Contents

• Introduction

• Overview of Medical Transition and Gender-Affirming Care

• Hormone Therapy: Primary Care

• Hormone Therapy: Public Pathways

• Hormone Therapy: Private Pathways

• Hormone Therapy: Self-Medication

• Surgeries

• Hair Removal

• Hair Growth and Restoration

• Voice Training

• References & Resources

Introduction

What this guide does:

This guide is designed to help trans people navigate the often complicated process of accessing gender-affirming healthcare, or medical transition, in Ireland, telling you:

• How to access hormone therapy, blood tests, surgeries, voice training, and hair restoration and removal.

• The pathways to care, both public, private, and self-directed, along with their potential challenges and barriers.

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 ways to access care. There is no perfect option—each has negatives and positives.

• Tell you how to navigate appointments with healthcare providers, provide in-depth info about hormone therapy, or dive into how to self-medicate. For that, check out our other zines.

Overview

What is it?

Medical transition is a process some trans people go through to change the hormones and appearance of our bodies to align with how we feel and how we want to present our gender. Though not all trans people wish to undergo all or any aspects of medical transition, access to gender-affirming care is essential and often life-saving for those who do.

Gender-affirming care is not a single category of services but instead is a range of services that help us medically transition. As much as any other form of healthcare, gender-affirming care helps trans people live safe and healthy lives.

What can it look like?

It can look all sorts of ways! But here are some common ones:

• Hormones (testosterone and/or oestrogen)

• Top surgery (e.g. mastectomy or breast augmentation)

• Bottom surgery (e.g. hysterectomy, phalloplasty, metoidioplasty, orchiectomy or vaginoplasty)

• Facial surgery (e.g. forehead contouring, jaw contouring or augmentation or tracheal shave)

• Hair removal or restoration procedures

Hormone Therapy: Primary Care

What is it?

Hormone therapy is the use of medicines to change the balance of hormones in our bodies.

The most sustainable, efficient, and effective option for gender- affirming hormone therapy and blood tests is through your primary care provider. As many GPs prescribe hormone therapy in their practice every day, most GPs should have the knowledge to provide this care to trans people.

Things to keep in mind

Many GPs feel that they are not competent in the provision of gender-affirming hormone therapy, so it may not be easy to convince your GP to provide this care.

If you feel that your GP is generally supportive and you are comfortable with them, you can ask them to provide your hormone therapy.

How do I ask my GP?

• Contact previous healthcare providers and request a summary of care and treatment records. Include the medicines you’re taking and their dosages, how long you’ve been on treatment, and any recent blood test results.

• Determine whether you prefer to make the ask in-person or in writing by either email or a letter you can hand to them.

• Explain why you’re seeking care through them, e.g. long wait times for the National Gender Service (NGS).

• Clearly outline to your GP what you’re asking for, such as a bridging prescription for your hormone therapy, blood tests to monitor your treatment, or help administering injections.

• Reassure them that guidelines such as the World Professional Association for Transgender Health (WPATH) Standards of Care can support their treatment.

• Share the Blood Test Quick Reference, published by the Professional Association for Trans Health Ireland (PATHI) at pathi.ie/resources, for guidance on monitoring.

• Prepare to discuss personal impacts, such as the length of time you’ve been waiting for public services, how accessing care privately has affected your finances, or any risks you’re trying to avoid, such as the need to self-medicate.

• Healthcare providers are bound to the principle of ‘Do no harm’ so framing their provision of care as a harm reduction approach may be effective.

What if they say no?

Contact organisations like Outhouse, TENI, Trans Harm Reduction, or the LGBT Helpline (1800 929 539) for GPs who are more likely to help. You might also consider private clinics that specialise in trans healthcare, though this may involve additional costs.

Hormone Therapy: Public Pathways

Choosing public care can offer free or affordable access to gender-affirming hormone therapy and other services, but it comes with trade-offs.

Pros

• No-cost consultations

• Access to Treatment Abroad Scheme and Cross-Border Directive for surgeries

Cons

• Many public providers are either closed for intake or have waiting lists years long.

• The NGS waiting list is currently estimated at more than 10 years for a first appointment.

• Gatekeeping models that require extensive, often invasive psychological assessments to access care.

• Refusal of care is common, and often for arbitrary or discriminatory reasons, such as employment status, neurodivergence, or gender expression.

• Lack of access to telehealth services, which can be restricting for rural and disabled trans people.

• The NGS is known to send letters to your GP once you are on the waiting list advising them not to provide you blood tests and hormone therapy, which could put your care at risk if you are currently receiving it from your GP.

Public services

Note: This is as of March 2026. These options may change.

What to expect from the NGS

• Confirmation: Once your GP submits your referral, you will receive a letter within 4–6 weeks confirming that you are on the waiting list. If you don't get one within 6 weeks, contact the NGS directly. It will be addressed to your new name (if it is included in your referral), so be mindful of this if others in your household do not yet know about your transition.

• Wait: The waiting list for the NGS is extremely long, with current prospective estimates of 10+ years. If you have the resources, you can seek private treatment elsewhere while you’re waiting.

• Assessment: When you get to the top of the waiting list, you’ll have a minimum of two assessment appointments. One will be with a psychiatrist, one will be with another member of the team (could be a psychologist, social worker etc). They often do these meetings in pairs. The first one will take about 3 hours and the second one will take 1-2 hours, often with months in between. These assessments often cover your gender identity, family, social life, employment, mental health, and sexuality. People report that they can be invasive, dehumanising, and traumatising.

• Review: The multidisciplinary team will review the notes from your assessments and determine whether they deem you a candidate for hormone therapy.

• Treatment: If the team is satisfied that you’re a suitable candidate for hormone therapy, they refer you to the endocrine clinic who will prescribe and monitor your hormones.

Hormone Therapy: Private Pathways

Choosing private care can offer faster access to gender-affirming treatments, but it comes with some considerable trade-offs.

Pros

• Shorter waiting times

• Telehealth access

• Often use the informed consent model

• Specialised services with more tailored support

Cons

• Higher costs, with initial consultations or sign-up fees costing several hundred euros and often ongoing subscription fees.

• Prescriptions of certain medicines may not qualify for the Medical Card or Drugs Payment Scheme if they aren’t prescribed by an Irish consultant.

• Some Irish pharmacies may not fill prescriptions of unlicensed medicines from non-Irish providers.

Note: If you need support to pay for private trans healthcare, you may try reaching out to the Small Trans Library regarding their mutual aid fund for trans people who are out of work or struggling.

Private services

Key: € 500-1,000 in first year | €€ 1,000-1,500 in first year | €€€ 1,500-2,000 in first year

Note: This is as of March 2026. These options are always changing.

Choosing a service

To ensure that you choose an appropriate service, whether public or private, it is important to find out:

• How long is the waiting list? Are you likely to be seen promptly by the service?

• If they ask your GP for blood tests or to prescribe, will your GP agree?

• Are the prices reasonable? Do they have fees or subscriptions and are you tied into a contract for a specific amount of time?

• How do their pricing structures compare to other services?

• Will they regularly monitor blood tests and your health if you are prescribed hormones?

• What’s their reputation like? Do past patients recommend the service? What are people saying online?

• Will they confirm your referral? Will you get written confirmation you have been added to a waiting list?

• Are there physical examinations? Will they perform medically unnecessary examinations of your chest or genitals?

• Do surgeons take their referrals? If they write a letter recommending you for surgery, will surgeons accept it?

• What is the level of contact? Do they respond quickly to questions? How often will they check in with you?

A well-run service will be happy to help you with questions on these subjects.

Source: TransActual

Hormone Therapy: Self-Medication

Self-medication, or DIY, refers to obtaining and using HRT without a prescription or oversight from a medical professional. In an ideal world, trans people would have prompt access to free HRT through the public health system based on the informed consent model. In our current reality, many trans people in Ireland turn to self-medication due to long waiting lists for public care, high costs for private care, or to realise their own bodily autonomy and self-determination.

Pros

• Access without gatekeeping

• Lower costs

• Autonomy over your transition

• Robust peer-support network

Cons

• Some GPs may be unwilling to provide blood tests to help you monitor your hormone levels.

• Homebrewed forms of hormone therapy are not subject to the same standards as prescription medicines, and could be contaminated, unsafe, or list inaccurate concentrations.

• Your medicine could be blocked or confiscated by customs.

Note: If you need support, reach out to Trans Harm Reduction (transharmreduction.org). You can also learn more on diyhrt.wiki and reddit.com/r/TransDIY. And check out the self-medicating survival guide on our website!

Surgeries

Access to gender-affirming or transition-related surgeries in Ireland is limited, with only a small number of options available locally. For many procedures, trans people need to travel abroad to access care.

Things to consider

• What you want your body to look like. Find results of the surgery method and the surgeon’s work after healing and consider whether the surgery examples meet your vision.

• What you want your body to be able to do (for example, do you want to stand to pee? Do you want to have penetrative vaginal sex? Do you want your body to still produce oestrogen or testosterone?).

• Whether it is available publicly or not, whether and how your insurance plan would cover it, and how you would fund private care.

• Whether you are willing and able to travel, and where you can travel to.

• Potential complications of different surgery types.

• What recovery is like and how it relates to your circumstances, your mental health, your body and any disabilities or medical conditions that you have.

Surgeries available in Ireland

• Masculinising top surgery or mastectomy (removal of breasts) may be available both privately or publicly

• Hysterectomy (removal of uterus and/or ovaries) may be available publicly through the National Maternity Hospital

• Feminising top surgery or augmentation mammoplasty (breast enlargement) may be available privately

• Orchiectomy (removal of testicles) may be available privately and publicly

• Chondrolaryngoplasty (tracheal cartilage shave) may be available publicly via the NGS

• Hair transplant surgery may be available privately

Surgeries only available abroad

• Masculinising bottom surgery: both metoidioplasty (maximising length of the clitoris) and phalloplasty (construction of a penis) as well as scrotoplasty (construction of a scrotum), urethraplasty (construction of a urethra), and vaginectomy (removal of the vagina)

• Feminising bottom surgery: including penectomy (removal of the penis), vaginoplasty (construction of a vagina), vulvoplasty/labiaplasty (construction of labia), and clitoroplasty (construction of a clitoris)

• Facial feminisation surgery: including procedures such as chondrolaryngoplasty (tracheal shave), forehead contouring, genioplasty (chin contouring), alveoloplasty (jaw contouring), rhinoplasty (nose surgery), lip lift, etc.

• Facial masculinisation surgery: including a range of procedures such as chin augmentation and jaw augmentation

• Phonoplasty (voice feminisation surgery)

• Lipoplasty (body contouring)

Choosing a surgeon

When deciding on a surgeon, it is important to find out:

• Does the surgeon offer the particular type of surgery that you’re interested in? Do they offer the outcomes you’re looking for? Do they have photographs?

• What are the referral requirements? Do they require a diagnosis of gender dysphoria?

• What are their requirements around BMI? Around smoking?

• What’s their reputation like? Do past patients recommend the surgeon? What do they say about their surgical results? Are they happy with them? How did they support them with post-operative care and any complications?

• Does the surgeon have experience operating on people with a similar skin colour and body type to you?

• If you’re non-binary, have other non-binary people had a good experience with this surgeon and their team?

• If you’re disabled or have a chronic illness, will they be able to meet your needs? In terms of the procedure itself, but also in relation to any appointments and hospital stays.

• How long is the waiting list?

• What is the level of contact? Do they respond quickly?

• Are there physical examinations? Will they perform medically unnecessary examinations?

• Do they offer any additional services to patients, such as access to a psychologist or dietician?

• What post-operative care and support do they provide?

• How do their prices compare to other surgical teams? If they are a lot cheaper than other providers, find out why.

• What is included in the price? For example, does the price include hospital fees, medicines, and implants? Do they offer payment plans?

• How long will you need to stay for post surgical care? Will you be kept in the hospital, or have to book a hotel nearby?

Finding options and support

Good places to hear peoples’ experiences, understand your options, and get resources include:

• Your local trans support group or online trans support groups. You can find these support groups through Outhouse LGBT+ Centre, Teach Solais, Gender Rebels, or TENI. Wexford Pride also runs an online transfeminine surgery support group.

• Facebook – there are general groups about different surgery types, and sometimes there are groups specific to patients of a particular surgeon. Some of these groups may not come up when you search for them, so ask around within the trans community.

• Subreddits such as r/TransIreland, r/TransgenderUK, and r/Transgender_Surgeries and Discord communities

• Websites such as TransBucket.com, Phallo.net, Metoidioplasty.net, TopSurgery.net, and MTFSurgery.net

Hair Removal

What is it?

Hair removal is often an important step in gender-affirming care, whether for facial hair, body hair, or preparation for certain surgeries. The two most common methods for permanent hair removal are laser hair removal and electrolysis.

Laser uses a concentrated beam of light to target and damage hair follicles, reducing hair growth over time.

Electrolysis permanently destroys hair follicles using an electric current passed through a fine needle or wire.

What can it look like?

• A transfeminine person may get laser to reduce unwanted hair that hasn’t thinned or reduced as a result of oestrogen therapy.

• A transfeminine person may get electrolysis instead of or in addition to laser. Due to the higher cost, electrolysis is commonly used to clear up hairs that survived laser treatment. Electrolysis may also be required to remove pubic hair to prepare for a vaginoplasty. Some surgeons may also do it as part of the procedure.

• A transmasculine person may wish to remove excess body hair triggered by testosterone therapy.

Things to consider

• For those with dark hair and light skin, a common approach is to use laser hair removal to eliminate the bulk of the hair and then switch to electrolysis for any remaining hairs.

• For those with light hair and/or dark skin, electrolysis is often the only effective option.

• Both methods can be uncomfortable but pain relief options, such as numbing creams, are often available.

• Both laser hair removal and electrolysis can be expensive.

• Each method requires multiple sessions and can take a long time. Laser typically requires at least 6–10 sessions spaced several weeks apart. Electrolysis can take several months to years, depending on the treatment area and hair density.

• Certain surgeries, like vaginoplasty, require hair removal.

Finding options and support

• There are many laser and electrolysis providers throughout Ireland.

• You can find provider options and reviews on the r/TransIreland subreddit.

Hair Growth and Restoration

What is it?

Hair growth and restoration treatments help improve hair density, promote regrowth, or restore hair in areas where it has thinned or been lost. This is often helpful for both transfeminine and transmasculine people. Common methods include medicines and surgical interventions, but here we will focus on the medicines.

Finasteride is an oral prescription medicine that blocks the conversion of testosterone to DHT (dihydrotestosterone), a hormone linked to hair loss.

Minoxidil is a prescription topical treatment that stimulates hair growth and slows thinning.

What can it look like?

• A transfeminine person who is not otherwise on hormone therapy may use finasteride and/or minoxidil to restore prior scalp hair loss and/or improve density.

• A transmasculine person may take finasteride to prevent pattern baldness or minoxidil to promote regrowth of scalp hair that has been lost as a result of testosterone therapy.

• A transmasculine person may apply minoxidil to the beard area to stimulate facial hair growth.

Things to consider

• Not all methods guarantee regrowth, and results may vary depending on the cause of hair loss and your genetics.

• Treatments may take several months before you see results.

• Minoxidil is known to be poisonous for cats, so proceed with extreme caution if you are a cat owner.

Finding options and support

• Your hormone therapy provider and/or GP may be willing to prescribe you these medicines. Just ask!

• There are also online services that can prescribe these medicines.

• You can find provider options and reviews on the r/TransIreland subreddit.

Voice Training

What is it?

Voice training or speech therapy is a common way to help align your voice with your identity, as it helps you modify aspects of your voice, such as pitch, resonance, intonation, and speech patterns. This is typically done with a Speech and Language Therapist, or SLT.

Things to consider

• Voice training is a skill that develops over weeks or months. It requires consistent practice and patience to see and maintain results.

• Voice training can be expensive if done with a therapist. However, there are free or affordable resources online to help you get started. The NGS may also offer free speech therapy to their patients.

Finding options and support

• Check out subreddits such as r/transvoice and r/TransIreland to understand your options for providers and see reviews.

• Search the ISTI website for qualified SLTs: https://isti.ie/find-a-therapist

Resources

References

• TransActual, How to access medical transition

• The Clare Project, Medical Transition: Tips by and for trans, non-binary and intersex people

Trans organisations

• Trans Healthcare Action

• Gender Rebels

• Trans Equality Network Ireland – TENI

• Trans Harm Reduction

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

Illustrations by Coileán Oscar