How can a child of three need transgender counselling?

An estimated one in 125,000 has gender dysphoria We live in an age of labels and neurosis

THErE are few things more upsetting than having an unhappy child — especially if, as their parent, you can’t work out what you’re doing wrong.

Every parent compares their son or daughter with classmates or friends’ children — you never want to think your own is the odd one out, the misfit.

But all children are different, often brilliantly and creatively so, and the progress of the world depends on oddballs.

The best advice is: ‘Give it time, support them, love them as they are, listen to what they’re saying.’

In today’s world, however, we like neat labels on everything.

There can be comfort in slapping a scientific name on your child’s behaviour, as if you were diagnosing an illness. And there is a powerful risk that professionals, fascinated by their own academic discipline, collude in that.

We know too many children — improbably many — are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), with symptoms including inattentiveness and impulsiveness.

Or perhaps it will be another newly-named ‘condition’, such as Oppositional Defiant Disorder — which ‘ often involves arguing (“opposing”) and disobeying (“defying”) the adults who look after them’, according to the NHS website.

In the process, tens of thousands of children are put on drugs to control their behaviour, without sufficient resort to sensible measures such as restricting their screen time, ensuring enough sleep and feeding them sensibly.

Others get labelled as clinically depressive, when the reason for their sadness is rational: divorce, bereavement, abuse.

And now we learn that there is a boom in the small but significant number of children below the age of puberty being referred to clinics with ‘ gender dysphoria’ — the conviction of being born in the wrong body, previously known as transsexualism.

The Tavistock clinic and others report ever more children referred to them by anxious parents, some as young as three. Boys who want to be girls, girls who assert that they are really boys. One charity specialising in the condition says it’s being contacted by 20 families a month.

Now, I believe gender dysphoria is real. It has been well-known for decades. No one quite knows why it happens.

Maybe it’s abnormal development before birth, perhaps simply an oddity of nature — even one to be celebrated, rather than fretted over.

In the past, it was unrecognised or condemned as perversion. Today, understanding is greater, and those — an estimated one in 125,000 — who are genuinely, deeply unhappy have the option of ‘transitioning’, both socially and surgically.

There’s a respectable history to this. Jan Morris, previously the star journalist James Morris, who reported from the conquest of Everest in 1953, lived as a woman in the late Sixties, went abroad for final surgery in 1972 and wrote a brilliant, wise, sensitive book called Conundrum, which demystified the transgender condition for many of us.

James was married; now, Jan and the same beloved wife are legally same- sex spouses, living a quiet life in Wales.

In another social sphere, April Ashley was born George Jamieson in tough Liverpool circumstances.

Aged 25, and having saved £3,000, she paid for reassignment surgery in Morocco in May 1960 and worked briefly as a model until her story was exposed in a red-top newspaper a year later.

She has spent a lifetime campaigning for gender equality and three years ago was made an MBE.

Understanding has grown, gradually, and that is good. Even Coronation Street has seen the much-beloved character of Hayley Cropper, who at first horrified the Street by admitting she was born as Harold, but subsequently married and became a stalwart of the community, and was only ever mocked by the nastiest character available (poisonous Tracy Barlow, who hates everyone anyway).

A 2004 Act of Parliament gave full rights to those in their new gender who, with medical and psychiatric help, manoeuvre themselves into the body they always needed.

Strange, but there it is. Even I wrote a novel (Passing Go) in which a transgender teenager is rejected by his/her angry father, only to prove the calmest and kindest member of the family.

The question now is whether the acceptance of this rare condition (I repeat, only one in 125,000) is panicking parents into misunderstanding or crazily encouraging young children in their innocent fantasies; and then feeding them to a psychiatric profession hungry for subjects with a fashionably interesting syndrome to study.

Some clinicians are quoted as saying that 1 per cent of us ‘have transgender feelings to some extent’ — which is 1,250 times as many as might be diagnosed with the full gender dysphoria.

But not every quirk of behaviour is a symptom. Small children, let’s face it, often live in a fabulous, magical world in which they may be a dog, a cat, a rabbit, or even a railway train.

My favourite exchange with one child on the subject came when I was asked: ‘Do wishes come true?’ ‘Well, sometimes, darling, if you work hard . . .’

‘No! I just wished I were an elephant, but I don’t want to be!’

And often, at that age, you fancy joining the other gender. A small boy plays dressing-up or covets dolls — he may well be expressing a perfectly normal range of male personality, and support you in your old age with his couture designs. That girl in dungarees and spiky hair who desires to be Spider-man? She may just be rejecting (quite rightly) the boring modern pressure to covet pop-tarty looks and shriek a lot.

Either child may refuse to dress in the conventional way for their sex, and announce that they want to belong to the other gender. It’s often a temporary thing, just a normal phase of childhood.

If that goes on and on towards puberty and makes them unhappy at school, then it is reasonable enough to explore, with a counsellor who is not obsessively over-interested, whether — by rare chance — the real condition lies at the root of this behaviour.

But we risk falling into the trap of seeing a problem where there is none at all, with children coming under terrible pressure to behave in a textbook way, as their parents’ anxieties about deviations from ‘normal behaviour’ are fed by the medical lobby.

Surgery in cases of gender dysphoria is still strictly for over18s. But, alarmingly, some clinics seem willing to prescribe drugs that delay the onset of puberty because of the ‘distress’ of what is normal development.

The drug route should only be a desperate resort. As one doctor at a Canadian gender clinic, Kenneth Zucker, puts it: ‘Suppose a black kid came into your clinic and wanted to be white. Wouldn’t you try to understand what is happening in the child’s life that is making him feel like that? You certainly wouldn’t recommend skin-bleaching.’

So, wise psychiatrists will listen calmly, and say: ‘Wait and see.’ As for pre- schoolers, the Tavistock clinic does not ‘generally consider it helpful to make a formal diagnosis in very young children’.

There is a school of thought, though, that is more gung-ho and which reckons that, especially with male-to-female transition, you can’t start too early, preventing puberty with drugs to stop a voice breaking and beard growing in adolescence.

How horrifying that anxious parents might be encouraging a child in that direction even though, given time, he might later accept that he is male. A happily feminine sort of male, perhaps, with a woman’s sensibility and maybe an attraction to his own sex, but a bloke nonetheless.

The problem is that we live in an age of labelling, medical neurosis and extreme parental anxiety, coupled with a trend — weird to us Sixties tomboys — of old-fashioned stereotyping.

We see pinkified, princessified little girls being taken to nail bars and makeover parties at five, to be made as vain and prissy as their mums.

Boys, meanwhile, are harassed by the need to be a tough-guy, shooty-bang or football-hero stereotype. No wonder some rebel.

It might help if schools made their uniforms less specific — trousers and open-necked shirts for all — to resolve morning dressbattles with children who need to work out who they are in peace.

Yes, it’s good that counsellors and charities are offering support to genuinely baffled parents.

I only hope that they do not act in haste, but say sensible things such as: ‘Let them be. Call them whatever name they favour, keep an open mind.

‘Either way, it’s not the end of the world. And, statistically, the odds are he or she will grow out of it.’