Gender identity in children has become a hot topic in recent years, with NHS specialist services catering for children wanting to change gender seeing a 700% increase in referrals over the past 5 years. If you have a child who is questioning theirs, it can be tough. This can often be exacerbated when you are separated from the other parent who has very strong views about gender identity, and you disagree on how to approach the issue. This article deals with the sensitive issue of what happens if parents disagree on their child’s gender.
Gender identity in children has become a hot topic in recent years, with NHS specialist services catering for children wanting to change gender seeing a 700% increase in referrals over the past 5 years. If you have a child who is questioning theirs, it can be tough. This can often be exacerbated when you are separated from the other parent who has very strong views about gender identity, and you disagree on how to approach the issue. This article deals with the sensitive issue of what happens if parents disagree on their child’s gender.
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What is gender dysphoria?
Gender incongruence or gender dysphoria is a condition where a person experiences discomfort or distress because there is a mismatch between their natal sex and the gender with which they identify. The older a child gets the more distressing gender dysphoria can be because of their developing body and increasing social divisions between gender becoming more apparent. Treatment options focus on psychosocial, psychological and psychoeducational support, with hormone therapy being considered for some children who may wish to proceed with gender reassignment in later life.
What action can I take if my ex refuses to agree to our child’s gender identity treatment?
If two parents cannot agree on the parenting of their child, and in particular what steps, if any, to take about a child’s gender identity, then either parent can apply to court for a specific issue or a prohibited steps order. It can never be overstated that court proceedings should always be considered as a last resort after all other attempts to reach an agreement have been explored, such as mediation, family therapy, or individual therapy.
If an application is made for a specific issue order, the parent is asking the court to determine a specific issue, for example, whether the child should be allowed to attend the NHS specialist gender referral unit. In cases where the parent agrees to the child participating in therapy or starting to take medication and the other parent objects, they can apply to the court for a prohibited steps order to prevent the other parent from allowing that activity to happen.
It is important to note that The Cass Review, an independent report into gender identity services for under 18s, recently made 32 recommendations on how future provision should operate. The NHS Children and Young People’s Gender Service has now opened that offers support with physical and mental health, as well as the emotional, psychological and social aspects of gender identity.
As a result of the Review, NHS England will only prescribe gender-affirming hormones, to patients who meet certain criteria from “around their 16th birthday.” The general advice is that such hormones should only be prescribed to under 18s under “extreme caution”, and only where there was a clear “clinical rationale” for doing so.
Regarding puberty suppressing hormones which delay or suppress the physical changes of puberty, prescriptions for such drugs for gender distressed children are now only recommended as part of clinical trials, which are, as at the time of writing, yet to be confirmed.
Essentially, then, before making any decision, the court will consider these new guidelines as set out in the Cass Review, together with evidence from the child’s gender identity specialists that they meet the criteria as set out below.
- The child has been assessed by the appropriate specialist multi-disciplinary team over a period of time (to be assessed by the clinical team relative to the needs of the individual) and fulfils the criteria for a diagnosis of gender incongruence. This includes those children who identify as non-binary.
- There is evidence of presentation coherent with gender identity and an intention to live in their preferred gender in the long term.
- The child is actively engaging with the multi-disciplinary team and attending regular appointments
- The child is in good physical health, and is preferably not smoking
- The impact of the child’s fertility has been discussed with them and they understand that the hormone treatment will compromise their fertility.
- The child is able to give informed consent and has cognitive and emotional maturity to do so.
- The child is interacting in their chosen gender with others and engaging socially, such as by attending school or college
- The child has support at home from one or both parents
- Any associated difficulties such as self-harming should be taken into account when considering the impact on a child to manage the effects of hormone treatment
The Children and Young Persons Gender Service National MDT, including clinicians not directly involved in the child’s care plan, must agree on the suitability of the child receiving hormone treatment based on the above criteria. This ensures the child understands the limited medical evidence on the effects and harms of receiving hormone treatment before they reach 16, that such treatment is significant, and has long-term indications.
What about the child’s wishes and feelings?
Where parents are unable to agree on what is right for their child and court proceedings are started for a specific issue or prohibited steps order, the court will look at a range of factors in addition to the above criteria before deciding whether making the order is in the child’s best interests. One of these factors is the child’s wishes and feelings. The views of an older, more mature child will obviously carry more weight than the wishes of a 7 year old, for example.
If a child is over the age of 16, they are presumed to have capacity to make their own decisions about medical treatment. This will be confirmed by the child’s clinicians, who must agree on the suitability of the child to receive hormone therapy.
If a child is under the age of 16, they may be able to consent to medical treatment if they are old enough to make an informed choice because they have sufficient intelligence and maturity to understand what is involved and the long term implications. This is also included as part of the new criteria following the Cass Review as set out above.
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