Landmark Cass report will influence new Irish gender service in 2026
HSE says model of care will include input from review that has called treatments into question
Anew national Irish service for those seeking treatment for gender identity issues will not begin taking patients until the summer of 2026 at the earliest. The HSE has recruited Dr Karl Neff, a consultant endocrinologist who currently works at the adult National Gender Service (NGS) in Loughlinstown, Dublin, to head up the new gender service.
The NGS is in the process of filling Dr Neff ’s current position before he can start full-time work on the new national gender health lead role.
Sources said Dr Neff is expected to launch a consultation process this summer that will lead to the development of a new model of care for the treatment of gender-questioning children, adolescents and adults in Ireland — and that will begin to be implemented in the summer of 2026.
The HSE has confirmed that the new model of care will include input from the Cass Review released last week in the UK that reviewed the NHS’s treatment of children in its Tavistock gender identity clinic.
The landmark report from Dr Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, found treatment of children with puberty blockers and hormones was done despite there being no reliable evidence that their benefits outweighed their harms.
Dr Cass said there were few other areas of healthcare where professionals “are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour”.
She wrote: “This must stop. Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.
“This is an area of remarkably weak evidence — and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint.
“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”
The report has been welcomed by Dr Neff ’s colleagues at the NGS, Dr Donal O’Shea and Dr Paul Moran. Since 2019 they have been warning the HSE that the referral of over 230 Irish children to the Tavistock for treatments with puberty blockers and hormones was dangerous due to an alleged lack of thorough assessments of patients, many of whom had developmental issues they said were not addressed.
Amid a surge in demand for gender treatments in the last 14 years, especially among biological girls, senior HSE administrators and transgender lobbyists groups such as Transgender Equality Network Ireland (Teni) have pushed for Ireland to adopt an “informed consent” or “affirmative” model of care, based on studies they claimed showed such treatment improved mental health outcomes.
This “affirmative” treatment involves patients being given access to hormones and puberty blockers, as long as they are made aware of possible side-effects which can include sterilisation.
This approach has been resisted by doctors at the adult NGS clinic. They say a thorough assessment of patients must take place, and any developmental issues should be addressed before proceeding with medical treatment for gender incongruence.
Speaking this weekend, Dr Moran said he welcomed the report from Dr Cass as “sensible” in emphasising caution in any medical treatment for people under 18.
He said it was notable that Dr Cass warned that socially transitioning — where a child begins to live publicly as the opposite to their biological sex — should involve the support of a clinician.
Dr Cass said a clinician could help avoid “premature decisions” and help a child keep their options open “until the developmental trajectory becomes clearer”.
Currently, policies in schools across Ireland are based on a variety of published advice from transgender support groups. One of the guidance documents still widely used is Being LGBT in School, a Department of Education-supported 2016 publication, written by the Gay and Lesbian Equality Network (Glen), a charity that was wound up in 2017.
This document states that the responsibility for determining a person’s gender identity rests with the individual themselves, or in the case of a young person who is not yet able to advocate for themselves, with their parents/guardians.
A 2019 guidance document, published by the youth organisation Belong To, advises teachers and youth workers to use whatever pronouns a student wants and says they should not “out” a transgender child to their parents even if they are asked a direct question.
The document advises teachers and youth workers to say they “don’t know” if asked by a parent, and encourages guardians or parents to speak to their child.
Dr Moran said the Department of Education should stop circulating material to schools “that suggests schools should take a lead in socially transitioning”.
He also said schools should stop inviting activist organisations in to train teachers.
Belong To says its 2019 advice manual stopped being used in May 2021 when it updated its resources.
“We know from our work and research that there are better mental health and life outcomes for LGBTQ+ youth when they have the support of their parents,” it said. “We encourage professionals to centre the wellbeing and welfare of LGBTQ+ young people while also supporting them to come out to their parents when they are ready to do so.”
Although the HSE has said fewer than 10 children are currently on puberty blockers with Children’s Health Ireland, it is believed there are many more children being given hormones and possibly blockers through private specialist clinics, most of which are based abroad.
GenderGP, which is based in the UK, was said to have 900 Irish clients by junior health minister Mary Butler in a meeting with NGS doctors in 2022.
Dr Cass recommended the UK health authorities consider preventing “inappropriate overseas prescribing” from private gender clinics. Dr Moran said Irish pharmacies should “stop dispensing” foreign gender healthcare prescriptions.
A source who works in gender healthcare in the HSE, and who supports Dr Cass’s recommendations, said there are concerns over some “hero-complex” GPs who may be prescribing hormones or puberty blockers to children in Ireland without adequate backup.
“They believe they are ‘saving’ these kids and they’re well intentioned because they want to make them happy in their bodies now — but they are not thinking of the consequences five years down the line,” said the source.
One private clinic that operates in both Ireland and the UK is Gender Plus, which was founded by Dr Aidan Kelly, an Irish clinical psychologist who worked in the Tavistock Clinic. Gender Plus said it treated 40 Irish patients last year, but has already treated 53 Irish patients in the first three months of 2024. It does not prescribe hormones to patients under 16 — but 22 of its Irish patients this year are aged 16 or 17.
Dr Kelly said the Tavistock gender service was “set up to fail”, due to the lack of a full service to treat children with autism and other needs. He said Gender Plus is a “bespoke gender service” that contains a multi-disciplinary team which already operates in line with the cautious approach recommended by the Cass Review.
He said 80pc of their patients are in the 16-to-25-year-old range. While under 16s are not able to access blockers or hormones, they can be treated by its psychology team.
Dr Kelly said there was a lot of “anger” in the trans community about the long NGS waiting lists and said the service had “lost the trust” of the trans community.
He fears the new Irish service could take three to four years to develop.
“These people deserve access to healthcare,” he said. He accepted that some private online services that provide hormones without proper assessments are “unsafe” and are causing worrying outcomes for patients. However, he said that was not the clinical set-up of Gender Plus.
“Not all private providers are equal,” he said. “In a utopia, we would provide our service through the public system and everyone could access it in a timely way. But we live in a reality where that’s not happening, it hasn’t been happening for a while and it’s getting worse.
“We’re clinicians who’ve worked the vast majority of our careers in public health — and our practices are absolutely in line with what NHS England and the Cass report has been saying.”
The Cass Review has set off a debate in the coalition parties about their policies regarding transgender medicine and on social issues such as the hate-speech bill, trans women in sport and the planned conversion therapy ban law.
One Green Party source said: “You would be more welcomed in the Greens if you were a climate change denier rather than someone with gender critical views.”
Polarisation and stifling of debate do nothing to help young people caught in stormy social discourse
They are not thinking of consequences five years down the line
Daniel Dunne, a councillor in Dún Laoghaire-Rathdown, said he resigned from the Greens last month in protest at its stance on gender identity and free speech.
“I hope the Cass Review puts the treatment of children with gender issues back on a scientific and evidence-based footing,” said Mr Dunne. “The suppression of speech that accompanies this extremist ideology must be countered.
“The chilling of open debate has been a contributor to harm here. The smearing of gender-critical women as haters and transphobes must stop. Politicians need to step up and push back against an illiberal trend here.”
Mr Dunne, who said he could be classified as “queer”, will not be running in the upcoming local elections. He said he had concerns that transgender support groups would use the planned new hate-speech laws to criminalise “broad brush gender-critical speech” by calling it transphobic and hateful.
In a statement, the Green Party said it “rejects the suggestion that it is somehow intolerant of differing views” on the issue of gender.
“The party broadly supports the hatecrime legislation currently before the Oireachtas and sees no conceivable likelihood that it will somehow shut down debate,” it added.
The HSE said that while its new model of care for gender healthcare is being developed, adults can receive specialist care from the NGS, while children can see a specialist endocrinologist in Children’s Health Ireland.
It said that because there is no psychiatry or psychology service for genderquestioning children in Ireland, this service was available through the Treatment Abroad Scheme and the current pathway directs referrals to the new UK service which is due to open shortly.
The waiting list for access to the adult gender service is now over three years.
The HSE has pledged to take the findings of the Cass Review in the UK into account when deciding on a new policy for Irish patients who question their gender. At first glance, that sounds reasonable — but it really doesn’t convey the gravity of the report’s findings. Dr Hilary Cass, the former president of the UK’s Royal College of Paediatrics and Child Health, conducted a fouryear review of how children struggling with gender dysphoria — over 200 of whom came from Ireland — were treated in Britain and her findings are horrific. Nightmarish.
The main one is that children were rushed into treatment, including being given hormones that “block” puberty, despite there being “no good evidence” for their use and plenty of concern that they may “change the trajectory of psychosexual and gender identity development” in those to whom they’re given, while producing “no changes… in body satisfaction”.
Dr Cass’s main conclusion, arrived at in the face of non-cooperation from many people working in the field, is that there should be an “unhurried” approach to such vulnerable children; that no hormones be given to them before the age of 18; and that other options, centred on mental health, be explored before more intrusive treatments potentially leading to lifelong medicalisation are entered into.
Her intent is that young people are given time “to keep options open” by “avoiding premature decisions”.
All this is sensible and measured, and it echoes similar concerns which have been expressed in Ireland by our own National Gender Service.
But there has been a muted reaction to the Cass Review here so far — possibly because so many voices in politics and media have invested hugely in the ideology underpinning the debate around trans issues.
The only party which has come out strongly against practices of starting gender-confused children on the road to transition, which have now been exposed as fraudulent, is Aontú.
Its leader, Peadar Tóibín, couldn’t have been clearer last week, accusing the Government of putting “Irish children in danger, by treating them on the basis of evidence-free ideology rather than science”.
They have no excuse any more. Some of the reaction from those still wedded to that ideology has been to say that only a relatively small number of children are officially prescribed puberty blockers in Ireland. That, however, is to miss the point. The mindset which led UK clinics to rush children into these quick fixes is one which still rules in Ireland.
The main concern has not been, as an editorial in the British Medical Journal (BMJ) starkly put it, that “the evidence base for interventions in gender medicine is threadbare” — but that “gender-affirming” treatments were not rolled out faster.
Schools have also been complicit in pumping out this propaganda.
If the Cass Review heralds a sea change in this culture, all to the good. But there’s no guarantee it will.
Activists are already rubbishing its methodology and findings as not being in line with “best practice” — an ideologically loaded term, if ever there was one. Recognising that this is a dangerous moment for the transgender cult, they are also seeking to subtly distance themselves from the worst excesses Dr Cass has exposed.
It’s a tactical retreat; a chance to regroup. They still have the ears of policymakers and opinion-formers. There will be more waves of attack before this assault on reason is over.
Most of all, it’s critical to bear in mind that what Dr Cass is asking for is neither radical nor uncaring. Her sole appeal is that healthcare for gender-confused children should accord with “the same standards” as all other treatment for young people. That’s it.
There is, after all, no automatic right to “self-affirming” healthcare in any other circumstance. You don’t get treated for cancer simply because you think you have cancer. It has to be diagnosed first.
Healthy body parts are not removed on request, but as a last resort.
Once a diagnosis of gender dysphoria is confirmed, the aim should be to find the gentlest treatment, centred on an understanding that there is no such thing as being born in the wrong body. There is only a feeling that you
Young people need to be gently guided through the minefield of gender confusion
have been born in the wrong body.
That hazardous state of mind demands a delicate, holistic response from health professionals able to guide those suffering from it through the minefield without making irreversible decisions whose seriousness they’re too young to understand.
That may not always be possible in the modern world. Anyone with the money to do so can jet off from the airport to buy whatever body modifications their wounded hearts desire.
In 0.27 seconds, a Google search brings up a clinic offering young women the chance, in one overnight stay, to remove their breasts to “achieve a flat, masculine chest”, promising that “in Spain bureaucracy is minimal, you just need to make a self-certification to be able to operate”. It adds: “Why wait any longer?” It used to be that a double mastectomy — as a treatment for breast cancer, for example — was regarded as major surgery. Now it’s being recast as a cosmetic treatment, minimised by the euphemism “top surgery”.
But while there have been many programmes on Irish TV in recent months warning against the dangers of getting dental work or tummy tucks done abroad in countries such as Turkey, there is a shameful silence about young people being butchered in the name of medical tourism.
There is nothing the State can do to stop young women heading overseas to cut off their healthy breasts at their own expense. At the very least, however, we can make it clear as a society that we neither endorse nor will facilitate this practice here at home.
First do no harm must be the conclusion of the ongoing HSE review.
Progressive opinion in Ireland is always terrified of being behind the curve, but in this case it could prove to be a blessing, giving us the chance to learn from others’ mistakes and — as the BMJ editorial put it — get “in line with emerging practice internationally” which is increasingly turning away from the medicalised model.
It remains an indictment of how this debate has been conducted hitherto that the proposition that medicine must be evidence-based has come to be seen as in any way controversial, or as part of some toxic culture war, when it ought to be self-evident.
The time for silence is over. There has been too much of it already. As a former health minister, the new Taoiseach Simon Harris should be pressed to clarify where he stands on this.
● Sir — In light of the UK gender identity services report by Dr Hilary Cass, Sunday Independent columnists Ciara Kelly and Eoin O’Malley should be congratulated for putting children first in recent editions.
Dr Cass has said puberty blockers were administered to children without “good evidence”.
It is shocking and mind-blowing in equal measure. How did the medical profession allow itself to perpetuate this pseudoscience on children?
Dr Cass provides the answer in part: toxicity. An environment so toxic that medical professionals were “afraid” to openly discuss their views.
This is an ideology so insidious that you can physically see politicians go pale and weak at the knees when confronted by any question related to gender. Any comments not in line with the ideology are immediately dismissed as transphobia, hate, and lying. Even worse, you can be cancelled, vilified and lose your livelihood.
It’s a toxicity so powerful that it browbeat an entire profession. Let’s not forget that the Sunday Independent reported back in 2022 that Irish doctors were concerned that the HSE was “ideologically committed” to hormone-based care for children. In this regard, does the Cass Review really comes as a surprise?
The politicians are part of the problem — because they did not put children first. They are probably cowering under a table, hoping no one asks them about this diabolical episode.
Andy Hales,
Kenmare, Co Kerry
Aontú was not taken in by gender ideology
● Sir — With the publication of the Cass Review, it seems timely to point out that every one of our political parties, with the exception of Aontú, supports the ideology that has led to this massive medical scandal.
A few years ago, all our TDs were sent a copy of Dr Helen Joyce’s book Trans, as part of an action by women’s rights advocacy groups The Countess and Women’s Space Ireland.
If they had bothered to read it, they would have seen this coming. Instead, they have spent the intervening years accusing anyone who tried to question this of transphobia. What do they have to say for themselves?
E Bolger,
Dublin 9
The fine line between fact and fiction
● Sir — How refreshing to read an article on gender dysphoria treatment that treads the fine line between fact and fiction (Eoin O’Malley, ‘Letting trans lobby groups set laws and stifle debate is foolish’, April 7).
However, O’Malley is not nearly pessimistic enough in his analysis. The Gender Recognition Act (GRA) allows a person to be whatever gender they choose. In combination with the Equality
Act, it obligates us to use the correct pronouns or risk the offence of hate speech. The GRA has many unintended consequences for women in sports, in medicine, in prisons and also for womenonly spaces.
The practice of “pausing” puberty in gender dysphoric children is unscientific and harmful. When we are born there are developmental pre-programmed critical windows of opportunity. Once the window of opportunity closes, the body moves on.
Hopefully the Cass Review and the forthcoming malpractice cases will put the brakes on.
Joe Dutton,
Greystones, Co Wicklow
Be careful what you teach your children
● Sir — Eoin O’Malley worries that children in primary school may be taught about gender “on the basis of an ideology that rejects or misrepresents scientific evidence”. He neglects to mention that many of these primary schools spend hours each week teaching children religion.
Where’s the scientific evidence for that?
Bernie Linnane,
Dromahair, Co Leitrim
Can we not let trans people have a voice?
● Sir — Can we stop constantly profiling people who are not members of the trans community worrying about trans people?
I am a gender non-conforming (GNC) person, and while I agree that trans medical care should only begin when the person is in their late teens (which is controversial amongst trans people), I think we need to stop constantly looking to people who claim to be experts but who aren’t trans.
The reason that data on trans people is unreliable is because gender fluidity is, well... fluid.
I identify as male, but I nonetheless am GNC.
Eoin O’Malley is peddling unverified stuff himself. Can we for once let trans people speak on the topic, rather than regurgitating the same outdated nonsense, day in, day out?
Yes, there are flaws (I think self-identification is flawed), but can we at least for once celebrate trans people, and not constantly villainise them?
George White,
Bray, Co Wicklow
Paddy Cosgrave isn’t the story, but Gaza is
● Sir — Niamh Horan says there was a “swift backlash” by tech giants following Paddy Cosgrave’s tweet last year, saying: “War crimes are war crimes, even when committed by allies and should be called out for what they are.” We know that tech companies made good on their threats and withdrew from Web Summit’s biggest event of the year.
Perhaps, instead of focusing on Paddy Cosgrave, your paper might instead ask these tech giants what they are doing to bring an end to the indiscriminate killing of children and innocent civilians in Gaza?
Tom McElligott,
Tournageehy, Co Kerry
Tim Pat Coogan and the old-school gardaí
● Sir — Tim Pat Coogan, that doyen of reporting, as opposed to opinion, once wrote that 1960s Ireland was a “policeman’s paradise”. Coogan — an editor, historian and author — had his thumb on the nation’s pulse.
I thought of him the other night. Our resident burglar wanders around the estates trying car doors for loose change and valuables. He’s “known” to the gardaí and the criminal justice system. The guards try, and the system fails. Why? Simple really, and Coogan knew it.
A garda force once embedded strongly in the community is now Police Ireland, indistinguishable from its counterparts up north and the Met in London.
A once-proud and sought-after cohort are becoming alien within the communities they are tasked to serve. Can we actually think for ourselves regarding policing, rather than following the broken
British model? Then a semblance of a paradise might return to us. John Cuffe,
Co Meath
I’ve speech ready for TV licence inspector
● Sir — Do I pay my TV licence? I have dutifully done so for the last 17 years. But in the wake of the RTÉ disclosures over the last year, I have had to motivate myself to pay.
Technology has moved on. I tend to watch more YouTube nowadays, and there are evenings when the TV is not turned on at all. I pay my tax through PAYE. I pay Eir €100 a month, which includes 23pc Vat. My service covers TV, internet and a landline. So, I need to have a licence for a subset of data.
So, if the TV licence inspector calls to my door, I have my speech ready. I might even vote for the party that promises to abolish this outdated instrument. John Martin,
Athenry, Co Galway
RTÉ bans weather north of the Border
● Sir — Each evening we, in the far north of this little island, await with bated breath the latest weather forecast from RTÉ, the national broadcaster. And every night we are disappointed that weather still does not exist here — in the land that time forgot, namely: the six counties.
Now, we appreciate that we are the proverbial “black sheep” of the Irish family, but to condemn us to a daily dose of no weather is a bit unfair.
Perhaps, with a fair wind this summer, the national broadcaster might discover that rain — and the occasional glimpse of sun — does not stop at Monaghan or Lifford but meanders all the way to Donegal. Sean Sheridan,
Omagh, Co Tyrone
Politics is hard work, but it needs doing
● Sir — One of the first political books I read was the diaries of Gemma Hussey, a Fine Gael minister in the 1980s. I recalled that book when reading the article by James McDermott (‘Why being elevated to high office isn’t all it’s made out to be’, April 7).
Leo Varadkar left office as the only Fine Gael leader never to have been opposition leader. After 13 years in government, he’d had enough. Hussey, in her memoirs, spoke about cabinet meetings that dragged on in to the early hours — and fish and chips coming at a certain hour. One minister hit the bottle when they ended. That was his solace.
I’ve knocked on a lot of doors at election time and am well aware that politics can be a cruel trade. Politicians should not be exposed to vile and vicious abuse. I want to see more people encouraged to seek public office — not put off by people who hide behind their ideologies.
Thomas Garvey,
Claremorris, Co Mayo