Olivia Purdie is medically delaying puberty because the 11-year-old doesn't want to develop the body of a woman.
"I am non-binary, which means I have no gender. I am just me," Olivia said.
The Year 6 student is one of a small but growing cohort of children around Australia seeking treatment because they don't identify as either a boy or a girl.
"The world basically revolves around boxes and those two boxes are a male and a female box," Olivia said.
"People try to duct tape the box so then you'll stay like that. But I cut the duct tape and opened up into my own box."
Two years ago, Olivia was diagnosed with gender dysphoria, a condition where a person experiences extreme distress due to the mismatch between their biological sex and gender identity.
Olivia's mother Jane Russo said her child was particularly stressed about growing breasts.
"I think part of that was saying, 'Well, I don't want to have breasts'," Ms Russo said.
Doctors recommended puberty blockers, drugs used to postpone puberty and to help Olivia cope with anxiety caused by pubescent body changes.
The injections have stopped Olivia developing breasts, menstruating and developing other female characteristics.
"I'll probably be coming off the puberty blockers when I'm 16. I have five years to think about this. There's no rush with this. No point in rushing anyway," Olivia said.
Photo: Olivia feels less anxious about body changes since starting puberty-blocking injections. (Four Corners)
Puberty suppression for young gender diverse people has been the subject of much controversy.
Some critics say the children are too young to consent and should not be on any hormonal medication.
According to Olivia's psychiatrist Georgie Swift, all medication has side effects and risks.
"The paediatricians who prescribe the leuprorelin do monitor that and we're aware if it becomes more of an issue for a particularly young person. So there are some concerns about a young person staying on puberty suppression for a long period of time."
Ms Russo said she weighed up the health risks but believed puberty suppression was what Olivia needed.
"We were informed about the risks of Olivia going on puberty blockers … about reduced bone density, but we believed this risk was low and we weighed it against Olivia's mental health and wellbeing."
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Video: Mother Jane Russo explains the difficult decision to put her child Olivia on puberty-suppressing injections. (Four Corners)
Olivia is under the care of two specialists at the Women's and Children's Hospital in Adelaide, Dr Swift and paediatric endocrinologist Jemma Anderson.
Dr Anderson said the medical impacts of puberty blockers were generally reversible and only prescribed "after a very long and considered process with extensive and in depth psychiatric evaluation for both Olivia and her family".
Dr Swift acknowledges there are strong critics who believe the children are going through a passing phase.
"I wonder if they've ever spoken to a young gender-diverse and non-binary person or really thought about what it would be like to walk in their shoes, rather than seeing it from a distant and more academic perspective," she said.
Ms Russo said she was appalled at accusations parents and doctors were committing child abuse by supporting medical intervention for gender diverse children.
"If I was to disregard Olivia's thoughts and how Olivia was feeling, I'd lose my child," she said.
"Because the reality is, I could have no child if I didn't respond to what I was hearing from my child. The need to go onto puberty blockers is actually saving Olivia's life, because Olivia can be what Olivia wants to be."
Infographic: Olivia has a wide range of hobbies and toys. (Four Corners)
Dr Swift said not allowing someone to have medical intervention could result in significant mental health problems.
"When young gender-diverse people get support from family, friends, school, education, they do much better in terms of their mental health," she said.
"Their number of suicide attempts are less, their deliberate self-harm is less, and their general wellbeing is improved."
Nine of the 65 gender-diverse children under Dr Swift's care identify as non-binary.
There is a waiting list for medical support of at least 12 months at the Women's and Children's Hospital in Adelaide for this type of treatment.
"It is concerning because waiting is probably the biggest fear that these kids have as their bodies start changing," Ms Russo said.
Photo: Parents Justin Purdie and Jane Russo sit in a session with Olivia and adolescent psychiatrist Georgie Swift. (Four Corners)
Not all non-binary young people want medical intervention like hormone therapy or surgery.
Audrey Mason-Hyde, 14, went to the same primary school as Olivia.
Audrey's sex was assigned female at birth, but Audrey does not identify as either male or female.
"I think a lot of people do identify as non-binary and want to change their body to fit what they see as the ideal body," Audrey said.
"I think that is great, amazing, go for it. But I also think you don't need to change your body to be valid as a non-binary person.
Photo: Audrey Mason-Hyde also identifies as non-binary. (Four Corners)
"And I love my body the way it is."
Hospitals in Australia are treating a growing number of children who identify as non-binary.
"I get asked quite a lot about why we're seeing so many more gender-diverse and in particular non-binary people coming out now," Dr Swift said.
"I don't think it is a new identity or a new type of being a person. I think non-binary people have existed as long as we have. But up until more recently there hasn't been a language for it."
Photo: Mother Jane Russo has been very supportive of treating Olivia's gender dysphoria. (Four Corners )
Olivia's father Justin Purdie has had a steep learning curve.
"As a parent, with the journey through puberty with a non-binary child, there's lots of questions," he said.
"I'm quite analytical. But there's no nice clear-cut solution. So, in many respects, you do just have to roll with it.
"I just want what's best for my child."
