The number of British children who want to change their gender has doubled in the last six months, according to the UK’s only NHS specialist service provider of gender identity support for under-18s.
The Tavistock and Portman NHS trust gender identity development service in London has said that attempting to meet the demand from children seeking their services has put them under huge pressure.
Many of the referrals – 151 from 2012-13 to 2014-15 – relate to children under the age of 10, including one three-year-old and 12 four-year-olds.
Polly Carmichael, director of gender identity services at the Tavistock, said: “We have seen a 40% to 50% increase in referrals every year since 2009 but this year to date we have seen about a 100% increase in referrals.
“The increase is challenging,” Carmichael said. “We are keen to provide space for young people to fully explore their options and find their own way forward. It is a very complicated issue.”
According to a freedom of information response obtained by the Guardian, the number of children referred to the Tavistock has jumped from 314 referrals in 2012-13 to 697 referrals in 2014-15. In the last six months the service has seen a further increase in referrals with 634 children referred between April and September.
The Tavistock treats children up to the age of 18 who experience difficulties with the development of their gender identity, including children unhappy with their biological sex, via a multidisciplinary team of experts in child and adolescent psychiatry, psychology, social work, psychotherapy and paediatric and adolescent endocrinology. This specialist service is unique in the NHS.
According to the Tavistock figures, more girls want to become boys (893) than boys want to become girls (579). Carmichael said the larger number of girls was likely to have a complex explanation. “It might be to do with increased confidence in natal females coming forward but there are lots of unknowns. But we’ve seen a large rise in natal females coming forward, which deserves fuller exploration,” he said.
Increased media interest, the proliferation of social media where children and young people can discuss gender identity issues, and the prevalence of trans figures in popular culture such as Caitlyn Jenner and Laverne Cox, is thought to be part of the reason why there has been such a significant increase in these referrals.
A spokeswoman for the Tavistock said: “Gender expression is diversifying”, adding that it was important for young people to explore and develop their own path with support from specialist services.
Jay Stewart, director of Gendered Intelligence, an NGO that promotes greater understanding of gender diversity, said there are now more than 50 gender options on Facebook rather than the traditional two.
“This is the tip of the iceberg of what gender identity is going to look like in the future,” he said. “Young people have a very sophisticated understanding of gender yet the world is lagging behind. There is poor understanding of these issues and a lot of hostility and discrimination. Everyone’s gender identity and journey is unique and the numbers of children and young people wishing to transition are going to keep going up and up.”
The women and equalities parliamentary select committee has been conducting an inquiry into the lack of equality experienced by trans people, including children and young people. Ed Vaizey, the culture minister, answering questions at the committee on Tuesday, called for greater transgender equality in mainstream culture. He said it was the duty of broadcasters to see transgender representation on screens not as “something exotic, but completely mainstream”.
Schools are increasingly acknowledging this development, offering support and changing toilet arrangements so there are more unisex rather than just male and female toilets.
But Carmichael urged caution in rushing to change gender at the onset of puberty. She said at the moment there is not enough evidence for choosing this course of action although the Tavistock does take a flexible approach when seeing children at the onset of puberty. She said more young people were thinking about the implications of physical treatments on their future fertility.
The charity Mermaids, which provides support to children and families on the issue of gender transition, says children who want to transition can be given gender hormone blockers to prevent the onset of puberty followed by cross-sex hormones. The former are reversible but the latter are less reversible. Currently cross-sex hormones are available from the age of 16 on the NHS.
Susie Green, the chair of Mermaids, said:“Our children are being failed on a daily basis … There is a crisis. NHS primary care services often don’t understand what is going on with these children and can be dismissive and say, ‘This is just a phase they’re going through.’
“We have trans boys starving themselves to prevent the development of breasts and the onset of periods. This is very concerning. This is not a lifestyle choice for children. It is incredibly distressing for them and many experience bullying and harassment at school. Children just want to fit in and they would never choose this option unless they have to.”
A survey by the charity found a 12- to 15-month delay from referral to treatment. Green said: “This delay translates into interminable torture for these teenagers.”