The Gender Identity Development Service (GIDS)

What is the Gender Identity Development Service (GIDS)?

Gender identity care for children and young people under 18 is provided within the NHS by the Gender Identity Development Service (GIDS). GIDS is a highly specialised clinic for young people who experience difficulties with their gender identity. It is based at 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, a young person usually needs to be referred by their GP or a local Child and Adolescent Mental Health Service (CAMHS). However, some people we spoke to talked about their young person being referred via school, or a charity. 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 you see the GIDs website (GIDS, 2020).

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.’* 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.’ Depending on the young person’s age and their experiences, GIDS may arrange a meeting with a paediatric endocrinologist 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.’ If appropriate, they can then clear the young person for hormone blockers. The young person can continue to meet with the GIDS clinicians after their assessment and receive support and guidance from GIDS until they are 18 years old.*
In our interviews, parents and carers shared a range of experiences with GIDS. In this section, you can find out more about these. Some of the things that parents/carers talked about included:
The first appointment at GIDS;
  • What happens in the GIDS appointments;
  • What happens between appointments;
  • Importance of trust and continuity;
  • Cost and time; and
  • Fears and hopes for future appointments.

The first appointment at GIDS

The parents and carers we spoke to shared their experiences of going to the first appointment at GIDS with their young person. They also talked about what happened in that first appointment and how they and their young person felt about it.
In our interviews, people shared mixed experiences of going to see GIDS for the first time. For some, the first appointment was positive, informative and reassuring, whilst others felt disappointed. Many parents had researched and looked for information about the existing pathways and support available to their family. This meant that there was often a lot of anticipation and eagerness to get input and help from the service, but at times also a lot of anxiety and uncertainly about how that experience would be.

Richard found the GIDS clinicians to be amazingly supportive and understanding’ of his family.

Depending on the age of their child and their needs, parents and carers had varying expectations towards the service. This point was emphasised by one parent who said, ‘I think the important thing to say is that the experience with GIDS is really dependent on who you get as your therapists and what your child’s needs are. So that, you know, it is kind of really, you know, unique, I suppose and a mixture of those things’ (Adele).
For many parents and carers, the first appointment would come at an end of a very long wait during which they would have had many conversations with their child about how their child felt about their gender, as well as about the service and what they wanted to get from it.

Adele talks about her son’s first appointment at the Gender Identity Development Service.

Some had very practical expectations, such as Andrew who had hoped his daughter’s hormone therapy, for which the family was paying privately, could be taken over by the NHS. He was disappointed to be told that was not an option. He shared: ‘after about two years on the waiting list, we eventually got to see two [specialist at GIDS], But, they couldn’t help us. We waited two years to see them and when we got to see them, there was nothing they could do, apart from psycho-social support, because she’s not [an] adult, yet.’ Andrew felt the NHS did not want to ‘get it wrong’ when it comes to young people. He emphasised: ‘They [the NHS] have to make sure that… trans kids have time to really figure out what it is they want. And then once they’re eighteen they can make a choice and then the NHS will, will help them.’ Other parents like Oonagh also believed that the service takes a wait and watch approach with the young people.
One parent felt that GIDS was not able to help his child, who needed hormone therapy but was under 18. He felt that he wanted more than ‘friendly chats over the table’ and wanted more help especially ‘when theres depression’ and dysphoric feelings.
The way people felt about the service sometimes changed. Parents spoke of negative first impressions, but an improvement in how they felt about the service over time. Whilst some parents and carers, felt the appointments started well, but with time, they found themselves questioning how helpful it was for their child to go to GIDS. In some instances, parents and carers asked to change the therapists their child was seeing at first, which people like Georgina felt improved the care their child was receiving.

Josie had positive first impressions of the Gender Identity Development Service but that changed with time.

Georgina was disappointed with the first appointment at the GIDS, but felt more positive when her son got a new therapist.

Often parents and carers did research on other people’s experiences with the service. One mother whose child was waiting for their first appointment at GIDS observed that she was trying to take stories of other people’s negative experiences with the service ‘with a pinch of salt.’ She said ‘people often repeat the bad stories if they’ve had a bad experience. And, so, I think some people have had a bad experience with individual clinicians that they’ve seen that they’ve not been happy with. But, you know, everybody is after something different and everybody gets on differently with different people.’

What happens in the GIDS appointments?

In our interviews, we asked parents and carers about what happens in the GIDS appointments. They talked about the therapeutic and assessment processes and how they and their young person felt about it. Many spoke about the kind of questions that the GIDS team would ask them and their child.
Georgina shared: ‘They …ask how things are going. And how were doing and, and if anything… significant has happened.’ Other parents described being asked about their family history and relationships. For example, Lisa emphasised: ‘we were asked lots of questions about our history, our family composition about our experiences, our individual experiences, the people who surround my son and their experiences and their relationships with him.’ While Mel said, ‘And we were all waiting for puberty. It’s like, that’s it, you know, they’ve gone through all the different options, all the psycho, psycho analysis. All the assessments and they still go every month and have consultations, which I haven’t attended any. I’ve been, I could but normally the days that they do them I’m working or it’s just not organised that way. But my husband and his ex-wife always go. Granma’s gone sometimes. Sister’s gone. But always report back on how things went, so that’s great. They’ve been fully involved in that process.‚Äù
Because young people can be referred at any age, the timing of getting to GIDS played a large role in affecting what happened in the appointments and also how people felt about their care. Parents and carers of young people who were going through puberty, stressed that there was a sense of urgency to get seen by the service and subsequently be able to access hormone blockers. Parents and carers felt the appointments and processes were a lot to ask from a young person who was expected to open up about very private and intimate details of their life, whilst knowing that they are being assessed to access the help they desperately need.
Other parents emphasised that they understood the cautious approach the service was taking ‘clearing’ their young person for medical interventions, while also sympathising with their child, who desperately needed them and was going through unwanted puberty.

Ali talks about her daughter’s experiences with the GIDS. She felt that she understood why the process was slow, but also why her daughter found it frustrating with time slipping away rapidly.

Lisa describes what happens in the GIDS appointments and how her son feels about the process.

Importance of trust and continuity

Parents and carers we spoke to emphasised the importance of trust and good rapport with the specialist team. Many spoke about the fact that it takes time for the young person to feel they can trust someone with sensitive and private issues, in particular in the context of being assessed. Leigh shared about her foster son: ‘When he attended [GIDS] he went monthly for assessments with his therapist who has remained his therapist throughout, he has had that constant and hes managed to build up a really good relationship with his therapist, Finally, maybe a year or so ago, [he] started opening up about other stuff. So, in that way, hes been supported with them. Thats, thats been quite good.’
For some people we spoke to, it felt like building trust was hindered by frequent staff changes at the service. Ross spoke about how his child’s therapeutic team changed several times and how he and his child felt that there was no sense of continuity to the therapeutic relationship as a result of staff changes. Lisa also shared that her son’s two therapists ‘left within a month of one another.’ For Lisa this felt like a setback. She shared ‘we’re now not quite starting from the beginning, but this new therapist has to reassess my son… [and] we haven’t been given a timescale for that assessment.’

Ross speaks about his child’s appointments and the frequent changes of therapists that left his child feeling disillusioned with the GIDS.

A point many parents and carers raised was how they felt the appointments were too infrequent and brief. Ali observed that she wanted ‘to talk things over with … the therapist … [but] because its only an hour appointment and its only … every four to six weeks [there] just wasnt the time to do it.’ Georgina felt that the three-monthly appointments her son was going to did not feel like enough. She emphasised, ‘I dont think thats enough for them to get to know somebody, especially a child whose gonna reluctantly talk about something so private and embarrassing potentially. They need to build a rapport and they need to see them more often, I think’.

Cost and time getting to appointments and taking time off school

Another common theme was the cost of travelling to the appointments and the time it took to get to a clinic, which was often not close to where they lived. Many parents and carers emphasised that it was both expensive (because of the travel costs) and time-consuming to attend the appointments. It was not uncommon for parents and carers to have to take annual leave to get to the appointments. For example, Lisa shared: ‘I don’t get paid if I don’t go to work. My son’s father has a limited amount of leave, so he’s now in the realms of taking unpaid leave. We have to go down to [GIDS] from where we live and in terms of lost income, every appointment costs us hundreds …of pounds’. Parents and carers also spoke about their child missing school to travel to the appointments.

Richard talks about the cost of getting to the appointments, and how they can be ‘quite enjoyable’ but also draining.

Mel felt the appointments were going well for her step-daughter but also stressed the cost of getting to the appointments.

What happens between appointments?

Some parents we spoke to felt that there was not enough communication with and support between appointments at GIDS.
Lisa said that it had been difficult to contact their new therapist and to have the appointments confirmed. She said, ‘We last had our, an appointment in September, we were supposed to have an appointment sent to us for December. I still haven’t had it. I’ve chased the appointment. I still haven’t heard anything.’ At the same time, many parents and carers acknowledged that the service is overstretched and struggling to respond to the increased demand and felt more resources should be put into it.

Georgina felt nervous about her son’s assessment at the GIDS. She also felt she had no way of communicating with her son’s therapists between the appointments.

Jan felt the long waiting times were unacceptable and the service needed more funding to meet the growing demand.

Fears and hopes for future appointments, and views of the service

Some parents we spoke to had children who were on the waiting list to the service, so had not yet experienced going to the GIDS. They shared their hopes and fears about going to see the GIDS. Some spoke about hoping for psychological support, whilst others wanted practical support or a mixture of both.
Oonagh shared that she was hopeful about the possibility of having a good experience with the service but also shared: ‘my worry is that [my daughter] doesnt really display dysphoria. And, that because she doesnt display dysphoria about her body that theyre gonna see that as some sort of indication that shes not trans. To me, Im giving it the benefit of the doubt, everythings pointing to the fact she is trans but she doesnt necessarily have to have dysphoria to be trans. But I worry that the GIDS system seems to think that you have to be really really in, trauma about your body to be trans.’
In our interviews, many people also shared their thoughts on how healthcare and the pathway could be improved for young trans and gender diverse people.
*Gender Identity Development Service, 2020. Support that we offer.

Experiences with private healthcare

Adults and children can access NHS specialist gender identity services free of charge. However, the waiting lists at these services may mean a long wait...