled."

Solidarity TD Ruth Coppinger said that: 

“I have a few points to make about informed consent versus clinicians. I was one of the people in here practically every week demanding change on abortion rights. I was one of very few TDs, to be frank; others then followed. Repeal was not won by doctors in this country at all. They came on board much later. They came on board when women, young people and LGBT+ people put it on the agenda with a mass popular movement. Then they came on board. It is similar with trans healthcare. I heard Sinn Féin Deputies talking in riddles a few minutes ago. I will demystify the riddle for them. The abortion pill was discovered by women in Latin America who were taking it to bring about miscarriages. It then became mainstream. It is similar with trans healthcare now. Young people are being forced to access hormones themselves because their doctors are not helping them. We need a directive issued by the Minister instructing every doctor to help people with blood tests and things like that.

I say to the Sinn Féin Members not to wait for clinicians. It is trans people themselves who understand their needs and the Deputies to my left need to listen to that. They are not listening in the North; they need to listen in the South. The same goes for all the parties. For the minority over there, I would not waste my time. They are going to continue to pick on trans people. We must be to the forefront in defending them.”

Speaking of trans people accessing their own medicine through informal channels, in non-Western contexts like South America and Thailand, HRT is accessible over the counter, and needs no prescription or clinical oversight, either invasive or supportive. 

Back to the debate on Dec. 3, TD Peadar Tóibín started on what could easily be called a transphobic screed, using talking points that sound like they came from the UK’s worst gender conservatives.

The talking points included cynically claiming without evidence that gay and lesbian youth are being transed to make them straight, blaming trans victims of draconian sex crime laws as if they were violent offenders, and so on.

TD Tóibín was interrupted multiple times by other Deputies. Unfortunately, one of the out LGBT+ Deputies, a gay man, Jerry Butimer, had to follow that anti-trans screed up. TD Butimer said, 

“The sad part is some of the comments this morning will get into the paper but the real story is about the stories of the people in the Gallery here today and their quest for healthcare. I make the point to all of us, as Members of the Oireachtas, irrespective of ideology or viewpoint, to reflect on what we articulate, how we articulate it, what we say and when we say it. I get emotional when I hear some of the inflammatory language being used.”

It remains to be seen what the outcome of the ongoing re-evaluation process will be in terms of which model wins in Ireland– transmedicalism or informed consent.

Either way, the fight is ongoing and the National Gender Service waitlist closure is a blow to trans people across Ireland. 

Prior to the closure, the only other ways to get HRT in Ireland were DIY, or expensive private health clinics that issue EU-recognized prescriptions, but operate outside of Ireland itself.

Without movement on the Dail’s resolution towards informed consent towards an actual change in the model, this closure now means that the only ways to get or remain on HRT are DIY or outside-of-Ireland pay-to-play clinics.