Memorandum submitted by Gender Identity Research and Education Society (E21)

 

Submission to the Parliamentary Committee on the Equality Bill - Protection of Gender Variant Children and Adolescents

1 - When transgender people of any age reveal their gender variance, they are exposed to a risk of discrimination, bullying and hate crime. That risk increases sharply if they embark on transition to a new gender role. Thereafter, they remain highly vulnerable. They also have greater need for social and medical care.

2 - Some commissioners and providers of services for the transgender community use the 1998 survey of gender dysphoria, which was conducted in Scotland, to estimate the likely number of people to be cared for in their areas. Prevalence of people who had presented with gender dysphoria was then estimated to be 8 per 100,000 people aged over 15 years. Other contemporary estimates were quite similar. However, subsequent rapid growth in the number of people who have presented for treatment in the UK requires an upward revision of the estimates based upon the earlier data.

3 - Current prevalence may now be 20 per 100,000, i.e. 10,000 people, of whom 6,000 have undergone transition. 80% were assigned as boys at birth (now trans women) and 20% as girls (now trans men). However, there is good reason to anticipate that the gender balance may eventually become more equal.

4 - Incidence was not measured in the Scottish survey. It may now be 3.0 per 100,000 people aged over 15 in the UK, that is 1,500 people per annum presenting for treatment of gender dysphoria.

5 - The current growth rate in the population who are presenting is 15 % per annum; hence the number is doubling every five years.

6 - Transgender people present for treatment at any age. The median age is 42.

7 - The adults who present emerge from a large reservoir of transgender people, who experience some degree of gender variance. They may number 300,000, a prevalence of 600 per 100,000, of whom 80% were assigned as boys at birth. However, the number would be nearly 500,000, if the gender balance among transgender people is equal. Service providers and employers need to be aware of this large group who, whether or not they present for medical treatment, may still experience discrimination and be vulnerable to bullying and hate crime.

8 - So far, only 10,000 adults have presented for treatment but a further 50,000, or even 90,000, may do so. Accordingly, the current growth in incidence may continue for a lengthy period, as more transgender people feel able or compelled to present to health professionals with gender dysphoria.

9 - Few younger people present for treatment despite the fact that most gender dysphoric adults report experiencing gender variance from a very early age. Only 84 children and adolescents are referred annually to the UK's sole specialised gender identity service, compared to 1,500 referred to the adult clinics. Nonetheless, medical services and schools should note that incidence among youngsters is also doubling every five years and has the potential to grow much more rapidly if gender variant people start presenting for treatment and undertaking transition while still young.

10 - GIRES requests the Committee to consider replacing the term "gender reassignment with "gender variance", in respect of children and adolescents.

11 - Gender variant children and adolescents will often express feeling that they are in the wrong body or refer to themselves as member of the opposite sex. By adolescence, for the majority of both boys and girls (80-95%), the gender variance remits.[1] Pre-pubertal gender variance remits most frequently in adolescence and adulthood as homosexuality or bisexuality.[2] It is usually not possible for these young people to predict reliably their final preference. Whereas, in those who still experience gender discomfort in adolescence, there is a very high rate of persistence of gender variance into adulthood. For these adolescents, it is clinically possible to predict a transsexual outcome with a high degree of certainty.

12 - The use of the term 'gender reassignment' would mean that younger gender variant children could only claim protection by making an unreliable prediction that they intend to undergo gender reassignment.

13 - As recommended in the international standards of care,[3],[4] in many other countries they would be offered safe medication to suspend pubertal development in what they see to be the wrong body. Inappropriate development of secondary sex characteristics is intensely stressful: breasts and menstruation in young men; facial and body hair, deep voice and enlarged Adam's apple in young women. Reversing these and other pubertal changes later is costly, painful and only partially successful, inflicting lifelong disadvantage on these vulnerable young people. As well as relieving stress, that medication gives the young person and the clinician more time in which to confirm the depth and likely persistence of the gender variance before embarking on hormone and, eventually surgical treatment to align the body with the confirmed gender identity. Careful screening ensures that the adolescents who are offered this treatment are highly unlikely to change their minds or express regret that they entered into it.[5]

14 - In the UK, the practice is still to withhold that medication until all pubertal changes are complete.[6] Accordingly, none of them below the age of 16 or even later could possibly meet the gender reassignment criteria of undergoing or having undergone a process (or part of a process) to change physiological or other attributes of sex. Indeed, it would be difficult for them, in the face of medical obduracy, even to establish that they propose to undergo such a process.

15 - GIRES is also deeply concerned by the Bill's proposed allowance of the harassment of gender variant youngsters in school. This is a highly vulnerable group. Among those who are adolescent, 23 % have engaged in self harm or overdose.[7] By its very nature, such harassment may be argued to be discriminatory and provide great scope for legal argument if this proposed provision in the Equality Bill were enacted in its present form. GIRES recognises and accepts that pupils should also be protected from harassment on grounds of sexual orientation or religion or belief.

 

June 2009

 

---

[1] Cohen-Kettenis, P. T., Delemarre-van de Waal & H. A., Gooren, L. J. G. (2008): The treatment of adolescent transsexuals: changing insights". Journal of Sexual Medicine. Volume 17, Issue 4, October-December, Pages 258-264.

[2] Zucker, K. J. (2005): Gender identity disorder in children and adolescents. Ann. Rev. Clin.

Psychol. 1: 467-92.

[3] WPATH, (World Professional Association for Transgender Health, previously known as the Harry Benjamin International Gender Dysphoria Association), The standards of care for gender identity disorders, sixth version Symposion Publishing, Dusseldorf;2001;11.

[4] Hembree WC, Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ, Meyer III WJ, Montori M, Spack NP, and Tangpricha V : Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline (2009); in Press.

[5] Cohen-Kettenis PT, Reed BWD, Reed T and Spack NP (2008), Medical care for gender variant young people: Dealing with the practical problems: Sexologies Volume 17, Issue 4, October-December 2008, Pages 258-264.

 

[6] Curtis R, Levy A, Martin J, Playdon Z-J, Reed B, Reed T, et al. Medical care for gender variant children and young people: answering families' questions. Department of Health; 2008;25.

 

[7] Di Ceglie, D., Freedman, D., McPherson, S., & Richardson, P. (2002). Children and adolescents referred to a specialist gender identity development service: clinical features and demographic characteristics. International Journal of Transgenderism 6 (1),