September | 2025 | Growing Up Transgender

The UK Government and UK research councils have contributed £10 million pounds to a series of research studies on service users of the newly established Children and Young People’s Gender Services.

These studies include the PATHWAYS study programme (Puberty suppression And Transitional Healthcare with Adaptive Youth Services) led by Kings College London in partnership with the NHS. This programme covers five different studies.

1) ‘PATHWAYS HORIZON’ is a longitudinal observational cohort study of all children and young people (n~3600) attending CYPGS.

2) ‘HORIZON Intensive’, encompasses a sample of those from PATHWAYS HORIZON who are not approved to receive endocrine care who will be more intensively studied as a control group for PATHWAYS TRIAL;

3) PATHWAYS TRIAL, a study of those approved to receive puberty blockers (GnRHa) as part of a research study.

4) ‘PATHWAYS CONNECT’ a study of cognition and brain development in CYP attending the services, including those who are and are not receiving GnRHa.

5) ‘PATHWAYS VOICES’ a longitudinal qualitative interview based study of CYP attending CYPGS. In this article we will focus only on the first study, PATHWAYS HORIZON.

Here I’m just focusing on the questions that will be asked under the first study, Pathways Horizon.

In this blog I want to do two things:

Highlight some big picture concerns with the questions asked in the PATHWAYS Horizon study, alongside some recommendations for families and young trans people engaged with the new NHS England and Wales Gender Clinics.
Outline in an accessible format all the questions that are being asked in that study, so that families and trans young people can be better informed on whether they choose to participate.

The PATHWAYS Horizon study hopes to gain the consent of 80% of young people and families to participate in it. I hope that number will be very much smaller. I do not believe it will add useful information to our academic understanding of trans young people, certainly not information that is worth the risks and harms inherent in the whole approach and service. I consider not participating in this study (or at least opting out of the more harmful tools) an act of harm reduction for trans children, young people and supportive families. When I was first given some of these exact same tools, many years ago, when I first attended a GIDS appointment as a naïve and unknowledgeable parent of a young trans child, I did not feel able to decline to participate in filling in questionnaires that made me feel really uncomfortable. I hope to empower others to make a different choice.

Big Picture Concerns

They are asking an excessive number of questions, which is itself abusive and unreasonable – over 314 questions are here listed.
A large number of these questions of more or less irrelevant or only tangentially relevant for trans kids – they are not clinically useful, necessary or meaningful
These questions will never demonstrate what healthcare benefits trans children.
The data collection shown here will be exhausting, time-consuming and expensive, a colossal waste of NHS and research resources whilst not delivering useful outcomes.
Many of the questions outlined below are deeply pathologising, invasive, trauma-inducing and inappropriate.
Several tools present trans children as a problem, potentially reaffirming parental biases, and potentially reinforcing trans children’s shame and self-hate.
I continue to recommend families to avoid the new service, as it holds very little potential of offering anything of value, and high potential to cause significant harm. For many families it may just end up being a significant waste of time.
If families choose to attend, hoping for the chance to be part of a puberty blocker trial, please think carefully before choosing to participate in this research. As an academic researcher specialising in this field, this planned research is not needed, will not lead to better care for trans youth, and in the wrong hands research of this nature can be distorted to further reinforce pathologisation, control and barriers to care. Participation in this research is not necessary to be eligible for the puberty blocker trial. Please know that you can decline participation. Please let your young person know they can decline participation.
If you do still choose to participate, please be aware of the potential for harm and trauma in several of the tools outlined below.
In particular I am concerned about the tools labelled the Child Behaviour Checklist (which is an awful tool to use for trans children, asking 118 questions on how much of a problem they are to the world), the Utrecht Gender Dysphoria Scale – Gender Spectrum (UGDS-GS) (which uses very outdated measures of gender dysphoria); Body Image Scale – Gender Spectrum (BIS-GS) (a horrific tool that asks children to assess how much they hate all their body parts); the ALSPAC Romantic Relations (which in spite of its name asks totally irrelevant and intrusive questions about the sex life of those aged 12-17). The SCOFF tool has a questionable name for a tool designed to screen for eating disorders.
I continue to be concerned about the questions that will be asked under the heading ‘medical history’, which by description is far wider a category with room to ask all kinds of irrelevant questions. I expect that component could include the typical gender clinic fascinations: many questions for parents on childbirth, parenting approaches, family deaths, family tensions, family gender roles and other irrelevant and trauma-uninformed lines of questioning. I expect there will be many questions for young people on defending and justifying their theoretical understanding of gender, and questioning them on proposed causes of gender confusion including social media, peer pressure, porn viewing, childhood trauma, parental homophobia or whatever is the latest transphobic focus in a search for anything other than transness to explain transness.
Throughout the years of the earlier GIDS clinic, there was a long and noble history of trans children, adolescents and supportive families putting the questionnaires that were offensive and harmful straight in the bin. Of asserting a right to not answer any question that feels off, that feels uncomfortable, that doesn’t seem relevant to the healthcare support being sought. Please continue this noble tradition in the new service. You should not answer any questions that make you or your young person uncomfortable. Bad questions always give bad data that will not benefit any trans young people. Research trauma is a serious concern. The NHS and associated researchers are not taking their ethical duty of care seriously, so we need service users to take this on. I’m writing this primarily to parents as I don’t think under 18s are likely to read this. But for any trans under 18s who do read this – please don’t feel pressured to answer questions that make you uncomfortable or seem strange or irrelevant. You do not have to answer and they cannot make you.
This is the non-intensive study – an additional ‘intensive study is also planned for those who will be in the puberty blocker trial and the control group for that trial). I repeat more than 314 questions for parents and more than 314 questions for children/young people is the non-intensive study.
These extensive, time and resource consuming, and largely irrelevant questions need to be understood in the context of a service that is trying to give the appearance of being busy, giving the appearance of doing something RIGOROUS, whilst failing to deliver any of the services that trans young people need and have a right to. It serves to keep service users distracted from the care that is not being offered. It provides baseline data on a host of largely irrelevant (or tangentially relevant) areas of mental health, generic well-being, neurodivergence etc, from which the service can seek to ‘further explore’ every one of those ‘issues’ or concerns, whilst denying or delaying affirmative healthcare. The type of intentional distraction and delay is a known component of modern conversive approaches.
Conversion therapy in the NHS never wears a badge saying ‘I will make you cis’. It comes much more subtly: Before we talk about the support that you need, FIRST we need to ask these hundreds of questions. Before we talk about puberty blockers or HRT, we first need to explore each of these areas of mental health or neurodivergence, or sexual attraction or family functioning or body image or sex life. We need to thoroughly explore what is going on holistically before we can do anything else. We need to be thorough. We need to avoid misdiagnosis. We need to rule out other causes. We need to Explore.
Not useful research: In spite of hundreds of questions, pages of spreadsheets and millions of pounds, this research will not answer questions that would be useful for a health service to know the answer to. Questions like: What are the things that make life harder for a trans child or adolescent? What are the things that improve things for trans children? The research isn’t answering these questions because we already know most of the answers. And our NHS and government and country does not like the answers to those questions. Cos they don’t care whether trans kids have a tough life. They don’t want to help trans kids at all. That is not the purpose of this service. It is a service to ‘study’ trans kids, to delay trans kids, and through delay to convert trans kids – pushing them to suppress their identity, to give up their fight, to think of themselves as a problem, as broken, pushing them to give up even thinking that they matter or have rights.

Number of Questions

Tool	Parent questions	Child/Young Person Questions
Kidscreen-52 (generic wellbeing)	52	52
CBCL (Problem behaviour)	118	118
Parental ‘About Yourself’ Questionnaire	2	0
SNAP-IV tool (ADHD)	18	0
Social Communication Questionnaire (SCQ) (autism)	40	0
PATHWAYS Gender Identity Questionnaire	0	2
Social Transition Questionnaire	0	5
Adolescent Primary Care Traumatic Stress Screen (APCTSS) (trauma screen)	5	5
Revised Child Anxiety and Depression Scale (RCADS) (anxiety and depression)	25	25
Utrecht Gender Dysphoria Scale – Gender Spectrum (UGDS-GS) (dated measures of gender dysphoria)	0	18
Body Image Scale – Gender Spectrum (BIS-GS) (body image)	0	33
Ask Suicide-Screening Questions (ASQ)	4	4
SCOFF Questionnaire – Test for Detecting Eating Disorders	5	5
Difficulties in Emotion Regulation Scale (DERS)	29	18
Sexual Attraction	0	1
ALSPAC Romantic Relations (sex life)	0	14
Parental Attitudes of Gender Expansiveness Scale for Youth (PAGES)	16	14
15 minutes questioning on ‘medical history’ that covers huge range of areas.	Unknown	Unknown
Annual Health Update	Unknown	Unknown

Total questions	Over 314 questions	Over 314 questions

Detailed Breakdown of the exact questions being asked

52 questions for parent & 52 questions for young person from the Kidscreen-52 tool (here the parent version)

In general how would your child rate their health? (excellent; very good; good; fair; poor)

Thinking about last week (with answers: not at all; slightly; moderately; very; extremely or never; seldom; quite often; very often; always)

Has your child felt fit and well
Has your child been physically active (e.g. running, climbing, biking)?
Has your child been able to run well?
Has your child felt full of energy
Has your child felt that life was enjoyable
Has your child felt pleased that they are alive
Has your child felt satisfied with their life
Has your child been in a good mood
Has your child felt cheerful
Has your child had fun
Has your child felt that they do everything badly
Has your child felt sad
Has your child felt so bad that they didn’t want to do anything
Has your child felt that everything in their life goes wrong
Has your child felt fed up
Has your child felt lonely
Has your child felt under pressure
Has your child felt happy with the way they are
Has your child been happy with their clothes
Has your child been happy with the way they look
Has your child felt jealous other the way other children look
Has your child wanted to change something about their body
Has your child had enough time for themselves
Has your child been able to do the things they want in their spare time
Has your child had enough opportunity to be outside
Has your child had enough opportunity to meet friends
Has your child been able to choose what to do in their free time
Has your child felt understood by their parents
Has your child felt loved by their parents
Has your child been happy at home
Has your child felt that their parents had enough time for them
Has your child felt that their parents treated them fairly
Has your child been able to talk to their parents when they wanted to
Has your child had enough money to do the same things as their friends
Has your child felt they had enough money for their expenses
Does your child feel they have enough money to do things with their friends
Has your child spent time with their friends
Has your child done things with other children
Has your child had fun with their friends
Has your child and their friends helped each other
Has your child been able to talk about everything with their friends
Has your child been able to rely on their friends
Has your child been happy at school
Has your child got on well at school
Has your child been satisfied with their teachers
Has your child been able to pay attention
Has your child been enjoying school
Has your child got along with their teachers
Has your child been afraid of other children
Have other children made fun of your child
Have other children bullied your child.

(the default questions use he/she and boys/girls language – I’m assuming they will adapt to use they and child as written above)

118 questions for parent & 118 questions for young person from the Child Behaviour Checklist

For each questions the available answers are:

0=Not true (as far as you know); 1=Somewhat or sometimes true; 2=Very true or often true

1.Acts too young for his/her age / I act too young for my age
2. Drinks alcohol without parent’s approval / I drink alcohol without my parent’s approval
3. Argues a lot / I argue a lot
4. Fails to finish things he/she starts / I fail to finish things I start
5. There is very little that he/she enjoys / There is very little that I enjoy
6. Bowel movements outside toilet / I like animals
7. Bragging, boasting / I brag
8. Can’t concentrate, can’t pay attention for long / I have trouble concentrating or paying attention
9. Can’t get their mind off certain thoughts/obsessions (describe) / I can’t get my mind off certain thoughts/obsessions (describe)
10. Can’t sit still, restless or hyperactive / I have trouble sitting still
11. Clings to adults or too dependent / I’m too dependent on adults
12. Complains of loneliness / I feel lonely
13. Confused or seems to be in a fog / I feel confused or in a fog
14. Cries a lot / I cry a lot
15. Cruel to animals / I am pretty honest
16. Cruelty, bullying or meanness to others / I am mean to others
17. Daydreams or gets lost in his/her thoughts / I daydream a lot
18. Deliberately harms self or attempts suicide / I deliberately try to hurt or kill myself
19. Demands a lot of attention / I try to get a lot of attention
20. Destroys his/her own things / I destroy my own things
21. Destroys things belonging to his/her family or others / I destroy things belonging to others
22. Disobedient at home / I disobey my parents
23.Disobedient at school / I disobey at school
24. Doesn’t eat well / I don’t eat as well as I should
25. Doesn’t get along with other kids / I don’t get along with other kids
26. Doesn’t seem to feel guilty after misbehaving / I don’t feel guilty after doing something I shouldn’t
27. Easily jealous / I am jealous of others
28. Breaks rules at home, school, or elsewhere / I breaks rules at home, school, or elsewhere
29. Fears certain animals, situations or places other than school / I am afraid of certain animals, situations or places other than school
30. Fears going to school / I am afraid of going to school
31. Fears he/she might think or do something bad / I’m afraid I might think or do something bad
32. Feels he/she must be perfect / I feel that I have to be perfect
33. Feels or complains that no one loves him/her / I feel that no one loves me
34. Feels others are out to get him/her / I feel that others are out to get me
35. Feels worthless or inferior / I feel worthless or inferior
36. Gets hurt a lot/accident prone / I accidently get hurt a lot
37. Gets in many fights / I get in many fights
38. Gets teased a lot / I get teased a lot
39. Hangs with others who get in trouble / I hang around with kids who get into trouble
40. Hears sound or voices that aren’t there / I hear sound or voices that other people think aren’t there
41.Impulsive or acts without thinking / I act without stopping to think
42. Would rather be alone than with others / I would rather be alone than with others
43. Lying or cheating / I lie or cheat
44. Bites fingernails / I bite my fingernails
45. Nervous, high-strung, or tense / I am nervous or tense
46. Nervous movements or twitching (describe) / parts of my body twitch or make nervous movements
47. Nightmares / I have nightmares
48. Not liked by other kids / I am not liked by other kids
49. Constipated, doesn’t move bowels / I can do certain things better than other kids
50. Too fearful or anxious / I am too fearful or anxious
51. Feels dizzy or lightheaded / I feel dizzy or lightheaded
52. Feels too guilty / I feel too guilty
53. Overeating / I eat too much
54. Over-tired, without good reason / I feel overtired without good reason
55. Overweight / I am overweight
56. Physical problems without known medical cause:
a) Aches or pains (not stomach or headache)
b) Headaches
c) Nausea, feels sick
d) Problems with eyes (not corrected by glasses)
e) Rashes or other skin problems
f) Stomach aches
g) Vomiting / throwing up
h) Other (describe)
57. Physically attacks people / I physically attack people
58. Picks nose/skin/other part of body (describe) / I picks my nose/skin/other part of body (describe)
59. Plays with own sex parts in public / I can be pretty friendly
60. Plays with own sex parts too much / I like to try new things
61. Poor school work / My school work is poor
62. Poorly coordinated or clumsy / I am poorly coordinated or clumsy
63. Prefers being with older kids / I would rather be with older kids than kids my own age
64. Prefers being with younger kids / I would rather be with younger kids than kids my own age
65. Refuses to talk / I refuse to talk
66. Repeats certain acts over and over; compulsions (describe) / I repeat certain acts over and over; compulsions (describe)
67. Runs away from home / I run away from home
68. Screams a lot / I scream a lot
69. Secretive, keeps things to self / I am secretive or keep things to myself
70. Sees things that aren’t there / I see things that other people think aren’t there
71. Self-conscious or easily embarrassed / I am self-conscious or easily embarrassed
72. Sets fires / I set fires
73. Sexual problems / I can work well with my hands
74. Showing off or clowning / I show off or clown
75. Too shy or timid / I am too timid or shy
76. Sleeps less than most kids / I sleep less than most kids
77. Sleeps more than most kids during day and/or night (describe) / I sleep more than most kids during day and/or night (describe)
78. Inattentive or easily distracted / I am inattentive or easily distracted
79. Speech problem (describe) / I have a speech problem (describe)
80. Stares blankly / I stand up for my rights
81. Steals at home / I steal at home
82. Steals outside the home / I steal from places outside the home
83. Stores up too many things they don’t need (describe) / I stores up too many things I don’t need (describe)
84. Strange behaviour (describe) / I do things other people think are strange
85. Strange ideas / I have thoughts other people would think are strange (describe)
86. Stubborn, sullen, or irritable / I am stubborn
87. Sudden changes in mood or feelings / My moods or feelings change suddenly
88. Sulks a lot / I enjoy being with people
89. Suspicious / I am suspicious
90. Swearing or obscene language / I swear or use dirty language
91. Talks about killing self / I think about killing myself
92. Talks or walks in sleep (describe) / I like to make others laugh
93. Talks too much / I talk too much
94. Teases a lot / I tease others a lot
95. Temper tantrums or hot temper / I have a hot temper
96. Thinks about sex too much / I think about sex too much
97. Threatens people / I threaten to hurt people
98. Thumb-sucking / I like to help others
99. Smokes, chews, or sniffs tobacco / I smokes, chew, or sniff tobacco
100. Trouble sleeping / I have trouble sleeping (describe)
101. Truancy or unexplained absence / I cut classes or skip school
102. Underactive, slow moving or lacks energy / I don’t have much energy
103. Unhappy, sad or depressed / I am unhappy, sad or depressed
104. Unusually loud / I am louder than other kids
105. Uses dugs/alcohol for nonmedical purposes / I use drugs for non-medical purposes
106. Vandalism / I like to be fair to others
107. Wets self during the day / I enjoy a good joke
108. Wets the bed / I like to take life easy
109. Whining / I try to help other people where I can
110. Wishes to be of opposite sex / I wish I were of the opposite sex
111. Withdrawn, doesn’t get involved with others / I keep from getting involved with others
112. Worries / I worry a lot
113. Please write in any problems your child has that were not listed above.

2 questions for parents on Parental ‘About Yourself’ Questionnaire

Do you identify’ as: ‘woman/girl’, ‘man/boy’, ‘transwoman/transgirl’, ‘transman/transboy’, ‘non-binary/genderqueer/agender/gender fluid’, ‘don’t know’, ‘prefer not to say’, ‘other’.
What was your sex assigned at birth? ‘female’, ‘male’, ‘don’t know’, and ‘prefer not to say’.

18 questions for parents on SNAP-IV tool, assessing symptoms of ADHD

(not at all; just a little; quite a bit; very much)

1. Often fails to give close attention to details or makes careless mistakes in schoolwork or tasks
2. Often has difficulty sustaining attention in tasks or play activities
3. Often does not seem to listen when spoken to directly
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
5. Often has difficulty organizing tasks and activities
6. Often avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort
7. Often loses things necessary for activities (e.g., toys, school assignments, pencils or books
8. Often is distracted by extraneous stimuli
9. Often is forgetful in daily activities
10. Often fidgets with hands or feet or squirms in seat
11. Often leaves seat in classroom or in other situations in which remaining seated is expected
12. Often runs about or climbs excessively in situations in which it is inappropriate
13. Often has difficulty playing or engaging in leisure activities quietly
14. Often is “on the go” or often acts as if “driven by a motor”
15. Often talks excessively
16. Often blurts out answers before questions have been completed
17. Often has difficulty awaiting turn
18. Often interrupts or intrudes on others (e.g., butts into conversations/ games

40 questions for parents on Social Communication Questionnaire (SCQ) for assessing autism (I haven’t updated the language to make gender neutral here)

1. Is she/he now able to talk using short phrases or sentences? If no, skip to Question 8
2. Do you have a to-and-fro “conversation” with her/him that involves taking turns or building on what you have said
3. Does she/he ever use odd phrases or say the same thing over and over in almost exactly the same way (either phrases that she/he hears other people use or ones that she/he makes up).
4. Does she/he ever use socially inappropriate questions or statements? For example, does she/he regularly ask personal questions or make personal comments at awkward times
5. Does she/he ever get her/his pronouns mixed up (e.g. saying you or she/he for I).
6. Does she/he ever use words that she/he seems to have invented or made up herself/himself; put things in odd, indirect ways; or use metaphorical ways of saying things (e.g. saying hot rain for steam)
7. Does she/he ever say the same thing over and over in exactly the same way or insist that you say the same thing over and over again.
8. Does she/he ever have things that she/he seems to have to do in a very particular way or order or rituals that she/he insists that you go through
9. Does her/his facial expression usually seem appropriate to the particular situation, as far as you can tell
10. Does she/he ever use your hand like a tool or as if it were part of her/his own body (e.g. pointing with your finger, putting your hand on a doorknob to get you to open the door)#
11. Does she/he ever have any interests that preoccupy her/him and might seem odd to other people (e.g. traffic lights, drainpipes, timetables)
12. Does she/he ever seem to be more interested in parts of a toy or an object (e.g. spinning the wheels of a car), rather than in using the objects as it was intended.
13. Does she/he ever have any special interests that are unusual in their intensity but otherwise appropriate for her/his age and peer group (e.g. trains or dinosaurs)
14. Does she/he ever seem to be unusually interested in the sight, feel, sound, taste, or smell of things or people
15. Does she/he ever have any mannerisms or odd ways of moving her/his hands or fingers, such as flapping or moving her/his fingers in front of her/his eyes
16. Does she/he ever have any complicated movements of her/his whole body, such as spinning or repeatedly bouncing up and down.
17. Does she/he ever injure herself/himself deliberately, such as biting her/his arm or banging her/his head
18. Does she/he ever have any objects (other than a soft toy or comfort blanket) that she/he has to carry around
19. Does she/he ever have any particular friends or a best friend
20. Does she/he ever talk to you just to be friendly (rather than to get something)
21. Does she/he ever spontaneously copy you (or other people) or what you are doing (such as vacuuming, gardening, or mending things)
22. Does she/he ever spontaneously point at things around her/him just to show you things (not because she/he wants them)
23. Does she/he ever use gestures, other than pointing or pulling your hand, to let you know what she/he wants
24. Does she/he nod her/his head to indicate yes
25. Does she/he shake her/his head to indicate no
26. Does she/he usually look at you directly in the face when doing things with you or talking with you
27. Does she/he smile back if someone smiles at her/him
28. Does she/he ever show you things that interest her/him to engage your attention?
29. Does she/he ever offer to share things other than food with you
30. Does she/he ever seem to want you to join in her/his enjoyment of something
31. Does she/he ever try to comfort you if you are sad or hurt
32. If she/he wants something or wants help, does she/he look at you and use gestures with sounds or words to get your attention
33. Does she/he show a normal range of facial expressions
34. Does she/he ever spontaneously join in and try to copy the actions in social games, such as The Mulberry Bush or London Bridge Is Falling Down
35. Does she/he play any pretend or make-believe games
36. Does she/he seem interested in other children of approximately the same age whom she/he does not know
37. Does she/he respond positively when another child approaches her/him
38. If you come into a room and start talking to her/him without calling her/his name, does she/he usually look up and pay attention to you
39. Does she/he ever play imaginative games with another child in such a way that you can tell that each child understands what the other is pretending
40. Does she/he play cooperatively in games that need some form of joining in with a group of other children, such as hide-and-seek or ball games?

2 questions for young people on PATHWAYS Gender Identity Questionnaire

1. What best describes your gender identity?’

‘definitely a boy’, mainly a boy’, ‘in the middle’, ‘definitely a girl’, ‘mainly a girl’, ‘neither a boy or girl’, ‘not sure’ and ‘none of the above’.

2. Are there other words that you use to describe your gender identity? (select all that apply), ‘cisgender’, transgender’, ‘non-binary’, ‘agender’, ‘genderfluid’, ‘genderqueer’, ‘two-spirit’ and ‘other’.

5 Questions for Young people on Social Transition Questionnaire

“Have you socially transitioned in any of the following settings?”, followed by a checklist of five settings: Home, School, With Friends, Online, and Any Other Setting (e.g., holiday).

5 Questions for Parent and 5 questions for young people on Adolescent Primary Care Traumatic Stress Screen (APCTSS) (here the young person version)

In the past month have you:

Had bad dreams about scary experiences or other bad dreams?
Had upsetting thoughts, pictures or sounds of scary experiences come into your mind when you didn’t want them to?
Tried not to think about or have feelings about scary experiences?
Been mad at yourself or someone else for making the scary experiences happen, not doing more to stop it, or to help after?
Felt jumpy or easily startled, like when you hear a loud noise, or when something surprises you?

25 Questions for parent and 25 questions for young people on Revised Child Anxiety and Depression Scale (RCADS)

Children or parents rate how often symptoms occur, using a four-point scale: 0 (Never), 1 (Sometimes), 2 (Often), or 3 (Always).

The tool asks 25 different questions written for either a child to self-complete (the version below) or with slightly rephrased questions for an adult to complete (where question 1 is “My child worries about things”.

1. I feel sad or empty.
2. I worry when I think I have done poorly at something.
3. I would feel afraid of being on my own at home.
4. Nothing is much fun anymore.
5. I worry that something awful will happen to someone in my family.
6. I am afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds).
7. I worry what other people think of me.
8. I have trouble sleeping.
9. I feel scared if I have to sleep on my own.
10. I have problems with my appetite.
11. I suddenly become dizzy or faint when there is no reason for this.
12. I have to do some things over and over again (like washing my hands, cleaning or putting things in a certain order).
13. I have no energy for things.
14. I suddenly start to tremble or shake when there is no reason for this.
15. I cannot think clearly.
16. I feel worthless.
17. I have to think of special thoughts (like numbers or words) to stop bad things from happening.
18. I think about death.
19. I feel like I don’t want to move.
20. I worry that I will suddenly get a scared feeling when there is nothing to be afraid of.
21. I am tired a lot.
22. I feel afraid that I will make a fool of myself in front of people.
23. I have to do some things in just the right way to stop bad things from happening.
24. I feel restless.
25. I worry that something bad will happen to me

18 Questions for young person on Utrecht Gender Dysphoria Scale – Gender Spectrum (UGDS-GS)

I prefer to behave like my affirmed gender;
Every time someone treats me like my assigned sex I feel hurt;
It feels good to live as my affirmed gender;
I always want to be treated like my affirmed gender;
A life in my affirmed gender is more attractive for me than a life in my assigned sex;
I feel unhappy when I have to behave like my assigned sex;
It is uncomfortable to be sexual in my assigned sex;
I wish I had been born as my affirmed gender;
My life would be meaningless if I would have to live as my assigned sex;
I feel hopeless if I have to stay in my assigned sex;
I feel unhappy when someone misgenders me;
I hate my birth assigned sex;
I feel uncomfortable behaving like my assigned sex;
It would be better not to live, than to live as my assigned sex.
Puberty felt like a betrayal;
Physical sexual development was stressful;
The bodily functions of my assigned sex are distressing for me (i.e. erection, menstruation);
I feel unhappy because I have the physical characteristics of my assigned sex.

33 Questions for Children/Young people on Body Image Scale – Gender Spectrum (BIS-GS)

Each questions asks: a) How happy are you with [insert name of a particular body part]?: With answers i) very happy ii) happy iii) neutral iv) unhappy v) very unhappy vi) don’t have.

Each question is followed up with: Would you want to change that body part if it was possible through medical or surgical treatment? i) Yes ii) No

1) Nose:
2) Shoulders
3) Hips
4) Chin
5) Calves
6) Breasts
7) Chest
8) Hands
9) Adam’s Apple
10) penis
11) clitoris
12) testes
13) ovaries
14) scrotum
15) vagina
16) Height
17) Thighs
18) Arms
19) Eyebrows
20) Waist
21) Buttocks
22) Biceps
23) Hair
24) Feet
25) Muscles
26) Facial Hair
27) Face
28) Voice
29) Weight
30) Body figure/shape
31) stature
32) Body hair
33) Appearance

4 Questions for parent and 4 questions for child/young person on Ask Suicide-Screening Questions (ASQ) (here the child/young person version)

1. In the past few weeks, have you wished you were dead? Yes No
2. In the past few weeks, have you felt that you or your family would be better off if you were dead? Yes No
3. In the past week, have you been having thoughts about killing yourself? Yes No
4. Have you ever tried to kill yourself? Yes No
If yes, How? When?

5 questions for parent and 5 questions for young person on the SCOFF Questionnaire – Test for Detecting Eating Disorders (here the child/young person version)

1. Do you make yourself Sick because you feel uncomfortably full? Yes No
2. Do you worry you have lost Control over how much you eat? Yes No
3. Have you recently lost more than One stone in a 3 month period? Yes No
4. Do you believe yourself to be Fat when others say you are too thin? Yes No
5. Would you say that Food dominates your life? Yes No

29 questions for parents and 18 questions for children/young people on Difficulties in Emotion Regulation Scale (DERS)

(here the child/young person shorter version)

Statements are presented that need to be answered as Almost Never, Sometimes, About half the time, Most of the time, Almost always

1. I pay attention to how I feel.
2. I have no idea how I am feeling.
3. I have difficulty making sense out of my feelings.
4. I am attentive to my feelings.
5. I am confused about how I feel.
6. When I’m upset, I acknowledge my emotions.
7. When I’m upset, I become embarrassed for feeling that way.
8. When I’m upset, I have difficulty getting work done.
9. When I’m upset, I become out of control.
10. When I’m upset, I believe that I will remain that way for a long time.
11. When I’m upset, I believe that I’ll end up feeling very depressed.
12. When I’m upset, I have difficulty focusing on other things.
13. When I’m upset, I feel ashamed with myself for feeling that way.
14. When I’m upset, I feel guilty for feeling that way.
15. When I’m upset, I have difficulty concentrating.
16. When I’m upset, I have difficulty controlling my behaviors.
17. When I’m upset, I believe that wallowing in it is all I can do.
18. When I’m upset, I lose control over my behaviors.

1 Question for children/young people on Sexual Attraction

(question for 12 years+)

Who are you attracted to?

Options: ‘Prefer not to say’, ‘Males’, ‘Females’, ‘Males and females’, ‘Neither’, ‘Not sure’

14 Questions for children/young people on ALSPAC Romantic Relations

(question for 12 years+)

In the past 30 days:

1. Have you hugged anybody?
2. Have you held hands?
3. Have you spent time alone?
4. Have you kissed?
4a. Have you been kissed by anybody?
5. Have you cuddled?
6. Have you lain down together?
7. Has someone put their hands under your clothing?
8. Have you put your hands under someone else’s clothing?
9. Have you been undressed with your genitals showing?
10. Have you touched or fondled someone’s private parts?
11. Has someone touched or fondled your genitals?
12. Have you performed oral sex?
13. Has someone performed oral sex on you?
14. Have you had sex?

16 questions for parents and 14 Questions for children /young people on Parental Attitudes of Gender Expansiveness Scale for Youth (PAGES)

(1= strongly disagree; 5= strongly agree

1. I am proud of my child
2. I am ashamed of my child
3. I try to hide my child’s gender identity
4. My child can be him- or herself around me
5. I advocate for the rights of my child
6. I protect my child and defend my child against others’ prejudice against gender-nonconforming/transgender people
7. I have problems with my child’s gender expression
8. I encourage my child to wear clothing and accessories consistent with their birth-assigned gender
9. I use toys, treats or other rewards to pressure my child not to gender transition and to live as his or her birth-assigned gender
10. My child can talk about romantic relationships and dating
11. I worry about how my child’s gender identity will affect our family’s image
12. I feel like a bad parent because I have a child that is gender-nonconforming/transgend
13. I think my child is gender-nonconforming/transgender because of something I did wrong
14. I feel like I am losing a son/daughter, or as if my child were dead
15. I am supportive of my child’s gender transition
16. I am worried that my child’s gender identity is a bad influence on my other children

Child/Young person version

1. My parents are proud of me
2. My parents are ashamed of me
3. My parents try to hide me
4. I can be myself around my parents
5. My parents advocate for my rights as a gender-expansive/trans* child
6. My parents protect me and defend me against others prejudice against gender-expansive/trans* people
7. My parents have problems with my gender expression
8. My parents use rewards or treats to pressure me to live as my sex assigned at birth
9. I can talk to my parents about romantic relationships and dating
10. My parents worry about how my gender identity will affect our family’s image
11. My parents probably believe they are bad parents because I am gender-expansive/trans*
12. My parents probably believe that I am gender-expansive/trans* because of something they did wrong
13. My parents are supportive of my gender transition
14. My parents are worried that my gender identity is a bad influence on other kids in my family

15 minutes questioning on ‘medical history’

This component is the least clear. It mentions covering the following vast topic areas that are defined as ‘Medical History’ Domains:

1. Family Context
2. Developmental History
3. Physical Health
4. Mental Health and Risk
5. Adverse childhood experiences
6. Safeguarding
7. Gender Development and Experiences
8. Sexual Development, Knowledge and Sexual Orientation
9. Education, Peer Relationships, and Social Context
10. Additional Information.
Clinical Judgements – Impact assessments and clinical evaluation for various aspects of the CYP’s development and wellbeing;
Parental Support – Judgements on the level of positive parental support and any conflicts between parents/carers/legal guardians or between parents/carers/legal guardians and the CYP.

Would be good to find out exactly what data is collected and why.

Annual Health Update

A questionnaire was designed to assess:

CYP’s current height and weight,
current prescribed medications
diagnoses including neurodevelopmental, mental health and physical health, received in the past year. number of GP appointments
planned surgeries or procedures
A&E attendances or other unplanned admissions in the past year.
The reasons for the GP appointments and A&E attendances
Length of hospital admission for planned surgeries or procedures and admissions following an A&E attendance

Experiences of therapeutic options

Data will also be collected on rates of referral to, uptake of and completion of:

Psychological therapy
Occupational therapy
Speech and language therapy,
Clinical nursing
Youth work support
School/College support
Non-endocrine pharmacological treatments

Compensation

Children/young people and parent/carer/legal guardian completing informant measures will each receive shop vouchers worth £20 for each data collection episode.

Growing Up Transgender

Raising our trans child

Month: September 2025

Questioning trans kids