Reading Australia’s Vine Review into trans youth healthcare: Part one – diagnosis and psychiatric control

January 21, 2026January 21, 2026 / growinguptransgender / Leave a comment

On the 28^th November, an Australian state review into trans youth healthcare, called the Vine Review, was published. It was commissioned in response to political fear-mongering about trans youth healthcare, including from the UK’s Cass Review. It was commissioned specifically for the state of Queensland, who have brought in a politically motivated state bans on provision of puberty blockers through the public health service.

The Vine Review is 532 pages long and I am reading it through in stages. Here I’m going to focus on just one paragraph, on one page, page 27. On the topic of diagnosis and psychiatric control.

Diagnosis.

The Vine review recognises that two diagnoses are available for trans healthcare. There is the 2013 psychiatric diagnosis of gender dysphoria from the DSM-V (Diagnostic and Statistical Manual for Mental Health Disorders). An explicitly pathologising diagnosis that explicitly defines trans people as having a mental health disorder.

And alternatively there is the 2019 ICD-11 diagnosis of gender incongruence, a diagnosis explicitly moved out of mental health, recognising the stigma (and psychiatric control) associated with defining trans people accessing trans healthcare as treatment for a mental health disorder.

Naturally, our past health systems have relied on DSM-V – the ICD diagnosis is newer (though now 7 years old) – and health systems evolve slowly. If we insist on past pathologising practices defining our current and future possibilities, we will never move away from harmful pathologising attachment to psychiatry.

A shift to an ICD-11 diagnosis needs to be on the table in shaping the options for trans healthcare in the present. You would have thought.

Not so according to the Vine review.

Use of ICD-11 is outright dismissed (p. 27). Here is their statement in full:

“The Panel acknowledges that both DSM-5-TR gender dysphoria and ICD-11 gender incongruence are relevant in the treatment and care of TGD children and adolescents. However, given the limited evidence base, we agree with the current practice of only providing PB and/or GAHT to young people who meet the diagnostic criteria for gender dysphoria under the DSM-5-TR. The ICD-11 criteria remain important, but do not accord with requirements to be met to support initiation of PB and/or GAHT in young people.”

The Vine review here takes an ideological position that trans healthcare MUST be tied to psychiatric diagnosis. An ideological position that runs in the face of the work of the World Health Organisation, that stated very clearly in 2019 that trans health should not be delivered as treatment for a mental health disorder.

The ideological nature of this decision to stick with psychiatry and a 2013 psychiatric diagnosis over a 2019 World Health Organisation diagnosis is not recognised. Instead, this highly impactful position is veiled under the explanation that ‘that is how things have been done historically’. Yes, Vine Review, we know things have been pathologised for trans people historically, this was the very reason for the WHO’s 2019 shift in ICD-11. This is not an explanation for centring a psychiatric diagnosis in 2026, nor is it a justification. Instead, this ideological decision is taken without any justification.

On paper, there isn’t even very much difference between ICD and DSM – one might question why they are making this effort to impose a dated and harmful psychiatric diagnosis on a marginalised population when the diagnoses are so similar.

WHOs’ ICD-11 Diagnosis for adolescence or adulthood

Any trans person who wishes to do any form of medical transition can be diagnosed as having ‘gender incongruence’ as per the World Health Organisation’s ICD-11. The first part of the ‘Gender Incongruence’ diagnosis requires a “marked and persistent incongruence between an individual’s experienced gender and the assigned sex”, which is just a description of being trans. The second component is “a desire to ‘transition’, in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual’s body align, as much as desired and to the extent possible, with the experienced gender”. This criteria captures a desire to medically transition.

DSM-V diagnosis for adolescence or adulthood

A diagnosis of ‘Gender Dysphoria’ for adults and adolescents is based on 6 assessment criteria. Criteria 1-3 relate to a trans person’s body, whether they have ‘a strong desire’ to change ‘primary or secondary sex characteristics’. Criteria 4-6 attempt to define transness, though in a way that feels very clumsy and written by a cis person, diagnosing ‘a strong desire’ to ‘be the other gender’, or ‘to be treated as the other gender’. Criteria 6 is particularly out-dated and cringe, ‘a strong conviction that one has typical feelings and reactions of the other gender’.

Differences between the diagnoses: The diagnoses are near identical, covering trans people who want to do some form of medical transition. They cover the same population.

There are two important differences between these two diagnoses though. The DSM-V diagnosis adds an extra requirement – it has to be accompanied by significant mental health distress. And it is classified as a psychiatric diagnosis, requiring the judgement of a mental health professional.

CIS-SUPREMACY in 2026 – MISPREPRESENTING THE WORLD HEALTH ORGANISATION

Reasonable sounding anti-trans folks, especially those in healthcare, are proactively playing one particular game, a component of an anti-trans playbook, a game that I am here calling ‘Misrepresenting the World Health Organisation’. It is important to recognise this game, because they are playing it a lot, and are having significant success at it.

Step one: Praise the WHO for depathologising trans people.

The game starts by praising the World Health Organisation for depathologisation – recognising that trans people are NOT mentally ill, that they, in fact, have healthy levels of respect for trans people. They do this to distinguish themselves from ‘transphobic’ people.

Step two: Misrepresenting the WHO

The game moves on to a clear misrepresentation of the WHO ICD diagnosis.

When the WHO introduced their ICD-11 diagnosis, it was intended to be a replacement for trans healthcare diagnoses centred in mental health. Not an addition. Trans people receiving healthcare were supposed to be diagnosed and treated as a minority population group, similar to the treatment provided to pregnant people or to those seeking reproductive healthcare. Neither pregnancy nor need for reproductive health services is defined and treated in terms of mental health, and nor should trans health.

Anti-trans folks actively misrepresent how the ICD-11 is meant to work.

They present the ICD-11 diagnosis as only useful in recognition that trans people are not inherently mentally ill on the whole. They say ‘of course trans people on the whole are not mentally ill, see ICD-11’.

They follow this statement up with ‘but some trans people, are ALSO very sad and distressed, and those people, impacted by poor mental health, need some form of TREATMENT, that must be provided as a treatment for their mental health distress, and must, it follows, be treated and diagnosed under DMS-V.

This approach denies the possibility of providing all trans healthcare under an ICD-11 diagnosis, outside of mental health, outside of psychiatry.

It misrepresents the WHO in claiming that healthcare provision MUST be provided under DSM-V.

Step 3: Ant-trans folks double down with a claim that, whilst trans people are not inherently mentally unwell (see ICD-11), medical treatment should only be provided to those trans people who are suffering from mental health distress, necessitating use of DSM-V for all trans people who want to medically transition.

By this sleight of hand, even the possibility of trans healthcare provision outside of mental health, as intended by the World Health Organisation, is magically disappeared.

Instead it is as though 2019 never happened, and here we are in 2026, doubling down on the need for trans healthcare being governed by the Diagnostic and Statistical Manual of Mental Health Disorders.

This playbook has already been played in the UK’s NHS. Across all recent publications from the NHS the position is laid out that ICD-11 somehow applies to trans people NOT accessing healthcare, and that DSM-V is a requirement for any area of trans healthcare.

WHY DO ANTI-TRANS FOLKS WANT THE DSM?

The reason why those opposed to rights-based healthcare for trans people NEED to keep to the DSM, is linked to the way in which a psychiatric diagnosis removes patient autonomy, de-centring what trans individuals want for their own bodies and lives.

Under a psychiatric diagnosis model of care, trans healthcare (PBs and HRT) are provided to TREAT mental health distress. This mental health distress needs to be measured by a mental health professional. It needs to be evaluated and accredited as sufficiently distressed by a mental health professional. The mental health professional can say ‘no you are not distressed enough’. The mental health professional can say ‘no you are not yet distressed enough, let’s watch your mental health drop’. The mental health professional can be duty bound to explore other factors that may have caused your mental health to be low. They can explore other treatments for your mental health problems, including counselling or anti-depressants. They can evaluate whether other treatments are more or less effective in treating your mental health problem. They can ask whether other treatments (other than PBs or HRT) have a higher quality evidence base. Whether other treatments (other than PBs or HRT) are less controversial. Whether other treatment (other than PBs or HRT) have fewer side effects in terms of impact on fertility. Centring treatment of mental health distress quickly moves us away from individual autonomy, informed healthcare decision making, respect for trans rights, respect for trans life pathways, and back into psychiatric control of trans communities.

How does this one ideological decision impact the wider review?

The decision, made swiftly and with no debate, on page 26, to centre a DSM-diagnosis as the only way to provide trans healthcare, brings with it considerable implications.

I’ve only read the start of the review, but even from those first pages I can see direct implications. The Vine Review weighed up different options, including a ban on puberty blockers, or additional safeguards. In considering the ‘not a full ban’ option, one page 12 they provide a table of recommendations for how to deliver trans youth healthcare if it is not fully banned: (abridged with my emphasis added):

a DSM-5-TR diagnosis of gender dysphoria is a requirement to indicate the use of PB and/or GAHT (p.12)
PB should only be initiated within a specialist setting with multidisciplinary staff after comprehensive assessment and family engagement;
PB should only be commenced at Tanner stage 2 or later, when there has been a thorough biopsychosocial assessment of the person and where co-occurring problems that may be contributing to distress have been addressed
[On biopsychosocial assessment – please see my earlier blog of reflections from AUSPATH]
initiation of GAHT should only occur after a comprehensive assessment involving multidisciplinary staff and holistic care planning that considers the prioritisation of interventions such that any other potential causes of distress are comprehensively addressed;
in all cases, psychological and social support should be offered,
QCGS can only function as intended with sufficient capacity, and sustainable workforce across psychiatry, paediatrics (endocrinology), psychology, speech pathology, nursing, social work and sexual health/general practice.

All of the above implications stem from the ideological decision, listed very briefly and without debate on page 26, to REQUIRE use of a psychiatric diagnosis for trans youth healthcare.

Requiring a psychiatric diagnosis for trans adolescents accessing medical intervention, also eases the route to also requiring psychiatric diagnosis and treatment for pre-adolescent trans children. Easing the route to requiring a parallel DSM diagnosis for pre-adolescent children, even perhaps, centring mental health distress in justifying the need for social transition. Even perhaps, centring mental health outcomes in justifying the evidence for or against social transition. Opening the doors wide to psychiatric oversight over all areas of trans children’s lives.

Of course, in practice, all of the above was a mute point, because the Government in Queensland instead implemented a full ban on provision of puberty blockers through the public health service.

RIGGING THE GAME

All of this needs to be understood in terms of rigging the game.

The outcome that is wanted by anti-trans actors is a full ban on trans healthcare, as seen in Queenland, the UK and elsewhere.

But they are also working to ensure that trans healthcare, where it is not banned, is as abusive and controversial as possible.

Requiring a DSM-V diagnosis is one important pillar of this strategy.

If health services shift to ICD-11, they might consider removing the power held by psychiatry and psychology.

They might consider the healthcare rights of a marginalised community

They might centre informed healthcare decision making, with patient autonomy centred.

They might find it harder to deny healthcare based, not on evidence of harm, but on having poor quality evidence of impact on mental health.

They might find it harder to place psychiatrists and psychologists in positions of medical power over trans people.

They might find it harder to impose ‘other treatments’ for resolving mental health distress, including conversion therapy.

They might actually focus on supporting trans children and adolescents.

Having got 26 pages into a 536 page report, I will have to consider whether to return to it. TBC

UPDATE: PART TWO IS HERE:

https://growinguptransgender.com/2026/01/21/reading-australias-vine-review-part-two/

Trans health waiting lists are a political choice

October 12, 2025October 12, 2025 / growinguptransgender / Leave a comment

I’m just back from an awesome trans healthcare conference in Norway (blog on that to follow). Here I wanted to share information from a presentation by the founder of the transit trans healthcare service in Catalonia (Barcelona region), Spain. Transit is respected across the world for being a service that is leading the field in informed consent depathologised healthcare. Here I will share information on the approach, the history, how it works today and reflections on trans health waiting lists. First a quick spoiler for why you should read on: their waiting list for new referrals is 3 weeks.

The approach
The transit service was set up with a strongly trans affirming philosophy of care, building from principles including 1) a firm commitment to depathplogisation, that trans people have a right to affirmative healthcare without being under psychological or psychiatric control and without requirement for psychological assessment or diagnosis.2) commitment to Informed consent,that trans people of all ages have a right make their own decisions about their own healthcare 3) commitment to avoid diagnosis, recognising that a doctor or psychologist can never know someone’s gender identity.

The history
The transit service ran from 2012-2016 as a service running outside of state management and state funding. It ran in parallel to a state run gender clinic that was pathologising and gatekeeping. Transit was very popular amongst trans communities. The state run gatekeeper service was widely disliked. Three things happened. One, trans communities across the state united behind one clear demand and goal, to demand the closure of the state run gatekeeper service and the transfer of funding to the popular informed consent service. Two, communities organised and did activism growing support and unity behind their goal. Three, they managed to gain the support of a state politician who had the authority in a devolved spanish system to make a change. In 2016 state funding was shifted to the transit informed consent service and the gatekeeping psychology and psychiatry dominated service closed.

How it works today
Trans people always have a first appointment with a medical doctor able to prescribe hormones and never have a first appointment with a psychologist, psychiatrist or psychoanalyst. Fifty percent of patients receive hormones on that first appointment. The waiting list for the service is three weeks, meaning half of patients wait three weeks from referral to hrt.

The service does not deny hrt at first appointment for those who ask for it. For those who come to the appointment asking for hrt, they are usually well informed about her, and hrt discussions take up a very small part of the appointment, instead defining the appointment as a safe space where they can talk about any parts of their life that are difficult, with this discussion having no impact on them getting hrt which is guaranteed as it is their decision to make. The reason people do not take hrt at first appointment is that they have not yet decided what they want and the patient themselves asks for more time, more support or other support.

The first appointment is 45 mins to one hour. There are zero required questions and no assessment of diagnosis. Doctors state that their job is not to assess or diagnose but to support their patient take decisions. The service operates what it describes as a multidisciplinary team but this means something completely different to what this term means in NHS children’s services. In transit it means that in addition to the medical doctor who takes the first appointment there are other professionals who the patient can request to see for additional support. A patient can ask to see a therapist to talk through their worries, history or mental health. A younger patient can ask to see a family support worker to get advice on getting support at school. They can choose to see a voice therapist. All of these additional professionals are offered and not required. The MDT offers value to service users,and does not operate as an abusive multi professional assessment, approval and gatekeeping gauntlet as happens in the UK. This same informed consent approach is followed for under 18s, with parents and legal guardians also involved in decision making for under 16s.

The transit service, with its three week waiting list, covers a population of 8 million, equivalent to the population of Scotland and Wales combined, or one seventh of the population of England, like one of our major regions. It has a total of 43 staff, a majority of whom are very part-time, working 6-7 hours per week for the transit service and working in other areas of healthcare the rest of the week. It has very high patient satisfaction rates. The key areas of complaint the service receives relates to the unavailability of particular formulations like injectable oestrogen, and complaints from parents who would prefer their child had gatekeeping in a slow psychological assessment and diagnosis model. The service has health provision in 8 locations across Catalonia, meaning people don’t have to travel far for an appointment.

Waiting
Last week UK trans healthcare advocates and journalists produced important work on the waiting lists for UK services. Those numbers are appalling. Whilst critiquing these ridiculous waiting lists I also hope we can do three other things:

1) Recognise the political and institutional choices that cause this waiting list: The NHS and our government choose to demand a gatekeeping psychology-led service that is the number one cause of our harmful waiting list. This is about the model of care, not about the amount of funding. In children’s care an increase in funding has led to an increase in the resources allocated to gatekeeping, not to any improvement in access to care. We should be long past arguing that increased funding is an form of solution without systemic reform

2) Recognise how easy it is to make better choices. Harmful gatekeeping services can be closed down and defunded. Respectful informed consent services can be funded and quickly expanded, delivering improved care at a smaller price. Importantly, a demand for informed consent care can and should be made for trans people of all ages, including trans children and adolescents. We need to stand together.

3. Recognise that the way in which we measure our waiting list matters. I hope we can move away from centring the metrics that our NHS and government think matter, and focus more on the metrics that actually matter. I would argue, that the key metric we should be counting, is a metric of the minimum expected time from referral to first getting a prescription for endocrine care, broken down by different characteristics including age and neurodivergence. Measuring a waiting list for access to a first appointment is entirely without merit in a service where the gap between first appointment and endocrine care is measured in years.

The UK children’s service has long had a waiting list of over 6 years for a first appointment. That statistic is likely to reduce. Trans under 18s are being forcibly discharged from the service for not attending identity exploration sessions, trans young people and families are ‘choosing’ to ask to be deregistered from a service that they find harmful and know won’t help them, trans young people and families are deregistering from the waiting list, and reforms to the referral system have made it increasingly impossible to get a new referral. But if that waiting list for the service goes down, does that matter? When those are the end of that wait have to wait for many year more, perhaps until they are 18 (or 25…) for approval for endocrine care.

For adults there has long been a minimum 1+ year delay from the end of the waiting list to getting endocrine care. That is part of the waiting. For many that wait is far longer than one year, and some people go years or never receive NHS approval for endocrine care. We need to focus less on the wait for a first appointment and more on the wait for endocrine care. This data could be collected, by the NHS or by ourselves.

Questions could be asked at the point of a first prescription including:
1. How long did you wait between referral and getting this prescription ?
2. How much of that wait was spent doing things that you found beneficial (counselling you chose to pursue before hormones, time for thinking, time for working through other issues including housing , employment and social transition that you chose to pursue before hormones, time to work through other mental health issues you chose to pursue before endocrine care, time to understand medical transition options). This can be defined as acceptable and patient-centred waiting for healthcare.
3. How much of that wait was not beneficial or harmful to you? (This can be defined as unacceptable waiting for care). Unacceptable and unwanted waiting for essential healthcare is a systemic inequality. Where this this number is counted in months or years rather than weeks, it is a form of state violence against trans people.

Huge waiting times for trans healthcare in the NHS, both in children’s and adult services, are there by design. Better political and institutional decisions in locations like Spain have removed this waiting list, delivering far better outcomes at a fraction of the cost. We demand better from our national healthcare.

Questioning trans kids

September 19, 2025September 19, 2025 / growinguptransgender / Leave a comment

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.

Trans children’s experiences in primary healthcare in the UK

January 30, 2024January 30, 2024 / growinguptransgender / Leave a comment

This is a pre-publication version of an article on trans children’s experiences with GPs in the UK.

Abstract

Background: Increasing numbers of trans children and parents are engaging with primary healthcare providers. There is limited research on the primary healthcare needs and experiences of this group.

Aim: This research aims to understand the primary healthcare experience of socially transitioned trans children and their families.

Design and Setting: Qualitative research with supportive families with trans children from England, Scotland and Wales.

Method: Interviews were conducted with 30 parents of trans children average age 11 (range 6-16) who socially transitioned at average age 7 (range 3-10. In-depth semi-structured interviews generated data on experiences in healthcare, in families and in education. This article analyses a subset of data on experiences in primary healthcare, applying reflexive thematic analysis within Nvivo.

Results: Findings showed a range of negative experiences with GPs, including dismissal and ignorance about trans children, encounters with prejudice, and approaches grounded in fear and a narrow view of risk, leading to refusal of care. Many families reported losing trust and confidence in health professionals, while others highlighted the positive impacts where GPs listened to families, were willing to learn, and provided empathetic trans-positive care.

Conclusion: Trans children and supportive parents’ negative experiences in primary care indicate a need for greater education, trans awareness and commitment to trans de-pathologisation in UK healthcare. GPs can play a critical role in encouraging and supportive parents to affirm and provide trans-positive care for trans children.

Keywords.

Transgender persons, primary health care, general practice, qualitative research, gender identity, health services, adolescent, child

How this fits in:

Trans children and their families are known to experience challenges within healthcare settings, though there is limited research into experiences specifically within primary healthcare. This study examines these challenges, highlighting experiences of dismissal, prejudice, or refusal of care, with parents losing confidence and trust in primary healthcare providers. The study highlights significant opportunities for progress and positive impact, emphasising how primary healthcare providers can support parents, in turn supporting trans children’s mental health and well-being. The study concludes with recommendations for primary healthcare providers to better meet the needs of trans children and their families.

Introduction

Lesbian, gay, bisexual and transgender (LGBT) communities are known to be at risk of experiencing poor care, due to a lack of awareness or prejudice within healthcare (1). A national survey of over 14,000 trans and non-binary respondents over the age of 16 by the UK Government Equality Office reported 21% had experienced healthcare professionals ignoring their specific needs in the past year, and 18% stated they avoided seeking healthcare for fear of discrimination or intolerant reactions (2). Trans adults commonly report additional barriers to routine healthcare, experiencing systemic inequality in cisnormative services not designed for trans service users, encountering transphobia and discrimination, as well as experiencing ‘trans broken arm syndrome’ where all medical concerns are ascribed to being linked to trans specific medical care (3). Within primary healthcare, a survey using a convenience sample of 92 trans adults reported 60% experiencing discrimination from a general practitioner (GP), noting that trans patients felt unable to complain “because they did not expect to be taken seriously… and felt powerless” (4).

Poor experiences and negative expectations can be a deterrent to trans people accessing healthcare from providers including in primary care (3,5,6). Healthcare systems have made some efforts to ensure services are welcoming to all, with initiatives like the doctors’ licensing body, the General Medical Council (GMC) producing LGBT patient guidance on rights to equality and dignity in healthcare (7). This guidance explicitly confirms that doctors must not deny trans people access to treatment or services based on personal beliefs, and that doctors must not express personal beliefs in a way that is likely to cause a patient distress.

Trans people face a range of barriers in primary care, including experiences of bias and prejudice, insensitive care, and encounters with professionals who lack knowledge of trans healthcare or broader trans lives (8). The UK’s General Medical Council has authored guidance on supporting trans adults, although his guidance does not cover trans children and families (9). As with adult gender services, trans child and adolescent tertiary care services in the NHS have waiting lists of many years, with many trans people forced to rely on private healthcare services. For pre-pubescent trans children, gender affirmation comprises a social transition, with a child being socially accepted as their gender, commonly including a change in pronoun. At and after puberty, medical transition can include access to puberty blockers and sex hormones, although not all trans adolescents desire to pursue a medical transition.

Current literature on trans-inclusive primary healthcare focuses predominantly on the experiences of trans adults, or on the experiences and perspectives of healthcare professionals (3,10). Research with trans adolescents has emphasised the importance of creating a welcoming primary care environment for trans youth, with respect for affirmed name and pronoun (11). One study with parents of trans children has highlighted specific barriers to primary healthcare providers engaging in shared care for trans adolescent healthcare (12). Existing literature provides limited insight on the primary healthcare experiences of younger trans children or their parents, presenting a critical knowledge gap. Our study aims to explore the challenges and barriers to healthcare faced by trans children and their families, highlighting areas for improvement, alongside recommendations for policy and practice.

Method

In-depth interviews were conducted to explore the experiences of supportive families with trans children in England, Scotland and Wales. 30 parents of trans children, with parents accessed through six closed support groups for parents of trans children in the UK. Interviews were conducted remotely via Microsoft Teams during the period December 2020 to September 2021 (during periods of COVID-19 pandemic related restrictions). Access to hard-to-reach families and children was enabled by the author’s positionality as a non-binary parent of a trans child, helping overcome trust related barriers to hearing from this cohort.

Semi-structured interviews, covering broad topics including healthcare, education and families, lasted 1-3 hours (average 2 hours). This article examines a sub-set of the wider data corpus considering references to primary care. References to primary care came from responses to questions such as “Tell me about your experiences with healthcare professionals”, or following prompts used flexibly to elicit further responses, for example “What happened when you discussed your child with your GP?”.

Interviews were transcribed by the first author and coded in Nvivo, applying reflexive thematic analysis (13), adhering to the 20-point checklist for quality reflexive thematic analysis (14). The analysis combined indictive and deductive coding, with the major themes, experiences in primary care and confidence in primary care, mirroring interview questions on 1) what were your experiences in primary care? and 2) how have your experiences impacted you and your child? The analysis comprised re-reading each transcript to become familiar with the data and generation of initial codes, coding sub-themes diversely without pre-conceived coding categories. The initial sub-themes were then reviewed to ensure they were internally coherent, consistent, distinctive, and accurately captured the dataset. Each sub-theme was analysed, and interpreted, including with reference to existing literature. Indicative quotations from a range of interviewees were selected to accurately illustrate each sub-theme. The research built in ethical best practices for trans-related research (15).

Results

30 parents of trans children were interviewed, discussing experiences with 30 trans children (15 girls, 12 boys and 3 non-binary children) who socially transitioned at average age 7 (range 3-10 years old), and whose average age was 11 at the time of the interview (range 6-16 years old). All parental interviewees were cisgender, 27 were white, 28 were female and 7 were disabled.

Challenging experiences with GPs

The first section of the results presents findings relating to challenging experiences with GP. Four sub-themes are presented, considering experiences of 1) dismissal 2) negativity 3) disrespect and 4) hostility to trans healthcare.

1. Dismissal of a trans child’s identity

A common theme in parental accounts was dismissal of their child’s identity, with GPs telling parents that their child would ‘grow out of’ being trans, that it was a passing phase. Some parents were told not to take their child’s identity seriously, to ‘give it six months’. For these families who had come to their GP for support and advice, dismissal left them feeling disregarded and not listened to, or as one parent described it ‘a bit fobbed off’.

‘Well, first of all, I went to see the GP who said, don’t worry about it, it’s nothing to worry about, give it six months, it’s no big deal kind of thing. So I felt a bit fobbed off’.

Several parents referenced their GP believing that their child was ‘too young’ to be trans, using age to dismiss their identity or to dismiss their parent’s request for advice.

‘Your GP generally is completely freaked out by this stuff, thinks your child is too young and doesn’t know what to do’.

Several parents were reassured by their GP that being trans would be temporary.

‘When she was about five, we went to the GP. And I had a GP who kind of patted my arm very reassuringly, and was like, “Don’t worry, they grow out of it”’.

Others were told that all children go through such as phase, dismissing their current identity. This parent was thankful that they didn’t listen to their GP and dismiss their child’s identity.

‘So the GP initially told us, don’t worry about it. Everyone goes through this, come back at the age of eight, if there’s a problem. This is, you know, and I went to them at age four. Thankfully, I didn’t listen to them’.

2. Negativity

A common theme in parental accounts was a perception that GPs held negative attitudes or biases towards trans children or towards parents supporting a trans child. Parents noted negativity through GP language or body language. One family noted their GP’s discomfort, interpreting this reaction as a sign of trans negativity or prejudice.

‘The first time we went to the GP to be referred. That’s when we really encountered some bigotry, straight up bigotry… She could not wait to get us out of her room. She was so uncomfortable, like visibly, visibly, uncomfortable, that I brought a child in with this thing…like, viscerally upset, that it was even a thing…she implied that my daughter had got the ideas from outside, not from herself’.

This parent’s GP suggested that something external had caused a child to assert a trans identity, a suggestion that other parents had also encountered. One parent was shocked that their GP insinuated their child being trans was likely a result of child abuse.

‘We had an appointment at the doctors, and [the Dr] basically blamed my husband said that he must have done something to her when she was younger. To make her want to be a girl rather than a boy’.

Several parents reported that they avoided discussing their child’s identity with their GP through fear of GP trans negativity or judgement.

‘I’ve never taken her to the GP about her gender ever. Purely because I felt like talking to a load of old white men about something that historically, they were probably going to judge me on was not going to be helpful. it’s probably a bad judgement to make, but I just didn’t feel comfortable doing it’.

Another parent who had brought their young trans child to an appointment to discuss their identity and ask for GP advice and support, shared her experience of GP trans negativity, and its impact on her child.

‘The doctor turned to me with [Child] in the room and said “If you told [him] to behave [himself], you wouldn’t be doing this”. I literally collapsed internally. I really did…And as we were leaving the doctor’s surgery, he (child) said, “Am I naughty? Am I naughty for being [Child’s affirmed name]?” And I had to say, “Don’t listen to that doctor”. I mean, how messed up is that to say to a 5-year-old? That’s like saying, when the lollipop lady tells you to cross the road? Ignore her. She doesn’t have a fucking clue what she’s talking about’.

The parent felt their child had been let down in this encounter, with potential negative impacts on their child’s self-confidence or trust in GPs. Several parents perceived that their GP’s approach was influenced by bias or negativity towards a child being trans.

3. Disrespect towards trans children

A majority of families referenced examples of feeling they or their child was disrespected during encounters with their GP. One parent described their GP responding to a request for support with derision.

“I did (go) to a doctor’s initially, and the doctor laughed me out of the office…the doctor basically said they couldn’t help me. And then I said about her gender dysphoria and stuff and she, almost – she smirked at me really. It was almost, she was trying to stifle a bit of a laugh. And so, I just, you know, I left and nothing else ever came of that’.

Several parents reported their GP being unwilling to respect their child’s identity, title or pronoun. For one family, their GP continued to use inappropriate pronouns in clinical appointments with their child.

‘The doctors have been very reticent to use the pronouns that we’ve put on the application forms’.

Another family encountered GP unwillingness to update administrative records, leading to their child being misgendered and outed publicly when attending an appointment.

‘So we went to the doctor, and they changed her name, but they still had Mr. At the front of it. And it was on this big TV. We’re surrounded by people’.

For other families, unwillingness to respect a child’s identity influenced their approach to wider identification, with the GP refusing to support an application to update their sex marker on their passport.

‘She had spoken to, like the people who assess risk, the lawyers, whoever they are, for the doctors. And the recommendation was not to write the letter to change the name on the passport. And her language, I found quite disturbing in terms of either ignorance, or anti trans but her response was, “I’m not – we’re not going to do that”’.

Several of these families felt themselves and their children were not treated with respect in primary healthcare.

4. Hostility to trans healthcare.

Parents perceived GP hostility to trans healthcare in a number of ways, through words, actions and refusals to support. One parent’s GP refused to sign a referral to NHS tertiary gender services, even when asked to do so by secondary care professionals.

‘So CAMHS (Child and Adolescent Mental Health Services) then referred back to the doctor and said, yeah, this child should be referred on to GIDS (Specialist Gender Service). The doctor still refused to sign the referral form’.

Another parent was aware of their GP’s hostility to trans healthcare, having been told that supporting a trans child was ‘against God’s will’.

‘(Current GP) refuses point blank to have anything to do with [Child’s] medical needs around (being trans). Who has phoned me up and told me that I’m going against God’s will- I should be ashamed of myself… And as such as a practice, they will not have anything to do with the prescribing of medication for this’.

In both these examples, GP attitude created a barrier to healthcare access. Parents described GPs having discomfort or hostility to families who accessed private healthcare. Several parents described their relationship with their GP deteriorating when they accessed private healthcare whilst on a multi-year wait list for NHS services. One GP initially agreed to support a trans adolescent with taking blood for hormone monitoring, but then withdrew the offer of support.

‘(When) we went with [Provider], you know, the private provider. She was a little bit less supportive. With us choosing to go down the private route. Initially said she’d do bloods and then withdrew it… I think when we went private, she then distanced herself from us a little bit. Cos she didn’t want to be seen to be supporting us going private’.

The parent felt the withdrawal of support was prompted by the GP wanting to avoid any association with private healthcare. A parent who felt private healthcare was critical for their adolescent shared their experience when asking for GP support in administering a private prescription.

‘I spoke to the GP hoping they might support us with a private injection from (Private Provider). My GP said I should think about because it might be seen as a child protection issue. I’ve just was so, so, upset when I came off the phone to her – cried, and I just – I had the day off work, couldn’t work. I was so upset. I just feel – you just feel like there’s all these barriers being put up and you’re kind of pushing them down, and then another one will come up. So it’s just been a nightmare’.

The parent described the significant impact the GP response had on them, feeling their GP was yet another barrier or threat to their child receiving critical healthcare. Parents noted that GPs were uncertain how to support trans adolescents seeking medical transition, with responses grounded in fear.

‘But it just felt like a fight in so many different places. You know, and especially at the doctors – like that surprised me. The lack of understanding, information, and the lack of like clear procedures and practices, you know, they just have no idea and they’re so afraid to do anything’.

Parents perceived that uncertainty or discomfort with trans adolescent healthcare left GPs ‘afraid to do anything’, with trans adolescents and supportive families left without GP support.

Negative impacts on parents and children

The second section of the results presents findings relating to the impacts of experiences with GPs on families. Three sub-themes are presented on 1) a loss of confidence 2) a search for trans-positive GPs and on 3) GP learning.

1. Loss of confidence in GPs

Loss of confidence in GPs was significant theme across many parental accounts. One parent summed up the impact of poor experiences in primary healthcare.

‘I’ve lost faith and I’ve lost trust in the health care system’.

Another parent spoke of exhaustion related to poor experiences with GPs, holding low expectations for future care.

‘I haven’t got the energy to defend myself against services that are not supposed to be there to degrade what you’re trying, when you’re trying to do the best for your child. I have not – I could not. Right now I could not fight’.

The parent chose to avoid any engagements with primary healthcare professionals, rather than risking further judgement or hostility. This distrust between parents seeking the best care for their child, and primary healthcare providers, risks driving children and families towards less safe methods of healthcare, and risks deterring families and children from engaging with routine non-trans healthcare needs. Several parents whose own experiences of hostility had contributed to anxiety and depression, had deterred, or avoided seeking their own mental health care from their GP, due to their apprehension of GPs.

‘I avoid GPs at all costs, if I can’.

Another parent described how negative experiences with a GP had put their child off wanting to see a GP under any circumstance.

‘It was an awful experience with both [Child] and I. And she didn’t want to go see a doctor at all after that’.

These accounts highlight significant ongoing impacts on supportive parents and trans children, with a loss of confidence in their GP.

2. A search for a trans-positive GP

Several parents spoke of their search for, or wish for, a trans-positive GP, someone who would support them and their child without displaying trans negativity or hostility. Parents spoke of how hard and stressful it is to search for a trans positive GP for a trans child.

‘You never know what their stance is on this particular topic because it’s quite contentious’.

The parent felt that GP stance or bias directly impacted on their capacity to provide trans positive care. Several spoke of their inability to complain about poor practice. Feeling their concerns would not be taken seriously, or even that complaints could put them in a more precarious position.

‘Because it’s our only GP surgery locally, I didn’t (complain). I was too scared to – to be honest with you. I was too scared to’.

Several spoke of wanting to find a trans positive GP, but not knowing how to locate one.

‘I want to, I really want to find a new doctor. But I don’t even know how to go about doing that…(how do I) find out if they’re trans friendly and trans friendly towards children?’.

3. GP learning to provide respectful care for trans children and families

A final sub-theme relates to GP learning, with parents sharing examples of GPs adapting and growing in their ability to provide respectful care for trans children and their families. For all our interviewees, their child was the first trans child their GP had encountered. Despite inexperience, several GPs demonstrated their ability to provide respectful care. One GP emphasised that they had never supported a young trans child but was able to build upon their experience with trans adults.

‘I was like, I don’t know if you’ve ever come across this before? And he was, no, I definitely have, this is just the youngest person I’ve ever come across this with…And he was very good’.

Another parent shared an example of a GP whose initial reaction was not respectful or well-informed, but who reflected upon their approach, and phoned the parent back to apologise.

‘He rang me back… the same GP and he said, after you left, I went online, I was online for about four and a half minutes, and I realised my approach was really wrong… Because he said, I have children. And because none of them have done this, I didn’t recognise this. I didn’t recognise this. And I pushed that on to you. So this is an apology.

This example demonstrates the importance of GP willingness to reflect and learn, especially when GPs are unfamiliar with trans children and their healthcare needs.

Discussion

Summary

Parents of trans children and trans children themselves have encountered a wide range of poor experiences with their GPs, characterised by scepticism, dismissiveness, and lack of knowledge of how best to care for trans children. In several cases GPs failed to treat trans children and families with respect, dignity, and empathy. In many cases families experienced refusal to provide both medical and non-medical aspects of healthcare. Several families experienced acute prejudice, and many felt unable to challenge poor practice. Negative experiences reduced parent and child confidence and trust in primary care providers, and risk deterring access to healthcare.

Strengths and limitations

This research provides qualitative insights into an under-researched group, examining the primary care experiences of parents who have supported and affirmed their trans children in pre-adolescence and is the first study to focus on this cohort. The research provides indirect insights into the experiences that trans children have with GPs, highlighting an area for further research. Importantly, the research does not illuminate the experiences with GPs of trans children or teenagers with unsupportive parents, nor does it consider the experiences of trans teenagers who come out at adolescence. The parental sample is diverse in several respects, though a large majority were cisgender white women, with scope for future research with individuals facing multiple axes of marginalisation, including children within the care system.

Healthcare bias

Existing literature has examined how healthcare professionals’ attitudes, prejudices, lack of knowledge, lack of training or lack of cultural competency can negatively affect their ability to effectively care for trans people (16–19). Studies have explored trans adults’ experiences in healthcare, with examples of trans adults encountering ignorance, prejudice or refusal of care (3,5,20). Experiences of discrimination or stigma in healthcare can lead to distrust and disengagement from healthcare services, contributing to wider health disparities in trans populations (6). This study contributes to the literature, examining trans children and their families’ encounters with ignorance, prejudice or hostility in primary healthcare, highlighting the negative impacts on their confidence in healthcare providers.

Minority Stress

Research has documented the challenges parents of trans children face when engaging with under-informed or prejudiced professionals (21–24). Parents and carers of trans children can be vulnerable to associative stigma and minority stress caused by interactions with institutions and individuals, including healthcare professionals, who respond to parents of trans children with ignorance or hostility (25,26). This study adds to the literature on parental minority stress, illuminating how negative experiences in primary healthcare contributes to parental stress, worry and distrust of healthcare professionals.

Safeguarding child mental health

Family affirmation is known to be critical to trans children’s mental health (27,28). Many parents of trans children initially struggle to understand and support their trans children, with research highlighting the importance of trans-positive information and affirmative support from professionals (29–31). This study highlights an opportunity for GPs to provide trans-positive reassurance to parents of trans children, playing a critical role in safeguarding trans children’s well-being and mental health.

Implications for research and/or practice
A trans-positive and well-informed GP can make a significant difference to trans children and family experiences in primary care. In the absence of UK guidance on support for trans children and families in primary care, healthcare professionals can look to international guidance, such as guidance for GPs contained in the ‘Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents’ (32). Fear of GP prejudice and ignorance can leave trans children and supportive families isolated and afraid, with distrust in primary healthcare providers risking negative impacts on current wellbeing, on social determinants of health and on future equality of healthcare outcomes. These findings reinforce the critical importance of GPs building knowledge and competence to work with trans children and their families. GPs need the confidence and trans-positivity to affirm, depathologise and de-problematise childhood gender diversity.

Poor primary care practice also misses a critical opportunity to educate unsupportive or uneducated parents of trans children. Trans children who are supported, respected and affirmed, especially by their families, are known to have good levels of mental health, whereas family rejection is strongly correlated with poor mental health, depression, self-harm and suicidal ideation (27,28). With family affirmation a key protective strategy to safeguard trans children’s mental health, GPs may need to reorient their interpretation of ‘risk’, prioritising the protection of trans children’s mental health and well-being.

Trans positive reassurance from primary health care providers like GPs is a critically important preventative mental health intervention that would be expected to deliver double mental health benefits. A supportive GP will reduce the minority stress burden on supportive parents of trans children, helping them to better care for their children. Trans positive advice from GPs to unsupportive or uneducated parents can help provide safe, nurturing family environments for trans children, facilitating trans children’s wellbeing and mental health.

Further research bringing together GPs, supportive families, trans children and trans adolescents can explore the barriers to affirmative primary care for trans children and their families. Such research can explore how to build GP confidence and competence; how to ensure safe and trans-positive access mainstream healthcare. Additional research can also explore how GPs can support access to affirmative trans healthcare for trans adolescents, drawing lessons from countries where trans adolescent healthcare is managed in primary or secondary, rather than tertiary healthcare.

Families reported the enormous difference made by having a GP who understood trans children’s healthcare, understood the failings in the NHS system for trans children, and who would put their child’s wellbeing as their top priority. Parents of trans children highlighted that they wanted to have GPs who are:

Trans-positive, with understanding that childhood gender diversity is not a problem or something to be pathologised (33), that trans children thrive with love and support.

Knowledgeable about research that emphasises the importance of family supportiveness, of respecting a child’s identity at any age, the importance of using a child’s pronoun, or having identification that matches their identity. Evidence shows that supported and socially affirmed trans children have good levels of mental health.

Aware of the prevalence of misinformation on trans children’s healthcare, the prevalence of transphobic attitudes or ignorance including from professionals, and the negative impacts of isolation, transphobia, hostility and minority stress.

Child-Centred, applying the above knowledge to ensure primary care providers put a trans child’s wellbeing at the heart of their approach.

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