Caroline Litman’s Journey: A Mother’s Reflection on Her Daughter’s Transition
Caroline Litman always prided herself on being a progressive parent. When her eldest daughter, Kate, came out as gay at the tender age of 13, the news felt both welcome and mundane. The conversation swiftly shifted from her teenager’s sexuality to the more pressing matter of breakfast. “I was like, ‘Okay honey, but what do you want on your toast?’” It was just an ordinary day in the Litman household.
However, the situation took a more complex turn when Caroline’s youngest child, Alice, began to grapple with her LGBTQ+ identity. When Alice (Caroline exclusively uses her post-transition name and she/her pronouns regardless of the era discussed) started experiencing gender dysphoria in 2017, she hesitated to confide in her parents. In fact, she never directly disclosed her feelings to them. Instead, the family slowly pieced together the puzzle of Alice’s identity over the course of months and years, often fumbling for clarity amidst uncertainty.
Alice chose not to open up to them, as Caroline grappled with her own skepticism. She often voiced doubts, sometimes to her husband, Peter, and at times out loud around the dinner table. Conversations about trans women accessing public toilets or being incarcerated lingered in her mind, as did media portrayals that sparked her concerns. Caroline found herself questioning whether her anxious child had been influenced by a “trans cult.” She thought, “Wouldn’t there have been earlier signs if she really was trans?” Reflecting on this, Caroline admits, “I didn’t think I was transphobic, but I clearly was. I was like, ‘Being trans is fine, just not for my child.'”
As Caroline grappled with her own misgivings, Alice faced numerous obstacles: unhelpful GPs, long waiting lists (“a torture chamber,” Caroline calls it), scant mental health support, and pervasive transphobia in society. Ultimately, the barriers to timely healthcare proved insurmountable for Alice, who tragically took her own life on May 26, 2022, at the age of 20. She had endured 1,023 days on a waiting list for her first appointment at a gender identity clinic.
Caroline, 57, hailing from Surrey, had always longed for a third child. On February 23, 2002, Alice was born, and from the very beginning, she exhibited a distinct personality compared to her elder siblings, Kate and Harvey, now 28 and 26. Alice was quiet, easygoing, and had a good-natured disposition. From just six weeks old, she slept through the night for 12 hours. “The other children used to say I favored her and let her get away with things, but she was never difficult,” Caroline recalls. Alice thrived in her family environment, delighting in baking, playing in the garden (her first word was ‘outside’), and engaging in imaginative play with her best friend, Lucy. They would create rocket ships from cardboard boxes and draw treasure maps together. “I remember saying she was an angel from heaven,” Caroline fondly remembers. When asked if she said that to Alice, she hopes she did, as it was how she described her to everyone else.
As a child, Alice seemed at ease in the world. But as she matured, everything changed. “Alice lost her effortless ability to communicate, and I lost my ability to read her,” Caroline reflects. “There’s no single moment I can pinpoint as the beginning of this change; it was an insidious process, occurring gradually, day by day, week by week, month by month,” she writes in her poignant memoir, Her Name Is Alice.
By March 2017, Alice, then 15, was refusing to attend school. Caroline, who had trained as a junior doctor and specialized in psychiatry for 12 years, began a direct inquiry to uncover the root of her child’s struggles. “Are you gay? Being bullied? Is it a teacher? Has something happened online? Have you committed a crime? Are you attracted to young children?” (This last question raised an eyebrow.) But no, Alice insisted—none of those were the issues at hand.
“It never crossed my mind to ask if she was trans. Perhaps subconsciously, I thought being trans was worse than being a paedophile,” she confesses.
With no answers forthcoming, Caroline took Alice to a GP to investigate her low mood. The doctor’s response, suggesting that Alice merely needed more fresh air and to play football, marked the beginning of Alice’s harrowing journey through the healthcare system. In England, trans healthcare is managed by specialized centers known as gender identity clinics (GICs). GPs must refer patients to these heavily oversubscribed services, rather than treating them independently. So, the first step is always the GP, and once referred, the waiting begins: as of February 2025, the Tavistock Clinic, the largest and oldest such facility in the UK, reported over 16,270 people on its waiting list. The clinic was only seeing individuals referred as far back as June 2019—almost six years prior.
But Alice wasn’t referred; in fact, nothing happened for a long time as her puberty progressed. After the first doctor, Caroline arranged for Alice to see another GP. This time, Alice attended the appointment alone. A few days later, Peter discovered a letter addressed to his child, lying near the kettle, with the heading ‘gender dysphoria.’ Neither Caroline nor Peter read the contents, respecting Alice’s privacy, but it provided a rare glimpse into their daughter’s internal struggles. “The possibility that she might be trans was never considered,” Caroline reflects. Yet, Alice remained tight-lipped about the letter.
Once again, this doctor failed to refer Alice to a GIC. Instead, she directed her to Child Adolescent Mental Health Services (CAMHS), where she was offered anxiety management. No deeper investigation into her underlying issues was conducted, and Alice was discharged from CAMHS in the spring of 2018.
As Caroline continued to search for clues, she became fixated on the absence of “signs” that would indicate Alice’s transgender identity. Growing up, Alice had played with both her brother’s and sister’s toys, developed an affection for a neon pink handbag that belonged to Kate, and loved to dance, though she refrained from attending classes due to discomfort around other girls. She didn’t feel at ease in a boys’ class either.
As her worries for Alice mounted, Caroline remembered a trans woman she had known in the 1980s. She and her friends had treated the woman with kindness, using the correct pronouns and generally being unperturbed by her trans identity. “Why did I suddenly care about Alice being trans? It fills me with shame,” she admits. “Even with a positive personal experience, I was still afraid of my own daughter’s transition. The only explanation is that I had absorbed a significant amount of media hostility.”
Caroline found herself distrusting organizations like Mermaids and grew wary of Alice’s friends who seemed to encourage her exploration of gender identity (one even gifted Alice an old Laura Ashley dress, prompting Peter to intervene). She delved into research regarding regret rates and notions of contagion and coercion. “In the midst of it all was Alice, my angel, the least monstrous person I had ever known.” Thus, the family remained in a state of limbo, filled with anxiety for Alice, as her parents stayed mostly in the dark with no clear path ahead.
Then, in May 2019, at the age of 17, Alice attempted her first overdose. Caroline and Peter were away for two nights, and when Caroline returned home, she found Alice barely conscious. They rushed her to St George’s Hospital. “My child was on the brink of death. If not because I left her vulnerable and suicidal for a brief break, then because I took the wrong route to Tooting,” she recalls. Fortunately, Alice had consumed a significant amount of alcohol and was sick, which “gave us a second chance.”
It was at this critical moment that the family realized they had no option but to support Alice’s exploration of her gender identity. “Not affirming her had led to this, so what else could we do? It was undoubtedly the right choice. Some will argue that affirming her led to her death, but they weren’t there to witness the events unfold before our eyes.”
The family organized a ‘coming out’ Mad Hatter’s tea party to celebrate Alice’s transition. Caroline and Peter visited their elderly mothers to inform them that they now had a granddaughter instead of a grandson. To their relief, both grandmothers were accepting; Caroline’s mother even sent Alice a card with cash for a new dress. “Alice was in a sunny mood, buoyant and optimistic,” Caroline recalls. “She spoke more freely about her identity during this time.”
Alice transitioned socially and returned to school that September. She formed two groups of friends: the Dungeons and Dragons crew and the ‘LGBTQ gang,’ who were supportive of her. However, she encountered hostility in other settings; fellow students threw ketchup on her at a house party, and later, bouncers assaulted her outside a nightclub, an incident Alice chose not to report to the police.
Shortly before her 18th birthday, Alice was finally referred to a GIC by a doctor. Another waiting game commenced.
The family sought private healthcare options, but those avenues were equally overburdened. During one consultation, Caroline later learned that the doctor had noted her as a “difficult parent” and claimed Alice had made “poor lifestyle choices.” Meanwhile, Caroline underwent her own moment of clarity during a cycling holiday when she overheard friends discussing trans women in sports. Their arguments struck her deeply, and she found herself sobbing. “It dawned on me, in a moment of clarity, if I could feel this unsafe amongst friends, what must Alice be experiencing?”
Though the family had come to terms with Alice’s identity, the wait for healthcare continued. Alice spent nearly three years on the waiting list before her tragic death, her mental health fluctuating wildly—sometimes making strides such as moving out to Brighton, other times confiding in her family about suicidal thoughts. “That waiting list is completely non-functional; it’s a holding cell,” Caroline asserts. “I felt utterly powerless in my attempts to secure the care my child needed.”
In the inquest following Alice’s death, a report indicated that her passing was preventable with appropriate support. It warned that future deaths could occur unless action was taken, highlighting concerns about delays in accessing gender-affirming care, a lack of mental health support for those on waiting lists, unclear directives for clinicians in primary care, and issues regarding knowledge and training.
The last day Caroline spent with Alice was May 11—just 15 days before her death. They attended a doctor’s appointment for Alice (who had an ear infection and was seen promptly, a stark irony) and afterwards treated themselves to Krispy Kreme donuts. Alice even allowed Caroline to buy her a coffee—an Americano, black, no milk, just like her mother’s order. “I’m turning into a grown-up,” she proudly proclaimed.
In the following days, they communicated via a family WhatsApp group about Doctor Who and Eurovision, though Alice seemed quieter than usual.
On May 26, a police officer knocked on their door to deliver the devastating news that Alice had died.
Reflecting on the past three years since Alice’s death, Caroline believes the system has deteriorated, not improved, particularly following the Cass Review and the indefinite suspension of puberty blockers for those under 18 (now only available as part of a clinical trial). “Sometimes I feel a fleeting sense of relief that Alice isn’t here to witness the current state of affairs, as it’s so disheartening it makes you want to weep,” she shares. In August 2024, NHS England announced plans to establish six new regional centers by 2026 to support those under 18. The Litman family advocates for a system similar to that in Wales, where GPs manage more trans healthcare within the community. Caroline questions, “Why isn’t this model used in England? Budget constraints are often cited, but I believe that’s an easy excuse. I think there is a significant amount of transphobia within the NHS. We don’t have healthcare-driven policies; we have policy-driven healthcare.”
A 2020 report by Ipso revealed a staggering 400 percent increase in trans-related stories in the press over the past decade. “I can only imagine the intrusive thoughts Alice was grappling with,” Caroline muses. “We are living in a society that is set to harm individuals like Alice. We are, indeed, ‘terf island,’ aren’t we?”
If Caroline could rewind time, what message would she convey to her past self or to other parents in similar situations? “Listen to your child and consider what they must be feeling, rather than solely focusing on your own emotions. Coming out in today’s climate requires immense bravery.”
She adds, “If you harbor doubts, seek help to discuss those feelings. I may not have been vocalizing monstrous thoughts, but I held my ‘reasonable concerns,’ which I now realize are utterly ridiculous.” In the epilogue of her memoir, she writes: “[Alice was] a child for whom living authentically is too often subject to political, religious, and journalistic debate, as well as dinner-table discussions.”
Among the many changes Caroline wishes to see, she emphasizes the need for reform in the treatment pathway and, most importantly, that Alice could have grown up in a household where being trans was discussed with the same “ease and grace” as any other aspect of the LGBTQ spectrum. “I failed Alice, and that thought plagues me. I will carry this self-recrimination, with varying intensities, until the day I die.”
Her Name Is Alice: My Daughter, Her Transition and Why We Must Remember Her by Caroline Litman is set to be published on March 13 (£22, Harper Collins)
