Submission to the Equality and Human Rights Commission re Government Schools Guidance

Further to our meeting with Natalie Johnson on November 3 2017, we submit evidence regarding three aspects of the proposed government schools guidance on pupils:

1. Social role transition of a child who identifies as transgender 2. Stereotyping, sexism and homophobia 3. Sex-based rights and protections

1. Social role transition

Regarding the specific advice for schools in the EHRC Technical Guidance (at 3.35) on the subject of a female pupil who has started to 'live as a boy' and has adopted a male name, the Guidance advises:

 Not using the pupil's chosen name merely because the pupil has changed gender "would be direct gender reassignment discrimination"  Not referring to this pupil as a boy "would also result in direct gender reassignment discrimination"

This aspect of the guidance forces schools to take part in a social experiment. By 'affirming' a child as the opposite sex, teachers are compelled to collude in the 'gender affirmation' model of care for gender dysphoric children, a model which is new, untested, and based on social change, not on research or evidence.1

The established clinical model for the treatment of gender dysphoric children is 'watchful waiting,' the model followed by the Tavistock gender identity service in London. This is because all published studies of pre-pubertal gender dysphoric children indicate that around 80% will desist and become happy in their natal sex during adolescence2 and that the greatest likelihood is that these children will grow up to be gay or lesbian as adults, not transgender.3

Recent studies have shown that rates of social transition have soared in recent years and it is very difficult for a child to 'transition back' after a social role change.4 It has also been shown that any social transition (from change of name/clothes etc to full social role change) significantly increases rates of persistence in gender dysphoria. 5

The medical pathway

Caution should be exercised in our response to gender dysphoric children because in affirming a child as the opposite sex we increase the likelihood that the child will embark on a medical pathway, without the maturity to understand the implications.

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Children's identities are not fixed but developing, the construction of the Self is influenced by many factors including parents and environment. Daily affirmation by trusted adults that a boy is really a girl (or vice versa) is clearly likely to have a self-fulfilling effect and create persistence of a child's belief, as children believe what adults tell them. The created fear of a puberty the child now believes to be the 'wrong' one creates the need for puberty blockers.

If a child starts puberty blockers at Tanner stage 2 and subsequently progresses to cross-sex hormones at age sixteen as almost all children on this pathway do, permanent infertility will be the result as eggs or sperm will not have developed. These children will never experience full puberty as cross-sex hormones can only affect the development of secondary sex characteristics and not opposite-sex reproductive development. Cross-sex hormones result in some permanent life-changing effects on the body. Testosterone, for example, results in irreversible increased facial and body hair, male-pattern baldness and a deeper, hoarser voice. These effects cannot be reversed even if a young woman stops taking testosterone.

The flood of sex hormones at puberty triggers the important changes and organisation of the teenage brain, a process which is not complete until the mid-twenties when the brain/personality is fully formed. The long-term effect on neurological development of blocking this crucial process is not known.

Androgen inhibitors have only recently been used for children with gender dysphoria. Licensed for use in the treatment of men with prostate cancer, studies have raised concerns about effects on short- term memory, language ability, mental flexibility and inhibitory control.6 Recent studies from the US indicate long-term serious health effects for some women who were administered blockers for precocious puberty, such as excruciating muscle and bone pain, depression, weakness and fatigue.7

There are no studies to show that blockers are truly 'reversible' when used to treat gender dysphoria as so few children come off them once they start that the number is too small to study. There are increasing concerns that their use may prevent the 'crisis in adolescence' necessary for stable identity formation.8

There is no professional consensus on the 'affirmation' approach.9 Clinicians and researchers in the field have cautioned against any treatment which is difficult to reverse, including social transition,10 puberty blockers 11 and any irreversible hormonal treatments, until after a child's psycho-sexual development is complete. 12

Statistics

 The Tavistock clinic for children and adolescents has seen referral increases of about 50% a year since 2010-11. In 2015 - 16 there was an unexpected and unprecedented increase of 100%  2,016 children and adolescents were referred to the Tavistock Clinic in 2016 - 17 (compared to 1,398 the previous year) and of that number 69% were girls, increasing to over 70% in the adolescent age group13  Research indicates that the majority of girls who transition during adolescence would otherwise grow up to be lesbian 14  A disproportionate number of children on the autistic spectrum identify as transgender 15

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Rapid Onset Gender Dysphoria in Teenage Girls

Although there exists plentiful research on the etiology of transsexualism in adult males16 there are no research studies on adults who underwent medical gender reassignment treatments in childhood as this is a new phenomenon. This is a non evidence-based treatment pathway, therefore great caution must be taken not to present medical transition as the only pathway for gender dysphoric children.

Some professionals have noted a new presentation of gender dysphoria which appears after the start of puberty with no previous indication of gender confusion or unhappiness. This recent development has been termed Rapid Onset Gender Dysphoria and it affects mostly teenage girls, predominantly lesbians.

The first study of this group 17 indicates a high incidence of internet and peer-group influence where a number of teenage girls within a friendship group 'come out' together as transgender. A high percentage of these girls report increased popularity although parents report worsening mental health and parent-child relationships. Typically these girls receive online advice, trust only transgender sources for information, retreat into transgender-only friendship groups and may mock those who are not transgender or LGBT.

Parents report that their teenager's sudden announcement that they are transgender typically follows their immersion in online transgender forums such as Reddit, 18 Tumblr and YouTube.

Regret

The increasing number of social media accounts and online support forums for young people who regret their medical transition should give pause for thought. A recent survey of detransitioned young women19 suggests that exploration and therapeutic support should be the first step in treatment and a medical pathway seen as a last resort. Only 6% of those surveyed felt that they had received adequate counselling before making their decision to undergo medically invasive procedures which cannot be reversed. A high proportion of respondents were lesbians and/or had suffered previous trauma/ sexual abuse which 'affirmation therapy' had concealed.

Activists have consistently promoted the message to parents that if a child is prevented from medically transitioning they will commit suicide23 and that puberty blockers are a fully reversible and safe way to 'buy time' for a child to decide. 'Affirmation' can be seen as a commitment to this pathway.

The affirmation and social transition model has in large part been driven by the tactics of transgender activists to shut down debate20 and silence those in disagreement.21 The issue of 'transgender kids' has become a political social justice issue and anything other than affirmation of a child's 'gender identity' has been painted as 'conversion therapy' by health organisations pressured by activists. 22

Conclusion

'Social transition' is a predictor of persistence, leading to the use of puberty blockers which are highly predictive of subsequent cross-sex hormone treatment resulting in infertility and some irreversible effects on the body, followed by a lifetime as a medical patient and possible surgeries.

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As there is no way of knowing which children will persist and which will desist and the majority of these children are likely to be 'pre-gay' children, social transition cannot be said to be in the best interests of the child.

Policy impacting on children should reflect the latest clinical research and evidence and not be based on the views of political activist organisations, but in consultation with clinical professionals.

Our recommendation

The existing EHRC Technical Guidance (above) needs to be mitigated in government schools guidance to reflect the current clinical evidence, so that teachers do not find themselves in a position of colluding in an approach which may cause harm to individual children.

2. Stereotyping, Sexism and Homophobia

Without a gendered analysis of the impact of transgender policies in schools, the detrimental impact on girls cannot be seen or measured. The Equality Act 2010 obliges schools to act with due regard to all pupils protected by different protected characteristics.

Female pupils are protected under the protected characteristic 'sex' as 'girls'. Pursuant to the Technical Guidance above, male pupils who are protected under the protected characteristic 'gender reassignment' as ' persons' must also be referred to as 'girls'.

EHRC Technical Guidance (5.114) states that a transsexual pupil is protected from discrimination if

 he or she starts or continues to dress, behave or live (full-time or part-time) according to the gender with which he or she identifies as a person

The suggestion that there is a way to 'dress, behave or live' as a girl is a reinforcement of gender stereotypes harmful to girls and is in contravention of CEDAW Article 5 (a) which recommends the elimination of sex-role stereotyping recognised as a factor in the subordinate position of women in society in relation to men. The government has a duty not to promote gender stereotypes which disadvantage girls.

This factor is not likely to impact on boys in the same way, given that gender stereotyping strengthens boys' position as the superior sex and girls' position as the inferior sex.

To what extent does this redefinition of the sex-class of females/girls to prioritise 'gender identity' impact on girls who do not fit within the normative standards of dress/behaviour/interests expected of girls?

Lesbian and Gay Pupils

Lesbian, gay and bi-sexual pupils are protected under the protected characteristic '.' As above, lesbian and gay pupils commonly defy the stereotypical dress/behaviour/interests expected of their respective sexes.

www.transgendertrend.com

To what extent will a redefinition of 'boys' and 'girls' which equates the sexes with stereotypes of behaviour and appearance suggest to lesbian and gay pupils that non-conformity is synonymous with transgenderism? As gender non-conformity and cross-sex identification in childhood is more predictive of gay and lesbian outcome rather than transsexuality, how can teachers ensure that gay and lesbian children are also protected?

Our recommendation

Official government schools guidance must remind teachers of their duty not to promote gender and sex-role stereotypes harmful to girls. Teachers must also consider the particular vulnerability of all gender non-conforming pupils of being misled into thinking they are 'trans' because of their defiance of sex-role stereotypes, in particular lesbian and gay pupils.

3. Sex-Based Rights and Protections

The definition of the word 'girl' is 'young human female' and the definition of the word 'boy' is 'young human male.' Schools are establishments of education and as such should teach and use biologically correct definitions and language. Opaque language based on ideology and belief (such as 'cis' and 'assigned male at birth') should not be used to replace factual information. 'Cis' is a label which presumes people have a 'gender identity' they may not have, and is therefore a word which reflects only the presumption of the user. Sex is not 'assigned at birth,' but correctly identified. Children have a right not to be labelled with ideology-based words such as 'cis.' Children have a right to learn biological facts and not ideology presented as fact.

Children should not be given the message that biology is bigotry. Children have a right to understand biological facts, recognise someone's biological sex and a right to name reality. It is especially important for girls to be able to recognise and name the male sex, otherwise the right to assert their boundaries is taken away. Girls must not be coerced into accepting males into their private spaces without their consent, through manipulative tactics such as suggesting that they should be 'inclusive' or that feeling uncomfortable equals 'transphobia' or 'bigotry.'

Female pupils are protected as 'girls' under the protected characteristic 'sex'. This protected characteristic does not include 'gender reassignment' which is a separate protected category.

The Equality Act 2010 provides exemptions where it is lawful to discriminate against those with the protected characteristic 'gender reassignment' as a proportionate means of achieving a legitimate aim if it is judged that new policies would amount to discrimination against girls.

As the female sex, girls have special requirements not applicable to the male sex. Schools have a duty to correctly identify these needs and consider them in the formation of any new policies. In the areas of competitive/contact sports and in situations where issues relating to personal hygiene/privacy arise it is lawful to base policies on biological sex differences so that the welfare of girls in particular is safeguarded. The protection of the safety and dignity of female pupils when in a state of full or partial undress is a legitimate aim.

When considering whether to permit transgender pupils to use toilets and changing-room facilities of the opposite sex, schools have a legal duty to consider the needs of teenage girls.

www.transgendertrend.com

This will include in particular and specifically menstruation as a factor in girls' need for private toilet facilities, rather than a 'gender neutral' layout where members of the opposite sex may observe the length of time a girl spends in the toilet or overhear a girl unwrapping sanitary products which may cause her embarrassment or humiliation. Girls may also need private facilities to clean up.

Schools must take into account the privacy and dignity of all pupils. However they must also consider girls' specific vulnerability to sexual harassment, assault, voyeurism, indecent exposure and impregnation. EHRC Technical Guidance states:

3.20 The way in which school facilities are provided can lead to discrimination. Example: A school fails to provide appropriate changing facilities for a transsexual pupil and insists that the pupil uses the boys’ changing room even though she is now living as a girl. This could be indirect gender reassignment discrimination unless it can be objectively justified. A suitable alternative might be to allow the pupil to use private changing facilities, such as the staff changing room or another suitable space.

All schools guidance from transgender and LGBT organisations states that transgender children should be allowed access to the toilets and changing-rooms 'matching their gender identity.' This is in contradiction to existing EHRC Technical Guidance. Toilets and changing-rooms are segregated on the basis of sex, not 'gender,' and should remain so. Given the specific vulnerabilities of girls, removing sex-segregated facilities amounts to sex discrimination against girls protected by the characteristic 'sex.'

Under the terms of Public Sector Equality Duty Positive Action Schedule 158, schools can lawfully initiate schemes to tackle, for example, low numbers of girls in STEM curriculum areas. The school must consider whether the inclusion into such schemes of pupils who have not experienced the same disadvantages of female socialisation/discrimination/lack of role models etc is fair. Consideration should be given to whether achievements and awards gained by a male pupil may negatively affect the motivation of the girls the scheme is designed to advance.

Schools must also ensure that girls have accurate information about their own female bodies as described in CEDAW General Recommendation no. 25. Therefore biologically accurate language must be used and girls must not be made to feel that talking about specifically female issues is 'transphobic.'

Our recommendation

Schools must be informed that 'gender reassignment' and 'sex' are two distinct protected characteristics under the Equality Act 2010. In giving rights to transsexual pupils protected under 'gender reassignment' as 'girls', schools must correctly identify the impact on female pupils protected under the protected characteristic 'sex' as 'girls.' Schools must be informed of the exemption clauses in the Equality Act 2010 which protect females as a distinct group on the basis of their sex and the Technical Guidance 3.20 which recognises the need for separate facilities on the basis of sex.

A school's approach must be based on objective reality and not on subjective beliefs. 'Gender identity' must not replace 'sex' as the distinction between boys and girls, either in the language used or the policies implemented by schools, which would create further disadvantage and discrimination towards girls. Schools guidance must be clear and unequivocal on this point.

www.transgendertrend.com

Schools have a duty to protect the welfare of all pupils. A supportive but cautious 'watchful waiting' approach would be in the best interests of gender dysphoric children themselves as well as all other children in the school community.

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1 Transgender Trend (2017) Hot Topics in Child Health: A Medical, Ethical and Political Debate 2 James Cantor (2016) Do Trans Kids Stay Trans When They Grow Up? Today

3 Li et al Childhood Gendered Type Behaviour and Adolescent Sexual Orientation: A Longitudinal Population-Based Study University of Cambridge 4 Steensma and Cohen-Kettenis (2011) Gender Transitioning Before Puberty? Letter to the Editor, Archive of Sexual Behaviour

5 Steensma et al (2013) Factors Associated with Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study, Journal of the American Academy of Child and Adolescent Psychiatry

6 Gunlosoy et al (2017) Cognitive Effects of Androgen Deprivation Therapy on Men With Advanced Prostrate Cancer, PubMed

7 Christina Jewett (2017) Women Fear Drug They Used To Halt Puberty Led To Health Problems, California Healthline

8 Guido Giovanardi (2017) Buying time or arresting development? The dilemma of administering hormone blockers in children and adolescents, Science Direct

9 Vreuenraets et al (2015) Early Medical Treatment of Children and Adolescents with Gender Dysphoria: An Empirical Ethical Study, PubMed 10 Steensma et al (2011) Gender Transitioning Before Puberty? Springer, Letter to the Editor

11 Hruz et al (2017) Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria, The New Atlantis 12 Korte et al (2016) The Treatment of Gender Identity (Gender Dysphoria) Disorders in Childhood and Adolescence - Open Outcome Therapeutic Support or Early Setting of Therapy Course with the Introduction of Hormonal Therapy? Sexuology 13 Transgender Trend (2017) From adult males to teenage girls: the movement from etiology to ideology 14 Steensma et al (2010) Desisting and Persisting Gender Dysphoria after Childhood 15 Glidden et al (2016) Gender dysphoria and autism spectrum disorder: a systematic review of the literature Sexual Medicine Reviews 16 James M Cantor (2011) New MRI Studies Support the Blanchard Typology of Male-to-Female Transsexualism, Springer Archives of Sexual Behaviour

17 Lisa L Littman (2017) Rapid Onset of Gender Dysphoria in Adolescents and Young Adults: A Descriptive Study, Journal of Adolescent Health

18 Transgender Reality (2016) Questioning teens and social contagion, Wordpress

19 guideonragingstars (2016) Female detransition and reidentification: Survey results and interpretation, Tumblr

20 Transgender Trend (2016) Transgender diagnosis and treatment of children is not up for debate

21 Jesse Singal (2016) How the Fight Over Transgender Kids got a Leading Sex Researcher Fired, The Cut 22 Rebecca Hardy (2017) How a psychotherapist who has backed transgender rights for years was plunged into a Kafkaesque nightmare after asking if young people who change their sex might later regret it Daily Mail interview with James Caspian 23 Transgender Trend (2017) The Suicide Myth

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