A paediatric doctor and parent of a trans child shares her view on the future of healthcare for gender diverse young people in England.

I have been a paediatric doctor for 10 years. I also have a primary-school age transgender child.

When my child first raised questions about their gender identity (“Mum, how do people know if they are a girl or a boy? Because I think I’m a boy”) I went looking for evidence to help me decide how to respond. 

After about six months of being supportive and non-judgemental while they continued to express their questions, my child asked to change their name and pronouns, haircut and clothes to reflect their male gender identity.

Following a further few months of making these changes at home, he made a full social transition at school and all other areas of his life, which was straightforward and joyful. I am confident that this is right for him now and in the future, however his exploration of gender identity turns out.

As an academic health professional I was dismayed to read the recommendations on social transition for pre-pubertal children in the NHS England commissioning documents that are currently out for consultation.

The document states that in most cases “gender incongruence does not persist into adolescence” and that we should be “mindful of the risks of an inappropriate gender transition and the difficulties that the child may experience in returning to the original gender role upon entering puberty” – discouraging a social expression of the child’s gender identity. 

What is really shocking to me is that the specification ignores a whole body of evidence that has been published in the last five years which directly contradicts their recommendation.

The specification relies on one source to support their claim about the low likelihood of “persistence” of transgender identity, the Endocrine Society guideline published in 2017. The evidence base indirectly cited in this guideline is made up of small and low-quality studies, including material published as far back as 1967 with titles including “the cissy boy syndrome”, focused on how to prevent homosexuality. 

However in 2022, we have evidence reporting the gender journeys of larger and more relevant cohorts of kids. One study found that 97.5% of socially transitioned North American kids (first assessed around eight years of age) retained a transgender identity at adolescence and after an average of five years follow-up.

Another study showed that even among the kids who “retransitioned”, social transition was primarily a positive experience, for example strengthening parent-child relationships through the demonstration of respect for the child’s chosen path.

We also now have evidence that the mental health of the teens who had been socially transitioned since childhood was similar to cisgender teens, especially important considering the poor mental health outcomes of transgender teens in non-affirmative settings. 

When making decisions on how to respond to my own child’s request for social transition, this was the most important factor I considered – how can I maximise and protect their mental health right now AND if their transgender identity is persistent? In my mind the answer is loud and clear – listen, trust, respect and affirm their expressed identity. 

Put simply, I could not parent my child in a respectful and loving way while simultaneously ignoring their expressions of gender identity. 

My child is incredibly happy in their social context and confident that their family and social community support them. They have learnt so much about themselves and felt empowered to form new friendships – things that will be of long-lasting value whatever they decide in the future. 

All parents want to do the best for their child and will look to the NHS for guidance. This specification must change to more accurately reflect the evidence in order to avoid further harm to our kids.

The consultation for the proposed specification runs until 4 December 2022. Mermaids has produced guidance to help you respond.

Two young trans people share their views on proposed changes to NHS healthcare services for trans and gender-diverse young people in England

We continue our series of blogs from our communities on the impact of the proposed guidelines with two young trans people, Jamie and Elijah, who have shared their views on the specification. 

The consultation on the proposed guidelines runs until 4 December 2022, and we have produced guidance on the consultation to help you respond. 

Jamie: “Social transition – it’s a lifesaver”

Social transition saved me as a teenager.

To some, it may seem unbelievable how such simple acts can have such a profound effect on someone’s life. For me, cutting my hair short started the long journey of being able to look myself in the mirror once more.

The new proposals argue for clinicians not to encourage social transition until a diagnosis of gender dysphoria has been made, citing Dr Hilary Cass’ statement that social transition is “not a neutral act” and fears over its long-term psychological impact.

To me, this is a huge step back in trans advocacy and self-determination. A clinical diagnosis to be permitted to cut your own hair short may seem preposterous. And that’s because it is! 

All individuals, trans or cis, go through a journey of self-discovery through their lives. Finding what it means to be authentically you is something inherent to the human experience, and it’s only once this authenticity is placed into a transgender context that it’s seen as something to be wary over, something to be medicalised. 

When I changed my name to a nickname, this was in a cis context, and thus was permissible, even encouraged. When I changed my name to what it is today, I was told to “think about my future”, and consider whether this was a “permanent” change that I really wanted. Silly considering how easy changing your name is here! 

The new proposals will undoubtedly cause harm to trans youth. Dr Cass was right, social transition isn’t neutral. It’s a lifesaver. 

Elijah: “a worrying outlook for what is to come for gender-diverse young people”

Holistic support is undoubtedly key for the well-being of young trans people and to make them feel supported there is a need for honesty and openness in communication from both sides. 

While young people using unregulated sources of medication is a concern, an approach that attempts to persecute the young person and their support system does nothing to reduce harm. 

The proposed guidelines state that safeguarding protocols will be initiated if a young person seeks medication outside the NHS which will make it difficult for young people to build trust with workers involved in their care.

The attitude towards social transition within the report is also concerning, painting it to be a process that requires medical approval rather than a gradual process of presenting in a way that makes you feel most comfortable. Young people know themselves better than a clinician who they only see once every few months.

I think it is ironic that while some claim that “allowing” children to be trans is depriving them of their childhood, in reality, the restrictions placed on trans young people create an environment where they are filled with fear, unable to simply enjoy their youth. 

Community support has been crucial in being able to manage the complex and overwhelmingly negative feelings I felt in relation to this consultation and has reaffirmed the importance of specific services for trans young people such as Mermaids. 

Although the specification seems to provide a worrying outlook for what is to come for gender-diverse young people in the UK, there is still hope and solidarity within the community, and we will push even harder for progress. 

Read more about the proposed changes in our explainer blog, and find guidance to help you respond here.