MM's Jessica Wilson discusses Gender Dysphoria, sexuality and acceptance with some of Manchester's transgender community.
In Native American tribes, the twin spirited body is the most prized gift of nature.
A berdache, or two-spirit, is someone who possesses two souls within one body- one male and one female.
Unlike much of the western world, this indigenous culture doesn’t restrain itself to two gender categories, but has openly embraced a third.
For thousands of years, two-spirits have been regarded by tribes as the binding force in their society, with the strength to negotiate between and unite its male and female counterparts.
But in The West we have not naturally welcomed the sacred aura of our own two-spirits; those among us who feel they are a different gender to that which Mother Nature gave them.
As a foetus grows in the safe harbour of its mother’s womb, the outside world prepares for its arrival.
And at a five-month pregnancy scan eager parents can discover the physical gender of their baby, from which point their world is created against a blue or pink canvas.
Babies turn to toddlers, and toddlers to young children, with most of them falling into their predisposed social gender identities with ease.
Generally, girls play with Barbie dolls and have tea parties with teddy-bears while boys climb trees and roll around in the mud.
But what if the soul of a person doesn’t fit inside the body they were born in? What if a little boy believes he is a girl? Or if a little girl desperately wants to grow into a man?
As much as 3% of the UK population feel this way.
Gender Dysphoria (GD) is the medical term given to people who strongly identify with the opposite gender and experience persistent anxiety about their physical gender.
Most transsexuals experience feelings of gender dysphoria between the age of five and seven.
In recent years, the number of stories about transgender children in the headlines has skyrocketed in correlation with the number of patients being diagnosed.
But although public awareness of the condition is growing, transgender children still face mountainous hurdles in their day-to-day lives.
There are endless moral, ethical and legal dilemmas to consider in children at such a tender age.
Jenny-Anne Bishop, the group co-ordinator at TransForum in Manchester, said that like a lot of things in life, if you haven’t lived through an experience then it is hard to understand or empathise with it.
And hundreds of transgender children face prejudicial injustices on a daily basis.
As a result, almost 50% of transgender children have thought about suicide or self-harm where the figure for most children lies at less than 0.1%.
Jenny-Anne told me that one parent she knows personally only realised the severity of her child’s distress when she went to the bathroom and found her supposed son trying to cut her penis off with a pen knife.
“We have heard many stories like that from members of the community. As a child, I remember thinking that one day I would lose it and become a girl,” she added.
One of the most difficult places for transgender children to find support can be at school. And for every 100 students in a school there is likely to be at least one transgender pupil.
Karen’s 15-year-old son, James, of Stockport, transitioned when he was 14 in the first year of his GCSEs.
The teenager’s mother told me that the school had been very reluctant about James’ transition at first but that she feels very lucky with the support they have now.
She said: “The school said that because he was at the end of year 10 it would be better if he waited until he left school, but that wasn’t an option.
“He had been building up to telling us about it for years so we couldn’t just say ‘right, OK, well you’re going to have to forget about it until you leave school’.
“And we couldn’t support him outside school and ignore it inside school.
“Since then, the school arranged for him to use the disabled toilets and organised a separate changing room for him for PE.”
Jenny-Anne told me that the practical issues that come up regarding toilets for transgender children in schools should not be a problem.
She said: “Unisex toilets are the obvious answer. In most places toilets are just toilets- we don’t use them separately in our homes.
“One thing I remember from my school days as being really awkward was changing and showering because I felt my body was inappropriate and I didn’t want the other children to see it.
“The other kids probably wouldn’t have understood at all but I just felt that my body wasn’t the way it should be.
Transgender education is still not taught in most schools.
Karen explained that this means if a child does come out as transgender at school, the other children don’t know about it.
Jenny-Anne said: “For youngsters that are changing it’s very important that the school is educated and the pupils are properly introduced to the subject.
“It’s no good the school just saying that a pupil can come back to school next term as the opposite gender and then leave it to chance.”
Jenny-Anne emphasised that being transgender is generally a primary school issue where as sexuality is a secondary school issue.
She said: “I think with very young kids it’s really a non-issue.
“Being transgender has nothing to do with sexuality. It’s about being comfortable in your gender. Sexuality comes much closer to puberty.
“People working in schools sometimes don’t help, not because they are not there to support but sometimes they discourage by not saying anything.
“If Linda goes and dresses up as a princess everybody says ‘oh how beautiful you look’ but if Tommy goes and does the same, even if nobody says anything derogatory, no one encourages either.”
The transgender community would love to give trans-awareness workshops in primary schools but they have generally been prevented from doing so.
“The immediate reaction is often that we are paedophiles trying to get at the kids,” Jenny-Anne said.
She added, “Another really difficult area is the other parents who can be extremely hurtful and even abusive to transgender children.
“The schools forget the other parents need educating too!”
Heather Jane, a member of the committee at TransForum Manchester, provides training for schools that have transgender pupils and staff.
She said: “I use a short segment from the King’s Speech which shows a character being forced to be right-handed when he was naturally left-handed causing serious detrimental effects in his life.
“In earlier times forcing a child to conform to the majority and be right-handed was seen as the right thing to do.
“Today we do not force pupils to be right handed but support them.
“We are sure that future generations will look back and see our current treatment of transgender children in the same way as we look back on that treatment of left-handed children.
“The way to support pupils to learn is to support anything that they cannot change otherwise we risk damaging them seriously.”
National charity Mermaids also offer educational support to schools alongside other groups such as Gendered Intelligence and the Gender Identity Research and Education Society (GIRES) who have issued guidance on countering transphobic bullying for the Home Office.
A Mermaids spokesperson said: “At school, children or teenagers with a gender identity issue are often subjected to abuse
“Bullying can take many forms; isolation and exclusion, insults and name-calling, and even physical attacks.
“The child or teenager may have great difficulty in dealing with school life, and can struggle to respond appropriately.
“However, education about gender identity issues in the school environment can be highly effective when dealing with these problems.
“Schools may never have dealt with a child with gender issues before, but this is no excuse to ignore it.
“It is vital that the child is supported and that peers are educated to ensure that the young person can continue in education.
“Mermaids has seen far too many young people leave school for home schooling, or have to move to another school, due to the ignorance and prejudice that they face.
“All schools have a duty of care, and supporting a vulnerable pupil who is dealing with gender issues is key.”
I asked Karen about support groups outside school for transgender children in the area.
She told me that Stockport Council used to run a support group called The Base which James went to a few times but it was closed in the council cuts last year.
Karen said: “I’m not sure there would be enough need for them to start anything else.”
“I only know of one other child in the area who is transgender. It’s very hidden.
There are a lot more transgender children than you would think but a lot of families keep it quiet.”
So it ends up being a vicious circle. People are unaware of support groups so don’t come out. Then the support group’s funding gets cut because no-one goes and it starts again.
Transgender children in the UK also have considerable problems receiving medial treatment.
Puberty blocking drugs have been administered in the USA and the Netherlands for more than ten years, but trials have only just begun in England.
The hormone treatment works by suppressing puberty: a trans-male can take oestrogen blockers to reduce breast development and a trans-female can take testosterone blockers to minimise testosterone generation and therefore facial hair and the deepening of the voice.
The treatment increases the chance that in the future people will be able to pass much more effectively as the opposite gender and need less drastic surgical treatment.
It also allows children to think about their decision, without the added pressure of developing into a body they feel is the wrong one.
Jenny-Anne said: “I spent a good part of my life trying to reverse the damage that nature had done to me.
“It’s all about putting things on hold until children are old enough and are comfortable making such a life changing decision.”
In a 2004 case put forward to the Australian courts for a 13-year-old born-female to take hormone treatment, one party questioned whether society would be required to give someone who deemed themselves a horse treatment to become a horse.
But although arguments have been put forward against administering hormone-blockers to children, the treatment is completely reversible and many would argue it’s unethical to refuse treatment.
Research from the Endocrine Society found that 75-78% of pre-pubescent children that were initially diagnosed with gender dysphoria before they reached puberty did not wish to transition after reaching 16.
These children can stop taking the hormones and puberty will resume as normal.
The benefit is that the remaining 25% have been spared the trauma of going through the wrong puberty
The figures are different for children who come out during puberty. 75% of transgender teenagers go on to transition in adulthood.
Children who wish to continue with full transition can begin cross-hormone therapy at 16 and be put forward for surgery from 18.
These treatments are irreversible after 3-6 months and patients receive substantial counselling before treatment is given.
James has felt like a boy since he was six and never thought he would develop into a girl. His trigger was hitting puberty.
The Stockport teenager is currently taking puberty-blocking drugs and being seen at the NHS Tavistock Centre in London where he hopes to get a formal diagnosis which will allow him to start cross-hormone treatment as soon as he turns 16 in August.
Karen said: “Hormone blockers press the pause button on puberty; allowing children to have assessments at somewhere like the Tavistock so that they can be sure of their decision.
“Boys who are transitioning have to deal with their beard growing and their voice breaking if treatment isn’t given. That’s irreversible,” she added.
At the moment there are no designated centres in the North West for the treatment of GD, meaning families based here have to travel to London to get a formal diagnosis.
And this diagnosis is the key to getting the right treatment: without it, cross-hormone treatment cannot be administered.
Karen said: “The problem is that there aren’t many people in the medical profession who know a lot about it.
“When we went to our GP they didn’t know anything about it and so referred us to a paediatrician at the hospital.
“Fortunately the paediatrician was quite young and forward looking and had done some research before we got there.
“We also met a psychologist at a local Hospital who knew of another psychologist in the Manchester area who had done a lot of work on GD.
“We ended up having to go to London because even the clinician in Manchester isn’t qualified to give a formal diagnosis.
Karen told me that the Tavistock had been very helpful and had sent psychologists up for one of the appointments to see James.
But the worry is that they might not get the diagnosis in time for James’ 16th birthday when he wants to start cross-hormone treatment.
Karen thinks they might have to go privately to get the diagnosis but even then there aren’t many private doctors who can give the right diagnosis and it would mean going to London for treatment either way.
If James does manage to get a private diagnosis, the family aren’t sure the NHS will accept it and fear they might have to go privately for testosterone treatment as well.
She said: “We know of other children who have been given a diagnosis but are still waiting for a formal report which will allow them to start cross-hormone treatment,” she added.
“I’m not sure how long we can stay with Tavistock - we just don't know how long they will take with the diagnosis.
“James has seen his friends growing up and changing and he’s stuck in a time warp.
“Their voices are breaking and they are growing taller and it’s very hard for him.”
The Tavistock are planning on opening a new centre in Leeds in the next few months which Karen hopes James will be able to go to.
A Department of Health spokesperson said: "This new centre will offer more choice for children and young people seeking support and possible treatment for gender identity issues."
But although there are still many problems facing the transgender youth of today, things are undoubtedly changing for the better.
Though puberty-blocking trials are only just beginning in the UK, we have come a long way since the late 1940s when electrical aversion therapy was considered an appropriate treatment.
It’s hoped that with increased awareness and acceptance of Gender Dysphoria our society will be able to follow in the footsteps of the Native American tribes and embrace our transgender children with open arms.
As Jenny-Anne says, we thrive on the diversity of nature; we just find it incredibly difficult to accept in ourselves.
Indeed, nothing is black and white.