Recent media coverage has centred around one of my patients, Jason, who is one of the youngest transgender children in the UK to receive medical treatment to pause their puberty.
Along with one or two eyebrows, the story has raised many questions, and one in particular: How can someone so young make a decision to take medication which will confirm their gender, when they may change their mind about their gender variance as they mature?
As this is a question that comes up time and again I wanted to outline my position on the matter.
The Gender Identity Development Service (GIDS) for Children and Adolescents, states that Cross Sex Hormone (CSH) treatment will not be given until around the age of 16. Prior to this, puberty blockers will be administered. The youngest person to have been prescribed puberty blockers by the Tavistock and Portman Clinic (the UK's only clinic specialising in the treatment of children and young people who experience difficulties in the development of their gender identity) is 10.5.
Jason, however, began treatment with hormone blockers at the age of nine.
When it comes to treating gender variant patients at the younger end of the scale, my approach is to manage each case individually. I believe treatment should start after careful assessment, when the child - and family - are physically and psychologically ready and have all the support in place around them.
My own first hand experience and that of other experts in the field is that 'watchful waiting' can, in fact, be damaging. Instead, I follow the school of thinking that treatment should be tailor-made for each patient, which is the approach in the US, where many UK children end up seeking treatment.
The law states that providing a young patient has shown competence according to the 'Fraser Guidelines' (Gillick Competency) they can inform their own medical treatment below the age of 16.
Each individual should be assessed as to whether they are able to make informed medical decisions and, if they are deemed to be 'Gillick competent', they should be allowed to follow a care pathway that is planned, together with their input, at a speed that is appropriate for them as an individual, rather than according to a strict, time limited protocol.
To put this into context, let's look at Jason's situation. When Jason and his mum Leanne first approached me wanting to discuss his options, Jason knew he was male and couldn't bear the thought of living out his life as female. Leanne was fully supportive having witnessed these signs of her son's gender variance since the age of three. His dad took a little longer to come round, but with a little time and a lot of understanding, he too is now fully supportive and appreciates that his son is taking the right action.
They had been informed that waiting times for an appointment with the Tavistock would be two years plus and with Jason's female puberty marching on unabated, they didn't have the luxury of time. So they chose to take matters into their own hands and Jason has become the youngest child to start this treatment.
Jason and his mum both talked about their experiences and hopes for the future with Victoria Derbyshire, you can watch the interview here.
The main concern raised by so many is: What if?
But instead of only considering what happens if we treat the child and then that child changes their mind years down the line, must we not also consider what happens if we refuse to treat that child? What happens to the MTF child who is told she must go through a male puberty before she will be taken seriously? Forcing her to accept that, until her voice drops she is not allowed to have an opinion. How about the FTM child who must watch as his breasts develop, in the knowledge that one day he will have to undergo painful surgery - knowing all the while that with the correct, timely treatment, their development could have been prevented in the first place?
The current understanding is that if a child presents with a strong feeling that their gender differs from the one society expects, and those feelings have been persistent through childhood and are still present as puberty commences, they are extremely unlikely to waver in these feelings.
The truth is, we can't see the future for these children. There is no blood test or brain scan that will confirm our suspicions, that will put a tick the box and justify our diagnosis. Instead, we must listen, learn and understand. We must take a 'whole life view', supported by the child's wider network, and together make the best decision for the child to ease their pain and try to give them the best chance of living a normal life.