In this section
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
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
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.
Being transgender or gender diverse is not a mental health problem. However, many young people with gender dysphoria also experience mental health concerns.
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.
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.
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 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.
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.
Once puberty has started, treatment options include the use of puberty blockers to stop the physical changes of puberty that the adolescent finds distressing.
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.
Are stage 1 and stage 2 medical treatments for gender
Puberty blocking medication (stage 1 treatment) slows the development of sex characteristics (e.g. breasts, voice changes), while allowing time for the child to develop cognitively and emotionally. This treatment is reversible. Gender-affirming hormone treatment
(stage 2), which initiates puberty in the teenager’s affirmed gender, is only partially reversible.
What is the difference between gender and sex?
Sex indicates whether a person is male or female, according to their sex chromosomes (female XX, male XY). These determine a person’s physical appearance (e.g. breasts, penis), internal organs (e.g. ovaries, testes) and hormones. Gender is how an individual identifies in society – their innate sense of being male or female.
Developed by The Royal Children's Hospital Gender Service. We acknowledge the input of RCH consumers and carers.
Reviewed September 2020.
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This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.