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In 2016, 20-year-old Lucy Dawson was sectioned for an apparent mental breakdown. Even though she had all the classic symptoms of encephalitis, she was misdiagnosed and left in a psychiatric ward until it was almost too late.
But medical negligence in women’s health is nothing new. Read Lucy’s story and the history behind it.
Female Patient

For centuries, doctors diagnosed women with “hysteria” – a condition characterised by emotional excess. In Western medicine hysteria was considered both a common and chronic disorder among women. Some of its symptoms included sexual desire, irritability, depression, and anxiety. In extreme cases, women diagnosed with “hysteria” were forced into insane asylum’s or underwent horrific and irreversible surgical procedures such as lobotomy or hysterectomy without consent.

The notion that women are somehow pre-disposed to negative behavioural conditions goes back to Ancient Greece, when the womb was thought to wander around the body and cause trouble wherever it went. This theory was rejected with the advancement of modern medicine, but the connotations persisted in Western popular thought for centuries. Today, researchers of medical history point to evidence that hysteria was simply a way to pathologize “everything that men found mysterious or unmanageable in women”.

Female Doctor

They were mutilated or molested – clitorises cut off when sexual pleasure was deemed to be the cause, or ‘medically stimulated’ into orgasm when sexual pleasure was deemed to be the cure.

Supposed ‘cures’ usually involved punishment intended to turn a difficult woman into a docile one. They were mutilated or molested – clitorises cut off when sexual pleasure was deemed to be the cause, or ‘medically stimulated’ into orgasm when sexual pleasure was deemed to be the cure. Hysterectomies and oophorectomies were unnecessarily performed – often without the patient’s consent – with the intent to sterilise reproductivity and neutralise hormonal fluctuations. Not to mention the dreaded ‘resting cure’ which inspired a short story so psychologically tormented that it convinced the pioneer physician to abandon it as a form of treatment altogether.

While hysteria is no longer recognised as a medical disorder, women are far more likely than men to be told their symptoms are psychosomatic or the result of a mental illness. The implications of this can be devastating.

Lucy’s Story

Lucy
Lucy Dawson photographed in 2021 by Christopher Thomond for The Guardian

In 2016, 20-year-old Lucy Dawson was sectioned under the Mental Health Act 1983 for an apparent mental breakdown. Even though she presented with all the classic symptoms of encephalitis, including confusion, personality change, hallucinations, and headaches, she was misdiagnosed and left in a psychiatric ward for three-and-a-half months.

During her time there, Lucy was given electroconvulsive therapy in a last-ditch effort to reset her brain, causing a seizure which made her fall out of bed onto an exposed radiator pipe.

Lucy recalls, “It was the end of November, so the pipe was as hot as it was ever going to be, and I lay on it half dead and having just had ECT, until an old lady screamed for help.”

Anti-psychotic medication had turned her from manic to catatonic, so she was unable to move or call for help on her own. When nurses finally discovered her, it was too late. She suffered third degree burns and was inexplicably paralysed in her left leg. Staff members falsely attributed this injury to one of many violent ‘breakdowns’ when friends and family started to ask questions.

Disabled Model
Lucy Dawson Photographed in 2021 at Cleethorpes Beach

In January 2017, Lucy was finally seen by a neurologist and tested for brain injuries. It was only then that she was diagnosed with anti-NMDA receptor encephalitis, a type of autoimmune disease where the body attacks otherwise healthy receptors in the brain. Lucy explains, “They call it friendly fire because your immune system identifies antibodies and healthy cells in the brain as being bad and attacks them.” This time, doctors explained that her paralysis was just another symptom of her disease.

Anti-psychotic medication had turned her from manic to catatonic; when nurses discovered her it was too late.

But Lucy was still not satisfied. She decided to hire a lawyer after being discharged from hospital and saw several specialists for her leg – none of whom could offer a real explanation. One day, a locum noticed the position of the scar the burn had left and checked it against a diagram for the sciatic nerve. It suddenly became very clear: the radiator had burned right through it. The damage was irreversible.

Since then, the hospital has apologised and launched a “robust internal investigation” to improve their standard of care for future patients. But Lucy insists nothing could ever make up for the physical and emotional trauma she endured at their hands.

Lucy
Lucy Dawson photographed in 2021 by Christopher Thomond for The Guardian

Lucy is now a British ambassador for disabled modelling and works to increase representation in the industry. She says that her success as a lingerie model “came out of nowhere. Because I’ve got quite a curvy figure, brands were interested and that became my niche.” She goes on to say that helping other disabled women to reclaim their sexuality “makes me feel what I do is worthwhile.”

In the five years that have passed, Lucy has encountered countless women with stories just like hers from all over the world. Australia is no exception.

Click here to follow Lucy on Instagram

A Bigger Issue

One in three women has had their health concerns dismissed by their general practitioner according to the latest figures from the Australia Talks National Survey 2021. It found that women were twice as likely to feel dismissed as men.

For instance, endometriosis affects one in nine women in Australia, but it usually takes six-and-a-half years to get a diagnosis.

“We literally know less about every aspect of female biology compared to male biology” – Dr. Janine Austin Clayton, director of the US Office of Research on Women’s health.

Research shows that health care providers prescribe less pain medication to women than men after surgery. In general, women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively.

“It’s a huge issue in medicine,” says Dr. Tia Powell, a bioethicist and a professor of epidemiology and psychiatry at the Albert Einstein College of Medicine in New York. Medical professionals may hold implicit biases that affect the way that women are treated, she said. “Medical schools and professional guidelines are starting to address this problem, but there is still much to be done.”

Karen Magraith, a GP and president-elect of the Australasian Menopause Society, said the gender gap extended beyond reproductive health issues.

Female Patient at Hospital

“We have evidence heart disease in women is not recognised as early, not treated as effectively and women receive less evidence-based treatments than men do. I think that’s a good example of where women’s health is not as effectively treated as men’s health,” she said.

One of the main reasons for this is that women have been historically underrepresented in clinical trials for new drugs, treatments, and devices in Australia and across the world. And in the few instances where women have been included, the influence of sex and gender is often ignored. As a result, women are more likely to be withheld effective treatment and exposed to harmful side effects – including a higher incidence of adverse reactions when new (and insufficiently researched) drugs hit the market.

The result? “We literally know less about every aspect of female biology compared to male biology,” says Dr. Janine Austin Clayton, director of the US Office of Research on Women’s health.

Lonely Woman

It would seem that women are just too hard to study. For decades, women were excluded from clinical drug trials based on the unsubstantiated belief that fluctuations in hormones associated with the menstrual cycle would make results more difficult to analyse. When thalidomide was found to cause serious birth defects in the 1970s, women of childbearing age in the US were banned from participating in clinical research studies in order to ‘protect’ their reproductive capabilities. Even though this ban was lifted in 1993, and the inclusion of women was mandated in government-funded research, drug companies were not required to comply.

A 2008 report found that Australian Human Rights and Ethics Committees (HRECs) failed to enquire about the numbers of male and female participants in clinical trials. The same report showed that opinions were also divided on whether research cost and convenience justified excluding women from research.

As it currently stands, the Australian National Health and Medical Research Council (NHMRC) has no policy comparable to those in the US or Canada requiring researchers to test on both men and women.

But organisations like the George Institute are calling for policy reform in order to standardise the way sex and gender is collected in clinical trials in Australia. Their demands include gender specific reporting in academic journals and a more equitable balance of female and male patients in clinical trials.

Patient Diagnosis

In response to such demands, a spokesperson for the Department of Health pointed to the $535 million package set aside for female health as part of the 2021-2022 national budget. It serves to improve cervical and breast cancer screening programmes, provide Medicare subsidies for testing of IVF embryos for genetic faults, increase support for the mental wellbeing of new and expectant parents, and boost women’s health initiatives including the Periods, Pain and Endometriosis Program (PEPP-Talk) developed by the Pelvic Pain Foundation of Australia.

However, this package amounts to less than $46 for every woman over the age of 15. More can be done to help.

What You Can Do

Standard consultations at the GP last just 15 minutes. Here’s how to make sure your health concerns are heard.

Come Prepared

Plan what you intend to talk about before you arrive for your appointment. Write down any concerns and questions so you don’t forget. Be specific.

Tell Your Story

According to Leana Wen, MD, author of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, “doctors end up asking about symptoms rather than the story. But studies have shown that over 80% of diagnoses can be made just by listening… By that, they mean listening to the story, the open-ended story of what happened, rather than asking a list of yes-no questions”

Be sure to mention:

  • When the symptoms started
  • Whether any life event/action coincided with the onset of symptoms
  • Whether the symptoms have appeared before
  • Describe how it feels
  • Whether the pain has increased/decreased
  • How often you feel the pain

Take Someone with You

If you are dealing with a particularly complex issue, have a condition that makes it difficult to discuss alone, or are particularly vulnerable, it might be appropriate to bring a patient advocate or a loved one along to an appointment.

Request a Female Doctor

Studies show that female doctors tend to listen more and their patients — both male and female — tend to do better.

Be Direct

If you still feel like you’re being dismissed, tell your doctor how you feel. Express concern that you are not being properly heard. A good physician should be able to listen and take your problems seriously.

It’s normal to experience grief when a child comes out as transgender. Here’s some ways that parents can navigate the process.

Ambiguous loss is the grief parents feel when they lose a transgender child to the process of transitioning. It’s called ‘ambiguous’ because it is not the concrete, tangible loss that follows the physical death of a child. For that reason, ambiguous loss may leave parents with feelings of unresolved grief.

Grief and loss are natural feelings when confronted with a child’s transgender identity because it shatters traditional images of gender. What it means to be a man or woman, girl or boy, informs much of our behaviour. This is especially true in family relationships, where roles are based on a set of pre-determined expectations for how we are supposed to act.

How a parent responds to their child’s transgender identity is critical to whether the transitioning experience is a positive or negative one.

How a parent responds to their child’s transgender identity is critical to whether the transitioning experience is a positive or negative one. It is essential that parents reframe the way they feel about their child’s transitioning, from regret and sadness to excitement about what the future holds.

The process of transitioning often challenges parents’ traditional gender role stereotypes

It’s essential because transgender and gender diverse people experience incredibly high rates of mental health issues. LGBTIQ+ Health Australia’s April 2021 report provides some alarming statistics. Of 14 to 25-year-olds surveyed, 48% had attempted suicide, 79% had self-harmed, 74% were diagnosed with depression and 72% with anxiety. A staggering 90% of transgender people aged 14 to 21 reported high or very high levels of psychological distress.

Given these statistics, it’s clear that for transgender children family support can be the difference between life and death. This is supported by research which shows that gender-affirming behaviour by family members has a hugely positive impact on mental health.

Gender-affirming behaviour by family members has a hugely positive impact on mental health.

Parents act as models to their children, based on socially and culturally constructed gender roles. Before a child is born, parents have started planning the child’s future and, usually, it’s gendered. So, having an emotional response to such a big event as a child telling their parents they’re transgender is normal. It is reasonable for parents to grieve the loss of an imagined future.

Embracing a child’s nominated gender has a hugely positive impact on their mental wellbeing

A 2020 study looked at whether parents had an emotional experience, like mourning, to their child’s transition. It was found that parents’ reactions followed the typical grief response. Not understanding what their child was going through led parents to experience feelings of denial, fear, anger, and powerlessness.

What the study revealed was that parents who best overcame their grief had a support system in place. Involvement in transgender advocacy groups reinforced the fact that, despite being transgender, their child was the same child they’ve always known. Importantly, realising their child was happy with their chosen gender had a positive impact on parental resilience when dealing with the transition process.

Research shows that children who come out as transgender already have a strong sense of their identity … They know who they are because they’ve always felt like that.

Research shows that children who come out as transgender already have a strong sense of their identity, usually from a very early age. They know who they are because they’ve always felt like that. It is important that parents understand that children change their gender to fit their identity, their identity doesn’t change because their gender does.

A child’s identity does not change just because their gender does

While there may be things that parents had planned to do with their child that they can no longer do, they will discover many new and different ways to bond with and love their child such as joining their experimentation with new clothing, helping them choose a new name or pronouns.

It is possible to remain loving and supportive while simultaneously experiencing loss, sadness, fear and confusion. Working through these feelings takes time. Just as a child needs compassion and support to navigate the transitioning process, so do parents.

Here are some ways parents can support themselves and their transgender child:

  1. Don’t give in to fear. Fear can cause parents to push back or reject their child. This fear is underpinned by love, driven by a concern that the world is a harsh place for transgender people. Make sure the child knows they’re loved and supported.
  2. Encourage exploration. Gender exploration is a normal part of a child’s development. Give children the freedom to explore their emotions about gender before they consider a permanent change.
  3. Education is key. Get familiar with the information that is out there about gender expression. There are a lot of online resources available, such as Transcend, QLife, Rainbow Door, queerspace, and Transgender Victoria (TGV).
  4. Create a safe space. Transitioning takes a long time and can be difficult. Encourage the child to openly discuss their feelings so they feel safe and protected as they transition.
  5. Families need to transition, too. Each family member must shift their thinking and understanding. Take the time to process these thoughts and any feelings of loss.
  6. Seek help. Ensure access to a team of medical and mental health experts. Identify allies at school, so the child knows where to go for support if they are bullied or excluded.

Yes, having a trans child means questioning personal views on gender. And, yes, it usually involves a lot of – sometimes uncomfortable – discussions with friends, relatives and complete strangers about the process of transitioning and what it involves. These conversations can evoke strong feelings in others that parents should be prepared for.

While the world might not always be understanding, parents can be.

But, while the world might not always be understanding, parents can be. A child might wear different clothes and go by a different name, but they’re still the person you know and love.

An understanding parent makes a world of difference to a transgender child

It’s important to remember that a parent’s grief and loss is theirs, not their child’s. Accept these feelings for what they are: natural and normal reactions. Parents need to work with their feelings, not against them.

At the same time, parents need to support, comfort, and maintain an open dialogue with their transgender child as they work through the process together. Recognise their child’s bravery and show gratitude. Parent and child will be so much the better for it.

Gender reveal videos are the latest social media craze for expectant parents looking for a fun way to disclose the gender of their baby-to-be. However, an increasing number of couples, including many celebrities, are opting to forgo this trend in order to raise their children gender neutrally.

In 2019, the leading children’s entertainment company, <a href=”https://news.mattel.com/news/mattel-launches-gender-inclusive-doll-line-inviting-all-kids-to-play”>Mattel</a>, launched ‘The Creative World’ doll range, enabling children to choose from a range of skin tones, hairstyles, clothes and styling options.

“Toys are a reflection of culture and as the world continues to celebrate the positive impact of inclusivity, we felt it was time to create a doll line free of labels,” says <a href=”http://www.barbiemedia.com/bios/executive.html”>Kim Culmone, Senior Vice President of Mattel Fashion Doll Design.</a>

Is now the time to embrace the progressive initiative of gender-neutral parenting?

<span style=”color: #33cccc;”><strong><em>So, what does ‘gender-neutral’ actually mean?</em></strong></span>

The term ‘gender neutral’ relates to avoiding the assignment of roles and expectations based on someone’s gender.

The goal is to move away from stereotypical assumptions and encourage increased creativity and freedom for individuals to choose who they want to be.

Many feel growing up in a gender-neutral environment increases one’s tolerance of others.

<span style=”color: #33cccc;”><strong><em>Why should we encourage gender-neutral parenting?</em></strong></span>

Encouraging boys to only play with trucks when they really want to play with dolls, for example, conveys a message that their true desires are not valid. Growing up in an environment where a child feels they need to hide their true self could lead to problems later in life as the child faces an ongoing internal emotional battle.

Many feel growing up in a gender-neutral environment increases one’s tolerance of others.An understanding that people can choose how to dress and which sports they enjoy, regardless of gender, can mean they meet  with acceptance rather than judgement.

Some argue that a lack of diversity in the workplace begins in childhood when gender is often assigned to certain hobbies and interests – girls dressing up as nurses and a boy dressing up as a builder, for example – conveying a message these jobs are gender specific. Increased exposure to the possibility of male nurses and female builders could enhance a child’s freedom when choosing a career.

The way in which we respond to our children when they are scared or upset can reinforce gender stereotypes<em>. </em>When boys cry, some parents feel they need to show less compassion to encourage resilience, whereas girls are often shown more affection. Perhaps if we removed these gender specific responses, we may encourage our sons to grow up unafraid of expressing emotions.

Supporting children to express themselves authentically and make choices based on what feels good to them could help nurture increased creativity and strong self esteem.

Some argue that a lack of diversity in the workplace begins in childhood when gender is often assigned to certain hobbies and interests.

<span style=”color: #33cccc;”><strong><em>How can we create a gender-neutral environment?</em></strong></span>

For many, creating a gender-neutral environment means no longer buying blue for boys and pink for girls and choosing colours and images that do not enforce a particular gender stereotype.

It may mean ensuring household chores are gender-neutral, encouraging children to learn it is not just their mother who cooks the meals and it is not just their father who takes the rubbish out.

We could encourage children to play with all kinds of toys, have various hobbies, play a variety of sports and read an assortment of books. Enabling children to see that girls also play football, boys can practice ballet, girls play with trucks and boys play with dolls, for example, helps children develop a mixture of interests and skills.

For some, raising children in a gender neutral environment can take a more extreme approach. In 2010, a Swedish couple opted to keep the sex of their baby, ‘Pop,’ a secret to discourage stereotypes being placed on their child. Many are following this example and choosing to not use the pronouns ‘him’ or ‘her’ at home, opting for ‘they’, which is deemed more gender inclusive.

<span style=”color: #33cccc;”><strong><em>Could gender-neutral parenting cause harm?</em></strong></span>

<a href=”http://lindablair.co.uk/?LMCL=uvrFql”>Clinical Psychologist, Linda Blair</a>, feels parents may be doing a disservice to their children. Linda argues that ‘between the ages of three and seven, children are searching for their identity, a part of which, is their gender.’ Children want to feel a sense of belonging and ‘fitting in’. Avoiding the assignment of a gender may make a child feel confused about who they are and where they fit in a society where gender roles remain prominent.

There is a concern that once a child starts school, their gender-neutrality may open them up to ridicule and bullying. Most children grow up in traditional households where gender is assigned at birth, which could make school years incredibly difficult for those who do not identify with a specific gender.

Many worry that children will grow up without a strong sense of their own identity and will never truly feel they belong. This may impact on their emotional wellbeing as they grow into adulthood.

The way in which we respond to our children when they are scared or upset can reinforce gender stereotypes.

<span style=”color: #33cccc;”><strong><em>What does the future hold?</em></strong><em> </em></span>

Many feel it will not be long before gender-neutral education systems are introduced. A preschool in <a href=”https://www.bbc.com/news/world-europe-14038419″>Sweden</a> has taken the lead on this, being the first of its kind to create a gender neutral environment, offering a variety of gender inclusive books, toys and sports; the use of pronouns that assign gender is also not allowed, opting instead for the term ‘friends’, ‘they’ or the genderless pronoun ‘hen.’

While some feel raising children in a gender-neutral environment will support their emotional wellbeing, others still worry it will create a childhood of confusion. When one of the largest doll making companies in the world introduces a more inclusive doll range, it is reflective of our ever evolving society in which gender identities are becoming more fluid.

Is gender a dying tradition?

For perhaps the first time in the world, a baby has been issued a genderless identification card. Canadian authorities gave eight-month-old Searyl Atli Doty a health card that designates sex as “U”. This is believed to stand for “undetermined” or “unassigned”.

Kori Doty, Searyl’s parent, has been fighting for months for Searyl to develop their own gender identity. Doty, who is non-binary and transgendered themselves, gave birth to Searyl at a friend’s home in British Columbia. As such, there was no medical “genital inspection” that assigned the child’s sex.

Kori Doty, with Searyl Doty. Source: Facebook.
Kori Doty, with Searyl Doty. Source: Facebook.

In a statement from Gender Free I.D. Coalition, a Canadian group that fights for genderless government records, Doty said, “I am not going to gender my child. It is up to Searyl to decide how they identify, when they are old enough to develop their own gender identity.”

Doty’s lawyer, barbara findlay (she styles her name as such) told CKNW news that it was a big surprise when Searyl’s genderless health card came in the mail. She argued that requiring a gender marker at birth was a violation of Searyl’s right to gender expression, as stated in the British Columbia Human Rights Code.

“A baby’s gender identity develops over time, not when a doctor examines its genitals right after birth.”

As findlay told Buzzfeed News, “the state has no business certifying a child’s sex at birth.”

“We would prefer they take ‘sex’ off these documents entirely,” she added, “A baby’s gender identity develops over time, not when a doctor examines its genitals right after birth.”

Searyl's genderless ID card. Source: Gender Free ID Coalition Statment
Searyl’s genderless ID card. Source: Gender Free ID Coalition Statement

While this health card is a victory in itself, Doty and Gender Free I.D Coalition are still fighting to get Searyl a genderless birth certificate. They will be taking the Vital Statistics Agency to court, for refusing to issue Searyl a birth certificate without a gender.

As Doty explained to CKNW, “The physiology of humans and the way that then translates to gender identity and the experience of gender is much more complicated than the binary of man and woman, boys and girls, male and female.”

Supporting children in gender diversity is essential for them to have healthy self-esteem and grow up into confident, happy and well-adjusted adults.

Is it a boy or a girl? This is one of the first questions asked when a new life enters the world. Even before birth, we are curious about the gender of a baby. Once we know that the baby is a boy or a girl, it can influence so much- the colour of clothes, decoration of nurseries/bedrooms, the type of toys and most importantly, how we perceive and treat the child.

Little boys are so often seen as tough, rowdy bruisers and little girls as sensitive, beautiful princesses. Parents, other family members, friends and general society subtly and explicitly encourage gender norms from the time we are born, to the time we die. It is worth considering what gender actually is.

Undoubtedly there are differences between “male” and “female”, but how these differences are expressed is societally constructed and changes remarkably throughout history and between cultures. What happens to the sensitive side of “tough, rowdy, bruiser” boys in our society, and how about the aggressive or assertive parts of our “sensitive, beautiful princesses”?

We can all be restricted by the gender norms we are ascribed, however, those of us who are born gender diverse generally have a particularly hard road to travel, due to societal expectations that our gender expression/identity will match our genitals. The majority of the time, this is exactly what happens, but a significant minority of people simply do not feel that their body matches their inner experience of who they truly are. We all have a role in making the road these children travel much less hazardous, and by contributing to a society that is less rigid in gender expectations, we may all benefit by being free to be who we truly are, not only what we are expected to be.

Gender diversity can be defined as a spectrum of behaviours, expressions, identities and feelings which society deems as atypical of a person’s biological gender. It is useful to think of gender diversity as a spectrum, rather than simply categories of “male” and “female”, because people can feel somewhere “in between”. Gender diversity may be experienced at any point in life, and people will either express or suppress this diversity, largely in response to how safe and accepting their social world is or is not.

A core concept to keep in mind is that gender diversity is not the problem, it is a natural reflection of the complexity and variety of human experience. Issues arise due to how an individual that is gender diverse is stigmatised, isolated, pressured and even persecuted by the world around them. This is what must be changed for all people in a society to live safe, fulfilling lives.

When gender diversity is present in childhood, it is useful to consider developmental stages to guide how best to support the child. Up until the age of three, young children have no fixed gender identity. Their understanding of other people’s gender is also fluid. This period of life should be approached with a high degree of acceptance of fluidity and experimentation.

When children up to the age of three behave in ways atypical of their biological gender, it is simply a reflection of their lack of categorisation, it is play, fun, learning and experimentation. Parents and other carers can join in with this play and show pleasure at their child’s exploration. The worst thing to do would be to force gendered behaviour, as this will not make sense to young children and runs the risk of causing shame and confusion. From the age of two to three-and-a-half, children are particularly susceptible to feelings of shame and doubt, which they can be assisted through supporting their growing independence in play, experimentation and undertaking simple tasks. This way of supporting them can be applied to any and all expressions of gender. It is not important as to whether it is typical of their biological gender or not, just that they are encouraged and supported.

“We all have a role in making the road these children travel much less hazardous, and by contributing to a society that is less rigid in gender expectations”.

After the age of three and up to the ages of five to six, children are starting to work out some of the differences related to biological gender and may become very curious about body parts and functions. However, even up to the age of six, some level of fluidity, or errors in terminology are common in relation to gender.

Answering questions about bodies and gender openly, focused on the question of the child, rather than adding information that may be beyond their understanding, assists children to learn about gender and bodies at their own pace.

Continuing to be accepting of fluid concepts of gender, rather than asserting norms, will also provide space for children to develop their own gender identity, while maintaining healthy self-esteem. For children in this developmental stage, there are big transitions to navigate, such as beginning pre-school and primary school.

If your child is presenting with signs of gender diversity, and especially if they show signs of distress at any pressure to conform to gender norms, it is very important to consult with others involved in your child’s education and care. It is advisable to ask what their approach to gender diversity is and to ask for changes to be made that will assist your child in these big developmental transitions. Some of the policies schools and child-care centres have created include gender neutral toilets, gender neutral approach to toys/play, support for clothing preference of children, use of pronouns/names that children choose and strong anti-bullying programmes which include a focus on acceptance of gender diversity. The goal of these policies and changes in both primary and secondary schools is to allow gender diverse children the space, safety and support to work out who they are in relation to gender, throughout a period of life which is characterised by fluidity.

In later childhood and pre-adolescence, children are well aware of gender categories, differences and norms. For those who are gender diverse, the awareness of being different is likely to become more pronounced. Support is required within the home, schools and other settings such as sporting teams to ensure that differences and diversity are accepted and ideally celebrated, rather than targeted as a source of shame.

Older children can be assisted to find settings and friendships where they feel they fit in, and to consider their capacity to adjust behaviours and interactions in ways that result in positive interpersonal experiences. It is important to only encourage kids to adjust their own behaviours and choices in ways that are affirming and authentic to them. Placing pressure on a gender diverse child to “fit in” and adopt societal norms, rather than focussing on adjusting social settings to be safe and accepting, is unfair and ultimately damaging to children’s development, well-being and self-esteem.

“If your child is presenting with signs of gender diversity, it is very important to consult with others involved in your child’s education and care”.

Adolescence can be a particularly difficult time for gender diverse people. The hormonal and physical changes associated with puberty, along with the complex developmental task of developing a stronger sense of self, is often fraught for many. Imagine how much more difficult this period would be if your body and its biological sexual characteristics were developing in a way which was severely contradicting your inner sense of self.

Gender diverse adolescents may become distressed at these changes and develop a sense of alienation, ambivalence or revulsion toward various aspects of their bodies and ways that society perceive them and pressure them to be. Unfortunately, gender diverse adolescents are at higher risk of mental health issues, risk-taking behaviours and suicidality. They can be protected if they receive strong family and social support which affirms their inner gender identity, and access to medical and psychological services.

A medical intervention for gender diverse adolescents which is becoming much more accepted is to commence “puberty blockers”. This hormonally halts the onset or progress of puberty, giving the gender diverse adolescent respite from distress related to unwanted bodily changes, and an opportunity to decide later whether they wish to start taking hormones of their affirmed gender, or stop taking puberty blockers and commence the process of maturation in their biological gender. Puberty blockers are safe and their effects are reversible, which is important in giving the young person time to decide what is best for them.

Adolescence is a time of experimentation and identity formation, and gender identity will play a part in this process for all teenagers, but for those who are gender diverse and experiencing distress, more support is required.

Longitudinal research into gender diverse children indicate that there are three main outcomes. A portion of gender diverse children will integrate their own sense of gender and be comfortable to identify as their biological gender. Others seem more likely to identify as diverse in sexuality later in life. Meanwhile, those who experience persistent gender diversity may go on to “transition”, which means taking hormones and sometimes undergoing surgeries to ensure their physical body matches their inner gender identity. This transition process is not the same for all, and it is important to consider gender identities other than the binary opposites of “male” and “female”, as this does not always represent an individual’s personal experience of gender.

Whatever pathway a gender diverse child takes into adulthood, the irrefutable fact is that they will be more happy, healthy and self-assured if we as parents, families and a society offer support, acceptance and love, which often means challenging rigid norms of behaviour that restrict us all.