Fears gen­der law could al­low teens ac­cess sex change surgery abroad

Pro­fes­sor re­veals young peo­ple are buy­ing dan­ger­ous drugs on­line

The Irish Mail on Sunday - - NEWS - By Anne Sheri­dan anne.sheri­dan@mailon­sun­day.ie

DOC­TORS fear that un­der-18s will be able to ac­cess ir­re­versible sex change op­er­a­tions abroad if Irish leg­is­la­tion is changed.

The Gen­der Recog­ni­tion (Amend­ment) Bill seeks to al­low 16 and 17year-olds to be able to de­clare their own gen­der – dif­fer­ent from their as­signed bi­o­log­i­cal gen­der – with­out their par­ents’ con­sent and be granted a gen­der recog­ni­tion cer­tifi­cate by the State.

Ad­di­tional changes to the law, first in­tro­duced in 2015, would also al­low un­der-16s to have le­gal gen­der recog­ni­tion – but with parental con­sent. A re­view of the Gen­der Recog­ni­tion Act is ex­pected to rec­om­mend adopt­ing the changes.

As revealed by the Irish Mail on Sun­day last week, 45 Irish chil­dren ques­tion­ing their gen­der iden­tity are cur­rently seek­ing ser­vices in the UK and a num­ber of those have moved on to re­ceive pu­berty blockers and hor­mone treat­ment, which would po­ten­tially pre­pare them for a sex-change op­er­a­tion.

The HSE has also warned there is some ev­i­dence of peo­ple di­rectly seek­ing surgery in Thai­land and the US with­out go­ing through any of the pre­scribed path­ways.

‘This prac­tice may have se­ri­ous im­pli­ca­tions for the im­me­di­ate and long-term health of the per­son,’ a HSE spokesper­son warned.

Pro­fes­sor Donal O’Shea, the coun­try’s chief en­docri­nol­o­gist who helps trans­gen­der peo­ple ac­cess surgery, said there are le­git­i­mate con­cerns the cer­tifi­cate could be pre­sented to med­i­cal prac­ti­tion­ers out­side the State who may ac­cept its le­gal sta­tus as a path­way for treat­ment.

And the con­sul­tant en­docri­nol­o­gist at St Vin­cent’s and St Colum­cille’s Hos­pi­tals in Dublin warned teenagers are al­ready ac­cess­ing hor­mone ther­apy, such as pu­berty blockers, from on­line GPs out­side Ire­land, which he be­lieves is ‘in­ap­pro­pri­ate and dan­ger­ous’.

Dr Paul Mo­ran, a psy­chi­a­trist at­tached to the Na­tional Gen­der Ser­vice at St Colm­cille’s Hospi­tal, was among those who made a sub­mis­sion out­lin­ing his con­cerns to the gen­der re­view group, which is due to present its re­port and rec­om­men­da­tions to So­cial Pro­tec­tion Min­is­ter Regina Do­herty.

Dr Mo­ran said he was strongly in favour of sep­a­ra­tion of le­gal gen­der recog­ni­tion from a med­i­cal di­ag­no­sis when the Gen­der Recog­ni­tion Bill was in­tro­duced but his views have since changed.

‘Un­for­tu­nately, there have been some un­in­tended con­se­quences which have arisen, and pose risks to trans­gen­dered pa­tients,’ he added. ‘First, is the risk of in­ap­pro­pri­ate treat­ment, in­clud­ing ir­re­versible surgery, due to the dif­fer­ence be­tween Irish and Euro­pean law.’ He said a change of state doc­u­men­ta­tion can only be ob­tained af­ter a clin­i­cal di­ag­no­sis of gen­der dys­pho­ria in many EU coun­tries.

‘This means that the doc­u­men­ta­tion is ac­cepted as a clin­i­cal record by some sur­gi­cal cen­tres and SRS (sex re­as­sign­ment surgery) per­formed ac­cord­ingly,’ he ex­plained. ‘Un­der Irish law, the change of gen­der in state doc­u­men­ta­tion is a self-dec­la­ra­tion re­quir­ing no clin­i­cal di­ag­no­sis.

‘Un­for­tu­nately, this is not un­der­stood by sur­gi­cal cen­tres in Europe, who as­sume the Irish doc­u­men­ta­tion is as clin­i­cally valid as their own na­tional ver­sion.’ The Bishop of Lim­er­ick, Dr Bren­dan Leahy, has also ad­vised cau­tion.

‘The pro­mo­tion of gen­der ideology is a to­tally new sce­nario and it would be im­pru­dent to start mak­ing sig­nif­i­cant leg­isla­tive en­act­ments that are not well grounded in sci­en­tific re­search and re­flec­tion,’ he said. ‘A de­sire to do the good com­pas­sion­ate thing is not al­ways the same as ac­tu­ally do­ing it.’

How­ever, a num­ber of trans­gen­der sup­port groups, specif­i­cally the Trans­gen­der Equal­ity Net­work of Ire­land (TENI) and BeLongTo, which sup­ports chil­dren and ado­les­cents, are ar­gu­ing for a sep­a­ra­tion be­tween le­gal recog­ni­tion and a med­i­cal di­ag­no­sis.

The re­view has been chaired by Moninne Grif­fith, ex­ec­u­tive di­rec­tor of BeLonGTo, a na­tional or­gan­i­sa­tion for LGBT young peo­ple.

Some 90 sub­mis­sions have been made to the group, in­clud­ing from the Om­buds­man for Chil­dren, Fine Gael LGBT, St Pa­trick’s Men­tal Health Ser­vices, the INTO, the Union of Stu­dents of Ire­land, coun­sel­lors, med­i­cal pro­fes­sion­als and hu­man rights lob­by­ists.

Ms Grif­fith said she wants young peo­ple to be able to de­clare their own gen­der with­out a di­ag­no­sis but did not wish to com­ment fur­ther.

Un­der cur­rent law, chil­dren aged 16/17 years are re­quired to have an ap­pli­ca­tion pre­sented on their be­half through the Fam­ily Cir­cuit Court. This re­quires two forms to be com­pleted, one by the child or youth, the other by their guardian.

‘This may have se­ri­ous im­pli­ca­tions for health’

PRO­POSED changes un­der the Gen­der Recog­ni­tion Bill al­low­ing 16 and 17-yearolds to select their own gen­der with­out parental con­sent or med­i­cal di­ag­no­sis and be granted a gen­der recog­ni­tion cer­tifi­cate from the State are caus­ing con­cern in some med­i­cal cir­cles.

Pro­fes­sor Donal O’Shea, the coun­try’s lead­ing en­docri­nol­o­gist who treats trans­gen­der young peo­ple, says the le­gal doc­u­ment might en­cour­age trou­bled teenagers to seek surgery abroad rather than wait un­til they are older and have a di­ag­no­sis of gen­der dys­pho­ria.

An­other un­in­tended con­se­quence of the change could be that young peo­ple avail of an ir­re­versible sex change only to change their mind later about their iden­tity.

Teenagers are al­ready ac­cess­ing hor­mone ther­apy such as pu­berty blockers from on­line GPs abroad, a prac­tice con­demned as ‘dan­ger­ous’ by Prof O’Shea.

Opin­ion dif­fers about whether le­gal recog­ni­tion and med­i­cal di­ag­no­sis should be sep­a­rate is­sues or aligned. Trans­gen­der sup­port groups ar­gue for the for­mer but many EU coun­tries in­sist on a di­ag­no­sis be­fore state doc­u­ments can be al­tered.

Gen­der dys­pho­ria has only re­cently gained cur­rency in this coun­try and gives rise to much mis­un­der­stand­ing. It’s vi­tal that in our ea­ger­ness to show com­pas­sion we don’t cause risk to those af­flicted.

u-TuRN: How we re­ported Prof O’Shea’s views

backeR: Moninne Grif­fith is chair­ing re­view

law: Prof Donal O’Shea

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