is what Carmichael and her team must grapple with. The increase in demand means that children who used to be seen within 18 weeks currently have to wait nine months (although it is hoped that the recruitment drive will change that). Transgender groups complain about the delay and argue that experts at units like the Tavistock are too cautious. Much of the debate swirls around hormone injections: both hormone blockers — prescribed at puberty to inhibit the development of secondary sexual characteristics such as breasts or facial hair — and cross-sex hormones, which the Tavistock prescribes at 16 to masculinise or feminise the body. Thus, a girl who wants to be a boy (a natally assigned girl) will be given testosterone (or “T”, as it’s known in the chat rooms). It’s after this that, when the person is 18 and goes into the adult service, they can opt for surgery.
Hormone blockers are seen as a chance to put the brakes on development, to pause and think about the future. However, 90 per cent of patients go from hormone blockers to cross-sex hormones, hormones that leave teenagers infertile. And it’s these cross-sex hormones that cause the most controversy. In America they are prescribed at private clinics to patients as young as 12. There are some in the trans community who argue that the age limit is too high in the UK.
Helen Webberley, a GP in Wales, has set up a private gender clinic and recently started treating children, a “handful” of whom, according to news reports, she has started on cross-sex hormones, including a 12-year-old. Meanwhile, the internet means that there is little to stop under 16-year-olds from buying cross-sex hormones online.
“Currently the zeitgeist is that you go with the child, following the child’s lead and wish at every step,” says Carmichael. “There has been a large decrease in the age at which cross-sex hormones are available, particularly in the US.
“The big debate at the moment is the pressure to introduce cross-sex hormones earlier and earlier. We have done so at around 16 and we might introduce some flexibility around that. But 12? That is a big departure. The reality is that for some young people, things change all the time. For example, starting a relationship with someone can be associated with them thinking very differently about their gender. This isn’t straightforward.
“If young people are being given the strong message that it is the end of the world if they don’t get hormones immediately — perhaps the suggestion you should fast-track people who are self-harming — that is potentially damaging.” As she says, with some understatement, “It is tricky, really tricky.”
Matt, born Matilda, is one of the increasing numbers of natally assigned girls who wish to change gender. The trend at the Tavistock used to be more boy to girl by 3:1, but in the past five years the ratio has reversed.
Matt is also on the autistic spectrum, which complicates the issues (according to the documentary, as many as 30 per cent of male-to-female cases are on the spectrum, a link no one can explain). Matt’s diagnosis means that he finds it especially hard to talk about his emotions and the therapists must try to work out if the gender dysphoria is real or an obsessional fantasy. As Carmichael says, “We know he has an incredible imagination. Might it be a story he has created for himself?”
Rachel, Matt’s mother, was clear when she agreed to take part in the Tavistock series that she didn’t want to sugar-coat what Matt and the family has been — and continues to go — through. They live in Wales. It’s fair to say that in their part of the world transgender rights are not on many people’s radar. Sometimes it’s the small things that resonate. Matt, who loves swimming, was recently disqualified from a competition for being in the boys’ team. “I said to my partner, Pete, ‘Don’t flower it up.’ I want it as gritty as it gets so people see what it’s like.”
At the Tavistock, Matt’s caseworker, Dr Charlie Beaumont, encourages him to unpick his feelings, but Matt finds it painfully difficult to talk. His caseworker is concerned there “is a lack of consistency of gender presentation”. On the other hand, if not prescribed blockers, might Matt self-harm? Matt is 12. There are signs that breasts are beginning to develop. It’s not long now before periods will start.
There is a sense that time is running out, but Rachel tells the doctors tearfully: “I’m not quite ready to lose Tills.” She struggles with the impression that has come from Hollywood that being transgender is easy. “I hear all the stuff about people being gender fluid and think, this isn’t a fashion thing. There are people in the media who make this all look easy: a man one day; a woman the next. But the reality is it’s hard work. I wouldn’t wish it on anybody. This isn’t left-wing parenting. I’m not somebody going, ‘Look how fluid I am with everything.’”
Matt, who loves writing stories and is a massive fan of David Walliams (who wrote the children’s book The Boy in the Dress), is round-faced, with short hair and expressive big brown eyes. At passport control the authorities often cast around for a girl — “Where’s Mathilda?” — and don’t believe his mum when she points to Matt. So much so, the family has a letter from GIDS for whenever they go abroad.
As early as aged two and a half, a health visitor commented that Matt — then known as Matilda, or Tills, which is what Rachel still frequently calls him, perhaps betraying her own bewilderment at the turn of events — had an unusually deep voice. “As she got older I always thought she was just a very strong tomboy,” Rachel says, looking back. “Detested wearing dresses, didn’t want to have her hair combed. I remember buying her knickers and thinking, why on earth does everything have to be covered in princesses? Aged five, she told me she wanted hair that didn’t move. In other words, she wanted me to shave her hair off.
“I wasn’t too bothered. Not until she started telling everyone she was a boy. At that point, I thought I’d better go to the doctor.” Hormone tests were carried out and the assumption was that this was a child who was intersex. When the tests came out negative, Rachel was referred to the GIDS unit.
What was that like? “Oh, they make you question everything,” she says. “I think they are trying to find out if this has been nurtured at all. Is this the child or is this the parent pushing their child to be something they don’t want to be? But I think they identified quickly that I wasn’t happy about it. Why would anybody want their child to face the kind of prejudice that was likely to come her way?”
Matt struggled with his education and being bullied until he got a place at a specialist school where he is accepted as male. “At the old school I’d beg them not to be so gender specific. Now I worry that I sent him to the wolves every day.” Despite his being happier at school, Rachel still checks on Matt through the night because she is worried he might hurt himself. She has got rid of anything that could cause harm — the cords on a blind, dressing-gown ties.
In the documentary we watch Rachel weighing up the pros and cons of hormone blockers. “My concern is that it suppresses things. Maybe if she did go through puberty, she’d click into girl mode and be actually, ‘I want to be a girl now.’ I don’t think that will happen, but my worry is that I really am interfering. Now this isn’t nature, it is nurture. On the other hand being able to press the pause button could be a good thing.”
What does Tills/Matt think? “Tills thinks the rest of the world has gone mad. Just leave me alone. What’s wrong with me? I’m just me.”
Stephanie Davies-Arai is a parent coach behind a website called Transgender Trend, concerned about the rise in the number of children referred to gender clinics. She argues: “We are setting children off on a path towards sterilisation: medicalisation. It is an experiment that has no precedent … Are we really willing to so readily accept that a child is the ‘wrong’ sex at this age rather than address the bullying and the culture that tells him so?” It’s a view, she says, that has lost her friends — “There’s a feeling that if you don’t go along with current trends, you are transphobic.”
At first I presumed Transgender Trend was religiously or politically motivated, but that doesn’t seem to be the case when we meet. Her view, thoughtfully argued, is that when she was a teenager she, too, would have questioned her gender. “I would have been trans. Because I was not only a tomboy; in my head I was a boy. My sister and I went through our pre-pubescence calling