A key element of developing the new HSE Model of Care for Gender Healthcare, as with any Model of Care, is evaluation of the evidence base. This work is supported by HSE National Library Services.

Evidence base is a term that encompasses many elements:

• Clinical research such as clinical trials or epidemiological studies.
• Audit data.
• ‘Grey literature’

‘Grey literature’ refers to clinical data that may have been generated but not published. For example, it may have been presented at an academic conference but not published. As it has not been published, it has not been put through a peer review process and so should be interpreted with caution.

A peer review process is the standard process used to inform decision making for scientific publications. Peer review involves an assessment by colleagues in a relevant field of expertise. The goal is to advise the editor of the specific academic journal if the academic paper is of sufficient quality to warrant publication.

Peer Review should be via independent individuals with expertise in the area. They should not be connected to the decision-making body or those who have prepared the material being reviewed.

In the development of the new HSE Model of Care for Gender Healthcare, we have begun our review of the evidence base with two initial questions in mind (additional clinical questions may arise as our work proceeds):

What are the clinical outcomes of medical transition?

1. A review of the evidence base is planned with respect to known clinical outcomes in medical transition: details on this systematic review are registered on PROSPERO (crd.york.ac.uk/prospero) under registration number CRD42024596567
2. This work is underway, with the support of the HSE Library Service.
3. Interim results of this systematic review will be made available for public review.
4. Details on this public consultation will be advertised on this webpage.
5. In this public consultation, if members of the public feel that an important academic paper, that has been published in a peer reviewed journal, has been omitted, there will be an opportunity to submit it for consideration.
6. Any submitted papers will be reviewed in line with the inclusion and exclusion criteria in the PROSPERO registered protocol: please see crd.york.ac.uk/prospero under registration number CRD42024596567

What clinical needs are known to exist in the population that are attending, or may attend, gender healthcare services?

1. To answer this question, we have been reviewing the evidence base with respect to co-existing clinical needs in gender diverse people with support from the HSE Library Service: this is registered as a systematic review on PROSPERO (crd.york.ac.uk/prospero) under registration number CRD42024596562
2. Interim results of this review were made available for public consultation during the month of August 2025.
3. During the consultation, members of the public submitted material that they believe to be important to consider in our review of the evidence base.
4. All submitted material will be reviewed.
5. Academic papers, that have been published in a peer reviewed journal, will be considered for inclusion in line with the inclusion and exclusion criteria in the PROSPERO registered protocol: please see crd.york.ac.uk/prospero under registration number CRD42024596562.
6. The results of the evidence base review will be considered in the development of the new HSE Model of Care for Gender Healthcare, and will be made publicly available.

As this work progresses, we will be updating this page with our findings.