As acceptance and understanding of transgender people continues to grow, they are coming out younger and younger.

The Gender Service at the Royal Children’s Hospital in Melbourne started with one referral in 2003. Last year, it received 170, up from 104 in 2014, 60 in 2013, and 18 in 2012.



Upon presenting at the Gender Service, children are assessed by a specialist team including clinical psychologists, child adolescent psychiatrists, paediatricians, and fertility experts. The process is “very thorough”, says Telfer, in response to public concern that growing acceptance of transgender people will see kids transitioning willy-nilly.

This arduous diagnostic phase varies depending on the age of the child. The clinic sees children aged from 3 to 18. The younger they are, the less urgent the diagnosis. “If we saw a 3-year-old, for instance, there would be no need to give a diagnosis for many years,” Telfer says. “We would wait, watch, support, educate.” For kids about to start or who have just started puberty, the process doesn’t skip any steps. But they are often moved up the year-long waiting list so they can get the treatment they need as soon as possible.

For prepubescent children, treatment can be as simple as gender affirmation. A young trans girl might grow out her hair, wear dresses and skirts, adopt a new girl’s name.



Once puberty hits, treatment can be divided into two stages. The first: puberty blockers. This medication, which can be prescribed by a doctor, suspends the development of secondary sex characteristics while allowing for cognitive and social growth. Blockers are reversible – if a child stops taking them, their body will go straight back to getting on with puberty.

The second is cross-sex hormones. This is the part that can only take place after court approval, and typically involves a transgender boy – like Jeremy – starting to take testosterone, or a transgender girl starting to take oestrogen, around the age of 15 or 16.

European studies show exceptional outcomes for young transgender adults who accessed these stages of treatment as kids, says Telfer.

“We see improved mental health outcomes, we see quality of life that’s the same as the general population, we see rates of higher education completion above average levels, and we see the same vocational outcomes as the general population,” she says.