Illustrations by Diane Faye

Introduction

What this guide does

This guide is geared toward trans people in Ireland who are accessing medical care—from your local GP to a ‘specialist’ psychiatrist and any provider in between.

It covers:

• Common issues we face in our interactions with doctors and other healthcare workers.

• Self-advocacy tools and strategies to address these issues and help you get the care that you need.

What this guide doesn’t do

• Serve as medical advice. The information contained here is meant for educational purposes only. We cannot guarantee any outcomes based on these suggestions.

• Provide fail-proof solutions to these issues. Self-advocacy can put you at risk of denial of care, especially when facing a gatekeeping system or if you are already marginalised by your race, immigration status, or dis/ability status

• Address broader issues like long waiting times for the National Gender Service, how to access private care, private insurance considerations, or other logistical barriers.

• Tell you where you can access trans healthcare. For that, check out our Accessing Gender-Affirming Care zine.

When doctors think they know best

What is it?

Sometimes providers assume or act like they know what’s best for you (regardless of whether that is actually true). This is called medical paternalism. It means they make decisions for you, rather than with you, often prioritising their own opinion over your autonomy, lived experience, or needs.

Some providers may also let their ego or emotions get in the way. They might get defensive, dismiss your questions, or act like you're challenging their authority just by advocating for yourself, making it harder to access the care you need.

Even though informed consent—where you understand and agree to your own care—is now more widely accepted, many doctors still assume they know what’s best for us and ignore our freedom to make our own decisions, especially in trans healthcare.

What can it look like?

• Getting annoyed or defensive when you question their advice or ask for a different approach.

• Ignoring your knowledge of your own body, transition, or needs.

• Acting like you're being difficult when you speak up or ask for clarification.

• Letting personal beliefs, about trans people or specific treatments, influence their recommendations.

• Refusing to explain why a test, exam, or treatment is being recommended.

• Not telling you about other options or alternatives.

• Refusing to prescribe certain medicines or treatments without clear reason.

• Requiring extra steps, like unnecessary assessments, before giving access to hormones or surgery.

Things to keep in mind

• You have the right to ask questions, speak up, and be part of decisions about your care. A provider’s ego or emotions should never get in the way of that.

• Sometimes pushing back can help, but in some situations, it might lead to care being delayed or denied. Trust your instincts and choose what feels safest in the moment.

• Many healthcare professionals in Ireland have had little or no training in trans healthcare. They’re often told it’s a specialist area, even though much of it is basic, everyday care. This doesn’t excuse poor treatment, but it can help explain why some providers fall back on controlling behaviour.

When doctors get weird about your gender

What is it?

Sometimes, providers act overly curious or just plain weird about your body, gender, or transition. They might ask personal questions that don’t seem relevant to your care, or focus too much on the fact that you’re trans instead of treating you like any other person. This is called medical voyeurism—when you’re treated like an object of fascination or a case study.

Other times, they might use language that’s invalidating or demeaning of your identity. 

What can it look like?

• Asking personal or invasive questions that aren’t relevant to your care.

• Requesting exams or tests that seem unnecessary or unrelated to the reason for your visit.

• Making you feel like a spectacle, such as calling in others to observe without your consent.

• Talking about your body in ways that feel disrespectful or dehumanising.

• Misgendering you or calling you the incorrect name.

• Using slurs, outdated terms, or language that pathologises being trans, like calling it a disorder or using terms like “transgenderism.”

• Making assumptions about your sexuality or relationships.

Things to keep in mind

• You don’t have to answer questions that feel invasive, irrelevant, or uncomfortable. That said, some providers may withhold care if certain information isn’t shared.

• Some of these issues may come from outdated training or rigid medical systems, like record-keeping software that doesn’t show your correct name or pronouns.

• That doesn’t excuse voyeurism or harmful language. Providers are still responsible for treating you with respect.

When doctors ignore your concerns

What is it?

Sometimes, a provider minimises, brushes off, or ignores something you’ve raised about your health.

Other times, you might seek care for a health concern unrelated to your gender, but the provider dismisses it as they assume your symptoms are just because you’re trans. This is called trans broken arm syndrome. 

This situation is not limited to transness. Weight and disability are also often used as catch-all explanations for any symptoms or concerns.

What can it look like?

• Dismissing persistent pain or unusual symptoms as “nothing to worry about” without looking deeper.

• Suggesting that distress about your gender is “all in your head” or “a phase.”

• Focusing on something unrelated, like your trans identity or body, instead of the reason you came in.

• Insisting that your hormones or transition cause unrelated health problems without evidence.

• Recommending stopping or changing hormone treatment just because they think your transition is to blame.

Things to keep in mind

• Sometimes a symptom really isn’t serious. For example, swelling after surgery can be normal and will usually get better.

• That doesn’t mean they get to brush off your concerns or suggest solutions that aren’t reasonable for you.

• Trans people, disabled people, and people of colour often face more dismissal because of bias or stereotypes, like the false idea that Black people feel less pain.

• Trans people often face over-medicalisation, but you deserve care that treats your body as a whole and addresses your concerns.

• Hormone therapy or surgeries are personal decisions that should not be used as an excuse to deny treatment for other medical concerns.

• If you feel confused, uneasy, or don’t feel like your concerns were heard and addressed, the provider’s work is not done.

When doctors make you prove you’re “trans enough”

What is it?

Some providers who offer transition-related care require you to go through a psychosocial assessment before giving access to hormones, surgery, or other trans health services.

These assessments are usually done by a psychiatrist or psychologist. They might ask questions about your mental health, work, social and family life, sexuality, employment, and ability to “function” in the community. These are often used as a gatekeeping tool, not a support, and can feel more like an interrogation than care.

You’re unlikely to face this kind of assessment from a GP, but if you're going through "specialist" services like the National Gender Service (NGS), it may be a required step.

What can it look like?

• Asking invasive or deeply personal questions over several hours or sessions.

• Pressuring you to tell your story in a way that fits with strict ideas about gender dysphoria, gender roles, and gender expression.

• Insisting you bring a parent or partner to validate or affirm what you are saying, which can feel infantilising.

Things to keep in mind

• Transness is not a mental health condition, and you should not have to face these assessments. These systems have been designed to control our bodies and lives.

• This isn’t your fault, and it’s normal to feel afraid, patronised, or invalidated during these assessments. 

• The NGS may deny care if you don’t participate or if your answers don’t align with their diagnostic criteria.

When doctors examine your body

What is it?

Physical examinations are when a healthcare provider inspects, feels, or listens to different parts of a person's body. A provider may tell you that they need to perform a physical exam either as a routine checkup or to look into a concern.

For trans people, physical exams can be uncomfortable or frightening for many reasons. Exams can bring up old trauma, put you at risk of experiencing new trauma, trigger dysphoria, or make you feel vulnerable and distressed.

What can it look like?

• Being asked to undergo a pelvic exam, cervical exam, prostate exam, chest exam, or another type of exam.

• Feeling like you’re being pushed into agreeing to an exam during a single visit, without time to prepare mentally.

Things to keep in mind

• You do not have to consent to a physical exam. It’s your body and your choice.

• You do not have to take off your clothes or show your doctor any parts of your body that you don’t want to.

• You can ask your provider to justify any requests.

• Your provider may be unwilling to provide any or certain types of care if you don’t consent to an exam.

• There may be a medical rationale behind certain exams. For example, pap smears, prostate exams, mammograms, and colonoscopies are critical for early detection of health issues.

• But no matter what, it is still your choice to consent to it.

What you can do

If you’re preparing for an appointment

Write down your agenda. Include:

• Your concerns and symptoms

• All of your questions

• What you want from the appointment (e.g. a referral, prescription, explanation)

Practice in advance.

• Researching the questions that are typically asked in similar appointments.

• Prepare answers to questions you’re comfortable with.

• Practice how you’ll set boundaries around anything you don’t want to answer.

Consider what support you need.

• Bring a support person if possible. Talk to them about the role you want them to play, when to step in or step out, how to check-in, and safe words.

• Decide if you want to print off your agenda or any resources.

Set the tone early.

• Let your provider know your name, pronouns, and preferred language for your body.

• Ask them to make notes in your chart.

• Ask to have another staff member be in the room as a chaperone if that would make you feel more comfortable.

If you’re at an appointment

If something is confusing or feels off, ask questions:

• “Why are you using that term?”

• “Why did you write that phrase in my chart?”

• “What is the purpose of this exam?”

• “How is this related to why I came in?”

• “Why do you need to know this?”

• “Do cisgender people get [x]? What do you recommend for them?”

• “Can you tell me how my gender is impacting my ability to get care for this issue?”

Set boundaries:

• “I’d prefer not to answer that.”

• “I don’t see how that’s related to the reason I’m here.”

• “I don’t feel comfortable doing that.”

• “I’d like to focus on the concern I came in for.”

• “Could you use [preferred word] instead?”

• “I’d prefer if you didn’t use that word to describe me. Can we use [preferred word] instead?”

• “I’d rather you refer to my body as [alternate word] when we talk. Can you please do that?”

• “Can you describe what you’re going to do before you do it?”

• “I need more time to prepare. Can we book this for another appointment?”

• “I’m not ready to do that. Could I think more about it and check in later?”

Redirect the conversation:

• “I hear you’re concerned about [y], but right now I need support with [x].”

• “I know we don’t have a lot of time, so I’d like to focus on [x].”

• “I appreciate your perspective, but I’m still worried about this issue. Could we explore it further?”

• “I’m looking for a treatment that works for both of us—can we discuss alternatives?”

If your care is refused or dismissed

Ask for clarification:

• “Can you explain why you think this symptom isn’t concerning?”

• “Can you explain why you’re refusing this treatment?”

• “Are there other options we could consider?”

• “Can you document in my medical record why this was denied?”

Keep a record.

• Write down the date, provider name, and reason for denial.

• Ask them to note your request and their refusal in your chart.

Request alternatives.

• Ask for a referral to another GP or specialist who can provide the care.

• Consider private services or trans-affirming clinics if accessible.

If you need to walk away or get help

You are allowed to leave.

• You can walk out of an appointment that feels unsafe or uncomfortable. Just be aware of any risks to your access to care.

• Ask yourself how severe the issue is and whether you are willing to live with it, or if you need it to be addressed now.

You can make a complaint about mistreatment. Get in touch with:

• The clinic manager, patient advocate, or social worker (if available at the practice)

• Regulatory bodies, such as the Irish Medical Council (for doctors) or the Nursing and Midwifery Board of Ireland (for nurses)

• Patient Advocacy Service (for public hospitals)

Find another doctor. These organisations have lists of trans-friendly GPs:

• LGBT Helpline (1800 929 539)

• Outhouse LGBTQ+ Centre (01 873 4999)

• TENI (office@teni.ie)

• Trans Harm Reduction (transharmreduction@protonmail.com)

• Transgress the NGS (transgresscampaign@gmail.com) 

Get peer support.

• Trans Harm Reduction (for self-medicating)

• r/TransIreland subreddit

• Gender Rebels Cork

• Trans Peer Support Group Dublin (TPSG)

• Galway Gender Support

• Trans Limerick Community

Resources

References

Note: This zine is derived from John and Elijah’s Trans Survival Guide: Doctor’s Office Edition, with their permission to adapt to Ireland.

• Alpert, A. B., Mehringer, J. E., Orta, S. J., Hernandez, T., Redwood, E. F., Rivers, L., Manzano, C., Ruddick, R., Adams, S., Sevelius, J., Belanger, E., Operario, D., & Griggs, J. J. (2023). Transgender People’s Experiences Sharing Information With Clinicians: A Focus Group-Based Qualitative Study. Annals of Family Medicine, 21(5), 408–415.

• Faden, R. R., & Beauchamp, T. L. (1986). A History and Theory of Informed Consent. Oxford University Press.

• Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., Kalauokalani, D. A., Lasch, K. E., Myers, C., Tait, R. C., Todd, K. H., & Vallerand, A. H. (2003). The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Medicine (Malden, Mass.), 4(3), 277–294.

• Paine, E. A. (2021). “Fat broken arm syndrome”: Negotiating risk, stigma, and weight bias in LGBTQ healthcare. Social Science & Medicine, 270, 113609.

Trans organisations

• Trans Healthcare Action (transhealthcare.ie)

• Gender Rebels (genderrebels.ie)

• Trans Equality Network Ireland – TENI (teni.ie)

• Trans Harm Reduction (transharmreduction.org)

• Transgress the NGS (@transgress.ie on Insta)