The Health Service Executive has defended its relationship with the Tavistock clinic in the UK, which provides psychological assessment and support for children with gender identity issues.
The clinic provides help to children and teenagers struggling with their gender identity, some of whom go on to be treated with hormone blockers under the supervision of their doctors.
In some cases the clinic recommends the prescription of puberty blockers, which put a pause on puberty, while a young person thinks about their gender identity.
Over the past number of years the HSE has been referring Irish patients to the service, with 238 children being referred since 2015.
A review was carried out into that service in the UK by Dr Hilary Cass, after whistleblowers alleged that the clinic was failing to give sufficient weight to patients' mental-health history.
Dr Cass found that that the Tavistock clinic needed to be transformed.
In an interim report she said the current model of care was leaving young people "at considerable risk" of poor mental health and distress and having one clinic was not "a safe or viable long-term option".
She recommended a more diverse, regional service with strong links to mental health services.
The HSE is continuing to refer patients to Tavistock, despite concerns being raised by senior clinicians in Ireland.
Dr Paul Moran, a psychiatrist working with the National Gender services, which treats people over 16, has been raising concerns about the HSE's relationship with the Tavistock clinic.
He said: "We have been aware even before 2019 that there were problems with the quality of the work being done by the Tavistock with Irish children, we were seeing children who were clearly not ready to be put on hormones who had numerous other problems that clearly were not being addressed and when saw these children coming through we had to raise our concerns and we had a meeting with Crumlin hospital to highlight this."
National Clinical Director for Integrated Care within the HSE Dr Siobhán Ni Bhriain said: "The service has not been deemed not safe, because if it was deemed completely unsafe it would have closed immediately, that's the first thing.
"The second thing is the Tavistcok will keep open for another year or so until the regional units are developed in the UK and increased numbers of people with the skills to deliver care to these children.
"So, we will continue to refer while Tavistock is still open, we will monitor extremely closely and we have for quite a number of years been exploring other options."
Meanwhile, the HSE said that its goal it is to set up a service in Ireland, but it said it has been unable to recruit a child psychiatrist, despite advertising the post a number of times.
Dr Ni Bhriain said: "We don't have a specialised psychiatric service for children with gender dysphoria, what we do have is community consultant adult mental health service teams who are able to do an initial assessment, and who would be able to assess many of the problems that these children may have.
"If children present to their GP with gender dysphoria they can be referred to their locals CAMHS service or to primary care psychology and if the CAMHS service is concerned they will refer on to Tavistock."
Senior clinicians within the HSE have now called for an investigation to be carried out by the Minister for Health into the use of the Tavistock clinic by the health service in Ireland.
Dr Moran said: "I don't think the HSE itself can investigate its own problems. I think it should be the department of health. I think the Minister for Health should take an interest in this and look carefully at it."
