Worried about your gender identity? Advice for teenagers
If you feel confused about your gender identity, you're not alone.
In the past few years there has been a huge increase in the number of teenagers questioning their gender, whether they feel female, male, non-binary or any of the other diverse terms used on the gender spectrum.
Some experts believe this is because society has become more accepting of differences in gender identity. Others believe young people in particular are rejecting male and female genders as the only identities.
Although most people don't question their gender, for some young people their gender identity is more complex.
You may question your gender if your interests and social life don't fit with society's expectations of the gender you were assigned at birth.
You may be uncertain about your gender identity and feel that you can't identify with being either male or female.
You may feel that you are both male and female or that you have no gender, which can be referred to as non-binary or agender.
You may have a strong sense of being the opposite gender to the one you were assigned at birth and may feel that you have been in the "wrong body" since early childhood.
For young people who feel distressed about their gender, puberty can be a very difficult and stressful time.
This is the stage where your assigned gender at birth is physically marked by body changes, such as the growth of breasts or facial hair.
Does it make me gay, lesbian or bisexual?
Gender identity isn't related to sexual orientation in a direct way.
Young people who are questioning their gender may identify as straight, gay, lesbian, bisexual, polysexual, pansexual or asexual.
Some people describe their sexuality and gender identity as being fluid – that is, they change over time.
How does gender discomfort affect you?
If you experience discomfort with your gender identity, you may feel unhappy, lonely or isolated from other teenagers.
You may even feel as though you have a mental illness, but it's important to remember that gender identity issues on their own are not a mental health disorder or disease.
You may feel social pressure from your friends, classmates or family to behave in a certain way, or you may face bullying and harassment for being different. This may be affecting your self-esteem and performance at school.
All these difficulties can affect your emotional and psychological wellbeing. In some cases the distress can be considerable. Depression is very common among young people with gender discomfort.
Who can help me?
If you are experiencing discomfort or uncertainty about your gender identity, and it's causing you distress, it's important to talk to an adult you can trust.
Options include your parents, who may be much more supportive than you expect.
Schools and colleges are now much more aware of trans and gender identity issues, are keen to support young people, and have a duty to do so.
If you don't feel able to talk to someone you already know, there are several charities and local gender support groups you can talk to. Many have trained counsellors you can speak to in confidence.
You can find charities and support groups on the Tranzwiki page on the Gender Identity Research & Education website.
What help is available on the NHS?
If you have strong and continuing feelings of identifying as a gender that is not the one you were assigned at birth, and are distressed about this, there are various options available.
These include talking therapy, hormone treatment (if approved by a court order for under-16s) and, after 18 years of age, surgery if appropriate.
Your GP, other health professional, school or a gender support group may refer you to the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust.
This NHS service specialises in helping young people up to the age of 18 with gender identity issues. It takes referrals from anywhere in England. Its principal clinics are in London and Leeds.
What can I expect from the service?
The team at GIDS considers the individual needs of each young person, including their age and their stage of development.
The GIDS will support you, involving your family as appropriate, your school and any other agencies that may be involved.
All sessions are confidential and information about you will only be shared with your consent (unless there is a concern that you are at serious risk of harm).
The first stage is an assessment, which will usually involve between 3 to 6 appointments over a period of time (usually up to 6 months).
You will have a named key worker who will co-ordinate your care. One or two members of the clinical team will oversee your assessment, such as a clinical psychologist, child psychotherapist, child and adolescent psychiatrist, family therapist or social worker.
The assessment is wide-ranging and will explore your past and current gender identity, your relationships with family and friends, your emotional and psychological wellbeing, your physical health and whether you have any other significant issues.
For more serious emotional issues, the GIDS team may refer you to your local child and young people's mental health service if you are not already in touch with them, where mental health specialists will support you.
After you have been assessed by the GIDS, you and your family will be offered support for as long as you need it (up to the age of 18). You may find that this support is enough to help you live in the gender or non-binary role with which you identify.
If you have lasting signs of gender dysphoria and you meet strict criteria, you may be referred to a hormone specialist (consultant endocrinologist) to see if you can take hormone blockers as you reach puberty. This is in addition to psychological support.
Little is known about the long-term side effects of hormone or puberty blockers in children and young people with gender dysphoria.
Although GIDS advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be.
GIDS needs to apply to the court for permission to start puberty blockers for children and young people under the age of 16.
This is because a recent court ruling states that it's doubtful children and young people under the age of 16 are able to give informed consent for this treatment.
The court will be asked to consider in each case whether hormone treatment is in the best interests of the young person.
Different arrangements apply for young people aged 16 and 17, as the law presumes they are able to give informed consent.
In these cases, an application to the court will only be necessary if there is any doubt about the young person's capacity to give consent or disagreement about the best interests of the young person.
Although you may feel you are too young to think about having children later in life, it's important that you consider your future fertility and other possible effects on your body before choosing to move on to gender-affirming hormones.
The GIDS team will help you to consider your options and recommend you seek further specialist advice via your GP regarding gamete storage. This is the harvesting and storing of eggs or sperm for your future use.
Gamete storage is sometimes available on the NHS.
Through the help and support of the GIDS, many young people become at ease with how they express their gender identity, whether that is trans male or trans female, non-binary, assigned male or female, or another gender variation.
Once you are aged 17 years, you can ask for a referral to NHS adult gender identity services if you wish to explore your gender identity further.
NHS England review of gender identity services
NHS England has commissioned an independent review of gender identity services for children and young people. The review will advise on any changes needed to the service specifications for children and young people in 2021.
Page last reviewed: 4 June 2018
Next review due: 4 June 2021