What does a doubling in referrals to our Gender Identity Development Service mean about how society’s view of gender is shifting?

12 May 2016

Nationally, globally even, we’re seeing a real shift in how we talk about gender. We seem to be moving to a less binary world. We have to take note of this shifting context. Having said that, the young people referred to our service come here with their own unique experience, which may or may not, reflect the shifting social discourse. Our job is not to pre-suppose anything about what they are going through. We continue to look at each child and their family individually. 

Anonymous adolescents (ado-486)

We’re often faced with the question about why we’re seeing such an increase in referrals and it’s an issue I have explored through discussion with the media, and via online commentaries. We can’t identify a single reason for the increase, but we have certainly seen a cultural shift and thankfully more acceptance in terms of how we think about gender and greater recognition of transgender and gender variant people. 

While we’re seeing an unprecedented rise in referrals to the service – we have to keep this in perspective. Against current census data, around 0.01% or one in 10,000 young people, are referred to our highly specialised service. Not all of those will fulfil the criteria for a diagnosis of gender dysphoria and not all of those will decide to transition. 

We’re regularly asked for referral data and there’s a particular interest in the age of the young people we see. More recently there’s been an interest in the natal sex (sex assigned at birth) of the young people referred to the service and the numbers going forward for early intervention. The data will show you that in 2015/16 14 was the average age of referral and a small percentage were referred for early intervention. The data also shows an emerging trend towards more natal females presenting at the service, something I have responded to previously. 

All of the young people we see here have one thing in common – they are experiencing difficulties with their gender identity. Aside from that, for every young person and family we see, the circumstances and related issues are all very different. As are the feelings they have about their gender identity, feelings which often evolve over time.  

The work we do here is highly specialist and the staff who see the young people are highly qualified. It’s our role to provide a safe, therapeutic space where people can speak to a range of professionals about their circumstances. We do this without judgement. We are currently working hard to recruit more staff and train them up to meet the demand for our service and ensure we are able to see young people within reasonable timescales. 

We see young people who, often, are experiencing real distress. Our multi-disciplinary team including psychologists, psychiatrists and psychotherapists and family therapists is here to conduct in depth assessments to provide them with the best possible support. 

I would like to dispel some of the myths, or misconceptions about the services and what we do. Sometimes there is a perception that the service’s primary purpose is to prescribe drugs. This is not the case. When young people first attend the service we spend time with them and their families and hear how they are doing in general, as well as talking more specifically about their gender.  It is not the case that all of the young people who attend the service choose to undertake physical treatments, far from it. For a small number of young people physical treatments can be very helpful to reduce the real distress they experience around their gender.  

As well as taking part in a Channel Four series, we recently invited Sima Kotecha, a journalist from BBC Radio 4, into the clinic. This is the first time we’ve given a journalist access of this kind and we did so for just this reason – we wanted her to see and report first-hand on what the clinic is actually like and hopefully dispel some commonly held myths or fears about how work with young people and their families. 

We’re pleased there’s an appetite to explore and discuss these issues and that transgender issues are taking centre stage. The take away messages from our service would be: every individual is different, every journey is different, there are no pre-determined diagnoses or fixed outcomes and physical intervention is not the focus of our under 18s service. Our service allows young people and families to explore the best way forward as individuals, as they develop.

Polly Carmichael, Gender Identity Development Service Director and Consultant Clinical Psychologist

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