• The teenager is being assisted in his fight for action by The Good Law Project
• It says the NHS has ‘legal obligation’ to provide specialist care within 18 weeks
• But the average waiting time for a first appointment is 18 months, group says
• NHS England insists an independent review into the service is already underway

A transgender teenage boy is launching legal against against NHS England over delays to gender reassignment treatment, having waited more than a year for a referral to the specialist clinic.

The 14-year-old is being assisted in his fight by The Good Law Project, which says the NHS has ‘a legal obligation’ to provide specialist care, or an alternative, within 18 weeks.

However, the average waiting time for a first appointment with the Gender Identity Development Service (GIDS), based at London’s Tavistock Centre, is 18 months, the organisation says, with some even waiting up to four years.

This is not even to actually get what the NHS describes as fully reversible puberty blockers, but just to begin the process of being assessed for eligibility.

Some 10,000 more young people have been referred to the already over-subscribed GIDS, according to figures obtained by the BBC.

NHS England says an independent review into the service has been launched, and insists any legal action ‘will only cost taxpayers’ money and not help the actions already under way’.

The service, which is run by the Tavistock and Portland NHS Foundation Trust, provides support to people under the age of 18 who experience difficulties related to their gender identity.

Reece, who came out to friends and family in primary school, told the BBC he would not want to bring such action ideally, but felt he didn’t have a choice as ‘nobody else is sticking up for trans young people’.

He added: ‘I know more than 30 trans people, from school and LGBT groups. Everybody’s been waiting for months, or even years, but nobody’s been able to get in yet.

‘It’s scary because it shows the service isn’t available to the people who need it.’

In a statement he added: ‘The length of the NHS waiting list means the treatments which are essential for my wellbeing are not available to me.

‘By the time I get to the top of the list it will be too late, and in the meantime I suffer the fear and terror that gender dysphoria causes, every day.’ 

Gender dysphoria is when a person feels a sense of unease because of a mismatch between their biological sex and their gender identity.

The NHS announced in September that an independent review into GIDS would be carried out.

An NHS England spokesman said it would include ‘how and when’ young people are referred to specialist services.

Jolyon Maugham QC, director of the Good Law Project said: ‘Whatever your views about the right treatment regime for young people with gender dysphoria, it can’t be right that they face lengthy waiting lists – on some reports up to four years – for a first appointment.

‘Children are losing the opportunity to be seen within a window in which they can secure effective treatment and so are, in practice, being denied access to that treatment.’

The Good Law Project said the case was not about the treatment GIDS should provide, but the ‘lengthy delays’ in accessing it.

The GIDS’ website says it is aware that young people are having to wait a ‘long’ time for their first appointment. 

An NHS England spokesperson said: ‘There has been more than a 500% rise in the number of children and young people being referred to the Tavistock’s gender identity service since 2013 as more people come forward for support and treatment.

‘The NHS has already asked Dr Hilary Cass to carry out an independent review including how and when children and young people are referred to specialist services, so legal action against the NHS will only cost taxpayers’ money and not help the actions already under way.’

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A way of making a person’s voice better reflect their gender

Voice surgery for transgender individuals may be an option for individuals who experience dysphoria about their voice and have not been helped enough by the practice of voice therapy.

Purpose

Voice therapy can be helpful for people who are learning to speak in a way that is read as more masculine or feminine. It can also help people, to a degree, make their speaking voices sound a certain way. However, it does not adjust the fundamental pitch of the speaking voice.

Transmasculine individuals often experience a deepening of their voice when on testosterone-driven gender affirming hormone therapy.1 This is because testosterone causes lengthening of the vocal cords.2

In contrast, transfeminine people do not experience a shortening of their vocal cords when they take estrogen. Therefore, if they are uncomfortable with the pitch of their voice, or feel as though it is not congruent with their gender, they may seek voice surgery.

Voice surgery is generally not recommended until people have tried voice therapy, which is a less invasive way to address voice dysphoria or discomfort.

Types of Transgender Voice Surgery

Most transgender voice surgery performed is feminizing voice surgery. In order to affect pitch, voice surgery is used to address one of the physical characteristics of the vocal cords that determine pitch. These are vocal fold tension, length, and mass.3 There are a number of different procedures that can be used to adjust these characteristics

Cricothyroid Approximation

Criciothyroid approximation (CTA) increases tension in the vocal cords by tilting the larynx and sewing the lower border of the thyroid to the Adam’s apple cartilage. This has been shown to increase voice pitch.

It also makes the thyroid notch more prominent, which is an undesirable side effect. (Indeed, many individuals combine voice surgery with a reduction in the size of the Adam’s apple.) This surgery is not recommended for individuals under 30 because younger patients do not yet have solid thyroid cartilage.4

Anterior Commissure Advancement

Anterior commissure advancement (ACA) is another tension modifying surgery. It was initially developed to treat medical conditions that affect the tension in the vocal cords. However, it generally does not affect pitch enough to be useful for transgender women.4

Anterior Glottic Web Formation

Anterior glottic web formation describes procedures that are used to shorten the length of the vocal folds. This can be done using a number of different techniques. These include both external procedures, done through the neck, and endoscopic procedures, done from inside the throat.3

Laser Reduction Glottoplasty

Laser reduction glottoplasty uses a laser to vaporize parts of the vocalis muscle and surrounding structures in order to change the density of the vocal folds. Originally used for cases where CTA had failed, it is now sometimes used in combination with CTA to take advantage of both density and tension changes and increase the magnitude of the pitch effects of surgery.4

Who Performs Transgender Voice Surgery

Voice surgery procedures should only be performed by surgeons who are specifically trained in the modification of the voice, ideally the modification of the transgender voice.

When surgery is performed by people who lack appropriate training, outcomes may be undesirable. People may lose range in their voice or experience other undesired vocal effects, including hoarseness.

Voice surgery is most often performed by ear, nose, and throat specialists, otherwise known as otolaryngologists. Such surgeons have advanced training in working with the structures of the throat.

However, not all otolaryngologists have experience with pitch modification. It is reasonable to ask doctors about their experience performing this surgery and if they can share samples of voice changes they have achieved using their work.

Eligibility

Unlike many other gender affirming surgeries, there are no specific eligibility requirements for accessing gender affirming voice surgery. However, most ethical surgeons will encourage patients to work with a voice therapist before undergoing surgery.

Voice therapy can address gendered aspects of the voice, and may affect people’s desire to undergo surgical modification of the vocal folds. Voice therapy may also be required after vocal surgery, in order for individuals to learn to use the changed structures of their throat.

People who are unable or unwilling to engage with voice therapy, and see surgery as a quick fix, may not be appropriate candidates, because where recommended, voice therapy is an important part of surgical recovery.

Association of Voice With Gender

Voices are, quite literally, the first way that most people communicate with the world. Whether talking on the phone or calling out to a friend across the room, our voices are a big part of how we are perceived.

Indeed, many of the assumptions we make about people’s identities reflect our perceptions of the way they speak. These assumptions are not only those related to gender, People often think they can determine other characteristics by hearing someone’s voice—including their race.5

What about a person’s voice is associated with gender? Although we think of women as having higher voices than men, pitch is only the most obviously gendered aspect of the voice. Gender is also associated with volume of speech as well as the ways that people pronounce different vowels.

The fact that perception of vocal gender is multifaceted is why vocal surgery is rarely performed in the absence of therapy for vocal technique—pitch change alone is unlikely to affect whether a person’s voice is heard as male or female.

A Word From Verywell

Having a masculine voice is a predictor of improved well-being for transmasculine people.6 The same is true for transfeminine people, and various aspects of the voice have been found to be associated with quality of life.7 Not every transfeminine person is interested in voice therapy or surgery. However, for some people it can be very important for their well-being.8

This may be particularly true for women who spend a lot of time using their voice—like teachers, or phone support providers—because being repeatedly misgendered can take an emotional toll. Vocal surgery may also have the potential to reduce the risk of other forms of transphobia and discrimination.

The post What Is Voice Surgery for Transgender Individuals? appeared first on MyMedicPlus.

Born male, Trinty would dress up in her mum’s clothes and adamantly express that she was a girl.

Trinity was then taken to a specialist child therapist who confirmed that she had gender dysphoria, but by then Trinity’s mental wellbeing was being impacted.

At four years old, Trinity began socially transitioning into a girl and her family accepted her.

Mum DeShanna bought her a pink dress to mark the occasion, which left Trinity in tears as she finally felt accepted. .

‘It made me feel so happy,’ she explained. ‘And mum said I was crying because of my happiness.

‘It wasn’t right for me in that body. It felt awful, I wasn’t even happy. I was always sad and angry.’

When she turned 12, Trinity made history by becoming the first child in Delaware to have their medical transition covered by Medicaid, a state program that offers health insurance coverage for lower-income families.

Although Trinity was initially denied puberty blockers by Medicaid, DeShanna fought for almost a year to get the treatment her daughter needed.

Now, Medicaid will be covering Trinity’s gender confirmation surgery. At 16 years old, she will be one of the youngest in her state to undergo this life-changing surgery.

At the time, it was difficult for DeShanna to come to terms with Trinity’s choice but the therapist helped her see the way.

She was asked: ‘You have to make a decision here. Do you want a happy little girl or a dead little boy?’

Though she came to terms with it, DeShanna wants more mainstream acceptance.

She added: ‘What makes it harder, it’s not because she’s trans but because I have to fight to make people and society see she’s a person that deserves dignity and respect like anybody else.

‘I would love to see black and brown trans people portrayed in a positive loving life.

‘They’ve been victims of violence, murder – I want to show that our family is a loving family.’

Speaking about her upcoming bottom surgery, Trinity said: ‘I want to actually be a girl, completely, even though I am a girl. I want to have this removed I am tired of it.

‘I want to be myself, I don’t want to be someone I don’t want to be. Because if I get this [surgery] done I can show those people who hate, I will show them that no matter how much you hate us, we will still beat you.

‘We are just all human I don’t know why we have to hate each other, it is not right, we are all supposed to be loved, we all should love ourselves.’

Trinity’s surgeon, Dr Sherman Leis, specialises in transgender surgeries.

He claims that minors undergoing gender confirmation surgery is becoming more common, however, they are still the minority.

According to Dr Leis, before any patient can undergo genital reassignment surgery, they must have been taking hormones for at least one year and be living as their desired gender for three.

They must also have clearance from two mental health specialists who have been trained to deal with gender dysphoria.

He said: ‘I don’t have one patient that regrets they did the surgery, not even one. That’s absolutely the truth – but I know that overall it’s about an incidence of 1% of patients that regret that they did the surgery.

‘I don’t think there’s another profession in the world, in or out of medicine that has the ability to bring such a profound improvement in a human being’s life as transgender surgery.’

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While the latest on impeachment continues to dominate headlines, two news items should have our interest before they go the way of the 24-hour cycle.

First, there’s the new episode of “Marvel’s Hero Project”—available on Disney Plus—that celebrates a 12-year-old boy who identifies as a girl and testified before New Jersey’s legislature in favor of a bill mandating an “LBGTQ history” curriculum to be taught throughout the state’s public schools.

And second, the announcement from Merriam-Webster that it has chosen “they” as its word of the year, celebrating the plural pronoun’s newfound utility as a referent to those declining the more traditional (read “biologically correspondent”) indicators like he, him, she, and her.

As merely the latest examples of a steady cultural drumbeat—the American Dialect Society named “they” its top word back in 2015—the news hooks from Disney and Merriam-Webster function more to nudge up the volume than introduce anything new, much less noteworthy. Yet, even as corporations and celebrities dial up their efforts to mainstream gender identity ideology, the gap continues to widen between the currency of woke virtue-signaling and the reality on the ground.

One way to gauge the width of that gap is to look at the way victims of gender identity ideology are treated by a culture increasingly sold-out to the idea that a man who feels he is a woman can simply become one with the help of irreversible surges of cross-sex hormones and sometimes-endless cycles of surgeries.

And by victims, I’m not talking about female athletes converted into spectators, professors and teachers who find their speech censored—and their jobs threatened if they dissent from the new orthodoxy, or even the specter of female survivors of rape, sex trafficking, and domestic violence forced to sleep alongside biological males because of gender ideology.

No, I have in mind those who have personally bought into the central promise of gender identity theory only to find that living as the opposite sex wasn’t bringing them closer to happiness—but in many cases, much further away. Though many of these individuals were once hailed as heroes, they can expect to find themselves facing staunch opposition, hatred, and—perhaps most painful of all—silence and indifference if they decide to “de-transition” and pursue a life that aligns with their biological sex.

Perhaps the best-known “de-transitioner” is a man named Walt Heyer. As he writes at USA Today, Heyer’s discomfort with his sex dated back to the time when he was a 4-year-old boy whose grandmother dressed him in girls’ clothes and lavished praise on him as such. If Heyer’s account sounds familiar, it’s likely because it bears a striking resemblance to that of James Younger, a 7-year-old boy whose mother insists that he is a girl.

At 42, Walt began living as “Laura”—an eight-year experience that cost him his marriage, his job, and left him permanently disfigured. Today, Heyer and his wife (he remarried in the 1990s) spend their life helping men and women grapple with the lasting damage of irreversible hormones, surgeries, and relational upheaval brought on by living as the opposite sex.

While Heyer and others—including James Shupe and Sydney Wright—are courageously telling their stories in the public square, there’s no question they’re fighting an uphill battle in a culture increasingly deluged with messages promoting gender identity ideology—much of which, like the Disney Plus project, is aimed at young children.

That these messages are aimed at children is especially troubling. According to the American Psychological Association’s “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), up to 97 percent of boys and 88 percent of girls experiencing gender dysphoria will grow out of gender-related discomfort by the time they reach adulthood. Meanwhile, available research indicates an alarming increase in mental health problems and suicide attempts among those who follow through with so-called gender reassignment.

Yet, as Carey Callahan—a woman who previously lived as a man and who worked at gender clinic—recently wrote at The Economist a patient’s mental health is often an afterthought for gender clinics. To illustrate, Callahan opens her piece telling the story of “Betty,” a patient whose violent mental health issues stayed largely unaddressed while under the clinic’s care.

“In the case of Betty, I felt that the clinic where I worked wasn’t sufficiently concerned whether her mental disorder created delusions that often controlled her life.” Callahan writes. “The medical staff’s attitude towards Betty and many of the other patients who were receiving hormones while managing (or failing to manage) severe mental illness was a profound lack of interest about whether one affected the other.”

Heyer, who eventually found life-changing help through counseling and his local church, sounds a similar note: “Underlying issues often drive the desire to escape one’s life into another, and they need to be addressed before taking the radical step of transition.”

As parents, grandparents, friends, and neighbors, we do well to hold our grip on the fact that—in spite of the spin from cultural influencers like Disney Plus and Merriam-Webster—ideas and ideologies have real-life consequences. Or in this case, victims.

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The NHS will let transgender patients choose whether to be treated on male or female wards, even if they haven’t had gender reassignment surgery.

Patients will be accommodated based on how they look, the way they dress and what name they go by, according to new NHS England guidelines.

This means they will share toilet and bathing facilities on single-sex wards. 

NHS England said that having ‘different genital or breast sex appearance’ is not a reason for denying patients a space on the wards. 

But the document, titled Delivering Same-Sex Accomodation, did specify that ‘pre-operative trans people should not share open shower facilities’

Non-binary patients – who identify as neither male or female – will be ‘asked discreetly about their preferences’ and given the choice of either a male or female ward. 

It added that ‘trans men and non-binary individuals can become pregnant and should be treated with dignity while using maternity services’. 

The guidance concludes: ‘Good practice requires that clinical responses be patient-centred, respectful and flexible towards all transgender people whether they live continuously or temporarily in a gender role that does not conform to their natal sex.’

The new guidelines have been met with mixed reaction, with trans rights groups hailing the move and critics branding it ‘shocking’ for the privacy of others.

Dr Jane Hamlin, president of The Beaumont Society, a transgender support group, told The Telegraph the policy had been ‘clearly been thought through very carefully and is sensible and encouraging’.

Tory MP for Monmouth, David Davies, said the move ‘drives a wrecking ball through those hard fought for rights’.

He told the paper: ‘It means people who are physically male will be placed in women’s hospital wards.

‘Nobody wants to see transgender patients discriminated against or treated badly in any way.

‘But placing people who are physically male in close proximity to vulnerable women who may be facing intimate medical procedures is not fair.’

Dr Nicola Williams of Fair Play For Women campaign group told the paper it was ‘shocking’ and means that women’s ‘privacy and dignity goes out the window’. 

An NHS spokesman said: ‘The NHS is here to provide all patients with the excellent physical and mental health treatment they need and to support them while they are in our care.

‘The revised document on “delivering same-sex accommodation” provides clear and considerate guidance for NHS staff so they can prioritise the safety, privacy and dignity of all patients.’

A Department of Health and Social spokesperson said: ‘We’re working closely with the NHS to consider the findings of the review.’  

It comes just over a month after MailOnline reported health chiefs were reviewing a service which gives transgender children drugs to pause puberty. 

NHS England said it was investigating issues around hormone-blocking drugs prescribed to under-18s to ‘pause’ their adolescence and prevent changes to the body like breasts or facial hair.

Children as young as 10 are being referred for hormone-blocking drugs, despite concerns they could cause emotional problems and long-term effects on the brain and body which are not yet known.

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One year has passed since the Supreme Court of India in a historic judgment ruled that Section 377 of the Penal Code can no longer be used to criminalize consensual sex between people of the same gender.

Justice Indu Malhotra, one of the five judges who delivered four concurrent verdicts on September 6 last year, said society owes the LGBTQ+ community an apology for the historical wrongs perpetrated against it. The judgment came as a beacon of hope to the hitherto criminalized queer community.

But one year on, the community feels that the government has done little for them and that the fight for equality is unfinished. Activists and lawyers say they are vexed about not yet having the right to receive legal recognition of same-sex relationships and about the lack of protective laws against discrimination and violence.

“The community is thriving not because of the government but despite the government,” said queer activist Harish Aiyer.

Debottam Saha, one of the petitioners who challenged Section 377, said, “Although the Supreme Court verdict has helped  many to come out of the closet, the government has been apathetic to our struggles.”

Lack of security

Saha, who was part of a pan-India group of 20 students and alumni of the prestigious Indian Institute of Technology who took the fight to the Supreme Court, added, “The government has taken no initiative for sensitization of the larger community to eliminate stigma and discrimination although it was suggested by the verdict.”

“Discrimination on the basis of sexual orientation is a violation of freedom of speech and expression,” Chief Justice of India Deepak Misra and Justice Ajay Manikrao Khanwilkar said in the landmark judgment in 2018.

A 2016 survey of Indian LGBTQ+ employees, the Mission for Indian Gay and Lesbian Empowerment, an advocacy group, found that 40% had been harassed at work and the majority were not covered by anti-discriminatory workplace policies. At least two-thirds of the respondents also reported having heard homophobic comments in the workplace.

Delhi-based lawyer Mihir Samson, who was part of the legal battle against Section 377, said, “We are aiming for an anti-discrimination law that not only applies to the government and its institutions but also extends to the private sector.”

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A law put up by Victoria’s Andrews government could expose women offering intimate services such as pubic waxing or underwear fitting to discrimination complaints if they reject trans women customers who still have penises, veteran human rights lawyer Moira Rayner has warned.

The new law would allow self-declared trans women, who possess a penis and have not undergone any sex-reassignment treatment, to change the sex that appears on their birth certificate, giving them access as women to equal opportunity protection.

Ms Rayner, a former state and federal human rights commissioner, said that, if enacted, the legislation could allow a Down Under version of Canada’s Jessica Yaniv case, in which a trans woman has lodged anti-discrimination complaints against 16 beauticians who did not want to handle her penis and testicles in order to grant her wish for a brazilian wax.

Ms Rayner said a female sole trader could come under pressure from a Yaniv-style action.

The Labor government said the current state law demanding surgery before any change to a birth certificate “sends a painful and false message that there is something wrong with being trans or gender diverse that needs to be ‘fixed’ ”.

Victorian Attorney-General Jill Hennessy said: “Everyone deserves to live their life as they choose, and that includes having a birth certificate that reflects their true identity.”

Critics of the new bill complain of a lack of robust debate, and Ms Rayner said Ms Hennessy “should be asked to make sure she is given proper advice” on its possible unintended effects.

The bill returns to parliament next month.

University of Melbourne philosopher Holly Lawford-Smith agreed a Yaniv-style anti-discrimination complaint would be possible in Victoria — “exclusion from being hired to fit clothing to women in a shop, or from admission to a girls’ school, or to a women’s room in a dormitory, or hospital ward … you name it, if it’s women-only, there could be a case”.

She urged outright rejection of the bill, which makes a statutory declaration sufficient proof of official sex status, and allows birth sex to be changed every 12 months.

“Sex should not be a matter of belief,” Dr Lawford-Smith said. “If progressives want to disincentivise sex-reassignment surgery, they should protect gender expression, or gender identity, or trans status, separately — rather than trying to shoehorn it into sex.”

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I usually assume that a Vatican document must have something right if it manages to send its conservative right wing into apoplexy, its left wing into handwringing concern, and the secular left into scandalised head-shaking. So it was with sunny optimism that I began to read the recent document on ‘gender theory’ in education, issued by the Congregation for Catholic Education.

Alas, I soon realised that the document was disliked by everyone because it’s so confused and woolly that it could mean many things. Given that it’s always prudent to suspect anything coming out of the Vatican, everyone went with their worst suspicions.

The social conservatives got stuck on the appeal to dialogue with ‘gender theory’, seeing it as a sop to ‘neo-pagan’ socialists. The left was aggrieved by the insistence that gender identity (roughly, the gender you subjectively identify with) is intrinsically linked to biological sexual identity.

Science still classifies sexual identity in terms of male and female, with anything in between being defined in terms of the two poles. So to assert that gender identity has to be based on sexual identity could seem like an argument that any other claimed gender is based on wishful thinking, not reality, and that sex/gender education policies, based on wishful thinking, are therefore likely to be harmful.

You can see why LGBTQ groups would be hostile to this suggestion. And you can see why claiming to wish to dialogue about this would appear, to social conservatives, to want to negotiate something that needs no negotiation.

The reason why the document is all over the place is that it tries to do several things at once, without distinguishing between them. It discusses both human nature in the abstract and how human nature can be distorted and frustrated in specific societies. It talks at once about descriptions of what actually takes place with what ought to be.

It’s never clear whether it’s talking about how gender identity actually is formed – a subject of interest to academic specialists – or what a Catholic curriculum ought to teach. Clearly, specialists can discuss things which are of no interest to teachers.

Specialists can be interested in debating whether a transsexual (pre- or post-operation) remains biologically of the sex at birth. They might even debate whether the opera­tion should strictly speaking be called sex- or gender-reassignment surgery.

Teachers, however, are interested in how children in their care should be treated. Does it help their personal and moral deve­lopment to be treated as belonging to one gender or another, or a third, irrespective of whether it’s a social fiction or not?

The Vatican document, in short, jumbles up those aspects of gender theory which are descriptions of actual cases, explanations of those cases, theories of what human gender actually is, and political philosophy based on these theories.

Where the document expresses doubt about claims, by some gender theorists, that human liberation calls for the dissolution of all gender differences, there are two ways to react. If you’re reading it with an eye on philosophy, you could raise your eyebrows and say – you disapprove of that? When you’re preaching the New Testament that says there’s no marriage in heaven and no male and female in Christ?

Or you could simply read it with the eye of a teacher, or catechist, and shrug, wondering what it all has to do with the price of eggs and helping your wards come to terms with the fact that one of their friends has two fathers, and another two mothers.

Strange to say, the reason that the document confuses so many different things is that it oversimplifies what ‘gender theory’ is. It treats it as a single doctrine, with some versions more radical than others.

Gender theory is a field of study, with rival ideas and arguments. Some are close to the Vatican congregation’s position that gender has some anchoring in sexual identity. At the other extreme end are theories that say our gender identity depends en­tirely on our subjective feelings.

What is common to all of them is the unexceptional idea that our gender identity doesn’t depend entirely on ourselves. It’s formed in our relation to others. In fact, gender is often assigned to consumer items (some cars are designed to look femi­nine, others masculine), food (meat and potatoes are masculine, rucola salad is not), and spaces (which is why a men’s club shower has a different texture and colours to that of a women’s).

It’s quite clear that if gender also de­pends on a culture’s symbolic structure, then some aspects of gender identity will have connotations that have nothing to do with sexual identity per se. They might even have the kinds of connotations of class and status that are based on exploitation – or, as the Church might call them, the structures of sin.

The document is a call for dialogue and further thinking on how a proper Catholic education might start off its wards onto the path of discovery – themselves and their friends. Let’s hope that the muddled beginning will lead to clearer ideas.

Not the clarity of the bigots, platitude merchants who oversimplify human nature. Nor the clarity of the social radi­cals, attitude merchants who oversimplify our ability to become what we are. But the clarity of those who understand that sexual and gender education is like learning a language, a lifelong experience based on recognising constraints as well as overcoming limitations.

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