LONDON - Children who believe they are transgender may actually have mental health issues, a landmark report is set to find this week.

It is expected to advise that children should not be rushed onto a path to change gender, and that they receive counselling that addresses the mental health issues they may have rather than being put on drugs.

Dr Hillary Cass, a paediatrician, will on Wednesday unveil her long-awaited review into how transgender children are supported and the medical treatment they receive.

It comes amid concern that children are being allowed to change gender in school without their parents’ knowledge or consent, and after the routine prescription of puberty blockers was banned by NHS England.

The Telegraph understands that the report will find that children who think they are trans disproportionately have mental health issues stemming from a difficult family situation or having suffered from abuse. They are also more likely to be neurodiverse.

Counselling to tackle issues holistically

It is expected to suggest that these children need counselling to tackle these issues holistically, rather than them automatically being put on a path to change gender.

The report is expected to warn that it is wrong to assume it is in the best interest of children who think they are trans to change gender, and urge extreme caution over the use of drugs such as puberty blockers and cross-sex hormones to facilitate this, even once someone is over 18 years old.

The review is also said to express concern about a significant rise in the number of young girls wanting to become boys, and say this group needs more support.

On Monday, Downing Street said the Government would act on the basis of the report to ensure children and adolescents were kept safe.

“We have talked about the importance of children and adolescent safety and wellbeing being paramount,” the Prime Minister’s spokesman said.

“That is part of previous work such as the NHS announcement to end the routine prescription of puberty blockers, it is behind our robust and clear guidance to schools. It is categorical that social transitioning is not a neutral act and no one should be forced to use preferred pronouns or accept contested beliefs as fact.

“We’ve also said there’s more to do in this area and we will look at the review when it’s published.”

He added: “The Government has taken a number of steps in this area, recognising the effect that social transitioning can have on children and adolescents, and we’ve made clear that single sex spaces must be protected.”

The interim Cass report in 2022 said that children being allowed to socially transition in schools – changing their name and pronouns, and being allowed to use the lavatories and changing rooms of the gender they identify as – was “not a neutral act”.

It also raised concerns about the NHS’s gender identity and development service at the Tavistock and Portman NHS trust in London.

Children who think they are trans may have other problems

The interim review led NHS England to close Tavistock service and replace it with regional centres that take a more “holistic” approach to treatment and look at other mental health or medical issues they may have.

Dr Cass’s final report is expected to conclude that there could be many complex reasons a child may think they are in the wrong gender.

It is believed to advise therapists that children presenting as trans may have had other complex issues such as a difficult family situation, having suffered from abuse, or having been exposed to pornography too early.

For this reason, cases need to be judged holistically.

The review is also believed to conclude that if you allow a very young child to socially transition they are more likely to grow up to have a fixed trans identity later in life, rather than their gender distress being resolved by other means.

Dr Cass’s report is understood to say that prepubescent children should not be put on the same “pathway” as older adolescents who wish to identify as the opposite gender.

‘Psychological repercussions’

It is expected to warn that children may experience “psychological” repercussions as a result of being allowed to change their name and pronoun to the gender of their choice.

Last month, the NHS announced an immediate ban on prescribing puberty blockers to under-18s unless they are part of a clinical trial. Ministers said the “landmark decision” was in children’s “best interests” and would help to ensure youngsters who feel their gender is not the same as their sex are treated using medical evidence.

However, campaigners have warned of a loophole, as there is nothing to stop transgender children getting hold of puberty blockers from private clinics.

In 2021-22, the NHS reported more than 5,000 referrals to Tavistock, up from just under 250 who were questioning their gender a decade earlier.