Guide To Supporting Patients Accessing Specialist Gender Identity Services
Managing the care of gender variant children and young people is highly specialist expert practice and the Tavistock and Portman clinic accepts referrals directly from GPs (see Section 4.5). However, as with adults, GPs have an important role to play. Most of the advice in this guide will be relevant to children and young people. However, there are some significant differences.
Cross-gender play and other expressions of gender variance in childhood are normal aspects of human development that will often never come to the attention of GPs. However, parents may consult GPs when a child’s gender development is atypical and/or when a child is expressing unhappiness, distress and anxiety. This may be accompanied by being withdrawn, self-harming or there may be accounts of bullying and exclusion at school. There is emerging evidence that trans young people are especially vulnerable to suicide and self-injury.
Findings from the Risk and Resilience Explored Study
- Trans young people were nearly two times more likely (48.1% of all young trans participants) to have attempted suicide in their life compared to non-transgender peers in the study (26.2%)
- In the past year, trans young people were over four times more likely to have attempted suicide (29.8% vs. 7.2%) and over two times more likely to have thought of suicide (59.3% vs. 27.1%)
- In the past year, trans young people were nearly three times more likely to have self-harmed (59.3%) than their non-transgender peers in the study (22.1%).
Children can be self-aware of gender variance at an early age. One small study (n=121) of adult trans people reported that 76% knew they were gender variant before they left primary school, but many lacked a language for this until later and were anyway discouraged from talking about their feelings 6. Emerging US research reports that the gender identity of trans children is “deeply held and is not the result of confusion about gender identity or pretence” 7. However, families have reported misunderstanding, barriers, hostility and stigma when trying to get help and support for their children experiencing gender dysphoria. One mother’s moving account in response to hysterical and misinformed media reporting about ‘sex-swap drugs for nine-year-olds’ sets out the issues and is worth reading in full.
There are some important factors to consider in relation to gender variant or gender questioning children and young people.
- As appropriate to developmental maturation, children and young people may express their feelings of gender variance differently from adults. They may be reluctant to confide in adults or may even lack a language to discuss this, being able only to say that ‘something’s wrong or different’. A careful, sensitive and age-appropriate approach will be needed to build rapport and explore the issues. However, even very young children can articulate transgender feelings
- The available treatment options for children and young people are different from those of adults, and GPs can help prepare families accessing SGIS and manage expectations. You can find information about this in Section 4.5.
- Families will also be involved in the care provided. They may also need support, as well as understanding how they can best support the young person. You can find information about local and national sources of support in Section 6.
GPs can play a major role in enabling young people and their families to get timely advice and support while they work out what is the best way forward and access medical services when needed.
Introduction Guide Home Page
Section 1.0 About This Guide
Section 1.1 Why This Guide Is Needed
Section 1.2 Current Context
Section 2.0 Developing Understanding About Trans People
Section 2.1 New Thinking About Gender
Section 2.2 About Trans Identities
Section 2.3 About Gender Pronouns
Section 3.0 High Quality Services for Trans People
Section 3.1 Getting It Right
Section 3.2 A Special Note on Children and Young People
Section 3.3 A Special Note on Screening: Screen for the Organs Present
Section 4.0 Understanding the Patient Groups
Section 4.1 Understanding Specialist Gender Identity Services
Section 4.2 The Approach to Treatment
Section 4.3 Treatment Protocols
Section 4.4 Available Treatments - Adults
Section 4.5 Available Treatments - Children and Young People
Section 4.6 The Role of the GP
Section 5.0 Changing NHS Records
Section 5.1 Information Sharing - The Gender Recognition Act 2004
Section 5.2 Medical Reports
Section 6.0 Supporting Patients
Section 6.1 Sources of Information and Support
Section 7.0 Glossary
Further Information On Gender Variant Children and Young People
Gender Identity Development Services (GIDS) - is a highly specialised clinic for young people presenting with difficulties with their gender identity. It is commissioned by NHS England, who set the service specifications.
Allsorts Youth Project: A Journey Without A Map: Being A Parent Of A Trans Child
GIRES (2014) Caring for Gender Nonconforming Young People.
NHS Choices website
- Allsorts Youth Project (2014) Top tips for working with trans and gender questioning young people
- Brill, S.A. & Pepper, R. (2008) The Transgender Child: A Handbook for Families and Professionals. San Francisco: Cleis Press
- Department of Health (2007) A guide for young trans people in the UK
- Department of Health (2008) Medical care for gender variant children and young people: answering families’ questions. N.B. Some advice on the use of ‘hormone blockers’ is now out of date (see Section 4.5)
- LGBT Youth Scotland (undated) Coming out. A guide for trans young people.
- In The Life Media (2012) Becoming Me