A new year means we can look back at how transgender healthcare has fared in the previous 12 months, using Freedom of Information (FoI) requests. The Health Service Executive (HSE) has once again been most helpful. And, because of this, I can now share and analyse the results.
There is a bit of confusion in that I got two sets of numbers. However, after a bit of back and forth I can confirm that there were 358 people added to the initial assessment waiting list for the National Gender Service (NGS) in Loughlinstown. How many were on the list at the end of 2021 is less clear. I was given a number of 861 for the end of the year but also a definite 869 for January 12th 2022. Depending on how you interpolate that you get either 862 or 863, so I’m going to go with the middle number of 862 for how many people were waiting at the end of 2021. Being one person off won’t make a big difference to the analysis.
A fine addition to my collection
These 358 people added to the list is lower than projected. Loughlinstown itself was expecting 420 as late as October 2021. This hints that while the rate of referrals is continuing to increase the rate of that increase is slowing. It becomes clearer with an updated graph from a previous article:
You can just see that the curve is starting to flatten a little so it may be moving from an exponential to a more logistic curve. Personally I had been expecting the referral rate to continue to grow exponentially for at least a few more years given the time for self-introspection that COVID-19 has given many. So, this is a bit of a surprise.
There are a few reasons why this might be. One is that as transgender awareness and acceptance increases, there are fewer people left who have yet to realise that they’re trans and seek medical care. On the other hand, the difficulty of finding a GP that is taking on new patients could be making it harder to get referred. Another possibility is that more trans people have heard about the length of the waiting list and stories around Loughlinstown, and are seeking more prompt and standard medical transition via other routes such as GenderGP or by self-medicating.
The long wait
The information from this latest FoI request can be combined with numbers from previous FoI requests which indicate that 664 people were waiting at the end of 2020. Looked at together it tells us that the waiting list increased by 198 overall. Considering that 358 people were added that means that 160 people were removed from the list in 2021.
With 862 people on the list at the end of the year, this means the predicted wait is around five years and five months if you were referred today. This is getting longer by over a year per year.
Previously Loughlinstown has indicated that it can handle only around 150 new patients per year. With this in mind 160 people being removed from the waiting list seems odd at first glance. People may be removed for reasons other than getting an initial assessment, including no longer wanting to be seen or emigrating. The patients seen in 2021 would have been referred in 2018/2019, so there’s been plenty of time for changes in personal circumstances.
The more astute reader will have noticed that it wasn’t just the 2021 number which was added to the above graph. A data point was also added for 2017. This comes from an article by the clinical lead which indicated that there were over 200 referrals in 2017.
Also indicated in the article was that 218 people were referred in the period of 2005-2014. But this is most likely incorrect. It presumably comes from the 2014 paper Gender dysphoria – prevalence and co-morbidities in an Irish adult population which gives 218 as the number through early 2014, March in particular per Figure 1, rather than the whole year.
Additionally, the article indicated that a gender service was initially offered almost 20 years ago at St Columcille’s Hospital in Loughlinstown. However, the 2006 paper Gender Identity Disorder in the Irish Medical Journal indicates that it started in 2000 which is just over 21 years ago. Finally, that 2014 paper also indicates that 2008 was not the first year there were over 10 referrals, as the paper talks about 52 referrals over a period of five years. So, at least one of the years from 2000-2004 must have had at least 10 referrals in accordance with the pigeonhole principle.
While I have looked at the statistics in this article, others have written more general critiques that warrant as much attention.
Jessica Black (she/her) is an Irish lady who dabbles in statistics from time to time.