Growing up transgender: ‘I wish I could have come out younger’

Growing up is tough enough for any young person approaching puberty. But for Aimee Challenor the challenges she faced as a 10-year-old were much harder: “It struck me when I was about 10 or 11 that I was a girl. I couldn’t put my finger on it but something wasn’t right. I was in year 6 and I left my parents a letter on their bed before I went to school one morning. When we talked about it later they were very supportive, but no one knew what trans was. So I went back into the closet.”

During the next six years Challenor, now 19, felt anxious, isolated, lonely and depressed. “I spent my time at secondary school feeling pressured by society to be somebody that I was not. I wasn’t able to be myself; there was always that nagging feeling at the back of my head, so I didn’t take opportunities and grab them. I didn’t reach my potential and my education suffered as a result.”

It wasn’t until her school graduation prom that she decided to come out as trans: “It was then that articles about trans started to appear and I discovered that there was a word for it. I found the trans guide published by the Tavistock and Portman NHS foundation trust and decided to come out at my prom – it was the day before I was due to leave school.”

Her mum helped her with her dress and one of her school’s teachers did her makeup on the night: “Some of the staff were very supportive, but they were not in the school leadership team. Generally, I didn’t get any support from my school – it wasn’t up to speed on the Equality Act and they wouldn’t let me wear a dress to the prom because they thought it was unnecessary attention seeking; they said it made the school look stupid. But I dug my heels in. I was incredibly nervous on the night, but it felt so positive – for me it reinforced what was right.”

Challenor is in the process of transitioning from male to female but feels “in limbo” as she waits to continue adult gender identity services: “I’ve been out now for three years and publicly present as female, but I wish I could have come out younger and not have had to wait until I completed puberty.”

Today Challenor speaks on LGBTIQ (lesbian, gay, bisexual, transgender, intersex and questioning) issues for the Green Party in England and Wales and also contributed to charity Stonewall’s Vision for Change report, published in April, which spells out what still needs to be done to deliver equality for the UK’s trans community. Challenor says: “I speak to schools about trans issues and I am the first openly trans person to work for a political party. I think trans [people] need to show that you can be trans and reach your potential.”

Growing up transgender: ‘I wish I could have come out younger’

How defunding Planned Parenthood could wipe out transgender healthcare

Calvin Kasulke was living with his parents when he came out to them as a transgender man. All of a sudden, he recalled gingerly, “I was disinvited from living at home.”

He needed a new place to stay. And Ithaca, New York, where he had gone to college, was the obvious choice. He would have friends there, he figured, and a place to live.

“And also,” he said, “Planned Parenthood was there.”

Unbeknown to many, Planned Parenthood is one of the largest sources in the US of transgender healthcare. The embattled provider offers hormone replacement therapy, which helps a person’s body appear more masculine or feminine, at dozens of its locations, and a growing share of its staff are trained to perform routine sexual health exams for trans patients.

“They are one of the most important providers of trans healthcare in the country,” said Harper Jean Tobin, the director of policy for the National Center for Transgender Equality, adding that their clinics are some of the few transgender healthcare providers located outside major cities. “Many of their clinics are the only places for miles around that trans people can go to for hormone therapy, HIV tests, and pap smears, and not face discrimination.”

With Congress on the brink of attempting to defund Planned Parenthood because of its role as an abortion provider, those services could easily be caught in the crossfire. Each year, Planned Parenthood is reimbursed hundreds of millions of dollars for family planning services it provides at little or no cost to low-income Americans. If Congress were to freeze Planned Parenthood out of those funding streams, it could force an unknown number of health centers to close. Health providers have long warned that this would have a detrimental impact on women’s health. But, Tobin said, the cuts could be particularly “disastrous” for trans people.

“As it is getting more real, in the back of my head I said, ‘Oh shit. What am I going to do now?’” said Raven Green, a patient of Planned Parenthood of the Southern Finger Lakes. “I don’t know where else I would go.”

The state of transgender healthcare in the US is already a fragile one. In one survey after another, large numbers of transgender people report difficulty accessing both basic and specialized services because of biased providers or the distance to the nearest provider with adequate knowledge of trans health issues. Only about two-thirds of trans people who want hormone replacement therapy, a common treatment during gender transition, have actually received it, according to a major survey of transgender adults taken in 2015, and 23% have avoided getting essential care out of fear of harassment. Thirty-three percent have had a negative experience with a healthcare provider, like needing to teach their doctor the fundamentals of transgender care. And 29% reported having to travel at least 25 miles for transition-related care.

The result is that thousands go without care every year.

“Everything is stacked against trans people” in the healthcare system, said Casulke, who now volunteers with Planned Parenthood part-time. “There’s always an extra layer of, am I going to have to educate my own provider? Is it safe to come out to this person? You’re having to advocate for yourself in a really vulnerable situation.”

Planned Parenthood in recent years has sought to address that problem. And it has made its clinics a magnet for thousands with few other options. Starting with Planned Parenthood of the Southern Finger Lakes, in upstate New York, a growing number of its health centers have become places where trans people can begin to transition medically, as well as get basic reproductive services. Its centers use a newer model for gender transitioning that gives the patient input on whether to start their transition, rather than turning the decision over entirely to a psychiatrist. Some clinics have staff with detailed knowledge of how to update driver’s licenses, passports and social security cards to reflect someone’s name and gender.

“It’s this little oasis in the middle of nowhere,” said Luca Maurer, the program director for Ithaca College’s LGBT center. His center has a partnership with Planned Parenthood. Previously, he said, many trans students and locals would drive to Manhattan or Philadelphia, at least four hours each way, for prescriptions and the routine checkups that accompany gender transition. A handful even crossed the Canadian border for treatment in Toronto.

Luca Maurer, the program directors for Ithaca College’s LGBT center, which partners with Planned Parenthood. Photograph: Jenn Foy Photography

“If I didn’t have them available to me, I’m not sure what I would do,” said Maurer, who is trans. “It would be a crisis. And I’m saying this as a person whose job it is to help others navigate healthcare systems.”

Upstate New York is a microcosm of the hurdles facing transgender people when it comes to medical care. In 2015, LGBT healthcare providers surveyed local trans people and learned that 57% had run into barriers because there were not enough providers trained to address their needs. A full quarter had been turned away by one of their doctors. Without the Planned Parenthood in Ithaca, there would be limited places for several hundred trans patients to turn. The only local endocrinologist, who specializes in hormonal therapy, is not able to absorb so many new patients. And a local primary care doctor who offers transgender care is near capacity.

The need is not limited to transgender-specific care. Doctors and other healthcare providers frequently refuse to treat trans people for conditions having nothing to do with their gender identity – what trans rights activists have sardonically termed “trans broken arm syndrome”.

In Florida, where Planned Parenthood recently began to offer transgender care at about a dozen of its health centers, some of the group’s physicians are offering trans patients basic treatments for diabetes, high blood pressure and the common cold.

Gina Duncan, an advocate with Equality Florida, said Planned Parenthood’s affiliates in Florida have been instrumental in pushing other providers to acquire the knowledge to care for trans patients. “Where Planned Parenthood has filled such a huge gap, is it’s a known, reliable, quality source for healthcare,” Duncan said.

In that region, too, Planned Parenthood is the major provider to trans people of hormone replacement therapy and general care.

Dinah, a trans woman who did not want her real name printed, used to drive 120 miles round-trip every time she needed basic blood work before the Planned Parenthood in her city began to offer hormone therapy.

“We have patients who are grateful that they only have to drive two hours,” said Dr Suzie Prabhakaran, the vice-president of medical services for Planned Parenthood of south-west and central Florida. The 11 health centers Prabhakaran oversees began offering hormone replacement therapy in October and are now treating 80 patients and counting. Four out of every five are starting hormone therapy for the first time.

As Planned Parenthood comes under fire, the prospect of possibly losing those services is throwing patients into turmoil.

Dinah says the care she has received at Planned Parenthood has been lifesaving. Recently, she worked up the courage to schedule her first physical in years. It was her first such exam since her transition, and during the breast cancer screening, she began to cry.

“It’s another thing that makes it real,” she said. “It meant that I’m a woman and I have to be treated like one.”

How defunding Planned Parenthood could wipe out transgender healthcare

I"m transgender: why does the WHO say I have a mental disorder?

It was in November 28 years ago when I saw a psychiatrist for the first time. I was 17. The school year was just finishing and I lived in Córdoba, Argentina, with my father and siblings. I had the same friends from kindergarten to high school. I knew their families, they knew mine; all of them had come to visit when my mother died, all of them were there when I held a party and kissed my first boy. All of them believed that I was crazy. After the first meeting with the psychiatrist, she prescribed me anti-psychotic medication – I was officially crazy.

But the doctors had other words for it: I had a gender identity disorder, that is to say, a serious mental health disorder.

I had been assigned female at birth but identified as a guy. Even worse, I identified as a guy sexually attracted to other guys. For the psychiatrist, my father and for many people around me, it was a disorder. For me, it was what it is today: just the person I am.

People like me, who identify as a different gender from the sex assigned to them at birth, have been historically pathologised, classified as people with mental disorders. In 1990 the World Health Organisation (WHO) started using the 10th version of the International Classification of Diseases (ICD), which include so-called “Gender Identity Disorders” in its chapter five on Mental and Behavioural Disorders.

Almost two decades later, the WHO is performing a comprehensive ICD revision, and a new version (ICD-11) is expected to be approved by the World Health Assembly in 2018.

Many trans activists from all over the world have been monitoring the ICD revision and reform process since the beginning – as we did around the reform of the Diagnostics and Statistical Manual on Mental Disorders, produced by the American Psychiatric Association. For us, the ICD process represents a historic opportunity to achieve trans depathologisation while ensuring full access to fundamental rights: legal gender recognition, access to gender affirming healthcare, and coverage under public and private healthcare systems.

To treat trans people as psychologically abnormal suggests that just being ourselves is a disorder. In many countries it also means that someone else – a psychiatrist, a psychologist, a therapist – needs to provide a specific diagnosis for us to have access to those key but basic rights: identity, freedom of expression, bodily integrity, autonomy and healthcare.

Currently, trans people rely on someone else’s authority to be recognised by the state with our name and gender, and to take informed decisions about our own bodies. This means that we are subjected to human rights violations, justified by the legal interpretation of those diagnostic categories pathologizing us, including those of gender identity disorder, gender dysphoria and transsexualism.

Different countries require trans people to be sterilised to apply for legal gender recognition, including 23 countries in Europe, while 22 European countries require trans people to divorce. In many places trans people, including children and teenagers, are subjected to “conversion” therapies – pseudo-scientific therapies to change their gender identity and gender expression.

Others, like me when I was a teenager, get treated with anxiety and anti-psychotic medication.

Despite these human rights violations, and the damaging ICD classification, the number of countries that respect trans people’s rights is growing. My own country, Argentina, is the first – and, so far, the only one – to grant access to legal gender recognition, gender-affirming healthcare and its coverage based on the human right to identity. Other countries, such as Malta, Mexico, the Netherlands, Bolivia, Sweden, Norway and Denmark are making advances in getting rid of requirements incompatible with human rights standards – to recognise trans people’s human rights.

Last year, Denmark announced it would no longer define being transgender as a mental illness, making it the first country to do so; and this year Sweden said it would do the same. A 2016 study found transgender identity should no longer be classified as a mental disorder, citing that the distress experienced by trans people was primarily a result of social rejection and violence, not the result of being transgender.

The world is undoubtedly changing. And how diseases are classified in changing as well.

In 2012 WHO announced the intention of removing all trans-related diagnoses from the chapter on mental health in ICD-11 – and to include a new category, called Gender Incongruence, in a different, non pathologising, chapter.

The proposed category will be divided into Gender Incongruence of Adolescence and Adulthood (GIAA) and Gender Incongruence of Childhood (GIC). GIAA is being critically accepted by many of the trans community as a far from perfect compromise to depathologise trans while ensuring access to fundamental rights.

Conversely, GIC is strongly rejected. Being a diagnosis to be only applied to children before puberty, it pathologises gender diversity in childhood. Trans and gender diverse children, and all children exploring their gender identity and expression as well as their sexualities, need love, acceptance, information and support – and no diagnosis is necessary to meet those needs. Access to hormonal blockers in puberty must be granted without depending on pathologising children because of who they are.

The completion of the ICD process in 2018 will hopefully bring good news for trans people around the world – but even the best possible ICD-11 version won’t be enough to change everything by itself. Legal pathologisation needs to continue to advance, to transform the rights landscape we are surviving in for good. Trans access to healthcare (including general healthcare) still needs to become a reality in too many places. And there is something else: achieving depathologisation will also open the way to justice. By struggling to put an end to human rights violations grounded on pathologisation, we are craving the time and place to talk about their victims’ human right to adequate reparations.

Mauro Cabral Grinspan is the executive director of Global Action for Trans Equality.

From 20–25 February the Guardian Global Development Professionals Network is highlighting the work of the LGBT rights activists throughout the world with our LGBT change series. Nominate LGBT heroes here, join the conversation at #LGBTChange and email globaldevpros@theguardian.com to pitch an idea.

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.

I"m transgender: why does the WHO say I have a mental disorder?

Risk of poverty and suicide far higher among transgender people, survey finds

Transgender people are substantially more likely to have attempted suicide, to be unemployed, and to be living in poverty than the broader US population, according to a landmark new survey by the National Center for Transgender Equality (NCTE).

The survey of more than 28,000 trans individuals by the Washington DC-based advocacy organization suggests that along with a battery of health and economic indicators, transgender people face persistent discrimination and a litany of other challenges.

“Responses revealed pervasive mistreatment, harassment and violence in pretty much every facet of life whether that be in the schools, the workplace or family life,” said survey project manager Sandy E James.

The results on mental health were of particular concern. Thirty-nine percent of respondents said they had experienced “serious psychological distress” in the past year, compared with 5% of Americans.

Forty percent of those surveyed said they had attempted suicide in their life, almost nine times the US overall attempted suicide rate. Seven percent said they had made an attempt within the last year, more than 10 times the national prevalence.

“We have already known that these are issues … in the trans community but now we actually have a tool that we can reference to [say] these are the numbers,” said NCTE executive director Mara Keisling. “That can be a useful instrument for creating transformative change in the lives of transgender people.”

Nearly one third of respondents said they were living in poverty, about twice the rate of Americans nationwide. Respondents also reported an unemployment rate of 15%, three times higher than than the national rate. Trans people of color were the most likely to experience high rates of unemployment. Researchers said they intentionally shaped survey questions to be comparable to survey data regarding the broader US public.

A quarter of those employed over the last year said they had experienced discrimination in the workplace, and more than three quarters of those who were “out” or perceived as transgender during school recall experiencing “some form of mistreatment”, including sexual assault and verbal and physical harassment.

James said NCTE plans to repeat the effort every five years to keep tabs on the challenges that transgender individuals face over time. The study released this week is the second such report, following a less expansive effort in 2011.

This year’s study also looked at what could be considered the most visible aspect of the battle for trans rights in the US today, public restroom accommodations. Legislation like North Carolina’s HB2, which restricts individuals to using only the bathroom reflective of the biological sex listed on their birth certificate, has turned the issue into a flashpoint for transgender rights.

The most visible recent debate over transgender rights has surrounded North Carolina’s so-called ‘bathroom battle’. Photograph: Mandel Ngan/AFP/Getty Images

“I can speak first hand for how critical [it is] for transgender people to have safe and private bathroom access just like everyone else”, said Sharron Cooks, a trans woman and activist. Cooks added that when she was in high school, she was banned from the women’s room, calling the experience “crushing”.

“It made it impossible to learn and it severely delayed my academic career,” Cooks said.

The study found that Cook’s experience is far from unique. More than half of survey respondents said they had avoided using a public restroom in the past year because they “were afraid of confrontations or other problems they might experience”. 32% said they had limited the amount they ate or drank in the previous year specifically to avoid using the bathroom.

But Keisling cautioned that while the bathroom issue is important, “we have a lot of issues … that are missed when all we talk about is bathrooms.”

Keisling added: “Every minute we spend talking about it, we’re not talking the problems in real people’s lives. We’re not talking about the economic marginalization and we’re not talking about people being alienated from their faith communities and families.”

Risk of poverty and suicide far higher among transgender people, survey finds

UK nurses lacking skills to treat transgender patients, says research

UK nurses are failing to meet the needs of transgender patients and feel they lack training and experience to treat the growing number of trans people seeking medical treatment in relation to their gender identity, according to research.

A survey of more than 1,200 nursing staff across the UK found 87% of those nurses who have directly cared for a trans patient felt unprepared to meet the patient’s needs.

The survey, which was conducted by the Royal College of Nursing, also found that 76% have encountered trans people during their healthcare work and 56% had cared for trans people directly.

Just one-fifth of all nurses surveyed said they thought the nursing workforce had the skills to care for trans adults and children, while 76% said more training for all healthcare staff was needed.

The survey comes after the Guardian revealed there has been a steep increase in the number of trans people referred to all 14 gender identity clinics around the country, with a number of clinics experiencing increases of several hundred per cent.

Referrals to adult clinics

The Guardian found that healthcare options for trans people at specialist gender identity clinics were inadequate, with an average waiting time of nine months for a first appointment for adults and some patients waiting up to four years for a first appointment.

Trans people also reported they often encounter medical staff who did not know how to engage with them, such as GPs having laughed at them when they said they wanted to transition, having their feelings dismissed as “just going through a phase”and being repeatedly misgendered – referred to by their birth sex, not the sex they identify with.

Kirsty Cass, a trans woman who has worked as a nurse for the last two years, says she has encountered prejudice and misunderstanding from healthcare professionals, most of which involved her being misgendered.

In one instance, several years after she had undergone gender reassignment surgery, she went to her local hospital for a biopsy on a lump on her ear. After the procedure, the porters wheeled her to a male ward and tried to make her stay there.

“To say I was upset was an understatement,” said Cass. “I was inconsolable, I was sobbing my heart out.”

Much of the problem, she added, had to do with a lack of training of medical staff, some thing was that was also identified as a point of concern by nurses in the RCN survey. Just 1% of respondents said their pre-registration training dealt with the treatment of trans patients and 78% said they had no training on the subject.

Tavistock clinic referrals

Louie Stafford, the trans programme coordinator for the LGBT Foundation, said he was unsurprised by the survey results.

“Gender identity issues are considered a speciality field, so unless you’re practising in that field, it’s unlikely you’ll have any training or any guidance. It’s great that the RCN are trying to shine a light on this from the medical perspective, there’s an urgency for academic medical institutions to consider the curriculum and the content that they’re teaching and put some awareness training in there.”

Wendy Irwin, RCN diversity and equalities coordinator, said the college was pushing for training regarding the treatment of trans people to become a mandatory part of pre-registration nursing training as well as part of continuing professional development.

“I think nurses are increasingly aware of the gap in their knowledge,” she said. “All nurses have a deep and personal desire to deliver the absolutely best care for all their patients, what they’re looking for is how to do that.”

UK nurses lacking skills to treat transgender patients, says research

Doctors lack experience and expertise in treating transgender patients, study says

Doctors and therapists are struggling to give transgender patients the best medical care because of a lack of expertise and experience, according to a new study from Appalachian State University in North Carolina.

The study, published this month in Sage, examined interviews with healthcare workers around the country, finding that medical providers are facing “vast amounts” of uncertainty when treating trans patients. Current guidelines carry little scientific evidence to show they work, writes the author, and the medical community’s narrow definition of what it means to be trans only exacerbates the issue.

“My research begins by asking what happens when there is no scientific evidence and little clinical experience to base medical decisions,” said the report’s author stef shuster (whose legal name is written in lowercase letters), an assistant professor of sociology at Appalachian State University. “This particular feature of trans medicine introduces the potential for providers to bring bias or limited knowledge into their work with trans people.”

Transgender is the umbrella term used to describe people who don’t identify with their biological, or so-called “assigned” sex. According to the American Psychological Association, a person who is trans has an “internal sense” of being a man or a woman, or something outside of these categories.

Often, trans people will seek to change their physical appearance and biology to resemble the identified gender, known as sex or gender reassignment surgery. It’s not a straightforward process, and generally requires multiple meetings with both doctors and therapists. Transgender medicine covers both physical care, such as estrogen or testosterone hormone therapy, as well as mental healthcare, to help a trans person transition both physically and socially.

When determining whether a person is a candidate for medical treatment, doctors, therapists and other health professionals typically use a set of clinical guidelines created by the World Professional Association for Transgender Health (WPATH), a nonprofit that promotes transgender healthcare. The guidelines lay out a series of steps, starting with one or more visits with a therapist, who decides whether sex reassignment surgery is the correct course of treatment.

If the therapist concludes that the person is indeed transgender, the trans person is sent to a doctor to receive treatment such as hormone therapy or surgery, including reshaping the breasts or the genitals to resemble the identified gender.

The process has many challenges, according to the study. The fact that a trans person’s fate is placed entirely in a therapist’s hands is morally questionable and controversial, writes shuster. Transgender medicine has also been built around the idea that to transition means to switch from male to female or vice versa. But that’s changing, shuster says.

“More recently, trans people’s understandings of their selves and bodies have become more fluid, and ‘cross’-gender transitioning is not always the ultimate goal,” writes shuster, who asked to be identified with the pronoun “they” rather than “he” or “she”. “The nuance in gender identification that trans people bring to the clinic exacerbates providers’ uncertainty.”

The study interviewed 23 doctors and psychologists who have chosen to work in transgender medicine. Many had entered the field because they personally knew someone who had trouble finding a provider to treat them. Only two of the participants worked exclusively with trans people, while just one identified as transgender.

According to the study, uncertainty about how best to treat a trans patient was something that was regularly experienced by all of the respondents. To cope with this uncertainty, providers used current guidelines to help inform their decisions.

The study found that some providers closely followed guidelines, while others were more flexible and interpreted them on a case-by-case basis.

Those new to the profession and those with a decade or more experience tended to be more rigid, expecting trans people to be “100% certain” about their desire to undergo sex reassignment surgery. One reason for this, writes shuster, is that more experienced providers may be slower to accept changing notions of what it means to be trans, while those new to their profession lacked the experience to confidently chart their own course.

One respondent named Sarah, a therapist in private practice, said she closely followed guidelines to ensure a patient didn’t come to regret their decision to transition later on.

“I can’t have you wake up on a surgeon’s table and say, ‘Who are you and what are you doing to my body?’ That has happened,” she said. “So I am really good about wanting to be holistic with people, and saying, please just let me be your therapist.”

This absolute power to decide the course of another person’s future made some of the participants uncomfortable. Alexis, a social worker, said although she has refused to okay some people for sex reassignment surgery, the double standards in transgender medicine versus other areas of medicine doesn’t always sit right with her.

“It is a tough function to fulfill,” Alexis said. “In all other areas of mental health practice, I don’t really have to give permission to people to do things.”

The idea that a trans person has to be absolutely certain about their desire to transition doesn’t take into account the complicated and oftentimes changing nature of gender identity, writes shuster. For instance, some people might start hormone therapy but decide months later that the treatment isn’t right for them.

“Trans people are allowed little room to explore their identities on their own terms,” writes shuster.

It also gets more complicated when people identify as “gender fluid” rather than explicitly male or female. One participant, Brandon, a psychologist at a university clinic, said it’s much easier for a therapist to make a decision when the boundaries are clear and a person wants to transition from male to female or vice versa.

“In the land of non-binary gender folks, you have to wade through waves and waves of ambiguity,” he said. “You have to build way more of a relationship with the person and establish a whole lot more trust.”

Respondents that took a more flexible approach to the guidelines said they weighed up what was more harmful: to treat someone even when it isn’t clear they are ready for medical treatment, or to not treat someone at all.

“It seems far less harmful to give someone hormones long term and take some risk that it might kill them, where maybe before they were suicidal,” said Anna, a family practitioner at a community clinic. “It is not for me to say to any given person, ‘Well you are not quite suicidal so I don’t think it is worth the risk.’”

Shuster describes gender as a “socially-ascribed category” that cannot be simplified or standardized. More research is needed in the area of transgender medicine, shuster says, especially from the perspective of the medical community. Shuster also urges doctors and therapists to be less dogmatic and allow trans patients to have more ownership in the process.

“From a trans patient perspective, healthcare encounters might feel easier to negotiate if providers stopped emphasizing this narrow definition of ‘transgender’,” shuster says. “And opened up more dialogue for their trans patients to describe how they understand their own identities and bodies.”

Doctors lack experience and expertise in treating transgender patients, study says

There needs to be more clarity in transgender healthcare

Imagine this: you’re the parent of a transgender 14-year-old. When they were born you thought your child was a girl, but it has been very clear for many years that they identify completely as a boy. He’s been known by a male name in your house for years and would be revolted if anyone used a female pronoun for him or referred to him as a girl.

You have been to see your GP, who has referred your son to the Tavistock clinic in London, the gender identity service for under-18s in England and Wales. But because of an unprecedented increase in the number of referrals over the past year, Tavistock has said it will be eight months before your child can be seen. He has just begun female puberty and is starting to panic about growing breasts, changing shape and getting a period. He is desperate not just to be put on hormone-blockers, which will prevent his female puberty, but also to be put on male hormones, so he can start male puberty, which the Tavistock clinic will not prescribe until he is 16 and has spent a year on hormone-blockers.

You’ve heard there are GPs who operate privately and prescribe hormones to children. But you’re not sure if this is legal: if there are age restrictions in NHS clinics, surely, you think, there are guidelines to restrict private practitioners as well. You read up and call around. But no one can give you a clear answer. Worse, no one even knows who you should talk to in order to get one.

Related: UK doctor prescribing cross-sex hormones to children as young as 12

Two weeks ago, the Guardian launched a series looking at some of the issues facing trans people. I spent weeks talking to trans people, their families, trans support charities, as well as doctors and psychiatrists. One issue that came up again and again was that there was an utter lack of clarity when it comes to some issues relating to transgender healthcare.

The issue of private prescriptions of hormones to teenagers is a good example. The NHS guidance says cross-sex hormones can’t be given to patients under 16 at its gender identity clinics, but after talking to a GP who prescribed cross-sex hormones to patients as young as 12, I tried to find out if there are similar guidelines or laws in place that applied to private gender specialists. It seems there aren’t, but the process of getting an answer to that question was beyond farcical.

I first put the question to NHS England, which told me it was a matter for the General Medical Council, which in turn referred me to the National Institute for Health and Care Excellence (Nice) and back to NHS England. Nice said it hadn’t been asked to write guidance on the subject and that this was a matter for the Department of Health. The department said that since private GPs were regulated by the Care Quality Commission (CQC) I should talk to them; the CQC said its job was to enforce guidance, not write it, but suggested speaking to the Royal College of General Practitioners and the Royal College of Physicians, both of whom couldn’t help.

I finally got a statement from the Royal Pharmaceutical Society, which said: “Doctors have to carefully consider each prescribing decision they take based on their own clinical judgment. Medicines can be prescribed off-licence as long there are sound clinical reasons for doing so.”

Trans people shouldn’t have to have some sort of NHS Rosetta Stone to work out what treatment they are entitled to

This is just one example of the muddy, bureaucratic waters that trans people have to swim in order to understand what healthcare is available to them, never mind trying to access it.

In Scotland, for instance, the current guidance says that people under the age of 16 can be prescribed cross-sex hormones if they are thought to “have enough intelligence, competence and understanding to fully appreciate what is involved in their treatment”.

But this is not the understanding of the only gender identity clinic that treats children and adolescents in Scotland, Sandyford in Glasgow, which has said that Scottish services don’t prescribe cross-sex hormones to under-16s and the reason the 2012 protocol says something to the contrary is that it “contains some inaccurate information and requires updating”.

And then there is the raging debate surrounding “bridging prescriptions”. Doctors at gender identity clinics (GICs) say “bridging” prescriptions are meant for patients who have been through an assessment at a GIC and have been prescribed hormones but who have, for example, moved away and need a prescription for hormones to tide them over while awaiting an appointment at a new clinic.

Talk to some trans charities and you hear a different story. They say bridging hormones can be issued to someone who has never been to a gender clinic, but who is on the waiting list to get in. They argue that since waiting times for treatment are so long, GPs are not only allowed to but are bound to issue hormone prescriptions to patients who ask for them in the name of harm reduction.

Related: Gender identity clinic for under-18s sees number of referrals double

I have read everything I can find on bridging prescriptions and I am still not confident as to what they are. The guidelines from the NHS (pdf) are unbelievably vague on the subject.

Trans people shouldn’t have to have some sort of NHS Rosetta Stone to be able to work out what treatment they are entitled to. They shouldn’t have to call nine separate health bodies to get a vague answer about whether a private GP can prescribe hormones to their child. And doctors – both within the NHS and operating privately – should have clear guidance about what treatments they can and can’t offer.

These questions aren’t for the sake of pedantry. If doctors aren’t confident of what’s legal or recommended when treating trans patients, then they will either err on the side of caution and not offer medical intervention when they should; or offer interventions when they shouldn’t, out of a desire to help.

It is only when there is clarity on trans healthcare that doctors who want to do the right thing will be confident of what that is, and that trans people will be able to get the treatment they need and to which they are entitled.

There needs to be more clarity in transgender healthcare

Transgender identity should not be diagnosed as mental disorder, says study

A transgender identity should no longer be diagnosed as a mental disorder, according to the first field study to evaluate a proposed change in the WHO International Classification of Diseases (ICD).

The mental distress experienced by many transgender people is primarily the result of social rejection and violence, the study found. Not, as has been assumed for decades, solely the result of being transgender.

The findings, published in the Lancet, show that viewing transgender people as having a mental illness might force them to get psychiatric care rather than the physical care they seek.

Authors of the “Removing transgender identity from the classification of mental disorders” study also warned that association with mental illness could be used by governments to deny decision-making authority to transgender people, in matters such as child custody and reproduction.

According to the first report by a UK parliamentary committee to tackle transgender issues, which was published earlier this year, as many as 650,000 people in the UK are gender incongruent to some degree. The transphobia they experience undermines their careers, incomes, living standards and mental and physical health, it found.

A third of transgender adults and half of “gender-variant” young people attempt suicide, and transgender people in the UK face high levels of transphobia on a daily basis, the Commons Women and Equalities Committee concluded. MPs urgedministers to draw up a new strategy to tackle discrimination in the NHS, prison service, police and schools.

Changing the classification in the ICD, the most influential medical bible, will have a significant impact on how transgender people are treated by the medical establishment, as well as how they are viewed by society.

“Stigma associated with both mental disorder and transgender identity has contributed to the precarious legal status, human rights violations and barriers to appropriate care among transgender people,” said senior author Professor Geoffrey Reed, of the National Autonomous University of Mexico.

“The definition of transgender identity as a mental disorder has been misused to justify denial of healthcare and contributed to the perception that transgender people must be treated by psychiatric specialists, creating barriers to healthcare services. The definition has even been misused by some governments to deny self-determination and decision-making authority to transgender people in matters ranging from changing legal documents to child custody and reproduction.”

The study’s authors interviewed 250 transgender people. It is the first of several field trials and is currently being replicated in Brazil, France, India, Lebanon and South Africa.

“Our findings support the idea that distress and dysfunction may be the result of stigmatisation and maltreatment, rather than integral aspects of transgender identity,” said lead investigator Dr Rebeca Robles, of the Mexican National Institute of Psychiatry. “The next step is to confirm this in further studies in different countries, ahead of the approval of the WHO revision to the International Classification of Diseases in 2018.”

The study found 83% of participants had experienced psychological distress related to gender incongruence during their adolescence. More than three-quarters had experience social rejection related to gender incongruence, most commonly by family members, followed by school and workmates, and then friends.

Over 60% of participants had been the victim of violence as a result of their gender identity: in nearly half of these cases the violence was perpetrated by a family member. Psychological and physical violence were the most commonly reported, while some experienced sexual violence.

A WHO working group has recommended that transgender identity should no longer be classified as a mental disorder. But it would not be removed from the codebook. Instead, transgender would be moved into a newly created category: conditions related to sexual health.

This, however, has stirred further controversy. “I think there is a bit of a problem with the idea of putting it in a chapter on sexual health because it has nothing to do with sex,” said Dr Griet De Cuypere, a psychiatrist at the Center of Sexology and Gender at University Hospital in Ghent, Belgium, and a board member of the World Professional Association for Transgender Health. “If it’s possible to have it more separately, it would be better.”

Transgender identity should not be diagnosed as mental disorder, says study

AMA Says Transgender Patients Don"t Need Surgery To Alter Birth Certificate

The American Healthcare Association today said transgender people shouldn’t have to have surgery to alter their birth certificate.

The move by the AMA at the group’s policy-generating Property of Delegates meeting is regarded as an critical healthcare voice amid a lately contentious situation in state capitals. Transgender people say they want IDs to accurately reflect their gender when they apply for jobs, travel and seek certain government companies among other items.

Most states demand a court order as effectively as evidence the transgender individual has had surgery ahead of the local government will concern a birth certificate.

Just final week, New York State stated it will no longer need transgender individuals to call for proof of surgical treatment when they try to modify the gender on their birth certificates. But earlier this 12 months, New Jersey Gov. Chris Christie vetoed legislation that would have permitted people who had a clinical sex change to amend their gender on their birth certificate.

Medical doctors who testified earlier this week just before an AMA panel mentioned “a birth certificate is seldom, if ever, utilized for the determination of medical treatment for sufferers,” according to text of the new policy the medical doctors approved says.

“Birth certificates are largely employed for legal issues, not health-related,” the new policy language authorized by the AMA says. 

AMA members stated the organization need to assistance modernizing state important statistics statutes “to make certain precise gender markers on birth certificates,” the group said in a six-page report on the issue.

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AMA Says Transgender Patients Don"t Need Surgery To Alter Birth Certificate