Transgender children and young people: how the evidence can point the way forward.

Philip Graham

doi:10.1192/bjb.2022.3

Abstract

The development of gender identity in children from around the age of 3 years is described. Wishes for transgender identity are distinguished from gender-atypical behaviour. Reasons for the recent rise in transgender referrals in the early teen years are discussed. The now widely used protocol developed by the Amsterdam group for assessing transgender children and young people and, where appropriate, offering them puberty blockers, cross-sex hormones and sex reassignment surgery is described. Evidence for the effectiveness of this approach is considered. The competence of young people to give consent to these procedures is discussed. Finally, proposals are made for topics urgently requiring further research.

Highlights

The aims of treatment are twofold: (a) to explore with the child or young person with gender dysphoria the reasons for their discomfort with their gender assigned at birth and to consider alternative ways forward, including living in the role of their birth-assigned gender or pursuing medical intervention that will enable them to transition; (b) in those who choose to live in their preferred transgender role, to start treatment, pausing for reflection before each step, first with puberty blockers, with cross-sex hormones and with gender reassignment surgery to relieve gender dysphoria
This study reported on the short-term outcome over 2 years of 44 children and young people aged 12 to 15 years when they started treatment with puberty blockers
One can conclude from the evidence that gender dysphoria is a relatively rare but well-defined condition, characterised by a strong desire to be of the gender opposite to that assigned at birth and by an insistence that one is, of the other gender

Summary

Introduction

(4) If intense gender dysphoria persists, consider using puberty blockers at Tanner stages 2–3 (5) Consider use of cross-sex hormones at age 16 (6) At age 18–19 and subsequently, consider gender reassignment surgery present and the reasons for the increase in referrals to transgender clinics is unknown.

Results

Conclusion