Northern Ireland child gender service has 29 referrals
A service set up for Northern Ireland children experiencing difficulties over their gender identity has had 29 referrals since it opened last summer.
Knowing Our Identity (KOI) works with young people unhappy with their biological gender - a condition known as Gender Identity Dysphoria.
It was opened in August 2014 and 26 young people and families are currently receiving assessment and care.
The majority of children are of post-primary age.
KOI says it provides "specialist intervention to young people and their families to help with gender related difficulties, and ensure young people are understood and supported by those around them - for example families, schools, clubs and activities.
"We often work alongside other services such as local mental health services and community services, which can provide additional support for young people and their families," it says.
It includes sessions from a clinical nurse specialist/family therapist, a clinical psychologist, a child and adolescent psychiatrist, a paediatric endocrinologist and endocrinology nurse specialists.
'Information not intervention'
Across the UK, the NHS says the number of children under 10 being referred for support services to help deal with transgender feelings has quadrupled in the past six years. Some are as young four.
However, Billie Hughes, the manager of children's services at the Belfast Health Trust where KOI is base, said the majority of children in Northern Ireland were older.
"Really it's not about intervention at that stage it's about information for parents," she said.
"Doing nothing can cause distress and harm to a child's mental health.
"There's a process of assessment that goes on over time. It's only when there's a distress about it that they [parents] might seek help or assistance."
Ellen Murray, Genderjam NI, who was born a boy, said it was something only a tiny percentage of people had to think about.
"We're not talking about putting four-year-olds on hormones or hormone blockers here, we're talking about letting them express themselves.," she said.
"Trans kids know who they are and they know their gender. People who know themselves that early assert who they are and that usually doesn't change.
"Parental acceptance and enthusiasm for supporting the child is crucial in this. We're talking about talking, family support and individual support."
Research in 2013 for the Office of the First and Deputy First Minister estimated that 144 individuals have presented with gender identity dysphoria in Northern Ireland