This study explores health provision for gender and sex diverse (GSD) children and young people in National Health Service (NHS) settings in England, Wales and Scotland. Recent years have been a time of profound challenge to traditional ideas about gender and identity. Young people have been developing increasingly diverse ways of thinking about and expressing gender. At the same time there has been a proliferation in the number of young people experiencing issues with gender seeking out health services. These dynamics have incited intense public, policy and clinical controversy, particularly over how best to support children and adolescents in specialist NHS clinics.

In this interdisciplinary, mixed-methods study I analyse data from 86 qualitative interviews with (40) GSD children and young people, (31) caregivers and (15) key experts; as well as a quantitative survey with (1,776) youth ages 14-24 years. I argue that young people’s experiences and wellbeing are hampered by a system of care which assumes gender and sex typicality to be healthy, permanent, ‘natural’ and ‘real’, while forms of gender and sex variance are framed as pathological, deviant, artificial and ‘curable’.

These presuppositions are rooted in naturalised accounts of sex, gender and sexual desire, which posit these categories as inextricably aligned and defined through unequivocal, binary, biological ‘truths’. Meanwhile, underpinning and regulating these ideas is a developmentalist discourse of ‘childhood’, which has depicted children as fundamentally naïve to matters of sex(uality), gender and the body, and defined gender and sex diverse knowledge, experience and expression as harmful to children’s development.

I show how this matrix of beliefs functions to limit the possibilities of viable childhoods through ordering medical practices. GSD children may be either denied services or obligated to undergo interventions (both physical and psychological), without respect for their individual autonomy and informed consent.

The wellbeing of GSD youth may be improved through an alternative system of care: one, which better recognises the complex heterogeneity of sexed and gendered experiences and welcomes and accommodates the creativity and agency of children.