Polarising debates around gender dysphoria are deeply damaging for young people – I’ve seen it firsthand

Working in any evolving field of NHS practice can be difficult as well as enlightening. And when it comes to supporting children and adolescents who are experiencing significant concern and distress about their gender, it’s uniquely challenging. The situation is not helped by the highly emotive and often polarised debates about the best way to care for these young people.

A number of new clinical and research papers have been published this week, adding to our understanding and reinforcing the complexities of this field of medicine. Across these papers, researchers and staff from the Gender Identity Development Service (Gids), the national NHS service designed to help children and adolescents experiencing distress about their gender, illustrate the wide variations of support needed for gender-diverse young people.

Gender is a fast-evolving field which frequently features in the media, in public policy debates and online. Discussions about healthcare are important, but polarised debate is highly damaging. There can be a powerful pull to reduce the diversity of how young people present and to simplify their experiences.

When it comes to the care of any young person, one size does not fit all. In cases of gender distress, individualised support is crucial. Emerging cultural, social and clinical trends, such as increases in referrals, shifts in sex ratio and an increasing number of ways that people self-identify all illustrate that gender-diverse individuals are not a homogeneous group.

Debates about childhood gender diversity often veer towards a disproportionate focus on the physical interventions that are sometimes provided to young people and children. Medical treatment is, of course, an important area of research and expertise, and it raises particular anxieties for families and clinicians. But the focus on this can miss the big picture. At Gids we support young people and families in a number of ways. This can be through initial and ongoing exploratory and therapeutic conversations (often over many years); group sessions with other young people; detailed and up to date information-sharing and liaison with key local agencies.

Some young people have identified, or currently identify, as gay or lesbian, and the ways they understand their gender in relation to their sexuality (and to homophobia and transphobia) is an important topic for exploration. It is increasingly apparent that the concepts of gender and sexual identity are becoming more nuanced. For the young people who come to Gids, gender is increasingly thought about in more fluid ways and we need to make sense of this as part of the care we provide. We must be mindful to provide help in ways that does not further marginalise the young people with whom we work.

Many young people and their families attending our service have limited access to sources of community support. This can heighten feelings of isolation, shame and difference, which in turn can contribute to a more hopeless perception of the options and the opportunities that are available. People are anxiously reaching out for simple explanations and rapid solutions.

Our experience tells us that every young person is an individual and there are varied outcomes for these children, so healthcare providers must not jump to conclusions. We must accept and respect a child’s deeply held feelings and beliefs, and create a space for them to settle on an identity and, if required, on a treatment pathway that they’re comfortable with. We must also bear in mind there can be no certainty about treatment decisions for any given individual.

Transparency about the limited, but slowly growing, evidence base is crucial for clinicians to provide answers to the many questions that the work generates. Ethical concerns around informed consent and self-determination are a central focus for the Gids team.

All young people need is to be supported to live well, and they are done an injustice if we do not try to examine the nuances of their situation and work with them to find the best care options, which may or may not involve medical intervention. Formal consent and education is part of a process which needs to establish not only whether the young person has the right information, but also capacity, consistency of their position and independence from external pressures. This is established over time as part of their assessment.

Young people should be encouraged to work with parents, wider family, schools, local mental health services, social care professionals and support group networks, alongside receiving help from specialist services. It is crucial that we provide space and time for every young child find their own path while accepting and respecting that there can be no certainty about the route each individual will take.

Bernadette Wren is a consultant clinical psychologist at The Tavistock and Portman NHS Foundation Trust