LOOKING in the mirror at the scars across her chest, Alex thought of everything she had put her body through over the last seven years.

Following puberty, Alex felt she was actually meant to be a boy, and set about her gender transition with doses of testosterone and a double mastectomy.

5 Susie Green, CEO of Mermaids, a charity that supports transgender children and young people and their families, argues that it’s patronising to suggest children may simply be confused (stock image) Credit: Getty

“Having that operation was a dream come true,” says Alex, now 24, a video games producer from Warwickshire.

“But after around 18 months, I began to realise I’d been changing my gender for all the wrong reasons – it wasn’t because I wanted to be a boy, it was because I felt uncomfortable with my female body.”

According to recent figures, the number of young people referred to the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service has risen by 1,000% in six years, with 2,519 referrals in 2017-18. Seventy-one per cent of them were female.

While the transgender community considers this surge in numbers a positive development, some people are beginning to question the reasons behind it.

In response to the sharp rise in figures, equalities minister Penny Mordaunt has ordered an investigation into why so many girls are seeking gender reassignment.

Meanwhile, a controversial paper by US physician Dr Lisa Littman suggested it could be down to a condition called rapid onset gender dysphoria (ROGD).

Gender dysphoria is the belief that your identity as a male or female is the opposite to your biological sex, and ROGD develops suddenly during or soon after puberty, mainly in girls.

According to Dr Littman, ROGD may be driven via social contagion – the spread of behaviours and attitudes within a group through imitation and conformity, which is associated with body-image and mental-health issues such as eating disorders and self-harm.

5 There are increasing numbers of social media accounts and online support forums for young people who regret their transition (stock image) Credit: Getty

However, Dr Littman’s methods were questioned and her theory was quickly rebuffed online by the transgender community.

Susie Green, CEO of Mermaids, a charity that supports transgender children and young people and their families, argues that it’s patronising to suggest children may simply be confused.

“The young people we see are not puzzled about their gender,” she says.

“They are saying, very clearly: ‘This is who I am.’ The truth is, numbers may not have actually increased.

Instead, people are making sense of the way they feel earlier and therefore more are seeking help.”

However, Stephanie Davies-Arai, founder of Transgender Trend, a UK campaign group made up of parents concerned about the rise in children identifying as transgender, disagrees.

“While anorexia or anxiety used to grip girls with body-image or self-esteem problems, these days switching gender could be seen as the latest coping mechanism,” she argues.

“There has been increased sexualisation of teenage girls, they don’t feel comfortable in their bodies and therefore they want to do something to alter it.

“In the past it was by eating less or cutting themselves, but now it seems the trend is to transition.”

Alex’s journey towards changing her gender started when she was just 12 and felt uncomfortable with her developing body.

“I hated my breasts and the attention they brought, especially as I was one of the first girls in my year at school to get them,” she says.

“People would tell me I had amazing curves, but I felt embarrassed and awkward. I began binding my breasts to hide them.”

By 16, Alex was aware she felt different from her peers, who would often chat about dream weddings or the latest must-have dress.

“It just wasn’t me,” she says. “I was attracted to guys, but didn’t feel I fitted the girlie stereotype. At night, I’d lie in bed and wonder what was wrong with me.

“I started to investigate online and came across the word ‘transgenderism’. It was really scary but the more I read, the more I felt it must be what I was going through.”

After speaking to her mum, Alex decided to come out as a boy at school.

“I’d always dressed in male clothes and been a tomboy,” she explains. “I began to ask people to call me by a new male nickname. Although I expected a backlash, everyone was really nice.”

In September 2012, a year before she started a degree in computer science at the University of Greenwich, Alex’s GP referred her to a gender clinic, where she received testosterone prescriptions.

She very slowly started to notice muscle growth and increased facial and body hair.

Then, in May 2015, Alex had both her breasts removed.

“At first, it felt like the answer to my problems,” she remembers. “But after a year or so, the old feelings of not fitting in began to plague me again. I still felt like a fraud.”

After around 18 months, I began to realise I’d been changing my gender for all the wrong reasons – it wasn’t because I wanted to be a boy, it was because I felt uncomfortable with my female body.

Alex didn’t experience any sort of “light-bulb moment”, but as the months went by it slowly dawned on her that she’d made a mistake.

“The more I thought about it, it wasn’t about wanting to be a boy,” she remembers. “I just didn’t like what it meant to be a woman.

“I hated that we were expected to settle down and have kids. It felt easier to say: ‘I’m not fitting in with girls because I was born in the wrong body.’”

In November 2017, Alex stopped taking testosterone and began the process of de-transitioning.

Alex said: “My fiancé Martin, who I’ve been with since I was 19, thankfully supported me every step of the way. I was really lucky as he always loved me for me, whether I was a boy or girl.”

According to psychologist Dr Lesley Prince, there’s a definite need for parents to be more aware of ROGD.

“Some research has found that a huge number of children who go through gender dysphoria grow out of it as they leave adolescence,” Dr Prince explains.

“And, in my experience, people who are trans are aware of their dysphoria for a long time. While it’s not always the case, it’s generally something that often starts in early childhood.

“But these days there’s a perceived trendiness behind transgenderism and a lot of cheerleading, too. Pre-social-media there wasn’t half the support or knowledge about transgender people, which of course made it incredibly difficult.

“But on the flip side, we’re now saturated with well-meaning encouragement and information, which also clouds the issue.”

5 The number of young girls using social media for more than three hours per school day has doubled in four years (stock image) Credit: Getty

With the number of young girls using social media for more than three hours per school day doubling in four years,** Stephanie believes that transgenderism is also being glamorised online.

“Many YouTube ‘celebrities’ document their transitions, displaying scars after a double mastectomy and increased facial and body hair after taking testosterone,” she says.

“Teenage girls are the biggest users of social media and these vloggers have hundreds of thousands of followers. Medical transition is presented as ‘cool’ and 100% positive.

“On top of that, I’ve seen young butch lesbians who are encouraged to believe that they are straight guys and not lesbian girls.

“And there are increasing numbers of social media accounts and online support forums for young people who regret their transition.”

Meanwhile, for those in authority, the issue has become so contentious that many are afraid to speak out in case they are labelled transphobic.

“A change to the NHS Memorandum of Understanding means that therapists are forbidden from exploring the reasons a patient might want to change gender,” explains Jane*, a child protection officer who wants to remain anonymous for fear of losing her job.

“They can only affirm the patient’s decision or face being found guilty of ‘conversion therapy’, which could lead to being struck off or sacked. If I have concerns about a child who says they identify as transgender, I can’t pass it on, as I could be labelled a bigot.

“But I have spoken off the record to GPs, education psychologists and social workers, and many of us are questioning why so many young women are doing this to their bodies.

“We should be allowed to at least ask: ‘Are you sure?’ It is a growing issue that needs to be addressed in a fair and balanced way.”

Mum-of-three Lily Maynard’s* daughter Jessie* came out as transgender when she was 15.

“She was never a girlie girl,” says Lily, 47, from London. “She mostly wore jeans and dinosaur tops and liked Lego as much as she liked Bratz dolls.

5 A young person has to wait 18 months before they are even seen for the first time by a gender clinic (stock image) Credit: Getty

“When she hit 14, she started watching videos by lesbian YouTubers. For the most part, I liked them. These women were happy and confident, and when Jessie came out as gay, it wasn’t a surprise.

“I didn’t care if she was a lesbian, I just wanted her to be happy. Then, a year later, she told me she was transgender.”

While a shocked Lily reassured her daughter that everything would be OK, she spent the night researching the subject online.

“I couldn’t stop crying,” she says. “It upset me to think how much Jessie must have grown to dislike her body.

“I wanted to support her, but the more information I read the less I was sure transitioning was the answer.”

As the weeks went by, Jessie switched pronouns and insisted on being called Jake.

“Most of the time we were still a happy family doing normal things,” says Lily. “I tried to support Jessie, telling her that whatever she chose to do, I’d always love her.

“She made friends online with people who trans-identified and they reaffirmed each other’s feelings, reassuring each other they’d made the right decision.

“In the end I limited her time on social media as I felt she was caught up in a circle of affirmation similar to those who go on self-harm or pro-ana sites for support.”

The tipping point came when, at 16, Jessie wanted to register at college as Jake.

“I thought if she went down that route there would be no going back,” says Lily. “Next it would be hormones and surgery. So I said she had to wait until she was 18. She was furious, but she had to go along with it.”

Nine months later, Jessie texted her mum to say that she no longer wanted to transition. “I was hugely relieved,” says Lily.

5 A young person has a minimum of four to six assessments before they are offered any medical intervention (file photo used) Credit: Getty

“She said she realised she was never meant to be a boy. It was like a window had opened in a dark room.”

Since then, Lily has watched her daughter grow in confidence. She is now 18, has a girlfriend and has just started university.

“I don’t dispute that for some people their only route to a happy life is transition,” insists Lily. “But just like an eating disorder or self-harming, transitioning seems to be a coping mechanism for some girls growing up in a difficult generation.

“People would tell me I had to support Jessie’s decision. But you don’t say to a girl with an eating disorder: ‘You’re right, you do look better skinny’. Support does not always mean agreeing with your child.”

However, Susie Green says there are plenty of steps in place to prevent someone going through transition lightly.

“A young person has to wait 18 months before they are even seen for the first time by a gender clinic,” she explains.

“Then they have a minimum of four to six assessments before they are offered any medical intervention. At the end of the day, anyone considering transition will constantly be questioned about it, not just by professionals but by society, too.”

As part of the transition process, puberty blockers – which suppress symptoms such as breast growth, voice change or periods – can be given from age 10 under referral from a specialist child and adolescent Gender Identity Clinic.

However, hormones such as testosterone can’t be prescribed until a child is 16. But not everyone follows the guidelines.

Just last September, GP Helen Webberley was restricted from treating trans patients unsupervised while the General Medical Council investigated complaints about her giving gender-change hormones to children as young as 12.

Worryingly, the website Transit.org.uk openly advocates bypassing the NHS to buy blockers and hormones online.

One of the site’s pages reads: “You have a moral responsibility as a parent to ensure the safety and happiness of your child… If you allow them to go through their genetical puberty, you could very well end up with a dead child.”

But what if a child changes their mind during transition? According to the NHS, puberty blockers are “considered to be fully reversible” once they are stopped.

However, there are a growing number of de-transitioned women who have reported serious issues with bone and blood disorders and joint problems in adulthood after taking puberty blockers such as the drug Lupron.

Oldest person in Britain to have reassignment surgery shares her joy at becoming a woman thanks to the NHS

Transgender Trend also claims that using testosterone after these drugs could affect fertility, while some “trans-regretters” have blogged about needing electrolysis to get rid of hair that didn’t disappear when they stopped taking it.

Alex, meanwhile, now feels at peace with her body. “I don’t feel ashamed about not having proper breasts.

“Despite my scars, for the first time in years I am free from this obsession of trying to be someone I’m not – this is who I am. Fortunately, the process hasn’t affected my fertility,” she says.

“Of course there are people who need to transition and live a happy life after. That’s really great and should be accepted.

“But there are others, like me, who clearly do it for the wrong reasons – and that’s why we shouldn’t be afraid to raise this issue.”

For help and support, visit Mermaidsuk.org.uk, GenderTrend.com or Stonewall.org.uk.

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Previously, we shared how a transgender woman was left in tears after her bank account was frozen as she ‘sounded like a man’ on the phone.

And the oldest person in Britain to have reassignment surgery shares her joy at becoming a woman thanks to the NHS.