258. Schools should be particularly conscious of safeguarding concerns relating to primary aged children. For example, the Cass Review noted evidence that children who socially transition before puberty – and those who transition prior to receiving clinical advice – are more likely to proceed to a medical pathway than those who do not. Schools should also keep in mind that some children who socially transition before puberty will be “living in stealth” meaning other pupils and/or staff may be unaware of their biological sex, and schools should be aware of related safeguarding concerns as in the section below on living in stealth.
Thoughts: Schools should be particularly conscious of safeguarding concerns relating to primary aged children and should work in partnership with parents to ensure they access clinical advice before supporting any social transition at school. Schools should not support children to “live in stealth” due to the related safeguarding concerns for the child themselves as well as other children at the school.
These are the relevant passages of <a class="break-all" href="https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/cass.independent-review.uk/home/publications/final-report/" rel="nofollow" target="_blank">Cass Review Final Report p164
Children:
• Parents should be encouraged to seek clinical help and advice in deciding how to support a child with gender incongruence and should be prioritised on the waiting list for early consultation on this issue.
• Clinical involvement in the decision-making process should include advising on the risks and benefits of social transition as a planned intervention, referencing best available evidence. This is not a role that can be taken by staff without appropriate clinical training.
• It is important to ensure that the voice of the child is heard in any decision making and that parents are not unconsciously influencing the child’s gender expression.
• For those going down a social transition pathway, maintaining flexibility and keeping options open by helping the child to understand their body as well as their feelings is likely to be advantageous. Partial rather than full transition may be a way of ensuring flexibility, particularly given the MPRG report which highlighted that being in stealth from early childhood may add to the stress of impending puberty and the sense of urgency to enter a medical
Adolescents:
• For adolescents, exploration is a normal process, and rigid binary gender stereotypes can be unhelpful. Many adolescents will go through a period of gender non-conformity in terms of hairstyle, make-up, clothing and behaviours. They also have greater agency in how they present themselves and their decision-making.
• For those considering full social transition, the current long waiting lists make it unlikely that a formal clinical assessment will be available in a timely manner. However, it is important to try and ensure that those already actively involved in their welfare (parents/carers, any involved clinical staff such as their GP, school staff or counsellors) provide support in decision making and plans to ensure that the young person is protected from bullying and has a trusted source of support.
Impacts of stealth:
Cass Review Final Report p159
12.12 The MPRG [Multi Professional Review Group] is concerned that some children living in stealth have a common, genuine fear of “being found out”, suffering rejection either due to not having taken friends into their confidence (withholding personal information regarding biological sex or specific sex-based experiences), or due to transprejudice or transphobia. They observed that this fear of “being found out” is driving a sense of urgency to access puberty blockers, which may not allow consideration of other pros and cons of the treatment.
12.13 The MPRG also observed that living in stealth appears to increase a child’s level of stress and anxiety with resultant behaviour and mental health problems. These included social withdrawal, with children becoming increasingly isolated, including resorting to home-schooling or tutoring and even rarely leaving their house.