To much excitement, and some confusion, the Medical and Healthcare products Regulatory Agency (MHRA) in the UK announced plans to make Hormone Replacement Therapy (HRT) available over the counter. This, initially, seemed to confirm what trans people have been saying for years: That there is no legitimate reason or science behind the torturous gatekeeping of HRT. This affirmation was quickly dashed when we got more details; this change was to treat menopause only, and specifically pertained to oestrogen taken vaginally.
There are two sides of the rope being tugged here: the ideological aversion to trans people having the individual autonomy to live their lives and affirm their gender, and the want to reduce the harms this anti-trans ideology has on cis people. The rope can be pulled in either direction, but no matter which side is pulled the other side gets pulled along with it: you cannot denigrate trans people without also stepping on people struggling with menopause, polycystic ovary syndrome (PCOS), endometriosis, etc. Conversely, you cannot support these people medically without the absurd anti-trans nature of the provision of gender-affirming healthcare in this country becoming blatantly (and viciously) obvious.
As it currently stands, according to the National Gender Service (NGS), the waiting list for an initial assessment is between two and a half to three years, and even before you get added to this shockingly long (and growing) waiting list you must convince your GP to send the NGS a referral form, which can be an insurmountable task in and of itself. And after all this upheaval and waiting, trans people are subjected to invasive psychological assessments to determine if they meet the health service’s definition of “Gender Dysphoria”.
This decision by the MHRA attempts to pull the rope in both directions. Trans people are suffering for no tangible medical reason as life-saving gender-affirming services, such as HRT, are locked away down a several years-long timeline. Things don’t have to be this way. By making HRT available over the counter for all those who need it and not a select few, the NGS can focus its resources on mental health supports for trans people & surgical interventions for those who need it. Waiting times would be slashed as people gain access to one of the most in-demand services offered by the NGS (although this shouldn’t act as an excuse to cut or stagnate funding to the NGS, which will still suffer from the pains felt across the Irish healthcare system).
This country should stand by its bold claims of being progressive on trans issues and do something ground-breaking by making HRT available over the counter.