Early Physical Intervention for Young People with Atypical Gender Identity Development

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Abstract
This article describes the misery and frustration of young people for whom the external reality of the body is at odds with their gender identity. As hormonal and surgical treatments to alter the sexual body increase in sophistication, clinicians may be under pressure to provide this treatment to the under-18s – if only for the postponement of puberty. This pressure is especially powerful in the absence of evidence for the effectiveness of psychological treatment in reconciling cross- gendered youngsters to their bodies. Current practice is outlined and the legal context is described briefly. The clinician’s dilemmas are explored with particular reference to conflicting views of adolescent development, our limited understanding of the aetiology of gender dysphoria, the lack of empirical data on the impact of early physical intervention and changing cultural attitudes to transsexuality.