The real problem for gender variant children is that reliable prospective data still doesn’t exist and so decisions on whether or not to treat are made on the basis of the data that is out there. The fact that it is widely acknowledged by those in the field as being flawed, appears to be a mere inconvenience.
One argument stayed with me: ‘Mummy, I don’t want to be a boy who is allowed to wear pink, I don’t want to be a girl, I don’t want to change into a girl – I AM a girl.’
The current understanding, which is also supported by these research papers, is that if children presenting with a strong feeling that their gender differs from the one society expects, and those feelings have been persistent through childhood and are still present as puberty commences, they are extremely unlikely to waver in these feelings.
The RCN document is a breath of fresh air and provides the following advice:
- Be positive and proactive in your approach to welcoming trans patients to your care
- Always treat trans patients in a respectful way, as you would any other patient or client
- If you are unsure about a person’s gender identity or need more clarity about how they would like to be addressed, then ask politely and discreetly
- Avoid disclosing a patient’s trans status to anyone who does not explicitly need to know
- Discuss issues related to a patient’s gender identity in private and with care and sensitivity
The majority of trans people do not want to have full reassignment surgery, and would be very relieved to just receive timely, compassionate support and simple hormone treatment.
There are many reasons why people might change their mind about any medical or surgical treatment to which they may have consented. However, one of the most common reasons is that the surgery does not provide the end result that they wanted. This is not only in relation to what the results look like in the mirror but also about how family, friends, loved ones, work colleagues and society react to the changes. Sometimes, the hopes and expectations a patient – trans or otherwise – has of the surgery, may simply not be met.
Through my clinic I offer diagnosis, assessments and safe, reliable medication and monitoring. Many people use my service as a stopgap, ensuring that, if they meet the criteria, they can start the process of hormonal treatment while they begin the long wait for NHS referral.
Unlike homosexuality, gender variance needs a little bit of medical help to allow the person to achieve the characteristics that fit their true gender.
He is famously quoted as saying: “I ask myself, in mercy, or in common sense, if we cannot alter the conviction to fit the body, should we not, in certain circumstances, alter the body to fit the conviction?”
The most important thing for young people, in whom long-lasting gender variance is suspected, is to offer to support them by delaying the so-called ‘secondary sex characteristics’ from developing (the primary ones being the genitals).
Outside of gender care, suicide in children is vanishingly rare. Within gender care it approaches 50%. Half of gender variant children attempt suicide. What else do these young people have to do to be heard?
January 1st, 2017 will see ‘being transgender’ declassified as a mental illness in Denmark, a momentous and long-awaited move which will surely put increased pressure on the World Health Organisation (WHO), to remove the diagnosis from its list of mental disorders.
The conclusion being that nobody should be penalised if they supplement their NHS care with private care, nor should they lose their place on the waiting list, or be given reduced care on the NHS, because of their private care.
The message to GPs is clear: “Most of the medications used for the treatment of gender dysphoria are not licensed for this specific indication, although GPs will be familiar with their use in primary care for other purposes. Our guidance clearly allows for prescribing outside the terms of the licence (‘off-licence’) where this is necessary to meet the specific needs of the patient, and where there is no suitably licensed medicine that will meet the patient’s needs.”
When it comes to treating gender variant patients at the younger end of the scale, my approach is to manage each case individually. I believe treatment should start after careful assessment, when the child – and family – are physically and psychologically ready and have all the support in place around them.