03:30, June 05 120 0 theguardian.com

2017-06-05 03:30:03
Utopian thinking  
 It’s still not easy being a trans child. This is what schools can do to help

The world has changed in the 30 years since I learned that the third of our four children wished to transition. She had been registered as male at birth and had given no indication that she identified as a girl, or so I thought. Hindsight is a wonderful thing; the signs were there. I had missed them. Trans issues are now more mainstream, and generally elicit less interest than in the past. On hearing of the impending transition of a classmate, the current response is likely to be the classic teenage shrug, and the bored, dismissive, “Whatever!”

Nevertheless, the social transition of children, especially in infant and primary schools, is often greeted by a mix of disbelief – “how can they possibly know?” – and prejudice, sometimes prompted by religious orthodoxy, a strong belief that “this is wrong”. These factors, combined with the mistaken belief that the trans population is tiny, may lead schools to be reactive, rather than proactive, in preparing for the transition of a student or staff member. Instead of taking pre-emptive steps in line with the public sector equality duty (Equality Act 2010), they respond with the belated, headless-chicken approach.

An academic study in the Netherlands found that roughly 5% of the population falls under the “transgender” umbrella, comprising 1% who are assigned male at birth identifying as girls/women, and vice versa; and 4% whose identities are between or outside the gender binary, that is “non-binary” individuals, who often use the pronoun “they’’; and “non-gender” people who may use the pronoun “per”.

Parenting is sometimes suggested as a causative factor in the development of gender incongruence; parents themselves may worry about their role in the unexpected gender development of their child. However, no evidence exists to support this “nurture” hypothesis. It is nobody’s “fault”. The historical, psychopathological understanding is also giving way to a growing body of scientific evidence demonstrating that biological factors are involved in the development of “gender dysphoria’’ (the social and physical discomfort experienced by trans people). However, the biological indicators are very variable and should not be used diagnostically, so “the only valid route to understanding a person’s identity is to listen to them. Whatever our scientific understandings, the needs of transgender people should be met on the basis of universally recognised human rights.”

Despite the welcome removal of the psychopathological label, trans people still experience challenges to their mental health. Factors such as rejection, bullying and isolation correlate with high levels of suicide attempts: 40% of trans people have attempted suicide. Schools need to be alert to mental health issues in this exceptionally vulnerable group.

Pre-pubertal children do not need medical intervention, but they do need their identities, and their chosen names and pronouns, to be respected, and to be allowed to dress according to their gender identity, rather than their assigned sex. Treatments now available after the onset of puberty were not offered when our daughter was a teenager. Her life might have been very different had she had the benefit of such interventions. She might have avoided the years of horrific bullying in the workplace that led her to attempt suicide.

Hormone-blockers to arrest unwanted development of sex characteristics may be quite literally life-saving: they are safe and reversible. The pioneers in this field, a Dutch team based at the VU university medical centre in Amsterdam, regard the hormone-blocking period as a diagnostic opportunity, enabling the young person to focus on their gender issues with a mind uncluttered by the fear of breast development, or facial hair and dropped voice. Once developed, secondary sex characteristics cannot all be reversed, and those that can involve extensive and costly interventions, including surgery.

If, during suspension of puberty, a young person feels that they do not wish to continue down this path, then they may stop taking the hormone-blocker, and allow their original puberty to resume. The blocker alone does not treat gender dysphoria, so for those who still experience this discomfort, gender affirming (cross-sex) hormone therapy is appropriate. Obviously, a young person seeking this intervention would need to have sufficient maturity to understand the benefits, risks and side-effects of treatment.

Yet, despite the advantages of early recognition and timely medical interventions, some parents and professionals still worry that supporting the young person’s identity pushes them towards a trans outcome. There is no evidence to support this, and the bigger question is, what if treatment is not provided and the child’s sense of self-worth spirals downwards into self-loathing and despair? One survivor of the “wait and see” approach, having been pressured to conform to cultural norms, described to me a childhood “tainted with patterns of worthlessness and shame and a chronic need to apologise for oneself”. The World Professional Association for Transgender Health standards of care state that “withholding puberty suppression and subsequent feminising and masculinising hormone therapy is not a neutral option for adolescents”.

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Schools vary in their willingness to accommodate the transition of pupils. A few years ago, in an all-girls school, the transition of a young person, assigned female, who identified as a boy, was initially resisted by the head teacher. Yet despite the memorable comment, “We don’t do boys”, they finally did, and the young man in question was socially integrated, and scholastically successful. There are now growing numbers of children who transition socially both in single-sex and mixed-sex environments. Even if not well prepared, schools are usually keen to learn and to do the right thing.

Even the vexed issue of toilets and changing facilities is becoming less problematic. A few years ago, in a case where a school denied a trans child access to gender-appropriate toilets, I explained that such exclusion would be discriminatory under the Equality Act. I was surprised to receive an anguished response pointing out that the 143 other pupils using those toilets needed protection. The child in question was aged seven, clearly neither predatory nor contagious. But now, many schools are accommodating children in toilets that accord with their gender identity, rather than their birth sex. Sometimes the issue is solved by providing gender-neutral toilets for all pupils.

School teachers and staff need to have access to the valuable training tools available, such as the NHS-badged e-learning resource “Support for Gender Variant Children and Trans Adolescents”. Curriculums should include trans awareness from an early age: Penguin Land books can be introduced from three years old upwards. Gender-variant young people must be included in sport and social activities to build their confidence.

Publishing simple protocols for the transition of students and staff encourages them to feel safe to transition: in line with the Department for Education’s census advice, schools should record the new name and re-classification of gender, “according to the wishes of the pupil and/or parent”; promoting a code of conduct that emphasises the institution’s zero tolerance towards bullying – including cyber-bullying – helps to stop problems before they start.

The message of my charity, the Gender Identity Research and Education Society, is that diversity should be embraced and celebrated. It creates a better society and it makes better people of us all. And school is where it starts.

If you need support with any of these issues visit the Gires or Mermaids websites