One psychiatrist says he is 'shocked' that the HSE is to keep sending Irish children to the Tavistock clinic in the UK.
The facility provides psychological assessment and support for children with gender identity issues.
This comes despite a UK review finding the clinic was leaving young people 'at considerable risk', while the British health service has also confirmed it will decentrailise services.
Dr Paul Moran is a psychiatrist working with the National Gender Service.
He told Newstalk Breakfast: "We have been raising concerns for some years about the Tavistock.
"We've been seeing the children, who the Tavistock have recommended starting on hormones, be very unwell and not ready to start hormones.
"It has led to further harm.
"We've seen their mental health being very poor, dropping out of school, self-harming and have substance problems.
"Clearly the assessments done were completely inadequate".
Dr Moran says he was 'shocked' the HSE will continue referring patients.
"When I heard Dr [Siobhán] Ní Bhriain say that she found no evidence that the clinic was unsafe, it was unbelievable.
"The evidence is overwhelming, and has been there for years."
He says an internal review, conducted by then-governor Dr David Bell, found it was unsafe.
"He resigned in 2019 because no action was taken", Dr Moran explains.
And he suggests any problems for patients are unlikely to emerge yet.
"If there are going to be problems, we would not see them yet.
"These children are still quite young, and it's too early for them to realise that they will never be able to have families and the health problems that can be linked with these treatments".
He says Irish reports seem to be focusing on the wrong issues.
"So far the narrative has been incorrect: it has been just about de-centralising the service.
"In fact if you read the report, it's about the safety of the service - and particularly the lack of evidence for safety of these blocker drugs that they're being given.
"They found no evidence of safety or benefit".
