Kylie said her family researched the best way to keep their trans daughter safe and well (file picture). Photo: 123RF
The mother of a transgender teenager says having her child come out at the age of eight let her and her family take "a deep collective breath".
However, as far as their daughter was concerned, they accepted it immediately, Kylie said.
"As soon she told us who she was, then we just went with that.
"And then behind the scene, we did quite a lot of gathering of information about what would be the best way to keep her safe and keep her well."
Responses from those around them were "mixed", some were supportive, others not.
"We had to educate the people around us at the same time we were learning ourselves."
At that stage, there was no need for medical interventions. Within a couple of years, however, puberty was looming.
"And at that point, she let us know very clearly she did not want the changes that would come to her, unless she was given something to give her support."
Puberty blockers, which stop the physical changes of puberty, are under scrutiny internationally, after a four-year independent inquiry in Britain led by Dr Hilary Cass found "remarkably weak evidence" for their use.
The UK's National Health Service has banned their routine use for gender affirming care, outside of clinical trials.
According to Pharmac data, 416 young people in New Zealand aged 12 to 17 were prescribed puberty blockers in 2022, up from 48 in 2011, which was the first year the hormones were used for gender affirming care in this country.
The rates were more than 10 times higher than in England.
Dr Cass and other child development experts have said it was not known whether blockers allowed time for young people to "consider their options" (as was originally intended) - or whether they effectively "lock them in" to a medical pathway.
Nearly all children on blockers subsequently progress to a medical transition using hormones.
Puberty blockers at 10, oestrogen treatment at 14
However, Kylie said blockers gave her family time to think.
"Sexuality and future fertility - those are really big conversations to have at 10. So the idea with puberty blockers is that you don't have to have all of those conversations at that age. You can wait until your child is a more appropriate age to talk about those things."
Before her daughter was prescribed puberty blockers at 10, she had multiple visits to a paediatric endocrinologist, a full medical assessment including blood tests, a hand X-ray (to assess bone density) and an appointment with a psychologist.
"I'm not surprised that most continue because it's a really rigorous process," Kylie said.
"They've already gone through rigourous screening to make sure this is something they really want."
At 14, her daughter started using oestrogen medication.
Before that, she had to have a psychiatric assessment, which meant eight months of visits and tests.
"She is unusually young to go on HRT. Usually in New Zealand not given to teenagers younger than 16, depending what area you're in.
"The doctors were willing to make an exception because of the thoroughness of the psychiatric reports done and the length of time she had been out.
"At 14, she'd already been socially out for six years, so it was not a fly-by-night decision."
'No parent is owed grandchildren'
The teenager was offered an option for fertility preservation, which would require her to stop using puberty blockers and go far enough through puberty to allow for the process. But that was not an option she wished to take.
Kylie said she had no personal sadness about that.
"No parent is owed grandchildren. When I chose to have children, I did not do so with a plan in my head that they would have to provide with me with biological grandchildren.
"She may well become a parent one day. The fact they won't be her biological children will not make them any less her kids."
Family has no regrets
While there had been an increase in young people seeking care, Kylie did not believe there had been an increase in actual numbers of trans children.
Her eldest child - who is now 24 - came out as non-binary a few years after her daughter.
"It's more likely that you will seek gender-affirming care if you think it will be there and be safe in your community.
"As it's become a little safer to be out in your community, it's become more likely for a person to talk to their parents at a younger age.
"I think through the generations we will have fewer people in their 30s seeking transition because they were able to make it at younger age."
No-one in her family had any regrets, she said.
"Our daughter is a happy, healthy, normal 17-year-old - she's done extremely well at school, is off to uni, she's got great group of friends, she's in a relationship - doing all the things you would expect a 17-year-old to do.
"We've never been concerned that her intellectual or psychological development has been stunted by her being able to express who she is.
"In fact, our concern [would have been] the damage from not being able to express who she is that would have been done to her, that she would have to work through as an adult."
The Health Ministry plans to release its own review of the evidence for puberty blockers shortly, along with a position statement to give clinicians guidance.
Separately, Health New Zealand Te Whatu Ora has commissioned the Professional Association for Transgender Healthcare Aotearoa (PATHA) to update its guidelines for gender-affirming care for healthcare professionals, including the use puberty blockers.