The informed consent model lets a trans person make decisions about their own body and treatment, based on clear, accurate information from a clinician about risks, benefits, and limitations. After discussing expectations, understanding, support systems, and overall health, the clinician documents the person's consent. This model centres the person's experience, needs, and autonomy.

This model is not about assessing or evaluating whether someone is “truly trans.” Its goal is to support thoughtful, person-centred decision-making, where the individual leads and the clinician acts as a partner, using their expertise to make care safe and effective, rather than relegating trans people to the sidelines as passive recipients of decisions made by doctors.

Informed consent has been a model used successfully in trans health for decades at community health centres like Callen-Lorde in the US. Adopting this model in Ireland would depathologise care, reduce wait times, improve experiences, and put self-determination at the centre of trans healthcare.

Resources

• The Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 by the World Professional Association recommends an informed consent model.

• TransHub provides detailed information to trans patients and guidance for clinicians about the informed consent model.

• The Australian Informed Consent Standards of Care for Gender-Affirming Hormone Therapy assist and enable clinicians to better meet the medical needs of their trans patients, centring the trans person seeking hormonal intervention and empowering the clinician to facilitate this access.

• The Path to Patient-Centred Care is a living resource for offering better patient-centred care using the informed consent model to transgender adults seeking gender-affirming medicine in Canada.

• The Guidelines for Informed Consent in Primary Healthcare by Gender Minorities Aotearoa detail what informed consent means and provide practical examples.

• This research article describes how more widespread uptake of an informed consent model of care to initiate hormone therapy by primary care physicians has the potential for high patient satisfaction and may be a practical solution to reduce waiting lists in gender clinics.

• This research article explains the informed consent model and how it shows promise for the treatment and understanding of the transgender experience outside of the lens of medical pathologisation.

• This research article describes how clinicians’ use of the informed consent model would enable them both to attain a richer understanding of trans patients and to deliver better patient care.

• This article shares recommendations for moving beyond psychiatric gatekeeping to take an informed consent approach to gender-affirming surgery.

• This research article illuminates that there is no evidence that gender assessments can reliably predict or prevent regret better than self-reported gender identity and embodiment goals and provides additional support for informed consent models of care.

The provision of gender affirming care is not a specialty service and therefore should be accessible through primary care providers in our communities. Community-based care enables patients to access gender-affirming medical services locally, delivered by their primary care general practitioners (GPs) and nurse practitioners (NPs), as well as within sexual health clinics. This model offers greater accessibility compared to the centralised gender clinic model, as patients are able receive services within their local community, which particularly supports access for those living in remote or underserved areas.

Primary care providers are uniquely positioned to support trans patients, as they are usually already familiar with their patients and thus can provide continuity of care and apply a holistic approach to gender-affirming health services built on trust. GPs and NPs also have knowledge around prescribing and monitoring hormone therapy in other populations, such as post-menopausal cis women and hypogonadal cis men, which they can apply in providing gender-affirming care to trans patients.

To ensure effective implementation of this approach, community health providers need proper education and empowerment to offer essential gender-affirming health services, including prescribing and monitoring hormone therapy. Implementing a community-based approach to care facilitated by primary care providers would significantly reduce barriers and increase access for trans patients seeking gender-affirming health services in Ireland.

Resources

• The World Professional Association for Transgender Health Standards of Care Version 8 supports the provision of gender-affirming hormone therapy by primary care GPs.

• The Primary Care Gender Affirming Hormone Therapy Initiation Guidelines from the University of Otago in Aotearoa New Zealand facilitate a primary care-based approach to gender-affirming hormone therapy through an informed consent model, providing tools for GPs and NPs.

• This clinical article provides practical guidance for prescribing hormone therapy to trans and gender diverse patients in the general practice setting in Australia.

• The Primary Care Toolkit from Trans Care BC provides informed consent-based guidelines to assist primary care clinicians offering gender-affirming care for their patients.

• The Medical Care of Trans and Gender Diverse Adults guidelines from Fenway Health in the US describe the provision of informed consent-based gender-affirming care within primary care.

• The Trans Primary Care Guide from Sherbourne Health and Rainbow Health Ontario offers guidelines for gender-affirming primary care, including hormone therapy and blood work monitoring for primary care GPs in Canada.

• This article highlights the importance of primary care GPs providing hormone therapy to trans patients.

A harm reduction framework for gender-affirming care means implementing practical approaches to reduce the risks and negative impacts associated with self-medication, including the provision of safe access to blood tests. This approach is facilitative rather than coercive, centring the patient’s bodily autonomy in making decisions about their health and their lives.

Resources​

• Trans Harm Reduction provides resources and support for trans people who are self-medicating.

• The WPATH Standards of Care 8 supports the value of harm reduction approaches.

Co-production involves the the active engagement and participation of the trans and gender diverse community in the planning, design, delivery, and evaluation of their own gender-affirming healthcare services. Co-production recognises that trans people are best positioned to advise on and oversee decisions that impact their healthcare outcomes and should be meaningfully involved in shaping care at every stage.

This collaborative approach values the lived experiences, perspectives, and expertise of trans and gender diverse people, ultimately leading to the design of more inclusive, effective, and patient-centred care.

Resources​

• This video from the Coalition for Personalised Care defines co-production and describes how to develop a culture of co-production.

• The Co-Production Collective provides a library of resources on co-production, including case examples.