Mick Clifford: Concerns over gender service are being ignored

'The HSE is currently advertising for a clinical lead in the National Gender Service but bizarrely prior experience is not a prerequisite.'

One of the most astute, albeit depressing, comments to emerge from the debacle that was the Brexit referendum was delivered by Michael Gove. When it was pointed out to him in the course of the campaign that there was expert evidence that leaving the EU would render the UK worse off, the leading Brexiteer MP replied: “The people of this country have had enough of experts.”

He was shown to be correct. Whether the people of that country in retrospect regret not paying more attention to experts is another matter. Over the last few years, experts in other areas have also been studiously ignored. The most obvious example is climate change where all manner of vested interests insist that the science is wrong. Just close your eyes and believe and the planet won’t burn. It would be nice to think that the sceptics are correct on this one but such wishful thinking is really for the birds.

This week another expert in his field offered a considered opinion and he has been studiously ignored. At various times in recent years, his expertise has attracted personal abuse. His credentials are unimpeachable but the problem is he is bearing inconvenient truths at a time when such truths are considered to be more trouble than they’re worth.

Professor Donal O’Shea is well known for his media contributions on obesity. He is the HSE’s national clinical lead on obesity but he also works as an endocrinologist in the National Gender Service within the executive. He has worked for over twenty-five years within the area of gender dysphoria. Last weekend he told the Sunday Independent that he and his colleague, psychiatrist Paul Moran, are alarmed that the HSE is trying to set up an “activist led” gender service which will be “dangerous for patients”. The HSE is currently advertising for a clinical lead in the National Gender Service but bizarrely prior experience is not a prerequisite.

Professor Donal O'Shea: 'We need to proceed with care to decide who and when it is appropriate to transition.'

“If you look at any other model of care advertised by the HSE you need to be working in the area for five years at a senior level,” he told this column. “This role has been advertised but the only requirement is to have a special interest in the area. To me that reads ideological interest.”

At a time when there has been a huge increase in teenagers questioning their gender, the two doctors working in the area want to progress treatment in a holistic and cautious manner. Activist bodies such as those in Transgender Equality Network Ireland (TENI) demand that hormonal treatment be done immediately.

“You have to transition personally, socially, and then medically,” O’Shea says. 

If you dive in and transition very quickly before it involves family and friends it can be a disaster. 

"About 60% of patients we see are neurodiverse and gender questioning in that population is common. We need to proceed with care to decide who and when it is appropriate to transition. You’re storing up massive problems if you just blanket affirm.”

His colleague, Professor Moran, echoed these sentiments in an interview in June. “There has been an explosion of young people with gender issues in Ireland and around the world, young people having problems with their bodies and fitting in and this is also connected with relationship problems, mental health problems, and problems with social functioning. What these people need is these problems to be explored in a very careful therapeutic way to see how best to resolve them. However, there are pressure groups against this and they are pushing for medical treatment without any therapy.”

These comments, coming from medics with a combined experience of over forty years in this area, are astounding. If this was any other sector of healthcare there would be consternation in the public square. Opposition politicians would be reaching for high indignation and immediate answers. The airwaves would be full of the story. HSE management would be hauled before Oireachtas committees to explain themselves.

Because the issue centres on gender dysphoria, most public figures run for the hills. Apart from Newstalk Breakfast on Monday, O’Shea was not interviewed.

 If, for instance, he had publicly claimed that HSE management was being overly influenced by big business to downplay obesity there would be outrage.

 If he had stated a belief that a Catholic activist from a marriage counselling service was in line to lead a new health body advising on pregnancy terminations there would be apoplexy. But he has strayed where most fear to tread these days, into territory where ideas and discussion cannot be brooked. Anybody questioning the ideology prevailing among activists around gender dysphoria is looking for trouble.

The ideology is enforced with an authoritarian approach to debate that resonates with how political discussion is dealt with in totalitarian states. The dictator or junta sees in every stray word the remotest challenge to power. The gender activists consider anything that does not conform to their ideology to have the makings of anti-trans bigotry. The dictator locks up or shoots transgressors. The gender activists move quickly to have nonconformists removed from the public square in a trail of shame. And yes, there are people out there who are bigoted when it comes to gender dysphoria, just as there are racists and all kinds of merchants of hate. However, considering every potential discussion in bad faith and suppressing debate will inevitably lead to resentment in some sections of society which in turn will do nothing for the continued acceptance of those who have gender dysphoria.

The concerns of the two professors are of a different order. They are not primarily concerned with issues around free speech or societal responses to authoritarian tactics. Their respective records suggest they are focused exclusively on outcomes for those who seek help and care. Yet nobody, in the HSE or the body politic, is listening.

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A few pertinent questions should be addressed by HSE management and public representatives. Are the bone fides of these two medics accepted? Is their expertise and experience in caring for their patients accepted? If so, why are their concerns being studiously ignored? If fear is the reason, fear of cancellation, fear of an authoritarian response from activists, does that mean that those whose health and welfare the doctors express concern about simply don’t matter?

One thing is certain. If O’Shea and Moran are correct in their respective assessments of the consequence of being guided by activists rather than medics then a lot of pain awaits some people down the line. This pain, for the greater part, will be suffered behind closed doors, far from the public square, beyond the social media echo chambers.

Then again, maybe the activists are right. Maybe they know best the correct physical and psychological healthcare that should be proffered to teenagers who find themselves in what they believe to be gender-related turmoil. Maybe ideology does trump science. Who needs expertise when everybody is an expert these days? Just ask Michael Gove.

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