What is the Gender Identity Development Service (GIDS)?
NHS gender identity care for children and young people under 18 is provided by the Gender Identity Development Service (GIDS). GIDS is a specialised clinic for young people who experience difficulties with their gender identity. It is hosted by the Tavistock and Portman NHS Foundation Trust and commissioned by NHS England. The service has clinics in London, Leeds, Bristol and Birmingham. To be seen by a specialist team at the GIDS, any professional can refer a young person (although self-referrals are not accepted). The service has a waiting list meaning that people who get referred have to wait to be seen. The waiting time for the first appointment varies, but with high demand can take a long time. To find out the current waiting time, see the GIDS website (GIDS, 2022).
Support offered by GIDS
Interaction with GIDS starts with a psychosocial assessment, which usually takes between 3 and 6 appointments, and is done by one or two mental health professionals from the GIDS team. The aim of the assessment is ‘to explore and understand the child or young person’s past and current gender identification, as well as their development across a number of areas of their life.’ (GIDS, 2021) What happens after the assessment depends on a number of factors including the ‘young person’s age, gender experiences and the support they and the family are already receiving.’ (GIDS, 2021)
Depending on the young person’s age and their experiences, GIDS may arrange a meeting with a paediatric endocrinologist (doctor who specialists in hormones) in the GIDS team. These specialists will ‘discuss the child’s feelings around the physical changes of puberty and order a range of physical tests to look at the young person’s pubertal status, and their hormonal and chromosomal characteristics.’ (GIDS, 2021) If appropriate, they can then recommend to the GP that the young person is prescribed puberty blockers*. The young person can continue to receive support and guidance from GIDS until they are 18 years old.*2
The young people we spoke to talked about their experiences with GIDS. Some of the things they talked about included:
- Waiting times
- Lack of information and expectations
- Experience of assessment and process of GIDS
- Relationship with GIDS staff
- Communication with GIDS
- Crossing over between GIDS and adult services
The waiting times before being seen by GIDS were a primary concern of many young people who talked about the length of time it took between making a referral and being seen by the service. Those people who were seen by the service at the time of interview had waited between 18 months to over 2 years. Most young people were currently on the waiting list with little information about when their first appointment would be. Loges said ‘It’s a very long wait like I’ve been [waiting for 10 months] and I still haven’t heard anything. I know I’m on the list, but the list just gets longer and longer.’
Finn wishes that the GIDS service could be honest and clear with the referral time so that young people would know what to expect.
Jacob said it has been two years since he made his referral without being seen and Bailey said he waited over two years for his first appointment. Cas said ‘Personally I don’t like the length of [the waiting list]’. However, he argued that the waiting times could give trans young people the chance to ‘be definite in the choice they’ve made’ and give young people the ‘chance to remove themselves from the list’.
Many young people talked about the lack of support during waiting and how this was a struggle. Patrick said he found the wait before being seen ‘really challenging because there was nothing I could do. I was just having to hope that they were getting through people and I was going to be seen at some point in the near future.’ He found it particularly difficult because ‘I was stuck living somewhere super rural and isolated [and he] didn’t know any other trans people’. To add to this, any trans youth groups were three hours away’.
Evelyn talks about accessing puberty blockers and feeling helpless’ to the irreversible changes’ of puberty.
For some young people the waiting time was distressing due to puberty and the development of their bodies. Tom said ‘When you’re trans, time is precious’. Charke said they were ‘waiting for 18 months before my first appointment’. They said, ‘[during that time] I was very much stressing about puberty the entire time.’ They shared that ‘there wouldn’t be a day when I wouldn’t think [about] my body changing… in a way that I really don’t want to, yeah it was horrible’ (see also Experiences of mental health).
Some people shared how they coped during the waiting time between being referred and having their first appointment. Loges said ‘I just try and remind myself like at some point I am gonna get seen, no matter how long that is I will like get… everything I need to be myself.’ Charke said ‘I looked after myself through the hope that it would be good when I got there and that I’d get the help I needed. I was very optimistic in telling myself that look things are going as fast as they can, it will happen, you know, it, you will be fine, it will work out.’
Jacob says the waiting times are ridiculous and disgusting.
Jessica talks about having waited two and half years from referral. They’ve not got in contact with me yet. I just know that I am on the list.
Lack of information and expectations
Young people heard stories about GIDS through friends and other people’s experience of the service. A friend of Jacob’s felt the doctors at GIDs had not listened to him at his first meeting and he decided not to go back. Patrick said he had heard experiences of non-binary people who ‘were challenged and questioned at every step’ of their GIDS experience.
A lack of information and hearsay meant that some young people were anxious and nervous about being seen by the service and what to expect. Cas said ‘I don’t have any idea of what to say. I mean my friends tell me to answer [questions] as honestly as possible. I’m just scared that if I’m so honest they are not gonna accept me for it’. He said ‘[I’m] just hoping that I’m gonna be able to calm down, keep my cool, answer the questions and everything’s gonna be okay.’
Rosa talks about her expectations before going to GIDS and how they didn’t match the reality.
Patrick reflects on his expectations of GIDS. At the time it was really frustrating but looking back it was really useful to have that space to just explore what I wanted.
Cas suggested a ‘website for information on what the experience is actually like and what kind of things they do ask you.’ He continued, ‘what might come up as a question, the experience, what actually happens…and what kind of topics do they ask you…cause I have no idea.’ Declan talked about his expectation of GIDS, ‘it was explained to me… they’d have the standard blood tests and they would have to check your bone density and then they’d do a physical exam which would involve examining your genitals and I didn’t want to do that.’
Some people talked about the information they received from GIDS before their first appointment. Declan said he was asked to fill in questionnaires about his wellbeing before the first appointment. Patrick was impressed with the information GIDS gave him before the first appointment. He said, ‘the gender clinic gave me a really thorough document which talked about all of the changes.’ He said, ‘you have to like sign it to say that you know, that they’ve told you this stuff.’ He ‘found it really useful having it all written down and just seeing it all in one place of like these are the like changes you can expect to happen. Bailey said, ‘[GIDS] have given like letters and leaflets and all that sort of stuff.’
Experience of assessment and process of GIDS
The young people who had accessed GIDS shared their experiences of the service. This included the assessment, the sequence of sessions, the questions asked and the relationship with practitioners. Some people had early experiences of GIDS that dated back a number of years. Tori said she first encountered GIDS as a six-year old. She said ‘they didn’t identify me as transgender at six years old, and even though my parents still were allowing me to buy the girls shoes that I wanted, or wear the girl top that I wanted, they still tried to encourage my male side too.’ However, she said ‘I think that balance kind of threw me off a little bit’. She revealed that ‘I would have loved them to have identified me there and then… because I would have still got into the place that I am now’.
Tom talks about his experience with GIDS the people were lovely and they really helped me get through.
People shared the sequence of sessions with the service. Eel said ‘They did talk about how we would have like six sessions where they would kind of like get to know me and then at the end of it they would write a big assessment or report on me.’ Bailey said ‘You normally have six to eight appointments every month to six weeks’. Declan said he ‘probably had about seven [appointments] maybe, around that’.
For some people the assessment sessions were an opportunity to talk openly how they felt and were a positive experience. Tom said ‘We met these two wonderful people, and I just managed to get everything off my chest, and it was a really good feeling.’
Evelyn talks about her experience with GIDS including the assessment process and the appointments.
Questions were asked about their wellbeing, their family and their childhood. Eel said the sessions he had at GIDS ‘made me feel a bit better and that I was working towards something’. Others felt that the assessment process was less positive and uncomfortable.
Some people found it frustrating after waiting so long to get an appointment especially if they had a clear idea of what they wanted. Rosa felt ‘my entire experience of trans specific healthcare is being grilled about my identity to see if I fit the criteria or not for more treatment.’ She didn’t feel she had the space to properly work through the issues she’s had with her gender and felt that ‘it was basically just medicalised gate keeping and that’s it.’
After the assessment sessions people received a written report. Rosa, Tom and Jacob felt their report did not reflect what they had been saying during their sessions or they felt unhappy with the way it had been phrased.
Most young people were seen by GIDS before they transferred to the adult list. But Jacob felt “cross and upset” at being on the GIDS waiting list for two and a half years without any communication from them and had not been contacted when he was aged 17 and half to transfer to the adult list. He felt “their system isn’t working,’ and chose to go privately.
Declan was pleased with the support that GIDS gave him with talking to his school.
Relationships with GIDS staff
Many of the young people who accessed the service were grateful for the supportive relationships they made with their GIDS doctors. Declan said ‘the people who worked there were actually really nice’. Eel described staff at GIDS as ‘really kind and …just very nice and I felt very cared for when I was talking to them.’ He also said they were ‘really helpful.’ He said that the work he did with the GIDS service ‘was a way for me [to] kind of unload and also just becoming friends with people again and [have] really meaningful …friendships with people that I really tried to maintain and that’s really brought my mental health up’. People talked about the different types of support they received from the GIDS service. Declan talked about how they wrote him a letter ‘to get my passport gender changed.’
Declan talks about his experience of the questions asked at GIDS including his wellbeing’ and transition goals.
Communication with GIDS
People had mixed experiences communicating with GIDS. Some of them shared their frustration about a lack of communication with staff. Declan said ‘There was very little communication to and from the clinic.’ In particular, it was nerve-wracking not knowing how they were progressing on the waiting list. Declan said his mum would try and contact the service for clarification. He said ‘if you didn’t do that, you just wouldn’t know where you were on the waiting list or if you were there and how long you should expect to wait.’
Sometimes people wanted to keep their communication with GIDS private due to a lack of support from family. Patrick said ‘Some of the letters when you’re with GIDS get addressed to your parents. I would intercept the letters and open them myself because it, I didn’t really want my parents having this information about me.’
Jacob talks about his frustration communicating with GIDS about his progress on the waiting list.
GIDS staff could also act as a useful communicators between the young person and their family. One person talked about the help GIDS staff gave in communicating his feelings about gender identity to his parents. Bailey said ‘The doctors told them. Cause I’m not great with words, cause obviously autism so they mentioned all the [GIDS] stuff and all of the treatment and all of that stuff. I didn’t say anything about that, cause I just found it difficult to talk to them.’
Crossing over from GIDS to adult services
At around the age of 17, young people seen by GIDS can be referred to the adult gender identity clinic (GIC). Currently, young people who are 17 ½ can be transferred from the GIDS waiting list to the adult gender identity clinic waiting list (check the GIDS website for the most up to date information). People talked about their experiences of this crossover. For one young person who was being seen by GIDS it was a smooth transition with less waiting than he was expecting. Tyra said she ‘had [no support] from 17 to 18…because of my age, like there was no service to put me into.’
Patrick says the crossover from the young person services to adult services had been really easy.
Eel talks about reaching GIDS at an age where he had already gone through puberty’ and hormone blockers wouldn’t do anything.
* As of 26/03/2021 “The High Court has handed down a judgment that confirms parents can consent on behalf of their child for hormone treatment to suppress puberty” (GIDS, 2021). Please always check the GIDS website for the latest news about this.
**Gender Identity Development Service, 2020. Support that we offer. Available at https://gids.nhs.uk/about-us#support-that-we-offer