NHS Arden & GEM National Referral Support Service

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Parent Advice

Why does my child feel this way?

The honest answer is we do not know exactly why any particular child or young person develops cross-gender or gender variant feelings or behaviour. Nor can we pinpoint why any one individual might develop a transgender identity. For each individual there are likely to be a variety of different factors that come together to shape them as a person, including biological, social and psychological factors, as well as their experiences as they are growing up.

There are, however, many different ideas and theories about why some children and young people’s interests and identities do not follow a stereotypical path when it comes to gender development.

Some people think that young people are “born this way”. They might look for answers in genetic studies, or wonder about the influence of hormones on a developing baby during pregnancy.  Some of these ideas are explored further on the GIRES (gender identity research and education society) website. Some people find it helpful to think about someone having, for example, “a boy’s brain in a girl’s body.” Others argue that current research hasn’t found many major differences between boys’ and girls’ brains – and many of the differences they have found may come from the experiences boys and girls have rather than their DNA or hormonal development. For example, academic psychologist Dr Cordelia Fine discusses these ideas in her book Delusions of Gender: How our Minds Society and Neurosexism Create Difference

We also know that how people express or experience their gender, and how people respond to gender non-conformity, is linked to the culture and the time in which they live.

We see many young people who have other developmental issues (e.g. autistic spectrum difficulties) or who have experienced significant difficulties at some point in their early lives (e.g. bereavement or trauma). However, we also see many young people who have not had any of these difficulties.

As a service, we look to keep in mind the different ideas and theories people may have about why a child or young person has developed in a particular way. Often different members of a family will each have different explanations. Rather than trying to work out who is ‘right’ or ‘wrong’, we value all of the different ideas that people bring and join families in thinking about how to best support their child.

See Charlotte’s story for the experience of one young person with autistic spectrum difficulties.

Parent Advice

Where can I get help for myself?

There a number of organisations that support and advise parents of transgender or gender non-conforming children.

Some parents also wish to have their own support, such as counselling or therapy, for help with managing their own difficulties. We would recommend you contact your GP to discuss this further. Other information is also available on the NHS website

Parent Advice

When is the right time to ask for professional help?

Young people can be referred to our service at any age.  We tend to receive referrals at two main points – around a social transition or around puberty.  If a young person is demonstrating distress at any time we would encourage you to initially seek input from local services such as CAMHS.  Local services can provide support around the distress and think with you about whether a referral to our service might also be helpful.  They may also be able to provide some support for you as a parent if things are feeling tough in any way.  There are also a number of charities and organisations who might also be able to help.

Parent Advice

Social transition for younger children

Over the past few years, we have seen increasing numbers of younger children making a full social transition – from living in the social role associated with their birth-assigned sex (male or female) to living, across all contexts, in the social role with which they identify.

When children wish to be known as neither male nor female, as some do, we do not usually speak about social role transitioning, as these children are sidestepping the traditional public categorisation of binary gender roles.

At GIDS we do not take a position on early social transition, either for or against. Whether a child formally transitions is a decision that families and children make together. We understand that this move is often driven by the child. Many families report that their child is happier after transition and functions better in everyday life.

Clinically, we have observed some positive changes from this transition, but we have also seen some potential pitfalls which we hope it is helpful to share, to support families to make their decision.

A full social transition may help children:

  • feel that their gender identity is accepted
  • interact more confidently with peers
  • feel more securely a part of their social groupings
  • experience less anxiety in facing new situations and new people

And yet, we know that in early childhood, children view the world in concrete terms and do not easily reason about abstract or hypothetical issues. They have not yet developed the cognitive and social maturity that will emerge later in childhood, and they find it difficult to see any given decision in a larger time context.

It is worth thinking what it might mean, subjectively, for a young child to be seen and known in a particular gender role, while still managing the fact that their body does not match their experience of themselves. We hear from families that socially transitioned children often experience great distress at any mention of the physical body. This can cause problems later, when there needs to be a full discussion of potential physical interventions and what they mean for the young person’s body.

Social transitioning is not right or wrong, but it does need a lot of consideration. It is tempting to avoid talking to children about their sex characteristics if this causes distress. And yet, discussing these things in a matter-of-fact way is important in building resilience, and in attempting to reduce any feelings of shame about the body as it currently is.

In some families, it can be tempting to avoid all conversations about gender norms and social roles once transition has taken place. But it is important to go on questioning gendered social ‘rules’ in order to create a freer social space in which gender diverse children can grow and develop.

For families thinking about social transition for their child, there are some messages that can helpfully be given:

  • that the child’s gender identity is accepted
  • that having sex characteristics that do not ‘match’ this does not undermine the family’s recognition of their gender as the child experiences it
  • that the body as it is should not be feared or hated: it is what it is.
  • At the same time, parents and carers need to keep in mind:
    • that important conversations need to continue about the potentially limiting way that gender roles and gender stereotypes operate, questioning simple binary gender rules about how we live our lives
    • that any potential alterations to the body that may lie ahead need to be thoughtfully discussed, in matter-of-fact terms, as possible medical interventions have to be understood, discussed and fully decided on in later childhood
    • that it is good to encourage the child’s curiosity about people whose bodies and identities do not entirely ‘match’ and whose lives have the same potential to be interesting, rewarding and worthwhile
    • that simple messages about the future, that may be strongly reassuring for a child in their early years, need to increase in richness and complexity as the child develops and matures.

If you are on our waiting list and have any questions or concerns about the above, remember that you can call our clinician rota to speak to someone in the service.

Parent Advice

Should I use my child’s preferred name and pronouns?

If a child or young person has a particularly strong desire for others to use a preferred name and/or pronoun, which they have repeatedly and explicitly requested, then many parents try to do this, particularly for adolescents.  Equally, some parents really struggle with doing so. They might be waiting to see how their child’s identity develops further before making big changes.  They might also, understandably, be really attached to the name that they chose and have been using for many years. 

Young people tell us that its important that their requests are acknowledged in some way.  How you acknowledge it might differ depending on the age or stage of development that your child is in.  For example, older teenagers can be in a better place to make considered decisions whilst for younger children parents may need to weigh up the pros and cons of those decisions for them.

Using a new name or pronoun doesn’t mean that they will be the ones your child uses for life, and by you trying this out alongside them, you might help them stay flexible and curious themselves.  Trying to use preferred names or pronouns is one way a parent can communicate their acceptance and love to their child, and it shows that they have really heard what their child is telling them. Other families find a gender-neutral nickname that they are all happy to use as a compromise. Parents who are keen to use preferred names and pronouns still usually make mistakes as it is difficult to change the habit of a lifetime, but young people can be quite forgiving of this.  If you feel that you cannot use new names or pronouns with your child right now, then you might think about how to carefully explain your reasons to them so that they can better understand your perspective.  You could then consider with them other ways that you can show that you are listening and support them.

Parent Advice

I’m worried that my child may harm themselves

The majority of the children and young people we see do not self harm, nor do they make attempts to end their own life. Although there is a higher rate of self-harm in the young people who are seen at GIDS compared to all teenagers, it is a similar rate to that seen in local Child and Adolescent Mental Health Services (CAMHS).

If you are worried that your child is at risk of hurting themselves, please contact your GP and/or your local CAMHS team. Local services are in the best place to support young people in this situation. If your child is already being seen at CAMHS, they may develop a safety and crisis plan with you and your child to keep them safe. In emergencies, you can also take your child to a local Accident & Emergency department or call 999.

You may also find NHS Website MoodZone a useful resource, as well as this guide for parents and carers developed by the University of Oxford.  

Parent Advice

How do I manage not knowing what will happen in the future?

This is tricky. If we knew what was going to happen in the future then we could prepare for it to the best of our abilities.  However, as with all areas in life, we cannot always know what is around the corner. Some people are better able than others to imagine coping, whatever the outcome. We work with young people and families to identify their existing strengths and resources for managing. We aim to help people to feel confident that they could cope, whatever happens.

Parent Advice

How do I know whether or not this is a phase?

The word ‘phase’ can be a difficult one to hear as it has been used in the past to belittle or minimise a person who is questioning aspects of their identity.  Nonetheless, it is a fact that whilst many young people retain the gender identity they develop in childhood or adolescence, some do not. 

Perhaps the better question to ask is ‘will this last?’  Parents will come to this question from different positions.  Some will have had a long time to notice and think about their child’s gender identity whilst for others the news that a child is questioning their gender, or identifies as transgender, is quite new. Tolerating uncertainty about the outcome for your child can sometimes feel quite difficult as it leaves you wondering about how best to support them.  It can be a particularly tough when it comes to making decisions about whether to socially transition or seek or accept a medical intervention.

We support young people and their families to come together, where possible, to make these decisions.  We acknowledge the uncertainty in our work and we encourage families to remember and draw upon their existing resources for coping, allowing them to feel more confident that they could manage whatever the outcome.


Parent Advice

How do I know whether my child is making the ‘right’ decisions?

The young people we work with can struggle with a number of decisions, ranging from deciding whether or not to ‘come out’ as transgender, to requesting a preferred name, socially transitioning or seeking a medical intervention.  As with many decisions we make in life you and your child have to consider all of the information available to you and make decisions based on what seems best at the time.

Younger children are not usually considered able to make decisions on their own, and can only make decisions with your input and approval.  As a child moves through adolescence they may be in a better position to make these decisions for themselves, but it is usually preferable that this is still done with parents’ support. 

We will always consider whether a child is able to consent to a decision with you in our assessments, and we will do this again if physical interventions (e.g. hormone blockers or hormones) are discussed.  It can sometimes be helpful to consider other decisions that you child has made and as they mature encourage them to develop decision making skills in other areas of their life, in order that they can feel more confident in making decisions about their gender.  Tolerating uncertainty is always part of any decision making process – see How do I manage not knowing what will happen in the future?

Parent Advice

How can I help my younger child?

Children are constantly exploring their identity as they grow and go through different developmental milestones.  Babies do not really have an identity as their brain has not developed enough for them to understand that they are a separate entity from their parent or care giver.  Toddlers and children then begin to learn who they are as they develop, mainly through the interactions that they have with other people.  Some traits might be there from birth, a child might have a tendency to be relaxed or outgoing, for example, but these traits can be encouraged, or not, by the environment in which the child grows.  In times past it may have been helpful to encourage aggressive traits for example, whereas usually this is no longer necessary for survival and such traits are discouraged in children.

Toddlers become conscious of the physical differences between boys and girls and can usually label themselves as either a boy or a girl by the age of about three.  During this same time of life, children learn about gender roles and what is expected from each sex in their community i.e. ‘things that boys/girls do or like.’  During this stage of development gender identity can appear quite stable in terms of stereotypical interests or the labels children use for themselves, and yet young children may still not fully understand the more complex ideas about gender.  Children go through various stages of ‘magical thinking,’ during which they can get confused between reality versus fantasy, until at least middle childhood, and sometimes this makes it hard to know how much a younger child fully grasps about what they are saying or understands about their own gender.  From adolescence and beyond it becomes more possible to talk through complex ideas about gender in their lives (find out more about cognitive development).

Below are some ideas for parents of younger children to consider:

Remind them that they’re normal.  Our ideas of what ‘boys do and like’ or what ‘girls do and like’ changes over time.  Much of what we now associate with masculinity or femininity has changed over the generations or is understood differently by different cultures.  Therefore, there is nothing ‘wrong’ with any child who explores interests and activities outside of the current gender stereotypes.  Indeed, it is probably helpful for all children to be encouraged to play with a range of toys, friends, activities and emotions in order that they can find out what works best for them as this will likely help them grow into rounded and accepting adults.

When a child’s interests and abilities are different from societal expectations, he or she can be noticed or even discriminated against by others. Understandably, parents may want to influence how a child plays or behaves in order to protect their child from stigma, but it is important not make the child feeling like they are doing something wrong.  Ensure that your child knows that you love them and that they are safe to play with and explore their gender with you, even if you do decide to limit things to certain situations or places for a time.  Each child will develop unique strengths and interests, even if they do not conform to society’s, or even your own, ideas about what is ‘normal.’

Consider development. Remember that very young children do not always fully understand what gender means, the difference between play and reality, or how their bodies will develop and change as they get older.  They will learn about all of these things gradually, over time, through their relationship with you and other important adults.  It will usually be important to allow them to explore and develop though play and fantasy without imposing more adult concepts of ‘reality’ of ‘fixedness’ onto them too early.

Gender isn’t all that matters. A sense of identity develops throughout childhood and adolescence. Young children are exploring their emerging identity, and gender is only one part of that. Try and get a balance between paying attention to a child’s gender-related preferences whilst not allowing gender to become the only way in which you understand your child.  Allow your child access to all sorts of toys, friends and activities, associated with both boys and girls.  Ensure that they remain involved with their education, friends and hobbies and remember to celebrate all parts of them, as you would with any child.  Regardless of their gender identity, they will still need to know that they are smart, funny or kind.

Who’s anxious?  There are some really powerful ideas about gender that come from many different sources (e.g. from family networks, communities, cultural and religious contexts, the media etc.). Alongside this, most parents are keen to get it right and do their very best for their children.  If you are feeling worried about your child’s gender identity it might be useful to consider where the anxiety might be stemming from.  Have other people made comments, for example, or have you read a few things about what you should or shouldn’t do that have made you doubt your own parenting?  There are rarely simple ‘wrongs or rights’ when it comes to a child exploring and learning about the world and how they fit within it.  

There’s no rush.  As parents we can easily fall into the trap of writing a sort of ‘life plan’ for our children, even when they’re really young.  This might involve our own dreams, such as a marriage or college for them at some point in their future.  Some parents come to us and discuss ideas about physical interventions in their child’s future.  Understandably, people often start to get worried about puberty, and what this might mean for their child, before it starts.  With younger children we do not have to rush decisions about anything when it comes to their gender.  Ensure your child has safe time and space in which to explore the many aspects of what will make them them.   It might be more important to focus on allowing them this room to grow rather than on second guessing what might be needed in the future, and possibly even worrying them in the process.  If physical intervention is indicated in the future, it’ll become clearer over time and steps can then be taken to plan and manage it.

Social transition? Based on knowledge of child development and our experience of working with families, we know that some younger children benefit from being given time to freely explore their identity when they appear to be questioning their assigned gender. The decision to move to a full social transition (e.g. changing the child’s gender identity in school) requires careful thought and preparation, and needs to be done in a way that does not limit options for further exploration by the child. We also work closely with families where younger children have made a social transition, prior to or whilst coming to our service.

Think about gender identity and expression in your family. You might want to think about ways that ‘masculinity’ and ‘femininity’ are expressed within your family.  Does your child fit with the gender roles in your family? If they don’t they might need extra support to feel okay and accepted.  Other people in the family, parents, grandparents, siblings etc., might feel unsettled by a family member having a different gender identity or role to their own.  Sometimes other people in the family need support in understanding and showing acceptance too.

Looking after yourself. Some parents have complicated feelings themselves when a child starts to question their gender identity.  Some parents tell us that they wonder whether they are to ‘blame,’ others describe it as like a bereavement – like losing their child in some ways.  Equally, other parents seem to take it all in their stride.  There is no ‘normal’ or ‘right’ reaction but it is often helpful to have a place of your own where you can discuss your personal responses. Draw on both professional and informal support yourself if you need to.  Keep in touch with the kind and compassionate people in your life.  Parents need support too so that they can keep giving to their child.  Your needs should not be put aside at this time.

Parent Advice

How can I help my teenager?

Adolescence is often seen as a time to explore identity, make some mistakes and learn from them while being supported by family/ trusted adults (find out more about cognitive development in childhood and adolescence). All young people need support as they go through this process, whether they are questioning their gender or not. Sometimes parents feel concerned when it comes to discussing gender with their child, they can be afraid that they don’t know enough themselves of that they might get it wrong somehow.  In our experience, supportive parents can often be more helpful than they realise.  It is helpful to provide a time to listen and try to understand your child if they come to you.  Give them permission to talk to you about any subject, even if that might be troubling or upsetting. At times, you may need to help you child access wider support, whether that comes through their school, their GP or Child and Adolescent Mental Health (CAMHS).  Here are some more ideas when talking to your teenager about gender:

Remind them that they’re normal. This might involve discussing how having non-stereotypical gender feelings or interests in adolescence is common and not in itself a concern.  

Think about gender identity and expression in the context of wider development. It is absolutely normal to explore and think about what you want from yourself and your life in adolescence.  It is important to allow your young person time and space to do this.  You can acknowledge that a young person’s identity may remain fixed from adolescence onwards, or it may change as their life unfolds. 

Think about gender identity and expression in your family. You might want to think about ways that ‘masculinity’ and ‘femininity’ are expressed within your family.  Does your child fit with the gender roles in your family? If they don’t they might need extra support to feel okay and accepted.  Other people in the family, parents, grandparents, siblings etc., might feel unsettled by a family member having a different gender identity or role to their own.  Sometimes other people in the family need support in understanding and showing acceptance too.

Help your young person manage uncertainty. A sense of identity develops throughout childhood and adolescence. Young people all explore their emerging identity, of which gender is only one aspect. It can be helpful to try and maintain a balance between permitting and paying attention to a child’s gender-related preferences whilst not allowing gender to become the only way to understand them. This can happen even if your child wishes to access physical interventions.  Tolerating uncertainty about the future and identity can be hard for both parents and young people but is often helpful as it keeps all options and ideas open, allowing for flexibility and thoughtful decision making. 

Talk about feelings.  For many reasons, young people who question their gender can experience a range of emotions related to this.  Check in with how your young person is feeling and managing everything.  Always check in again if there have been any changes, when a young person has ‘come out’ to someone new or has made a social transition for example.  If talking about feelings isn’t something you are comfortable with yourself, ensure that someone else is doing this talking.  It could be a professional or another family member or friend.  Many young people are incredibly resilient but if you ever feel that you or your child needs extra support with emotions, you can speak to your GP or school as a first step.

Discuss how they feel about their body.  Some young people who question their gender identity experience significant dysphoria about their body. This means that they feel uneasy or dissatisfied with it, as though it doesn’t quite fit with their sense of who they are. Some young people chose to modify their bodies as much as they can. Young people who were assigned female can bind their breasts to create a more ‘masculinized’ chest, or they might take contraceptive medication to manage their periods. Those who were assigned male sometimes tuck their genitals or pluck facial hair to ‘feminise’ the way they appear to others. They might want some practical support with the changes that they are trying out, or they might not, so check this with them. Some young people have strong urges to harm their bodies as a result of dysphoria and if this is happening you should make your GP aware as a first step.  Do not be afraid to ask for help if you need it. 

Help your child stay healthy, supported, and in education.  It can be unsettling for someone to question their gender or identity which makes it even more important that other parts of a young person’s life stay consistent.   Try and problem solve things that could get in the way of them accessing education, keeping or maintaining their friendships, or looking after their physical or emotional health.  Gender is just one part of your child and you will both be better able to manage it if other aspects of their life are going well.

Consider accessing peer support groups.  There are a number of LGBT groups around the country where young people can meet and support each other.  Some of these groups also run events for meeting other parents.

Draw on your support network. Who else knows what is going on?  Who else is supporting you and your child, and what support may they be able to provide, if necessary? Talk to your young person about their social experiences when they are away from you.  Is there any unkindness or bullying that needs to be addressed?  You might want to encourage their more supportive friendships? 

Looking after yourself. Some parents have complicated feelings themselves when a child starts to question their gender identity.  Some parents tell us that they wonder whether they are to ‘blame,’ others describe it as being like a bereavement – like they are losing their child in some ways.  Equally, other parents seem to take it all in their stride.  There is no ‘normal’ or ‘right’ reaction but it is often helpful to have a place of your own where you can discuss your personal responses. Draw on both professional and informal support yourself if you need to.  Keep in touch with the kind and compassionate people in your life.  Parents need support too so that they can keep giving to their child.  Your needs should not be put aside at this time.

Parent Advice

How can I encourage exploration and keep options open?

It is important to be supportive, where you can, about your child exploring their gender identity.  It is also important to consider how you can do this without rejecting the possibility of their current identity changing in the future.  This may seem very unlikely indeed for some young people.  However, others have told us how hard it was to further explore their identities, or consider transitioning back, once they and other people had fought so hard for them to be able to express themselves in a certain way. 

Gender is complicated and young people are constantly developing . Try and maintain a positive supportive relationship with your child during these critical and sometimes challenging years. 

Find ways to demonstrate that you love your child however they express their gender. You do not have to be completely affirmative about a gender identity in order to be affirmative about them.  Show that your relationship with them won’t change if their gender expression changes. You could express these ideas in words, or you could demonstrate permission for them to keep exploring their gender identity by allowing ongoing access to a variety of clothes or activities, whether they choose to use them or not.  As usual, being transparent with your child about your ideas and theirs helps to avoid too much confusion and can allow you to provide emotional support where it is most needed.

Parent Advice

Helping my child whilst waiting for input

Many young people that we see are unhappy with having to wait – this might be waiting for appointments with services, waiting for other people to adjust or talk with them about gender, or waiting for a physical intervention.  Young people seem to struggle most when they feel that there is nothing that they can do but wait.  Sometimes, however, there are things that could be done, such as joining a local LGBT group, trying out different ways of expressing their gender, or for some changing a name by deed poll.  We would encourage you to think with your young person about whether there is anything they can actively do now.  When there is nothing practical to be done, remember that listening, encouraging and empathising with them is equally as important in helping them to feel supported and resilient.

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