Open Letter to the PPTA: Why is discussion about the medicalisation of gender off-limits?

I recently read an opinion piece  in the PPTA magazine by Lizzie Marvelly about the so called ‘bathroom battle’ over transgender students and their access to toilets and facilities which match their gender identities. Because I strongly disagreed with Marvelly’s perspective on and framing of the issues involved in this discussion, I was motivated to write a reply. Unfortunately the PPTA News editor did not accept my piece, so I am reprinting it here because I doubt that any attempt to revise my argument would satisfy the stringent conditions the PPTA places on debate about transgender issues. I believe that the PPTA News editor has refused to publish my piece for ideological reasons. I will also argue that this refusal to allow debate amounts to a violation of one of the key stipulations in the PPTA's Code of Ethics.

Here is the article I submitted:

In a recent article published through the PPTA, Lizzie Marvelly called the gender “bathroom battle” a “front for intolerance”.

Marvelly is right to say that schools should support and respect their LGBTQ+ students. Bigotry, intolerance and bullying behaviour needs to be challenged and does not have any place in our schools. I’m proud to work at a school that has a thriving ‘Rainbow Youth’ club, where many students take part in events such as the ‘pink shirt’ day supporting tolerance and respect for gender non conforming people.

I also agree with Marvelly’s contention that the bathroom battle is ‘proxy war’ with much deeper issues in the background.

Marvelly’s portrayal of these issues is problematic, though, for a number of reasons.

It may well be that Family First, her target for criticism,  is a conservative organisation with values opposed to LGBTQ+ rights. Yet whatever the background motivations of Family First, I struggle to understand how the concerns of female students can be so flippantly thrown out with the bathwater as ‘bigotry’.

The recent case of a male transgender student gaining access to female facilities at Marlborough Girl’s College is a case in point. Laura, the student who spoke out last year against the granting of this access, does not speak the language of bigotry. Laura’s mother referred to the ‘vulnerability’ of teenage girls, and insisted that males and females are ‘built differently’ and therefore need private spaces. Laura said that she and her peers were not consulted, and talked about the ‘stressful and embarrassing’ time girls can go through during puberty, and their increased need for privacy from boys. She said that younger girls with a history of abuse or trauma would be particularly sensitive and ‘triggered’ by the presence of males inside their toilet facilities. In the AUT youtube video Marvelly mentions, many of the women who spoke out against the wholesale replacement of female only facilities voiced concerns based on their cultural values. None of these were motivated by bigotry.

Another important background issue is the debate surrounding the identification of transgender children. Many feminists are critical of the medicalised approach towards gender non-conforming youth. They point to the gender stereotypes implicit in much of this identification, and question the appropriateness and effectiveness of physical transition. Lupron, the puberty blocking drug sometimes prescribed to transgender identified children, has a number of very serious potential side effects. Taken in conjunction with synthetic hormones, Lupron causes permanent sterilisation. Other potential effects include higher risks for chronic pain, osteoporosis, depression and anxiety. There are unanswered questions about the magnitude and extent of these risks because few scientific studies have been carried out, and the fact that the population of medically transitioned people has only very recently begun to increase dramatically. The long term effects of drugs such as Lupron and the ongoing use of synthetic hormones are still largely unknown - and this spells medical experimentation.

This medicalised approach towards gender non-conformity goes hand-in-glove with the concept of a free-floating ‘gender identity’ which sometimes gets mixed up in the ‘wrong body’. Young boys, for example, who like to play with dolls and wear pink are encouraged by this ideology to identify as girls trapped in a boys’ body.

How does this ideology connect to the bathroom battle? I am worried that promoting access to previously sex-segregated spaces such as toilets based on ‘gender identity’ will effectively normalise and validate this contentious ideology.

Do we really need to add to all the pain and turmoil teenagers experience during puberty by suggesting the possibility that their troubles are due to them being born in the ‘wrong’ body? Is this even possible?

It seems clear that gender identity ideology, not ‘bigotry’, is the bogeyman lurking in the shadows of this debate.

*           *

The reply explaining why my piece was refused I found deeply disturbing. Clearly my views on this issue are at odds with the PPTA News editor, but I am certain that I am not the only PPTA member out there with similar questions and concerns. Shutting down debate and discussion about an issue which directly affects the wellbeing of some our most vulnerable students seems to me clearly at odds with the PPTA Code of Ethics, which demands that teachers “help all pupils to develop their potentialities for personal growth”. How can we do that if we cannot even have a debate when the views about how that growth can best be fostered are so hotly contested?

The really depressing reason behind this is that the PPTA News editor is completely convinced that my views are based on prejudice and intolerance:

A piece that questions whether such a thing as being transgender is ‘even possible’ and refers to gender diversity as ideology is not something we would run given we have members who fit into these groups and work with these students. We have democratically agreed guidelines affirming students with diverse genders and sexualities and we don’t want to negate our work supporting all of our members.  

I wonder what exactly ‘gender diversity’ is, and why it is wrong to call it an ‘ideology’? I never used the phrase in my piece, and I’m not sure of the answer to either of these questions. What I am very clear about is what I object to and why. ‘Gender identity ideology’ as I understand it involves the idea that people can be born into the “wrong” body. There is typically some kind of appeal to the notion of gendered brains or ‘essences’ which somehow get misplaced inside a body which does not match up. The medicalised model of ‘gender affirmation’ via things like synthetic hormones and surgery is the practical consequence of this idea, together with the assumption that the body is more ‘plastic’ than the mind.

I don’t believe in gendered brains, gender essences or the assumption that the body is more plastic than the mind. I reject these ideas not out of ‘bigotry’ but because I believe that they do not withstand scientific scrutiny, and also because I believe that these ideas seriously undermine and negate critical feminist perspectives on gender.

I strongly believe that gay, lesbian and gender non conforming youth should be supported and validated. I also believe that there is absolutely nothing ‘wrong’ about the bodies of any of these young people. I don’t believe that their bodies benefit from breast binders, puberty blockers or synthetic hormones. I don’t believe that they should be sterilised.

Clearly my beliefs at are at odds with the PPTA News editor, and many others who embrace the medicalised gender identity model. There is a debate to be had. Lots of people and organisations have interests and agendas here – the drug companies and medical institutions who profit from medicalising gender, parents of GNC children, feminist critics and of course the children and youth who experience the real and acute pain of gender dysphoria. I’m a parent of two young children and a teacher of teenagers. I have an interest in this debate too as a human being and as a teacher who takes seriously the stipulation in the PPTA Code of Ethics – let’s repeat it again:

Teachers should help all pupils to develop their potentialities for personal growth

This is what the PPTA News editor says about this important debate:

‘We also feel it would be irresponsible to publish comments on side effects of specific medications as we are not medical professionals.’

Well I’m not a medical professional either. All I can do is read books and internet articles on this topic. I’m sure there are many science teachers out there who read the PPTA News and also know a huge amount more than I do about endocrinology, human biology and the effects of puberty blockers. But of course we cannot even begin to discuss any of this, because the people in charge of the PPTA News are not medical professionals.

We can talk about toilets and the conservative bigotry of Family First, but we can’t talk about the physical effects of breast binding. (I bring this up because the ‘Rainbow Youth’ facebook page recently featured an advertisement which celebrated these devices - see also Renee Gerlich's piece for more on this topic). This is what a ‘top surgery’ specialist has to say about breast binders:

If you are considering long-term chest binding, then there are some important things to keep in mind. This following are the three biggest health consequences of chest binding that you need to be aware of before you do begin.

Compressed Ribs

One of the biggest health consequence of chest binding is compressed or broken ribs, which can lead to further health problems. Unfortunately, you can fracture the ribs fairy easily so you should avoid binding your chest using bandages or tapes, as these can be unsafe.

Compressing your chest too tightly or incorrectly can permanently damage small blood vessels. This can cause blood flow problems and increase the risk of developing blood clots. Over time, this can lead to inflamed ribs (costochondritis) and even a heart attack due to decreased blood flow to the heart.

The following are some symptoms you should look out for:

·         Loss of breath

·         Back pain throughout the back or shoulders

·         Increased pain or pressure with deep breaths

Collapsed Lungs

Since chest binding can lead to fractured ribs, this can increase the risk of puncturing or collapsing a lung. This happens when a broken rib punctures the lung, causing serious health issues.

Once the lung is punctured, it has a higher risk of collapsing because air can fill the spaces around the lungs and chest.

Back Problems

If you bind your chest too tightly then it can cause serious back issues by compressing the spine, which is part of your central nervous system. The spine controls many functions, and you need to be very careful when doing anything that may cause damage.

Back pain from chest binding can also be an indication that a lung has been injured. If the pain is coming from the upper back or shoulder, consult with a doctor for further examination to ensure proper lung health.

Fractured ribs, damaged blood vessels, or punctured lungs can cause difficulties down the line and may stop you from being able to move forward with surgery. Keeping these issues in mind will allow you get the most out of using chest binding.

Discuss chest binding with an expert to ensure that you get the best results, reduce the risk of complications, and create optimal health for you.

If you are a PPTA member, please don’t talk about any of this. We can’t debate this because we are not medical professionals. It’s much nicer and easier to just get Lizzie Marvelly in to talk about toilets. That way we don’t have to deal with any of the hard questions. Please don’t worry too much about the stipulation in the PPTA Code of Ethics – let’s repeat it again just for good measure:

Teachers should help all pupils to develop their potentialities for personal growth

Don’t worry about Lupron either. You’re probably not a ‘medical professional’, so you shouldn’t even be trying to read or understand the scientific literature on this topic. Please ignore and do not dare to discuss with the PPTA facts such as:

Unproven: Lupron Depot is unproven and not medically necessary for puberty suppression in patients with gender identity disorder due to the lack of long-term safety data. Statistically robust randomized controlled trials are needed to address the issue of whether the benefits outweigh the substantial inherent clinical risk in its use. 

Of course it could be true that for some gender dysphoric teens, the medical treatment model might be the only thing that works for them. This is complex and difficult territory, and I am sure that the PPTA News Editor would not encourage any debate around the issues involved. We should not consider, talk about or debate the surveys which indicate that about 80% of gender dysphoric youth desist from transgender identification by the time they become adults. You should not read this article which scrutinises the debate around this statistical claim, and concludes:

Every study that has been conducted on this has found the same thing. At the moment there is strong evidence that even many children with rather severe gender dysphoria will, in the long run, shed it and come to feel comfortable with the bodies they were born with. The critiques of the desistance literature presented by Tannehill, Serano, Olson and Durwood, and others don’t come close to debunking what is a small but rather solid, strikingly consistent body of research.

Well, I see that I have gone way over the 250 word limit for letters to the PPTA News, and for obvious reasons I know you will not even consider publishing this anyway. It’s a shame that this discussion has to be limited to blogs. If any PPTA members are actually reading this, I would encourage them to read some of the recent pieces by Renee Gerlich on this issue. I would also encourage them to contemplate the meaning and moral force of the stipulation in the PPTA Code of Ethics, which I will repeat once again in conclusion:

Teachers should help all pupils to develop their potentialities for personal growth