Oliver with Donna Eade, a clinical nurse consultant with the gender dysphoria service. Credit:Jason South To have kids ask you why you are using the girls' toilets, because you look like a boy. And boys say you can't use their toilet, because you're a girl. How did Oliver feel? He was nervous, really, really nervous. "I used to think I was the only one like me," he says in a quiet voice. Afterwards, teachers at East Bentleigh Primary School told him they were so proud. Some cried. The kids were OK too, no teasing. And he got the wellbeing gig. Ollie, now 12, has been a patient at the Royal Children's Hospital's gender dysphoria clinic for the past two years.

The clinic, the only one in Australia, treats children between the ages of five and 18 and has experienced a huge growth in demand since it was established in 2003 by Associate Professor Campbell Paul, a child and adolescent psychiatrist. From two patients in 2003, it has grown to 104 in 2014, with more expected this year. "Sex" refers to a person's physical appearance, determined by their chromosomes and hormones, Dr Michelle Telfer, the clinical leader at the hospital's centre for adolescent health, explains. "Gender" refers to their innate sense of being male, female, or somewhere in between. A transgender person's sex and gender do not match. When this causes severe distress it is called gender dysphoria. When Ollie was younger he did not know what transgender meant. But he always felt like a boy.

He hated wearing dresses. At eight he got a short, short haircut. He became more distraught at going to school, and cried at night. Oliver's parents, Peter and Sarah, decided it was important to get Oliver into the clinic and onto "puberty blockers". These medications stop the procession of normal puberty and are totally reversible. They are used to decrease the distress a young person feels from bodily changes they do not want, Dr Telfer says. As the patient matures and is able to make long-term decisions they can move onto cross hormone medication, which is not totally reversible. Australia is the only jurisdiction in the world where approval from the family court is needed for the cross hormone medication, which Dr Telfer believes is unnecessary.

Surgery – known as gender affirmation surgery – is not recommended, or legal, until a person turns 18. It varies with the individual, from mastectomy to facial feminisation to laryngeal changes. Many transgender people do not undergo surgery. And 99 per cent of transgender people do not transition back in adulthood. All these decisions are made with the support of the clinic's experts, which includes adolescent physicians, child and adolescent psychologists, gynaecologists, an endocrinologist, and a speech pathologist, who can assist with voice training. About 50 per cent of adolescents without support try to self harm, and about 30 per cent try to take their own lives. Over a lifetime, about 50 per cent of transgender people try to take their own lives.

The most high-risk period is between deciding to seek assistance, and accessing it, which is where the clinic's newly-appointed clinical nurse consultant Donna Eade comes in. She will be the new first point of contact for anxious families seeking help while they wait for an appointment. Oliver will next year go to a high school in Mordialloc, which already has two transgender students. He enjoys his visits to the hospital clinic: "It's not a reminder that I'm different. It's more that I'm making a change." For support contact Transgender Victoria: 9517 6613

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