Inside Europe's Transgender Medicine System with Róisín Michaux

Irish journalist Róisín Michaux, based in Brussels, presents findings from an undercover investigation into how young people across Ireland and Europe access gender-related medical interventions — online prescribers, cross-border hormone services and clinics in Spain offering mastectomies to minors. For UK readers the picture is instructive: the same informal networks and overseas workarounds that the Cass Review warned were displacing NHS provision operate at considerable scale across the continent, underpinned by a common WPATH-sanctioned framework.

Róisín Michaux is an Irish journalist based in Brussels who has spent considerable time mapping the infrastructure that connects distressed young people to gender-related medical interventions across Europe. In this episode she describes going undercover, posing as a fictitious autistic teenage girl in emotional distress, to document the pathways from online peer communities through to clinical consultations and, ultimately, surgical procedures. Her investigation begins with Ireland, where the national gender service has recently undergone a significant restructuring that has left some young people and their families navigating a more fragmented system. Michaux found that the gap left by reorganised statutory provision is being filled by private online prescribers and by services operating across national borders. Among those she examined are Gender GP, a service called Gender Plus, and an organisation called Imago, which she found was issuing hormone prescriptions to Irish patients from outside the country. What makes these findings particularly relevant to UK readers is the degree to which they mirror concerns raised domestically. The Cass Review, published in April 2024, identified the same structural dynamic: that when NHS England tightened its pathway and closed the Gender Identity Development Service, demand did not disappear but shifted to private providers and overseas services. Michaux's European reporting suggests this is not a peculiarity of the British system but a consistent feature of how gender medicine has organised itself internationally, with the World Professional Association for Transgender Health supplying the framework that legitimises low-barrier and cross-border prescribing. Perhaps the most striking finding concerns surgery. Michaux visited clinics in Spain, including one in Madrid, where double mastectomies are offered to minors. Her undercover approach gave direct access to consultations that would otherwise remain hidden from external scrutiny. She also visited a youth gender clinic in Antwerp, allowing comparison across different national models. The episode includes a detailed account of the WPATH pipeline: the sequence of steps, gatekeepers and referral mechanisms through which young people move from initial self-identification to irreversible procedures. Michaux also documents the role that online communities play in shaping young people's expectations of clinical services. Her account of infiltrating online trans groups records the peer pressure, the sharing of strategies for obtaining diagnoses and the active discouragement of psychotherapeutic alternatives — a pattern directly relevant to UK debate, where subsequent NHS England guidance has moved to require more thorough psychological assessment before any medical pathway is considered. The thread running through the entire investigation is whether systems designed around affirmation are capable of providing genuine safeguarding for vulnerable young people — a question that now sits at the centre of policy in England and Scotland.

The dossier behind this episode

The Cass Review: findings and recommendations

The Cass Review was commissioned by NHS England after serious concerns emerged about the capacity, clinical model and evidence base of the national service for children and young people presenting with gender-related distress. For many years, the Tavistock’s Gender Identity Development Service, usually known as GIDS, was the sole national NHS specialist service in England. Referrals rose sharply and the profile of those referred changed substantially, with a marked increase in adolescent girls and young people with complex mental-health, neurodevelopmental and safeguarding needs.

Read the evidence dossier