Rise in number of Irish children seeking medical help for transgender issues
Since 2010, 30 children from Ireland have been referred to an NHS clinic in London which treats transgender children - but in the last year there has been a surge in referrals.
The children, between the ages of eight and 17, are initially psychologically assessed in Tavistock Clinic in the UK or an outreach clinic in Dublin's Crumlin Hospital.
The surge in Irish referrals in the past two years can be linked to a broader acceptance of gender dysphoria. High-profile gender transition stories like that of Caitlyn Jenner and Orange is the New Black star Laverne Cox have pushed term transgender into the mainstream.
Transgender children with gender dysphoria are distressed about their bodies and gender identities over a prolonged period. They find it hard to identify with the gender they were assigned at birth and often show signs of serious psychological distress, including self-harm. They may wish to transition, socially and sometimes medically, to the gender they identify with the most.
Dr. Polly Carmichael, Director of Gender Identity Development Service at the Tavistock Clinic told the Sunday World that children are assessed carefully and provided with ongoing counselling and support.
"We assess gender and gender identity and how long these difficulties have been there and what the young person's hopes and wishes are," she said.
"In appropriate cases where they are very distressed by the fact that their body is developing in a way that feels wrong, the first stage of the physical treatment is something called the hypothalamic blocker.
"That is a monthly injection that stops the production of natal sex hormones. It takes away the pressure of the body going in a direction that is not wanted. The local team in Ireland manage that monthly injection.
Hypothalamic or puberty blockers are carried out at Crumlin Hospital. The blockers have potential side effects, including the emotional and psychological fallouts from hormones. But, according to Prof. Donal O’Shea of St Columcille’s Hospital in Loughlinstown, these are minor compared with the mental damage that can be done by forcing a young person to live in and be recognised as the wrong gender.
Last year, the American journal Pediatrics published the results of a longitudinal study which found that, of 55 teens who had taken puberty blockers under clinical and psychological supervision, none had regrets.
"In younger children who haven't yet developed Adam's apple for boys and breasts, for example, for girls, it is possible to have the blocker from the early stages of puberty around the age of 12," said Dr. Carmichael to the Sunday World.
"The majority of young people who come to the service have already gone through puberty and in those cases the blocker helps because the young people can experience their body without sex hormones. The blocker is completely reversible. If you stop the injections the pre-programmed sex hormones resume."
The next step for young people who still feel they want to change their body in line with their gender identity is cross sex hormones which can be administered in adult services in their late teens.
"These are not fully reversible. They bring changes to the body that then couldn't be taken away. Cross sex hormones can be prescribed from the age of 16."
After 18, surgery is an option, but not everyone takes it. The most important factor, however, is that trans children are starting to gain recognition and respect in their true gender, whether or not they transition medically through hormones and/or surgery.
"My experience in Ireland is that families are amazingly supportive of their children," said Dr. Carmichael.
"Young people are socially transitioning in school now to live in the gender they feel they are and we have met with schools in Ireland and found them incredibly supportive and helpful."