‘There was a moment, at the height of the problems, where I felt I had lost my perfect girl and now I had a broken boy. I had no idea how to deal with that, so I just forced myself to think ‘I will be really positive: I have not lost a daughter, I have gained a son.’”

Ally is recalling the turmoil, two years ago, that surrounded her then 14-year-old daughter Caleb’s decision to transition from female to male; what she didn’t realise then was that Caleb’s journey had only just begun. After three months of taking testosterone, Caleb decided not to transition – choosing instead to avoid identifying as male or female – and began to identify as non-binary, using the pronouns they and their.

For now, Caleb remains on hormone blockers, postponing a female puberty while deciding how to proceed. Ally, 47, understands the treatment is controversial but has fully supported Caleb: “I knew the risks, the ethical dilemmas and side-effects. But for me, as long as one of the side-effects wasn’t death then it was the right way forward.”

I was so naive. I thought we’d go to the doctor and get medicine to put puberty on pause and give Caleb time to think

It was, though, something much more prosaic than death that caused early problems: pronouns. While Ally has accepted the situation, other people aren’t so able to grasp what it means to be non-binary: “NHS medical practitioners have told me it is ridiculous. One doctor refused to use ‘they’ – she said it was impossible. Someone else told me they were a ‘grammatical purist’ and would continue to use ‘she’. Although it might seem unusual at first, really, we have to try. These people don’t seem to realise that constantly mis-gendering Caleb is very offensive.”

Ally noticed that Caleb was not going to be a typical little girl at a young age: Caleb was very androgynous and a big, muscly child – “not feminine at all. It was then I thought perhaps I was going to have a gay daughter – which would have been fine.” Caleb struggled to fit in at primary school, and was bullied. “It broke my heart, but the school just told me that kids can be cruel and Caleb was sensitive,” says Ally, who split from Caleb’s father when Caleb was a toddler.

“Around 13, Caleb’s female friends began to wear makeup, dresses and high heels. Caleb’s attitude was very much ‘No thanks, not for me.’” As the friendship group began to change and break down, Caleb didn’t conform. This is when the abuse on social media began – “teenage stuff on the one hand, but heartbreaking on the other, as it made Caleb so unhappy,” says Ally.

Caleb was given medical leave from school and began seeing a counsellor for stress and anxiety. Ally decided on a fresh start, and a new school. “Caleb made new friends and all was well in our world. Then, in August 2015, Caleb came out as gay, aged 14. I wasn’t surprised at all. It made sense. I felt completely comfortable about it.”

But just weeks later, Caleb wanted to transition to a boy. “I hadn’t seen it coming at all,” says Ally. “My overriding emotion was that I was really pleased Caleb was able to confide in me. In hindsight, I was so naive. I just thought we’d go to the doctor and get some medicine that would put puberty on pause and give Caleb time to think.”

Caleb’s social media pages were plastered with abuse. It demolished Caleb's confidence

Ally contacted Mermaids, a charity supporting young people who are questioning their gender, and learned that the waiting list to be considered for treatment would be at least three months. “When I realised just what lay ahead, I began to feel very overwhelmed. That’s when I started doing some real research. It was my way of trying to get some level of agency and control back.

“Mermaids was invaluable to me. Whatever we have gone through, there has been someone there who has gone through it, too. It was a relief to know we weren’t alone and this wasn’t my fault.”

As they waited for treatment, Caleb also began a social transition. “I wrote to the school, telling them that Caleb would now be living as a boy,” Ally recalls. “I included links to training and more information for them and thought that would be it. But I was so wrong.”

After going public with their transition at school, Caleb was verbally abused, spat at, pushed, shoved and slapped. “Caleb’s social media pages were plastered with abuse, calling them tranny and freak. These students also consistently and constantly mis-gendered Caleb, using ‘she’. It demolished Caleb’s self-confidence and the new identity they were trying to build.

“The school said it would train staff and pupils about trans issues, but nothing materialised. I began to feel quite depressed, and I pulled Caleb out of school. They were placed in a small medical unit for students with mental health issues. I just wanted Caleb to be able to study somewhere they were not constantly under fire. I tried to shut out my own grief and anxiety, but there were days when I felt there was very little hope. I did have moments where I would sob for the daughter I had lost.”

Caleb began to self-harm and even admitted to Ally that they had made a plan to kill themself. Ally began to sleep on Caleb’s bedroom floor, to ensure her child would still be alive in the morning. With no resolution from school, Ally reported the main culprits to the police for hate crime; they received a caution.

I am hopeful for the future. Caleb is the gentlest of souls but the strongest of spirits

Caleb finally received a referral, via London’s Tavistock Centre mental health trust, to start on hormone blockers, but was told a physical examination – including a genital examination – would be necessary first. Ally says: “Caleb began to sob. They couldn’t bear to look at themself in the shower, let alone strip naked for a stranger. They said, ‘Mum, please, I can’t do it,’ so we walked away. I was furious the system would force young people with such severe gender dysphoria to undergo such an exam.”

Ally then contacted Dr Helen Webberley, a GP who specialises in gender and who issues private prescriptions for hormone treatment. In August 2016, she prescribed blockers for Caleb.

Three months later, Ally approached Webberley again, this time for a prescription for testosterone. Caleb was 15, and NHS guidelines recommend that young people should be 16 to have cross-sex hormones, or have been on blockers for at least a year. (In September 2017, the General Medical Council began to investigate Webberley after concerns were raised by the Tavistock Centre about her medical treatment of other young trans people. Webberley says: “I welcome the GMC investigation if it will assuage the fears of those who wrongly accuse me of substandard practice.”)

Caleb started using a low-dose testosterone gel, but after three months told Ally they had changed their mind. Caleb felt instead that they could not conform to being male or female, and were non-binary. The low dosage of testosterone, and short amount of time it was taken for, seems not to have had a permanent effect.

Caleb, now 16, remains on hormone blockers. Ally realises this isn’t a long-term solution, but after more than two years of emotional trauma and turmoil, she is still reluctant to make any detailed plans for the future. For the moment, Caleb is studying fashion and design at college.

“I am hopeful for the future,” Ally says. “I don’t know whether Caleb is extraordinary or has become extraordinary because of what has happened. Caleb is the gentlest of souls but the strongest of spirits. It will be 18 months before they can even be referred for adult surgery. People can change and evolve and grow – we have seen this through our journey. Caleb is kind, generous, sassy and funny. I look at them and I think, by the skin of my teeth, we made it.”

In treatment: the NHS and young trans people

NHS England guidelines state that young people who identify as transgender can be prescribed hormone blockers from puberty, providing they meet “relevant criteria”. There is no set age for this; each case is assessed individually depending on the patient’s development. It is recommended that cross-sex hormones (testosterone or oestrogen) are not prescribed to patients who meet the eligibility criteria until “around their 16th birthday”.

Criteria include the patient being assessed by specialists over a period of time; the patient having received hormone blockers for a period of time; and the patient understanding the long-term impact of cross-sex hormones on their fertility.

Gender reassignment surgery is not undertaken until a patient is over 18.

Source: NHS England

• See mermaidsuk.org.uk for more information about supporting young people who are questioning their gender.

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