Writing about Veronica’s transition in 2025 feels a great deal more fraught than it did five years ago. My own gender journey feels less politicised — not non-politicised, just less so — but trans women have only gained ever-more venomous attention in political discourse. Ultimately, it was Veronica’s decision that we should continue the series and document the experiences she has had over the past seven years.

So far, we covered the initial conversation, the spike in dysphoria that followed, navigating pronouns, and her choosing a name. I want to repeat this one paragraph on our early experience of medical transition, written in 2019:

The reality of medical transition in Ireland was a huge stressor. The HSE still adheres to a backwards practice with multiple gatekeepers rather than the informed consent model. It includes an unnecessary psychiatric evaluation. She had to find a GP who’d agree to refer her to a psychiatrist who’d decide if she’s “transgender enough” to be referred to one of only three endocrinologists who provide services to transpeople.

Medical care for trans people in Ireland has only gotten worse since then. A 2022 report on access to gender-affirming healthcare in the member states of the European Union found that Ireland has the worst healthcare system for transgender people. Issues include:

• A continued use of the psychiatric gatekeeper model
• Bottlenecks leading to waiting times of nine years to talk to the National Gender “Service”
• The gatekeepers of the Irish system instructing GPs not to offer blood tests or bridge prescriptions to trans people who haven’t been seen by the gatekeepers yet
• A complete refusal by those gatekeepers to engage with any organisation that’s trying to improve transgender healthcare in Ireland

Dysphoria isn’t the same for everyone. Some people have relatively mild experiences, but for most, it’s a deep and severe reaction that often worsens as people confront their gender head on. In 2018, Veronica’s was like a destructive force in her head and body. She needed to quickly start her medical transition journey to address it (gender-affirming care saves lives) and waiting for the Irish system was not an option.

At the time, Veronica and I had financial privilege enough to do something about it. We searched a private clinic that would perform the due diligence to ensure that Veronica could give informed consent for the hormonal stage of medical transition; and who would thereafter provide the monthly prescriptions for her hormones. We went with GenderGP, at the time one of the only providers of such a service in Europe.

The catch was that we needed an Irish GP to perform blood tests and again, we had a lot of privilege at the time and managed to sort that out. It’s not a given: some are reluctant (even though they provide blood tests for cisgender patients taking hormones) and some don’t have the facilities to provide that service, meaning further networking and convincing is required. We would later also need the GP to “reissue” GenderGP’s prescriptions as Irish prescriptions, and there were some hiccups with that. But by and large it went smoothly.

It took four meetings over the course of eight weeks for Veronica to have a prescription in her hand. But it could have been nine years. Nine years of anxiety and severe, hopeless, crushing dysphoria.

That’s the reality for so many trans people here. Very few have the privilege we had then. We no longer have the privilege we had back then: we don’t have the kind of income that would allow us to pay GenderGP’s fees, pay for the hormones, and pay for the blood tests. What’s more, most Irish GPs are now even more reluctant to do the blood work, thanks to the aforementioned gatekeepers.

Globally, transgender healthcare is underfunded and not fit for purpose. Very few countries offer anything close to what is needed. In many countries, conservative lobby groups and politicians are attempting to roll back whatever progress has been made in this area. People are suffering and it’s all entirely unnecessary. Another way is possible. And if you care about trans people, find out what it’s like in your country… and if have it in you to write to representatives or elected officials, to push for change, then please, do it.

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