One of the biggest current causes of worry for practitioners involved in transgender care, are the increasing numbers of children, adolescents and young people emerging as transgender, or gender diverse. Worry, because of the lack of resources available in the UK to deal with this very vulnerable patient group for whom the biological clock is definitely and literally, ticking very quickly, second by second.
For these, a few weeks or months can have a huge impact on the rest of their lives. We have all watched our own children or children of friends, change from relatively shaepelss, prepubertal youngsters into distinct young men or women, seemingly in the blink of an eye and this is the dilemma faced by the NHS at the moment, burgeoned with long waiting lists in all specialties and in particular, gender care.
We can’t begin to imagine the distress this must cause these youngsters as they watch their bodies transform into the opposite sex from that which they genuinely identify. Admittedly we know that many younger children (below 10) dabble in cross sex activity such as dressing up in opposite sex clothes for example and about 80% of these will revert to their true genetic gender . But research suggests that virtually 100% of children who consider themselves transgender as they enter puberty, will remain transgender for the rest of their lives.
There is one clinic serving the whole of the UK based at The Tavistock and Portman Mental Health Trust in London, with satellite clinics in Leeds and Exeter. It is largely run by the local CAMHS (child and adolescent mental health service) with referrals into the Paediatric Endocrinology Liaison Service of those patients who are deemed ready to start treatment. Although undoubtedly many of these young people do need very careful assessment and counselling, the whole process from referral to treatment can be harrowingly long and many patients end up being transferred into the adult services, because they have waited such a long time.
As a result of this, the dysphoria (mental anguish, often as a result of frustration with society and the medical profession) can be hugely impactful, with mental illness, suicide and depression being a very serious problem. Some studies have suggested that up to 65% of young transgender people have attempted or considered suicide as a result.
Distraught parents have frequently sought help abroad with many transgender British children being treated as far afield as Hamburg and Boston.
Depressingly, this does not need to be the case as treatment is very straightforward. Puberty blockers (gonadotrophin receptor agonists) can be administered as an injection every month or three months and prescribed in Primary Care. All they do is just stall puberty, are completely safe, entirely reversible and literally save lives. But GPs are reluctant to use them because of a lacking of knowledge, understanding, compassion and a reluctance to get involved (sometimes sadly due to prejudice). Testosterone and oestrogen cross-sex hormones can also be prescribed in general practice but it is probably reasonable at the moment to leave this to the specialist centres.
This all needs to change and quickly. The BMA and GMC as well as the House of Commons Equality Commission have issued strict guidelines regarding treatment and GPs will be gently persuaded to adopt them although funding and time will remain an issue.
The children’s transgender charity, Mermaids, continues to work tirelessly on behalf of these young people and has formed new alliances with other providers of care including specialist UK online doctors and one hopes that the future of transgender care for our children will be brighter.