We had friends round for dinner this evening and towards the end of the meal as we were sat around the table the conversation turned to news items we’ve seen this week (as it so often does).  We started talking about the news item this week about the Christian couple that removed their child from a primary school because the school were supporting a transgender child by “allowing” them to wear a skirt!  Of course it is a much deeper argument than just about the clothing the child was wearing.  The parents at the centre of the reporting stated that “our concerns were raised when our son came back home from school saying he was confused as to why and how a boy was now a girl.  We believe it is wrong to encourage very young children to embrace transgenderism, boys are boys and girls are girls”.

Naturally, the media have been all over this event and have invited the parents to talk about their decision on chat shows and radio shows.    The conversation round the table tonight saw a frank and full discussion about this with varying opinions being offered.

 

I’ve been thinking about it ever since (it’s now the wee hours of the night) and decided to write a blog article about it. Now, I hear you saying “what has speech and language therapy got to do with being transgender”?

 

Well firstly, people who are transgender are human beings and therapists work with human beings.  Speech and language therapists do many things, but a large part of our work (regardless of the client type) is listening and empathising with people.  It’s a caring profession.  We share journeys with our clients and often come across situations where deep emotion is expressed.  People trust you and open up to you in an intimate way and it is a privilege when someone does that.  I’d even go so far as to say that it is sacred.  Whilst at university we study modules in sociology and psychology to prepare us for this, as it is a vital element of our work.  I believe this makes us sensitive to areas that others are not.  A lot of clients will express some form of grief or another during sessions, whether it be a parent who is grieving over their child’s delayed development or an adult who has experienced a life changing brain injury.

 

Secondly, you may not know this, but speech and language therapists work with people who are transgender, mainly to help feminise the voice after someone has had male to female gender alignment surgery.  So, we learn about being transgender at university.  When I sat in a lecture theatre and was taught about what it means to be transgender and about the process of gender realignment it was revelation (please note that I use the term realignment rather than reassignment purposely, because reassignment suggests that gender is a choice, rather than organic).

At the time I had a family member going through the process and I was so pleased to develop my understanding of it.

 

It can be hard to ask someone who is going through the process, about it.  I’m British and we Brits don’t like to ask personal questions for fear of offending someone.  However, conversely some parts of society seem happy to make assumptions.  So, when I heard the news article this week and saw the sorts of comments that were being posted on social media it really got me thinking.  Some of the comments that were made were along the lines of:

• they’re (the children) too young to know
• the parents have planted the idea in their minds
• children have fads and how do the parents know they won’t change their minds in a few years
• the parents shouldn’t be indulging this
• the parents are ultimately making the choice for the child
• it’s too confusing for other children

 

I want therefore to take this opportunity to address these arguments in some small way through the little understanding I have.  I’m going to attempt to do this in two ways, by presenting information about the subject (including research) and also offering you some personal insights I have, but before I do so I want to reiterate that this is a highly, highly, complex issue and that even specialists in the field have slightly conflicting opinions about it all.

 

Okay, so here we go for the factual stuff:

 

1. People refer to the term trans – what does this mean?      Trans is an umbrella term for various people who feel that the sex that they were assigned at birth does not match or sit easily with their sense of self.  The world is generally divided into two categories – men and women.  Sometimes it is thought that trans is complicated because a trans person doesn’t fit neatly into these two categories.  Indeed the concept of ‘trans’ raises questions about what it even means to be a ‘man’ or a ‘woman’.  The trans spectrum encompasses transsexual and transgender people, crossdressers, and anyone who challenges gender norms.  It may be that a trans person feels more the “opposite” sex and so chooses to use medical intervention in order to align their body with their mind or their outside appearance with their internal feelings.  Crossdressers may dress to express the more masculine or feminine side of themselves, or simply because those clothes feel more comfortable.

 

2. So, what does the term transgender mean, is it the same as trans – It is someone who self identifies their gender identity as that which does not match the sex which they were assigned at birth.

 

 

3. What sexual orientation do transgender people have – people sometimes confuse gender identity with sexual orientation, and as a result, think that trans is another category of sexual orientation or sexuality.  Trans, however, describes how you feel about your gender identity only.  Trans people can be straight, gay, bisexual, or something else entirely – just like everyone else!

 

4. What is gender dysphoria –                                                children are socially defined as male or female based on genital appearance at birth.  The expression of characteristics that are not associated within society with one’s assigned sex at birth, is a common and culturally diverse human phenomenon, that should not be judged as inherently pathological or negative.  Children and adolescents may not always feel that they fit with their assigned sex. The way they look on the outside may not fit with how they feel inside.  The way they are expected to behave may be quite different from the way they actually want to behave.  This overwhelming sense of feeling like the opposite gender causes strong discomfort and is called gender dysphoria (‘dys’ – meaning difficult or painful and ‘phoria’ meaning condition of feeling/mental state).  (World Professional Association for Transgender Health, 2011; Royal College of Psychiatrists, 2013).

 

 

5. What is gender variance –                                            by the age of 3 years, most children express an interest in or preference toward activities and behaviours typically associated to their specific gender.  We call these behaviours “gender-typical” because the members of one of the sexes favour them.  For example, boys enjoy rough-and-tumble play and identify with male heroes, while girls enjoy such activities as playing with dolls and pretending to be a mummy.  By age 5-6 years, children have a strong sense of the gender-appropriate behaviour that is typical for their social group.  However, some children develop in a different way.  Some children have interests more typical of the other sex and sometimes want to look and act like the other sex.  For example, a 7-year-old boy plays with Barbie™ dolls and pretends to have long hair and be a princess.  A 6-year-old girl is only interested in playing outside with the boys, refuses to wear anything except jeans and t-shirts, and talks about being a boy.  We call these gender-variant behaviours and interests.

 

6. What is thought to cause gender dysphoria –               although science has yet to pinpoint the causes, we know that gender-variant traits are not typically caused by parenting style or by childhood events, such as divorce, sexual abuse, or other traumatic experiences.  Children do not choose to have gender- variant interests any more than other children choose gendertypical interests.  Both types of interests represent what comes naturally to each child.  The transgender condition is understood increasingly to have its origins before birth. Research studies indicate that the baby’s brain development does not always coincide with the sex differentiation of the rest of its body.  Divergent development predisposes the baby to a future mismatch between their gender identity and their body (Gender Identity Research and Education Society, 2015).  There is no evidence that social environment after birth has an effect on gender identity (Swaab & Garcia-Falgueras, 2009).

 

7. Do children grow out of being transgender –                  some children with gender dysphoria will not grow up to be transgender adolescents or adults, however, it is likely that the more intense gender dysphoria is in childhood the more likely it is to persist into adulthood.

 

 

8. What are the treatments for gender dypshoria – Treatment for gender dysphoria aims to help people with the condition live the way they want to, in their preferred gender identity.  What this means will vary from person to person, and is different for children, young people and adults.  Generally though for children if your child is under 18 and thought to have gender dysphoria, they’ll usually be referred to a specialist child and adolescent gender identity clinic (GIC).  Staff at these clinics can carry out a detailed assessment of your child, to help them determine what support they need.  Depending on the results of this assessment, the options for children and young people with suspected gender dysphoria can include:

• family therapy
• individual child psychotherapy
• parental support or counselling
• group work for young people and their parents
• regular reviews to monitor gender identity development
• hormone therapy

Most treatments offered at this stage are psychological, rather than medical or surgical.

Teenagers who are 17 years of age or older may be seen in an adult gender clinic. vThey are entitled to consent to their own treatment and follow the standard adult protocols.

By this age, doctors can be much more confident in making a diagnosis of gender dysphoria and, if desired, steps can be taken towards more permanent hormone or surgical treatments to alter your child’s body further, to fit with their gender identity.

Adults with gender dysphoria should be referred to a specialist adult GIC. As with specialist children and young people GICs, these clinics can offer on-going assessments, treatments, support and advice, including:

• mental health support, such as counselling
• cross-sex hormone treatment
• speech and language therapy – to help alter your voice, to sound more typical of your gender identity
• hair removal treatments, particularly facial hair
• peer support groups, to meet other people with gender dysphoria
• relatives’ support groups, for your family

Once social gender role transition has been completed and the care team feels a person is ready, then they are eligible for gender reassignment surgery which is a surgical procedure where a transgender person can alter their existing characteristics to resemble that of their identified gender .

 

 

So, now to my own thoughts on the matter:

 

Argument 1                                       “The parents have planted the idea into the child’s mind” –      my first thoughts are that at 5 years of age I knew that I was a girl.  At every age I knew it for sure and did not have any doubts about my identity.  Did you know what gender you were as a child?  How did you know?  Was it because someone told you, or did you intrinsically know? If someone had come along and told me I was a boy I would have known it wasn’t true, because I knew I was a girl.  What drives gender-typical or gender-variant traits cannot be changed through the influence of parents, teachers, coaches or therapists.  Although a child may alter his or her behaviour in response to parental pressure or social pressure, such changes may be skin deep and may not reflect how the child truly feels.

The following information from http://www.mermaidsuk.org.uk states that “at the age of 5 or 6years, children begin to be influenced by social pressure to conform and may adjust their behaviour in public to blend in.  This does not necessarily mean that the child’s “core traits have changed”.

 

Argument 2                                       As for it being a fad – well it might be?  It’s an area with few studies, however, some of the evidence emerging is that some of children with gender dysphoria will not grow up to be transgender adolescents or adults.  As with all medicine there are also opposing studies that suggest that the more intense gender dysphoria is in childhood the more likely it is to persist into adulthood.  This poses a challenge then because how can you predict which children will continue to have gender dysphoria?  Well you can’t and I would go so far as to say that unless we support these children to explore their gender and feel confident in it then they won’t be able to find out and we as a society run the risk of witnessing people suffer greatly and also of losing our precious citizens.  Hormone blockers that delay the onset of puberty offer a temporary respite in which a child can explore their gender and become more confident.

 

I believe in listening to people, so I worry when huge swathes of the population dismiss the perceptions and perspectives of others.  I have observed that when people don’t necessarily understand something well, they have a tendency to dismiss it.  There is a fabulous website supporting transgender people called mermaidsuk.org and I found this powerful and insightful quote on it “the world is indeed rather a gender rigid place and for the most part people do not know very much about trans.  Where there is ignorance there is fear and of course fear creates hostility”.

It’s huge thing to begin living as the opposite gender and not generally something that one would choose to do unless there were very real issues about gender dysphoria.  I don’t think that any parent or child would pursue such a route unless there were very real issues and without much careful, consideration.  I have not experienced living with gender dysphoria so who am I to say that “boys are boys and girls are girls?”  The one thing that I have learned through my own experiences of mothering children with ASD is that you cannot judge another unless you take a walk in their shoes.  It’s easy to sit on the side-lines and have an opinion.

 

My understanding is that many children/adolescents/adults who are transgender suffer a great psychological burden as a result of their unease at being in the wrong body.  They also suffer terribly from a society that often stigmatises and discriminates against them.  Research from the Equality and Human Rights Commission (2015) found that 91% of trans boys and 66% of trans girls experience harassment or bullying in school, often leading to depression, isolation and a desire to leave education as early as possible.

The suicide rate within this population is somewhere between 30 – 50 %.  That is a staggering statistic!  So, imagine a school year group and then imagine anywhere between a third to a half of it committing suicide.  Such a phenomenon would cause outcry if it were to happen in real life, but it is happening in the transgender community right now.  Many parents who support their children do so because their child has shared suicidal thoughts with them.  It’s hard to stand by and see your child suffer and I applaud the parents of transgender children who go to great lengths to help them.  They listen and they show them respect by really hearing what the child is saying.  Just such a parent said “we got lots of opposition from our family; we were told what if they change their mind, but we knew that we had to listen to our child and that nothing else mattered.”

 

Now to the final argument against supporting transgender children “it’s too confusing for other children”.  I think most children are quite resilient and can understand a lot when it is presented to them in the right way.  I can see how it could be confusing, but then I think it presents us all with a perfect opportunity to think about gender and identity, but also to think about respect, kindness and understanding.  It’s a great opportunity to teach your children about supporting others and not just accepting but respecting difference.  I really like this guidance from East Sussex county council on transgender issues, (increasingly seen as the leading reference on the subject) which states that “transgender pupils should not be seen as a problem, but rather, as an opportunity to enrich the school community and to challenge gender stereotypes and norms on a wider scale.”

 

I guess at the end of the day it comes down to how we see our fellow human beings?  Do we look for confusion and differences or do we look for the humanity we have in common and try and see how we can expand our own understanding?