Synopsis
Offer respectful, exploratory and developmentally appropriate care to a young person with gender-related questions or distress, address physical and mental health without diagnostic overshadowing, assess consent and safeguarding, support family and social functioning, and use the current commissioned specialist pathway for any gender-service or medical intervention decisions.
- Ask the young person which name, pronouns and terms they want used, who may know them, and which communications are safe; do not disclose identity information casually.
- Offer an open exploration of experience, duration, distress, body concerns, hopes and uncertainty without steering towards a predetermined identity, social outcome or medical intervention.
- Take a complete adolescent history including development, puberty, menstrual or genital symptoms, mental health, neurodevelopment, eating, substances, relationships, school, online life, bullying and safeguarding.
- Treat depression, anxiety, self-harm, pain, acne, menstrual symptoms, sexual-health needs and other ordinary conditions promptly; referral to a gender service is not a reason to withhold general healthcare.
- Assess decision-specific competence or capacity and family and peer influence for each care choice, using communication adjustments and private time rather than assuming autonomy or incapacity.
- Support families to maintain safety, connection and respectful dialogue even when views differ; protection is required when conflict becomes abuse, coercion or threatened homelessness.
- Use the current NHS Children and Young People's Gender Service referral pathway and service specification; confirm local eligibility and information requirements because commissioned pathways can change.
- Puberty-suppressing hormones are not routinely commissioned by NHS England for gender incongruence, and non-specialists should not initiate or informally continue unregulated prescribing outside current policy and governance.
- When medication has already been obtained elsewhere, do not abandon the young person: assess what was taken, adverse effects, immediate safety and safeguarding, and obtain current specialist and regulatory advice.
Key red flags
Suicidal intent, escalating self-harm, severe depression, psychosis or inability to remain safe requires direct urgent assessment irrespective of whether distress is attributed to gender.
Threats, punishment, forced concealment or disclosure, conversion attempts, eviction, bullying or online exploitation indicates safeguarding and housing risk.
Medicines obtained from unregulated sources may have uncertain identity, dose and monitoring and require non-judgemental assessment of immediate adverse effects and specialist advice.
Headache, visual symptoms, chest pain, breathlessness, unilateral leg swelling, jaundice, severe mood change or injection complication during hormone exposure requires urgent medical evaluation.
Pubertal delay, rapid virilisation, galactorrhoea, growth disturbance or genital or gonadal symptoms should be investigated clinically rather than assumed to arise from gender distress.
Investigation priorities
Understand the young person's experience, goals, distress, functioning and interacting needs.
Management branches
There is suicide risk, abuse, homelessness, severe distress or possible medicine toxicity.
- Use emergency physical or mental-health pathways and maintain respectful name, pronoun, privacy and communication choices where safe.
- Assess privately for self-harm, family violence, bullying, exploitation and the exact source and use of any medication.
- Involve safeguarding, paediatrics, toxicology, endocrinology or emergency services proportionately and explain information sharing.
- Secure safe accommodation, supervision, treatment and follow-up without making ordinary healthcare conditional on identity decisions.