What Happens in Classrooms Shouldn’t Stay in Classrooms

Conflating teaching with social gender transitioning jeopardizes the well-being of children while relegating parents to bystanders

The medical care of children and adolescents with gender dysphoria is evolving. While there is absolutely no doubt that certain children with gender dysphoria do best with social, medical and surgical transition, the best way and time to assess children and, when indicated, assist in their transition is a subject of debate. Unfortunately, like so many issues today, these decisions are becoming politicized, thus leaving the realm dictated by actual medical evidence. Today’s article focuses on one area where political activism might be getting ahead of (or going in an entirely different direction than) the science. —Adam Cifu, MD

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School permission forms requesting consent are routine. They are sent home for anything from cough drops to field trips. Thus, parents would reasonably expect involvement in classroom issues related to their children’s mental health.

A recent event shows that this expectation might be unfounded. A New Hampshire mother who discovered her child was using different pronouns at school sued her school district when, despite her objections, staff continued to facilitate her child’s social gender transition in compliance with a school policy requiring the new identity be concealed at the student’s request.

Lawsuits brought by parents alleging parental rights offenses have been seen in multiple states in response to school transgender policies that parents say are overruling their constitutional fourteenth amendment rights to direct the upbringing of their children. These policies recommend hiding students’ social gender transitions in accordance with the National School Board Association’s 2016 transgender student guidance, which advises school staff to avoid unnecessary disclosure of a student’s transgender status to parents.

All children, including transgender kids, deserve respect and acceptance. But passionate efforts to frame social gender transition as the only approach to gender incongruent children are not supported by a consistent body of evidence. Despite the American Academy of Pediatrics and other prominent US medical organizations advocating for the immediate acceptance of a child’s transgender identity, thereby paving the way for future transgender medical and surgical interventions, many experts disagree that current research justifies this recommendation. Sweden, Finland, the United Kingdom and France have all walked back gender-affirming treatments for children after an extensive review of the literature revealed that gender-questioning kids did not necessarily fare better as a result.

There is no way for teachers, or even medical professionals, to be certain that a child’s unhappiness with their gender, termed gender dysphoria, reflects a true transgender identity. Studies reveal that most children outgrow gender dysphoria without intervention. Conversely, a recent study found that 97.5 percent of children with gender dysphoria who were socially transitioned to their preferred gender maintained their transgender or nonbinary identity five years later.

The persistence of transgenderism, and possibly gender dysphoria, with social gender transition versus the desistance of transgenderism without it provides compelling evidence that the practice can alter children’s psychology, maybe even shifting their life course, with unclear consequences. Schools secretly facilitating these transitions are potentially performing mental health interventions without informed or parental consent.

It is improbable that informed consent has crossed the minds of school personnel encouraging social gender transitions, while obtaining it from a minor can be legally problematic due to minimum age of consent laws. Children are unlikely aware that living a transgender identity can trigger a cascade of life-long medical interventions and invite health risks. Gender-questioning children approaching adolescence are often prescribed puberty blockers - synthetic hormones that impede natural sexual maturation. Most who start puberty blockers continue on to the cross-sex hormones estrogen or testosterone. Puberty blockers, which pause more than puberty, have been linked to abnormal brain and bone development, while cross-sex hormones worsen cardiovascular health and promote cancer. Mastectomies and genital surgeries cement the transition, and surgical removal of natal sex organs to curb the cancer risk render patients sterile.

While advocates of gender transition in children claim it improves mental health, there are no consistent findings supporting this and more research is needed. Rates of mental health disorders and suicide in transsexual adults are significantly higher than the general population, and a growing number of “detransitioners” have come to realize that their dysphoria was caused by something else. Some detransitioners regret the sequelae of medications and surgery, while others feel misled by the medical community and have chosen to sue those responsible.

The United Kingdom’s National Health Service released draft guidelines for gender-curious children in October that discourage social gender transition, describing the practice as not a “neutral act,” that “should only be considered where the approach is necessary for the alleviation of, or prevention of, clinically significant distress or significant impairment in social functioning and the young person is able to fully comprehend the implications of affirming a social transition.”

Many school officials in the US perceive social gender transition as a compassionate means of supporting gender-questioning children. While simple cough drops often require parental consent, shielded social gender transitions are increasingly allowed because they theoretically protect children who may suffer abuse from unsupportive parents. This strategy of secrecy assumes the worst from parents, and is not replicated in any other countless school scenarios that could ignite a parent’s temper. It rejects the common sense fact supported by research that parental involvement is protective against mental health issues in kids. Alarmingly, it ignores any coexisting psychological issues. Adolescents identifying as transgender have higher rates of comorbid mental and neurological conditions, such as anxiety and attention deficit disorders, which may go unrecognized and untreated when their unhappiness is attributed entirely to gender dysphoria. 

In the aftermath of numerous legal judgements, the New Hampshire School Board Association in February rescinded a 2015 transgender student policy recommending that students’ social gender transitions be hidden from parents at the student’s request.  New Hampshire courts, however, have not yet ruled in parents’ favor. The New Hampshire mother suing her school district for socially transitioning her child without her knowledge is appealing her case after it was dismissed on the grounds that her right to parent “is not absolute,” and “does not include the ability to direct how the school teaches her child.” 

Conflating teaching with impactful social gender transitioning is a dangerous mistake that jeopardizes the well-being of children while relegating parents to mere bystanders.

Aida Cerundolo, MD is a practicing emergency medicine physician.