Gender Dysphoria in Young People: How Psychoanalytic Psychotherapy Can Help
Understanding gender identity, the body and sexuality in children, teenagers and young adults.
Gender dysphoria in young people raises questions that deserve time and careful thought. Parents often want to understand what their child is experiencing and how best to respond. A young person might be looking for somewhere to speak about their body or identity without being expected to defend a position or reach a particular conclusion.
Questions about gender do not necessarily involve distress. Being transgender or gender-diverse is not itself a mental illness, and not every trans person experiences gender dysphoria. Gender dysphoria refers to distress associated with a difference between a person’s experienced gender and their sex registered at birth. Discomfort with the body also has other forms and meanings; it should not automatically be understood as gender dysphoria. (NHS: Gender dysphoria and incongruence)
At Eastbourne Child Therapy, I work with children, teenagers and young adults aged 2–25, as well as parents. The psychoanalytic approach I offer provides a space to explore these experiences in the context of the person’s life, without deciding in advance who they should become.
Taking a Young Person Seriously Without Deciding for Them
Discussions about gender have become highly polarised. Young people encounter strong views about what their experiences mean and what they should do next. Parents also feel pressure to take a position while they are still trying to understand what their child is communicating.
The psychoanalytic approach I offer does not begin with a predetermined answer or steer someone towards or away from a transgender identity. It validates the young person by taking their experience fundamentally seriously, without deciding where their exploration should lead. Respect for how someone understands themselves in the present belongs alongside their freedom to discover something new about it.
In psychotherapy, this involves close attention to the young person’s own language. Words such as “boy”, “girl”, “trans” or “non-binary” have shared meanings, but they also acquire meanings particular to each person and their own history, culture and experience. The therapists task is not to impose an interpretation, but to explore together what these words express about their experience and what remains difficult to put into words.
Psychoanalytic psychotherapy also recognises unconscious life: feelings, wishes and conflicts that influence us without our being fully aware of them. This is part of being human, not something peculiar to gender questions. Exploring the unconscious does not mean assuming that a trans identity conceals a problem or that the therapist knows who someone “really” is. It means remaining curious about dimensions of experience that neither person yet fully understands.
There must also be room for change, including rapid change - particularly in formative years. A young person should be able to speak with conviction, express doubt or describe themselves differently without feeling bound by what they said in an earlier session. Equally, an identity that remains important should not be subjected to an expectation that it must change. The therapeutic relationship offers continuity without requiring the young person to remain the same.
The Body, Sexuality and Growing Up
Childhood, adolescence and early adulthood involve profound changes in how a person experiences their body and relates to others. Puberty brings changes that arrive without permission, alongside the growing awareness that one’s body has sexual meaning for other people. Being looked at, desired or expected to behave in particular ways acquires a new significance, and this is not always welcome or easy to understand.
Sexuality is a substantial and complicated part of this period of life. It involves more than identifying whom someone is attracted to. Desire and fantasy do not always fit comfortably with a person’s image of themselves, and the prospect of intimacy raises questions about exposure, pleasure, vulnerability and control. Discovering what one wants, what one does not want and how to communicate those boundaries is demanding work. Shame or fear of judgement makes it harder to speak openly about experiences that already feel confusing.
Gender identity and sexual orientation are distinct, but a person’s experiences of gender, sexuality and their body do not occur in separate compartments. Psychotherapy allows their connections and differences to be explored without assuming that one explains away the other. A young person does not have to know in advance whether a feeling concerns gender, attraction, bodily discomfort or something for which they have not yet found words.
Of course, this work must be appropriate to the person’s age and development. A young child’s play and curiosity should not be interpreted through assumptions drawn from adolescent or adult sexuality. With teenagers and young adults, there is room to speak about sexual feelings and experiences without embarrassment or pressure to adopt a label. The aim is to help each person develop a growing understanding of complex, confusing thoughts, feelings, desires and experiences, that may get over simplified, or compartmentalised in popular culture, that belongs to them.
Gender Dysphoria and Mental Health
Research has found higher levels of mental health difficulties among transgender young people than among their cisgender peers. In a US matched cohort study of young people aged 12–29 receiving healthcare, Reisner and colleagues found higher rates of depression, anxiety and self-harm among transgender participants. This was a clinical sample rather than a representative survey of all young people, so its findings should not be treated as a prediction for any individual. (Reisner et al., 2015).
These findings do not establish that being transgender causes mental illness. Bullying, rejection and discrimination belong in any consideration of distress, as do relationships and the wider circumstances of a person’s life. Gender dysphoria itself is also painful. Understanding what is troubling a particular young person requires more than identifying the group to which they belong.
Depression or severe anxiety should neither be treated as proof that a trans identity is mistaken nor overlooked when attention becomes concentrated on gender. These difficulties deserve attention in their own right, alongside exploration of how they relate to the young person’s experience of their body, identity and relationships.
Autism and Gender-Related Experiences
Research has also identified an association between autism and gender dysphoria or gender incongruence. A systematic review and meta-analysis by Kallitsounaki and Williams estimated an autism diagnosis prevalence of around 11% across the gender dysphoria/incongruence samples studied. The research included different age groups, not only children, and estimates varied considerably between studies. (Kallitsounaki and Williams, 2023).
An association does not provide an explanation for an individual. Autism cannot tell us what gender means to a particular young person, whether an identity will remain important or which choices they will eventually make. Neither autism nor a trans identity is, in itself, something psychotherapy sets out to cure.
The overlap underlines the need for an individual approach. In therapy, attention to the person’s communication and sensory needs is important, including how they experience the setting and the pace of the work. A diagnosis should inform how we listen, not replace listening with assumptions about what someone’s experience must mean.
The Cass Review and Medical Treatment for Under-18s
The Cass Review, published in April 2024, examined NHS gender identity services for children and young people in England. It recommended broad, individual assessment and attention to mental health and developmental needs, while identifying substantial gaps in the evidence for both medical and psychosocial interventions. Its recommendations and interpretation remain debated; it should not be read as proof that one particular psychotherapy is an established treatment for gender dysphoria. Cass Review: Final Report.
Medical treatment for gender dysphoria in under-18s has become highly restricted. Puberty blockers are not routinely available through NHS England for this purpose. In March 2026, NHS England opened a consultation on a revised policy proposing that masculinising and feminising hormones should no longer be routinely commissioned for under-18s; that consultation closed on 7 June 2026. These changes should not be simplified into a claim that no under-18 has access to any medical treatment, since existing treatment arrangements and specific exceptions need to be considered. NHS England: hormone-policy consultation.
For families seeking NHS support, a GP is a practical starting point. In England, under-18s are referred to paediatric services or Child and Adolescent Mental Health Services (CAMHS), which can assess their needs and, where appropriate, refer them to the specialist NHS Children and Young People’s Gender Service. Support for emotional and mental health difficulties should remain available while a young person awaits specialist assessment. NHS: assessment and treatment.
I have worked for many years, both in the NHS and privately, with young people experiencing gender incongruence, with psychotherapy often forming a core part of their wider care. In my experience, it offers a valuable space to explore what they are going through, develop their own understanding of themselves, and positively impact any mental health difficulties they are experiencing. This work has value whether or not someone seeks specialist gender services: it takes their questions seriously while also attending to their emotional life and any mental health difficulties that need treatment.
The Boundaries of My Role
My role is to provide psychoanalytic psychotherapy, not medical treatment. I do not prescribe puberty blockers or hormones, and I do not arrange or support referrals of under-18s to private clinics for medical gender interventions. Questions about medication and medical eligibility belong with appropriately qualified medical professionals working within the relevant clinical and legal frameworks (I will always support GP and NHS referrals where appropriate).
These boundaries do not prevent a young person from discussing medical transition in therapy. Their wishes, expectations and concerns deserve thoughtful attention, including any frustration about restrictions or uncertainty about future decisions. Psychotherapy offers a place to explore these questions without making a medical intervention—or a decision against one for over 18s —the purpose of the work.
What Happens in Psychoanalytic Psychotherapy?
Psychoanalytic psychotherapy gives a young person space to speak without having to arrive at an approved conclusion. Gender might be central to the work or become less prominent as other concerns emerge. The direction is shaped by what the person brings, including experiences they have not previously felt able to share.
A younger child often communicates through play, drawing and the relationship they develop with the therapist. Work with parents is an important part of many children’s treatment. Teenagers and young adults are more likely to speak directly, although silence, humour and what becomes difficult to say also deserve attention. Confidentiality and its safeguarding limits are discussed in a way appropriate to the young person’s age.
The therapist listens for connections that have not yet been recognised and repeated patterns in how the young person experiences themselves and other people. The aim is to make overwhelming or confusing experiences more thinkable, so that the person has more room to understand their feelings and respond to them. This is an account of the clinical approach, not a promise of a particular outcome or a claim that gender dysphoria will necessarily resolve.
Each Person Has Their Own Direction
Over the years, I have worked with young people whose experiences of gender and their bodies have been enormously varied. For some, being trans became or remained an important part of how they understood themselves. Across this work, young people found many different ways of describing their gender and living their lives. Their individual paths were not measures of therapeutic success: the purpose was not to produce a particular identity.
In my experience, psychotherapy provided a clinical space alongside the other parts of their lives in which questions fundamental to themselves could be explored in depth. The work was broader than gender, and the young person was never reduced to it. Where depression, anxiety or other mental health difficulties were present, these could be taken seriously and treated, without treating a trans identity as an illness or assuming that every difficulty arose from gender.
What mattered was the opportunity to understand themselves more fully and find their own ways forward. This required a relationship in which they could be heard without having to defend a position, satisfy someone else’s expectations or know in advance who they would become.
References
Cass, H. (2024). Independent Review of Gender Identity Services for Children and Young People: Final Report.
Reisner, S. L. et al. (2015). Mental Health of Transgender Youth in Care at an Adolescent Urban Community Health Center: A Matched Retrospective Cohort Study. Journal of Adolescent Health, 56(3), 274–279.
Kallitsounaki, A. and Williams, D. M. (2023; first published online 2022). Autism Spectrum Disorder and Gender Dysphoria/Incongruence: A Systematic Literature Review and Meta-Analysis. Journal of Autism and Developmental Disorders, 53, 3103–3117.
NHS England (2026). Clinical policy for prescribing masculinising and feminising hormones for children and adolescents who have gender incongruence or dysphoria: consultation. Consultation ran 9 March–7 June 2026.
NHS (reviewed 14 May 2026). Gender dysphoria and incongruence.
Written by Ben French BSc, C-Psych, C-Obs, MA Psych.
Ben French is a Child and Adolescent Psychotherapist and Psychoanalyst working with children, teenagers and young adults aged 2 to 25. He has over 15 years’ experience supporting young people’s mental health, including senior roles in CAMHS and education.
