GIRES Lesson plan
The Gender Question (©Gender Identity Research and Education Society and Gender Matters)
Lesson Details: This lesson gives background information about trans and non-binary issues and some
explicit information about sex differentiation. It explains in broad terms, the role of the brain, and how this is
not always congruent with the sex appearance.
Context: Most schools are subject to the Public Sector Equality Duty, and all are required to abide by the
Equality Act 2010. Understanding gender diversity starts in school. In law, gender diversity is as important as
race and ethnicity diversity. Religion, belief, or cultural norms may not be used to discriminate against those
who are gender non-conforming. As children reach puberty, more of those who experience gender
incongruence will be seeking physiological intervention, although this is not necessary for all trans and nonbinary young people. Roughly 1% of the population is gender variant to some degree, so schools must be
prepared to support these young people if they choose to transition.
Lesson Objectives: This lesson gives information to students about why some people have a gender identity
that is not congruent with the sex they were assigned at birth. With this knowledge comes understanding,
and understanding makes it less likely that gender variant youngsters will be bullied or isolated. In an ideal
world, people should be treated with respect regardless of why they are different, but sometimes, if others
are better informed, it helps to bring down barriers. It also gives teachers a way of dealing with the anxieties
of some parents, who may think it is ‘catching’, or that it arises as a result of abuse, and is possibly a
safeguarding issue. These myths need to be laid to rest.
Lesson Delivery: The script provided is just a guide. Teachers, having familiarised themselves with the
resource, may use their own words to flesh out the words that appear on the slides. However, terminology
should not be changed. See slide 6: Gender identity applies to the sense of being a boy, girl, or somewhere
else on the gender spectrum (non-binary or non-gender). Gender identity that is not congruent with the sex
assigned at birth (male, female, intersex) causes discomfort known as gender dysphoria.
Learning Activity:
This resource is designed to involve the class at all stages and to encourage debate between different points
of view.
For instance, in the John: Joan case, one pupil could be given the task of defending the decision to operate
on the infant to create a female appearance and to raise the child as a girl (Joan).
Another pupil could defend the opposite view, that the child should not have surgery as an infant, and
should be allowed to grow up as John, and only have surgery if he wished to, and could give informed
consent. After the debate, the class could take a vote.
Link this with the school’s anti-bullying policy. Is it OK to be unkind to people who are different? Is it OK to
be unkind to people whose families are different? Talk about cyber bullying and the devastating effect this
has on those targeted.
Class project – how are we going to spread the word – celebrate diversity.
See also: NHS/GIRES elearning: www.nlmscontent.nesc.nhs.uk/sabp/gv
Guide to the resource and suggested script.
The teacher may alternate between the script on the slides and the suggestions below. Sometimes the text
on the individual slide is sufficient.
Opening slide:
How do we know whether we’re boys or girls? Seems like a straightforward question – but is it?
Slide 2
Why is it the first question we ask, sometimes even before a baby is born, ‘is it a boy or a girl?’ because
some people have already chosen to be told?
How do you think parents-to-be react to finding out the sex of the baby? What kind of things might they
do?
e.g. Painting the baby’s room pink or blue
Buying clothes
Slide 3
And when baby arrives, do we use gendered language? Are we more likely to refer to a girl as ‘beautiful’
or a boy as ‘strong’?
CLICK > Do we actually treat the infant differently according to whether it is a boy or a girl?
Students should be able to give some examples of how we treat babies differently according to their
gender:
• How they are dressed
• The way we talk and interact with them
• The kind of toys we give them
• What type of play / activities we encourage
• How we expect them to behave
Slide 4
Socially we expect women to behave in feminine ways, and men to behave in masculine ways. Although
there is a lot of overlap, we nonetheless expect girls and boys to have different groups of friends, different
interests and often, to play different sports.
Our social and cultural practices influence the way in which children are treated, in terms of their dress,
toys and games, so the way that boys and girls, men and women, are expected to behave and dress will
vary between cultures.
CLICK > In the UK, we see many different cultures and forms of dress but these almost always make a
distinction between men and women.
E.g. Students might give as examples that men wear only trousers but women wear trousers or skirts /
dresses. Point out that this depends on the culture, e.g. men wear kilts, sarongs, dhotis etc. But whatever
the culture there are differences (as well as overlaps) between the way men and women dress.
Students should be able to give examples of different expectations of men and women, for example:
• Clothes
• Employment choices
• Hobbies and interests
CLICK > Discussion should include the point that we are discussing how society is and not necessarily how
we would like it to be. Students should be encouraged to consider the disadvantages of a rigid adherence
to gender stereotypes, e.g.
• Prejudice and discrimination in employment (e.g. against men wanting to be nursery nurses, or
women wanting to be company directors)
• Segregation in employment leading to the gender pay gap (e.g. women being encouraged to go for
jobs in caring professions that are relatively low paid
Slide 5
So where does it all start?
Can we tell by looking? What do we judge by?
Here we have a boy and a girl – which is which?
Baby A is in fact a girl (although clearly is not possible to tell from the photograph). Her name is Mary.
Baby B is a boy. His name is Maurice. He looks like a girl to us because we tend to make assumptions
about a baby or toddler’s gender based on clothes and hair. This is a Victorian photograph and at that
time in the UK babies and young children often had long curls and wore skirts whatever their gender.
CLICK > CLICK > The photo below shows Maurice as an adult. Young Victorian boys were dressed like girls,
but nonetheless comfortably developed gender identities as boys.
Therefore we may infer that their dress, in their early years, did not lead boys of that era to self-identify as
girls.
Slide 6
So what else do we look for? Well, of course, we look at the genitalia. Does baby have a penis or not? We
assume if we see that, we know for certain whether the baby will identify as a girl or a boy
The vast majority of people identify comfortably in line with the way that they look, so it is assumed that
all babies will. So, babies are registered at birth on the basis of external appearance alone as ‘male’ or
‘female’, and a gender identity (boy or girl) is assumed, at that time, on the basis of external appearance
alone.
Note that the words male and female denote sex; they don’t really denote gender but they are often used
in exactly the same way, because, in most people, sex and gender identity match. This is not helpful to
people whose sex and gender identity don’t match, as we shall see
People whose sex and gender identity do match may be referred to as cisgender
Slide 7
CLICK > So where does it all begin?
In TYPICAL development of boy and girl babies it starts with the chromosomes
We have 26 pairs of chromosomes - one pair will be XX or XY. These are the sex chromosomes and they
carry the genes that prompt sex differentiation into male and female. Chromosomes are present in all the
cells of our body. Genes are small sections of DNA (the double helix) through which we inherit
characteristics from our parents.
Genes are the reason you may have your Dad’s nose, or your Mum’s eyes, for instance.
CLICK > CLICK > We get an X chromosome from Mum – always. Without that there is no viable fetus. This
comes from the egg that is formed in the ovary
And we get either an X or a Y from Dad – from the sperm that is formed in the testes
CLICK > Where the sperm from Dad is carrying an X chromosome, it combines with the egg to give two X
chromosomes,
CLICK > resulting in a female fetus
CLICK > if the sperm is carrying a Y chromosome, it combines with the X to give XY chromosomes
CLICK > resulting in a male fetus.
That’s why sex chromosomes are depicted as XX in a female fetus, and XY in a male fetus.
Regardless of our chromosomes, all of us, at the very earliest stage of development in the womb (uterus)
have both reproductive tracts, so we could go develop either way
But, TYPICALLY if the sperm carries a Y chromosome, certain genes on it (SRY and ZFY) trigger the testes to
produce testosterone and that masculinises the fetus.
Without the Y chromosome there is no trigger to masculinise the fetus.
So, the presence of testosterone in a male fetus, and the absence of it in a female fetus, is a critical factor
in sex differentiation.
However, it is not the only factor; the process is complex and not all of it is understood. (optional - For
example, recent research in mice shows that there are genes on other chromosomes (not the sex
chromosomes) that maintain feminization of the ovaries in adulthood. It is likely that further research in
humans will reveal even more complex interactions between genes and hormone environment.)
Slide 8
Sex differentiation affects our whole bodies: the skeleton (men are usually taller), musculature (men are
usually physically stronger), reproductive organs are distinctly different and sex appearance diverges
during puberty as ‘secondary sex characteristics’ develop, as in this image.
Testes and ovaries are called ‘gonads’ – they manufacture sex hormones testosterone and oestrogen.
CLICK > Importantly, also, the BRAIN is different.
Slide 9
And this story helps us understand how powerful the brain is in predisposing us to identify as boys or girls.
It was called the John/Joan case; it became very famous, and we learn a lot from it.
Identical twin boys were born in the 1960s.
CLICK > One of them – John (not his real name) – lost his penis in a circumcision operation that went
wrong. The parents were told that as long as the child was made to look female, which involved further
surgery to the genitalia, and he was raised as a girl – he would be a girl ! So they raised John as Joan and
this is a picture of her living as a girl – Joan.
CLICK >
For 30 years the doctors who had treated this child, kept the real truth a secret.
The child had never identified comfortably as a girl and in adolescence refused to continue living as a girl.
CLICK > He started to live as a boy again, and as an adult man, he married a woman with three children.
So this child’s development was, in fact ‘typical’ because if he hadn’t lost his penis, and if doctors hadn’t
interfered to try to make him into a girl, he would always have identified as a boy, just like his twin
brother. They both had XY chromosomes and were typical boys.
Sadly, both twins took their own lives in their thirties. The family always blamed the doctor who had first
advised raising the child as a girl. This decision, although well-intentioned at the time, destabilised the
future of the entire family.
What we learn from this sad story is that, right from the start, something in John’s brain was telling him
that he was a boy, despite the way he looked on the outside, and despite the fact that everyone treated
him as a girl.
This is true for all of us. Society reinforces masculine and feminine behaviours, and the family of this child
treated her as a girl, but just being raised in this way, didn’t make her identify as a girl. The identification
comes from within us, just as it did with John, and it prevented him from being able to identify as Joan,
even though there was constant pressure on him to do so.
This decision, although well-intentioned at the time, destabilised the future of the entire family.
Learning exercise: Engage the class - How would you feel if someone tried to tell you that you are not the
person you know you are. Imagine having to live with that discomfort. You’re dressed in the wrong
clothes, given the wrong name, have to use the wrong pronouns: he/she.
Try to put into words what that would feel like.
Extension information (if the group is responding well and the teacher feels secure enough in their
knowledge of intersex):
This section can be omitted if preferred
A few children are born with medical conditions that cause their genitalia to look neither clearly male nor
female so they are, in a way, in the same situation that John was.
Encouraged by what was believed (for 30 years) to be a successful outcome in the John/Joan case, infants
born with indeterminate (ambiguous) genitalia were often also surgically altered to look like girls, even
though some of them had XY chromosomes. When these infants grew up, many of them were very angry
that such important decisions had been taken without their consent because, like John, they knew who
they were and sometimes their bodies had been made to look quite different from the way they
identified.
Learning exercise: Do you think it is right to decide for a children whether they are boys or girls. What
would you do?
Medical practitioners have also learned from their stories and from the John/Joan story, and no longer
automatically operate on babies with ambiguous genitalia to make them look female.
Slide 10
So, just to reinforce the point, it’s the brain that tells you whether you’re a boy or girl, or something in
between, a bit of both perhaps. It’s not the way you look on the outside – although this has a powerful
influence on our thinking
And it’s not the way you’re raised, although this too, has a powerful impact on how you see yourself. But
unless the brain is in sync. these factors will be overruled.
The key factor in making us identify as boys or girls, men or women, or somewhere in between, is the
BRAIN,
CLICK > and we know that the brains of trans people are a little bit different from other men and women
in parts of the brain that are ‘hard wired’, which means they cannot be altered or rewired.
Slide 11
So what happens if the brain doesn’t match up with the sex appearance?
In a very small number of people the brain tells them something different from their appearance, right
from birth. In other words, their ‘gender identity’ is at odds with their appearance. People who experience
this kind of mismatch may be described as gender variant or gender non-conforming. This may cause
significant discomfort sometimes described as gender dysphoria (dysphoria means unhappiness). It
sometimes takes many years for a person to work out the source of their discomfort. Many try hard to
conform to what is expected of them.
Slide 12
CLICK > CLICK > This is Lili Elbe who was assigned male at birth and raised as a boy: she is a trans woman
or woman of trans history. She ‘transition’ in the 1930s, when most people hadn’t even heard of
transgender people.
When gender discomfort is severe, people may
CLICK > ‘affirm’ their gender identity, by undergoing ‘transition’ to live in the other gender role.
CLICK > They may have medical treatment: female hormones, if they identify as women, like Lili Elbe; and
CLICK > some will have surgery to make their genital appearance match their gender identity.
She was one of the first people to have this kind of surgery - gender confirmation surgery
As a man she became an accomplished artist, but abandoned her profession following gender
confirmation surgery.
Slide 13
CLICK > In 1974, Caroline Cossey, had gender confirmation surgery to make her genital appearance female.
She later obtained legal rights as a woman from the European Court of Human Rights. However, the UK
government appealed that decision, and the right was taken away from her. That right has now been reestablished as we shall see in a minute
She eventually married in 1992. She and her husband live in Georgia, USA
Under the name Tula, she was a successful model and had a small role as a ‘Bond girl’ in a James Bond
movie.
We have so far looked at TYPICAL chromosomes but there are a number ATYPICAL (unusual) conditions
where the usual rules of sex development don’t apply. (I mentioned some: ‘intersex/DSD, a few moments
ago, where the genitalia at birth are neither clearly male nor female) but this is an example of a different
kind of intersex condition.
Caroline Cossey has unusual chromosomes – XXXY – and she was very feminine in her appearance even
before she transitioned to live as a woman.
There are many varieties of unusual chromosome configurations, for instance: XXY, XYY, XXYY, and so on.
Although most people with these kinds of variations do not experience a mismatch between their brain
and their appearance, there are a greater number of trans women in these groups than in the population
generally. It is even possible to have what is known as mosaicism, where some cells in the body have one
chromosome configuration, and other cells have something different. This is just one of the many ways in
which nature is so varied.
Slide 14
People who are born looking male and are registered on the birth certificate as male, but who identify as
women are known as trans women
People who are born looking female and are registered on the birth certificate as female, but who identity
as men are known as trans men. The man in this photo was assigned female at birth; he is currently (20142015) the President of the World Professional Association of Transgender Health. He was assigned female
at birth. We used to think that there were more trans women than trans men, but a lot more trans men
are transitioning now, and the numbers seem to be becoming more equal.
Slide 15
Although we always think of people as being one thing or the other: boy or girl, man or woman, as
mentioned on a previous slide, some people identify between or outside these two extremes. They may
be bit of both, and closer to one end of the spectrum or the other, or completely neutral. A few people
don’t see themselves as having a ‘gender’ at all, and may describe themselves as non-gender.
The may use different pronouns: some use, ‘they’ and ‘their’. Some use new pronouns, like ‘per’, ‘zie’, and
‘fey’. Titles may be written as Mx, instead of the usual Mr, Mrs, Miss, Ms.
Learning exercise: Ask the class what difficulties this might cause: e.g. record keeping, exam results in
‘wrong’ name. IT systems that only recognise binary indications M or F.
Slide 16
For many trans people, transition (change of role) is supported by medical treatment
Trans women take the female hormone, oestrogen, that feminises the body so that over a period of about
2 years their breasts develop and their bodies become rounder on the hips; their skin softens.
Trans men take the male hormone testosterone which makes their facial and body hair grow and may lead
to male-pattern baldness; their voices deepen.
In addition, trans people may change their gender role completely so that in every aspect of their lives:
social, family and leisure, they are living in the gender role that matches their gender identity, not the sex
they were assigned at birth.
Slide 17
CLICK > Not everyone wants surgery
Some trans people have a real disgust for their bodies and really need to have surgical correction,
but not everyone wants or needs to go that far.
CLICK > Trans men almost always have chest reconstruction. The breast tissue is removed and the
chest is made to look like a male chest.
CLICK > Trans women may also need to make their breasts bigger if the oestrogen therapy hasn’t
achieved this
CLICK > Both trans women and trans men may have genital surgery to bring their bodies as closely
in line with the gender identity as possible. The surgery for trans men is much more difficult to
do, and often requires several operations, so fewer trans men opt for this surgery although many
have their uterus and ovaries removed.
This kind of surgery leads to infertility so, of course, it is no longer possible for trans people to
have children once they have undertaken this treatment. They can store reproductive material
before surgery, but this means coming off hormones for a period of time which many are not
willing to do.
CLICK > YOU SHOULD NEVER ASK IF A PERSON HAS HAD SURGERY. IT’S RUDE
Slide 18
Gender identity is not the same thing as sexual orientation
CLICK > •Trans men and trans women, like anyone else, may be:
•gay (men who are attracted to men)
CLICK > •lesbian (women who are attracted to women);
CLICK > •heterosexual (attracted to people of the opposite sex);
CLICK > •bisexual (attracted to both men and women); or
CLICK > •asexual (not attracted to either men or women).
Learning exercise: Ask the class to think about how you describe a relationship where a man and a woman
are married = straight (heterosexual); one partner transitions, then the relationship is….gay (or is it?)
Two women are in a civil partnership or same-sex marriage (lesbian couple), one partner transitions, then
the relationship is straight (or is it?) How do people see themselves in these situations?
Slide 19
Most people with a trans history just want to get on with their lives as ordinary men and women, like this
couple, both of them are trans and legally married, photographed with their daughter. Her father (on the
left) is, in fact, her biological mother. Trans men can still give birth if they have not had genital surgery and
still have their uterus (womb).
Slide 20
Young people who do feel able to say who they really are, or who simply can’t hide it, may be able to have
treatment that will help them through their teenage years and make life easier for them as adults.
This involves taking medication to block the hormones that cause the physical changes associated with
puberty. This can be done for a few years, giving them time to be absolutely sure about whether they will
live as men or women in adulthood.
Slide 21
Trans girls on hormone blocking medication will not grow facial and body hair, and their voices will not
drop; their growth will be arrested before they become too tall
Trans boys will not grow breasts or have periods, and they may grow a little taller
All these things help the person blend in with other men and women as adults
This blocking treatment is reversible, so anyone taking this medication can just stop and the body will
start to make the pubertal changes that were on hold.
In this photo, Nicole (on the left) had been given a hormone-blocker for three years to suppress her
puberty, and oestrogen for one year so that her face remained feminine, and she didn’t grow facial hair.
Oestrogen stopped her growing – she is now 4” shorter than her identical twin brother and she is starting
to grow breasts.
Not everyone wants to have surgery to make their genitalia look like the other sex, in this case female but,
in any case, this cannot be done before the age of 18.
Slide 22
CLICK > Currently….
CLICK > The underlying…
CLICK > The specialised clinics…..
There are many more people experiencing gender variance than was previously thought, so it’s important
to remember that if you make a general comment that is disrespectful or pokes fun at a group of people,
you can never be sure that someone close to you isn’t affected by what you say.
Learning exercise: Open discussion with the class about the impact on an individual who might be
affected by this condition, or who may have a relative or friend affected. It could be that a person you
know actually experiences gender variance, so you could be hurting their feelings and making them scared
to come ‘out’.
The number of pupils in our school is……..
If 1% of us is gender variant to some degree, how many would there be in our school?
Slide 23
The Equality Act, 2010, makes ‘gender reassignment’ a protected characteristic. It protects trans people
and those mistaken for a trans person (even if they are not) from discrimination. It also protects people
who are ‘associated’ with them – like family members, for instance. Under the Equality Act you are
protected if you undergo, or intend to undergo, a process (or a part of a process) which could include
changing things like your name, pronouns, dress, having medical treatment, e.g. hormones
A trans person, just like anyone else, is protected by the Human Rights Act 1998 which entitles us all to
respect, privacy, dignity and equality.
Slide 24
CLICK > The GRC can be used to obtain a new Birth Certificate
CLICK > People who have a GRC have anew legal gender ‘status for all purposes’
CLICK > It is not necessary to have medical treatment to be granted a GRC but you do have to show that
you have lived continuously in your new role for 2 years, and intend to continue in that role
CLICK > you must be 18
A woman of trans history called Christine Goodwin, won her case in the European Court of Human Rights
in Strasbourg (2002), and as a result, the law was changed in the UK with the introduction of the Gender
Recognition Act in 2004. This gives people a new gender status and a new birth certificate. The law started
to be used in 2005 and since then about 3,500 people have obtained a GRC. Many more trans people don’t
have a GRC, sometimes this is because they are married, and they don’t want to change the status of that
marriage (into a same-sex marriage or a civil partnership). Others may already be in a same sex
relationship (civil partnership or same-sex marriage) and if one of them has transitioned and wants a GRC,
they will have to change into ‘marriage’.
Slide 25
Being trans is something you are born with, and more children and young people now come ‘out’ as trans,
gender variant or non-binary, but others hide their discomfort and just try to fit in. They may want to
dress differently but they are scared of being bullied and teased at school or even of being rejected by
family members. So they repress their true feelings and this can make them very depressed. Sometimes
they don’t come out until middle age or even old age, because they are scared of losing their jobs and
losing their families.
Learning exercise: How do you feel about that?
Slide 26
Would you bully someone who seemed ‘different?
Would you want to make them unhappy just because they aren’t like you?
Is that fair?
Develop conversation about bullying people who are different
Slide 27
As we saw earlier, nature is very varied. People may be different in all sorts of ways.
Nature loves variety, so being ‘different’ from the majority is not a bad thing or a good thing. It’s just how
the world is. In an ideal world all these differences should be celebrated because they make our society a
better place.
Nature loves variety. Society needs to love it too
Learning exercise:
What can we do in our class, in our school, to celebrate diversity and make people who are different, feel
welcome. Brainstorm to come up with an event that the class can take ownership of.