Young, Trans and Waiting: The Case For and Against Under-18 Treatment

Let's get one thing out of the way immediately: this is not a simple topic. Anyone who tells you it is - on either side - is either selling something or hasn't thought about it very hard. So let's actually think about it.

The question of whether under-eighteens who identify as transgender should have access to medical treatment manages to be both deeply personal and furiously political at the same time. Brilliant. Exactly what a vulnerable young person needs.

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The case for treatment

The evidence on what untreated gender dysphoria does to young people is not cheerful reading. Elevated rates of anxiety, depression and self-harm don't appear from nowhere - they're the product of a mind and body being in profound conflict during what is, already, a spectacularly difficult period of life. Puberty is grim enough when you're comfortable in your own skin. When you're not, it can feel like a catastrophe happening in slow motion.

And for some people, that feeling arrives very early indeed. I knew at three and a half years old. Not as an abstract concept - as a bone-deep, clear, entirely unambiguous sense of wrongness. I asked my mother why I was in a boy's skin instead of a girl's. My mother, to her credit, took that seriously enough to seek medical advice. The doctor, considerably less to his credit, told her I'd grow out of it.

I didn't. I spent the next fifty-five years living in the wrong body.

That's not a cautionary tale about rushing into treatment. That's a cautionary tale about what happens when a child's reality is dismissed by an adult with a stethoscope and a confident assumption. The cost of getting it wrong in the direction of "wait and see" is not neutral. It is fifty-five years. It is a lifetime. It is incalculable.

Early intervention - particularly puberty blockers, which pause development rather than advance it - gives young people time. Time to explore, to be certain, to work with clinicians before anything irreversible happens. The clue is rather in the name: they block, they don't rush ahead. For many young people, that breathing room has been genuinely life-saving. That's not rhetoric. That's what the research and the lived experience both show.

Supportive parents are a significant part of why early intervention works. When a young person has at least one parent or carer in their corner - attending appointments, advocating within school, providing a home environment where they aren't constantly having to defend their own existence - outcomes improve markedly. Parental support doesn't replace clinical care, but it creates the conditions in which clinical care can actually do its job. A child who comes home from a gender clinic to warmth and acceptance is in a fundamentally different position to one who comes home to silence or hostility.

There's also the small matter of medical consensus, which - until very recently and in very specific political climates - broadly supported access to care under appropriate clinical oversight.

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The case against (or at least, for caution)

Here's where it gets uncomfortable and where I'd ask you to stay with me rather than reach for a label.

Adolescent brains are not finished. The capacity for long-term decision-making is still developing well into the twenties. Gender identity in young people can be complex, fluid and - for some - something that shifts over time. That's not a reason to dismiss trans identity in young people; it's a reason to ensure the clinical processes around treatment are robust, thorough and genuinely in the young person's best interest rather than a tick-box exercise.

And then there's the parent problem - because there absolutely is one and it runs in both directions.

Much of the public debate focuses on parents who reject a trans child and the harm that causes is real and well-documented. But there's a less-discussed dynamic that clinicians have quietly flagged for years: parents who push in the opposite direction. Parents who, for their own reasons - whether that's a desire for a particular kind of child, an ideological commitment, a need to be seen as progressive, or something more complicated and harder to name - may consciously or unconsciously steer a child towards a trans identity rather than simply following where the child leads.

This is not a reason to dismiss trans identities in young people. It is, however, a reason why good clinical practice needs to see the young person independently, assess their views without a parent in the room and be alert to dynamics that suggest the child's voice isn't entirely their own. A twelve-year-old who has been marinated since infancy in a particular set of expectations - in any direction - deserves the space to find out what they actually think.

The concern isn't that trans kids don't exist. Of course they do. The concern, when expressed honestly rather than as a culture-war weapon, is about ensuring the right young people are getting the right treatment, and that no one is being nudged - gently or otherwise - into permanent changes by the adults around them rather than by their own genuine, sustained and independently-held sense of self.

There are also real questions about long-term data - particularly on bone density effects of prolonged puberty blocker use - where the evidence base is thinner than clinicians would like. Acknowledging that isn't transphobia. It's just science being honest about its own gaps.

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The parental tightrope

What good parenting looks like in this context is genuinely difficult to define, and probably deserves more honest conversation than it gets. It isn't simply "believe everything your child says without question" - that's not good parenting in any context. Nor is it "override your child's expressed identity because you know better" - that's demonstrably harmful.

It's something harder than either of those: holding space for your child's experience, taking it seriously, getting professional support involved and somehow managing to do all of that without projecting your own feelings, fears or wishes onto the person in front of you. Easier said than done when the person in front of you is your child and you love them fiercely and the stakes feel enormous.

My mother did the right thing. She listened. She acted. She was then overruled by a medical professional who was, with the very best of intentions, catastrophically wrong. That distinction matters. Her instinct, in that case, was ahead of clinical practice by about half a century.

Parents who get this right - and many do - are an extraordinary resource for their child. Parents who get it wrong, in either direction, can cause damage that takes years to undo.

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Where does that leave us?

Somewhere uncomfortable. Access to care matters enormously. So does rigorous, compassionate clinical oversight. So does a hard, honest look at the role that parents, culture and social environment play in shaping how a young person understands their own identity. None of those things are opposites - but in the current climate, they're too often treated as if they are.

The young, trans and waiting in the middle of all this deserve better than a proxy war. They deserve actual medicine, actual support, adults who can hold complexity without dropping it and parents who are honest enough to ask whether they're truly listening - or just hearing what they wanted to hear.

And they deserve doctors who understand that "wait and see" is not a neutral position. Sometimes, waiting has a cost. A fifty-five year cost. Ask me how I know.

I am a D&I consultant, keynote speaker, Mental Health First Aider, writer and transgender woman with 20+ years of senior corporate leadership experience. I work with businesses across all sectors to build genuinely inclusive cultures whilst also supporting transgender individuals and their families through every stage of the journey. If this piece resonated, you can find more articles on andreaking.net  or  book a free discovery call if you'd like to talk.

The views expressed in this article are my own and are based on personal experience and perspective. They are not intended as medical, legal or professional advice.

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Additional Supporting Research - Young, Trans and Waiting: The Case For and Against Under-18 Treatment

Research consistently shows that access to timely, gender-affirming care is associated with better mental health outcomes for transgender adolescents. A large prospective study found that puberty suppression in eligible young people was linked with lower rates of depression and suicidality over time, which supports the argument that delay can have meaningful psychological costs. https://pmc.ncbi.nlm.nih.gov/articles/PMC7906234/

A report by Science Direct suggests that access to puberty suppression and other gender-affirming care can make a meaningful difference to young people who need it. Studies have found that adolescents who received pubertal suppression were later less likely to report lifetime suicidal ideation, and that youth who accessed gender-affirming medication had lower odds of depression and suicidality over time compared with those who wanted care but did not receive it. That does not remove the need for careful clinical oversight, but it does support the argument that for some young people, timely treatment can reduce distress rather than add to it. https://www.sciencedirect.com/science/article/pii/S0029655425003306 

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Frequently Asked Questions

What is the main argument for treatment?

Untreated gender dysphoria can contribute to anxiety, depression and self-harm, while early intervention can give young people time and relief.

Why is caution still important?

Because adolescent brains are still developing, and clinical decisions should be robust, independent and in the young person’s best interest.

Why do parents matter so much in this debate?

Supportive parents can improve outcomes, while overly controlling or rejecting parents can distort a child’s ability to explore their identity safely.

What is the concern about puberty blockers?

There are still unanswered questions about long-term effects, particularly around bone density, so the evidence base needs honesty and care.

What is the overall message of the piece?

That young people deserve proper medicine, support and complexity from adults—not a culture-war proxy battle.

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