A History of Structural Discrimination

Transgender identities deserve recognition and respect, not a medical diagnosis or psychiatric evaluation. In Ireland, the current healthcare model for adult-focused gender-affirming care is structured through the National Gender Service (NGS), a centralised model of care which heavily relies on psychiatric oversight.

The pathologisation of homosexuality as a mental illness historically caused profound harm to gay, lesbian, and bisexual (GLB) communities. From the early 20th century until the declassification of homosexuality as a mental disorder in 1973 by the American Psychiatric Association (APA), homosexuality was regarded as an abnormality, fueling discrimination and stigma that profoundly affected the lives of GLB individuals (B.D. Kelly, 2017; Irish Journal of Psychological Medicine).

Earlier diagnostic guidelines have historically pathologized gender diversity, starting with the inclusion of “transsexualism” in DSM-II (1960s) under categories like “sexual deviations” and “psychosexual disorders” framing gender diversity as a mental illness (Thomas-Castillo and Rush, 2023), and requiring a person to experience significant distress or impairment in social, occupational, or other important areas of functioning for a diagnosis of gender dysphoria as suggested in the latest DSM-V.

Framing gender diversity and transgender identities as mental health issues has similarly led to significant harm, as pathologisation contributes to stigma, discrimination, and negative mental health outcomes for transgender individuals. Until recent years, gender variance was predominantly framed as a psychiatric disorder, a perspective that positioned transgender identities as symptomatic of a mental condition rather than natural expressions of human diversity. This view has influenced medical, legal, and social institutions, creating systemic barriers and negative impacts for transgender people (Drescher, 2010; Beek et al., 2016).

Earlier diagnostic guidelines have historically pathologized gender diversity, starting with the inclusion of “transsexualism” in DSM-II (1960s) under categories like “sexual deviations” and “psychosexual disorders” framing gender diversity as a mental illness (Thomas-Castillo and Rush, 2023), and requiring a person to experience significant distress or impairment in social, occupational, or other important areas of functioning for a diagnosis of gender dysphoria as suggested in the latest DSM-V.

This evolving understanding of gender diversity has led to calls for healthcare systems to adopt an affirming model of care for transgender individuals, focused on informed consent and self-determination rather than mental health gatekeeping. Right now, transgender healthcare in Ireland requires individuals to undergo extensive mental health evaluations to access gender-affirming treatments, such as hormone therapy or surgeries.

This gatekeeping model, which relies on diagnosing gender-identity as a mental disorder, has been criticised for framing transgender identities as pathological and unnecessarily delaying or denying care (Mayer et al., 2023).

Ireland’s healthcare system must evolve to reflect modern understandings of gender diversity and align with international standards. The continued use of psychiatric evaluations as a barrier to gender-affirming care contradicts best practices and reinforces stigma. An informed consent model, rooted in self-determination and bodily autonomy, would allow transgender individuals to access the care they need without unnecessary delays or distress.

We call on policymakers, healthcare providers, and advocacy groups to push for systemic change. Reforming trans healthcare in Ireland requires immediate action. Join the movement by advocating for an affirming model of care, supporting trans-led initiatives, and demanding policies that respect transgender people’s rights to make decisions about their own bodies.

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The table below highlights key commitments regarding transgender rights and healthcare as outlined by leading political parties in their general election manifestos for both 2020 and the more recent 2024 elections.

General Election Manifesto Comparison

Political Party	Manifesto 2020	Manifesto 2024
	Promised to develop a best practice model of care for Trans People in line with World Professional Association of Transgender Healthcare (WPATH) standards of care. Had promised to deliver a framework for the development of National Gender Clinics and Multi-Disciplinary Teams for children and adults, funded by the Acute Hospitals and Mental Health divisions of the HSE based on the 2017 Service Development Model (see: Page 57 of the Election 2020 – Fine Gael Manifesto).	Promises to support the HSE in serving the transgender community and ensure a well-governed, patient-centred clinical model of healthcare for the transgender community (see Page 86-87 of the Fine Gael Manifesto 2024).
	Promised to ensure that services are expanded in an LGBT+ and gender understanding manner (see: Page 46 of the Fianna Fáil Manifesto 2020).	Promised to ensure a gender healthcare service that is based on clinical evidence, respect, inclusiveness and compassion (see Page 55 of the Fianna Fáil Manifesto 2024).
	Promised to extend the Gender Recognition law to trans youth and non-binary persons, and reform our trans healthcare towards an informed consent model (see Page 72 of the Sinn Féin Manifesto 2020).	Promises to implement a new and holistic model of care for gender identity services (see Page 93 of the Sinn Féin Manifesto 2024)
	Promised to increase the availability of support and medical services e.g. hormone replacement therapy, gender confirmation surgery, psychological services, and funding for support groups (see: Page 37 of the Green Party Manifesto 2020).	Has promised to implement a community-based, person centred model of trans healthcare, ensuring universal access to evidence based care. Our policy will be guided by the World Professional Association for Transgender Health (see Page 74 of the Green Party Manifesto 2024).
	Promised to improve access to healthcare for people who are transgender, and amend the Gender Recognition Act 2015 to address shortcomings, such as lack of recognition of non-binary identities (see: Page 29 of the Labour Party Manifesto 2020).	Promises to improve access to trans healthcare by ensuring timely, inclusive, and affirming services by introducing a model of gender-affirming care in primary care settings, grounded in informed consent and international best practices. They pledge to secure legal recognition for trans parents by amending the Assisted Human Reproduction Act and reforming the Children and Family Relationships Act, and reform the legal gender recognition system, aligning it with the recommendations of the Review of the Gender Recognition Act 2015 (see Page 89 of the Labour Party Manifesto 2024).
	Promised to implement recommended amendments of the Gender Recognition Act to provide legal gender recognition to non-binary people and trans people under 18, and develop national trans health services to provide an informed consent model of trans healthcare, providing access to hormone prescriptions from GPs (see Page 104 of the Social Democrats Manifesto 2020).	Have committed to amending the Assisted Human Reproduction Act and reforming the Children and Family Relationships Act to ensure equality for children of LGBTQI+ families and full legal recognition for transgender parents. They pledge to implement the recommendations of the Government’s review of the Gender Recognition Act, enabling legal gender recognition for non-binary individuals and trans people aged 16 and older. In addition, the manifesto includes plans to legislate for the protection of intersex rights, including a ban on infant genital mutilation, and to end harmful conversion practices. Central to their healthcare reforms is improving access to trans-affirming healthcare based on an informed consent model aligned with international best practices. They also aim to review healthcare provision for intersex individuals to ensure the nationwide implementation of best practices (see Page 84 of the Social Democrats Manifesto 2024)
	Promised to extend the Gender Recognition Act to those aged from 16 to 18, and include a third gender option for non-binary people on all official forms. Provide free gender care through an Irish NHS, including services like psychotherapy, counselling, speech and language therapy, hormone therapy, hair removal and gender reassignment surgery (see Page 34 of the People Before Profit Manifesto 2020)	Has promised to ensure that transgender and non-binary people have publicly available, accessible, and high-quality free healthcare services in line with best international standards. Introduce a progressive gender-affirming care based on an informed consent model of healthcare (see Page 15 of the People Before Profit Manifesto 2024)

As can be seen, commitments to transgender healthcare and legal rights have increased in some political parties, while they have declined in others. To deepen understanding of these qualitative statements, thematic analysis was conducted in accordance with Braun and Clarke’s (2006) guidelines. This involved a deductive approach to coding, identifying recurring patterns across the statements, and refining these themes to distill key insights. The analysis was facilitated using an open-source qualitative data analysis (QDA) software package QCoder (Duckles et al., 2024).

The resulting themes were further organised into clusters to reveal overarching patterns and trends in the manifestos. These clusters were then analysed to compare party-specific emphases, track changes in commitments over time, and highlight the relative prominence of various issues within each manifesto. By visualising these trends, the analysis provides a clearer understanding of the evolving political landscape and the specific priorities of different parties regarding transgender rights and healthcare.

Thematic Overview of General Election Manifestos

The thematic analysis of political party manifestos from 2020 and 2024 reveals both continuity and change in commitments toward transgender rights and healthcare. By examining shifts in thematic clusters across these two timeframes: Conversion Therapy Bans and Ethical Practices, Equality and Rights Advocacy, Holistic and Inclusive Healthcare, Legal Reforms and Policy Updates, and Social Inclusion and Public Protections – this analysis highlights evolving priorities and significant differences in approach, and is intended to provide a comprehensive overview of where each political party currently stands on key issues affecting the transgender community and its allies. This overview aims to equip voters with critical insights into the alignment of party policies with the needs of the LGBT+ community, fostering informed decision-making in the upcoming general election.

While this provides a thematic overview of where each political party currently stands on key issues affecting the transgender community and its allies, readers are strongly encouraged to review each party’s most recent manifesto themselves. Doing so will ensure they are fully informed and can make educated decisions about the political parties that best aligns with individual persons values towards the rights and well-being of transgender and gender-diverse people.

Sources

Kelly, B.D., 2017. Homosexuality and Irish psychiatry: medicine, law and the changing face of Ireland. Irish Journal of Psychological Medicine, 34(3), pp.209-215.

Thomas-Castillo, M. and Rush, S., 2023. De-pathologizing gender identity: Psychiatry’s role. Current Psychiatry, 22(5).

Drescher, J., 2010. Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the Diagnostic and Statistical Manual. Archives of sexual behavior, 39, pp.427-460.

Beek, T.F., Cohen-Kettenis, P.T., Bouman, W.P., de Vries, A.L., Steensma, T.D., Witcomb, G.L., Arcelus, J., Richards, C., Elaut, E. and Kreukels, B.P., 2016. Gender incongruence of adolescence and adulthood: Acceptability and clinical utility of the World Health Organization’s proposed ICD-11 criteria. PLoS one, 11(10), p.e0160066.

Mayer, T.K., Becker-Hebly, I., Elaut, E., Heylens, G., Kreukels, B.P. and Nieder, T.O., 2023. Desired decision-making role and treatment satisfaction among trans people during medical transition: results from the ENIGI follow-up study. The Journal of Sexual Medicine, 20(6), pp.893-904.