The scale of referrals of patients with gender identity disorders to two Dublin hospitals for hormonal treatment confirms that the relatively rare condition exists in the Irish population to a significant degree, according to a new study.
The study reviewed referrals to the single department of endocrinology based across St Columcille's Hospital, Loughlinstown, and St Vincent's University Hospital over a five-year period and found 52 patients sought treatment over that timeframe.
Some 45 of the patients had male to female gender identity disorder and seven had female to male gender identity disorder.
The review noted that 23 of the patients had received hormonal treatment without medical review before attending the Dublin hospitals. A number had obtained the treatment over the internet. Some 18 of the patients have been or are married and 14 of the group have children.
The authors of the review published in the Irish Medical Journal said: "The fact that a significant number of this cohort have either been married or have children seems initially surprising.
"This probably reflects the efforts these individuals make to deny or repress the effects of the condition. It also underlines the importance of early assessment, evaluation, diagnosis and treatment intervention."
They also said the familial status of the patients "greatly complicates treatment modalities from a psychological perspective, and there are no simple resolutions to this complex issue. Accurate and early diagnosis of gender identity disorder may well avoid the situation of spouse and children being so prevalent."
The patients were referred between the years 2000 and 2004, having been diagnosed by a mental health professional. They came from all four provinces: 30 from Leinster, 17 from Munster, four from Connacht and one from Ulster. The mean age for men was 38 years and for women it was 30 years.
"The age at presentation in this group is approximately nine years older than in international studies . . . this is likely to reflect the cultural barriers to personal acceptance of the diagnosis in Ireland, also the absence of a pathway of care for this patient group in Ireland, leading to later interaction with the health service. Over half of the patients had experienced significant difficulties accessing any health services related to the condition.
"Some of our patients have travelled independently overseas to obtain surgeries, at significant financial cost, that they felt were unavailable to them here," the report said.
It added that the scale of referrals gives some indication of the true prevalence of the condition in Ireland for the first time. It says the Irish College of Psychiatry and the Royal College of Physicians of Ireland should work together to ensure a safe, accurate and efficient management pathway is established for them.
Dr Donal O'Shea, a consultant endocrinologist and one of the study's authors, said patients with gender identity disorder would also be seen in smaller numbers at some other hospitals across the State.
He said the patients could have simple surgery in the Republic, but for final sex reassignment surgery they would have to travel abroad. Gender identity disorder was, he said, "a devastating condition" and those with it needed to be able to access the right support services. This did not require any capital investment, he stressed.