My name is Dr Helen Webberley, and I’m the founder of GenderGP. Over the years, I’ve gained great experience and knowledge about the health and well-being of trans children. In response to the recent UK puberty blocker ban, I’ve worked with the specialists at GenderGP to create this frank and open FAQ article about how to support a trans child.
Below, we answer very real questions about how to tend to the emotional and potential medical needs of a trans kid that I and specialists have been asked over the years and until now.
Q: What does it mean to be trans?
A: A transgender child has a gender identity that is different to their birth assigned sex. They have testicles and a penis yet they identify as a girl, or they have ovaries and a vagina yet they identify as a boy. There are variations in between, but that is the nuts and bolts of it.
Q: Is it real, is it a phase, and will it go away?
A; Listen to your child. If they’re really telling you that they’re actually trans, then they are. Your belief and understanding is crucial to them. It may be hard at first but it gets easier. Being trans is very real and here to stay, and your child will need your support more than ever.
Q: Can I persuade my child that they aren’t trans?
A: No! You can try but that will only harm your relationship. Trans kids need to be believed and they need your unwavering love and support, as they always do in everything they do.
Q: How can I be sure they are trans?
A: How is anyone sure of their gender identity? And how do you know you are a woman? How do you know you are a man? Is your gender created by your genitals, or is it just who you are on the inside? Listen to your child, try and understand them, and work it out together.
Q: Is it a “social contagion”?
A: Like-minded people stick together, so you’ll find that LGBT groups have lots of LGBT people in them, but this doesn’t mean that a non-LGBT person who enters an LGBT group will be turned LGBT. It just doesn’t work like that.
Once we put fear aside and start to understand identity, we see that it is just innate. It’s a part of us, it’s who we are. Many families have more than one child; they have the same home, the same internet, and the same school – but one might be gay, one might be trans, one might be straight, and one might be cis. They’re all themselves, and they’re all individuals.
Q: What should I do?
A: Listen, learn, join groups, and talk to other parents of trans children. Be careful of groups who will pretend to help but are actually telling you to be cautious. Learn all about what it means to be trans along with the challenges and questions your child might have.
Q: Will we need counselling?
A: Everyone and anyone who is struggling with their feelings can benefit from positive and affirmative counselling, but they have to be ready to access it. Counselling works best when the person is ready for it, wants it, and asks for it.
Q: What medicines are there that can help?
A: There are two main aims of medication. One aim is to stop the body’s natural hormone production and pubertal development, which stops your trans daughter from going through a male puberty (or your trans son going through a female puberty). The second aim is to give the opposite hormone – the one that will develop the puberty that is in line with your child’s gender.
So, your trans daughter will develop breasts, hips, and curves. Your trans son will grow taller and bigger, his beard will grow and his voice will break.
Q: What about binding and tucking?
A: Many parents find this very hard because it feels like such an assault on the body. But these binding and tucking practices can cause immense relief. Try and help your trans child access the right size for them, and educate yourselves about the right techniques.
Q: How do we stop puberty?
A: There are different drugs that can do this. GnRHa puberty blockers are the best and the safest, but they’re also the one that has a current UK ban. You can potentially use other drugs; spironolactone and cypoterone prevent the actions of testosterone on the body, while raloxifene can help prevent the actions of estrogen.
Q: Can I still get a prescription for GnRHa blockers?
A: Non-UK prescribers are perfectly able to prescribe for you, and you can use that prescription with a chemist that’s outside of the UK (and therefore not held under the UK government’s puberty blocker ban). Many parents opt to receive a private paper prescription and take it abroad to have it dispensed.
Prescriptions can be dispensed in the UK if the person named on the prescription has a date of birth over 18.
Q: Which blocker shall I choose?
A: All of the GnRHa blockers are identical. All the different brand names are the same drug although the injecting system will be different and the brand name different.
Apart from the GnRHa blockers there are other options available – see below.
Q: What options are there for transgender girls?
A: The Australian Treatment Guidelines recommend two medicines that prevent the actions of testosterone, if you can’t use the GnRHa puberty blockers:
- Spironolactone 100mg oral daily, increasing to up to 200mg oral twice daily as required
- Cyproterone acetate 12.5-50mg oral daily
Q: How do spironolactone and cyproterone work?
A: They work to prevent the action of testosterone on the body and therefore help prevent the developments that testosterone causes and maintains. They have been used for many years in countries where access to GnRHa medicines is limited due to costs or insurance coverage.
Q: What options are there for transgender boys?
A: There are fewer options for boys who can’t get the GnRHa medicines. Luckily, starting testosterone therapy to induce male puberty is often enough to suppress ovarian function.
Drugs such as raloxifene have been used to suppress the effects of estrogen in other conditions such as unwanted breast growth (gynaecomastia) in cisgender boys. There’s little data available about their use in trans boys. However, there’s no reason they wouldn’t work in the same way to prevent the effects of estrogen. Raloxifene works to prevent estrogen developing the breast and womb, so it will help suppress breast growth and periods.
Q: If I can’t get blockers, should we just start hormones?
A: You should only start hormones when your child is ready to embark on the journey of puberty. While the effects of blockers are completely reversible, the changes hormones bring are not. Don’t rush into it, and make sure you are ready.
Q: Are these drugs safe?
A: Nothing is ever 100% safe, and nothing is ever 100% effective. That said, medicines are widely used across the world to help a trans child prevent the development of the wrong puberty and support the development of the right puberty.
Q: What about hormones?
A: The sex hormones are estrogen, progesterone, and testosterone. These make puberty happen and bodies develop, and they’re very good at doing just that in transgender children. They’re very safe, very effective, and give your trans child the opportunity for their body to develop in line with their gender identity.
Q: When should my trans child start hormones?
A: We consider that any cisgender child who hasn’t started puberty by 14 is a late developer and they should have their puberty kick-started with hormones. The same rules apply to trans children. We want them to develop normally, at the same time as the kids at school, along with their friends and classmates. If your trans child is telling you that they’re ready to start puberty, then support them, listen to them, and believe them.
Q: What if my trans child changes their mind?
A: Transgender children will always be trans, they don’t change their mind, and transition regret rates are very low. Some people do regret transitioning, but the reason is not because they are no longer trans. They either were not trans in the first place, or life is just too unaccepting of them as a trans person.
If your child is trans then believe them, support them, and help them adjust.
Q: Where can I get healthcare for my trans child?
A: The options are very limited in the UK due to the puberty blocker ban and in some other countries. NHS services are severely restricted, and there are very few private options. GenderGP has proudly supported trans youth since 2015 and will assist you in finding solutions to access care.
Q: Will I be referred to Social Services if I access private care?
A: Safeguarding referrals are acted upon if there are reasonable grounds to suspect that the child is suffering, or is likely to suffer, significant harm and whether further enquiries need to be made. Accessing necessary care for your trans child will not cause harm.
Q: Will the NHS refuse to see us if I access private care?
A: Sadly, due to the recent UK puberty blocker ban, there’s little or no medical service in the NHS for trans youth. The chance of getting puberty blockers or hormones for new patients under the age of 18 is vanishingly small. Then, after the age of 18, the NHS waiting lists for gender services are years long.
Q: Will hormones and other puberty-suppressing drugs also be banned?
A: There will be many people who would love to see this happen, but even the current UK puberty blocker ban seems to be very tenuous and maybe even illegal. Who knows what they will try and do, but they have to be lawful.
If they attempt to ban further medications in the UK aside from puberty blocker medications, then what they are actually doing is banning care, and this is not the right avenue to do that. They must act in the best interests of patients and the public, and they must make sure any risk assessment is robust.
Q: I am really struggling with this. What should I do?
A: It can be hard, very hard at times. But your child needs you.
Find a shoulder to cry on, let it all out, and then come back with renewed vigour to help support your trans child. Lean on people who will truly help and support you, and lean away from those who can’t or aren’t able to. Seek out professional help if you’re able to, and ask to be part of true support groups. You may feel alone but you are not, believe me.
Q: When will things get easier?
A: Like many things that are inevitable, things get easier when you relax into them, go along with it, and motivate yourself to find solutions. The world is a difficult place for trans people at the moment, but don’t let that spoil your time with your child. Explore your options together, support and love each other, get the help you need for you and your trans child by hook or by crook.
A trans child that is believed and supported in their gender identity, both by their families and the professionals in place to help them, will flourish.
Q: How can I get my prescription for my trans child?
A: If you don’t have a doctor that will prescribe for you on the recommendations created by our systems then we can refer you to one of our independent prescribers. They’re experts in gender care, and they’re up to date with current clinical guidelines and best practice from across the world. They can issue you a paper prescription or an electronically-signed and delivered prescription.
Q: How do paper prescriptions work?
A: They take about two weeks to get to you in the post and you then take it to your local chemist to dispense for you. It is a physical piece of paper that you take to the chemist.
Q: How do electronic tokens work?
A: These are delivered by email or SMS. You will have a token (a unique ID) that you give to your chemist and they can download the prescription by confirming it’s you with the details on the prescription.
Beware: these tokens are single-use and if you use it and the chemist doesn’t dispense for any reason, then you can’t re-use it. Make sure the chemist you choose has stock of the medication, and they’re happy to dispense before they open your prescription.
Q: What if the pharmacy doesn’t have stock?
A: We can’t influence pharmacy stock control, but if you need a new prescription, simply submit a new request. You can be referred back to the prescriber for a repeat.