Children as young as 12 are to be allowed drugs to block puberty while they decide whether to have a sex change, it has been revealed.
By Richard Alleyne
The monthly injection suspends the onset of adulthood so that young people confused about their gender can be sure of any decision before they take on too many masculine or feminine features.
Supporters say that the "window" prevents a great deal of mental and physical anguish caused by the maturing of sex organs, facial hair growth and changes in the voice.
But critics argue it only prolongs the agony and can prevent people "growing out" of any feelings of confusion.
The treatment can be prescribed for people diagnosed with Gender Identity Disorder (GID) – a rare psychiatric condition where a person is born one sex, but feels they are the other.
One of the main effects of the drugs is to stunt the development of sexual organs so less surgery will be required if someone chooses to permanently change their gender at a later date.
However, bodily and hormonal changes will continue as normal if the medication is stopped.
Until this month, British doctors were prevented from offering youngsters diagnosed with gender issues any medical intervention before the late stages of puberty usually at 16.
But now the National Research Ethics Service has given approval to the UK's only specialist clinic for GID – the Tavistock and Portman NHS Trust in London – to prescribe the drugs to youngsters from 12 years old.
Dr Polly Carmichael, the clinic director, said the reduction in the age limit will be welcomed by families who would have otherwise had to travel abroad to the US for the treatment.
"The majority of our referrals are 15-plus and we get fewer from a younger age group," she said.
"Certainly, of the children between 12 and 14, there's a number who are keen to take part.
"I know what's been very hard for their families is knowing that there's something available but it's not available here.
"This delay gives us a window to explore together that they are definitely making the right decision But as professionals we need to be looking at the long term and making sure this treatment is safe."
The hormone blockers, which are already used for early onset puberty, will only be given to around a dozen children and teenagers selected for an NHS research project jointly run by the clinic and University College London Hospital.
To take part, they will have to meet strict eligibility criteria including having full support from their parents, the existence of long-standing gender identity issues, an ability by the child to give formal consent and an absence of other mental health problems.
Those chosen will go through a series of psychological and medical assessments before receiving the blockers.
As a result, they will stop producing the hormones which tell the sex glands to make oestrogen or testosterone.
Boys will be prevented from developing male traits such as facial hair, deeper voices and Adam's apples and girls will not develop breasts or menstruate.
But Dr Carmichael said that only around 10 to 20 per cent of prepubescent children with GID went onto have a sex change.
Around 80 per cent in late puberty were likely to have the operation.
The Tavistock and Portman clinic is currently the only place in Britain where under-18s with GID and their relatives can access specialist psychotherapy.
The 22-year-old service, which received 127 GID referrals this year, helps families avoid common traps such the temptation to keep their child's condition secret.
Case study: 'My six year-old son demanded a sex change'
At nursery, she shunned boys' games and preferred to play with the girls.
By four, Nicki was telling her mother Sharon, an IT manager, that "God made a mistake by making me a boy".
Two years later, she was already asking for a sex change operation.
It was at this point that Sharon, now 42, decided to attend the Gender Identity Development (GID) service at the Tavistock and Portman mental health trust in North London.
Shortly after, Sharon also decided it was time to allow Nicki to attend primary school in female clothes.
"By this time, Nicki was telling everyone she had a girl brain in a boy body," said Sharon.
"She got quite a lot of stick because she was going to school as a boy and saying she was a girl.
"So, at eight, we made the decision not to let her do that.
"I let her grow her hair and she got a blouse and a skirt. She didn't have to wear boys' clothes at all anymore.
"As soon as I did that she was so much happier and the other kids understood it because she looked like a girl now."
But matters took a turn for the worse when Nicki moved on to secondary school, where she became suicidal because of bullying.
"She took four overdoses," said Sharon, from Yorkshire.
"For a year and a half she was spat at, kicked, punched, pushed over.
"One day, when she was walking home from school a group of boys surrounded her and tried to pull her skirt down."
"When she first got to the school, one boy announced 'So where is the tranny?' It was awful."
With the abuse expected to get worse as Nicki got closer to puberty, her mother began to look into the possibility of her daughter being prescribed hormone blockers.
She went back to the Tavistock clinic but was told they were unable to prescribe the treatment because it was against their guidelines to do any interventions before 16.
Fearing that her daughter may take her own life if forced to go through puberty, she went to an American expert Dr Norman Spack in Boston.
To her relief, Dr Spack, who runs a Gender Identity Disorder clinic in Boston, agreed to prescribe the 13-year-old Nicki the blockers.
Now 17, she has had a sex change operation and works as a care assistant.
"She holds down a full time and has been with her boyfriend for 18 months and she is gorgeous," said Sharon.
"I am absolutely positive she would not be here without the treatment."