Concerns being voiced around the HSE's National Gender Service are not being listened to, one doctor has said.
Endocrinologist Professor Donal O'Shea told Newstalk Breakfast those working in the service are pro-trans and pro-transitioning, but proper assessments must be carried out.
"There's been an explosion in gender questioning and that means we need to be careful before we just say, 'It's fine to go on hormones' without proper assessment," he said.
"The bottom line is that we are pro-trans and we are pro-transitioning in a positive way.
"If you just say 'Yes' to everyone who wants to go on hormones... without looking in some detail at the other health-related issues that are going on, then you will end up with the disasters that we saw in Tavistock.
"We said, 'Stop the Tavistock link', the HSE persisted with it until Tavistock closed... and then a couple of weeks ago we find out that they've established the same kind of links with a clinic in Antwerp that is at least as bad as Tavistock - most likely worse."
'Idology cannot direct clinical care'
Prof O'Shea said he has concerns for a position advertised for a HSE Clinical Lead for Transgender Services.
"Every other HSE lead it demands that you have been working in the area," he said.
"This HSE lead position requires that you have a special interest in the area; that could be just an ideological interest, which seems to be pervasive in senior levels in the HSE.
"Ideology cannot direct clinical care."
'Politicians are cancelled'
Prof O'Shea claimed his concerns on the issue are being silenced.
"Every time I've gone with something obesity-related they listen to your opinion and you guide clinical care in line with international best evidence," he said
"Here, every time we've gone along to say, 'This isn't safe', we've been told, 'Stop saying that'.
"None of our concerns have been addressed; they've just said [to] stop speaking about it.
"Politicians are cancelled - I've had party leaders say, 'No, no we can't talk about this or we'll be cancelled'.
"When clinical care is being directed by ideology, then you've got a problem.
"At a senior level... the HSE is not listening to our advice, I've been working in the area since 1996, I've seen the changes.
"I know how this needs to be done - that's how we are doing it in the adult service - but senior people in the HSE are funding a path to Antwerp that is at least as bad as Tavistock," he added.
HSE response
In a statement, the HSE said it's goal is to "develop a person-centred model of care and invest in an integrated service that meets the needs of transgender people in Ireland.
"The HSE is establishing a team to lead the development an updated model of care for the treatment of gender dysphoria following the HSE’s thorough, consultative and clinical review of the Interim Cass Report," it said.
"The HSE is currently advertising for the post of Clinical Lead for Transgender Services.
"Under EU Directive 2011/24/EU the HSE must inform patients of their rights to access treatment under the Cross Border Directive. This is an EU regulation we must adhere to.
"The HSE wrote to patients on the Treatment Abroad Scheme waiting list for Tavistock services advising them of their rights to access healthcare under the Cross Border Directive, if eligible, and also advising that such third party providers are not part of the HSE.”
