The specialist clinic at Melbourne’s Royal Children’s Hospital treats teenagers who feel trapped in the wrong body and want to suppress puberty before it becomes harder to influence how their body develops.
The operators of the clinic say parents struggle to overcome the many obstacles to treatment and more treatment services are needed.
People with gender identity disorder often liken the experience to living in an alien body.
Dr Campbell Paul, a child psychiatrist at Melbourne’s Royal Children’s Hospital, says children can be affected by the disorder from a young age.
"Often even at a young age, at six and seven, young people are talking about, ‘can I have my body changed? Can I have bits cut off?’" he said.
"And for some of these kids, the depression that they experience, the anxiety and alienation becomes very intense and they have thoughts of self harm and rarely, but at times act that out too, and actually may hurt themselves."
The hospital’s Paediatric Gender Identity Disorder Clinic was set up in 2003.
In its first year the clinic saw only one patient, but last year it treated eight children and Dr Paul says it has had about 50 referrals in the nine years since it began.
"As a result of people being aware that a clinic is available and that there is an understanding and a way to help, I think more and more parents are seeking help," he said.
"In the past, I think, often the children and the parents as well, tended to feel that they had to manage this by themselves."
Seven children referred to the clinic have successfully applied to the Family Court for permission to suppress puberty, giving them more time to consider cross gender hormone treatment and surgery.
But Dr Paul says some families have chosen not to pursue treatment because the legal hurdles and lawyer’s fees are too much to bear.
"At the moment that’s the way the law is. But each time we’ve been with families to the Family Court, the Family Court has approved treatment. But for families with limited resources it can be a problem," he said.
He says he and his colleagues have seen children who have been referred from interstate and as the awareness of gender identity disorder continues to grow other states should establish similar services.
Dr Paul is the co-author of a paper just published in the Medical Journal of Australia, reviewing the clinic’s activities.
He admits the long-term psychological and health outcomes of cross-sex hormone treatment are unknown and there are ethical questions to consider.
"We take that issue very seriously; which is why we have a multidisciplinary, interdepartmental clinic; so we have people from psychiatry, from endocrinology, gynaecology, paediatrics," he said.
"And we also work very closely with the Hospital Clinical Ethics Service. So we don’t make a recommendation for hormone treatment unless we have had discussion with a clinical ethics group and approval from them."