Gender dysphoria is the distress felt by people whose sense of being male or female differs from the gender they are assigned at birth based on their sex. For some people, the difference between their gender identity and physical characteristics can cause significant and persistent emotional distress.

The terms ‘transgender’ or ‘gender diverse’ are often used to describe these identities. About 1.2 per cent of Australian school children (about 45,000 children) are thought to identify as transgender. Being transgender or gender diverse is seen as part of the natural spectrum of human diversity.

Signs and symptoms of gender dysphoria

Almost all children begin expressing their gender identity at two to three years of age through their preferences for particular clothing, toys and interests. Many transgender or gender diverse children will also express their gender identity around this time, and this may differ from what parents are expecting.

It’s normal for children to experiment with gender roles. Many children will not desire any form of transition and will feel comfortable with their gender identity.

For others, living in their birth-assigned gender role is extremely distressing. In these cases, it is important for families to discuss with their child or teenager what they need to do to protect their physical and mental wellbeing, and consider seeking professional assistance.

For many transgender children and teenagers, the onset of puberty, with the development of secondary sex characteristics (e.g. breasts, changing voice) that don’t match their gender identity, is a particularly distressing time.

Difficulties associated with gender dysphoria

Being transgender or gender diverse is not a mental health problem. However, many young people with gender dysphoria also experience mental health concerns.

• In younger children, this is often in the form of emotional and behavioural difficulties.
• For teenagers, there are higher rates of depression, anxiety, self-harm and suicide attempts.

A supportive family and school environment that affirms the child’s gender identity helps protect young people against these difficulties, and can improve mental health outcomes. 

When to see a doctor

Knowing when a child needs support can be difficult for parents and carers to determine. If your child or teenager has been showing ongoing distress about their gender, visiting your GP is a good first step to take in seeking professional help.

In Victoria, The Royal Children’s Hospital (RCH) Gender Service will see children aged three to 17 years. You will need a referral from a GP. In other states, talk to your GP about what services are available.

The RCH’s Gender Service team includes child and adolescent psychiatrists and clinical psychologists, paediatricians, nurses and other clinicians who specialise in gender identity. The team will work with your child to assess their gender diversity or gender dysphoria. Following the assessment, support and treatment pathways will be proposed and discussed with your family.

Treatment for gender dysphoria

Treatment for gender dysphoria depends on the individual needs of the young person and their family. Treatment aims to support individuals in affirming their gender identity, with a focus on physical and psychological wellbeing.

Treatment before puberty

For children who haven’t yet reached puberty, treatment focuses on gender affirmation through talking to the child and their family and providing support for home and schooling environments.

Treatment after puberty

Once puberty has started, treatment options include the use of puberty blockers to stop the physical changes of puberty that the adolescent finds distressing.

• Known as Stage 1 treatment, puberty blockers are used mostly in early puberty. Stage 1 treatment is reversible.
• Stage 2 treatment involves using gender-affirming hormones (oestrogen or testosterone) to change the body to be more consistent with the teenager’s affirmed gender. Depending on the circumstances, this treatment can usually be started around the age of 16.
• Stage 3 treatment involves surgery, which is not commonly undertaken before adulthood.

Other support

For all forms of treatment of gender dysphoria, your child should be monitored and treated for other medical and mental health difficulties that may occur. It is also important that families and schools are supported in maintaining a gender-affirming approach.

Treatment focused on changing someone’s gender expression and identity to match the gender assigned at birth (known as conversion or reparative therapy) causes harm to the young person and is considered unethical.

Key points to remember

• Children whose gender identity differs from the gender they were assigned at birth are known as transgender or gender diverse.
  
• Gender dysphoria is the distress a child experiences about the difference between their gender identity and their physical body.
  
• Treatment for gender dysphoria can take many forms, and is always tailored to the individual and their family.
  
• After puberty has started, treatment may involve puberty blockers.

For more information

• The Royal Children’s Hospital: Gender Service
  
• Transcend
  
• Parents of Gender Diverse Children

Developed by The Royal Children's Hospital Gender Service. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.