THE number of children being treated for gender identity disorder in Scotland has quadrupled in just three years – to more than 200 cases last year.

It is understood the majority of the under-17s undergoing treatment are being prescribed puberty-blocking drugs, though precise Scottish figures are not yet available.

Around 800 are receiving treatment in England.

The country’s specialist gender identity centre for young people, the Sandyford Clinic in Glasgow, has seen a 300 per cent rise in referrals, from fewer than 50 in 2013.

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Doctors say the onset of puberty can cause “significant” distress to young people who identify as transgender and medicating to delay the physical hallmarks of adulthood provides huge relief to children and their families.

Young people who are born feeling that their gender is not the same as their biological sex find the prospect of their body changing traumatic. In some cases, according to trans activists, treatment can be quite simply life-saving as trans young people have taken their own lives rather than go through puberty.

Stephanie Davies-Arai is founder of the website Transgender Trend, which provides a forum for parents concerned about the treatment their children are receiving.

She argues that too little is known about the effects of the drugs, while treatment from an early age means many young people are medicated before their identities are fully formed or they can fully understand the implications of treatment.

"These drugs are being used off-label, mostly on teenage girls, and the young people are starting earlier and using them a lot longer," she said.

"The medicine keeps people in a state of suspended childhood and because it is preventing their development they don't get the chance to 'change their minds'.

"There may be a lot of reasons for cross-sex identification in childhood - such as abuse, parental separation, past trauma or feelings of alienation."

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For boys taking feminising hormones side effects include Hypertriglyceridemia – a condition in which the body produces excessive levels of fatty molecules called triglycerides, and increased risk of thromboembolisms, otherwise known as blood clots.

For girls on masculinising hormone treatment, the side effects include polycythemia – an abnormally elevated red blood cell count.

Transgender Trend and its supporters argue that being trans has become “fashionable” and many young people who would previously have come out as gay - particularly girls - are instead identifying as trans, due to a mixture of influences including anti-lesbian prejudice and a proliferation of online forums and trans 'vloggers'.

However some research has shown that in up to 90 per cent of cases, young people 'desist' from claims or symptoms that they are trans during puberty.

"Parents say there no longer seems any route to a non-medical, 'wait and see' approach,” says Stephanie Davies-Arai.

“Meanwhile young people are being given autonomy when they are not sufficiently mature to understand the consequences of treatment."

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NHS Greater Glasgow and Clyde and the Sandyford Clinic were unable to provide figures for the numbers of young Scots currently prescribed puberty blocking drugs, and did not put anyone forward to comment.

However in a paper delivered at a conference in Stirling earlier this year, Dr Gordon Wilkinson, consultant child and adolescent psychiatrist at the Sandyford, said transexualism in young people was characterised by a persistent or intense distress about being a girl or a boy and a stated desire to be the opposite gender, along with an aversion to a child's own anatomy and to 'normative' clothing.

He said gender identity disorders (GID) in children persist in 16 per cent of cases but disappear at around the onset of puberty. However gender dysphoria in adolescents persists in almost 100 per cent of those cases where puberty blockers are prescribed.

A 2014 study showed positive outccomes for the majority of young transgender adults who had been treated with puberty suppression, who progress to full gender reassignment surgery once they turn 18.

Commenting on a study of 55 young transgender patients, Dr Wilkinson said. "One year post surgery, gender dysphoria was alleviated, psychological functioning improved and well-being was comparable to their same-age peers."

There is a "window of opportunity" in early puberty, he said, and “symptoms in pre-pubertal children were unlikely to be just a phase. But treatment should recognise that gender identity beliefs, while firmly held, can become less so with time."

James Morton from the Equality Network said: “Young people’s exploration of gender is not being medicalised.

"Only the most severely gender dysphoric adolescents are referred to Scotland’s Young Person’s Gender Service.

"The Young Person’s Gender Service primarily provides specialist psychological assistance.

"If an adolescent is finding their puberty extremely distressing and has been carefully assessed, they may be carefully prescribed puberty blocking medication to protect their wellbeing and reduce their risk of self-harm.

"Pausing their pubertal development gives these teenagers vital breathing space to get counselling to explore their gender identity and the various options they have for their adulthood.

"Those who turn out to be young trans men can be saved from developing breasts and needing to undergo chest reconstruction surgery as adults. Those who turn out to be young trans women can be saved from developing facial hair and their voices irreversibly breaking.

"Those who decide not to transition just stop taking the puberty blocking medication and their puberty resumes as normal and still within the typical pubertal age range of 12 to 17.

"Puberty blocking medication has been proven safe through decades of extensive use relieving distress in young people who have entered puberty unusually early. The fact that nobody expresses any concern about that use of puberty blockers shows that this is actually about people opposing transgender people’s existence and not real concerns about these safe medications."

He added: "There is no pressure being put on teenagers to transition."