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Alex is a 16 year old natal female with a diagnosis of Gender Dysphoria. I will refer to Alex as ‘he’ as he is known as male within his family and at school. He has made a social transition and he has changed his birth name from Eloise to Alex by deed poll approximately one year ago. He lives at home with his parents and an older brother who is at university. Parents are baffled by Alex’s cross gender identification and hold a sceptical stance, although they have been willing to address him by his chosen name and pronouns, as this has brought Alex significant relief and improvement in general functioning.
Alex is an androgynous looking young person of slender build, with diaphanous skin and delicate features. He ‘passes’, meaning his looks, at superficial glance, do not betray his biological sex, although his mannerism is rather feminine. He has been wearing a binder to compress his chest since the age of 14. Upon meeting him for the first time, he could easily be perceived as a rather effeminate, shy, young boy in his early teens on the cusp of puberty.
Alex and his family have chosen not to intervene to halt his female pubertal development with the prescription of hormone blockers as one of the side effects could be a lowering of mood and energy. Alex could, after the age of 18, be prescribed testosterone if he continues to meet criteria of Gender Dysphoria and he chooses to access physical intervention. Alex has been suffering for years from ‘fatigue’, disrupted sleep, anxiety, eating difficulties, superficial self-harm and mild OCD symptoms.
He is a very bright student at a high achieving all-girls school. Despite missing significant periods of school due to his ‘fatigue’ he has secured a place in the Sixth Form by gaining the highest grades in his GCSEs. Alex does not have any male friends and he socialises exclusively with girls from his school.
Alex has engaged well in his psychotherapy sessions, he is very forthcoming and values his sessions which star