Watchfully waiting; UK continues to harm transgender children


Today the UK Royal College of Psychiatrist’s launched a brand new position statement “supporting transgender and gender-diverse people”.

Their statement endorses ‘watchful waiting’ for trans children.

“The College believes that a watch and wait policy, which does not place any pressure on children to live or behave in accordance with their sex assigned at birth or to move rapidly to gender transition, may be an appropriate course of action when young people first present.”

It does not acknowledge that a watchful waiting approach, as commonly understood, entails a blanket one-size fits-all approach that recommends delayed transition for all trans children.

‘Watchful waiting’ does not make it clear what we are meant to be watching and what we are meant to be waiting for. In the experience of parents of trans children, watchful waiting means watching your child get sadder and waiting for them to become completely without hope.

When a child continually asserts their identity there is no ‘neutral’ reaction that does not equate to rejection and shame. What answer do the ‘watchful waiting’ proponents suggest a parent give when their child asks to be acknowledged for who they are? They don’t advocate we tell them they are wrong (aka conversion therapy) but what do they suggest? Should we just pretend we haven’t heard them? For how long? Shall we just change the subject? Every day? For how many years?

For insistent, persistent, consistent trans children who are very distressed at being rejected by their families, being mis-gendered and being forced to act out a lie, watchful waiting causes harm. It causes children to feel shame. It causes them to feel that they are wrong. Unacceptable. Un-loveable. It advises parents that they should not tell the child that they are not trans, but equally must delay accepting them as the gender they are asserting

Not accepting a child’s identity is the same as rejecting their identity. To that child. They notice their parent avoiding pronouns. They notice their parent refusing to call them a girl (for example). They notice their parent not sticking up for them at school. This rejection causes transgender children to put on hold their hopes of a happy and carefree childhood. Their one and only childhood. A childhood they will never get back.

I’ve seen my child move from a miserable child when she was being continually rejected and mis-gendered, to our now happy girl getting on with her life, loving school. I know so many other children who have flourished once given a chance to be accepted and acknowledged.

There is no medical intervention for young children so watchful waiting is nothing less than denying social transition. Denial of pronoun change. Denial of acceptance.

And for what? You’d better have some damn strong evidence to deny my child her happiness. Her childhood. Her education.

We know the benefits of social transition.

We know how children not supported by their families struggle.

We know few children revert to a cis identity – and even if they do, there is no harm in a second social transition so long as the child is listened to and respected. “Let the child lead the way”.

The Royal College of Psychiatrists position paper ignores available evidence supporting affirmative approaches, showing that affirmed trans children flourish, as so many parents have seen.

It does not provide a single piece of evidence that watchful waiting is better than affirmative care. What arrogance on behalf of the Royal College of Psychiatrists to condemn yet another generation of trans children to spend their one and only childhood in denied transition, leaving us parents to watchfully wait as their self-confidence crashes, as they stoop their shoulders in shame, as they drop out of education, as they self-harm and learn to hate themselves for being so ‘wrong’.

There’s increasing evidence of the appropriateness of an affirmative approach:

“being trans or gender diverse is now largely viewed as being part of the natural spectrum of human diversity” (RCH, 2017)

“there is a durable biological underpinning to gender identity” (Endocrine Society, 2017)

“Transgender children do indeed exist and their identity is a deeply held one.” “Early in development, transgender youth are statistically indistinguishable from cisgender children of the same gender identity.” (Olson, 2015 and Fast, 2017)

“Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex. (Olson, 2015)

“Social transitions are increasingly common for transgender children. This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups. (Socially transitioned) transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers and they reported marginally higher anxiety. Compared with national averages, (socially transitioned) transgender children showed typical rates of depression and marginally higher rates of anxiety. These findings are in striking contrast to previous work with gender-nonconforming children who had not socially transitioned, which found very high rates of depression and anxiety. (Durwood, 2017)

“The number of children in Australia who later socially transition back to their gender assigned at birth is not known, but anecdotally appears to be low, and no current evidence of harm in doing so exists”. (RCH, 2017)

Where is the up to date evidence in favour of a watchful waiting approach?

Here is the American Academy of Pediatric’s position on watchful waiting, published in 2016:

Delayed Transition: Prolonging Dysphoria

Certain clinicians, along with non-expert critics of transgender advocacy, have taken a position that they describe as “watchful waiting.” They contend that most children with gender dysphoria do not become transgender adults and, therefore, early social transition may be unnecessary, even harmful. They advocate waiting until adolescence, or even adulthood, to permit any type of gender transition. Because watchful waiting is a general phrase that could also apply to affirming a child’s gender identity as they grow, we use the phrase “delayed transition” to more specifically describe this approach.

It is true that most gender-expansive children, and even some children with gender dysphoria, do not become transgender adults. Indeed, some children become more comfortable with their assigned gender as they reach adolescence. Unfortunately, delayed-transition advocates often support their claims with misleading interpretations of research. More important, competent clinicians generally can tell transgender kids apart from other gender-expansive children. Many delayed-transition advocates say this is impossible until a child reaches puberty, but their own studies contradict them, identifying early characteristics that predict whether gender dysphoria will continue. Persisters in these studies had more cross-gender behaviour and more intense gender dysphoria during childhood, as measured on various psychological tests. Interviewed later, they also described their childhood experiences with gender differently. For instance, persisters recalled insisting that they were the “other” gender, while desisters had said they wished they were that gender. Many children who are gender-expansive or have mild gender dysphoria do not grow up to be transgender — but these are not the children for whom competent clinicians recommend gender transition.

As in most areas of medicine and life, there is no perfect test to predict what is best for each child. But delayed-transition advocates treat unnecessary or mistaken gender transition as the worst-case scenario, rather than balancing this risk with the consequences of the delay. There is no evidence that another transition later on, either back to the original gender or to another gender altogether, would be harmful for a socially transitioned child — especially if the child had support in continuing to explore their gender identity. More important, untreated gender dysphoria can drive depression, anxiety, social problems, school failure, self-harm and even suicide. Delayed-transition proponents have few answers for children and families in the throes of these symptoms. What’s more, we know little about the long-term consequences of prolonging gender dysphoria.

Those who advocate delayed transition say it allows a child to explore gender possibilities without pressure in a particular direction. While this may be their intent, the delayed transition approach actually makes it impossible. Children may be permitted to express certain gender-expansive behaviours, such as play preferences or dress, but they are prohibited from other forms of self-expression, like adopting a gender appropriate name and pronouns, that they may ardently wish to take. These constraints communicate to the child that being transgender is discouraged. Tragically, youth whose families fail to affirm their sexual orientation, gender identity or gender expression are at significantly increased risk of depression, substance abuse and suicide attempts.

While delaying a child’s gender exploration can cause serious harm, a deliberate approach is wise. Some children need more time to figure out their gender identity, and some do best by trying out changes more slowly. For these children, rushing into transition could be as harmful as putting it off. The problem with “delayed transition” is that it limits transition based on a child’s age rather than considering important signs of readiness, particularly the child’s wishes and experiences. A gender-affirmative approach uses this broader range of factors, with particular attention to avoiding stigma and shame.

“Waiting to transition…was not an option if we cared anything about [our son’s] health. The despair he went through…was not manageable. But when he did transition, it was like a light switch. We had a happy, healthy kid. And it has been that way ever since — four years and counting.” Peter Tchoryk Father of a seven-year-old transgender boy

Here is the ANZPATH (Australian Professional Association for Transgender Health) position as reflected in their 2017 guidance:

“increasing evidence demonstrates that with supportive, gender affirmative care during childhood and adolescence, harms can be ameliorated and mental health and well being outcomes can be significantly improved”.

Avoid causing harm”. “withholding of gender affirming treatment is not considered a neutral option, and may exacerbate distress in a number of ways including depression, anxiety and suicidality, social withdrawal, as well as possibly increasing chances of young people illegally accessing medications”

“Supporting trans and gender diverse children requires a developmentally appropriate and gender affirming approach”.

“for children, family support is associated with more optimal mental health outcomes”

“trans or gender diverse children with good health and wellbeing who are supported and affirmed by their family, community and educational environments may not require any additional psychological support beyond occasional and intermittent contact with relevant professionals in the child’s life such as the family’s general practitioner or school support”.

“social transition should be led by the child and does not have to take an all or nothing approach”

“social transition can reduce a child’s distress and improve their emotional functioning. Evidence suggest that trans children who have socially transitioned demonstrate levels of depression, anxiety and self-worth comparable to their cisgender peers”.

“The number of children in Australia who later socially transition back to their gender assigned at birth is not known, but anecdotally appears to be low, and no current evidence of harm in doing so exists”.

Key roles for a clinician of younger child:

Supportive exploration of gender identity over time

Work with family to ensure a supportive home environment

Advocacy to ensure gender affirming support at school

Education (to child and family) on gender identity and signposting to support organisations for child and for parents

If child is expressing desire to live in a role consistent with their gender identity, provision of psycho-social support and practical assistance to the child and family to facilitate social transition

Here’s the Australian Psychological Society’s Information sheet, produced in 2017:

“Support from families, as well as broader social support, is crucial to transgender and gender diverse children’s mental health.

Affirm your child’s expressed gender

It is essential to their child’s wellbeing that parents, caregivers and families support the child and affirm the child’s gender.

  • Support your child in his or her gender expressions in the form of dress and activities.
  • Use the names and pronouns that the child expresses (rather than those they were assigned at birth).

The degree to which parents and caregivers are positive and supportive has an impact not only on the child but also on all those around them, such as extended family, community, and schools, as they often seek their cues from how the child’s family is responding.

There is no right age for your child to let you know they are transgender or gender diverse. Some children know as young as three years old and others may only realise when they are teenagers. Often a child has known for a long time before they find the courage to talk to someone. There is also no right or wrong way to be transgender or gender diverse. Each child will be different.

Seek support from a mental health professional

Even though being transgender or gender diverse itself is not a mental health issue, getting some support from a mental health professional who affirms your child’s gender is likely to be helpful for children and their families as they navigate daily experiences and longer-term decisions. A mental health professional can help:

  • Affirm your child’s gender and help them to feel accepted and normal for who they are.
  • Help you navigate society’s expectations of gender that can cause anxiety and depression.
  • Assist with social transition as your child decides to show or let people know their preferred gender.
  • Assist with access to gender-affirming medical treatment. Having the option of treatment in the form of hormone blockers (to delay puberty) or gender-affirming hormones can have a significant positive impact on the mental health of TGD children in particular.

The Australian Psychological Society recommends mental health practices that affirm transgender people’s experiences.

The Royal College of Psychiatrists include absolutely no reference to the most recent publication on this topic, capturing the most up to date evidence (published in 2018):

Diane Ehrensaft, Shawn V Giammattei, Kelly Storck, Amy C Tishelman & Colton Keo-Meier (2018): Prepubertal social gender transitions: What we know; what we can Learn – A view from a gender affirmative lens, International Journal of Transgenderism, DOI:10.1080/15532739.2017.1414649

This new paper is a really important read. There is no excuse for clinicians at the Royal College of Psychiatrists not having read it and for not citing it.

The paper’s conclusion is:

“Newer research suggests that socially transitioned prepubertal children are often well adjusted, a finding consistent with clinical practice observations. Analysis of both emerging research and clinical reports reveal evidence of a stable transgender identity surfacing in early childhood.”

The full paper is essential reading for anyone interested in transgender children. it includes a direct critique of the ‘watchful waiting’ approach. But it is a journal article behind an academic paywall, a barrier to parents keeping up to date with the research (this is literally the job of the experts). To help those who are not in academia I will include a long quote – those less interested in the detail can skip to below the quote.

“Those transgender youth who have families that support their transitions and affirm their identities have significantly better physical and mental health outcomes than those who do not (Hill, Menvielle, Sica, & Johnson, 2010; Kuvalanka, Weiner, & Mahan, 2014; Ryan, Russell, Huebner, Diaz, & Sanchez, 2010; Travers et al., 2012). It should be mentioned here that it is not specifically medical gender-affirming interventions that are the kingpin, but more generally all experiences gender expansive and transgender individuals are afforded—medical, psychological, behavioural, social, or legal—that facilitate a person to live in their authentic gender. As a result, most professionals, regardless of their theoretical orientation, have come to believe these interventions are necessary for the overall well-being of their patients.

The WPATH guidelines (SOC 7 from 2011) included a cautionary note on prepubertal social transition on two counts: (1) the persistence/desistence studies indicated a relatively low rate of persistence of gender dysphoria in children studied; and (2) transitioning back to one’s original gender role can be stressful for a child, based on evidence of one qualitative report of two youths who experienced distress when desiring to do so (Steensma & Cohen-Kettenis, 2011).

The cautionary note specifically invited families of children under the age of puberty to consider in-between solutions or compromises, rather than facilitation of a full social transition from one gender to another, with a message delivered to the child that they are always free to revert to their original gender position.

There is an inherent bias in SOC 7 toward the “watchful waiting” approach to pediatric gender care (Cohen-Kettenis & Pf€afflin, 2003), in which a child is given safe spaces to explore their gender but asked to wait until puberty to transition from one gender to another. This bias is evident in both counts of the cautionary note and the reliance on the studies of persisters and desisters in which most young children in the clinical studies were no longer evidencing gender dysphoria by adolescence. However, some of the persister/desister data have been reanalyzed to indicate that more children than originally cited in the data (Steensma & Cohen-Kettenis, 2011) were found to be persisters (Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013) and reevaluation of the data revealed early childhood indicators that could identify a group of young children who were asserting a gender identity that did not match the sex assigned to them at birth and would remain stable in that identity into adolescence, and beyond. Furthermore, the persister/ desister data which inform the SOC 7 guidelines on social transitions only measured children’s gender dysphoria, not their sense of their gender identity or the nature of their gender expressions, the latter two to be differentiated from each other and also measured separately from gender dysphoria (Ehrensaft, 2017). Lastly, the research results may include inflated percentages of desisters, as counted among their number were those who did not return to the clinic for care; therefore, reporting all patients lost to attrition as “desisters” represents an assumption that has never been validated, and rates of persisters and desisters cannot be verified unless these patients are tracked down. Ehrensaft (2016, 2017) guided by her own clinical observations of children, perceived that the studies were actually talking about two separate categories of children who could readily be identified early in life if the proper measures were employed: some young children would be centrally exploring their gender identities while others would be exploring or articulating their gender expressions. In fact, a reevaluation by the Dutch team of their research on persisters and desisters corroborated Ehrensaft’s perception by identifying early factors that differentiated persisters from desisters, including: the statement, “I ama…” rather than “I wish I were a…”; consistent, persistent, and insistent articulations of an asserted gender identity other than one that matched the sex assigned at birth; evidence of body dysphoria (unhappiness about the genitals they had); and an early history of gender-expansive behaviors, perhaps as young as the toddler age (Steensma et al., 2013). If we are to have SOC regarding social transitions that reflect the realities of transgender children who are clear from an early age of their gender identity and are persistent, insistent, and consistent in the articulation of that identity, they will best be based on both research studies and collated clinical observations that assess the more salient variable: the child’s articulated gender identity, whether or not it is accompanied by dysphoria.

Lastly, the reference in the SOC 7 to the problems of “desocial transitioning” for pubertal or postpubertal youth with an early social transition is based on the slimmest of evidence—a case study of two youths. In the youth referenced by Steensma and Cohen-Kettenis (2011) in their short note in Archives of Sexual Behavior, two girls in the desisting group of their study had transitioned, using their own terminology, to a masculine gender role in elementary school, desired to return to their original feminine gender role, but expressed fear of teasing and shame about having been wrong about their gender, culminating in an extended period of distress. Because of the above mentioned conflation of gender role and gender identity underlying the research protocols and lack of mention of a change in name and pronouns, it was not clear from the reported evidence whether these youths had completed a full social transition or simply presented as more masculine and now wished to evolve to a more feminine self in middle school. (Ehrensaft asserts that it is not clear from the paper whether the two girls had socially transitioned – from reading the underling PhD it is clear that they had not – they had not changed pronoun).

Further, the fear of being teased or shamed for having been wrong may be a response to external lack of supports, rather than evidence of an internally based problem. Such stress is typically dependent on social stressors, in this case a social milieu, evident throughout the world, in which there is no acceptance for a child to be fluid in their gender expressions. With that said, the more reasonable standard of care would not be to hold a child back from a social transition but instead ensure social supports for any child who may discover new aspects of their gender over time, including an alteration or shift in gender identity and expression of that identity, with no aspersion cast on their character. If such supports are not in place or achievable through therapeutic supports, within a comprehensive standard of care, the alternative approach would be to support the child in their self-knowledge of their asserted gender identity and communicate an understanding that the impediments to social transitions are externally located, that is, there are not adults available to support the transition, rather than that there is something wrong with the child for desiring the transition or simply desiring to have others mirror back to them their authentic gender identity.

The watchful waiting approach evolved from the first model of care for transgender children developed in the Netherlands, often called the Dutch Protocol. The Dutch Protocol is informed by the belief that gender dysphoria, or a transgender identity, persists into adolescence in only a small minority of people (Steensma & Cohen-Kettenis, 2011). As outlined earlier, this research suffers from potential methodological flaws and the way the data have been interpreted suggests that providers be more concerned about the rare cisgender child being treated for gender dysphoria at the expense of the many transgender and gender-expansive children who would be helped if social transition were an option. The result of this interpretation has the potential to have profound negative impacts on treatment practices in pediatric transgender healthcare (Winters, 2014). In general, the watchful waiting approach is a cautious practice in which assertions of gender diversity and the consideration of a social transition are either tempered or held as possibly true and beneficial, but not until it is determined that the child is capable of knowing their gender with great validity, usually sometime after the advent of puberty (Cohen-Kettenis, Owen, Kaijser, Bradley, & Zucker, 2003). When a child’s gender identity is unclear, the watchful waiting approach can give the child and their family time to develop a clearer understanding and is not necessarily in contrast to the needs of the child.

For children who are clear about their gender but are prohibited from exploring or experiencing the benefits of affirming their gender through a social transition, the watchful waiting approach can create potentially harmful disruptions by negating a young child’s gender identity and delaying the development of their asserted gender identity, especially in cultures that do not support gender diversity.

Similar to the watchful waiting approach, the gender affirmative approach has a foundation of collaboration with children and families to understand and affirm a child’s gender and works to meet the child’s needs as they develop. In contrast to the watchful waiting approach, however, the gender affirmative model does not involve waiting for puberty or adolescence to facilitate a child’s affirmation of their authentic gender, instead endorsing prepubertal social transitions where appropriate (Ehrensaft, 2012; Hidalgo et al., 2013). Gender affirmative care places substantial significance on a child’s understanding of their own gender and allows the child, and their knowledge of their gender, to lead the way to interventions. Social transitions are viewed, explored, and supported as an important and effective intervention that nurtures a transgender or gender-expansive child’s health and well-being. The gender affirming approach has allowed for a salient “ex-post facto test” (i.e., response to intervention) that enables us to discern the profound and overwhelmingly positive effects a social transition can have for gender-expansive children. With the help of social transitions, some children previously struggling with serious mental health and behavioral issues, carrying multiple diagnoses and treated with various psychotropic medications eventually settle into a significantly more stable life free of such issues, (mis)diagnoses and medications (Nealy, 2017).

The Royal College of Psychiatrists exclude a number of critical pieces of evidence (particularly Olson 2015, Olson 2015, Fast, 2017, Elhrensaft 2018) that support the  benefits of an affirmative approach, the latter of which critiques the harm of a watchful waiting approach. And the Royal College of Psychiatrists do not provide a single scrap of evidence of why watchful waiting is better than affirmative care.

Remembering that watchful waiting entails denial of transition as long as possible until the child and family decide to ignore their experts. How is that expert advice? Wait until you no longer trust our advice and then start supporting your child. Wait until your child is desperate and self-harming? Wait until when exactly?

Those who advocate watchful waiting sometimes describe ‘affirmative care’ inaccurately. Affirmative care does not mean encouraging, much less forcing transgender children to socially transition. It does not mean social transition will be appropriate for every transgender child, and certainly not for every gender expansive or gender non-conforming child. Affirmative care just means listening to each child as an individual, respecting their identity and supporting those who need and wish to socially transition to do so without shaming them into living a lie, without forcing them to sit and wait as their chances of a happy childhood tick by.

The UK medical establishment’s un-evidenced commitment to ‘watchful waiting’ may be marketed as careful and benign, but it causes real harm.

The endorsement of ‘watchful waiting’ causes parents like me who love and accept/support our daughter to be painted as fringe or even reckless (despite this being absolutely mainstream advice from gender experts in other countries). The endorsement of watchful waiting directly makes my life harder, entrenching and emboldening those people who have accused me of child abuse in person, and daily on social media.

I can see how happy acceptance, support and social transition has made my child – so I take frequent accusations of child abuse on the chin. I take on the chin the fact that I have lost close friends over this, who genuinely believed support for social transition was harming my child. I take on the chin the responses of scepticism or hostility I get whenever I mention I have a trans child. I take it on the chin that I stand unsupported – with the enormous toll this has taken on my mental health, stress levels and well-being. I take it on the chin that I stand vulnerable to reporting to social services, and stand thankful that I’m not at the whim of a potentially ignorant judge in a child custody case against an unsupportive partner.

I find it harder to stomach the fact that the UK medical establishment’s endorsement of ‘watchful waiting’ makes life harder for my child. It makes it less likely that she will be fully supported by her teachers. It makes it less likely that she will be fully supported by her GP. It gives credibility to groups who campaign ardently to minimise her rights – groups who would rather transgender children just disappear. Adherence to a ‘cautious’ and ‘watchful’ approach, dissuades would be allies, including transgender adults, from sticking up for my child. It directly translates into the current situation where no one in the UK medical establishment ever advocates for transgender children in the UK media.

In countries like US, Australia, Canada, where experts adopt an affirmative approach,  advocacy for trans children in the media is standard practice and considered a standard part of their remit as people who are meant to help transgender children. See the media engagements of Ehrensaft, Spack, Olson, Lopez, Rosenberg in the US. See Telfer advocating for trans children in court cases in Australia. See experts from children’s gender services publicly endorsing a critique of a fake diagnosis in Canada.  This never happens in the UK, and the UK’s endorsement of ‘watchful waiting’ is a key reason why the UK never stands up for trans children in our hateful media.

I feel heart broken for those trans children living in the UK today who would never be supported by bigoted and transphobic parents – transgender children who are enduring childhoods of cruelty, rejection and loneliness. I hope they see that the future will be brighter, once they are older. I hope they can make it through the wait.

But my main emotion right now is anger for those transgender children who could be living supported and happy childhoods right this minute in the UK. But who are not. Whose parents are desperate to tell them that they are loved and accepted just as they are. Parents who with the right support and advice could accept and support their trans child. But parents who hold so much trust in the wisdom of UK ‘experts’ that they make their child ‘wait’. Parents who are encouraged to passively ‘watch’ as their child goes downhill. Parents who are watching and waiting for permission from UK ‘experts’ to go ahead and love unconditionally their child. Those children are being denied a happy childhood right now. And this is directly down to the cis-normativity, entrenched transphobia and ivory tower arrogance of the UK medical establishment and the UK College of Psychotherapists.

I know no one in the UK will care. Who cares about sad, depressed, lonely, shamed, hopeless transgender children? Does anyone in the UK medical establishment care even a tiny bit? And who outside of the UK medical establishment will hold them to account for their continual failings? It can’t just be me speaking up.

Will anyone stand up for trans children?

And one side question. Now that we know there is a “biological underpinning to gender identity”. Now that we know that it is not a mental health disorder. Now that we know it is just another part of human diversity. Now that we know that transgender children’s identities are as real as cisgender children’s identities. Now that we know that transgender children who are affirmed, accepted, supported have good levels of mental health and wellbeing (similar to cisgender peers). Now that so many families are seeing the happiness that comes to their children when they ignore UK medical ‘advice’. Isn’t it about time to say that there is no place for psychiatrists in having any power over healthy, well-adjusted transgender children? My daughter does not need a psychiatrist. And I am done listening to transphobic ‘experts’ who don’t give a damn about transgender children.


GPs and trans children – BBC drama ‘Doctors’ and the UK Gender Identity Development Service


BBC show Doctors included a trans teenager, and their mum meeting with a new GP. The show certainly had made an effort to provide an accurate and appropriate portrayal of a trans adolescent, so does score some points. It did also include some misleading stereotyping of trans children, and ignorance/misinformation on NHS protocols and timelines. I hope upcoming ITV drama Butterfly will do even better.

The first segment was the worst for misrepresenting the experience of parenting a trans child, and for perpetuating lazy stereotypes.

The child is described by the mum as ‘born a boy’ who ‘liked girly things’. The emphasis in the first segment is on the child’s interests, toy preferences, clothing preferences, not on the child’s gender identity. A later segment makes clear the child had identified as a girl her whole life, but this is not mentioned in the first segment.

The focus on non-conformity is misplaced – many trans girls I know are not especially feminine or especially in to girly toys – trans girls are not the cliché of femininity the media leads you to believe.

The first segment suggests that the child one day stated ‘I want to be a girl’ and the parent switched pronoun. It mentions that two years later the child is on puberty blockers. It makes it sound so straight-forward. This unlikely scenario is a misrepresentation of the current NHS pathway for gender variant or trans children and does not match the experience of many families who I know.

Let’s look at a more realistic scenario.

A child, assigned male at birth, states ‘I am a girl’. Frequently. Consistently. Insistently. Persistently. (sure some children are less insistent, some are more fluid, some less clear – in my experience only the ones who are extremely insistent are likely to be supported to socially transition at a young age – it is a huge step in this gendered and transphobic world).

The parent spends months or often years telling their child that they can be a non-stereotypical boy, as non-stereotypical as they like, so long as not trans. Perhaps they say things they will later regret, like it is not possible to be trans, or that your genitals define who you are.

The parent spends months or years reading and learning, working through their own ignorance, fear and transphobia (I have met very few cis parents who did not have to first work through a lifetime of unconscious transphobia).

During this time while the parent finds the knowledge and understanding (and courage) to listen to their child, the child gets increasingly distressed and withdrawn – being rejected by your family is hard on a child.

The parent finally takes what feels like a monumental step of booking an appointment with their GP. The media may have led them to believe that things happen quickly from that point, so the parent may have delayed visiting their GP until the child is in puberty and increasingly distressed.

In, as a rough estimate, half of cases the GP refuses to refer the child to the children’s gender service, sending the parent on an unnecessary 12+ month delay via children’s mental health services. Or the GP tells the parent to come back in a couple of years. Or to come back at age 16. Or the GP flat out tells the parents that kids can’t be trans and they shouldn’t pander to a delusion. This happens a lot.

Parents with transphobic or ignorant GPs go away without any help, only returning to the GP when their child is extremely distressed, depressed, self harming or suicidal.

If they are lucky enough to get a referral from a GP to the sole Children’s Gender Service (In England and Wales), and the referral is accepted, the parents then wait in limbo for a further 14 months for a first appointment. 14 months. For an increasingly distressed child.

Once they get to the gender service the approach is extraordinarily slow and conservative, frequently breaking international guidelines that recommend puberty blockers at tanner stage two. It is often 1-3 years before approval for blockers (even for children who reach the service when puberty is well underway).

Clinicians have all the power and are quite keen to emphasise that the teenager and their parents have no rights whatsoever on whether the service will ever prescribe puberty blockers. Trans children feel this powerlessness, adding greatly to their stress and anxiety at what is already a very difficult time of progressing puberty.

Puberty blockers, let’s not forget, are a safe, reversible and proven effective treatment that has been in use for cis kids (in precocious puberty) since the 1970s, that in countries with a less transphobic health system are prescribed to trans kids (or gender diverse kids distressed about puberty) promptly at the start of puberty. A treatment that is recommended by the international experts on these issues – WPATH (The World Professional Association on Transgender Health) and the International Endocrine Society. A treatment that has been shown to be effective for trans children since the early 1990s.

If approval for puberty blockers is eventually granted by the (monopoly) children’s gender service there is a referral (and further wait) for the endocrine service, with several further appointments (each requiring further trips to London and further days of missed education (and lost earnings for parents) for yet more 1 hour appointments) before prescription of blockers.

Then the parents and child are left to manage a drawn out discussion between the NHS endocrine service and their GP about who will administer the puberty blockers (a simple injection) and who will take on responsibility for the ongoing prescription.

The NHS endocrine service says the NHS GP should do this. The GP usually refuses, claiming that this simple injection, that has been deemed necessary by NHS specialists, that they already administer to cis children, is ‘specialist’ knowledge that they are allowed to refuse to administer (just because the child is trans). Parents are left to sort out this incompetency between different wings of the NHS.

In our realistic example, the parents are now trying to keep safe a desperate teenager  who has been waiting for years for the medically necessary treatment that they need and have a right to. Reports of self harm are common. These parents sometimes have to teach themselves how to administer an NHS prescribed injection as they can’t find any NHS workers locally willing to do this for trans adolescents. A simple injection that has been prescribed by NHS specialists which the local GP and nurses refuse to administer. Stressed adolescents are injected by a parent who has never before given an injection as their GP surgery has neglected their patient.

This is for a treatment that is already given as standard to 6 year old cis kids in precocious puberty. Because we can’t have a 6 year old cis girl with periods and breasts but that is fine for a 14 year old self-harming trans boy. Because we can’t have a 6 year old cis boy with a beard but that is fine for a 15 year old trans girl.

It is basic anti-trans children discrimination in health care.

The BBC show ‘Doctors’ includes a further brief reference to sex hormones. The mum states that the only way of getting hormones pre-age 16 is to go to the US. The GP shows a face heavy with scepticism and talks about safe-guarding. It would have been appropriate here to mention to Gillick competency, a concept familiar to all doctors. Across all areas of medicine adolescents are able to consent to complex irreversible medical interventions if they are deemed Gillick competent. The same benchmark should be applied to transgender adolescents.

The segment on sex hormones omitted to mention that provision of hormones before the age of 16 is deemed medical best practice in many clinics in the USA and elsewhere in certain circumstances – based on the benefits of peer concordant puberty (going through puberty at the same time as peers), due to recognition that children with a long track record of fixed trans identities are not going to suddenly change gender identities at age 15.

A well-informed GP would have also mentioned the global Endocrine Society’s 2017 guidance stating: “We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years”.

The mum in the BBC drama also makes a reference to “the operations” – a statement which is not clarified. There is so much ignorance about trans children in the UK that the fact that surgery is not considered for trans girls until adulthood does need stating.

One thing the show did portray convincingly is the parent pretty much begging a not-transphobic and slightly clued up GP to care for and advocate for her child. The programme ends with the GP in an ethical dilemma about whether to agree to be this child’s GP, and whether to be willing to state medical facts about accepted best practices for trans children’s care in a family court. Why is this an ethical dilemma? If the family were following any other medical specialist recommended health care, the GP would not consider it an ethical dilemma to defend this in family court.

The real ‘debate’ and ethical dilemma when it comes to GPs and trans children is why is there still such varied and poor practice? Why are desperate families encountering ignorance and transphobia from GPs? Why are GPs allowed to opt out of administering medically needed treatment that has been prescribed by an NHS specialist? Why are GPs treating trans children so much worse than cis children and why does no one care?

And if you want to a good indication of the wider institutional transphobia across the NHS that allows this poor healthcare for trans children to go unchallenged, look no further than the nonsense hokum that is “Rapid Onset Gender Dysphoria”. NHS children’s specialists have referenced ‘Rapid Onset’ in a presentation in a way that did not make it clear to service users and the general public that it is junk science.

In Canada, meanwhile, specialists working with trans children have endorsed a condemnation of Rapid Onset Gender Dysphoria as junk science, bunkum and quackery.

Where is the similar condemnation from the UK Gender Identity Development Service? I won’t hold my breath.

Given the poor state of the UK specialist service, whose protocols are outdated and not fit for purpose (with a 14+ month wait for current first appointments), we need GPs to step up and do more. GPs cannot continue to refuse basic care for trans children and adolescents. GPs cannot continue to claim that simple health care for trans adolescents is ‘too specialist’. It is discrimination clear and plain.



In episode 2 the GP goes to see a psychotherapist who tells him that the majority of socially transitioned 14 year olds change their minds. This is an outright falsehood.

Even the discredited Zucker/Steensma studies showed 14 year olds were extremely likely to maintain a trans identity.

The latest studies (Olson 2015 and Fast 2017) show that trans children have a clear identity at a very young age, that their identity is as valid and consistent as any other child’s.

The latest stats from Australia showed “From 2003 to 2017 96 percent of all patients assessed and diagnosed with Gender Dysphoria continued to identify as transgender or gender diverse into late adolescence”.

The ‘expert’ knows scarcely a thing of the latest evidence-based scientific consensus on care for transgender children.

My Daughter is that ‘Scary Trans Kid’ the BBC warned you about.


I am crying and sad and afraid – watching yet more hate and fear-mongering thrown at trans children, specifically at girls like my daughter.

The BBC Victoria Derbyshire show (05/03/18) want a discussion on the Gender Recognition Act. An act that at present only applies to adults and only relates to birth certificates. Not, as they are discussing, access to changing rooms or toilets.

An act that bears zero relevance to the Girl Guides having a progressive policy of welcoming trans  girls.

Yet the BBC gives air time to the worst type of bigotry – raising fear about the threat my young daughter poses if she goes on a camping trip with her friends. .

No wonder trans children are struggling in the UK RIGHT NOW

Take any other minority. Take Muslim children, or black children or Jewish children, or neuro diverse children.

Would the BBC give air time to a person saying that Jewish girls are a threat to other girls? Would they say that parents need to be made aware of any Muslim girls going on a camping trip?

Would they allow such hate to go unchallenged?

Why is it fine to throw my child under the bus time and time again?

And to have this dangerous, scary, legally and morally wrong rhetoric of trans children being a threat utterly unchallenged?

With two trans panellists who were clearly out of their comfort zone on the topic of trans girls like my daughter.

One trans panellist even seemed to agree, focusing on the importance of careful ‘trans’ risk assessments before camping trips for children.

My child is not a risk. She is not a threat. She does not need a risk assessment. She is not to be feared.

She would love to go camping with her friends. She is a child.

She’d love to stay up late and eat marshmallows and tell ghost stories and play and laugh

How dare the BBC present trans girls in girl guides as a safety concern?

How am I meant to keep my child safe when even the lovely Victoria Derbyshire gives space to this outrageous hate and fear-mongering?

How dare the panel nod and agree that this scare-mongering against vulnerable children is balanced?

I don’t blame Rebecca Root or Clara Barker both incredible women.

They did a better job than I could of at staying calm in the face of such prejudice.

They were brought on to talk about the Gender Recognition Act not to talk about trans children.

But wake up people! We know that those opposed to trans rights are targeting trans children.

We know they quickly turn discussions to focus on children.

This is their standard approach. One of the panellists was even the public face of a website which explicitly states trans children are a ‘trend’ simultaneously denying their existence.

They do this because focusing on children is an easy win for those opposed to trans equality. They are defenceless.

They know that, like today, trans adults are often hesitant about speaking up for trans kids, possibly as the experience of socially transitioned trans kids today is outside of their direct experience.

They know that the UK public are totally ignorant about wonderful trans children like my daughter.

It is hard to stir up fear about trans women when sat opposite kind intelligent articulate trans women.

But without any young trans children on the show it is easy to spread fear about an unknown.

It’s easy to paint trans girls as a scary shadow.

The people who know trans children like my daughter see how preposterous this fear-mongering is.

She is just like any other girl.

But those raising anti-trans fear know that the public don’t know any trans girl guides.

They rely on this ignorance. They don’t care about the impact of this fear-mongering on my child.

Can you imagine being a 10 year old girl, happy to be moving up from Brownies to Girl Guides, excited to be going camping.

And watching the BBC describe you as a threat to your friends.

No wonder trans children are at breaking point in the UK.

The UK is not a safe place for my child and with every ‘debate’ which allows lies and misinformation to go unchallenged it becomes more dangerous.

How am I meant to tell my wonderful kind sweet (brave, clever, strong, funny) girl that everything is going to be alright when I just don’t have hope?

This country is a scary place to be a trans girl.

I am scared and I have had more than I can bear.

This is not balanced debate.

This is hate.

This is intent to incite fear and prejudice against a defenceless and vulnerable group of children and the BBC has once again provided the platform.

This is not ok.

This is never ok.

World. Be Better.


P.S. The photo is not my daughter. But is a wonderful trans girl (Rebekah) who deserves all the care and kindness and happiness the world can send. That girl’s mum (Jamie) blogs here