Outcomes and Predictors of Outcome for Children and Young People Referred to UK Gender Identity Development Services: A longitudinal Investigation

What is the background to this research? Emerging data from several countries suggests that gender diversity in children and young people (CYP) is more common than previously thought (1.2% to 2.7%). This is reflected in the significant increase in referrals reported in gender clinics across a number of countries, including in the UK. While not all gender-diverse CYP will experience gender dysphoria (that is, the distress associated with a mismatch between the sex assigned at birth and gender identity) a significant proportion do. The available evidence suggests that gender dysphoria is further associated with a range of negative mental and physical health outcomes, including depression, anxiety, suicidality and substance abuse. Current treatment in the NHS for CYP experiencing ‘Gender dysphoria’ is aimed at alleviating dysphoric feelings and improving psychological wellbeing. However, the evidence base on which the current treatment protocols are based is widely acknowledged to be both limited and shifting. A particular gap in the evidence, both in the UK and internationally, relates to children/younger adolescents presenting to services for which there is minimal research evidence to inform questions regarding likely trajectories and outcomes particularly in the context of: a) physical treatments (e.g. hormone blockers to suppress the onset of puberty); b) social transition (where a child presents to other people as their experienced gender e.g. using preferred gender pronouns) and; c) co-occurring ASD. What are we aiming to do? We aim to understand the key issues children, young people and their families face when accessing GID services. We wish to understand more about the factors that lead some children to experience ongoing distress about their gender development while for others their distress subsides over time. We are also interested in the factors that influence whether a young person will choose to have medical treatment with hormone blockers to pause puberty or not. This is an important question for the NHS as most young people who opt for hormone blocking treatment to suppress puberty will later choose to have further treatment with hormones to enable them to transition to their preferred gender. We are particularly keen to know more about how the decisions young people and their families make later affect their quality of life, physical health and psychological wellbeing. How are we going to do it? We are going to speak to experts in the UK and abroad as well as searching the research literature in order to select the best tools and measures to use in a study that will follow children, young people and their families over time. As part of this study we will also speak to young people and their families about their experiences and the outcomes that matter to them and how this may or may not change over time. We will also look at the outcomes and costs for young people who have used NHS and Dutch services in the past to examine whether there is anything we can learn from this. What are the benefits of doing this research? The UK GID service for children and young people is the largest such service in the world and this study will be the largest study of its kind to date. We anticipate that there will be great interest in the findings in the UK and elsewhere and that the study will generate much needed evidence about outcomes for young people and their families and thereby enable services to provide better, more individualized care.