For as long back as he can remember, Dylan would go to bed at night and pray that he would wake up a boy. "I had no idea. I would have classified him as a tomboy," his mother, Kirsty Donohue, says of the child who, until he turned 13, she thought of as her daughter.
Unlike other parents of trans children, some of whom say they “always knew”, Donohue was “totally blindsided” when she discovered Dylan was transgender. “At that stage, he had started to self-harm. He discovered there was a word for how he felt. He came across the word ‘transgender’, and he thought: ‘That’s me.’”
At that point, Donohue says, “I didn’t even know what the ‘T’ in LGBT stood for. I’d never looked it up. It didn’t apply to me.”
Her first reaction was to say: ‘You’re spending too much time on the internet. You don’t need to put yourself in a box. You just need to talk to somebody. Come back to us when you’re 18.’
“All,” she says now, “the wrong things to say.”
Within a couple of days, she realised that what Dylan needed was “our acceptance and love and support”.
In 2007, just 10 people accessed gender identity services for adults; by 2017, the number was 210
For others, recent media coverage – including last week's RTÉ Prime Time debate – might have offered their first insight into the issues facing trans and non-binary people in Ireland.
As the programme reported, Ireland is experiencing an increase in the number of adults and children accessing gender identity services. No overall figures for the number of transgender or non-binary people in Ireland are available, beyond those accessing services.
In 2007, just 10 people accessed gender identity services for adults; by 2017, the number was 210.
Gender identity clinic
London's Tavistock gender identity clinic runs a satellite monthly clinic for children through Crumlin hospital. In 2017, 35 Irish children were referred there, compared with one in 2011. There are many children and young people waiting to access services, says Vanessa Lacey of Teni (Transgender Equality Network Ireland), the national support group for transgender people. Teni has supported children as young as primary school age, who are struggling with gender identity issues.
Irish society has generally avoided the polarised, often quite toxic debate currently characterising some of the conversation in Britain, particularly online
Moninne Griffith, executive director of BeLongTo and chair of a review group on the 2015 Gender Recognition Act, cautions against reporting of these increases as an "explosion" or an "epidemic".
“It’s not thousands of young people. It’s not a significant proportion of the population. It may feel like that because in the past there was no visibility,” and now there is, she says. “But it’s not a negative thing. It’s young people and teachers and parents being more educated.”
In spite of this growing visibility, Irish society has generally avoided the polarised, often quite toxic debate currently characterising some of the conversation in Britain, particularly online. There, some high-profile feminists and trans activists have been engaged in a vitriolic public war of words, bringing a new and frequently confusing lexicon of “safe spaces” and “terfs” (trans-exclusionary radical feminists) to wider public attention.
People working with LGBT groups in the UK report that, anecdotally, they have noticed an increase in homophobia and hate crimes, and wonder if it might be related to the more generally toxic atmosphere unleashed by Brexit.
For some people with gender identity issues, social transitioning is enough
In contrast, for three years now, and without incident, Ireland has been offering an administrative process for transgender people over 18 to achieve full legal recognition of their preferred gender, and have it changed on their birth cert and passport, through the 2015 Gender Recognition Act. By mid-2018, 297 people had been issued with gender recognition certificates.
The process is also open to people aged 16-18, though they currently have to go through the Circuit Court and get a doctor’s certificate and parental consent.
A review of the Act that took place in 2017 recommended extending gender recognition to children of any age, subject to parental consent, and through the Department of Social Protection, rather than the courts.
Nobody is claiming being trans in Ireland is easy: suicidality, self-harm, harassment, bullying, violence and systemic discrimination disproportionately affect the community here as everywhere else. But overall, there has been comparatively little public rancour in this country over the need for young transgender people to have their rights recognised, or to be supported. Where views do tend differ is in how that should happen.
Sometimes in the discussion the social, legal and medical aspects of transitioning are conflated, leading to further confusion.
For the purposes of clarity, social transitioning means living in your preferred gender identity, adopting a new name, using different pronouns and possibly changing your hairstyle and clothing.
For some people with gender identity issues, social transitioning is enough. For others, it is a first step towards the more permanent adoption of their new identity, a way of trying it out before committing to it legally or medically.
Donohue explains why it was not enough for Dylan, who is now 17. “Even for me, it took a long time to understand how difficult it is for Dylan to get out of bed every morning. To have to have a shower and wash body parts he doesn’t relate to. To have to use a binder to flatten his chest. To go to school and feel that people are going to judge him, look at him, misgender him, call him by his old name.”
Legal recognition usually happens after, or in tandem with, social transitioning. The 2015 Act was introduced here with relatively little friction, though the parallel debate in the UK has been intense.
Two camps
It is the discussion around medical options that has become perhaps the most contentious recently. Broadly, it tends to fall into two camps. On one side of the debate are those who say that children experiencing what’s known as “gender variance” are having feelings and thoughts that might well prove transient, a normal part of development. It is, they argue, safer to wait and see than to put them on a path to medical treatment that will eventually prove difficult to reverse.
On the other side is the view that there are risks to doing nothing too, and that a balance needs to be struck. "There's a need for a middle ground," says Dr Aileen Murtagh, consultant child and adolescent psychiatrist, and assistant medical director with special responsibility for adolescent mental health services at St Patrick's.
“It’s not an either or. There’s risk to intervention, and there’s risk to non intervention. It’s weighing everything up and making a balanced decision. One of the first things I learned in this work is that everyone’s gender identity and journey is unique.”
Gender variance, or the feeling that your true gender is at odds with the one you were born with is not a mental illness
Stella O’Malley is a psychotherapist who went through what she describes as a “harrowing” childhood experience. “I identified as a boy, I wanted to be a boy and I hated being a girl.”
O’Malley believes that if she had been born 30 years later she would have been diagnosed with gender dysphoria, and “would have been the type of kid who would have got on the internet, learned about puberty blockers and become obsessed with obtaining them”.
But her feelings passed with puberty – not overnight, “it was the slow pulling off of a plaster; puberty was profoundly distressing for me” – and today she is happy being female.
O’Malley is concerned that, among the growing cohort of children presenting with gender variance or gender dysphoria, there are some who – if they do not start down the medical route – might eventually choose to stay in the gender they were born with.
“Social transitioning is good, gender fluidity is good, changing your name is fine if that is what the person needs to do. Figuring out your identity and finding yourself I would really encourage,” she says, “even though I know many academics don’t agree with me.”
But she worries that the debate around important issues, such as the effects of medical treatment, is being stifled. “Even people who have devoted their life to studying gender can’t speak freely” about transgender issues, she says, citing claims made by UK academics that their research is being censored, and pointing to the protests outside RTÉ ahead of the Prime Time programme this week.
As a result, she says, we don’t know the long-term effects of a medical journey that begins with puberty blockers and ends with cross-sex hormones and can lead to infertility. (Not all such journeys progress to cross-sex hormones.)
Exploring your gender identity and sexual orientation is “a normal part of adolescence,” says Moninne Griffith. “Nobody is saying that should be pathologised. The majority of young people will explore it, and find out they are cis-gendered [ie, they identify with their birth sex].”
But for those who don’t, the medical route is embarked on only after a long period of self-discovery and self-reflection. “Nobody is marching trans young people down to their GPs for medication. Nobody is telling young people that they’re transgender. In my experience, for the vast majority of young people, by the time they get to that stage of hormone blockers, they’ve been living like that for years, and they’re absolutely certain. It’s typically a very brave person who has done a lot of self-exploration.”
Nobody, she says, is taking puberty blockers or cross-sex drugs “on a whim. There’s not a glimpse of a whim.”
Waiting lists
Waiting lists for medical intervention in this country are so long, says Vanessa Lacey of Teni, that it can be three years from someone disclosing to their family until they get to the stage of taking hormones. In the meantime, “if that child is experiencing chronic gender dysphoria and is constantly binding their chest, and is experiencing self-harm or suicide ideation, we have to try to keep them safe, give them hope and work on their resilience, mental health, coping strategies.
“We try to keep the family together, and keep the child at school, until they get help. It’s a very precarious time in a child’s life.”
Gender variance, or the feeling that your true gender is at odds with the one you were born with, “is not a mental illness,” stresses Dr Aileen Murtagh. The children who end up in her office are the ones for whom “that mismatch between the body they’re assigned at birth and their gender identity causes significant distress in day-to-day life.”
The aim of the service is “to create a space where it’s safe to think about choices”.
“There’s a misperception that most people attending services do want hormones or blockers.” Instead, she says, “only about half of the people coming to us want medical interventions”.
But for “young people who are experiencing very high levels of distress, and whose body is growing in a way that feels really wrong to them”, there is also a risk to doing nothing.
Murtagh adds that while using puberty blockers and cross-sex hormones is “a relatively new treatment . . . and we do certainly need more evidence on the effects of hormones or blockers on the developing adolescent brain,” it is not untested.
Those unknowns – as well as the known risk of infertility of cross-sex hormones – are some of the reasons why clinicians engage in discussions with families, sometimes to the irritation of young transgender people, who accuse medical professionals of acting as “gatekeepers”. Ultimately, the numbers who go on to have full surgery are low.
Open minds
Chris is a writer who believes that if we are to become a society that supports transgender, intersex and non-binary people we must open our minds to the possibility that some of us are neither simply male or female. Chris was born in the 1960s with a female body, but has always identified as male and has never sought any medical or surgical intervention.
Chris gave birth to two children, and is now in a relationship with a “wholly heterosexual” woman. “My partner will tell you I have a completely different perspective on the world.”
Chris believes our rigidly binary notions of gender are forcing children to choose, when some might be happier to embrace “the perfection that you already are. There’s no voice out there going: ‘You can actually live being a duality. You’re fantastic the way you are. You’re amazing the way you are.’”
Young people who feel like they’re “not male or female try to become one of the two binaries out there, because otherwise, where do you fit in? What box do you tick on your passport form? And then there are a lot of people like me going: ‘Why do I have to put my gender on my passport in the first place? Why do I have to put a gender on anything I do?’”
There’s not enough conversation about “the possibility that you can be two things in one body”, Chris says.
Kirsty Donohue understands the arguments in favour of waiting before beginning medical treatment, but says it wasn’t an option for her son.
“If we had made him wait, we may not have our son any more. And I can only speak about our son. Because he’s been supported at home, and by Teni and BeLongTo, and by his school and his friends, he has been able to become the person he is today.
“To have made him wait, to pretend to be somebody he wasn’t, to know the stress of putting on that skirt every day, and to know the damage that’s doing to him – what kind of a parent would I be to make him do that?”
Teni.ie and belongto.org have details of regular peer support for trans people around the country, and of family support groups in Dublin, Waterford and Limerick
Talking about gender: understanding the terminology
Assigned at birth, or assigned sex: the phrase "sex assigned at birth" is seen as more accurate and respectful than "biological sex".
Cisgender or cis: someone whose identity and gender corresponds with their birth sex.
FTM: someone who was assigned female at birth and is now male. MTF is someone who was assigned male at birth and is now female.
Gender dysphoria: a medical term for the conflict between a person's assigned gender and the gender with which they identify.
Gender identity: the gender with which someone identifies.
Gender variance: someone whose gender identity or expression is different from traditional or stereotypical expectations of how that gender should behave.
Intersex: someone born with sex characteristics (chromosomes, genitals and/or hormonal structure) that are not strictly male or female, or may be both.
Non-binary: a person is non-binary if their gender identity is something other than male or female. An umbrella term.
Pronouns: if you're not sure which pronouns someone prefers you to use, ask.
Safe spaces: somewhere a person or category of people can feel confident that they will not be exposed to discrimination, criticism, harassment. In this context, there is some debate over trans women's access to traditionally female-only spaces.
Terfs: trans-exclusionary radical feminists. Used to describe feminists who oppose the inclusion of trans women in women's spaces and organisations.
Transgender: refers to a person whose gender identity or expression is not the same as the sex assigned at birth. Teni advocates this as an umbrella term. There is a full glossary of trans terms at Teni.ie.
This article was edited on January 30th
