Working with young people questioning their gender? Ditch the label and understand the child’s world

Anthony DouglasAnthony Douglas, Chief Executive

The Government’s consultation about proposed amendments to the Gender Recognition Act is a good example of legislation catching up with social trends and the way citizens live their lives. The proposed amendments would make it easier for individuals to self-certify their gender without having to be assessed by clinicians. This will make it easier for those who change gender to obtain official recognition of their acquired gender for every purpose and reason that is needed. The climate is changing. Herbert Smith Freehills has become the first law firm to offer to cover part or all of the costs of gender affirmation surgery for its transgender employees. I was told of a study in California conducted recently in which over 20% of teenagers asked about their gender questioned the gender assigned at their birth. This reflects more ambiguity generally about identity, not just gender identity.

Cafcass works with this grain. When we meet with a child or young person who is questioning their assigned gender or is intent on changing gender, we do not make assumptions. The child may be perfectly comfortable to be in their new emotional and psychological skin and may always have felt that way. Their parents, relatives and the professionals they have come into contact with, may have been supportive or hostile. That is not for us to judge. We have to understand whether we should support a fast track transition, which can for example mean we recommend immediate use of hormone blockers so that transitioning does not become more complicated biologically if there is delay. It can mean we recommend those around the child start to refer to the child in the way the child wants – their name, the pronoun used to refer to them (she/he/they). It can mean we support the child in the way they see their future.

Of course, for some children or young people, transitioning may represent an extension of a more general emotional and psychological confusion they are experiencing, rather than a confirmation of who they know themselves to be.  For these children, we have to assess whether help is needed and, if so, what form that help should take. Our approach should be the same as it is whether children are seeking to live with one parent rather than another, to form one relationship rather than another or to choose one form of study rather than another. All choices made by children have potential lifelong consequences, including adverse consequences, and all children need help with the multiple transitions they go through.

We have to assess children in this situation in the same way we do all children. Rather than worrying about labels such as gender dysphoria, we should understand the child’s world. We should understand their behaviours and the behaviours of those around them, as we would in other cases where use of labels may lead to an over-classification of one side of an issue rather than us reflecting its complexity. Many children do not get the help they need because access to help such as CAMHS depends upon a child being assessed as eligible for one specific clinical pathway or another, rather than the child being seen in the round, more holistically.

Finally, it is crucial to listen to the child, to how they feel, to what they want and to make sure that we either advocate for them, or that we have a strong evidence base and a strong professional assessment and rationale for disagreeing with them. For all children, we must recommend a way forward which is in their best interests.

We will now be working with the senior judiciary, partner agencies and transgender groups representing children to develop a protocol for timely decision making and any necessary authorisations for treatment under the current legal framework. This aims to better assist children and young people going through the family courts.


Please note that our blogs provide individual views on a subject and are not intended as guidance for practitioners.

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