Questions and Answers: Gender Identity in Schools – What do we know about gender identity?

What do we know about gender identity?

The term ‘gender identity’ refers to an individual’s sense of self as ‘male’, ‘female’ or an identity between or outside these categories.^{Footnote 6}  The majority of people have a gender identity that matches their anatomical sex and/or that matches societal expectations for males and females. However, there are individuals whose gender identity does not match their anatomical sex or that conflicts with societal expectations for males and females. There are a variety of identities and expressions that exist on a continuum between male and female including, cross-dressers (e.g., drag queens, drag kings), gender-benders and gender variant, gender non-conforming, and two-spirit individuals. For consistency in this document, we use the term ‘gender variant’ to refer to all of the above gender identities between male and female, on this continuum.

Are all gender variant individuals gay, lesbian or bisexual?

There is a common misunderstanding that gender variant individuals are gay, lesbian or bisexual however, the majority of  gender variant individuals do not identify as gay, lesbian or bisexual^{Footnote 7}. This is because gay, lesbian, and bisexual identities refer to an individual's 'sexual orientation' which is different than an individual's gender identity. Sexual orientation refers to an individual's emotional and sexual attraction which may be to members of the same or the  opposite sex, or both.Though it is possible that some gender variant individuals will also struggle with their sexual orientation, we do not specifically address this issue in this document focusing instead only on gender identity. A  separate document entitled Questions & Answers: Sexual Orientation in Schools explores these issues more fully.^{Footnote Footnote 8}

Have gender variant individuals always existed?

Though the language of gender identity is contemporary, people who have challenged the stereotypical categories of gender have existed for much of human history. Gender variant individuals have existed in many cultures including indigenous^{Footnote Footnote 9}, Southeast Asian^{Footnote Footnote 10}, South American^{Footnote Footnote 11}, Caribbean^{Footnote Footnote 12}, European^{Footnote Footnote 13}, and African tribes^{Footnote Footnote 14}. The most well-documented of these gender variant identities exists in indigenous cultures. "Two-spirit" people of the First Nations are Aboriginal peoples who are 'other gendered' in their abilities to cross traditional gender categories and to express both genders. These individuals are recognized as 'third gender,' are honoured and respected as healers, and turned to for guidance and strength.^{Footnote 15}

Do people choose to be gender variant?

Research on the development of gender variant identities suggests that it is linked to a number of factors including neurological^{Footnote Footnote 16} , hormonal^{Footnote Footnote 17} , biological^{Footnote Footnote 18} , social and relational influences^{Footnote Footnote 19}  and is not a passing phase.^{Footnote Footnote 20}  Instead, the development of gender identity, including a gender variant identity, occurs in stages across the lifespan.^{Footnote Footnote 21}  Studies on gender variant individuals suggest that the awareness and experience of being 'different' begins as a child, and that there is a long history of internal tension between the individual's anatomical sex and their sense of their gender that extends into adolescence and, in some cases, beyond.^{Footnote 22}

There are many terms to discuss gender identities. What are the proper terms and how do I know when to use them?

Language to describe gender variant identities is continually changing and keeping track can be challenging. Gender variant youth self-identify in many ways and have constructed a language about their identities and experiences that is critical for other individuals to understand and respect. For example, gender variant youth may self-identify as one of many terms, including their use in derogatory ways, making it unclear how to address and respond to gender variant youth in a sensitive manner. If you are not sure of how an individual self-identifies, don’t make assumptions. Let the youth tell you how they self-identify. Admitting you are unaware is much more respectful than assuming and using the wrong language.

In addition to adopting the language the youth themselves prefer to use, there are other important things to consider. Be cognizant of the language being used in the classroom and during school events. For example, texts and lessons that use the ‘she/he’ binary ignore the range of gender identities discussed in this document. By using more inclusive language, such as ‘they’ instead of ‘she’ or ‘he’, not only will transgender youth feel more supported but it will also help to educate the entire school community about gender diversity.

Ensure that you use the appropriate language in regards to the pronouns and names of all transitioning students. Refer to a gender variant youth using the name and pronouns they have chosen to fit their gender identity instead of by their birth name which can make them vulnerable to harassment, ridicule and violence from fellow students.^{Footnote Footnote 23} 

There are no gender variant youth in my school. Why address these issues?

Gender variant students are attending schools in Canada, whether or not they are visible to other students, staff or administrators. There are several reasons why gender variant students may not be visible within the school community. First, most gender variant youth are invisible out of fear for their safety.^{Footnote Footnote 24}  Individuals whose behaviours do not conform to the stereotypical societal expectations of male and female genders are vulnerable to discrimination, verbal abuse, bullying, and physical violence.^{Footnote 25}  Second, while some gender variant individuals’ goal is to ‘transition’, a process where their external appearance is altered to cross from one gender to the opposite^{Footnote Footnote 26} , there are a variety of other gender variant individuals that do not embody such drastic changes. The remainder adopt gender variant identities at various points along the continuum. For example, some may choose to alter only their dress. Finally, making the assumption that there are no gender variant youth in schools creates a barrier for gender variant youth to disclose their identities or for recognizing students who may be struggling with this issue.

While many gender variant students remain invisible for the reasons cited above, there have been increasing numbers of students openly identifying as ‘transgender’ and/or openly struggling with their gender identity in the past decade.^{Footnote Footnote 27}  Research studies on the proportion of transgender individuals in a population have found numbers as low as 2% and as high as 10%.^{Footnote Footnote 28}  Given this prevalence in the population, it is likely that educators, school administrators, and health professionals have or will encounter at least one gender variant youth at some point in their professional career.^{Footnote Footnote 29}  Addressing gender identity issues in the school benefits the entire school community by providing safe and optimal learning environments for all students, and by increasing the ability of the entire school community to tolerate difference and to respect everyone’s unique experiences.^{Footnote Footnote 30}  Identifying gender roles and expectations and how they play out in a variety of settings, including the school setting (even without students disclosing a gender variant identity), allows for the healthy development of all students through the creation of safe spaces, prevention of violence, and avoidance of mental health issues, such as depression and suicide, that result when these are lacking in the schools.^{Footnote Footnote 31} 

What are the health, safety, and educational concerns of gender variant students in our schools today?

Harassment and Verbal Abuse

Gender variant individuals, by definition, challenge traditional gender roles. Youth who are targeted by their peers for not assuming the conventional gender roles may be harassed and bullied at a young age. By stepping outside of social expectations, these individuals are vulnerable to verbal abuse^{Footnote 32}, physical abuse^{Footnote 33} and even sexual violence^{Footnote 34} at higher rates than their gender-conforming peers.^{Footnote 35} Studies suggest that in the school setting, as many as 96% of gender variant youth are verbally harassed and as many as 83% physically harassed.^{Footnote 36} As a result, as many as three-quarters of gender variant youth report not feeling safe in school and three out of four report dropping out.^{Footnote 37}

Mental Health

In 1980 the American Psychiatric Association listed “gender identity disorder” (GID) in their Diagnostic Manual of Mental Disorders (DSM IV) and since then some people in the mental health profession have viewed ‘gender variant’ as a mental illness. Some individuals feel that including GID has unnecessarily labelled individuals who express gender variance as having a ‘disease’ or mental defect and advocate for its removal. ^{Footnote 38}  Others feel that the removal of GID from the DSM IV would not be beneficial since a diagnosis of GID is often required in order for gender variant individuals to start medical and surgical treatment for gender transition ^{Footnote 39} . In addition, a diagnosis of GID provides a basis for the provision of supportive counselling to reduce mental distress from gender identity. This tension illustrates the range of perspectives which are evoked by the discussion of gender identities.

It is important to highlight that gender variant youth face the same general risk factors for depression and suicide as other youth. However, due to gender variant youths’ experience of discrimination, stigmatization, harassment, verbal abuse and rejection, the effects of low self-esteem and depression may be severe.^{Footnote 4}While not all gender variant individuals will experience low self-esteem and depression when compared to their gender-conforming peers^{Footnote 41} , there is a strong link between mental health issues and the alienation of not fitting in, especially in the school setting where students can be very critical of others who are different. When confronted with a negative social environment, some gender variant youth experience confusion^{Footnote 42} , low-self esteem^{Footnote 43}  , depression^{Footnote 44}and behavioural problems^{Footnote 45} . Furthermore, gender variant youth often lack accurate information, support networks, and role models about emotional and mental heath and physical well-being^{Footnote 46}  Without the presence of resources or support, gender variant youth may be more vulnerable to internalizing their negative experiences, producing feelings of shame^{Footnote 46 Footnote 47} , anxiety^{Footnote 48} , self-hatred ^{Footnote 49}  and often self-harm ^{Footnote 50} . Compounding the lack of support for gender variant youth is the fact that they may be hesitant to seek help. There can be a sense of deep-rooted shame at the individual level for not conforming to the gender norms and gender variant youth may remain silent and try to act 'normal'. Youth may also not seek support for fear of a negative reaction from their parents/caregivers, teachers, peers and health professionals.

Suicide

In some circumstances, the increased abuse and emotional turmoil faced by gender variant youth can lead to desperate outcomes. It is estimated that more than one-third of all teen suicide at tempts and actual suicides are made by lesbian, gay, bisexual and gender variant youth. Suicide attempts among gender variant youth are higher than they are for lesbian, gay, and bisexual youth^{Footnote 51}, with some reports indicating that approximately one third of gender variant youth have attempted suicide.^{Footnote 52} Interpersonal violence and a lack of support from family and peers have been cited as reasons for increased rates of suicide attempts in gender variant individuals.^{Footnote 53}

Hormone Therapy

While the changes associated with puberty can be unsettling for all youth, the physical expression of biological sex attributes can be even more distressing for gender variant youth. The development of secondary sex characteristics that they feel do not correspond with their gender can have harmful mental and emotional effects.^{Footnote 54}

Careful consideration must be given to adolescents who wish to undergo hormone therapy to transition from one sex to another as hormone therapies may cause irreversible effects on the body. Furthermore, health care professionals must be aware that not all youth who express a desire to use hormones to transition to their self-identified gender will still feel this way once they reach adulthood. Research has shown that 80 to 90% of pre-pubertal youth diagnosed with GID no longer experienced GID into adolescence.^{Footnote 55}

However, delaying the start of hormone treatment past puberty has been linked to depression, suicide attempts, anorexia and social phobias.^{Footnote 56} The changes in their body may be so distressing that some youth who do not receive hormone therapy from a health professional may turn to the streets to get unregulated hormones.

Without the guidance from a physician, youth may find it difficult to regulate the appropriate hormonal balance for transitioning sexes. The improper use of hormones can lead to serious health problems, impacts pubertal growth and puts youth at risk for HIV and hepatitis C infection due to contaminated needles^{Footnote 57}.

Other Health Risks

Gender variant youth may also be at an increased risk for sexually transmitted infections, including HIV. A sense of hopelessness and suicidal tendencies, has been linked to high risk sexual behaviour, making gender variant youth particularly vulnerable to sexually transmitted infections, including HIV.^{Footnote 58} In one study of ethnic minority gender variant youth, African American males transitioning to a female identity were eight times more likely to report being HIV positive than other ethnic minorities. In the same study, sexual assault and unprotected anal intercourse was reported among participants and up to 59% of youth also reported sex in exchange for money, shelter and/or drugs. Gender variant youth may run away for various reasons, including escaping a negative home environment,^{Footnote 59} and end up on the streets where they engage in sex work to survive and become at risk for STIs, including HIV.^{Footnote 60}