Hormonal therapies are only prescribed in specialist clinics with input from a paediatric endocrinologist. In children who have not started puberty, hormones are not normally advised. In those who have started puberty (Tanner stage 2 and above) a gonadotrophin hormone receptor blocker can be started to halt the development of secondary sexual characteristics. This is reversible, and allows time for the child or adolescent to decide preferred gender at an older age, at which point decisions about starting oestrogens or testosterones can be made on a more informed basis. Surgical gender reassignment procedures are not usually recommended before the age of 18 years.¹