When Bella started year 9, she was the target of a persistent bullying campaign and felt isolated from her peers. She had undiagnosed autism spectrum disorder and her mum, Sally, says Bella didn’t fit into any of the usual boxes. Many of the children in her school were identifying out of their birth sex, the school promoted ideas about gender and she was caught up in narratives about it online. Bella told the school that she wanted to be called Ben, to use he/him pronouns and to be treated to all intents and purposes as a boy. The school agreed. They didn’t tell Bella’s parents, though, who found out accidentally a few months later through another parent.

Sally was blindsided. Kids are told online that their parents will hate them and disown them for questioning their gender, she says, so their distress remains hidden. “Bella was basically, at the age of only just 13, terrified that we’d kick her out, which would never, ever, ever, ever happen.” 

Parents across the country are having similar experiences, driven — in part — by a poorly evidenced, one-sided narrative that it’s been difficult to counter. #nodebate has been its defining hashtag. This rendering tells children that whether they are a boy or a girl, or indeed something else, is a choice. They are often led to understand that, if they don’t conform to gender stereotypes or they don’t like their bodies (what teenager does?), they must be trans. Social media reinforces this message. Schools and parents are told that to affirm children in their chosen gender is the only ethical choice.

But the wisdom of affirming children in this way is anything but settled science. Long-term consequences of social and medical transition are mostly unknown, but we do know some things — that teenagers and adults at the end of this pathway experience irreversible effects, including infertility and an inability to enjoy sex. We also know that an increasing number of people who transition experience regret. This information is often glossed over or its existence denied. Stonewall tells schools they “have a responsibility to support trans children or young people through a transition,” but makes no mention of schools’ safeguarding responsibilities.

Even the short-term consequences of affirming teenagers in the gender they choose haven’t received proper attention. Our review of the research shows that this affirmative approach is based on shaky evidence at best. At worst, it may actively be harming children. Without high-quality research on physical and mental health outcomes for children who are affirmed in their chosen identities, parents, schools, therapists and medical professionals are flying blind. 

It’s impossible to say whether teenagers have an innate, immutable sense of gender identity, because it’s subjective. We do know, though, that most gender-questioning teenagers have underlying risk factors. Many have mental health issues that pre-date any gender-related distress. Most are same-sex attracted. Teenagers who are gender-questioning are eight times more likely to have autism spectrum disorder than their peers. Still others see TikTok and YouTube videos telling them that if they’re uncomfortable with their bodies, they must be trans and transition will solve their problems. There’s strong evidence for an element of social contagion through which clusters of friends experience gender dysphoria.

Teenagers lost in a black hole of gender TikTok aren’t helped back into the real world

We don’t fully understand the consequences of affirming children in this context. We do know that ignoring this evidence risks missing an opportunity to support them in resolving what’s happening underneath. Girls who like girls and boys who like boys aren’t helped to be comfortable with their sexual orientation. Sad, anxious teenagers don’t get mental health support. Those with neurodevelopmental conditions aren’t supported to understand their sex doesn’t determine how they need to act or dress. Teenagers lost in a black hole of gender TikTok aren’t helped back into the real world. 

Another risk is that an identity is made concrete that would only otherwise have been a passing state. Teenagers experiment. Identity shifts. This is normal.

The discovery that their child is experiencing gender distress often comes as a huge shock to parents. In Brighton, for example, the local council tells schools that if children are questioning their gender, their parents don’t need to be informed. This guidance even states that school staff may want to use a child’s preferred name and pronouns at school, and birth-registered name and sex-based pronouns in front of parents. Parental deception, in other words, is not just accepted but encouraged. 

The lack of evidence underpinning the affirmative approach of many schools and healthcare professionals has led some parents to take action. “Social transitioning isn’t a neutral act,” says Sally, who has lost her trust in institutions to act in children’s best interests. This has led her to join advocacy groups and attend protests to effect change. “I never thought I’d find myself shouting outside the Houses of Parliament.” 

Schools are complicit in harming children when they socially transition them without parental consent, she believes. “They need to be made aware of that.” Bella’s school eventually agreed to follow a watchful waiting approach — supporting Bella, while not affirming all aspects of her new identity — after Sally encouraged them to do so. Parent support groups have also sprung up in recent years. These are helping parents to connect with others in similar situations, as well as to understand the very limited evidence base and what it may mean for their children.

It’s easy to act emotionally when your child tells you they’re questioning their gender, says Sally, but it’s best to tamp emotions down. “Keep your child as close as possible,” she advises, “because people online try to separate you. It’s really important to keep the relationship strong, even if you have to push things under the carpet for a while and not talk about it.” 

Then, once your child is ready, you can present an alternative narrative — that it’s fine to be gender non-conforming, and the aim should be to feel comfortable to be yourself, whatever your sex. It would be even better if institutions or others outside the family could help children with this message too. “But that side isn’t presented,” she says. “It’s presented as if you don’t follow this route, you’ll never be happy. You’ll kill yourself.”

Sally’s hopeful for the future. Bella has a strong friendship group now, and therapy has helped her to build her self-esteem. She’s also been diagnosed with autism spectrum disorder, a mantle that she’s happy to wear as part of her wider quest for an identity. “I’m so proud of her,” says Sally. “What I want, really, is for her to be safe, healthy and happy — but that’s what anybody wants for their kids.” 

As for Sally, she says she’s a completely different person than she was before Bella experienced her gender-related distress. Her optimism is forged by better information, an ever-strengthening evidence base and people willing to challenge positions based on flimsy data that have, until recently, been unassailable.

Names have been changed.

Teenagers and Gender Identity: The Evidence Base is published by Sex Matters