The Health Service Executive (HSE) is to develop an updated model of care for the treatment of gender dysphoria, its chief clinical officer, Dr Colm Henry, has said.
A report on the topic was presented to the HSE executive management committee on Tuesday and a multi-disciplinary team to update the model for one of the most controversial areas of contemporary healthcare will now be established.
“We intend that the team will be led by a clinician from a relevant specialty, whose role will be to lead this process, ensuring widespread stakeholder engagement,” Dr Henry told The Irish Times.
“The epidemiology of gender dysphoria is changing and will continue to do so. We are aware of 15 other countries including the UK who are looking at their models of care and we are doing so too.”
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The development comes after a visit to Dublin to meet the HSE last week by Dr Hilary Cass, who is heading an ongoing review in the UK of the treatment of gender dysphoria in children and young people. In an interim report last year, she recommended the replacement of the single specialist gender identity service, in the Tavistock clinic in London, with six regional centres in England and Wales.
Following the visit by Dr Cass, the HSE is hoping to participate in a collaborative, international research programme as part of the effort to develop an appropriate care model. The longitudinal programme will follow up on patients to see how treatment has addressed their underlying issues and their gender dysphoria in an effort to better understand a condition the cause of which is the source of much conjecture.
New model
“We will be, through my office, be establishing a new model of care, a multidisciplinary model of care, covering primary, secondary and tertiary services, to update and replace [the existing model of care],” Dr Henry said. “The objective is to have an entirely domestic service.” An integrated youth and adult service is to be developed.
The effort to develop a domestic service has been hampered, amongst other reasons, by divergent views on the best approach within the health service and difficulties in recruiting staff to an area that is frequently the subject of contentious debate.
For the past number of years, a visiting specialist clinic from Tavistock has been seeing child and adolescent patients at the Children’s Hospital in Crumlin, Dublin. In more recent times, Irish child and adolescent patients are being seen by new centres set up in London and Manchester in the wake of the Cass report, though some are also being referred to Tavistock. Overall, only a small number of patients are being referred abroad, Dr Henry said.
“We will be developing a new end-to-end model of care because since the model of care [that was] developed in 2016 there has been a great amount of change in the epidemiology, there are many more people declaring a gender dysphoria, and in addition there is more knowledge.”
In her interim report, Dr Cass did not give an opinion on the prescribing of hormone treatments to children and adolescents suffering from gender dysphoria.
“The Review is not able to provide definitive advice on the use of puberty blockers and feminising/masculinising hormones at this stage, due to gaps in the evidence base; however, recommendations will be developed as our research programme progresses,” she said.
In Ireland and internationally, a change in patient profile has been noted with an increasing numbers of natal females presenting with gender dysphoria that arose during their early teens, contributing to intense debate as to how the condition should be treated. In her report, Dr Cass said approximately one third of the young patients in the UK have autism or other types of neurodiversity, and there is an over-representation of “looked after” children compared to the population nationally.
“At primary, secondary and specialist level, there is a lack of agreement, and in many instances a lack of open discussion, about the extent to which gender incongruence in childhood and adolescence can be an inherent and immutable phenomenon for which transition is the best option for the individual, or a more fluid and temporal response to a range of developmental, social, and psychological factors,” she said.
