The country’s leading doctor who helps transgender people change their sex is now supporting three patients who regret having surgery.

Professor Donal O’Shea has told Extra.ie that their trauma highlights the need for proper support and resources to prevent post-operative remorse.

This country has a high rate of adults who regret treatment, he said.

Sixty adults have travelled abroad for sex-change operations since 2012, according to the HSE, and we can reveal that 40 Irish teenagers who have questioned their gender identity are getting treatment in the UK — a five-fold increase in four years, according to the British Clinic that treats them.

Meanwhile, two of the three people who Prof O’Shea is helping to deal with post-op regret are going through the ordeal of reversing their sex-change. Prof O’Shea, consultant endocrinologist at St Vincent’s and St Columcille’s Hospitals in Dublin, said that while data is difficult to compile, he believes the level of regret in Ireland is higher than it is internationally.

While some transgender support groups do not wish to highlight the number of people who suffer from post-operative regret, Prof O’Shea believes it is important that people be made aware. He said three transgender people have died by suicide in the past five years, two had surgery and one was on hormone therapy.

‘We need to be able to quantify the risk for people. If there were better psychological supports for transgender people and those who have surgery, the outcomes might have been different, but you can never say for ure,’ he said.

‘The real conflict in this profession is seeing someone who makes a very positive transition, and that’s a humbling and amazing thing to see, and then at the other end, you also see some devastating outcomes. We are trying to come up with a situation where there is the least harm, but we cannot mitigate against all harm unfortunately,’ he said.

‘The worst outcomes I have seen are those who have transitioned who have said “Oh dear, what have I done” and in some cases “Why did you let me do that?” Transitioning needs to happen at a pace that is appropriate for the individual and that the diagnosis is absolutely correct,’ he stressed.

Prof O’Shea specifically referred to one earlier case where a man in his late 30s ‘desperately’ sought hormone treatment and surgery. The professor advised against it, as he believed the patient had other issues that needed to be explored, but the patient sought treatment abroad, outside of the scheme funded by the HSE. He returned a year later, saying ‘I have made a terrible mistake’ and was referred St James’s hospital for the removal of both breast implants.

He was later placed on testogel, or testosterone, and is receiving ongoing psychological support.

‘The experience of those who suffer from post-op regret and those who die by suicide highlights the need for resourcing and ongoing psychological and psychiatric support, and the need for input through each stage,’ he said.

He said the death of patients by suicide has a profound impact upon him and staff at the centre. ‘It is very difficult. When you see someone who is doing very well and then hear that they are dead, it’s halting, it knocks you in your tracks, and affects everyone, all the medical and administrative staff here who have come to know these people over a period of time.

‘A patient, by their very nature, is vulnerable, and those with gender issues are particularly vulnerable, and you have to protect the most vulnerable among your vulnerable.’ Stephen O’Hare, chief executive of TENI (Transgender Equality Network Ireland) said it was ‘continuously engaging with the HSE to seek improvements in services and welcome new posts, but we feel additional services and more work needs to be done, including improving access to services’.

A previous TENI study showed a high rate of mental health issues and suicide ideation among trans. It found that 78pc of trans respondents had thought about suicide, with 63pc of respondents saying they thought about attempting suicide within the past year.

Dr Andrew Jordan, head of the National Association of General Practitioners, said that some GPs are seeing an increase in children questioning their gender identity and there is a dearth of HSE information.

‘It would help to have one dedicated centre for transgender issues and that it would be properly resourced,’ he said. There is no clear pathway outlined for young people. This is a real issue and it’s here, no matter what people’s views are.

‘If you don’t deal with it in a complete way and address it, we are running the risk of leading young people towards anxiety, depression or self-harm. You don’t want to lead them down the wrong path and inadvertently lead them towards mental health issues, exacerbated by issues they are already dealing with. There is a lot at stake here and not a lot of back-up. People can change their minds and need to be fully informed along the way,’ said Dr Jordan.

An issue of contention for the transgender community and support groups is the need for a psychiatric assessment before a person can progress to surgery. Fianna Fáil TD Niamh Smyth has questioned in the Dáil why a requirement of psychiatric diagnosis for necessary, as she said it is ‘viewed as offensive by the transgender community.’

But Minister Catherine Byrne said that ‘informed consent is essential’ and international best practice involves an assessment by a multi-disciplinary team.

‘Although regret rates are low, it can happen and can also lead to high levels of psychological distress,’ she said. Prof O’Shea said the need for psychiatric and psychological assessment is multi-fold.

‘People who have true gender dysphoria from a young age don’t feel the need for psychiatric intervention and feel it’s a heavy-handed [measure], but for every one of those, there is another case where it is not straightforward and it’s not easy, and the transition may not deliver what the individual was hoping for.

‘They’re disappointed, as they thought there would be more of a lightbulb moment, and if you don’t have that input you will have regret and a really bad outcome.

‘Additionally, there is a risk after surgery when people bump into friends from their previous life, and it’s a very common trigger for suicide. If you are working with a psychiatrist and a psychologist, you will be prepared for that.’