Young people are understanding gender in an increasingly diverse way. For example, Facebook now allows users to choose from an “extensive list” of pre-populated gender identities, or to enter their own preferred terms(read about this on Facebook). Each individual can add up to 10 terms describing their gender to their profile and can customise how public this information is made. Young people who we meet at GIDS have often familiarised themselves with a large range of different identity labels in discussions online or with their peers.
Young people are also talking about the people they are attracted to or have relationships with in diverse and nuanced ways. There are a many different terms in common use to describe sexuality including lesbian, gay, bisexual, pansexual, omnisexual, asexual, heteroromantic, questioning, fluid, queer-identified, men who have sex with men, same-gender loving, polyamorous and more (see a list of LGBTQ+ vocabulary definitions).
We recognise that sexual orientation and gender identity are distinct concepts. However, we also acknowledge that whilst some people experience them as entirely separate, others experience them as overlapping or intertwined to varying degrees. We also recognise that there is a degree of overlap in the language that has been available to think about them, and the shared histories of marginalisation, community and activism. This can be a contentious issue and there are a wide variety of different viewpoints on how closely transgender people and lesbian, gay and bisexual people should be grouped together and how far their goals and priorities align.
The possible links between how we see sexuality and how we see gender identity have received much academic attention. Drescher (2010) provides a review of how gender identity and sexual orientation have been linked in scientific and medical literature, as well as in wider society, and discusses parallels between the classification of homosexuality and gender identity disorder as psychiatric diagnoses and the debates around this. Read the review
It is sometimes suggested that there may be some people who align with trans identity, rather than as lesbian or gay, perhaps because in some social groups homosexuality is still seen as unacceptable. We have no way of knowing if this is ever the case. However, on this page we look at some of the ways that we try to open up exploratory conversations on these matters, while not favouring one outcome over another.
How we consider referrals where sexuality may be the presenting issue
When we receive a referral it is screened by clinicians in our intake team. At our intake meetings we look for information about distress related to gender identity. Occasionally, we receive referrals which appear to be related specifically to sexual orientation rather than gender identity. In these cases, we liaise with referrers to understand whether the young person is also experiencing issues related to their gender identity. If this is not the case, we would recommend other services or sources of support.
Our approach with younger children
For younger children, we encourage parents to support their child to safely explore their interests, allegiances and preferred activities, whilst keeping a range of options open to them. We recommend keeping an open mind about how a child’s interests and identity might develop over time.
Our approach to discussing sexuality and distress around gender with adolescents
We discuss sexuality with young people and their families in our assessments, as part of the broader discussions we have about relationships and bodily feelings. We work with each individual to find the best way forward for them, remaining mindful that feelings and priorities may change over time. Adolescence is a stage of life when people are working out in all sorts of ways who they are and who they want to be.
At a developmentally appropriate age, and in an appropriate fashion, we also have conversations with young people about sexual and romantic relationships, safer sex and sexual health, and their relationships with others. We might also discuss with teenagers their relationship to their own body and sexual feelings. We would consider with them how this might relate to their hopes for transition and the impact of potential physical interventions, if they are considering starting these. We aim to empower young people to make informed decisions about their futures, and recognise that sexuality – in the broadest sense – is an important aspect of life for many people as they approach young adulthood.
We understand that this can be an embarrassing topic to discuss in front of parents. Whilst some young people talk quite freely with their families about who they are attracted to, for others the very thought of doing so makes them cringe. We therefore let young people know that we can have these discussions in one-to-one sessions with us, without their parents in the room: this is something we routinely offer.
We also discuss, where appropriate, any perceived connections between sexuality, sexual orientation, and gender. We realise that whilst sexuality and gender are different and for some people feel very distinct, for others they can overlap and it might not always be helpful or possible to think of them as entirely separate.
For some young people, it may seem quite difficult to untangle sexuality and gender identity or to figure out what is the best path for them. We encourage them to safely explore and experiment and let them know that we will support them however they come to identify, and we will help them over time to make choices that they feel are the best for them. Others may feel that their gender identity and sexual orientation have already settled and that this kind of exploration is less relevant to them.
As you would expect in any large group of people, we see people of all different sexualities: some describe themselves as heterosexual or straight, others as gay or lesbian, as bisexual, pansexual or queer. In our clinical experience, many trans young people have spent a period of time identifying as lesbian, gay or bisexual before identifying as trans. But for some adolescents it can be frustrating or invalidating that people often confuse their sexuality and their gender, or assume that they are the same thing.
Homophobia, transphobia and bullying
We pay attention to and explore experiences of homophobia and biphobia, just as we do for young people’s experiences of transphobia. We are acutely aware of the pervasive nature of transphobia, homophobia, biphobia, and sexism throughout society, as well as within and between marginalised communities. The young people we see frequently have repeated, first-hand experience of this from others. We also work with young people to address feelings of internalised stigma and shame that many people experience.
We believe that bullying is never acceptable and that young people should not have to accept this as normal. If bullying is taking place, we work with families and schools to address this.
Sexuality of young people coming to GIDS
The question of how to ‘measure’ or record the sexual orientation of a population has long raised a host of questions for researchers. For example, are you asking how people identify, who they are attracted to, or about sexual behaviour? This is of course even harder to measure in children, and indeed some would question whether it is ever either possible or appropriate to describe a child in terms of their sexual orientation. At GIDS, we simply record the gender(s) a young person says they are currently attracted to for use in our anonymised data-sets.
In our most recent statistics (2015), of the young people seen in our service who were assigned male at birth and for whom we have data, around 30% were attracted to males, 30% to females, and 30% to both males and females (or other genders). The remaining approximately 10% of those for whom we have data described themselves as not being attracted to either males or females, or as asexual.
For young people assigned female at birth for whom we have data: over half were attracted to females, a quarter were attracted to males, just under 20% were to both males and females (or other genders), and a small percentage described themselves as asexual or as not being attracted to either males or females.
How do these figures relate to the general population of adolescents? It is hard to say. Estimates of sexual orientation at the population-level can vary widely. A YouGov survey in 2015 found that almost half of 18 to 24 year olds reported at least some level of same-sex attraction, although 83% of all respondents also described themselves as heterosexual. 10% described themselves as gay or lesbian. Many people report their sexual orientation continuing to develop into their adult lives so we do not know how the young people in our service will identify in terms of sexuality in 5, 10, or 15 years’ time.
As we noted above, at GIDS we see young people of all different sexualities: some speak of themselves as heterosexual or straight, others as gay or lesbian, bisexual, pansexual or queer.
We see quite a lot of young people who identify as trans for a period of time before coming to understand themselves in terms of a (cisgender) gay or lesbian identity instead. We also see a number of people who have a trans identity but who do not wish to have physical interventions, such as hormone blockers, testosterone, or oestrogen. And there are of course many more levels of nuance and complexity to people’s evolving identities and the terms they use for their experiences than our numerical data can describe. Whilst apparently neat categories for both sexuality and gender can sometimes provide a useful shorthand, for many people this does not adequately reflect their full experience.
Conversion therapy – defined as therapy which aims to attempt to change an individual’s gender identity or sexual orientation – is unethical and damaging to both individuals and communities. There is no credible evidence that such attempts do anything to change an individual’s underlying feelings or their sense of self, although these may result in people trying to hide these feelings from others and can lead to psychological distress. The Gender Identity Development Service rejects the idea of conversion therapy in the strongest possible terms. We would consider all appropriate steps to protect a child’s safety if we believed they were at risk of this from anyone else.
Our approach: empowering young people
Whilst we would never attempt to change a child or young person’s gender identity or sexual orientation, we acknowledge that a child or young person’s perceived gender identity or sexual orientation may change or develop during the time that they are with our service. This may be so even when at any one time they feel very sure that their identity or orientation is fixed.
For this reason we discuss collaboratively with young people and families the many possible identities and outcomes that their futures may hold in store. We think carefully with young people and parents about informed consent and we see our role in helping young people to make their own sense of who they are and what their priorities might be. This can sometimes include sensitively asking constructively challenging questions. Our supportive and neutral stance is affirmative towards however a young person has come to understand themselves (and however they will do so in the future) without seeking to confirm, reject, or impose upon them any of the options which are available.