THE ELIGIBILITY OF transgender women under the free Hormone Replacement Therapy (HRT) scheme has sparked significant confusion among pharmacies.

The Journal has spoken to several trans women about their experiences with the scheme. They report inconsistent approaches from pharmacies, with some trans women granted free HRT under the scheme, while others are denied.

The Irish Pharmacy Union has confirmed to The Journal that they are seeking clarity on the issue from the Department of Health.

A spokesperson for the organisation has said that “there has been some confusion in practice as to the eligibility of certain prescriptions”.

This is because some HRT medications, which are used to relieve symptoms of menopause, perimenopause and postmenopause, can also be prescribed to transgender people as part of gender-affirming healthcare.

For those who have had an orchiectomy, HRT can be the sole source of their hormones, making it incredibly important to their ability to function normally.

The legislation which gave power to the free HRT scheme does not specifically exclude transgender women from the scheme.

Instead, it states that “women who are ordinarily resident in the State and have been prescribed menopause products by a registered medical practitioner…and who are supplied with the menopause products from a pharmacy provider shall not be charged.”

Adding to the confusion, the Minister of Health, Jennifer Carroll MacNeill, was asked in March by People Before Profit TD Paul Murphy whether trans women would be eligible under the scheme.

But the Minister did not provide a clear answer, instead stating that the scheme covers HRT products “which have been prescribed for the purposes of alleviating the symptoms of menopause”.

A spokesperson for the Department of Health echoed this statement when asked by The Journal.

But many in the trans community argue that some of them do experience the same menopausal symptoms as other women if they stop taking HRT.

They also argue that, as they have prescriptions for the same medicines as on the prescribed list, they should be entitled to access free HRT under the scheme.

‘We are used to fighting for everything’

The lack of clarity on the situation is leading to inconsistencies among pharmacies in their approach to transgender women seeking HRT under the scheme.

The Journal has heard from several transgender people about their experiences with pharmacists.

Niamh*, a trans woman living in Dublin, was denied free HRT under the scheme in June and again in July.

She told The Journal that as she is post-orchiectomy, she should be covered under medically induced menopause – something that is specifically outlined in the legislation.

But when she asked the pharmacy if she was covered, she was told that because the products weren’t being used to treat menopause, the pharmacy wouldn’t be reimbursed.

“Going off HRT would literally be dangerous for me,” Niamh said. She added that while she can afford to pay for it, others can’t, which is why the scheme was introduced in the first place.

Confusingly, another trans woman who spoke to The Journal said that she has been able to access her prescription for free under the scheme from the very same pharmacy.

Caoimhe, a trans woman from Cork, also told The Journal that she has also been forced to pay for HRT like before since the rollout of the scheme.

Like others we spoke to, this HRT is “medically necessary” in her case. But when she asked if she would be covered under the scheme, her pharmacy was unsure and didn’t seem to have a clear answer.

“Without trying to be too critical of them, they were signed up to the scheme, but they didn’t seem to have the clarity as to whether I was eligible or not,” she said.

Caoimhe said that having to ask to even be considered under the scheme is “utterly exhausting”.

“We are used to fighting for everything”, she continued, “this is what we’re used to, and it’s disappointing.”

“Unclear guidance from the Department of Health is creating unnecessary confusion and placing barriers in the way of equitable care,” a spokesperson for the Professional Association for Trans Health Ireland told The Journal.

They added that pharmacists are “ready and willing” to provide free HRT to trans women under the scheme, but “they need confirmation from the Department of Health that trans people are included in the scheme.”

They called on the Department to address the confusion, adding that “trans people should be included without ambiguity”.

A spokesperson for the Department told The Journal that “there are no plans to expand the eligibility of this measure at this point.”

The HSE also referred to the Department of Health for comment.

*Name has been changed

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Conor O’Carroll is an investigative reporter with The Journal Investigates.

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