Health - Reform of gender identity support

Children experiencing gender identity issues are set to get better access to vital help next month when support services go national.

At present, children and adolescents can, in theory, access the Gender Identity Development Service (GIDS), established in 1989 and based at the Tavistock and Portman NHS Foundation Trust.

It is the only service in the UK for young people up to the age of 18 who believe they may have been born the wrong sex, but many experience problems securing a referral.

Faster access to services

Treatment available includes expert psychological observation, assessment and support, possible suspension of puberty to allow children more time to decide what they want, and hormonal medication.

The service also liaises with schools in an attempt to ensure teachers are aware of specific circumstances in order to reduce the likelihood of bullying.

Existing arrangements are funded through individual primary care trusts (PCTs), which means the speed of referrals varies from area to area depending on local budgets and expertise.

But from 1 April these services will be commissioned at a national level, which experts say will help children get faster access to the help they need.

However, some argue more progress is required, both socially and medically, to ensure children affected by gender identity issues get the right support.

Last year, 64 children and adolescents were referred to the service. An estimated three-quarters of these are expected to become comfortable with their gender by puberty.

Despite hopes that the changes will lead to big improvements in access to services, controversy surrounds the way those with a definite desire to change gender are treated shortly after the onset of puberty.

Christine Burns, a member of the Department of Health's LGBT advisory group, says the service does not administer drugs to suspend puberty until the age of 16, a policy which goes against the practice in other countries, including Holland and the US.

"Some of the physical changes at puberty, such as a male's voice breaking, are irreversible, while others are very expensive, or involve invasive surgery, to remove," she says.

"If you use drugs that block the body's hormones and postpone the onset of puberty, you buy a bit of time for the child to become older. That way if they decide when they are 16 or 17 they are definitely going to change gender for life, they start with the best possible set of circumstances."

Her view is backed by Margaret Griffiths, liaison officer at Mermaids, a family support group for children and adolescents with gender identity issues.

Focus on gender education

Griffiths believes these drugs should be available - in the right circumstances - part way through puberty, because the full transformational experience can be hugely traumatic, with a number of children attempting suicide as a result.

She says more focus should also be placed on educating children about gender issues to help prevent bullying.

"Those of us on the committee actually prefer children to be treated early with more proactive and consistent treatment," she says. "We also believe children should be educated from an early age about gender issues and the affect that not accepting them can have.

"For some of these children, gender issues may be just a phase they are going through, but it can cause a lot of problems. They can be extremely lonely, finding it difficult to join social groups. They often contemplate suicide and some succeed."

CASE STUDY - WHEN A CHILD IS BORN THE WRONG GENDER

Sharon Brown's daughter Nicky is 15. Born a boy, she was diagnosed with gender dysphoria at the age of seven.

"It wasn't a surprise," says Brown. "You could see something was going on from a very young age. I raised it with my GP when she was four, but he told me to see how it went. By the time she was seven I had become aware of the work at the Tavistock clinic and asked for a referral.

"Fortunately the mental health services guy I saw had worked at the Tavistock and referred us immediately. It was a lucky break because I know other parents have had real trouble getting a referral.

"The Tavistock diagnosed her with gender dysphoria. They came and spoke to teachers at her school and helped us to deal with bullying issues.

"As she became older, she was dreading the onset of puberty. She was being badly bullied at secondary school and took four overdoses.

"At the Tavistock they believe children cannot be certain until they reach puberty, so they do not use blockers before the age of 16.

"My GP was very supportive and eventually we got treatment in the US. It costs £6,500 a year as we have to travel to Boston every month. I think if we hadn't, she would not have been with us by the age of 16."