Maeve Higgins: ‘Ireland in the past few years feels less safe for trans people’

Noah Halpin via Twitter.

THE Irish Medical Journal published an illuminating study this week, about how even a one-hour teaching session delivered to final-year medical students “was effective in improving student knowledge of care of transgender people”.

Any improvement is welcome, because multiple studies show that transgender people experience more health inequities and have specific healthcare needs compared to their cisgender counterparts. 

Noah Halpin is the healthcare officer of the Transgender Equality Network of Ireland (Teni). 

His work includes supporting the trans community as they go through the healthcare system; mainly in the areas of gender-affirming healthcare, sexual health, and mental health supports.

Halpin also helped facilitate the  Irish Medical Journal study, so when we spoke I asked him about educating doctors, healthcare, and media representations of trans people in Ireland today. Our conversation has been edited for clarity and length.

Maeve Higgins : I saw that you helped facilitate the  Irish Medical Journal’s study by sharing the patient’s perspective as a trans person, I wondered how that experience was for you?

Noah Halpin: It was really good. The questions were good, the students were super engaged and interested. And that’s really encouraging; seeing med students wanting to know about trans identities and about how they can care better for trans people in a health care setting. It was interesting too that this was specifically guided care — gynaecology obstetrician care — again that’s really good because that is under researched and understudied when it comes to the trans community.

Maeve Higgins: I remember going to my OBGYN before and he had a student with him and I was like, "Oh dear". So, it was quite generous of you to share your experience this way!

Noah Halpin: (laughing) I had a similar experience when I went to one of my appointments with my OBGYN. She’s brilliant, she probably sees the majority of all transmasculine people in Ireland. But I remember one time going and she had a student shadowing her and she said to the student, "This is another sensitive one, if you don’t mind waiting outside." And I asked them to stay because they could be an absolute diamond to any trans patient that they come across in the future. I’m like, the more they learn, the better, you know?

Maeve Higgins: So, where are we today with the state of trans healthcare in Ireland?

Noah Halpin: Firstly, it’s important to note not all trans people want medical care. Not all trans people will want hormones or surgeries. But for those who do, it’s a really, really arduous process. And at Teni, a lot of people make contact to tell you they cannot wait that long. Mentally, a lot of people can’t. And we are actively losing people to waiting lists at the moment.

Maeve Higgins: By ‘losing people’ do you mean losing them to suicide?

Noah Halpin: Yes, I’m afraid so. Suicidal ideation and suicide rates amongst trans people are really quite high and trans people are disproportionately affected by poor mental health outcomes. 

We know now that sometimes, gender-affirming healthcare is lifesaving health care. This is an area of healthcare that’s underfunded and understaffed, but it’s not just that. It’s the model of care that is a problem here in Ireland. 

International best practise standards of care suggest an informed consent model, whereas in Ireland we’re using a psychiatric diagnostic model. 

This is so outdated — the World Health Organization declassified trans identities as a mental health or behavioural disorder years ago — yet we are still treating them as such in Ireland.

[The 2016 HSE funded study, Supporting LGBT Lives: A Study of the Mental Health and Welbeing of Lesbian, Gay, Bisexual, and Transgender People, reported that one in four trans people in Ireland have attempted suicide, and 44% had self-harmed in their past.]

Maeve Higgins: I didn’t know that. And I apologise for the scale of this next question, but what is it like at the moment to be transgender in Ireland?

Noah Halpin: Overall, at the moment, I would say Ireland in the past few years feels less safe for trans people. We are seeing more and more anti-trans narratives in our media and online and on the streets. We’ve seen physical violence, and in the reports that are coming in to us at Teni, trans people are definitely feeling less safe.

Maeve Higgins: In the US right now, there’s danger coming from street-level violence right up to state legislatures passing anti-trans laws. I wonder how best to stop that train before it hits Ireland, is there a way to counter those narratives that we’re seeing?

Noah Halpin: The best way to counter it is to amplify the voices of trans people and not to amplify the voices of people who know nothing about trans people. Nothing about us, without us. 

There’s a lot of media outlets amplifying the voices of people who are actively anti-trans, who are running with a narrative that just isn’t true, who are fear mongering or spreading lies. 

So, if you’re going to talk about healthcare for trans people, talk to trans people. The media need to talk to trans people and simply look at the scientific research too.

Maeve Higgins: Thanks for your time and insight today. Is there anything you’d like to add?

Noah Halpin: I guess just that it’s important to remember that trans people are people, we have the same emotions as everybody else. You know, we are just trying to live our lives. We are as boring as everyone else; we have to do our laundry, we have to go to work, we have to mind our kids. But many of us feel like we are now where gay men were in the 1970s. We are fighting for our existence. We are fighting for our rights, our equality. And at the end of the day, that means we are fighting for our lives.