Astonishing rise in number of Northern Ireland people seeking expert help over gender confusion
Over 200 seek help in last year
The number of people referred for professional help because they are confused about whether they are male or female has rocketed by 1,600% in a decade. More than 200 referrals to gender identity services were made in Northern Ireland last year - up from just 13 in 2006.
They range from children to pensioners, figures released by the Department of Health reveal.
Separate statistics show that dozens of people under the age of 18 have contacted a specialist service, Knowing Our Identity, in the last two years.
Campaigner Ellen Murray, who changed gender in 2013, said a shift in attitude meant more people felt able to talk about gender issues.
"There has been a change in societal attitude, which I think has helped more people come forward for help," she said.
"It's so important the people get the support they need and can access services in a timely manner."
Official figures show almost 1,500 referrals to the regional identity service between 2006 and 2016.
The 13 referrals in 2006 had soared to 229 in 2015.
Two children between the ages of five and 15, and 32 people over the age of 65, accessed the regional identity service during this period.
Additionally, there have been 135 referrals to the Knowing Our Identity service between 2014 and 2016.
It supports children and young people under the age of 18 who are experiencing difficulties in the development of their gender identity.
The service provides young trans and gender-variant people - those who don't conform to a particular gender - with counselling, family and peer support, and mental health support services. Patients can also access hormonal treatments from age 15 and up, subject to assessment.
Northern Ireland's identity service is provided by the Belfast Health Trust at Brackenburn Clinic on the outskirts of east Belfast.
Staff at the unit work with patients who have gender incongruence, where a person does not agree with the gender they were given at birth.
The service provides adults in Northern Ireland with assessment, psychological support and onward referral, where appropriate, for hormone replacement therapy and surgery.
Green Party MLA Clare Bailey, who obtained the figures, said they represented only a small number of people struggling with gender identity.
She said: "The significant increase in the number of people seeking statutory support is a welcome sign, but likely to only be the tip of the iceberg.
"Trans advocacy and support groups have been clear in their articulation that it is time for a review of the Gender Identity Recognition Act of 2004 and its subsequent provisions.
"When the Gender Recognition Act was introduced, it was a long overdue but welcome step forward.
"Over a decade later it is clear from the consensus among trans organisations across the UK that it is time for it to be updated."
Ms Murray, who chairs Gender Jam NI, a transgender charity, also warned that children struggling with identity are waiting up to nine months to see a doctor.
She said the delay in getting an appointment is causing additional suffering.
"I think gender identity services are moving in the right direction, but if we don't address the capacity issues we are going to have real problems," she added.
Ms Murray said if young people can't access hormone blockers and decide at a later stage that they are transgender, then they have to go through much more invasive surgery, such as having breasts removed.
"These are hormones that are available to other young patients for other medical conditions and they don't have to go through the same psychological assessments to access them," she added.
Health Minister Michelle O'Neill said the figures show there is a clear need for services for people with gender identity issues. "It is also vital to have appropriate access to regional specialist services when this is required," she said.