The number and type of referrals to GIDS has changed over the past five years or so.
- There has been increase in the number of young people referred to us – read about this on The Guardian website
- There has been an increase in the percentage of assigned or natal females that we see. Previously the majority of young people we saw were assigned male at birth; now it is the other way around
- There has also been an increase in different ways that young people self-identify when it comes to gender identity – you can read more about this on the Gendered Intelligence website
Understandably, these changes have led to some debate – in the media, online and in academia – about what is contributing to them. People are also discussing how we might best help young people who are experiencing gender dysphoria. There are many different opinions and views and this can be confusing and upsetting for young people and families. We think it is important that people are aware of the debates so that they can think and talk about them themselves.
Passions often run high when discussing gender dysphoria in young people. Most of us want to do the very best to help, but there are different ideas about how best to do that.
What we think about the term ‘rapid onset gender dysphoria’
The term ‘rapid-onset gender dysphoria’ has been used in the media and online to describe “a phenomenon where the development of gender dysphoria is observed to begin suddenly during or after puberty in an adolescent or young adult who would not have met criteria for gender dysphoria in childhood”. It is a descriptive term and not a recognised diagnosis, and there has been debate about whether it is a helpful description.
We do not use the term ‘rapid-onset gender dysphoria’ in our considerations around a young person’s gender identity development and any possible physical interventions that they may, in collaboration with a clinician, decide to pursue.
Alarmist descriptions of social ‘contagions’ can contribute to the stigma and isolation around gender-diverse young people. We would encourage a more aware, welcoming culture in which young people living with distress around their gender identity feel confident talking about their experiences and coming forward to access whatever support might be best for them.
We work with every young person who visits our service individually, on a case-by case basis, with no preference or expectation for the pathway or outcome they may follow. We work closely with them and their families, in contact with their local healthcare teams, offering psychosocial support as they explore their gender identity development.
A change in the demographics of young people coming to gender services has been reported worldwide with more people who were assigned female at birth being referred. We are always thinking as a service and as individual clinicians about the young people who are referred to us. We think about and with them as individuals and as a group, including thinking about the shifting demography, increasing heterogeneity and complexity of the situations of the young people who come to see us.
Ever since the NHS launched the national service, more adolescents than pre-pubertal young people have been referred to us. This could be because gender dysphoria has been present but not stated, or because experiences of gender dysphoria have only occurred recently. For young people who are experiencing difficulties or distress around their gender identity, the onset of puberty can be an especially distressing experience. We are also mindful that many young people who aren’t experiencing difficulties around their gender can also find the onset of puberty stressful and confusing.
We work to add to the evidence base around gender dysphoria and gender identity development through our own research, and we welcome all rigorous research from across the health and care spheres nationally and internationally that helps us to improve the ways we can best support the young people who are in our care.
We agree with the World Professional Association for Transgender Health (WPATH) that “knowledge of the factors contributing to gender identity development in adolescence is still evolving and not yet fully understood by scientists, clinicians, community members, and other stakeholders in equal measure. Therefore, it is both premature and inappropriate to employ official-sounding labels that lead clinicians, community members, and scientists to form absolute conclusions about adolescent gender identity development and the factors that may potentially influence the timing of an adolescent’s declaration as a different gender from birth-assigned sex.”
Why have the referrals to GIDS increased?
There are a number of theories about this. The referral rates may have gone up due to greater awareness of gender dysphoria and the reduction in stigma in recent years. Equally, some people worry that gender dysphoria is being over diagnosed, possibly as people are so keen to help young people in distress. When young people are making sense of their sexuality and unhappy with their developing bodies, might they be too readily given the label of ‘trans’? Read more on the Evening Standard website
Why the increase in people assigned female at birth?
We do not yet know the answer to this question. It is likely that a number of factors are contributing to it. Some argue that changes in society have made it particularly difficult to be a teenage girl at the moment – read an article on the Telegraph website that discusses this. Could this be linked to the changes we are seeing in our service?
There are concerns that neither boys or girls are exposed to enough role models that show that they can enjoy and express themselves in any manner regardless of whether that matches the stereotypes associated with the sex of their body. Some argue that society has become more binary in what it expects of young people – see the 'Pink Stinks' website, a group that targets the products, media and marketing that prescribe heavily stereotyped and limiting roles to young girls. Could this lead some young people to experience their identity as not fitting with their physical body? What do you think?
How should we best support young people questioning their gender?
As you can imagine, these changes and these ideas and theories have led to people wondering how best to help young people with gender dysphoria. There are a number of arguments put forward and we have presented a few of these arguments below. They are simplified somewhat and there are many other views as well as these, but they give you a flavour of the debates.
- Some people believe that it is essential to offer all young people who want it any help they need to change their bodies to align more closely to their gender identity. Some argue that we should have very little mental health or psychosocial assessment, or even none at all, as this might delay access to a much needed medical intervention.
- Some people also argue that medical intervention should be available very early in childhood if children seem sure they are unhappy about being in a male or a female body.
- Other people feel that we should be more cautious given the lack of evidence of the longer-term outcomes for children having these treatments and the fact that referrals have increased so rapidly in the last year or so. These people think we should do longer and more in-depth assessments and wait until we know more before we advise young people either way.
- Yet others believe that gender dysphoria is not always related to being transgender. They argue that difficult life experiences or problems with how society impacts on us as we develop a sexed body can lead to some young people experiencing a mismatch between their felt identity and their body. For people who believe this, they would recommend extreme caution in either affirming or intervening medically with regards to gender identity at all.
As you can see, some of these ideas are in direct conflict and some of these ideas are experienced as offensive to some people. At times, it seems some people find it difficult to even discuss or debate these differences of opinions as it can raise such strong emotions. For example, the NSPCC cancelled a debate called 'Is society letting down trans children?' after strong criticism from activists
People often take up very extreme and polarised positions in the public debate which is understandable given the commitment we all have to young people’s welfare. We continue to need trustworthy information and thoughtful discussion. What we can all agree on is that we want the very best outcomes for young people who are experiencing distress related to their gender. It’s a complex and changing area and we all have a lot to learn.
So what is GIDS doing?
Just like everyone else in society we are going through a process of trying to understand what is happening and work out how best to help. What is clear is that with the diversity of presentations and the ever changing picture we simply cannot have a ‘one size fits all approach’ to working with young people with gender dysphoria. Each individual is different and we need to work with them in ways that acknowledge their unique experiences and needs.
Clinically, we continue to want to do our best for every young person that we see. It is not always clear when we first meet someone how we might do that. In an ever more diverse and complex world, we seek to remain open minded and flexible in how we work with young people and families. We know that what will best serve one young person may not another – In fact an intervention that may enhance one person’s life may hinder another’s. So we aim to affirm the value and worth of every individual, whatever their gender identity, and however they end up expressing that.
Through collaborative assessments we aim to support young people and their families to explore their experiences and the options available to them in order that they come to the best decision they can as to how to manage gender related distress. For some, this will involve medical interventions and for others it will not, as you will see in the young people section
We are also working hard to research what is happening so that we can develop an evidence base which can help guide our clinical decisions and debate in the future. Visit our evidence base
You can read and view more perspectives on the debates below: