In my previous article I started looking at the different version of the Models of Care (MoC) of the National Gender Service (NGS), finding and denoting the 2016, 2018, and 2019 MoCs. I found the 2018 version oddly appears to be the newest version. And while the contents of my last article was based on the first paragraph of the MoC in question, this article will get to the second paragraph of the MoC.
But first there’s an interesting change in the Endocrinology section from the 2016 MoC:
to the 2018 MoC:
This is not the only removal of the Transgender Equality Network (TENI) from the 2018 MoC, as can be seen from the 2016 MoC Governance section:
Compared to the 2018 MoC:
This removal of any mention of TENI being involved is particularly intriguing in light of the outdated 2016 MoC being provided to the TENI CEO on 9 October 2018, and the lack of any involvement from TENI or other patient support and advocacy organisations up to this point.
The 16 August 2018 Paper
My previous article mentioned that a reference to a 16 August 2018 paper was added in the 2019 and 2018 MoCs, now is the time to elaborate further. First the reference:
This paper is infamous in trans circles, and rapid-onset gender dysphoria (ROGD) continues to be referenced by transphobes. It is junk science, with extensive corrections and an apology issued by the journal that published it. There are detailed critiques of this study, so I won’t retread that ground.
What is interesting is that Dr. Paul Moran presented the MoC and Gender Clinic Operational Model of Care (GCOMoC) on 6 September 2018, both of which contained references to this paper:
I suspect that the parents surveyed for this paper were recruited on anti-trans forums is possibly related to these parents having worse relationships with their trans children after they came out.
I think we should, however, applaud the authors of the MoC for being so on top of the science as to include a paper published just three weeks beforehand. I wonder what other 2018 papers were added in?
Oh, that’s odd. None were.
In fact, the only other paper added to the references section of the 2018/2019 MoCs since the 2016 MoC is the 2011 Swedish study mentioned in GCOMoC. I cannot find any changes between the MoC versions that obviously tie to this study.
So it’s interesting that of all the papers that were published between when the 2016 MoC and 2018/2019 MoCs were written, the only one added to the references is a highly controversial study.
Now, to be fair, the authors may well have missed the statement on ROGD from WPATH on 4 September 2018 just two days before Dr. Moran’s presentation. It also took several months for the corrections to come out, which would have been after the outdated 2019 MoC was sent to the Department of Health.
However, in an email of 29 January 2020, while sharing a Daily Mail article, Dr. Moran referenced the underlying ideas from the paper of people coming out as trans due to their friend groups:
A simpler explanation is that birds of a feather flock together. To provide a personal example, it turns out one of my good friends from back in college is also trans. We only discovered this after we had both begun transition, having cracked (realised we are trans) in our 30s, and not having talked for many years prior. In retrospect the signs for each of us were there before we even met at college, but the lack of trans visibility meant it took another two decades for us to individually crack.
Waiting and Age
Finally, let’s look at the original 2016 MoC second paragraph:
This is a bit unclear, later on is more specific:
So the plan would be that St. Columcille’s where the NGS is based would handle 16+, and the National Pediatric Hospital mostly handle younger than that. Later versions of the MoC use a more current name, The National Children’s Hospital. Here’s the 2018 MoC second paragraph:
This is emphasised in the 31 May 2018 meeting notes of the Steering Group that established the NGS:
It looks like attempts to have any under 16 care in the NGS were shot down, though they hedged their bets that St. Columcille’s may start treating younger in the 2018 MoC:
Those familiar with Irish trans healthcare will however spot an oddity here, the NGS only handles patients who are 18+. So at some point the NGS decided to ignore own their MoC and stop the only service in the country providing any care to 16 and 17-year-olds:
Per this letter from 30 April 2019 within Crumlin Hospital, it may have happened in the months after the NGS was established:
This seems to go against key principles against the MoC itself, from the 2018 MoC:
To this day, there is no HSE service established for under 18s within the country. Which is a bit problematic, as the MoC itself says:
Jessica Black (she/it) is confused as to why you’re bringing up Ian Betteridge.