SCOTLAND'S only specialist NHS service to help children with gender identity issues has seen a "significant rise" in referrals over the past decade, including helping youngsters aged under five.

The Gender Identity Clinic, based at the Sandyford clinic in Glasgow, supports under-18s across Scotland who are experiencing transgender feelings.

It assists parents and children by offering assessment and counselling services and youngsters over the age of 16 can be offered hormone treatment to delay puberty. Sex-change operations are only available to adults over the age of 18.

Last week figures revealed the number of children aged under-10 being referred to specialist services to help deal with transgender feelings south of the border had more than quadrupled in the past six years.

Dr David Gerber, lead for the Sandyford's Gender Identity Clinic, said while he could not provide exact figures, there had been a "significant" rise for in referrals to the under-18s service in Scotland in the decade since the service was set up.

He said: "I think across the world, there is a similar phenomenon. There is more awareness, better availability of services and there have also been societal changes.

"It all creates greater awareness and allows people to find out more information and to receive support and gain courage to make choices they might not have ordinarily made."

Gerber said it was often difficult for parents to accept their young children had transgender feelings, and with no specific treatment available the usual approach was "watchful waiting."

He said: "I have certainly spoken to parents who have children who are very young - under five - and are identifying with the alternative gender and don't know what to do.

"Sometimes a middle ground might be allowing a child to express themselves at home or around the family, but adopting gender appropriate behaviours at school or in public. But parents obviously need to make up their own minds about that."

He also pointed out failing to provide help and support for young people who believe they are the opposite sex could lead to serious problems, including self-harm depression, suicide and turning to drugs and alcohol as a means of coping.

The Sandyford also has a support group for parents of transgender children, called Transparentsees. Jean, who wishes to remain anonymous, set up the group after her 17-year-old daughter, who was born a boy, came out as transgender when she was 14. Her daughter was referred to the specialist service at the Sandyford clinic and is now taking hormones to block puberty.

She said: "When my child came out, I didn't know where to go or who to turn to. Transparentsees was started by me, in September 2013 as I knew there were similar parent support groups in England, and it has now grown from just a few attending to 15 parents.

"So there is growing and obvious need for it - parents come along quite shell-shocked not knowing what to do. People really value it and are glad it is there."

She added: "My daughter told us when she was two-and-a-half to three-years-old she was a girl. She was then a boy and she told us as soon as she could speak that she was a girl and wanted Barbie dolls. I thought if it is a phase I am not going to deny it. I didn't want to be into gender stereotyping - with her older brother she played with Lego and Thomas the Tank Engine for example, but I did get her a doll and she had lilac bedding. They also had a toy hoover and a toy kitchen.

"She is much happier now. She transitioned at school at the end of 2012. She attends a school which has been very good and there has been no bullying or hostility."

Meet Drew: sometimes a man, sometimes a woman, sometimes no gender at all

Drew O'Donnell, 23, from Paisley, is a non-binary transgender - that means Drew can feel male, female or gender-neutral. The call-centre worker - who prefers to be known as they, rather than he or she - says they were aware from a young age of feeling different.

O'Donnell, who is the transgender representative for National Union of Students Scotland, said: "I never felt male or female, I always knew there was something different about me that made me not fit in as much - but because there was no support I didn't know what was happening.

"It was hard for me to get along with boys. I fitted in a lot easier with the girls, so with that I was quite comfortable, but it was quite difficult for me growing up because my parents would always buy me boys' toys - for example Action Man and wrestling figures. But what I really wanted was cuddly bears, as that is what I felt more comfortable playing with.

"I never knew what trans and transgender was and I had never heard of non-binary until I went into college. Even then it was a further four years before I got information to help me understand there are more than just male and female genders in the world.

"I have started full-time work so I have to go in wearing masculine clothing - a suit shirt and smart trousers - and most of the time I do feel uncomfortable with it. I want to feel comfortable going into work wearing more feminine clothing but I am scared and worried in case people make fun of me or judge me.

"I would like to see a lot more services for trans and non-binary young people - there are a lot of young children and young people now coming out as trans and non-binary and there needs to be support services in place for them."