A person’s gender identity is their personal experience of who they are, as being female, male, neither or a combination of both. Some people’s gender identity matches with the gender they were presumed to be when they were born. Some people’s gender identity is different from their presumed gender at birth, and this can be described as gender diversity. This includes, but is not limited to, transgender and non-binary gender identities. About two to three per cent of Australian high school students identify as gender diverse. Being transgender or gender diverse is part of the natural spectrum of human diversity.

For some trans and gender diverse people, the difference between their gender identity and their gender presumed at birth can cause significant and persistent emotional distress. This is called gender dysphoria. Gender dysphoria can be supported with gender affirming health care, which is health care that affirms and supports a person to live in a way that is authentic to them. 

Terminology

Gender or gender identity: a personal sense of having a particular gender. This is a deeply felt, internal and individual experience.

Gender expression: how a person expresses their gender identity, often through clothing, hairstyle choices and behaviour.

Trans or transgender: a person’s gender identity is different from the gender presumed for them at birth

Cis or cisgender: a person’s gender identity is the same as the gender presumed for them at birth

Non-binary: a person’s gender identity is not entirely female or male

There are many other terms people use to describe their gender. Respecting and using the term chosen by each individual is important.  

Gender identity and gender dysphoria

Many children become aware of their gender identity around three to four years old, whether it is aligned with what people expect, or not. It is very common for children to explore different clothing styles and types of play, and this does not mean they are transgender. Young children can also find words to describe their gender and may report being of a particular gender, wanting to be called a boy or girl, or wanting particular pronouns to be used (e.g. he/him, she/her, they/them). It is appropriate and safe to support your child's choices at this time.

Some children think more about their gender when they are older, particularly during puberty. Adolescents commonly explore different gender roles, many will do this and remain comfortable with their gender presumed at birth and cis identity.  Some adolescents will identify as transgender or gender diverse, have no associated distress, and they may not want or need medical support.

For others, living according to the gender presumed for them at birth is distressing. This is called gender dysphoria. It’s important to discuss with your child or teenager how best to support them. This may involve finding some peer support, family/parent support or seeing a health professional.

Mental health

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

• In younger children, this is often in the form of anxiety, or challenging behaviours.
• For adolescents, there are higher rates of depression, anxiety, disordered eating, self-harm and suicide attempts.

A supportive family and school environment that affirms a child’s gender identity has been shown to be associated with better 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 adolescent has been showing ongoing distress about their gender, visiting your GP is a good first step in seeking professional help.

The Royal Children’s Hospital Gender Service (RCHGS) will see children and adolescents, who live in Victoria, and are younger than 16 years, at the time of referral. You will need an RCH GS referral from your GP.  Other services that also provide gender affirming healthcare in Victoria include Monash Health Gender Clinic (for those 16 years and over), Orygen TGD Health Service, and some private psychologists and General Practitioners. In other states, talk to your GP about what services are available. See RCH GS webpage for further details and links to services.

The RCH Gender Service team includes psychiatrists, psychologists, paediatricians, nurses, speech pathologists and other clinicians who specialise in supporting gender diverse children and adolescents. The RCH Gender Service spends time supporting the young person and their parent or caregivers.  Each young person’s support needs are different, some people will only want a few appointments and some people will have support for many years. Adolescents spend time with the health professionals on their own and together with their parent or caregiver.

Support options

Gender affirming care means supporting a person to feel safe and well in their identified gender. Gender affirming care looks different for every person. Some young people may want support to wear different clothes or use a different name or pronouns. This support can be provided by family, peers, or a professional, such as a psychologist or school counsellor. Some young people need regular mental health support. For some adolescents, medicine, or medical affirmation, is an important part of their healthcare.

Medical support options

For some young people, medical treatments may play a role in their gender affirmation.

Once puberty has started, support options include the use of pubertal suppression (puberty blockers) to pause the physical changes of puberty that the child is finding distressing. Puberty blockers can be used from early to mid-puberty. Puberty blockers ‘pause’ puberty, and this is reversible.

Gender-affirming hormones (oestrogen or testosterone) can be used to change the body to be more aligned with the young person’s affirmed gender. Depending on the individual circumstances, this treatment can usually be started from mid to late adolescence.

Other support options for young people include voice therapy, hair removal, menstrual management and safe binding practices.  Gender affirming surgery is not commonly undertaken before adulthood. The RCH Gender Service does not provide gender-affirming surgery.

Change or suppression practices

Treatment focused on changing someone’s gender expression and/or gender identity to match the gender presumed at birth (known as conversion or reparative practices) causes harm to that person. Conversion practices are unethical and illegal in Victoria.

Key points to remember

• Trans, or transgender is a term that can be used to describe someone whose gender identity differs from the gender presumed at birth
• Gender dysphoria is the distress experienced by a person when their gender identity does not align or match with their gender presumed at birth
• Gender affirming care can take many forms and is always tailored to the individual and their family.
  

For more information

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

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

Reviewed June 2024.

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