Supporting transgender pupils

Written by: Dr Stephanie Thornton | Published:
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This is the best article on gender diversity for non-specialists that I have seen. I would expect ...

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Schools have legal and moral duties to support pupils who face gender identity issues or have gender dysphoria. Dr Stephanie Thornton explains and offers advice

Not so long ago transgender was primarily a source of prurient curiosity and medical mystification, poorly understood and poorly accepted. It is better understood today, but it is still tough to “come out” as transgender, still likely to elicit social disapproval, rejection, teasing and bullying.

It is surprisingly hard to say how common transgender is. A survey in 1998 reported very low rates – around eight per 100,000. However, this more than likely reflected the social difficulties of admitting to a transgender identity.

A decade later, as social acceptance grew, the figure stood at around 20 per 100,000. This is still almost certainly an underestimate of the phenomenon: it includes only those seeking treatment for what the medical profession call gender dysphoria.

There is a far bigger pool of transgender people who have not yet – and may never – take that step. Estimates including these individuals suggest a prevalence of around 600 to 1,000 per 100,000 of the population.

For many decades transgender was regarded as a psychological disorder, probably caused by trauma or poor parenting, that could be cured by psychotherapy.

At the time it was believed that gender was socially rather than biologically constructed, so that any child could as easily be raised a boy or a girl. This view was severely challenged by the case of David Reimer, a boy whose penis was accidentally destroyed shortly after birth, who was raised as a girl but whose profound discomfort with that identity led him to revert to a male identity in adult life.

Though social factors almost certainly play some role, transgender is now widely regarded as having a strong biological basis. It is probably mediated by an excess or insufficiency of/insensitivity to prenatal androgen at some crucial point in foetal development.

There is clearly a genetic component: twins are far more likely both to be transgender if they are identical, so sharing the same genes, than if they are non-identical. Studies have found specific genes associated with transgender.

Advances in neuroscience have demonstrated that various brain structures are different in transgender individuals, with the brain structure of male-to-female transgender persons resembling the female pattern, and female-to-male transgender persons resembling the male. This research supports the practice of gender reassignment. But of course, it leaves many questions unanswered: how does a brain pattern translate into an identity, let alone an identity at odds with the body?

Children below three generally don’t realise that gender is fixed, or that it is defined not by behaviour or clothes but by physiology. As this idea dawns, and with it a sense of gender identity, some children realise that there is a misfit between their body gender and their gender identity. Most transgender individuals understand their plight in early childhood, between the age of four and six.

Realising that you are “in the wrong body” can be a frightening, miserable and isolating thing. Families and schools pressure the child to conform to his or her body gender in dress and behaviour.

Peers can be a ferocious source of this pressure, ridiculing and bullying those who don’t conform to (body) gender stereotypes – and this is as true in early childhood as in adolescence. Many transgender children and teenagers are too scared to tell anyone of their problem, though this does not relieve the intense longing to be “in the right body”. Many keep their secret well into adult life, even old age – or forever.

Puberty presents a major crisis for the transgender child, as their bodies take on the sexual characteristics of the “wrong” gender. For some the trauma is too much.

For those with no support, the extreme isolation and desperate feelings of wrongness, the fear of rejection and bullying drive depression, self-harm and suicide – more than 40 per cent of transgender individuals attempt suicide before leaving their teens. Many transgender teenagers are too afraid to admit their predicament and so don’t seek help in this crisis.

Thankfully, more and more feel able to do so: the numbers of teenagers applying for gender reassignment treatment is currently rising by 50 per cent every year.

When a child is thought to have gender dysphoria, UK policy is to take this seriously but play it softly.
There is only one specialist centre for such individuals in Britain – at the Tavistock and Portman NHS Foundation Trust in London. Pre-pubescent children are likely to be referred for psychotherapy, and the family offered counselling: the majority of children thought to be transgender will not have this condition when they reach puberty, so the emphasis at this stage is on support, and discerning their level of commitment.

Those who reach puberty with clear distress over the misfit between their body gender and their gender identity and a strong desire to live in their gender identity will be offered hormonal treatments that suppress puberty. This treatment is fully reversible, should the teenager change his or her mind. Only at around 18 is it likely that permanent hormonal and surgical treatments to permanently align body and gender identity will be invoked.

A school viewpoint

From a school’s point of view, it is hard to know how to respond to transgender issues. The high levels of bullying and rejection, the extreme isolation and high suicide risk of the transgender suggest that this should be a priority – but gender dysphoria is comparatively rare, with less than one per cent of the population affected, even on maximum estimates.

However, that figure is just the tip of an iceberg. Gender identity is a problem for many others besides those committed to sex change. There are many who don’t want to change sex, but who don’t conform to conventional gender identities (not feeling or being as feminine or masculine as stereotypes suggest they should, or not identifying with either gender).

This broader constituency is also subject to teasing and bullying, social marginalisation and the risks of depression and self-harm that those things generate – and this is justification for strong efforts to create school cultures more tolerant and supportive of difference and confusion in gender identity. How best to do that?

Practical steps

Take gender confusion seriously: support groups for the transgender report that schools are often insensitive and unresponsive to those struggling with gender identity. The misery and high risk of suicide for these individuals makes a more accepting and supportive stance from staff vital – which requires better training as to the causes and experience of transgender and other gender identity issues.

The signs of those struggling with gender dysphoria or gender confusion are not always obvious, but quite often there will be clues in the individual’s behaviour or demeanour. If you suspect an individual is struggling with these problems, a sensitive conversation and follow up may make all the difference in the world.

Address transgender-related bullying directly: transgender support groups object to transphobia being lumped in with homophobia. Gender and sexuality are two different things, and transgender and homosexuality elicit fear and rejection for different reasons. The fears surrounding transgender need to be addressed directly rather than being buried in efforts to undermine homophobia.

Shake up ideas about gender: gender is not the male/female dichotomy we suppose, but a continuum. Up to two per cent of births differ from standard male or female physiology in some way.

Furthermore, since brains and genitals form at different periods of gestation and the hormone levels that shape gender can fluctuate through pregnancy, brain and body sex can easily be somewhat – and sometimes totally – divergent. Most of us are actually androgenous to some degree, having both male and female characteristics.

Teaching a more nuanced understanding of the biology of gender may foster tolerance for gender confusion/transgender.

  • Dr Stephanie Thornton is a chartered psychologist and former lecturer in psychology and child development.

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Comments
This is the best article on gender diversity for non-specialists that I have seen. I would expect no less of Stephanie - I was taught by her at Sussex in the late 70s (she knew me as Mike O'Neill). She is perfectly correct to say that fear holds people back. In my case reactionary behaviour by one school in particular not forgetting my parents (my response was to act out and be an obnoxious teenager), bad advice by clerics who thought they knew everything about the subject but in fact knew nothing, and so on. Psychotherapy? If only. Beating more likely (this was the 1950s). And total confusion with sexuality. This kind of thing gets internalised and is hard to shake off. Even at unisex 1970s Sussex I would have been stamped on by aggressive, third wave feminists. So here I am at 75 in the early stages of the change. Better late than never but, teachers, Udo realise your charges need your help to be themselves, no matter their gender identity or any other characteristic some might find odd.
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This is the best article on gender diversity for non-specialists that I have seen. I would expect no less of Stephanie - I was taught by her at Sussex in the late 70s (she knew me as Mike O'Neill). She is perfectly correct to say that fear holds people back. In my case reactionary behaviour by one school in particular not forgetting my parents (my response was to act out and be an obnoxious teenager), bad advice by clerics who thought they knew everything about the subject but in fact knew nothing, and so on. Psychotherapy? If only. Beating more likely (this was the 1950s). And total confusion with sexuality. This kind of thing gets internalised and is hard to shake off. Even at unisex 1970s Sussex I would have been stamped on by aggressive, third wave feminists. So here I am at 75 in the early stages of the change. Better late than never but, teachers, Udo realise your charges need your help to be themselves, no matter their gender identity or any other characteristic some might find odd.
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