How to respond, when a child says they are in the wrong gender body? Such gender dysphoria (GD) is becoming more common across the world. In the UK, the incidence of children under 18 making this complaint rose over 30-fold between 2011 and 2021 (Jarvis et al, 2025), most markedly in children assigned female at birth. And whatever sex at birth, GD begins in early childhood: in nearly 80% of cases, it is the child’s earliest memory and is an established conviction by six years of age (Zaliznyak et al, 2021).
GD is a controversial topic. Some simply deny its reality, attributing it to psycho-social factors or “woke” agendas. Others are more accepting, noting that it is the lived experience of many, and it is not a new phenomenon – for example, the Hijras have been accepted as a third gender, neither completely male nor female, generally effectively “trans”, throughout the Indian subcontinent for more than 800 years).
But many people are puzzled, struggling to understand, and particularly to know what to do for the best when a child or teenager presents with GD.
Whatever one’s attitude to GD, children with this issue are in urgent need of support: concomitant with GD, more than 50% of these children have high levels of depression and self-harm (Jarvis et al, 2025). They are at high risk of suicide (Day et al, 2019). Like every other depressed, self-harming, suicidal child they surely need and deserve pastoral support.
An area of clinical need in disarray
In the UK, provision for child and youth GD was through the Tavistock Clinic, which was closed in March 2024, after considerable criticism of its practices (inadequate assessment of clients, too hasty intervention including the use of treatments such as puberty blockers without evidence of either benefit or long-term safety).
A major review, the Cass report (2024) found that research in this area is of such poor quality that there is too little reliable evidence on which to base clinical decisions. For example:
- Research on mental health in GD is poor. Key instance – autism is more common in children with GD (Glidden et al, 2016), but we lack research exploring this relationship.
- We don’t have the research to predict which GD children will go on to have an enduring trans identity. A percentage of those who transition will change their minds and want to return to their birth sex. Poor quality research means that we don’t even know how common that is – estimates vary from 1% to more than 13%, many citing external pressures as the reason for detransition (Turban et al, 2021).
- Critically, Cass (2024) reported that poor quality research means that we don’t have evidence for mental health benefits of puberty blockers, or their long-term safety. Puberty blockers, often prescribed in the past, are now banned in UK except in the specific context of research trials. Cass’s conclusions are supported by other meta-studies (Miroshnychenko et al, 2025a; Miroshnychenko et al, 2025b).
Fixing the research?
The normal reaction to a finding of “more research is needed”, especially in areas where there is urgent clinical need, is for more research to be commissioned.
This is already happening – some good quality research is coming through in UK and Canada (Jarvis et al, 2025; Miroshnychenko et al, 2025a, 2025b). However, cuts in federal funding will reduce research in the USA, up to now a major player here.
Furthermore (Kreiger et al, 2025), it is reported that a presidential edict asserts that research using words and phrases associated with GD and transgender currently in line for publication should not now be published. Much British and international research is usually published in USA science journals. Such an edict would do damage to research and to the development of clinical practice.
A new structural system in the NHS
Following the closure of the Tavistock, the NHS is planning for six regional centres for GD in the young, which will be opened by 2026. These will operate on a different basis from the Tavistock, drawing – hopefully – on quality research.
Until this new system comes online, we have the National Referral and Support Service for the NHS Gender Incongruence Service for Children and Young People. Since NICE has no recommendations for addressing GD, this unit does not provide treatment or offer advice. It merely holds the waiting list for referrals to expert care, making transfers as resources become available. One may assume that these waiting lists are long.
Coping with GD children ‘on the ground’
GD has been with us for hundreds of years, as the Hijras show. Research as to the best clinical solution is in disarray. What is more, the “debate” today often becomes very toxic, very quickly, especially on social media and online, and on both sides of the divide. Has this toxicity made vulnerable youngsters still more vulnerable?
We do not yet understand how GD develops, but there is a broad consensus that it is the result of a complex interplay between biological, psychological, and social factors (Cass, 2024).
The biological factors are perhaps the least understood. Some research suggests that variations in prenatal hormone exposure may influence aspects of gender development such as sexual orientation (Hines, 2020). Other research suggests that DSD (Disorders of Sexual Development – which used to be called intersex) increase the likelihood of an individual experiencing GD (Babu & Shah, 2020).
The one thing that is very clear about GD is that those with this issue are in urgent need of emotional support: as noted above, concomitant with GD, more than 50% of these children have high levels of depression and self-harm (Jarvis et al, 2025). They are at high risk of suicide (Day et al, 2019). The question facing professionals – including those working in schools – is what to do for the best welfare of children and teenagers with GD?
Here are some thoughts.
Offer pastoral support
For example, offer a safe and private space where any – including those with GD – depressed or suicidal child can seek support. This is not about offering input on transition for those with GD: indeed, given the absence of clinical advice and the enormity of issues surrounding transgender, such input should be avoided. What we should offer is simply pastoral care for youngsters in distress. Some GD individuals keep their “true” identity secret for decades (Zaliznyak et al, 2021), and along with that don’t seek help for depression or suicidal thoughts. Offering a space where depression and suicidal feelings can be safely expressed, listening with sympathy and without judgement, is a pastoral gift – and for some it will be a life-line.
Seek professional help
As always, any child or youth with serious depression or suicidal thoughts should be referred for expert support asap. This is important, in GD. Only expert professionals who have directly assessed the individual’s feelings, experience, and situation should engage discussions about GD and transition. Given the disarray of expert provision in UK, finding such help may take some time. So how to seek professional help for a child who says they are in the wrong gender body? Until the new regional centres for GD come online, such expert help looks very difficult to arrange. NHS advice is to approach the GP for a referral to whatever service may be available locally, perhaps a counsellor. Be aware: GP services are not always well informed or supportive in this area (Carlile, 2019). The NHS website also recommends Samaritans.
If a child insists on transition?
Whatever others may say, some individuals will insist on starting to transition now, perhaps changing name or pronoun, maybe dressing differently. Whatever else, this is a brave decision. These children are at risk of being teased or bullied and may be rejected by both cisgender peers of the chosen identity, and cisgender peers of the rejected identity. That’s a lonely path. Whatever your view on GD, surely it is right to do our best to support the emotional welfare of every child? Organisations such as Young Minds offer advice on supporting the mental health of children and teenagers wanting transition.
- Dr Stephanie Thornton is an author and lecturer in psychology and child development. She is the co-author of Understanding Developmental Psychology (Macmillan International/Red Globe, 2021). To read her previous articles for SecEd, visit www.sec-ed.co.uk/authors/dr-stephanie-thornton
Resources
- National referral and Support Service for the NHS Gender Incongruence Service for Children and Young People: www.ardengemcsu.nhs.uk/services/clinical-support/national-referral-support-service-for-the-nhs-gender-incongruence-service-for-children-and-young-people
- Young Minds: Gender identity: www.youngminds.org.uk/parent/parents-a-z-mental-health-guide/gender-identity
References
- Babu R, Shah U. Gender identity disorder (GID) in adolescents and adults with differences of sex development (DSD): A systematic review and meta-analysis. J Pediatr Urol. 2021 Feb;17(1):39-47. doi: 10.1016/j.jpurol.2020.11.017. Epub 2020. PMID: 33246831: https://pubmed.ncbi.nlm.nih.gov/33246831/
- Cass, H. The Cass Review: Independent Review of Gender Identity Services for Children and Young People: Final Report. NHS England. 2024: https://cass.independent-review.uk/home/publications/final-report
- Carlile A. The experiences of transgender and non-binary children and young people and their parents in healthcare settings in England, UK: Interviews with members of a family support group. Int J Transgend Health. 2019 Nov 23;21(1):16-32. doi: 10.1080/15532739.2019.1693472. PMID: 33015656; PMCID: PMC7430470: https://pubmed.ncbi.nlm.nih.gov/33015656/
- Day D S, Saunders J J, Matorin A (November 12, 2019) Gender Dysphoria and Suicidal Ideation: Clinical Observations from a Psychiatric Emergency Service. Cureus 11(11): e6132. doi:10.7759/cureus.6132: www.cureus.com/articles/20779-gender-dysphoria-and-suicidal-ideation-clinical-observations-from-a-psychiatric-emergency-service#!/
- Glidden D, Bouman WP, Jones BA, Arcelus J. Gender Dysphoria and Autism Spectrum Disorder: A Systematic Review of the Literature. Sex Med Rev. 2016 Jan;4(1):3-14. doi: 10.1016/j.sxmr.2015.10.003. Epub 2016 Jan 8. PMID: 27872002: https://pubmed.ncbi.nlm.nih.gov/27872002/
- Hines M. Prenatal endocrine influences on sexual orientation and on sexually differentiated childhood behavior. Front Neuroendocrinol. 2011 Apr;32(2):170-82. doi: 10.1016/j.yfrne.2011.02.006. Epub 2011 Feb 17. PMID: 21333673; PMCID: PMC3296090: https://pmc.ncbi.nlm.nih.gov/articles/PMC3296090/
- Jarvis SW, Fraser LK, Langton T, Hewitt CE, Doran T. Epidemiology of gender dysphoria and gender incongruence in children and young people attending primary care practices in England: retrospective cohort study. Arch Dis Child. 2025 Feb 4:archdischild-2024-327992. doi: 10.1136/archdischild-2024-327992. Epub ahead of print. PMID: 39855722: https://pubmed.ncbi.nlm.nih.gov/39855722/
- Krieger. N & Gruskin, S. Gender removal by fiat: impacts of new Trump administration edicts. The Lancet, Volume 405, Issue 10479, 620. 2025: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00243-0/fulltext
- Miroshnychenko A, Roldan Y, Ibrahim S, Kulatunga-Moruzi C, Montante S, Couban R, Guyatt G, Brignardello-Petersen R. Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis. Arch Dis Child. 2025a Jan 30:archdischild-2024-327909. doi: 10.1136/archdischild-2024-327909. Epub ahead of print. PMID: 39855724: https://pubmed.ncbi.nlm.nih.gov/39855724/
- Miroshnychenko A, Ibrahim S, Roldan Y, Kulatunga-Moruzi C, Montante S, Couban R, Guyatt G, Brignardello-Petersen R. Gender affirming hormone therapy for individuals with gender dysphoria aged <26 years: a systematic review and meta-analysis. Arch Dis Child. 2025b Feb 12:archdischild-2024-327921. doi: 10.1136/archdischild-2024-327921. Epub ahead of print. PMID: 39855725: https://pubmed.ncbi.nlm.nih.gov/39855725/
- Turban JL, Loo SS, Almazan AN, Keuroghlian AS. Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT Health. 2021 May-Jun;8(4):273-280. doi: 10.1089/lgbt.2020.0437. Epub 2021 Mar 31. PMID: 33794108; PMCID: PMC8213007: https://pubmed.ncbi.nlm.nih.gov/33794108/
- Zaliznyak M, Yuan N, Bresee C, Freedman A, Garcia MM. How Early in Life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for Patients, Providers, and for Our Healthcare System. Sex Med. 2021 Dec;9(6):100448. doi: 10.1016/j.esxm.2021.100448. Epub 2021 Oct 31. PMID: 34731778; PMCID: PMC8766261: https://pmc.ncbi.nlm.nih.gov/articles/PMC8766261/
- This article was updated on April 22 to clarify certain points and to include additional research and references.