A growing number of children in Britain are being referred to the state-funded National Health Service (NHS) for counseling for transgender feelings, a development activists hailed on Wednesday as a sign of greater awareness of transgender issues.
The number of children - under 11 and some as young as three - being treated at the country's only specialist center for children with gender issues has quadrupled in the past six years, rising to 77 this year from 19 in 2009, NHS figures show.
Experts say up to 1 percent of the world's population are transgender - a term used to describe people who feel they have been born with the wrong gender.
The rise in child referrals shows a greater understanding of transgender issues, said Richard Köhler, senior policy officer at human rights organization Transgender Europe (TGEU).
"Transgender people now tend to be much younger when they come out, which is positive because they don't have to go through years of denial, and it means they have a supportive family," Köhler told the Thomson Reuters Foundation by phone.
Yet better awareness did not mean greater acceptance of transgender people, he said. "In that respect, we need to look at suicide rates, homelessness and the number of hate crimes."
An increasing number of countries in Europe are providing care for young transgender people, said Evelyne Paradis, executive director of lesbian, gay, bisexual and transgender (LGBT) organization ILGA-Europe.
Malta last week became the first European country to allow parents or guardians of a person under 18 to apply in court on their behalf to change their legal gender without any medical intervention or diagnosis.
The children referred to the NHS, primarily by psychologists, doctors and schools, are increasingly interested in exploring their gender, according to the Tavistock and Portman NHS Trust, which has clinics in London and Leeds.
While some transgender people experience gender dysphoria - discomfort due to a mismatch between their biological sex and personal sense of identity - others do not, and are comfortable with their body but not the gender they were born with.
The trust said gender dysphoria in young people was a complex and rare condition, and that it was not common or helpful to make a formal diagnosis in young children.
Young children with gender issues are instead offered counseling and support sessions until they reach puberty, when hormone blockers may be provided, which suppress the body's natural hormones and delay physical changes.
From the age of 16 patients can be offered hormones to make them more masculine or feminine, and from 18, gender reassignment surgery, at an estimated cost of around 10,000 pounds ($15,000) to the NHS.
"There is not one straightforward explanation for the increase in referrals, but it's important to note that gender expression is diversifying," the trust said in a statement.
"(This) makes it all the more important that young people have the opportunity to explore and develop their own path with the support of specialist services."
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