uhh well I was thinking he would just not have phys ed on his schedule..he would just take other classes. I knew a few students in my old high school with doctors notes one being in a wheel chair and another had a heart condition and they were simply given another class to do instead.(the gender thing never came up really since I went to an all girl school) In this case it would out him pretty damn quick if he had to shower and it would raise some questions if he showered in a separate place or not take one at all.