There’s no right or wrong way to be trans or transition. Some people decide that medical transition is the best thing for them – for others, it isn’t a necessary part of the process. It all depends on how you feel about yourself and your body: only you can make the decision that is right for your life. Unfortunately, it can be quite difficult to access gender-affirming healthcare in Northern Ireland for a number of reasons.
Details on accessing public and private healthcare options can be found below:
Public Options (NHS Pathway)
Accessing gender-affirming healthcare in Northern Ireland has been quite difficult, in particular over the past 5 years. For a period of 2-3 years, the adult Gender Identity Clinic (the Brackenburn Clinic) stopped accepting new patients, creating a backlog both within that service and having knock-on effects on other services including the under-18s Knowing Our Identity (KOI) clinic.
The Rainbow Project, alongside our partners across the LGBTQIA+ sector, has been working to improve access to gender-affirming healthcare for all trans people in Northern Ireland. There is currently a review underway looking at improving and streamlining gender identity service pathways, so any information provided within this section is liable to change over the next year or two. You can find some information regarding this review below:
- Outline of the Gender Identity Service Pathway Review Group
- Objectives for the Gender Identity Service Review
In this section, we will cover the pathways for accessing gender-affirming healthcare in Northern Ireland, the public and private services that are available to you, as well as some information on your rights and what to expect when you’re accessing these services.
Under 18 Years Old
The main public health service in NI for trans and gender diverse people under 18 to access gender-affirming healthcare is the Knowing Our Identity Clinic, based in the Beechcroft health centre. This Clinic accepts referrals from anyone under the age of 17 ½ – if you are approaching your 18th birthday you may be referred to the Brackenburn Clinic, discussed in a different section.
NHS Pathway
- Contact your GP and request a referral for gender-affirming healthcare. Your GP may ask you a series of questions in order to fill out a referral form to get the process started. You can have someone, including a parent/guardian or other support, in this appointment with you.
- Your GP will refer you to the Children & Adolescent Mental Health Service (CAMHS) for assessment and further referral to the KOI service. If you are already accessing CAMHS for other reasons, you can speak directly to your CAMHS worker instead of going to your GP.
- You should receive ongoing assessment and support from CAMHS before accessing KOI – the time spent within this service varies from person to person and maybe longer than usual due to staffing issues in KOI and the backlog in the adult Gender Identity Service.
- Your CAMHS worker should refer you to KOI when they are satisfied you fulfil the criteria for accessing the service.
- When in KOI, you should receive ongoing assessment and support with your transition, both in terms of your social transition as well as accessing healthcare intervention. KOI can provide counselling, family & peer support, and support with your mental health. KOI patients should also be able to access hormonal treatments from age 15 and above, following assessment.
NOTE: due to ongoing issues within these services, as of the time of writing, KOI has suspended the provision of puberty blockers and hormone replacement therapy to any new patients referred. We are working with them to urgently resolve this issue and ensure that every trans young person can access the care they need.
In terms of the care you can expect to receive in KOI, you and your family should be supported through talking therapies and exploratory work to fully understand your identity and choose the right path for yourself. There are referral pathways for services including the fertility clinic for fertility preservation, however, places are quite limited and these pathways are currently under review.
Over 18s
The main public health service for trans and gender diverse adults to access gender-affirming care is the Brackenburn Clinic, based in the Knockbracken Healthcare Park. The Clinic accepts referrals from anyone over the age of 17 ½ – if you are a trans child or young person you can access KOI, discussed in a different section.
NHS Pathway
- Contact your GP and request a referral for gender-affirming healthcare. Your GP may ask you a series of questions in order to fill out a referral form to get the process started. You can have someone, including a friend, advocate or other support, in this appointment with you.
- Your GP should refer you directly to the Brackenburn Clinic. Make sure your address is correct on your GP records, as you may be contacted by letter in order to opt-in to the service. This is done by calling the number on the letter or email you receive to confirm that you are interested in accessing care from Brackenburn.
- When you reach the top of the waiting list, you will be called forward for an initial assessment to ascertain what kind of support you require, including social support and medical intervention.
NOTE: Due to staffing issues and a breakdown in the service which has recently begun to be addressed, the waiting list is currently quite long, with many people have been on the list for 3-4 years. We are working hard with the Department of Health, Belfast Trust and Health & Social Care Board to improve this and ensure timely access to appropriate care.
Our sector partners TransgenderNI created a resource for people accessing Brackenburn to understand what they should expect, including the questions that may be asked and the care you may receive. You can find that resource here.
In terms of the care you should expect to receive, Brackenburn should refer you to other specialities for support with your transition following assessment and diagnosis. The services available include:
- Endocrinology support (Hormone Replacement Therapy)
- Gender affirmation surgeries
- Speech and language therapy
- Fertility preservation (subject to availability)
- Talking therapies and mental health support
Private Options (External to NHS)
There are several options for accessing gender-affirming healthcare privately. Due to the crisis in the gender-affirming services here in Northern Ireland, these options are quite popular, however, accessing them can lead to issues in your journey through Brackenburn or KOI.
Unfortunately, patients enrolled in KOI services will be discharged if they access private healthcare services. This is despite the fact that KOI is currently refusing to provide hormone treatment to any patients referred after March 2020. This may change as a result of the Gender Identity Service Pathway Review, however, it’s important to be aware of when considering your care options.
Patients enrolled in the Brackenburn clinic are not immediately discharged for accessing private services, and recently there have been indications that they are willing to move people from a private to public prescription with very little fuss. However, due to a lack of communication with LGBTQ+ communities, we cannot guarantee this is the process taken with every individual in the service.
For those who are not current patients of either Brackenburn or KOI, private care can be an appealing option as it is usually a much quicker and easier way of accessing medical transition, avoiding the long waits and often invasive assessment that accompany public services. However, it is important to be aware of the hidden costs of private care, including ongoing blood testing (GPs in Northern Ireland usually refuse to help with this) and, depending on the type of hormone, safe injection processes.
Options for accessing private care include:
All of these services are based in Britain or are online providers.
All these providers have different processes, pricing structures, and requirements for accessing their services. While we can’t answer all your questions about these providers, you should be able to find most information on their website, including pricing, reviews, and information on how to access support or ask more questions.