I should of said "Where was the threat?"
Treatment for children
If your child is under 18 years of age, they should be referred to a specialist child and adolescent gender identity clinic. These clinics can offer ongoing assessment for children with gender dysphoria, and specialised treatment and support for children and their families. Your child will be fully assessed before any treatment begins.
Your child?s treatment should be arranged with a multi-disciplinary team (MDT), a team of different healthcare professionals working together. Your child?s MDT may include:
- a mental health professional, who is trained in dealing with gender dysphoria in children and teenagers
- a paediatric endocrinologist, a specialist in hormone conditions in children
Children before puberty
If your child is diagnosed with gender dysphoria before they reach puberty (when a child progresses into a sexually developed adult), they will not receive endocrine treatment. Endocrine treatment is treatment with hormones (powerful chemicals). It is the first step to developing the physical signs of your preferred gender.
Guidelines from the Endocrine Society do not recommend endocrine treatment for young children because a diagnosis of transsexualism cannot be made before a child has reached puberty. Transsexualism is a life-long and extreme form of gender dysphoria, when someone seeks to change their sex.
The Endocrine Society found that 75-80% of children who were diagnosed with gender dysphoria before they reached puberty did not have the condition after puberty. Therefore, endocrine treatment is not recommended until after puberty, when a diagnosis of gender dysphoria can be confirmed.
Children up to 16
If your child has been diagnosed with transexualism and they have reached puberty, they may be treated with gonadotrophin-releasing hormone (GnRH) analogues. These are synthetic (manmade) hormones that suppress the hormones naturally produced by your body.
The recommendation for endocrine treatment must come from a mental health professional, and they must continue to be part of your child?s ongoing care. An endocrinologist (a specialist in hormonal conditions) must also confirm your child?s diagnosis.
Puberty is divided into stages. These are called Tanner stages, named after James Mourilyan Tanner who first identified them. GnRH analogues may be suitable for children who have reached Tanner stage two, which means a number of physical changes have taken place, such as pubic hair starting to grow. In girls, this is around 11 years of age and in boys it is around 12 years of age.
See the Health A-Z topic about Puberty - symptoms for more information about the different stages of puberty and the changes that take place.
Some of the changes that take place during puberty are driven by hormones. For example, the hormone testosterone, which is produced by the testes in boys, helps stimulate the development of the penis. As GnRH analogues suppress the hormones that are produced by your child?s body, they also suppress puberty.
GnRH analogues can be taken until your child reaches 16 years of age, after which cross-sex hormones can be taken (see below).
Children over 16
If your child has been taking GnRH analogues for several years and are still diagnosed as transsexual, they may be offered cross-sex hormones. These can alter your child?s body further to fit with their gender identity. The effects of these hormones are only partially reversible, so they are not offered to children who are under 16 years of age.
Once your child reaches adulthood at 18 years of age, they can begin the process of gender confirmation surgery, which will change their gender irreversibly (also known as transition). Not all children who experience gender dysphoria will go on to transition. In fact, the number of children who go on to become transsexuals is very small.
For more information about cross-sex hormone treatment and gender confirmation surgery, see the section below about treatment for adults.
The amount of treatment that your child has will depend on how strong and long-lasting their feelings of gender dysphoria are. However, all children and their families should be offered counselling and support through their gender identity clinic.
The Department of Health has published a number of leaflets about gender identity, including one aimed at parents whose children are experiencing gender dysphoria.