Gender Identity
The current conversation around gender identity is very polarised, and there is a lack of awareness around gender incongruence and dysphoria. The current narratives are having a harmful effect on people of all ages who experience gender incongruence or dysphoria and are especially damaging to children and young people who are struggling to understand themselves. In exploring or discussing this subject we must remember that at its heart, there are children and young people who are struggling to get the support and acceptance they need.
What do the terms gender identity, transgender, gender incongruence, and gender dysphoria mean?
Gender identity refers to a person’s sense of their own gender, whether male, female, or others such as non-binary or gender-fluid. This may or may not be the same as a person’s registered sex at birth which is based upon external sex organs (referred to in this information as ‘biological sex’, although human biology is more complex than just external sex organs).
The term transgender (or ‘trans’ for short, and the T in LGBTQ+) is a description used by people whose gender identity is different to the one registered at birth. They may have undergone or are undergoing gender reassignment. The reassignment process is usually long and difficult, and involves social transitioning (such as a change of name, pronouns, honorifics, and appearance through clothing etc.), and may or may not involve medical transitioning (use of hormonal treatment or surgery), noting that medical intervention is restricted on grounds of age by the NHS.
Although both identities fall under the banner of ‘trans’, transgender identity should not be confused with someone who enjoys dressing in the style of the opposite sex, but their gender identity remains the same as their biological sex.
Gender incongruence is a term used to describe the experience of someone whose gender identity does not match their sex registered at birth. Children as young as four or five can begin to show signs of gender incongruence, although this can also come in later life. To begin with, a person will be questioning their gender identity (the Q in LGBTQ+ can incorporate this, and can also apply to people questioning their sexual orientation). A person with gender incongruence may go on to have this confirmed by a clinician as having a diagnosis of gender dysphoria.
Gender dysphoria is a medical term that describes a sense of unease that a person may have because of a mismatch between their biological sex and gender identity. This sense of unease or dissatisfaction may be so intense it can lead to depression and anxiety and have a harmful impact on daily life. The feelings of gender incongruence/dysphoria are so intense that transgender people may express that they feel they “were born in the wrong body”.
The cause of gender dysphoria is unclear. Gender development is complex and there are things that are not known or fully understood. It is important to note that gender dysphoria is not a mental illness, but some people may develop mental health challenges as a result of it.
For some people, their gender questioning could be arising from body dysmorphia or other factors such as rejection of gender stereotypes or fears of growing into an adult body, but just because this applies to some does not mean it applies to all. Puberty is a complex process and young people need to be given the space, information, and respect to explore and understand their identities and growth.
It is also important to note that whilst there is a higher proportion of people with neurodiversity who identify as LGBTQ+, the reasons are not fully understood. This highlights the need to consider multiple factors and intersectionality when supporting gender questioning young people.
Supporting gender questioning children
The Cass Review stated that young people need a safe, non-judgemental space in which to explore their gender identity. Failure to provide this may result in more harm coming to children and young people who are more vulnerable and often misunderstood.
Understanding gender identities is important. If a child or young person shares their thoughts and feelings about their gender, being equipped with the knowledge and language will support them to continue to feel safe. Exploring identity is a normal part of child development and as such it is important to have an open and non-judgemental approach to discussing identity. Shutting children and young people down can lead to harmful internalised shame.
- Start with open questions about gender identity
- Let the child/young person tell you what is important to them without making assumptions
- Remember you might be the only person the child or young person has trusted to talk to about their feelings and so your response is key
- Having a safe adult children and young people can talk to can lead to accessing safe help and support
- Ideally, parents/carers should be involved and whilst it is important to encourage young people to share these issues with their parent/carer, keep in mind that a young person may not feel safe to do so, and the reasons behind this should be explored
Decisions and medical care, which involve affirmative action, about a person’s gender incongruence or dysphoria rest with the NHS. Schools or social workers should do what is best for the child emotionally and socially, in consultation with the parents/carers (where it is safe to do so). In school, all members of the school community should be respectful and allow the child or young person to explore and grow without judgement or distress. School staff can also help to support young people by seeking or signposting to clinical or other professional support where needed.
Creating a supportive and inclusive school culture
Having a school culture which fosters inclusion, respect, and compassion can support all children and young people to feel confident and comfortable to be themselves.
Requiring a gender questioning or transgender person to conform to binary sex provision or continue to identify as their birth-sex can cause confusion, uncertainty, or distress. Typically this can arise when asking boys and girls to queue separately, or splitting an activity based on sex identity, access to toilets, sleeping, or changing facilities, participation in sport, uniform policies, and the use of pronouns and names. Responding to these issues requires care and consideration. Meeting the needs of trans pupils may raise concerns for others – for example, girls feeling uncomfortable about a trans girl accessing the toilets. Further guidance on practical measures for schools are expected, and in the meantime we recommend considering ways in which everyone’s concerns and needs are met where possible. For example, provision of a unisex toilet and separate changing facilities.
LGBTQ+ youth groups and charities can provide young people a safe space, where they are in contact with trained youth workers who are able to provide appropriate support and identify safeguarding and wellbeing concerns at an early stage. Without access to safe information and support, children and young people may turn to unregulated advice or support on the internet – this can include sourcing information about hormones and puberty blocked in light of restrictions and delays in accessing gender identity services in the NHS. This could have a significant impact on their emotional and/or physical wellbeing. Likewise, such groups provide children access to age-appropriate social networks without which they may connect with strangers online. If you are concerned about the welfare of a child, please refer to safeguarding policies and procedures.
Keeping Children Safe
In September 2024, the Department for Education (DfE) its guidance on Keeping Children Safe in Education. Part Two: The Management of Safeguarding, clarifies the legal protections conveyed by the Human Rights Act 1998 and Equality Act 2010. It also sets out guidance on safeguarding for children and young people who are lesbian, gay, bisexual, or gender questioning.
- The Cass Review identified that caution is necessary for children questioning their gender as there remain many unknowns about the impact of social transition and children may well have wider vulnerabilities, including having complex mental health and psychosocial needs, and in some cases additional diagnoses of autism and/or ADHD.
- It is recommended that when families/carers are making decisions about support for gender questioning children, they should be encouraged to seek clinical help and advice. When parents are supporting children pre-puberty, clinical services should ensure they can be seen as early as possible by a clinical professional with relevant experience.
- When supporting a gender questioning child, schools should take a cautious approach and consider the broad range of their individual needs, in partnership with the child’s parents/carers (other than in the circumstances where involving parents would constitute a significant risk of harm to the child), including any clinical advice that is available and how to address wider vulnerabilities such as the risk of bullying.
- Risks can be compounded where children lack trusted adults with whom they can be open. It is therefore vital that staff endeavour to reduce the additional barriers faced and create a culture where they can speak out or share their concerns with members of staff.