Trans Safety Network

The European Social Survey: A Case Study In Gender Assignation

2026-02-12T00:00:00+00:00

Introduction</h1>
In this article, I will show that it is incorrect to assume that “observation” can be used to find out a person’s gender or sex.
Surveys and other forms of data collection often use “observational coding”, meaning that the interviewer simply records what they assume the gender/sex of the person being interviewed to be. This approach is specifically endorsed by the trans-hostile Sullivan Review</a>, which made a large number of sweeping and harmful recommendations to the UK government about data, statistics and research.
The European Social Survey (ESS)</a>, a large-scale survey of social attitudes run by multiple countries since 2001, has used “observational coding” throughout its history: a “gender” data item is used by interviewers to record each participant as either “male” or “female”.
However, in the most recent ESS round, an additional question on “non-binary gender” also captured the participants’ self-reported gender. This question allowed for a broader range of answers including “a man”, “a woman”, and “other”.
The parallel use of these two different “gender” items allows us to directly compare “observation” and “self-report” data about gender/sex; as we will see, the level of disagreement between them can only result from “observational coding” being unreliable.
This implies that Sullivan is wrong, and that “observational coding” should be discontinued entirely: using this approach may introduce serious inaccuracies in data, raising problems of data interpretation and potential legal issues.
I will also note problems with the ESS “non-binary gender” question, and discuss how to avoid those issues when designing survey questions to capture gender/sex inclusively.

Assumptions About “Observing” Sex</h1>
The practice of “gendering” a person based on a glance is so commonplace that it is generally unremarked and unconsidered. However, it’s clear that the idea that we can directly “observe” gender in this way assumes both cisnormativity</a> and gender normativity</a>: it ignores the fact that gender identity and gender expression do not always neatly align.
Likewise ignoring this fact, despite its close focus on trans existence, the Sullivan Report</a> recommends that “observational coding” be used when collecting data. For example, Chapter 7 of this report is entirely dedicated to the notion that “the meaning of sex has become progressively destabilised” and nostalgically harks back to the practices of the pre-1990s era, with their “well-established understanding” which did not question the accuracy of “gendering”.

In Recommendation 20 of the report, Sullivan states that asking for a person’s sex/gender can be perceived as “rude” and suggests that the use of “observation” can avoid “potential dissonance and break of rapport”.

This ignores that failing to ask may equally well lead to misgendering, which itself is not simply “rude” but potentially deeply offensive, the source of inappropriate outcomes</a>, and the stuff of harassment</a> – besides being a potential source of data inaccuracy. Sullivan is here putting forward a disingenuous recommendation that is outright hostile not only to trans existence, but to anyone that does not align with gender norms.
However, Sullivan is not alone; “observational coding” is still commonly accepted as a practice in face-to-face surveys. For example, Eurostat</a>, the organization that drives harmonization in statistical methodology across Europe, provides guidance</a> on the collection of statistics states that “it might not usually be necessary” to ask what the correct value for “sex” is.

Where “administrative sources” are not available, such guidance is assuming that the “sex” of a person must be directly observable. Even recent reviews of survey practice that display some caution about “observational coding” fail to consider that gender norms cannot be simply assumed to apply across any segment of the population. For example, Cartwright and Nancarrow (2022)</a> say, without evidence, that the validity of the practice is liable to be high, if one just neglects the existence of non-binary people:

Besides incorrectly assuming there must be a specific non-binary androgynous “look”, this also takes it for granted that the rate of misgendering cannot be significant in relation to the majority cisgender population.
Clearly, the practice of “gendering” individuals at a glance is so embedded in everyday life that the idea that it is can be wrong is very rarely considered by authorities. As we will see, the ESS data shows that this assumption is simply incorrect: the inaccuracy of “observational coding” is a significant, pervasive problem.

Types Of Gender Values In The ESS</h1> The ESS is a large scale multi-national survey that aims to give a comparative view of social attitudes across European nations, by using a standardised set of question items</a> that can be translated for use in different countries. It was established in 2001, has been run every two years since, and is a key part of European research infrastructure, with ERIC status.
Each round of the survey includes a standard set of questions divided into modules, reused in each round, plus a number of “rotating” modules, which are sets of questions that are specific to current research topics of interest.
Round 11 of the ESS, run in 2023 across 31 countries, included a rotating module titled “Gender in contemporary Europe”. This introduced for the first time questions relating to gender identity, including item E1, intended to capture self-reported gender identity (SRGI) as opposed to interviewer identified gender (IIG), and to allow for non-binary gender to be recorded.

IIG has been recorded by the ESS in every round. In round 11 it is item F2 within the module on “Gender, Year of birth, and Household grid”, which can be given only binary gender values (“male” or “female”). Unlike other survey items, there is no specific ESS question associated with item F2 that is posed to the survey respondent. In fact, there are no specific, detailed instructions for interviewers in respect to this variable: the interviewer is simply told to CODE SEX</a>.

There is no further elaboration on this instruction; it is assumed to be self-explanatory. Interviewers are expected to be able to simply and accurately perceive the gender of a respondent directly.
The use of two different measures of gender in the ESS gives us a unique opportunity to check how well IIG and SRGI align. As we will see, the IIG data recorded for some countries is far out of line from what we would expect, strongly suggesting that the practices used to “CODE SEX” are unreliable.
Gender Data Discrepancies In The ESS</h1>
All of the ESS round 11 data</a> is freely available and the analysis tool</a> allows for the relationships between different data items to be plotted.
For some countries, we find that the two different measures of gender align neatly.
For example, both Germany and Iceland show 100% alignment between self-description as “a man” and “male” IIG coding, and likewise for self-description as “a woman” and “female” IIG coding.


(We will consider self-description as “other” later).
These examples of 100% agreement between SRGI and IIG (for “man” and “woman” categories) is likely to be the result of the interviewers in those countries following the instruction to “CODE SEX” by checking participant self-report about binary gender for item F2, just as self-report is used for item E1. This seems to be the only way to explain the perfect levels of alignment, given that other countries show serious discrepancies between the two measures.
The most extreme example of disagreement is provided by the data for Austria, in which fully 6.5% of those whose self-described gender is “a woman” were coded with an IIG of “male”. Similarly, 1.3% as those who self-describe as “a man” were coded with an IIG of “female”.

This equates to 7.2% of the “male” coding by interviewers being misaligned with self-reported gender identity, and likewise for 1.2% of the “female” coding.

Many other countries show a similar pattern, with the discordance between IIG and SRGI particularly notable with respect to “male” coding. Examples of this pattern include Slovakia (4.2%), Ireland (2.6%), Cyprus (2%), Hungary (2%), the UK (1.8%), Greece (1.5%), and others to a lesser degree. (Inaccurate coding of men as “female” also occurs, but at much lower rates).
The fact that there appears to be systematic misgendering in play in these cases cannot be explained by reference to a set of transgender or non-binary (TNB) people perceived as not “passing</a>”. While at first glance the mismatched IIG percentage levels seem to mostly fall within the range of estimates for the percentage of the population who are TNB (roughly between 0.5%</a> and 3%</a>), those size estimates are for the TNB population in its entirety. The very existence of the concept of “passing” tells us that only a proportion of TNB people might be coded with an IIG that does not match SRGI.
Some of the observed discrepancies are several times larger than could be accounted for even if every TNB person in the sample was misgendered (assuming TNB percentages in the sample mirror those in the population itself). The mismatch therefore must primarily represent the miscoding of gender for a portion of the cisgender population. Naturally so: because the cisgender group is roughly a hundredfold larger than the TNB population, even very low rates of gender misattribution applied to cis people will vastly overshadow any influence on data from the misgendering of TNB people.
The single-percentage rates of gender misattribution for cisgender people this implies are not unreasonable; in fact we can see similar rates in other situations that allow for measurement. A laboratory study of gender classification by O’Toole et al (1998)</a>, for example, found a gender attribution accuracy of approximately 95% in a face classification task (slightly higher for female observers classifying male faces). The study noted that there was “no indication of a speed-accuracy tradeoff.”

This study was based on gender classification using photographs of young white adults only, so it does not account for effects of race or age on gender perception; nor does it tell us about the possible influence of additional gender cues available in face-to-face interviews. But it does clearly indicate that a rate of misgendering of several percent is not an unusual consideration, even in a situation where the targets were selected as representatives of a clearcut gender binary.
There are no obvious factors in the country documentation</a> for ESS round 11 that might systematically explain the rate differences between countries, but naturally this raises a suspicion that different coding practices may have been followed in different countries.
Eurostat guidance</a> states that “The quality reporting related to the variable 'sex' should contain information on the number of records where the sex is imputed”. We don’t have that information in relation to the ESS, but it is possible that different rates of gender mismatching across countries simply reflect the degree to which interviewers felt it acceptable to check with participants in cases where they were uncertain what to record as “observed”.
In any case, it is clear that the systematic direction in which gender is misattributed in the ESS is not random: there is a general cross-country interviewer tendency towards attributing “male” gender to people who identify as women, to a much greater extent than the reverse. This is showing a “male as norm” cognitive bias</a> which is likely to have affected ESS data in every round.
As the “rotating” modules will change for future rounds of the ESS, cross-checking on IIG coding with SRGI as done here will not be possible in the future. However, the ESS is moving away from face-to-face interviews to a self-completion questionnaire model: half the data in Round 12 will be collected via self-report, and all of the data in Round 13. Presumably, then, “observational” coding bias in the ESS will shortly be no more: but it will have affected historical data, and such coding will continue to problematically be used and recommended elsewhere.
Implications Of Coding Bias</h1>
The discordance in the ESS results for gender shows that misgendering by interviewers is a substantial phenomenon</a>, and this raises urgent questions about the extent of inaccuracies in any survey that has allowed this practice.
The erroneous assumption that cisgender people are highly unlikely to be misgendered has allowed a possible extensive, systematic bias towards “male” in gender attribution to pass unremarked.
A stated aim of the Sullivan Review was to ensure accurate data collection:

However, the report is repeatedly wrong</a> in the assumptions it makes about what “accurate” information is, to the point where certain of its recommendations have potentially dangerous or fatal consequences – the inevitable outcome of forcing the systematic misgendering of the trans population in a medical context.
The ESS data shows another of those badly mistaken assumptions. Sullivan’s drive to return to “observational coding” has the potential to deliver massive inaccuracies in data of all kinds. Miscoding several percent of the population could reduce, eliminate, or even reverse evidence about gender differences within a population. The existence of systematic bias in interviewer coding of gender casts doubt on the accuracy of any statistics that have been gathered in this way.
In this context it is worth noting that Appendix 1 of the Sullivan Report, a legal opinion, emphasises the importance of ensuring that data collected by public authorities is accurate. It states that data inaccuracies introduced due to the way in which data is collected will mean it is difficult to legally justify that the collection and retention of that data is compliant with human rights law.

Eurostat states that “there are no technical issues” relating to “sex” as a core survey variable</a>, and its rationale for using it says that the variable provides a solid basis for evaluating “elimination of still existing gender-based stereotypes”. However, this idea is very much undermined by the finding that interviewer coding of “sex” is biased under the influence of those self-same stereotypes.

The ESS mismatch between gender data items shows that Eurostat, Sullivan, and many others are simply incorrect on this: the assumption that “we can always tell</a>” what the sex assigned at birth of a person is a nonsense; not just in reference to trans people, but in reference to the entire population.
Continued reliance on this practice is unjustifiable.
Non-Binary Gender Data In The ESS</h1>
The binary classification of “observation coding” does not align with the increased recognition of gender/sex states beyond the binary in recent years: legal status of self-identified non-binary gender in a number of European countries (such as Iceland, Germany and Malta</a>); a parallel movement towards equal rights for intersex persons</a>; and a broader scientific</a> understanding.
The adoption of the “Gender in contemporary Europe</a>” module in ESS round 11 in part reflects this shift, but the data relating to it raises important questions about survey design.
The module included a non-binary gender question (E1), pictured below:

Only 0.1% of respondents to this question chose “Other” (N=63), an extremely low figure; approximately twice as many people refused to answer the question (N=122).
This is far adrift from the results of a 2021 cross-national survey by Ipsos</a> which found across 27 countries that >1% of respondents described their gender identity in a way “other than male or female”. Specific countries in the Ipsos survey displayed notably higher rates (e.g. Germany was at 3%) and there was also a large generational difference (e.g. Gen Z was at 4%).
One possible reason for this discrepancy is that nowhere is there any context within the ESS module that makes it clear that question E1 is specifically about gender identity.
As the results table below indicates, the module is introduced to respondents only with the phrase “Now some questions on a different topic”. Following this, the question itself is simply “Which of the options on this card best describes you?”. That is an unclear opening to the module, which doesn’t clarify the context or purpose of this question.

The lack of context is deliberate: the ESS Interviewer Briefing</a> documentation used by national co-ordinators explicitly states for item E1 that interviewers “should not provide any clarification at this question beyond what is on the screen.”

The question thus literally does not ask for gender as personal identity: it asks for an option that “best describes” the respondent. This does not account for the fact that TNB people repeatedly have to try and guess what exactly the intent behind questions concerning gender/sex is, in order to be able to give an answer that works for that context. Personal safety concerns may also play into whether a person wants to give an answer to a such a question that outs them as LGBTQ+ or not.
Coming in the middle of an extensive, formal survey, participants won’t naturally assume that self-identity is the target of the question as opposed to legal or medical status. Notably, of the countries surveyed, only Iceland had at that time introduced legal recognition for a self-determined third gender, and this county had the highest percentage of respondents that chose “Other”, at 1.1%.
The design of the module</a> states that it is a response to the challenge that “we have been blind to a crucial societal development of anti-genderism”. However, the low numbers for “Other” gender means that it is unclear if the results are genuinely interrogating modern conceptions of gender.
Besides self-reported gender, the “non-binary gender” module also asks a number of questions about self-conception in terms of masculinity and femininity. The stated intent of this is to provide a more nuanced view of “gender identity”; the approach is based on the Bem Sex-Role Inventory (BSRI), a personality instrument that dates back to 1974.
It’s questionable whether working with a 50 year old instrument truly meets the aim of providing “new and innovative ways of measuring gender identity and gender salience”, particularly given that the BSRI gender model is strangely distant from modern, queer-informed conceptions of identity. The four personality types the BSRI identifies (masculine, feminine, androgynous, undifferentiated) do not fit with the idea that being non-binary does not equate to being androgynous</a>, nor with ideas of gender fluidity that take “masculinity” and “femininity” to be transient aspects of self rather than fixed aspects of personality.
Conclusion</h1>
The data from ESS round 11 prompts the fundamental question: when we are measuring “gender” or “sex”, what is it we are actually measuring?
Assumed cisnormativity and gender normativity blinds researchers to the fact that it is methodologically absurd to work on the basis that interviewers can accurately “observe” something like gender that does not have a fixed pattern of manifestation.
We know that gender expression is historically</a> and contemporarily</a> volatile, and that societal association of notionally “gendered” traits with gender/sex classes have changed over time</a>, yet survey designs still accommodate this assumption that “gendering” by observers is intrinsically reliable. The result can be, as we have seen, a strong androcentric bias in the data: several percent of the population who describe themselves as women may be coded as “male” by interviewers.
This should clearly not be how gender is recorded. It does not capture reality; indeed the reality is that gender/sex itself is not stable. Guidance and designs from the early years of the 21st century or before no longer reflect contemporary society, and the practice of “observer coding” is frankly an archaism.
The key challenge for the future is therefore to ensure that surveys use question designs that allow for contemporary gender data to be captured effectively, using an inclusive approach of co-design with gender minority groups, together with extensive piloting.
An example is this development approach from Ipsos</a>, which reports that “people who are transgender or non-binary told us they find poorly worded gender questions exclusionary and difficult to answer from both an emotional and a cognitive point of view.” The answer that Ipsos reached was simple and elegant: it solicits information from participants by asking directly about gender, by using contemporary categories.

This starkly contrasts with the recommended approaches of the Sullivan Report, which far from engaging in co-design with minority groups, is clearly a transphobic document aimed at denying the existence of gender minorities within data and, more broadly, within society.

Defining the Boundaries: Local NHS policies put trans patient safety at risk

2025-12-28T00:00:00+00:00

Trans patients in certain regions are having their repeat prescriptions withdrawn and being left at risk of serious medical harm, following slipshod new policies rolled out by local NHS England authorities. 
In the last two years, a number of Integrated Care Boards (ICBs) have instituted policies forbidding NHS GPs from maintaining shared care agreements with private specialists, effectively banning in certain regions one of the few accessible and timely ways of accessing hormone prescriptions available to trans adults. Although many ICBs’ policies share a title and most of their content, some allow shared care with private providers, while others forbid it – the difference seemingly coming down to minor differences in interpretation of NHS England policy about co-funding. In addition, we have found that in cases where shared care has been banned, NHS processes to catch and prevent unlawful discrimination have not been adequately followed. Opaque bureaucracy, media scaremongering, inadequate funding, and unprofessional conduct have come together to leave many trans people at risk of serious harm, and unable to even begin to find out who is responsible.
In December 2024, the Bureau of Investigative Journalism and the Independent reported on GPs halting prescriptions for trans patients</a>, describing the experiences of Emily*, a trans woman who was informed by text that her GP practice were going to stop prescribing her HRT. A hormone prescription had allowed Emily’s life to feel ‘ordinary’, but it had been taken away with minimal explanation, and no regard for her health or wellbeing. Social media is now awash with similar stories</a> of trans patients having existing shared care agreements terminated, or being told that there is no prospect of shared care with a private provider. We spoke to Will*, whose usually supportive doctor had told him that due to a new policy, he couldn’t be offered shared care. The impact has been huge – Will described being unable to leave the house because of the way he looked. These decisions can have drastic effects on people’s lives, but attempts at patient safeguarding have been minimal. New policies brought out by NHS bodies are usually supposed to be accompanied by Equality Impact Assessments – short questionnaires designed to make sure that the policy is not discriminatory, and that equality law is not being breached. In our survey of NHS shared care policies, we found Equality Impact Assessments missing, incomplete, and sometimes filled out with totally nonsensical answers. One went so far as to claim that banning shared care would actually benefit trans people, and every other protected group. 
Shared Care</h1>
Accessing transition-related care was never easy. Even prior to the release of these policies, trans patients in England faced numerous, often arbitrary, barriers. Waiting lists and available services vary wildly by region. Some ICBs commission GPs to do routine blood tests and prescribing – most don’t. You might get lucky, and live in the catchment of a GP surgery where GPs have some freedom to prescribe hormones before you are seen by a Gender Identity Clinic – either through a shared care agreement, or a bridging prescription. Luckier still, you might find a GP who is willing to do so, working under a practice manager who allows such prescriptions. Or you might get rejected by your GP, stuck on a seven-year waiting list</a> for a GIC, and then kicked off for failing to respond to a phonecall that never arrived</a>, get re-referred, and finally after years discover that nobody will prescribe for you anyway</a>. The care offered by the GICs looks nothing like international best practice – although British nationalism allows individuals to gloss this worrying discrepancy as evidence of superiority. Instead of responding to excessively waiting lists by allowing GPs to prescribe, as is common in many countries, NHS England has doubled down on prioritising control.1</a>
In the face of this dangerous healthcare landscape, trans people and concerned doctors have created workarounds within NHS systems to keep the bare minimum of transition-related care going. Bridging prescriptions by GPs and endocrinologists were one such workaround. Another was shared care with a private provider. Under this model, the patient would pay out of pocket to see a ‘gender specialist’ and then an endocrinologist privately, and their NHS GP would then prescribe them hormones on the advice of these private providers through a shared care agreement. Monitoring would be handled by the endocrinologist, but the GP would initiate blood tests and sign off on the prescription. This kind of shared care allowed trans people to access healthcare spending hundreds, rather than thousands, of pounds – and waiting months, rather than years. It was unfair, and regrettable, but it was an amount of money that many of us could save, or crowdfund, or borrow. In an ideal world, or a functioning healthcare system, shared care with private providers wouldn’t have to exist – but it has been a lifeline for many trans people.
Shared care agreements are not uncontroversial, even outside of their relationship to trans healthcare. GPs’ labour in managing shared care is often unfunded, as it falls outside of the General Medical Services contract</a>. Collective action by GPs in recent years has sometimes involved withdrawing from shared care agreements</a>, sometimes including shared care agreements with NHS providers. While in theory shared care agreements can be arrived at with private providers across disciplines, in practice they are most commonly used for prescribing ADHD medication, and hormones for trans patients – two areas of medicine where the level of public need has vastly outstripped the existing infrastructure, where ongoing monitoring is beneficial, and where there is limited will to prescribe. Guidance on shared care often appears impersonal, and focused on logistical and economic, rather than medical matters – but it disproportionately affects kinds of prescribing that are widely misunderstood, and subject to ongoing media scaremongering. This is surely no coincidence. Addressing the labour issue directly would be difficult, especially in the current political climate. But banning shared care through a minor policy change is easy, and makes the problem go away. The only losers are many thousands of vulnerable patients.
ICBs</h1>
A feature of this recent rash of GPs cutting off trans patients’ access to hormone therapy has been a lack of transparency (or possibly understanding by clinicians and administrators) about what has driven these changes. Sasha Baker, reporting in Trans Safety Network, recently described the appalling state of ICB guidance for GPs</a> regarding their responsibilities to trans patients, including policies from two ICBs which explicitly discourage shared care and bridging HRT prescriptions respectively. We can further report on another likely source of many of the cutoffs: new ICB policies on shared care. 
Of the 42 ICBs in NHS England, we found four that held (new) policies which explicitly banned shared care, and six that discouraged but did not explicitly rule out shared care agreements with private providers, two of which included exhaustive conditions that seemed to reflect recent media discussions of Gender GP, both referring to paywalled guidance produced by the private Community Interest Company, Prescquipp. Most of these policies, whether they banned or permitted shared care, have the same name: ‘Defining the Boundaries’.2</a> In many cases, the difference between a trans patient being allowed to live in peace, or being taken off hormones by their GP, came down to a single sentence and a postcode.
NHS Bedfordshire, Luton and Milton Keynes</a>, NHS Frimley</a>, NHS Mid and South Essex</a>, and NHS Cambridgeshire and Peterborough</a> all have publicly-available ‘Defining the Boundaries’ policies, dated to 2024 or 2025, which explicitly ban shared care agreements with private providers. They are only marginally different to other ‘Defining the Boundaries’ ICB policies which do allow shared care – a single additional sentence changes everything: ‘Where a patient has self-referred to a private provider for treatment, GPs should not enter into shared care arrangements with a non-NHS funded provider specialist for these medicines, as this constitutes co-funding of a single episode of care which is not permitted.’ Many other ICB policies similarly ban co-funding (funding from the NHS and from a patient) being used across a single episode of care – but do not identify shared care agreements as incidents of co-funding. No explanation is given for this difference in interpretation, as each policy is authoritative in its own region. 
Not every ‘Defining the Boundaries’ policy bans shared care, but many leave its status ambiguous. NHS Nottingham and Nottinghamshire</a>, NHS Birmingham and Solihull</a>, NHS Herefordshire and Worcestershire</a>, and NHS Devon</a> ICBs all hold policies which make no explicit mention of shared care with private providers for ongoing prescription and monitoring.3</a> These policies allow GPs to prescribe medicine on the advice of a private specialist, as long as the GP is willing to accept clinical responsibility for prescribing, and considers the prescription medically appropriate according to their clinical discretion, but leave the question of ongoing monitoring open. 
Even in areas which explicitly allow shared care, it is far from guaranteed. Some ICBs have policies that permit shared care with private providers, but require a series of almost impossible conditions to be met.4</a> In the areas covered by NHS South East London</a> and NHS Derby</a>, the agreement has to be approved by not only the GP and the practice manager, but also by all the other clinicians working at the practice, who all must be willing to take on responsibility for prescribing.5</a> This gives every clinician at the practice an effective veto on any shared care agreement with a private provider. For trans adults living in areas of England where shared care is theoretically allowed, access to hormones is still dependent on finding a GP who understands the medical need, is willing to take on extra uncompensated work, and is not prevented from prescribing for trans patients by more specific guidance</a>. There may be others, but the only ICB we could find that explicitly stated that there is GP-level funding in place for ongoing prescribing and monitoring of HRT for trans patients, regardless of whether the shared care agreement is with a private or NHS provider, was NHS Sussex</a>.
Co-funding rules apply across the entirety of NHS England, but they have been interpreted radically differently in different ICBs, leading to serious consequences for trans patients. This process of interpretation has been totally opaque, and it has produced a labyrinth of a system. Received wisdom has for a long time been that if your GP won’t accept a shared care agreement, you should try other GPs in your area – this is no longer useful in some regions, and still applies in others. NHS policy has functioned to make moving house or changing GP surgery a potentially life-altering nightmare for trans people.
Equality Impact Assessments</h1>
The NHS believes itself to have procedural safeguards against policy decisions having a discriminatory impact against a protected group, regardless of intent. An Equality Impact Assessment</a> aims to identify whether any groups protected under the Equality Act could be ‘disproportionately disadvantaged by a policy, practice, process or service (or a planned change)’. Gender reassignment is one of the protected characteristics – an adequately conducted EIA for a policy banning shared care with private providers would identify that this would disadvantage trans patients, who are disproportionately likely to be reliant on ongoing prescribing and monitoring through shared care.6</a> We have seen no such adequately conducted EIA.
The policies which explicitly ban shared care – leading to trans patients having their hormone prescriptions abruptly stopped – are all missing thoroughly completed Equality Impact Assessments 7</a>. NHS Cambridgeshire and Peterborough’s policy has a brief Equality Impact Assessment, which simply attempts to offload responsibility by claiming that any equality impacts are more to do with commissioning decisions, and therefore can’t be addressed by this policy. NHS Frimley ICB’s policy has no EIA at all. NHS Bedfordshire, Luton and Milton Keynes does – a column asks ‘Could the policy create a disadvantage for some groups in application or access?’ – the answer boxes are left blank. A second column asks ‘If Yes – are there any mechanisms already in place to mitigate the potential adverse impacts identified? If not, please detail additional actions that could help. If this is not possible, please explain why’. For every row, including gender reassignment, it just says ‘no’. NHS Mid and South Essex ICB’s policy also features an Equality Impact Assessment – with the same nonsensical answer copy-pasted after every question – totally failing to address what each question asks. In the NHS Mid and South Essex table that follows, the writer has ticked to say that the policy will have a positive impact on transgender people – and every other protected group:

‘What data / information have you used to assess how this policy might impact on protected groups?’”
“Mid and South Essex ICB is committed to promoting equality in all their responsibilities – as commissioner of services, as a provider of services, as a partner in the local economy and as an employer. This policy will contribute to ensuring that all users and potential users of services and employees are treated fairly and respectfully with regard to the protected characteristics of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.”
“Who have you consulted with to assess possible impact on protected groups? If you have not consulted other people, please explain why?’”
“This policy will contribute to ensuring that all users and potential users of services and employees are treated fairly and respectfully with regard to the protected characteristics of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.”
NHS Mid and South Essex, Equality Impact Assessment, Policy MSEICB 080 </blockquote>
This is the best we’ve got – the same block of text, responding to two questions, neither of which it even remotely begins to answer.
Conclusion</h1>
It is not, and has never been, appropriate for a GP to attempt to unilaterally medically detransition a patient. To do so on the basis of a policy change is appalling. The justifications for these denials of care are often impenetrably complicated, and make it incredibly difficult for a person being subjected to them to name any individual as responsible. The same NHS leadership that is celebrating partnerships with private providers</a> is creating a climate of fear for the trans people who currently rely on NHS prescriptions initiated by private providers. Policy changes of this type are dangerous, not least because they can put an official gloss on an unofficial prejudice. It is abundantly clear that the NHS’s safeguards against discrimination in policy-making are not currently fit for purpose. There are many justifications</a> GPs in NHS England may use to refuse to treat trans patients, even in collaboration with a specialist team (whether NHS or private), and each one can be made to sound reasonable. We are subject to constant unpredictable threats, and blamed for not being reasonable enough in the face of them. Shared care with private providers is not a fair model for trans healthcare, but leaving patients with no care is far worse. The current system is farcical, negligent, and cruel, and it’s able to be so because there is almost no relationship between the experiences of trans people and the decisions made about our own bodies.
If you have had your access to hormones revoked due to an ICB policy, we urge you to make a formal complaint. This is not an alternative to pursuing other ways of accessing care, but applies pressure, which we need.
^{1
Including but not limited to parts of the US, Canada, Australia, Spain, and Aotearoa New Zealand.
</div>}
^{2
Many of these policies appear to be based on the same central policy document, or on other ICB policies based on this document. We sent NHS Herefordshire and Worcestershire ICB a freedom of information request to ask if they could send us a digital copy of the NHS England national principles policy that their ‘Defining the Boundaries’ policy stated it was based on. We received this response: 
</div>
“Unfortunately, no, this was the main reason for ICBs deciding to adopt the NHSE Principle Commissioning Policies locally. When we asked NHSE whether the policies remained active, the answer was a resounding yes, but they had archived the page and never confirmed whether they would (or had) relocated them.”}
^3
Not every ICB that dismisses shared care does so with a policy. Buckinghamshire, Oxfordshire and Berkshire ICB, in their guidance on prescribing for ADHD following private consultation</a>, say that “BOB ICB has no local policy in place that allows shared care between non-NHS commissioned private providers and NHS prescribers”. </div>
^4
These two policies seem to have a different genealogy than the ‘Defining the Boundaries’ policies - both cite (publicly unavailable) guidance from PrescQIPP</a>, a Community Interest Company that offers resources and training about prescribing to NHS clients. </div>
^{5
The private provider in question must also be UK-based, CQC registered, and employing GMC-registered doctors – ruling out GenderGP and GenderCare.
</div>
^{6
This should also bring up the impact on the protected characteristic of disability, as ADHD medication is one of the other common use cases for shared care with a private provider.
</div>
^{7
A number of the policies which don’t explicitly ban shared care but discourage it also have inadequate or missing EIAs.
</div>}}}

Trans Safety Network statement on serious concerns regarding NHS research plans

2025-12-21T00:00:00+00:00

Trans Safety Network are concerned to see that NHS England have committed to expanding the role of the National Research Oversight Board for Children and Young People’s Gender Services to cover audit and research for adult patients too. We have previously raised concerns about its chair, Simon Wessley</a>.
Other members of the board are associated with the anti-trans group CAN-SG</a> and SPLC listed hate group SEGM</a>. A 2025 FOI</a> asking for minutes and associated documents for the CYPGS Research Oversight Board revealed a communications strategy</a> that suggested CYP clinicians should “possibly participate” in conferences hosted by SEGM and CAN-SG, whilst only mentioning WPATH and BAGIS conferences “for awareness”.

Beyond this, to our knowledge no members of this group have experience working with adult transgender people. As such, it is unclear why they have been chosen to audit and choose research priorities for transgender adults. We believe it will be hard for patients to feel as if their best interests will be considered during audits and research recommendations due to the associated baggage and lack of expertise.
In light of this, Trans Safety Network strongly suggests all transgender people in England consider opting out of their healthcare data being used for research. This can be done via the following links, the first to stop GP records being shared</a> and the second to stop secondary care records being shared</a>.
We also suggest you email your GIC the following to ensure your opt-out is clear and ask to have a note of this added to your care record. I do not give my permission for any aspect of my patient data to be submitted to, or collected for, the purpose of any research or non local audit without my express permission in writing being obtained in advance.
Emails should include your name, DOB and NHS Number to assist your GIC admin in finding your record. If you have been referred but not been seen by a GIC, you can still contact the GIC you were referred to.

From Lacking to Malicious - An investigation into NHS England's ICB's guidance

2025-11-25T00:00:00+00:00


Since the Cass Review’s was published in April 2024, trans healthcare on the NHS has become significantly more precarious and unpredictable. While the dire situation for children has happened in the open – the puberty blocker ban made national headlines – the driving forces behind the erosion of adult care are more nebulous, and their effects distributed seemingly randomly.
On paper, little to nothing has changed. In practice, in the months following the publication of the Cass Review, many trans people went to reorder their repeat prescriptions for hormones, only to discover that their GP surgery was terminating the agreement that had enabled the prescription</a>.
One potentially influential intervention was the release of new guidance</a> from the Royal College of GPs in late April 2024. While noting that GP surgeries should work with Gender Identity Clinics in the same manner as any other specialist service, it also noted, “Given the significant existing workload challenges in general practice, the RCGP supports those who feel that issues of workload preclude them from sharing care.”
Many GP surgeries appear to have taken this as a licence to discriminate against trans patients. Examples of letters from GP surgeries that have taken the unilateral decision to stop prescribing HRT abound.
Whether driven primarily by transphobia, a desire to save money, or an unwillingness to incur the wrath of anti-trans bigots, the effect has been the same: trans people who had gone through the lengthy and humiliating process of obtaining a diagnosis of gender dysphoria on the NHS had the their access to hormones thrown into doubt – or in some cases terminated altogether.
The RCGPs appears to be aware of the harmful effects of its 2024 guidance, releasing overhauled recommendations</a> in March 2025 This update emphasises that working with GICs is part of a GP’s “core role” in managing the healthcare of trans patients, and makes clear that “prescriptions should not be abruptly stopped” for patients taking cross-sex hormones.
It also recommends GPs refer to local advice when it comes to initiating hormone prescriptions for trans patients – which can mean very different things in different areas. Integrated Care Boards have a huge amount of influence over many people’s lives in England, making some areas of healthcare essentially a post code lottery.
ICBs set their own rules for when they will fund ADHD medication, fertility preservation, IVF and breast reductions, and make individual decisions about funding requests for rare conditions. They also provide guidance to local GPs.
However, their guidance about trans healthcare is often based on misunderstandings of how trans healthcare is commissioned. Gender Identity Clinics are staffed largely by psychologists and the system relies on GPs to take over prescribing, technically on a shared-care basis, but, in reality, almost always without ongoing specialist input from an endocrinologist. Prescribing and monitoring HRT for trans people isn’t complicated, but as GPs are not trained to do it, many say it is outside their competence.
Perhaps more importantly, under these arrangements, they take on legal responsibility for prescribing, which many are reluctant to do.
FOI requests to English Integrated Care Boards and Welsh University Health Boards reveal the wide variety of approaches to trans healthcare around the country, and may account for some of the inconsistency between different local areas – though in all cases individual surgeries have significant latitude.
‘Not my problem’</h1>
The majority of ICBs provide no specific funding to trans healthcare, and many said they had not issued any local advice to GPs about treating or registering trans patients since the Cass Review was released.
This is unsurprising as trans healthcare is centrally commissioned by NHS England, though responses to my FOI requests reveal problems with the commissioning model. Many ICBs told me to redirect questions about commissioning of trans healthcare to NHS England, even though a few others do commission local services.
Disturbingly, North Central London ICB and Birmingham and Solihull ICB told me to redirect questions about GP care, as well as commissioning, to NHS England. The suggestion that all trans healthcare is the purview of NHS England implies a severe lack of consideration for the needs of trans patients who are yet to be seen by a GIC or have been discharged, when they are likely to remain on HRT and in need of blood tests to monitor their hormone levels.
The existence of a national specialist service appears to act as an excuse for many local services to ignore the issue entirely, allowing patients to fall between the cracks of a broken system.
Meanwhile, Hampshire and Isle of Wight ICB only communicated with GPs to inform them about the puberty blocker ban, providing no information on the limited scope of this to ensure it does not have a chilling effect on trans healthcare more widely. Similarly, both Gloucestershire and South-East London ICBs communicated with GP surgeries only to tell them that in the wake of the Sullivan Review, they could no longer issue new NHS numbers to trans patients under 18
No ICB explicitly told GP surgeries they could cut off access to existing care for trans patients, or that they could refuse to register trans patients. However, some offered advice that appears intended to strongly discourage GPs from playing any role in trans healthcare.
Worst of the worst</h1>
NHS Frimley, which oversees local services for patients in parts of Berkshire, Hampshire, Surrey and Buckinghamshire, is a notable outlier, providing actively hostile guidance to GPs.
It goes beyond mentioning the need to safeguard young trans children, saying that “the young person’s gender identity may be consciously or unconsciously influenced and not necessarily the young person’s sense of self”.
It also repeatedly encourages GPs to inform the ICB, make safeguarding referrals and inform regulators if any trans person under 18 requests or admits to taking cross-sex hormones, placing them in the same category as puberty blockers, which have been banned.
When it comes to adult care, the guidance goes out of its way to provide a range of excuses to GPs under which they can refuse to provide it. It cautions against bridging prescriptions, saying they should only be considered if a patient is already self-medicating or likely to self-medicate, and at risk or self-harm or suicide, and the GP consults with a specialist.
This guidance is wrongly attributed to the GMC, though the RCGP makes the same error.
Frimley ICB is also at pains to discourage shared care agreements with private providers. It cautions against sharing care with any clinic not regulated by the Care Quality Commission, and then argues against Gender Plus, one of few CQC-regulated providers, saying its registration was “under legal challenge” (true at the time of the FOI) and suggesting that it is “primarily aimed at the 16-25 age group”, insinuating that people in this age group should be prevented from accessing transition care.
Even when it comes to NHS providers, Frimley ICB is at pains to remind GPs that they must be confident of the safety of the medication they are prescribing, and can end a shared care agreement with an NHS service if the service becomes insufficiently communicative. The issues raised by abruptly ending someone’s access to hormones are not mentioned at all.
The guidance ends with a template letter laying out suggested conditions to enter a shared care agreement with a private provider. The template says that it will only accept requests from CQC registered clinics, and that any specialist providers must have spent at least two years working for an NHS gender service. It asks the specialist prescriber to provide evidence of “participating in credible research relating to gender nonconformity and gender dysphoria”, and requires it to have a multidisciplinary team of gender specialists that meets regularly.
It unsurprisingly refuses to consider shared care with private providers for 16–17-year-olds, and – extremely disturbingly – infantilises 18–25-year-olds. For this group, which the letter says are “ at [sic] potentially vulnerable stage in their journey” ICB advises GPs to say: “We require evidence that there has been consideration given to reaching a point of maturity before taking a decision to transition and / or take hormone treatment, and has [sic] been offered and / or received holistic, therapeutic support, including addressing any comorbidity such as anxiety, depression or neurodiversity.”
It is clear the authors of this guidance have an agenda, and are going out of their way to prevent transition care being accessed. The requirement to assess “maturity” in legal adults is likely illegal, though very unlikely to be litigated.
Another ICB with guidance that goes beyond NHS England’s anti-trans position is Nottingham and Nottinghamshire, which strongly advises against HRT bridging prescriptions for suicidal trans patients, saying instead that “patient needs to be referred to Crisis team if thought to be high risk”. It goes on to recommend against providing bridging prescriptions to trans patients who are buying hormones from the internet, including if they are suicidal, unless a GIC recommends it.
A hopeful note</h1>
Frimley and Nottingham and Nottinghamshire are outliers. Most ICBs aren’t doing anything to make trans healthcare more accessible, but neither are they going out of their way to thwart it.
A few are even taking action to support trans patients. One of the most surprising responses to my FOI requests was from Somerset ICB, which is currently piloting an informed consent pathway, allowing trans patients to self-refer to a service (run by the WellBN GP practice in Brighton, which the ICB commissioned) that does not require a diagnosis of gender dysphoria to get HRT.
Patients need to read and understand the risks and side effects of HRT, as well as the changes that will occur, and then attend an appointment with a doctor which covers their physical and mental health. The appointment is also an opportunity to ask any questions they may have about the treatment; it is the kind of support trans people have been calling for.
While no other ICB seems willing to roll out trans healthcare on an informed-consent basis, several provide additional funding to GP surgeries willing to prescribe HRT to trans adults, and some say they have provided training on engaging respectfully with trans people.
Meanwhile Wales – which has University Health Boards (UHBs) instead of ICBs – has a gender service that appears more willing than many of those in England to work with GPs to ensure their patients get timely support, including providing advice on bridging prescriptions.
Though outside the scope of my investigation into commissioning of local services, TransPlus in London, and the Indigo Gender Service in Manchester have shorter waiting times than other NHS-England commissioned clinics. However, they do still assess and diagnose gender dysphoria, rather than offering trans healthcare purely on an informed consent basis.
The state of trans healthcare across England has undoubtedly worsened since the Cass Review, but while many ICBs have cracked down, others – like Somerset – show that it is absolutely possible for NHS services to do better by trans patients, even in a hostile regulatory climate.

Wes Streeting continues to ignore safeguarding concerns about parents group linked to abusive practices

2025-11-24T00:00:00+00:00

Trans Safety Network has seen evidence Wes Streeting and the DHSC solicited feedback on a “puberty blocker risk form” from Bayswater Support Group and other anti-trans groups in September 2025, 6 months after Trans Safety Network first contacted him and DHSC to raise about their influence over trans healthcare policy given the significant safeguarding issues.
Leaked logs from the Bayswater discord show that parents discussed putting chilli sauce in their child’s mascara and advocated for destruction of their childrens belongings</a>. Investigative reporting by The Bureau of Investigative Journalism</a> also showed that parents in the forum suggested blocking their child’s access to childline, and one member talked about refusing to allow their child to attend a local rape crisis centre after sexual assault due to the centre being “affirming”.
TSN has spoken to young people whose parents are members of Bayswater</a> about the significant distress caused by practices advocated by the group. They told TSN that their parents shouted at them and other trans people in public, that they believed their transitions were “wrong and evil”, cut off access to the internet and attempted to sabotage their A levels in the hope they would not be able to attend university as a result, and therefore would continue to be more under parental control. Many of these young people reported becoming suicidal as a result of this rejection and abuse. Additionally, Bayswater continues to link</a> to the conversion therapy manual Desist, Detrans & Detox</a> on its website, where it is described as “an essential read for parents starting this journey with their child”.
All of the above is highly concerning and suggestive of significant harm to trans young people. Trans Safety Network are alarmed that Bayswater continues to be consulted with in view of this.
This request for feedback was sent by the DHSC to Bayswater on the 11th of September, 4 days before Streeting gave a speech to the NHS LGBT+ Conference in which he claimed his “only motivation” for banning puberty blockers was to “make sure that medicine given to children is safe and effective and grounded in robust evidence.” It is unclear how continued engagement with a group where parents normalise physical and psychological abuse of transgender children and young people fits with this claim.
Other anti-trans/anti-affirming groups solicited to provide feedback include:

CAN-SG</a></li>
Genspect (a SPLC listed hate group)</a></li>
LGB Alliance</a></li>
Sex Matters</a></li>
The Integrated Psychology Clinic</a></li>
Thoughtful Therapists</a></li>
Transgender Trend</a>.</li> </ul>
Many of these groups lack any relevant expertise in healthcare for transgender children and young people, and all argue against established international best practices</a>. These groups also have significant membership overlap</a>, meaning that a handful of anti-trans actors are given larger prominence as a result.
In late April, we received a response to the concerns we raised from the minister for patient safety which claimed that the government is "steadfast in protecting LGBT+ people", that they will avoid engaging with stakeholders "who promote unsafe practices and hold discriminatory views”, and that they consider conversion therapy practices to be abuse. They also suggested we report Bayswater to CQC, despite the fact that the CQC does not regulate parental support groups.
It is hard to reconcile this response with DHSC’s continued engagement with Bayswater and other anti-trans groups given the evidence outlined above.
Trans Safety Network call on Wes Streeting and DHSC to stick to their promises and stop all collaboration with Bayswater and other anti-trans groups. We also ask them to disregard their responses to this and other consultations they have been invited to give input to, and to reconsider any decisions made as a result of their responses.

'Dangerous Recommendations': Trans Safety Network write to Healthwatch

2025-10-16T00:00:00+00:00

Dear Healthwatch,
Trans Safety Network was shocked by the dangerous recommendations of your recent trans healthcare report. We find it hard to believe that any trans organisations or persons were involved significantly beyond the initial survey, given the transphobic language used in the initial blog post talking about this, citation of reports written by known anti-trans authors, and the harmful recommendations made against broader trans community wishes.
To start with, the report suggests that various screenings are "sex based". This is factually inaccurate even if we accept a trans exclusive definition of sex - they are either anatomy based or hormone level based. Cervical screening depends on presence or absence of a cervix. Breast screening will depend on presence of breasts- something many transgender women and transfeminine non binary people have, and something many transgender men and transmasculine people will lack. AAA screening is under researched in transgender people, but as testosterone exposure (as opposed to anatomical differences) is the major factor in AAA risk profile it would likely be appropriate for transgender men and transmasculine non binary persons taking testosterone to be screened. It may or may not be appropriate for an individual trans woman or transfeminine person to be screened depending on their endocrine profile and how old they were when starting hormone treatment.
Trying to simplify these differences down into "sex", meaning "sex as assigned at birth", ignoring that HRT and surgery change many physiological aspects of a persons sex is ignores patient needs and biology. Misgendering trans patients in this way leads to disengagement from healthcare, and inappropriate medical decisions. As an example, if screenings were to be done only based on assigned sex at birth, as Healthwatch appears to suggest with its endorsement of "sex" and "gender" as discreet fields, transgender women who have breasts will be missed for routine reminders. The Healthwatch report completely fails to acknowledge this problem. These separate sex and gender fields can't be used, either separately or together, to determine which screenings are appropriate for a particular patient because this depends on surgical and hormonal history, not sex or gender. The solution to this is the one currently implemented in the NHS England system after years of it being requested by transgender people - the ability for GPs to opt people in and out of various screening programs depending on their actual needs as per anatomy and hormones, and not based on assumptions from the sex they were assigned at birth.
This brings us to the next point. The Healthwatch report suggests, citing only a review led by a </a> known anti-trans researcher</a> and featuring contributions from several more anti-trans ideologues</a>, that the NHS ceases allowing patients to change their NHS number and redacting previous records when changing sex marker, and suggests that in the future all records should record so-called "biological sex" (i.e. sex as recorded at birth) and gender separately, preventing any trans person from being able to change their sex marker. There are many issues with this recommendation:

As Healthwatch itself notes in the report, being outed as transgender in healthcare settings often leads to discriminatory treatment such as trans broken arm syndrome, excessive scrutiny from healthcare workers and admin teams, invasive and irrelevant questioning from healthcare professionals, and misgendering and deadnaming. All of these experiences are likely to lead to worse health outcomes, distress for the patient and patient disengagement from healthcare services. Given a forced "biological sex" marker would out trans patients in all healthcare situations where their record is accessed, it is hard to understand why Healthwatch considers this to be an appropriate recommendation. </li>

It ignores both that it is currently possible to change sex marker without generating a new number, and the reasons people may want a new number and redacted records. Some people will not mind having a clear link between their previous name and identity and current, and, afterseveral years of trans people requesting this from the NHS, it is now an option. Other transgender people will want their previous name and records redacted so there is no risk of staff discovering and using a trans person's previous name and significantly reduced risk of misgendering. Whilst this Healthwatch report only covers England, it is likely any adopted recommendations around sex markers will be mirrored across all four UK nations, which will significantly disadvantage anyone accessing NHS services in Scotland, as unlike other UK nations Scotland encodes the original sex marker in a patients CHI number, meaning that any trans person with an unchanged CHI number will be outed to anyone who sees it, even if that person does not have any access to the trans persons record itself. Under the GRA 2004, disclosure of someone with a GRC's transgender status is a criminal offense with a large fine attached, and GDPR maintains that people have a right to rectification of records. Under the ECHR, it has been ruled that this includes a persons sex/gender on anything used to identify them. Under the current system, when done correctly, there should be no loss of data or care from an updated sex marker on a new GP record and number. It is unconscionable that Healthwatch is recommanding removing transgender patients' privacy, right to choose when to disclose, and increasing legal risk for medical professionals, because some GP practices fail to do admin tasks correctly, instead of suggesting that GP practices should receive better training and instructions on how to correctly transfer records across. </li>

As covered above, this will result in transgender people missing out on essential screenings, whilst ignoring that we already have a solution that does not invade privacy, risk legal action, or forcibly out people and ensures people would not be missed - opting in/out of screenings as appropriate. It also risks other health issues being missed- for example, recommended haemoglobin and haematocrit range depends on a persons testosterone levels, not their assigned sex at birth.</a>. If a transgender man with cisgender male levels of testosterone is incorrectly tested against "female" range due to a "biological sex" marker suggesting that is appropriate, if his levels are below standard male range, i.e. suggesting he is anaemic, but within the lower end of female range, this anaemia is likely to be missed, leading to delayed treatment and investigation and worse health outcomes. This is not a hypothetical - Trans Safety Network is aware of multiple cases of transgender men on testosterone reporting they had anaemia missed due to having their haematocrit levels compared to female ranges, who were out of male range for months but were only identified as having issues when their levels dipped below female range. Whilst there may be some circumstances in which some medical tests or considerations a transgender person's results or needed investigations may differ from a cis person of the same genders, this could also be accounted for without reducing to a single "biological sex" marker, which would do nothing to fix overall accuracy of test ranges or needed investigations, and entrenches harmful beliefs about trans healthcare needs. The "gold-standard", which trans advocacy groups have been requesting, would be the ability to change lab ranges on an individual basis (whilst defaulting to male/female as appropriate for marker, and supplying both for people listed as indeterminate), so a trans patient could have this adjusted according to their individual care need. As well as this, an "organ inventory", hidden behind a "break glass" to ensure privacy where it is not relevant, listing reproductive organs as relevant could be used - e.g. has Uterus Y/N, has testes Y/N. Again, this would default to what would be expected as standard for a person of that gender, but would be able to be edited by a GP or other appropriate health professional as needed.
This would not only benefit transgender and non binary people, but also cisgender people who do not have anatomy one would assume, be that due to surgery, being intersex or another reason. </li> </ol>
As a final example of the lack of engagement with trans community, the Healthwatch blog announcing the report initially referred to cervical screening as "a critical check provided to women to see if they are at risk of developing cervical cancer." Whilst this has now been amended to read "people with a cervix" instead of women, the fact the original sentence made it to publication without anyone noticing suggests Healthwatch has a lack of familiarity of basic inclusive language, and has failed to get trans oversight on this report.
Overall, the Trans Safety Network is extremely disappointed that what could have been a beneficial report highlighting health disparities and specific trans health needs has instead been used to deepen healthcare harms further, whilst citing a thoroughly transphobic report which has been widely criticised by trans advocacy groups to do so. Healthwatch is supposed to enable and advocate for the voices of patients and their voices to be heard, not to use them as a prop whilst pushing for more inequalities. Nothing about us without us means that we need to be listened to and our views accurately carried across, not to be ignored.
We are aware Healthwatch has responded to complaints from members of the community, claiming that "the report reflects the wide range of views we recovered". It is hard to square this claim it the fact it recommends that sex marker changes are stopped with the fact the majority of respondents had either changed or intended to change their sex marker, and that all issues that arose from this change are down to administrative failure on behalf of the GP surgery and not an innate feature of changing this. Additionally, it fails to reckon with the points raised above that preventing sex marker changes will cause harm, including missing vital screenings, and that the solution is to improve training and not to punish trans people for administrative incompetence.
We demand that Healthwatch immediately retract the report and remove the recommendation to ban NHS number and sex marker changes and medical history redaction and apologise for having suggested this. We also ask that Healthwatch produces a new report, this time working closely with trans advocacy groups and transgender people, focusing on concrete actions such as increased training for GPs in prescribing transgender HRT, and ways to actually ensure equitable healthcare and screening access, and not to act as a mouthpiece for anti-trans groups.
We will be publishing a copy of this letter on our website. We hope you will carefully consider this and respond accordingly.
Regards,
Trans Safety Network

Major Problems with the Sullivan Review

2025-07-29T00:00:00+00:00

Background</h1>
The “Sullivan Review” was commissioned by Michelle Donelan (then Minister for Science) in February 2024. She announced it as a response to “the slow creep of wokeism</a>” in science, marking it as a close cousin of the “anti-DEI” yahooism currently causing immeasurable</a> damage to scientific research in the US</a>.
This article is concerned with the first of the two reports this review has released. The initial report</a>, which we will refer to as the “Sullivan Report”, was published on 19th March 2025, and is concerned broadly with “data, statistics and research on sex and gender”. In total, it makes 59 recommendations, many of which have profound implications for transgender people. Of those, 10 are picked out as “key recommendations”, and we’ll refer to these as KR-1 to KR-10.
A second report</a> in the series was released on 2nd July 2025. It is concerned solely with complaining about criticism levelled at “gender critical” academics. We will consider the second report no further here; Nathan Oseroff has provided some detailed analysis and debunking of its claims in this Bluesky thread</a>.
The Sullivan Report Is Not Independent</h1>

Despite repeatedly describing itself as “independent”, the report is notably not. All those involved with it have close connections to the anti-trans organization</a> Sex Matters.
Alice</a> Sullivan, the author of the report, is a member of the Sex Matters advisory group.
Appendix One of the report contains a legal opinion on the workability of Sullivan’s recommendations, written by Timothy Pitt-Payne, who is the husband of Naomi Cunningham</a>, the chair of the Sex Matters board of trustees.
Providing assistance to Sullivan was Murray Blackburn Mackenzie, another anti-trans group, whose founders include Lucy Hunter Blackburn</a>, again a Sex Matters advisor.
Further assistance was provided by Kathryn Webb who describes herself</a> as “researching sex and gender” at Oxford University’s sociology department. Another member of that department with similar interests is Michael Biggs</a> (aka Henry Wimbush</a>), a trustee of Sex Matters who is frequently cited within the report.
This report is, effectively, a Sex Matters review, and it is therefore unsurprising that it is transparently a vehicle for attacking trans inclusion in society.
It is worth noting that subsequent to publication, Sullivan stated in an interview</a> that her position in relation to trans people was one of “agreeing with Donald Trump … he is simply saying that there are two sexes and this matters”. Trump’s method of saying this is to remove all legal protections from trans people and make discrimination against them legal</a>.
Also of interest, in terms of the authors’ stance towards trans people, is that Pitt-Payne’s “Technically Human” blog on Substack includes a post called “Digital Brains In Silicon</a> Vats</a>” which rehearses the conspiratorial obsessions</a> of Jennifer Bilek, a conspiracy theorist who notoriously invokes "billionaire trans activitists" to launder antisemitism</a>. The post, which discusses the possibility of a cadre of rich immortals eternally ruling the world, and which connects these thoughts with “transgenderism”, is effusively praised by Bilek in a comment.
The authors are clearly not disinterested parties.
Despite KR-1 of the report recommending alignment with the UKSA Inclusive Data</a> Taskforce Review</a>, Sullivan notably did not follow the inclusivity recommendations of that report on community engagement and trust building.
At no point before publication were trans-led organizations or the wider trans community given the opportunity to contribute to, review, or comment on the report or its recommendations, despite the far-reaching and devastating effects that implementing it would have on the trans population. (Note: the three words “trans”, “transgender”, and “non-binary” are each used more than 200 times in the report).
Sullivan’s Conception Of “Sex”</h1>
The report’s main focus is urging that it is important to gather data on a property that Sullivan variously calls “biological sex, natal sex, sex at birth”.
For clarity, we will call this “sex per unmodified certificate” (SPUC), as it conforms to the “sex” value on a birth certificate that has not been modified or replaced at a later date.
The report recommends that:

SPUC should be the target of all questions about “sex” (KR-3)</li>
data about SPUC should be ubiquitously collected “by default in all research and data collection commissioned by government and quasi-governmental organisations” (KR-2)</li> </ol>
Sullivan suggests that KR-3 “future-proofs” data collection against change because:
"Sex as a biological category is constant across time and across jurisdictions" (p5)
However, that is trivially untrue, as different jurisdictions</a> categorize sex differently. There is no universal consensus that “binary sex” identifies natural kinds</a>, and there is no bar to the UK updating legislation to reflect a changing scientific and social understanding of sex differentiation.
Sullivan’s vision of “future-proofing” also involves reversing the trend of the sole graph in her report (p4), by rewinding language usage back to the 1940s so that “sex” qua SPUC is used in place of concepts such as “gender” or “gender identity”.
As we will see, this would be extremely detrimental to the ability of the trans population to participate in civil society; some specific recommendations are potentially life threatening.
Sullivan’s justification is that there has been a “loss of data” about SPUC, and that this rewind would achieve ongoing “consistency” or “clarity” in data:
“The importance of clarity is a recurring theme in this report.” (p22)
This quest for “conceptual clarity” is effectively a demand that data collection and therefore services that use that data in the UK swallow “gender critical” metaphysics whole. This would require adopting a world view entirely neglectful of gender’s biosocial entanglement</a>.
To illustrate how damaging this would be, I will first examine the serious issues that arise in the context of a specific recommendation, KR-7.
Problems With KR-7</h1>
KR-7, like several of Sullivan’s recommendations, urges that a very concrete, specific actions be taken by an individual organization:
“The NHS should cease the practice of issuing new NHS numbers and changed ‘gender’ markers to individuals, as this means that data on sex is lost…”
It’s extremely striking that a sociological review is presuming to dictate how a medical service operates, and notable that this is significantly more assertive than Recommendation 28 of the Cass Review which suggested only that the process be reviewed by appropriate organizations to address any implications.
In other words, KR-7 appears to be a startling overreach; it might be thought that Sullivan must therefore have extremely compelling evidence to support it. Ultimately, the recommendation can only be justified if it positively affects the quality of care that patients receive.
So it is that Sullivan strongly asserts that the ability to change gender markers has the result of "putting individuals at risk regarding clinical care, screening, and safeguarding".
However, the examples that Sullivan presents to support this view are preposterously bad where not completely erroneous.
Clinical Care</h2>
First of all, let’s consider clinical care.
The sole example of "sex-specific" treatment requirements that Sullivan raises</a> (p91) relates to kidney dialysis. However, using SPUC to evaluate values for trans patients would not provide medically sound guidance, because eGFR values are affected by gender affirming hormone treatment, as per Jue et al (2021)</a> (which Sullivan does not cite).
Of course, the reference ranges for hormone levels themselves in such patients will be those of “acquired” gender; achieving that is the intent of the treatment. If SPUC- associated reference levels are used, then routine monitoring will routinely be taken to signal alarming medical conditions.
Likewise, the same applies for reference levels with respect to many other blood tests. For example, Nolan and Cheung (2025)</a> found that for four common blood tests, reference ranges aligning with gender identity should be used for individuals established on gender-affirming hormone therapy.
So the ability to change gender marker is important in ensuring the delivery of appropriate clinical care for many trans patients. Sullivan ignores that the “material circumstances” of trans bodies are affected by the process of transition, and cites none of the work on this issue, nor offers any specific research or evidence about harms in the patient population.
Good-faith approaches to addressing the issues that trans patients do face would include research on appropriate reference ranges</a> or allowing the reference range to be selectable per test.</a>
</a>
Implementing KR-7 to create a system in which gender markers are immutable rather than allowing patient choice will directly cause clinical care issues for trans patients: the exact inverse of what Sullivan claims.
Screening</h2>
Sullivan mentions screening repeatedly, and refers to the "potentially fatal consequences" (p19) of trans people not being invited to appropriate health screenings. However, the sole citation she gives on this is an article in the Evening Standard</a>. Worse, she is amplifying the article’s headline while ignoring the content.
This article, in fact, discusses at length the fact that trans people can get access to the screenings they need (see NHS guidance on this</a>). It also notes that medical history, as well as birth status, plays a strong role in determining what screenings are appropriate: the need for mammograms is prompted by having breasts, not by SPUC; the need for cervical screening is modulated by hysterectomy as well as trans status; and so on.
Preventing patients from changing gender marker will therefore also have “potentially fatal consequences”, and a good-faith effort to improve screening invitations for trans people and others would instead focus on solutions such as introducing anatomical inventories</a>.
Sullivan asserts that “only males suffer testicular cancer” (p17) as an example that some diseases simply are “sex-specific” as per SPUC. But this is a generic statement that doesn’t consider that individuals suffer from those diseases only contingently, and it might be more enlightening in the context of trans healthcare to consider the universally true statement that “people who don’t have testicles can’t suffer from testicular cancer”.
Safeguarding</h2>
Sullivan explicitly says that there is “a particularly serious safeguarding risk” associated with gender marker change for under 18s, advancing as evidence a single unsourced anecdote attributed to “a paediatrician and safeguarding expert”. This tells us that a mother had requested a change to the gender marker of an infant, that the GP had complied, and that Children’s Social Care did not view this as a child protection issue. The anecdote implies that this has caused later behavioural issues, but no explanation of how they are linked is provided.
Sullivan herself said</a> “when I first heard about that case, I was physically sick”. She expects us to likewise recoil at it, to take it as solid evidence of the anti-trans conspiracy theory that there is a cohort of parents working to forcibly “trans” their children, with the willing acquiescence of “woke” professionals.
Yet a possible alternative explanation is that it describes a situation in which the parent of an intersex child</a> decided to change the assignment of sex made at the time of birth, in the light of new information. It is also possible to correct a birth certificate without a GRC</a> for people who are “intersex or have a variation in sexual characteristics”.
Of course we cannot determine what happened because all we really have is a “gender critical” urban legend, a story without a concrete source, relayed by “a friend of a friend”.
It is unclear why someone conveying what is (at best) third hand information should think themselves in a stronger position to evaluate risk than the GP and social workers that were directly involved.
Sullivan’s assertion of “particularly serious” risk should be evaluated in light of it resting on a single non-verifiable anecdote for which an alternative explanation is available.
Administration and Research Effects</h2>
There are two other considerations that Sullivan puts forward in favour of KR-7, which are a) that changing a person’s gender marker “places an undue administrative burden on NHS services”; and b) that it “it undermines the integrity of data that is used to improve national clinical practice”.
Firstly, administrative costs might prompt consideration of how the system could be redesigned to make the process simpler, but a cost cutting exercise cannot be a valid reason to make changing one’s gender marker impossible. The cost of reworking the UK’s entire benefits system to accommodate gender change was addressed in §91 of the judgment in Goodwin vs The UK in the following terms:
“the Court considers that society may reasonably be expected to tolerate a certain inconvenience to enable individuals to live in dignity and worth in accordance with the sexual identity chosen by them at great personal cost.”
Secondly, Sullivan’s notion of riding roughshod over patient identity merely for the sake of the convenience of researchers is not only ethically unjustifiable</a> but also is a recipe for poor research outcomes. The report ignores the literature about research design which takes account of the entanglement of sex with gender</a>, and it also entirely neglects the impact of gender on the effectiveness of healthcare interventions.</a> We’ve already seen that bad assumptions based on SPUC can lead to incorrect diagnosis and treatment; those same assumptions should not be embedded in research practice.
Likely Effects Of Implementing KR-7 On Patients</h2>
Given these flimsy and erroneous rationales, it is utterly reprehensible that the Prime Minister’s office immediately said that this review’s recommendations represented “just</a> common sense” for healthcare</a> immediately following the release of the report, and that Wes Streeting has already moved to implement KR-7 for under 18s.
Worse, it appears that at no point did Sullivan or the Health Minister consider any of the other potential impacts of implementing it. There is no record of the affected population, patient advocacy groups, or experts on transgender health being consulted on KR-7 before the recommendation was made or accepted.
It is therefore unsurprising that the review fails to evaluate the catastrophic impact that KR-7 would have in eroding the quality of patient care across every interaction that trans patients have with the NHS, driving disengagement from healthcare services. Systems that disrespect patient identity and that misrepresent medical history are known to be a</a> major barrier to trans people accessing healthcare of all kinds</a>.
By forcibly outing patients as trans (throughout their entire lifetime, including to non-medical staff such as receptionists), KR-7 would cause every medical interaction to become a potential source of prejudicial treatment, distress, and/or misdiagnosis through the phenomenon of “trans broken arm syndrome</a>”. Doing so would also grossly infringe on trans patients’ basic right to a private life, by making personal history apparent to others when medically unnecessary to do so.
Given these major failings, and the dangerous consequences of this recommendation, implementation of KR-7 should be revoked immediately, and any further implementation of any of Sullivan’s other recommendations completely halted pending a full analysis of both their rationales and their likely wider impacts.
Legal Questions Relating To The Report</h1>
Beyond the specific issues that individual recommendations bring (and there are many issues across the 59), there are fundamental questions about the soundness of the report as a whole, due to its core positions relying on very questionable legal assertions.
The Report Is Built On A False Dichotomy</h2>
The stated aims of the report presuppose that “sex and gender identity” are separate properties that must be recorded separately.
This is also explicitly asserted at several points, for example:
“Sex and gender identity are distinct characteristics and therefore should not be treated as substitutes.” (p23)
Much ink is spilled within the report on trying to convince the reader that “sex” and “gender identity” are non-overlapping, despite the fact that “sex” and “gender” are frequently used as synonyms, including in legal use:
“GRA 2004 uses the terms sex and gender interchangeably. It is reasonably clear that in GRA 2004 ‘gender’ is being used as a synonym for ‘sex’.” (p22)
All this is intended to direct our attention away from the simple fact that the intended or appropriate referent of “sex” is often “gender identity”, which represents “social” or “lived” sex, rather than SPUC.
A good example of this is recommendation 40, which suggests renaming the gender pay gap to the “sex pay gap”, despite Sullivan’s own citation</a> discussing that much of the gap is driven by social rather than biological factors, and despite research that suggests trans</a> women are subject to a much larger pay gap than women in general</a>.
(The suggested term “sex pay gap” also inadvertently exposes the infelicities that would be attendant on a search-and-replace of “sex” for “gender”; the actual implementation of such terminology manipulation in scientific data by the Trump administration, and the problems this poses are discussed by Freilich, Janet et al.</a>).
The report aims to persuade its audience that the false dichotomy between “sex” and “gender identity” is recognized in law, as per the assertion that treating them equivalently might constitute a legal breach:
“Recording data on sex as gender identity is likely to be a breach of UK GDPR and the DPA 2018, read together, and likely to breach article 8 ECHR.” (p44)
This is Timothy Pitt-Payne’s legal opinion, but if that opinion was to be upheld in court it would cause UK GDPR to sharply diverge from EU GDPR regulations; six days before the Sullivan Report was released the Court of Justice of the Europen Union (CJEU) ruled that the right to rectify inaccurate data includes replacing SPUC with gender identity</a>.
The CJEU ruling follows the common sense principle that when the purpose of recording data is identifying an individual, the appropriate target is their identity, and not a description assigned at birth that they actively repudiate.
It is of course possible that the UK will diverge from this view, and ultimately undermine data adequacy</a> in order to cement “gender critical” metaphysics into law, but that divergence would potentially be hugely consequential for the UK as a whole.
Asserting there is a legal difference here would also require the UK rejecting the entire</a> body of rulings</a> from the European Court of Human Rights (ECtHR) on “gender identity issues”, which has repeatedly found Article 8 violations over decades in respect of enforcing the recording of sex as SPUC.
While some “gender critical” voices advocate leaving the European Convention on Human</a> Rights</a>, torching the entire roster of human rights in the UK seems like an extremist position, even today.
These GDPR and ECtHR rulings entirely contradict the Appendix One reasoning in §§86- 91 that the review relies on; therefore this central plank of the report is entirely rotten.
The repeated ECtHR rulings on privacy also contradict the absurd</a> Appendix One assertion of “we can always tell” as a legal principle:
“If a person’s sex at birth is readily apparent to anyone who encounters them (e.g. from physical appearance, or voice) then it is hard to see how there can be any reasonable expectation of privacy in the mere fact that their sex at birth is male or female.”
The ECtHR rulings were not contingent on assessments of the physical attributes of a person, or any other form of transvestigation. Indeed, the very opposite is true: Article 8 violations were found to have resulted from the recognition of identity being made contingent on medical intervention (for example, X and Y v. Romania</a>).
Key Recommendations Are Unworkable</h2>
SPUC is not information that trans people will (or should) provide routinely.
Asking a question about it can, unless handled carefully, read as a demand to deny one’s personal identity; answering it is also likely to reveal trans status and therefore carries with it the threat of (potentially ongoing) discrimination, harassment, or mistreatment related to incorrect assumptions about the social or physical realities of one’s existence.
Unless there are powerful explanations of the relevance of this data and guarantees that it will not be misused, asking for SPUC will therefore generally be met with refusal or disengagement. Mandating its use ubiquitously therefore directly militates against the possibility of achieving “data accuracy” while also directly creating barriers to trans people fully participating in society. (Note also with respect to the ubiquity of collection that Sullivan urges, GDPR data minimization principles do not allow for harvesting data about gender in contexts where it has no relevance</a>).
Such issues are obviously part of the reason that “gender” or “gender identity” is today widely used rather than asking for “sex” qua SPUC.
The report attempts to reverse this move away from the terminology of “sex” by asserting that “gender identity” should not be used as a question target (see KR-5 and KR-6); it supports this by advancing the hypothesis that there is a category of people who “do not understand themselves as having a gender identity at all” (see Appendix One §35, §88, and §§97-98).
Again, legal peril is threatened:
“Holding gender identity data about a person who does not have a gender identity is likely to be a breach of data protection legislation” (p44)
This is fatuous for the following reasons:

The category of people that Pitt-Payne is discussing are people with “gender critical” beliefs. These people have a gender identity, whether they “believe” they do or not, because gender identity incorporates one’s understanding of one’s sex. This is said in §35 to be “contentious”, but we’ve already seen that it is erroneous to hold that “sex” and “gender identity” are entirely distinct in law.</li>
The “belief” of “not having a gender identity” in these terms is akin to not understanding oneself as having a name. One is inevitably lumbered with such a characteristic in virtue of a “naming ceremony”, such as the status being recorded on a birth certificate (or through a later declaration of an alternative).</li>
The notion of §35 that some people might be members of such a group “because the concept is unfamiliar to them and not understood” does not mean it would be impossible for them to grasp what the concept refers to when explained. If this were grounds for a “breach” then it would potentially be a “breach” to hold any kind of personal data whatsoever.</li>
The identity of genuinely agender</a> people can be accommodated by an “agender” option or by making the question optional. But “gender critical” people do not claim such an identity: they want to be identified as a “woman” or a “man”.</li> </ul>
Pitt-Payne’s argument represents the attempted weaponization of an employment tribunal</a> ruling</a> which stated that gender critical beliefs concerning gender identity were protected.
However, the right to hold a belief does not imply that the belief is true. The ruling noted this distinction between “is” and “ought” with respect to a parallel situation:
“the legal recognition of civil partnerships does not negate the right of a person to believe that marriage should only apply to heterosexual couples”
The Report Fails To Account For Human Rights Duties</h2> Sullivan states in KR-5 that for purposes of meeting the Public Sector Equality Duty</a> (PSED), “sex” rather than “gender” should be used; an addendum</a> to the report claims the recent UK Supreme Court judgment</a> (FWS vs Scottish Ministers) vindicates this position.
The judgment does indeed discuss PSED in §§237-244, in the context of positive action measures for women, the topic of the case. For allowable exceptions to sex discrimination provisions, the Supreme Court’s definition of “sex” must now be considered, but as explicitly called out in §250, trans people can still access protections against sex discrimination on the basis of perceived sex; as per §§254-256, the same applies with respect to harassment.
The judgment is distinctly odd. It results in a situation which, in common sense terms, is clearly unfair and absurd: two women with identical careers, both treated identically in the course of their career because they are both perceived as women, must be treated differently if they are distinct solely in terms of so-called “biological sex”. This is a characteristic not mentioned anywhere in relevant legislation; the nature of it was held to be ‘self-explanatory’ by the court but, ironically, it may not correlate with any perceptible aspect of adult biology, let alone with the social realities of “sex”, in its broader sense as “gender” (which is how it is interpreted in all legislation other than, now, the Equality Act 2010).
Likewise, the judgment explicitly suggests that the members of a couple may be treated in law as being of the same sex for the purposes of matrimony but as being of the opposite “sex” for the purposes of association. This is a fundamentally incoherent position, with chaotic implications which will ultimately require further legislation or litigation to resolve.
As Crash Wigley has strongly argued</a>, the court failed to properly analyze the human rights implications of their judgment, and the same is true of Sullivan moving in lockstep with it. As a result, both the judgment and the report directly mandate what is an unsustainable situation as per the §90 of the EctHR judgment in Goodwin v The UK</a>:
“In the twenty first century the right of transsexuals to personal development and to physical and moral security in the full sense enjoyed by others in society cannot be regarded as a matter of controversy requiring the lapse of time to cast clearer light on the issues involved. In short, the unsatisfactory situation in which post-operative transsexuals live in an intermediate zone as not quite one gender or the other is no longer sustainable.”
The question now is to what extent the fundamental rights of trans people will be violated in the UK if they are further forced into such an “intermediate zone”.
While it is hard to foresee how this Gordian knot will be undone, the judgment may well provide additional impetus towards providing services in a gender-neutral way; so-called “biological sex” is such a rarefied abstraction that segregating people on this basis seems a very uncertain basis for a “proportionate means to achieving a legitimate aim”.
Meanwhile, mechanically following Sullivan’s recommendations simply cannot align with the PSED aims broadly. One cannot, for example, “foster good relations between people who share a protected characteristic and people who do not share it” or “advance equality of opportunity” by using an approach that is likely to cause the harassment of trans people due to violation of their Article 8 rights. Nor does using terminology that is perceived as directly hostile to specific identities fulfill this duty.
Far from guiding us to compliance with PSED, Sullivan pushes us towards breaching it.
Conclusion</h1>
The Sullivan Report is fundamentally a bloated example of the typical four-step “gender critical” pattern of argument, each step of which we can tag with phrases repeatedly used:

assert that sex and gender are non-overlapping (“mixed/muddled target”)</li>
assert that gender is in some sense unreal (“conceptual clarity”)</li>
assert that sex is immutable (“data accuracy”)</li>
deny recognition of trans identities on this basis (“loss of data on sex”)</li> </ul>
The means of achieving the desired trans-exclusionary outcome is to take us back to the conceptual landscape of the 1940s: forcing the ubiquitous use of “sex” (meaning SPUC) while discouraging the use of “gender identity” by asserting that it is illegal to hurt the feelings of “gender critical” conscientious objectors.
Prescribing the verbal usages of the past will certainly not provide genuine “conceptual clarity”, because the end result will be terminology that is not be aligned with today’s social realities (such as the existence of a class of non-binary people). It is the “clarity” brought by wearing blinkers.
Worse, as we’ve seen in evaluating KR-7, these recommendations don’t just work to eliminate the presence of trans people in data, they will also directly work to harm the trans population through forms of social exclusion. Even this most plausibly “biological” of the report’s recommendations is incredibly ill-evidenced and dangerous; the other examples of the importance of “data about sex” that Sullivan touches on are much less plausibly
SPUC-driven. Sullivan appears to think that “biosocial” refers solely to the effect of the biological upon the social, but it represents a two-way entanglement that the existence of trans people is a vivid reminder of.
The fact that aspects of the report were acted upon immediately on its release is extremely worrying, suggesting there is a realistic possibility that these recommendations may become widely adopted or widely influential, as happened with the internationally</a> condemned Cass Re</a>view. We can already that see lobbying</a> by Sex</a> </a>Matters</a> **has worked to successfully influence</a> ONS guidance, which often cascades to other organizations; this is picked up in this report and used as though it provides independent justification for Sullivan’s recommendations (via KR-9 and KR-10).
The UK establishment, including political and judicial bodies, have been repeatedly credulous with respect to this repeated pattern of lobbying by ideological extremists, including the use of “independent” reviews to launder anti-trans attacks on the participation of trans people in society.
We urge a future robust stance of profound scepticism as to the influence of damaging “anti-DEI” ideology within future reports, rather than an eager welcome to it as “common sense”. The badly evidenced, directly harmful recommendations of both the Sullivan and Cass reviews should have been rejected entirely.

“My parents very clearly do not love me”: Children of Bayswater Speak Out

2025-07-22T00:00:00+00:00


London Trans Rights Protest, April 2022. Photo by Karollyne Videira Hubert</a> on Unsplash</a>
In July last year, we exposed Bayswater Support Group’s private Discord for The Bureau of Investigative Journalism, revealing evidence of child abuse and political lobbying. Bayswater describes itself as offering “parents whose children have a transgender identity somewhere to talk, share and be understood”. But posts from their private Discord forum revealed that parents exchanged conversion therapy tips</a>, and fostered relationships</a> with MPs to push anti-trans policies.
The Trans Safety Network has since revealed</a> more of the abusive practices</a> that Bayswater parents discussed on Discord.
Health secretary Wes Streeting met with and expressed sympathies for members of the group in an interview before last year’s election, as we reported for QueerAF.</a> He met with the group again in government, and The Department for Health and Social Care invited Bayswater to take part in last year’s consultation on puberty blockers, before they were banned indefinitely for trans kids.
Despite ample evidence of its harmful actions, Bayswater Support Group remains active and politically connected. Streeting has repeatedly refused to comment on his connections to Bayswater.
We have now spoken to several children of Bayswater members. Their experiences highlight the harm groups like Bayswater do to young trans people, and the gateway they provide to broader far-right politics.
When Charlotte1</a>, then 22, came out as nonbinary, their parents reacted poorly. “My mum started crying,” they recalled. “They begged me not to take medication for a while, because they believed I should have consulted with them.”
Charlotte was used to their mum being controlling. She had similar reactions when they dyed their hair or got a tattoo. She had also expressed some homophobic and transphobic views in the past.
Nonetheless, Charlotte hoped that their parents might get used to having a daughter. They were relieved when their mother found a group to share her feelings about their transition, until their father revealed that she was spending almost every evening on the Bayswater Support Group.
In the years since, they have noticed their mother becoming increasingly radicalised through adoption of the group’s gender critical rhetoric.
Charlotte says it began with suggestions that they had been groomed online, and that they may have undiagnosed autism. Over time, the rhetoric became more overtly hostile and mocking.
“She's gone past this point of being like, ‘I'm doing it because I love you’,” said Charlotte. Now, they believe their mother views their transition as “wrong and evil”.
Maria 1</a>, who was 21 and living with her parents when she came out, describes a similar pattern: while her mother was supportive, her father’s existing homophobic and transphobic beliefs solidified after contact with the online gender-critical movement.
Maria knew coming out to her father would be difficult, and delayed her transition for several years because she was scared of his reaction. He was a devotee of the Canadian right-wing influencer and former academic Jordan Peterson, and had expressed hope that neither of his children would grow up to be gay.
He took the news poorly, according to Maria, and admitted to quickly joining several groups, including Bayswater, to help him deal with his daughter’s coming out.
One night, Maria noticed that her father had gone to bed and left his computer logged into Bayswater’s Discord server. She was curious and began to scroll.
“It was just horrifying,” she said.“ The group told him to keep control over me by not fully throwing me out of his life, so he could exact some level of control and try and stop me from transitioning.”
Maria created a fake Bayswater profile so she could monitor her father’s activity in the group and the ideas that were influencing him. Witnessing the conversations within Bayswater helped her contextualise his increasingly erratic behaviour.
“He progressively just got more drawn into the whole gender-critical mindset,” said Maria. “ I remember one time I was really surprised because we were having a nice chat for like ten minutes, and then he just started crying and then shouting at me like, ‘Why don't you “desist”?’, which is just words plucked straight from Bayswater.”
Liam 1</a>, now a sixth-form student, experienced immediate rejection when he first came out in his early teens. His parents accused him of having been brainwashed, and took away his phone, ultimately forcing him back into the closet.
Like Maria and Charlotte, Liam’s parents sourced advice and support from anti-trans groups like Bayswater and Genspect. Over several years, Liam witnessed his mother’s transphobia intensify, and with it her susceptibility to other far-right beliefs.
GB News, a right-wing British news channel, is now a constant presence in Liam’s house. “It fed into her existing anti-trans beliefs about transgender people in schools ‘coming for you’,” he said. “But it was also like ‘the Muslims are coming for you and your children’.”
Bayswater does not portray itself as a far-right group, but group members have shared links to British far-right news outlets like GB News and Spiked, and Libs of TikTok, an American social media account that promotes transphobia. Parents have praised other American far-right influencers, like James Lindsay, who popularised “groomer” as an anti-LGBTQ+ slur, and the Daily Wire’s Matt Walsh, who made the anti-trans documentary, What Is a Woman?.
Some members' anti-LGBTQ+ views are not limited to trans people. Posts show members mocking efforts to promote bi inclusivity, saying teachers should not facilitate LGBTQ+ clubs or teach about asexuality and aromanticism, and arguing that it is “developmentally inappropriate” for teenagers to call themselves queer.
Ableism is also tolerated, with parents casting doubt on their children’s experiences of anxiety, or accessibility needs.
Some parents have also blamed involvement in progressive activist groups like Black Lives Matter and Extinction Rebellion for their children’s trans identities.
Noah1</a>, currently an A level student, has seen how his mother’s transphobia has morphed into broader reactionary politics. “I think she's very worried that I'm going to get off to uni, get involved in an illegal protest, and then go to jail for a bunch of years,” he said.
While this may appear unrelated to him being trans, Noah says in his mother’s mind, the two are intimately connected. “She said that she didn't actually want me to get the grades that I wanted because it would mean going off to uni, and that she kind of hoped that I would fail so she'd have more time to desist me.”
Noah believes her fear has led his mother to attempt to sabotage his A levels, embroiling him in regular hours-long arguments that distract him from his studies.
He says his mother used to be “a generally very accepting left-leaning person” who “hated” Nigel Farage, the leader of the right-wing Reform Party. Now, he says she uses her anonymous X account to follow and retweet Reform MPs, express hostility towards immigrants and student protesters, and share antisemitic conspiracy theories about the trans rights movement.
He believes Bayswater, which his mother found through a friend who also has a trans child, led her down this rabbit hole. “It's the perfect radicalization tool by itself, because you don't even need to be there very long before you get networked out to everyone else,” he said.
Liam and Charlotte both describe their parents becoming increasingly isolated. “[My mum] finds it really really challenging to go out in public,” said Liam. “Meeting someone who has an ally badge: that would be enough for her to go off on them.”
Charlotte says their mother “just spends all her evenings talking to parents from [Bayswater]” and “doesn’t really go out and talk to people as much as she used to”. Even though Charlotte’s father is also transphobic, their mother’s extreme positions have put their parents’ marriage in jeopardy.
But the greatest harm of parents joining an anti-trans group like Bayswater is the impact on their children.
Maria holds Bayswater responsible for her father’s abusive behaviour. “We'd have really bad arguments,” she said. “Every time that happened, I would quickly check the group to see if he'd been posting, and actually him interacting in the group used to be very strongly correlated with how badly he treated me in the days after that.”
Despite support from her mother, and other family and friends, her father’s behaviour took a significant toll on Maria. “I think I became quite suicidal,” she said.
Bayswater parents often try to enlist other relatives into rejecting their trans child’s gender. Maria says her father unsuccessfully pushed her brother to misgender her, and generally tried to instill in him “transphobic rhetoric”.
Charlotte’s mother has been more successful in creating barriers between them and their extended family, weaponising the idea that trans people are dangerous to children to prevent them seeing their niece.
“My mum told me that as long as I present as Charlotte I'm not allowed to see her, because it's not fair on the child to be caught in this situation,” they said. “I don't feel comfortable talking to that side of the family because I know how much my mum talks and what my mum says.”
Noah has also observed his mother co-opting other family members into her rejection of her trans son. Despite coming out several years ago, he has never had a forthright conversation with his younger siblings about his own gender.
Instead, Noah says his mother instilled fear about transition in his younger siblings. They were left believing “as soon as I went off to uni, I was gonna pump myself full of horrible drugs, that was gonna give me heart disease, and I was gonna die of a heart attack,” he said.
Noah thinks his mother believes in a link between “gender and the possibility of death”.
If Noah manages to get hold of hormones, his mother has “stated plans to destroy them”, he says. He also expressed concern that she plans to force him to see a conversion therapist over the summer as a last-ditch attempt to prevent him transitioning.
Liam believes his parents are following the playbook of Desist, Detrans & Detox, a conversion therapy manual promoted</a> on Bayswater’s website. The book contains a section about how to recruit relatives into conversion efforts.
He has witnessed his mum talking to relatives about his transition. “I told another family member [about my parents’ attempts at conversion practices] and I wasn’t believed,” Liam said.
When he came out for the second time, his mum’s abuse intensified. “When people would identify me as male in public, things really took a turn,” said Liam. He recalls his mother “shouting at me, shouting at people in public, shouting at trans people in public”.
The abuse took a serious toll on Liam. “ I was pretty seriously suicidal, and I was also getting to the point where I would hear my mum when she wasn't there, like hallucinations,” he said.
Liam began seeing a therapist through NHS Child and Adolescent Mental Health Services (CAMHS). He thinks that his parents only allowed him to access the service because they thought it would be conversion therapy, but in reality his therapist was supportive.
Some Bayswater parents with experience of CAMHS advise other group members to “avoid them like the plague”. Many discuss avoiding CAMHS entirely: seeking out private conversion therapists or denying their children any form of mental health support.
When Liam’s parents realised the CAMHS practitioner accepted his gender, they pulled him out of therapy. His mother also became increasingly paranoid that Liam's school was allowing him to transition behind her back – a common fear articulated on Bayswater’s forum – and prevented him from leaving the house alone.
Eventually, Liam’s school and his GP made safeguarding referrals, but the safeguarding hub declined to open an investigation, concluding that rejecting Liam’s gender was a matter of “parental choice”.
Liam was also referred to a therapeutic art class, which his parents did not allow him to attend.
“It kept getting worse,” he said. “I feel if your average teenage boy was being forced to attend bra fittings as a punishment, that would be immediately identified as sexual abuse, and it would mean instant removal, but it was just ‘parental choice’ for me.”
While Liam’s parents could cut off his mental health support, Charlotte’s were unable to stop her going to therapy.
“Seeing a therapist was the big thing that really helped me through all of this, and it’s one of the things which my parents found the most frustrating,” said Charlotte. “My mum actually said to me the phrase ‘No therapist is better than a bad therapist’.” This wording comes directly from Bayswater, which openly makes this argument on its website</a>.
Charlotte’s parents have become an overbearing presence in their life. “[My mum] wakes up at three or four in the morning to send me these long text messages about how terrible me being trans is,” they said.
The messages also repeatedly deadname Charlotte. “The hardest thing is when [I say] please use this name for me, and I’m being very firm about it, she tells me she's going to ring the Samaritans because she's so depressed,” they said.
Charlotte’s father, who views himself as a reasonable middle-ground between his wife and daughter, has his own way of imposing on them, regularly visiting their home to confront them. At first, Charlotte says, “his whole purpose was to argue with me about taking hormones and try to get me to stop.”
Overcome with stress, Charlotte quit their job a year ago, and had to move away from queer community for more affordable housing, though after a promotion they are now able to move back.
The unwanted visits from their father continued unabated. Since Charlotte cut off communication with their mother a few months ago, he has repeatedly pushed them to resume contact.
Charlotte says their parents believe that the only loving thing for a parent to do is push back relentlessly against their trans child. Charlotte vehemently disagrees. “My parents very clearly do not love me,” they say.
Maria’s father died unexpectedly two years ago. By then, Maria had been forced out of the family home and into a flat owned by her parents. It improved her mental health, but meant accepting the end of her relationship with her father.
Shortly before his death, Maria and her mother convinced him to stop posting in Bayswater’s forum, but Maria cannot be sure that he ever truly left the group.
“The group, I think, destroyed most of my relationship with my dad,” she said. “I'm not doubting the fact that they love their children, because my dad loved me very much, but it's just the way they express that...”
While Charlotte and Maria have negotiated complex familial relationships, Liam has made peace with the fact that he “won’t have parents anymore” after he finishes school. He has been planning his escape for years.
He is profoundly angry at systems that have failed to protect him from abuse, describing what he has been forced to endure as not just tolerated, but “basically legally protected”.
Noah has also made plans to leave, but remains deeply conflicted. “There are a couple of lines that she’s crossed that a year, two years ago, I made a mental note to myself – if she ever does this, just leave,” he said.
He has gone through periods of severe depression, but says that ultimately, “my general mental health became better out of spite,” adding that he wanted to show his mother “I can have a future as a trans guy where I am happy.”
Though he struggles to imagine cutting her off, Noah cannot tolerate the idea that she may have actual political power, which is why he decided to speak out.
“I want it to be the case that if you search any of those websites, then the first thing that comes up is what they've done, what the people involved have done, what they make parents do,” he said.
“Every fucking trans kid in all of the UK has now been screwed over by this politician [Wes Streeting] who might literally have my mother's voice in his ear.”
We gave both Bayswater and Streeting the opportunity to respond. Streeting declined to comment and Bayswater provided no response.
^{1
Name has been changed
</div>}

TSN write to the EHRC to call for meaningful consultation on new statutory Code of Practice

2025-05-18T00:00:00+00:00

Trans Safety Network have written to the Equality and Human Rights Commission (EHRC), who announced that a new consultation would be launched on changes to their statutory Code of Practice for services, public functions and associations tomorrow (Monday, 19th May 2025). In light of the transphobic and harmful interim update issued by the EHRC in the wake of the recent Supreme Court judgment on the definition of sex under the Equality Act 2010, TSN have significant concerns about the direction of and intent behind this consultation.
The letter, reproduced below, was copied to relevant Parliamentary committees and the Department for Health and Social Care. Trans people, organisations and allies who share our concerns may also wish to write regarding this to:

The EHRC (correspondence@equalityhumanrights.com)</li>
The Women and Equalities Committee (womeqcom@parliament.uk)</li>
The Joint Committee on Human Rights (jchr@parliament.uk)</li>
The Department for Health and Social Care (dhsc.publicenquiries@dhsc.gov.uk)</li>
Their own MP. If you are not sure who your MP is or how to contact them, you can search by postcode on the Parliament.uk website</a>.</li> </ul>
Dear Equalities and Human Rights Commission,
We are writing to you as Trans Safety Network, a trans led organisation that monitors organised and institutional harms to the trans community. We understand that on Monday 19th May, you will be opening your public consultation on updates made to the statutory Code of Practice for services, public functions and associations, following the Supreme Court’s judgment in For Women Scotland v Scottish Ministers.
Whilst we are pleased that this consultation has been extended to six weeks, rather than the inadequate two weeks initially proposed, we wish to ensure that the correct stakeholders are enabled to feed into the consultation.
Given the exclusion of trans led stakeholder groups and organisations for the Supreme Court ruling, and before the release of your interim guidance, it is crucial that this consultation is not undertaken without us.
There are other marginalised groups that are be affected by this Supreme Court ruling. Therefore in addition to engaging with trans and non-binary people, and trans led organisations it will be essential to consult with trans inclusive feminist and queer organisations, racial justice centred organisations, migrant rights groups, prisoners rights organisations, disabled peoples organisations and psychiatric survivor and service user led organisations and well as trade unions. Whilst each of these will bring a wide range of perspectives to enrich the consultation, the following examples illustrate some of the range;

Disabled people's organisations, as in those genuinely run and led by disabled people rather than charities. The EHRC no longer has a disability committee for consultation, and presumably has not previously consulted with disabled people's organisations for the interim guidance either. Your position appears to be that trans people should be forced into accessible toilets, no matter whether any are available or if they have sufficient capacity. Trans people do have a right to use accessible toilets and should be permitted to do so. However, proposing this as a solution justifies trans people’s exclusion from gendered facilities as well as from the large number of spaces that disabled people already are. This position is both disablist and transphobic.</li>
Under your proposals, people who are, or are perceived to be gender non-conforming, whether trans or not are now at increased risk of being challenged or harassed when using single-sex facilities. Attempts to scrutinise gender very frequently fall into racist and disablist assumptions of how particular people are expected to look.</li> </ul>
You have stated that you will also hold Q&A sessions with stakeholders representing affected protected characteristic groups. We wish to ensure that this happens sufficiently, and that stakeholders are not chosen directly by yourselves or any other organisation, but are allowed to engage based on their community expertise. This should not be undertaken on the basis of a tickbox exercise that neatly covers protected characteristics, as many stakeholders have significant overlaps and intersections in practice and so should be free to identify themselves as relevant stakeholders.
We also urge you not to treat “gender critical” groups as stakeholders because these groups exist primarily to undermine the human rights of trans people, and have already been overrepresented thus far, whilst trans led organisations were excluded.
Furthermore, we ask for clarification on whether you will be seeking submissions from legal perspectives regarding areas of potential conflict with broader human rights legislation.
Please can you therefore confirm that, for your Q&A sessions and for the consultation itself, you will actively seek to engage relevant stakeholders from a wide range of impacted community led organisations and that all future consultations will not be about us without us.
Thank you in advance.
Yours sincerely
Trans Safety Network

Press release: 141 LGBTQ+, feminist and allied organisations call for transphobic political parties to be banned from Pride events

2025-05-06T00:00:00+00:00


London Trans+ Pride 2023, photo by John Lubbock, WikiMedia Commons</a>
141 LGBTQ+, feminist and allied organisations have signed an open letter</a>, written by Trans Safety Network (TSN), calling for the organisers of Pride events across the UK to take a stand against transphobia by barring all political parties advocating for or complicit in transphobia, including the Labour Party and the Conservative Party, from their events.
The letter, which was signed by 24 Pride event organisations from around the UK, criticises senior Labour and Tory politicians for their response to the recent Supreme Court judgment, which redefined sex for the purpose of the Equality Act 2010 as ‘biological sex’ (meaning, in practice, sex as registered at birth), and calls the Labour party “increasingly hostile to the interests of trans people.” The Supreme Court judgement has been largely uncritically praised by mainstream political parties, but has been criticised by trans community organisations such as TransActual as seeking to “exclude trans people wholesale from participating in UK society.</a>”
Many in LGBTQ+ communities across the UK no longer feel that mainstream political parties represent their interests and this is reflected in the Pride events that have rejected any further involvement from those parties. A number of local Pride events across the UK have already acted to bar either political parties engaging in transphobia or all political parties altogether from having an official presence, including Bristol Pride, Belfast Pride and Birmingham Pride. In a post on Instagram</a>, Stirling Pride, a signatory to the letter, said that they would be “barring all political parties advocating for or complicit in transphobia from our events.”
The letter issued a challenge to politicians to take action to defend the rights of trans people in a meaningful way, saying “if you won’t stand with us, you can’t march with us.”
A spokesperson for TSN said “Pride belongs to LGBTQ+ communities, political parties are not necessarily entitled to use our events for photo opportunities and self-promotion, especially if they are harming us. It is within the government’s power to introduce new legislation to protect the right of trans people to participate in public life. Every day that any party with representation in parliament doesn’t push for this, they are making a choice to allow trans people to be further marginalised.”
Another organisation supporting the letter, Middlesex Pride said "We at Middlesex Pride believe pride is political and that is because LGBTQ+ have historically had to fight for our rights. But now, trans people are facing unprecedented discrimination from our government so we fight for trans liberation.”
The open letter also attracted support from feminist organisations. Natacha Kennedy of Feminist Gender Equality Network said “Prides are still necessary because of the oppression directed at LGBTQ+ communities. Starmer’s Labour Party is implementing the most harmful and repressive anti-trans policies of any UK government in history. Both its puberty-blocker ban and its extreme interpretation of the Supreme Court judgement are designed to harm, oppress and segregate trans people as well as tacitly encouraging violence against us. Parties that support this are a danger to all minority groups. Consequently Labour, and other parties with transphobic policies are a danger to our communities and others and must not be allowed to pinkwash their oppressive actions.”
Explaining their support for the open letter, the campaigning group Merseyside Disabled People Against Cuts said “Trans and disabled people have a shared struggle, and disablism is frequently used to facilitate institutional transphobia. The assumption increasingly baked into new youth gender services is that neurodivergent youth up to the age of 25 lack the self-knowledge to know their own genders and make decisions about their medical care that they have the capacity to understand. This is an attack on the rights and bodily autonomy of all disabled people that has happened under both Tory and Labour governments. As a disabled people's organisation, Merseyside DPAC opposes such attacks on disabled trans people and stands in solidarity with all trans people.”
Further information: For more on the open letter and Trans Safety Network, contact info@transsafety.network. The full open letter and a list of all signatories is available at https://transsafety.network/posts/open-letter-pride-events-stand-with-trans-people-no-pride-for-anti-trans-parties/</a>

Open letter to Pride events: Stand with trans people, no pride for anti-trans parties

2025-04-28T00:00:00+00:00


London Trans+ Pride 2023, photo by John Lubbock, WikiMedia Commons</a>
We are LGBTQ+ and feminist organisations and individuals calling on the organisers of Pride events across the UK to take a stand against transphobia.
In the wake of the recent transphobic</a> Supreme Court judgement, Labour minister Karin Smyth called for the Tories to apologise</a> for previously having promised to make reforms that would benefit trans communities. This comes on the back of other key Labour figures, including Keir Starmer and Wes Streeting, parroting anti-trans rhetoric</a>, associating with anti-trans organisations</a> and calling for discrimination</a> against trans people and our segregation</a> within healthcare services. It is clear that the Labour Party is increasingly hostile to the interests of trans people.
Meanwhile, the Conservatives, having presided over a period of increasing hostility to and violence against trans people</a>, made repeated threats against trans rights</a> and used transphobia as a central plank of their electoral campaigning</a> have been gloating</a> about the Labour Party openly adopting their transphobic stance.
In light of this, we, the undersigned, call on the organisers of Pride events to follow the lead of Pride events in Northern Ireland</a>, Brighton</a> and Bristol</a> in barring all political parties advocating for or complicit in transphobia from their events, including the Labour Party and the Conservative Party. This includes any official presence of those parties on parades and marches, speaking invitations to politicians and any official support or endorsement by Pride organisations of these parties.
To politicians and party officials, we say that if you won’t stand with us, you can’t march with us. Pride belongs to LGBTQ+ communities, not politicians. The UK government must urgently introduce legislation to meaningfully protect the right of trans people to participate in public life, including our access to public services and facilities under our lived gender. No politician that cannot commit to this has any right to use our communities’ events for self-promotion.
Signed
Organisations
Trans Safety Network</a></li>
United Tech and Allied Workers</a></li>
Black Trans Foundation</a></li>
Trans Aid Cymru</a></li>
Trans Liberation Cambridge</a></li>
Leeds Comets CIC</li>
Recovery in the Bin</a></li>
TransActual</a></li>
Manchester Disabled People Against Cuts</a></li>
Merseyside Disabled People Against Cuts</a></li>
Not A Phase</a></li>
Leeds Queer Climbing</a></li>
Bent Collective</a></li>
Oswestry Pride</a></li>
Lesbians Against Fascism and Transphobia</a></li>
Feminist Gender Equality Network</a></li>
Lazypins</li>
What the Trans?!</a></li>
Dandelion</a></li>
Shrewsbury Pride</li>
Sisters Uncut Leeds</li>
Wirral Trades Union Council</a></li>
TransWorcester</li>
Birmingham Queers for Palestine</li>
Not Your Scapegoat</li>
Manchester Trans Liberation Assembly</a></li>
Queers Play Stuff</a></li>
Norwich Pride</a></li>
Trans Aid Bristol</a></li>
Queer Boots</a></li>
UK Light Haulage</li>
Spectrum Inclusion</a></li>
Bristol Pride</a></li>
My Genderation</a></li>
Pride in STEM</a></li>
Mandells Publishing</li>
Stand For Trans Liberation</a></li>
Biscuit Bi+ Advocacy</a></li>
Queer breakfast club - Grangemouth</a></li>
Clarion LRP</a></li>
QUILL Scotland</a></li>
Bristol Leading Against Transphobia</li>
Queer Coffee Sutton</a></li>
Trans Pride Collective</li>
Tower Hamlets Trans+ Pride</li>
London Trans+ Pride</li>
Trans Pride Brighton</a></li>
Conventry Trans Pride</a></li>
Global Butterflies</a></li>
Trans Pride Hastings</a></li>
Hampshire Trans+ Network</li>
Trans Pride Portsmouth</a></li>
Trans Sheffield Brunch</a></li>
TACC</a></li>
Hampshire Feminist Collective</li>
Club Des Femmes</a></li>
My Gender Rules</a></li>
Wipe Out Transphobia</a></li>
Claires Trans Talks</a></li>
Socialist Alternative</a></li>
English Collective of Prostitutes</a></li>
Huddersfield Alternative Pride</a></li>
Fenris Games</a></li>
LGBT Out in the Bay</a></li>
Queer Tango Bristol</a></li>
TMSA-UK (Trans Masculine Support & Advice UK)</a></li>
Trans Healthcare Access Glasgow</li>
Orkney Pride</li>
Nottingham Against Transphobia</a></li>
Trans Pride Walthamstow</a></li>
Queer in Tech</a></li>
Equality Party</a></li>
The North Wales Trans, Intersec and Nonbinary Network</li>
BiCamp UK CIC</a></li>
TRUK United FC</a></li>
Trans Radio UK</a></li>
Trans Pride Southampton</a></li>
Butch Revival CIC</a></li>
House Ball Scotland</li>
Equality Amplified</a></li>
LGBT+ Barking and Dagenham Adult Social Network</li>
Seditionist Distribution</a></li>
Trans Mission Wirral</li>
Ellie Lowther Collective Ltd</a></li>
Hastings and Rother Rainbow Alliance</a></li>
TransPALS</a></li>
Quirk! Church for Queer People by Queer People</li>
Resisting Transphobia on Edinburgh (RTiE)</a></li>
Sussex Transcendence</li>
Deal Pride</a></li>
CYOA sober queer dance party</a></li>
Transmuted</a></li>
Polari Press</a></li>
Big Queer Picnic Cardiff</a></li>
Socialist Party</li>
Southampton & South West Hampshire Trades Union Council</li>
Anarchist Federation</a></li>
Global Women's Strike</li>
Cool2BTrans</a></li>
Southampton Hospitals Unison</li>
Westminster LGBT+ Forum</a></li>
The Alphabet Collective</li>
Trans Pride Bristol</a></li>
TransLucent.Org.Uk</a></li>
Southend Pride</a></li>
Liverpool Sisterhood</li>
Bicon Continuity Ltd</a></li>
Queer Fight Club Newcastle</a></li>
Kent and East Sussex Socialist Party</li>
East and Southeast Asians North East</li>
Zesty Siblings</li>
Lincs Trans Pride</li>
Pluto Q</a></li>
Sordya</a></li>
Stirling Pride</a></li>
The Unique Transgender Network - North Wales</a></li>
Derby Pride CIO</a></li>
BiCon 2025</a></li>
Revolutionary Communist Group</a> - Liverpool</li>
Hot Shoe Media Ltd</a></li>
Bristol Leading Against Transphobia</li>
Decolonising The Outdoors</a></li>
The Martial Arts</a></li>
DPAC Sheffield</li>
Revolutionary Communist Group/Fight Racism! Fight Imperialism!</a></li>
Octavius Theatre Company</li>
Cook'd and Bomb'd</a></li>
Queer Strike</li>
Be Gay Do Climbs</li>
Trans Pride Exeter</a></li>
Middlesex Pride</a></li>
The Trans Tearoom</li>
Essence of Thought</a></li>
Songbirds Choir</li>
PCS London and South East Regional Committee</li>
PCS Proud</li>
Glow Choir Brighton</a></li>
Bears Against Bigotry</li>
Leeds Queer Film Festival</a></li>
Moorpride @ Moorfields Eye Hospital</li>
Exeter Pride</a></li>
Angus Pride</a></li> </ul>
Individuals

Owen Blacker</li>
Azena Timmins, Senior software engineer</li>
Ethan Levi Cain</li>
Dylan Mancuso</li>
Max Wilkins, Design & Marketing Lead, Shrewsbury Pride</li>
Bella Frimpong, Operations, Black Queer Women CIC</a></li>
Ashley Ballinger</li>
Dr Josephine Sirotkin</li>
Linda Wall</li>
Alex Lambert</li>
Anson Mackay</li>
Rowan Reynolds-Wright</li>
Julia Georgiou, General Secretary, NHBC SA</li>
Amara Wears</li>
Elizabeth Veldon, Research student, Napier University</li>
Dr Chris Parkes, Senior Lecturer in History Education, King's College London</li>
Mina Nielsen</li>
Scarlett Starck</li>
Hannah Baldwin</li>
Aasa Timonen, Researcher, University of Tampere</li>
Michael Pereira, LGBTQ DEJ staff lead, Guardian News & Media</li>
Aaron Michael Read</li>
AJ Gardner</li>
Damien Donnelly, Teacher & Trade Unionist</li>
Ryan Castellucci, Cybersecurity Expert</li>
Molly Maclachlan</li>
Andrea Carr, Mother</li>
Charlotte Lunn, Chemical Republic</li>
Will Albone</li>
Noel Schornhorst</li>
Louise Stretch</li>
Ashley Kent</li>
Vala Thorne</li>
Amory Oliver</li>
Alannah Life</li>
Reena Life</li>
Patrick Wells</li>
Emma Williams</li>
Ellen Linter</li>
Sherri, Retired</li>
Abigail Thorn, Actress & Writer</li>
Jae Halton</li>
Lucas Ali</li>
Elizabeth Charlton</li>
Jaimi Robyn Tubb</li>
Sammantha Harris</li>
Nevan Spier</li>
Derek Des Anges, Member, NUJ</li>
Becca Tomlinson, Fundraising Officer, Be Free Campaign</li>
Fran Amery, Senior Lecturer, University of Bath</li>
Ada Elbert</li>
Aida Paul, Founding Engineer, Reddy.io</li>
Dylann</li>
Kathy Virasith</li>
Catherine Edgson</li>
David Thomas</li>
Alexandra Moylett</li>
Ethan Osborn</li>
Kelly Machin</li>
Esmé Beaumont</li>
Nina Hannagan, Worried parent of trans daughter</li>
Jo H, Trainee Healthcare Professional</li>
Danni Rowan Poulton</li>
Charlotte Hadland</li>
Lucille Wright</li>
Charlotte Vinsen</li>
Katy Montgomerie</a></li>
Janice McCauley</li>
Caitlin McKay</li>
Arthur Webber</li>
Joe Kanuritch</li>
David Marsh</li>
Andrew Rodgers</li>
Patch Donahue</li>
Jude FireSong, performance poet, fiction writer, visual artist</li>
Ryan O'Carroll</li>
Rhi Belle, Community researcher, Trans Safety Network and Disabled People Against Cuts</li>
Grace Knight, Writer</li>
Hazel Hamilton</li>
Sarah Pattison</li>
Tabitha Cole</li>
Cara Legender</li>
Caylee Morris, Software Engineer, ROLI</li>
Rob McClenaghan-Harrop</li>
Lucy Lanois</li>
Cyan Goffin</li>
Alec Burrett</li>
Danielle Baxter</li>
Rae Haylock</li>
Dr Jay Todd, Research Fellow in Trans Geographies, University of Glasgow</li>
Tiago Sousa</li>
Libby Bradshaw, Canterbury Against Transphobia</li>
Skellie Hughes</li>
Will Slater</li>
Sarah Rose Jones</li>
Amy Stubbs</li>
Mae Smith</li>
Aneurin Redman-White, Chartered Engineer</li>
Rhedyn Thain</li>
Meredith Donaldson</li>
Iain Shepherd</li>
Catherine Backhouse</li>
Steph Paton, Journalist</li>
Marcus James</li>
Voros Medve</li>
Carrie Marshall</li>
Beth Webb</li>
Anya Portus</li>
Philip Hoggart</li>
Dylan Coldwater</li>
Lenny Fynamore</li>
Dr Nicolete Burbach, Social and Environmental Justice Lead, London Jesuit Centre</li>
Naoise Quinn, Trainee (ENVI), Volt Europa</li>
Lee Hurley, Journalist</li>
Jemma Fry</li>
Petra Kramer</li>
Billie Jean Sweeney, Freelance journalist</li>
Nora Shenair</li>
David Morgan</li>
Samantha Cohen</li>
Oliver Hood</li>
Ed Barton</li>
William Frederick McDouall</li>
Nika Mehta</li>
Todd H C Fischer</li>
Alexander Lane</li>
Amy Burford</li>
Praveen Amarasinghe</li>
Olly Tew, Secret Queer Cinema</li>
Alice Lee</li>
Gwen lloyd</li>
Emily Rogers</li>
Aspen Watts</li>
Tamara Marie Keating</li>
Dr. Gary Dillon</li>
Jane VanWormer</li>
Morgan Spicer</li>
Andrew Godfrey-Collins</li>
Cait Hurley, Independent bisexual woman</li>
Jayne Sutherland</li>
Catherine Day</li>
Callum Roy</li>
Kathryn Thompson</li>
Tristan Grayford</li>
R.H. Rishton</li>
Ri Baroche</li>
Beth Watson</li>
Winter</li>
Peter Kingswell</li>
Jordan Evans</li>
Ava Hummerstone</li>
Blue Firth</li>
Joe Groves</li>
Reesha Dyer-Evans</li>
Gosse Bootsma</li>
Lucy Luca</li>
Li Veiros</li>
Joanne Mason</li>
Janet Cashman, Equalities Officer, Wirral Unite Community Branch</li>
Mx. Adam Khan, Trans Activist</li>
Shane Phillips</li>
Artemis Johnson</li>
Heather Farnworth</li>
Rowan Pierce</li>
Dee Nutbourne</li>
Rudy Harries</li>
Victoria Oldman, Director, Trans Pride Hastings</li>
Steff Lee</li>
Yannick Forbes</li>
Shae Harmon, Shae Queer Therapy</li>
Milo Eyre-Morgan</li>
Sabrina Armstrong-Squires</li>
Emrys Jones</li>
Maffy Carnevale</li>
Jayde, Member of the wider community</li>
SJ Beard</li>
Fiadh Finnegan</li>
Jackie Lederer, Branch Secretary, Unite Community Portsmouth and District Branch</li>
Kaima</li>
Edvin Bekreniov</li>
Gwilym Evans</li>
Jack Newbold</li>
Jonathan W</li>
Chris Scott</li>
Nicola martin</li>
Kalvin Crawforth</li>
Luke brennan</li>
Joseph Byrne</li>
David Shipman</li>
Sophie Rose</li>
Kelly Wright</li>
Matilda Fitzmaurice, Vice chair, LGBT+ Members' Standing Committee, University College Union</li>
Damien Prince</li>
Adam Barr</li>
Lindsay Belderson</li>
Heike Holubek</li>
Charlie Gill</li>
Annie Wallace</li>
Cormac Kelly, Committee member, NEU</li>
Erin Browne</li>
Danielle Hughes</li>
Elspeth Barraclough</li>
Philip Matusavage</li>
Daniel Williams</li>
Patricia Ragazzon</li>
Nic Turner</li>
Julie smith</li>
Joanna Meader</li>
Oli Curtis</li>
Shelagh Hewitt</li>
Samantha Joce</li>
Alison Gaughan, Organiser, Huddersfield Alternative Pride</li>
Lyra Urrutia</li>
Mair Davies</li>
Rosie Woods</li>
That Clare, Trans protest singer songwriter</a></li>
Sam Berridge</li>
Tristan Chadwick</li>
Nick Ferran</li>
Andy Bean</li>
Lily Smith</li>
Al dsym</li>
F. Field</li>
Elias Mikael Yassin, PhD Researcher, King's College London</li>
Valery North</li>
Dr Jackie Grunsell, GP and member of Socialist Alternative</li>
Ashley</li>
Anna Madeleine</li>
Monica Baldwin</li>
Adele Retter</li>
Sylvie</li>
Helmut De Nardi</li>
Abby Ragazzon-Smith</li>
Michael Everritt, Psychotherapist</li>
Mara Flint, Broadcast Engineer</li>
Marianne Wells, Parent</li>
Zephyr Ogden</li>
Brandon D’Orlando, Health Promotion Specialist</li>
Stacey Tims</li>
Gary Lee</li>
Rhys Lawton</li>
Em Calam</li>
Jocelyn Price</li>
Jen F</li>
Bobbu Abadeer</li>
Tamsin Budd</li>
Anthony Bird</li>
Charlie Stapleton</li>
Sarah Dearie</li>
Rosemary Cumes</li>
Ada Wolf</li>
Ian Palmer</li>
Hannah Roberts</li>
Kiba Gudnadottir, Solo rights activist</li>
Lyndsay Thomson</li>
Jennie Rigg, Exec member, LGBT+ LibDems</li>
Rev. Graeme Thomson</li>
Amy Lowe</li>
Matilda Wilkinson, member, LAFT</li>
Petra Davis</li>
Ella Watts</li>
Tristan Smith</li>
Sophie Coyne</li>
Jenni Goodchild</li>
Braden Quade</li>
Rachael Spurway</li>
Mikey Lio</li>
Philippa East, Clinical Psychologist and Author</li>
Sam Halford</li>
Andrea Swanson, LGBTQ+ mom and ally</li>
Sonya Fiset</li>
Cheryl Morgan</li>
Sloan Rowan-Richards</li>
Jake Tibbits</li>
Emma Day</li>
Sarah Browning</li>
Michelle Goldsmith, Parent of gender non-conforming kids</li>
Ethan S</li>
Amelia Sanders</li>
Rebecca Pillinger</li>
Mel Bridge</li>
Jay Statham</li>
Bima Loxley</li>
Dylan Jones</li>
Mandy smith, Manager, Afterschool club</li>
Grey Nicholson</li>
Will Taylor</li>
Ellie Lewis</li>
Felix Weber</li>
Zoë Wilcox</li>
Teagan Curwen</li>
Dane Rogers</li>
Ricardo Fonseca</li>
Rory</li>
Jamie Rogers, Ally</li>
Kari Gledhill</li>
Rae Elster</li>
Devin Valentine</li>
Tom Purdie</li>
Eilís Ní Fhlannagáin</li>
Zofie Darley</li>
Ceridwen Whittington</li>
Jacob</li>
Christine</li>
Adi Aliza Daly-Gourdialsing</li>
Lori Topper</li>
Bryony Davies</li>
Davina Haggett</li>
Rachel Collinson</li>
Meg Shepherd-Foster</li>
James Smith</li>
Jack Dover</li>
Stephanie Gray</li>
Polly Llwynfedwen</li>
Stephenie robinson</li>
Chase Mnatzaganian</li>
Lauren Levine</li>
Stacey Maginnis</li>
Roxána Báthory</li>
Stephen Turnbull</li>
Emily Raven</li>
Ashley Williams</li>
Samantha Mullaney</li>
Jack Michael Ellis Blomfield, Committee Member, Eastern Region Young Greens</li>
Peter Ó'Máille</li>
Alex Celeste</li>
Briar Lovett</li>
Becky Essex</li>
AC Baker</li>
Alex Montgomery</li>
Rowan McLaughlin</li>
Binx</li>
Paula Goodwin</li>
Sophie</li>
Simon Hawthorn</li>
Lindsey Spilman</li>
Francis Coultas</li>
Drayce Beckett, Economic development officer, Plymouth City Council</li>
Aiden Fraser</li>
Ellie Rowland-Callanan</li>
Fergus Murray</li>
Hannah Dalton</li>
Jessica Smith</li>
Robin</li>
Caitlin Young</li>
RoseMary Warrington, Officer, Waltham Forest Green Party</li>
Dr Clements</li>
Chloe Anderson, Organiser, Huddersfield Alternative Pride</li>
Sarah Walker</li>
Dr Jenna Scaramanga</li>
E. Ahmed</li>
Tom Ashley</li>
JJ Green</li>
E O'Shea</li>
Revd Matthew Watts, Curate, Chruch of England</li>
Zoë Coxall BSc (hons), Feminist & Psychologist</li>
Erin Sage</li>
James Gretton</li>
Rosie</li>
Jo fredericks</li>
Declan Clune, Member, Unite the Union</li>
Tas Cooper, Clerk, Oxford Quaker Meeting</li>
Dana G.</li>
Josephine Seaton</li>
Katie</li>
Ùna Proops</li>
Nick Davies</li>
Sophie Rebecca</li>
Professor Pippa Catterall, Co-chair, Westminster LGBT+ Forum</li>
Marlo High</li>
Evan Mackie, PTQ parent and LGBTQIA++ activist</li>
Benedetta Pintus, Transfeminist and queer activist from Sardinia</li>
Katie Toulmin</li>
Roxána Báthory</li>
Donna Dee, Workplace Trade Union Representative</li>
Derek Mcmillan, Socialist</li>
Ilia Wardell</li>
Mo Moulton, Professor, University of Birmingham</li>
Milo Theobald</li>
Chantelle Callagher</li>
Alyssa Ridgeway</li>
Sara Pintus</li>
Mrs Allison Medhurst, Retired Business Owner</li>
Gaz de Vere, Photographer</li>
Jodie Crellin</li>
Sarah Gaines</li>
Debs Harris, University of Westminster</li>
Rhiannon Thomas Val</li>
Jack C</li>
Joanna Haigh</li>
Lyndsey Cannon</li>
Daisy Jay Bretherton</li>
Ffion Wyn Jones</li>
Julie Lowe, Site Manager</li>
Steve Davis, Senior Lecturer, University of Westminster</li>
Kirsty Morrison</li>
Cath Tomlinson, Student Advisor</li>
Keira James</li>
Emma Scarbrough, Lead Engineer</li>
Carl W. Jones</li>
Amie Curry, Illustrator</a></li>
Lauren Cook</li>
Jaime Hill</li>
Sophie Ciurlik Rittenbaum, member, Fossil Free Pride</li>
Alexander Lilley-McCamley</li>
Dr Sally Coe, GP, NHS</li>
Luke</li>
Eris Vornhecke</li>
Rayleigh</li>
Dr Liz James, Security Researcher</li>
Alexis Footman</li>
Alexandra Wald</li>
Alana Mullen</li>
Etho Burrow</li>
Zoë Playdon, Emeritus Professor of Medical Humanities, University of London</li>
Vicky Pulman, Leadership Team, The Equality Party</li>
Christian Jago, Content Designer, University of Westminster</li>
James E</li>
Hazel popham</li>
Clare Peterson, Equality, Diversity, and Inclusion Manager, University of Westminster</li>
Dawn Grant</li>
Michael Trahair</li>
Jeremiah Kelly</li>
Dr. Hannah Eberle</li>
Jayne Sharples</li>
Kathryn</li>
xuying j</li>
Scarlett Wilkie</li>
James Campbell</li>
Hannah Nicholson</li>
Sinéad Collins</li>
David Harris, Manager, NHS</li>
Steven Perkins</li>
Mhelescent Soriano, Clinical Nurse Specialist, Royal Free Hospital Hampstead NHS Trust</li>
Dani Riley</li>
Zoe Blackmore</li>
Olwen Lachowicz, Durham Alt Pride</li>
Gemma Audus</li>
Gabriel Silvano</li>
Ruan Chennell-Barraclough</li>
Naomi Webb</li>
Chloe Querishi</li>
Ruqn Chennell-Barraclough</li>
Fraoch Lux</li>
Dion Georgiou, Associate Lecturer in History, Goldsmiths, University of London</li>
Ryan Oliver</li>
Lucy Phipps</li>
Jethro Richards</li>
Iona Rodman</li>
Cira Searle</li>
Dr Rosemary Smith</li>
William Fieldhouse-Allen</li>
Vidda Le Feber</li>
Findlay Bewicke-Copley</li>
Ben Hutchings</li>
Dr David Allsopp</li>
Sam Hope</li>
Ray Goodspeed, Lesbians and Gays Support the Miners (LGSM)</li>
Md Samrat Khan, Member, LGBT Barking and Dagenham Adult Social network</li>
Carly Swanson</li>
Alex Cheung</li>
Pam</li>
Melanie Richmond</li>
Chris Attfield</li>
Han Senarillos</li>
Carla Ottersen, Founder, Hot Shoe Media Ltd</li>
Mandy Parry</li>
Emma Spencer</li>
Josh King, Construction management</li>
Matthew Dark, Customer Experience Manager, University of Westminster</li>
Arlo H</li>
Imogen Yeung</li>
Rajat Shah</li>
M</li>
Leah Siegel, Lab Technician, University of Westminster</li>
Martin Cox</li>
J Smith, Co-organiser, Bristol Leading Against Transphobia</li>
Lucy Aphramor, Dietitian</li>
Rachel Miller, PhD Candidate, University of Manchester</li>
Alexandra Mason</li>
Abbie Healy</li>
Brenda Marie Lissimore, Member, White Rock Pride Society</li>
Stephen Dickinson</li>
James Brough</li>
AB</li>
Michael Broussard</li>
Paul Whitelaw</li>
Aoife Justia</li>
Hollie Fullerton</li>
Lucy Lanois</li>
Simon Richardson</li>
Dr Adrian Howlett</li>
Lindsay Pollock, Artist</li>
Phoebe Dunsire, Co-Founder, United in Awareness</li>
Dani Ostanek</li>
Johanna D</li>
C.Wardle</li>
Louise Nightingale</li>
Lotte Holmes</li>
Andrew S Hickman (he/him), Trans Rights Activist</li>
Alexandra Greenwood</li>
Michael Clelland</li>
Dr Tom Moore, Associate Head of Liberal Arts and Sciences (Education and Students), University of Westminster</li>
Stephanie Hilditch</li>
Juno Perry</li>
Clara Halsall</li>
Tom Layton, Author</li>
Kevin Sweeney</li>
Joaquim Marques, PCS Org. & Equality Officer, DCMS GEC and L&SE Exec. Committee member, The Wallace Collection</li>
Alexis</li>
Noah Brown</li>
Liz Brown</li>
serpilkemalbay, İmece Domestic Workers Union</li>
Declan Gallagher</li>
Theodore Savage</li>
Sarah Louise Gregory</li>
Joe Dale, PCS rep, signing in personal capacity</li>
John Ainslie, Branch Secretary, PCS</li>
Jamie Edgar</li>
John Foley</li>
Samantha Turner</li>
John Gribble</li>
Ken Shinn, Administrator, National Health Service</li>
Puck Oseroff-Spicer, PCS rep</li>
Michael Wiggins</li>
Dominie Leigh</li>
Airen F.</li>
Nick Butt</li>
Penelope Friday, Writer</a></li>
Isobel Gray</li>
Jessica Haynes</li>
Dr Chris Parkes, Senior Lecturer in History Education , King's College London</li>
Aimil Proudman-Harris</li>
Nic Turner</li>
Julia Shacklock</li>
Andrew Barnes</li>
Ash Paley, PhD student, Institute for Medieval Studies, University of Leeds</li>
jack rees</li>
Ash Alexander, Artist</li>
Mischa Griffiths</li>
Maria Enriquez Harris</li>
Nathan Oseroff-Spicer</li>
Liat Norris, Secretary, PCS Proud</li>
Jordan David, PCS</li>
Libbie Noakes, Mum</li>
Travis Suttie</li>
Hilde Stephansen, University of Westminster</li>
Amber Wynn</li>
Jane Briggs</li>
Robbi H</li>
Julie Kenny</li>
Joanne Hawkes</li>
Nadia</li>
Katie Munday</li>
Chloe Hawryluk</li>
Niamh Mitchelhill</li>
Richard Morris</li>
George</li>
Cathryn Wynn-Jones</li>
Beth Grady</li>
Tracey Farrar</li>
Megan Butt</li>
Bea Smith</li>
Katharine Howard-Comber</li>
Daniel Lopez</li>
Kai</li>
Philip Hammond</li> </ul>
We are accepting new signatures up until Friday 2nd of May 2025, if you want to sign as an organisation or an individual, you can do so here</a>.

Chili sauce in mascara: Wes Streeting's complicity in conversion abuse

2025-04-07T00:00:00+00:00

Content warning: This article discusses gender identity conversion practices involving physical and emotional abuse of children and young people by parents. This includes some details of specific abusive acts. If you have been affected by abuse of this kind, the charity Galop maintain a conversion therapy helpline</a>. Please note that screenshots in this article from an anti-trans organisation repeatedly misgender trans children and young people, these have been included to document the harmful behaviours discussed in the screenshots and TSN does not support any of their content.
Multiple attempts have been made by Trans Safety Network (TSN) to talk to Wes Streeting and the Department for Health and Social Care (DHSC) regarding serious safeguarding concerns about a group influencing trans healthcare policy. Leaks seen by TSN from the private Discord forum of the pro-conversion therapy organisation Bayswater Support Group document cases of child abuse, including one parent speculating about carrying out “sabotage” of a teenager’s eye makeup with “extra hot chili sauce.” At time of writing we have received no reply from either Streeting or the DHSC. Given the seriousness of the abuse described TSN urge Streeting and the DHSC to address this.
Bayswater Support Group have previously been the subject of an expose by The Bureau of Investigative Journalism</a>, outlining abusive practices including destruction of possessions and denying a trans child who had been sexually assaulted access to crisis support services. As noted in previous TSN coverage</a> Bayswater Support Group promote the “DIY conversion therapy book</a>” Desist, Detrans and Detox on their website</a>.
Despite evidence of harmful practices by the group, Bayswater Support Group have been allowed to influence trans healthcare policy. Bayswater Support Group have met with Health Secretary Wes Streeting, who has expressed sympathy for the group</a>, on multiple occasions both as Shadow Health Secretary and as a government minister</a>. Bayswater Support Group were one of eight anti-trans organisations invited to take part in a targeted government consultation</a> on the puberty blocker ban and have been cited in training delivered to NHS clinicians</a> and quoted in BBC reporting on trans healthcare issues</a>.
Discord forum leaks</h1>
In one leak from the forum seen by Trans Safety Network, several Bayswater parents were discussing destroying personal items belonging to their children that might be used to express trans identity, including clothes, underwear and pride flags. In the course of this conversation, one parent of a teenage trans girl suggested that they were considering putting “extra hot chili sauce” in her eye makeup. TSN have been unable to learn if the parent followed through on this plan, but note that we also could not see any evidence that any member or moderator of the forum challenged this or pointed out the severe pain and discomfort that could result.

“Any ideas how to sabotage make up would be gratefully received (maybe injecting some indelible blue dye into the foundation, or some extra hot chili sauce in the lipstick and mascara????).” - Bayswater Support Group Discord user, emphasis added by Trans Safety Network </blockquote>


The use of pain and discomfort to punish LGBTQ+ expression, sometimes called “aversion therapy,” has a long and well documented history</a> as part of conversion practices, with recent BBC reporting documenting similar practices involving inducing vomiting</a> carried out by religious organisations. Physical abuse as part of conversion practices appears to be commonplace, with around 2 in 5 (38%) trans and non-binary people responding to a recent survey by Stonewall</a> reporting experiencing physical assault aimed at changing their gender identity or sexual orientation.
In another Discord conversation about destroying their children’s possessions at a later date, another Bayswater parent appeared to discuss encouraging or permitting their cis child to be “brutal” with their trans child in order to discourage feminine gender expression, a user of the Discord praised the cis child’s “straight-talking,” with a third parent expressing distaste for the “fawning girl friends” of transfeminine children.

Health Secretary Wes Streeting was sent the evidence documented in this article by a Labour MP on behalf of a TSN volunteer and constituent of the MP, outlining this as a safeguarding concern. The letter, dated 18th of March 2025, includes screenshots from the Bayswater Discord and outlines concerns that “by continuing to treat [Bayswater Support Group] as a legitimate stakeholder in matters of trans healthcare, you [Streeting] are allowing a group posing a serious safeguarding risk to influence Labour government policy.” Streeting’s relationship with Bayswater Support Group was recently raised by protesters from Trans Kids Deserve Better when confronting the Health Secretary at a public event</a>.
Streeting has been quick to respond to other trans related stories, acting on the recommendations</a> of the “biased, inadequate and potentially harmful</a>” Sullivan report quickly, claiming safegurding concerns. At time of writing, Streeting has not responded to the concerns raised regarding Bayswater Support Group, despite both the letter from an MP and multiple attempts by our volunteer to contact him by email in the weeks since. Wes Streeting has been contacted for comment via the Department for Health and Social Care (DHSC) and via social media direct message. Trans Safety Network call on Streeting and the DHSC to answer our questions:

Does the Health Secretary feel that it is reasonable or appropriate for a parent to punish a child for gender nonconformity by putting a chemical irritant that could cause pain and discomfort in that child's eye makeup?</li>
Given that this is not the first time that concerns have been raised regarding Bayswater Support Group</a>, how do the Health Secretary and the DHSC justify continuing to treat them as a legitimate stakeholder in matters of trans health?</li>
Recently some young trans protesters challenged the Health Secretary</a> on, among other issues, his continuing engagement with Bayswater Support Group. Does the Health Secretary regret not responding to the concerns raised by these young people directly?</li> </ul>

Are trans teens safe in NHS BDD services?

2025-03-13T11:00:00+00:00

In early October 2024, the head of the NHS’s only specialist service for children and young people with Body Dysmorphic Disorder (BDD) spoke at an anti-trans conference. Amita Jassi was one of several NHS clinicians to participate in an event put on by the Society for Evidence Based Gender Medicine (SEGM)</a>. Jassi’s talk was called ‘body dysmorphic disorder and gender dysphoria’. Following the presentation, she joined a panel for a Q&A session on ‘body image and control’. Appearing alongside her was Anastasis Spiliadis, inventor of ‘gender exploratory therapy’, and Alexander Korte, author of ‘Elective affinities? Trans-identification and anorexia nervosa as maladaptive attempts to solve developmental conflicts in female adolescence’. We don’t know what was said – there is no public record – but a close examination of Jassi’s recently published work paints a disturbing picture. Young people suffering from BDD need care, and support – including young trans people, who may face intense social stigma about their bodies. But is NHS BDD treatment safe for trans patients when approached like this?
Amita Jassi’s involvement with SEGM risks, at best, alienating patients within the BDD service who become aware of it. Jassi didn’t appear on a panel that reflected the current state of the field – even the moderator was an anti-transition radical</a>.1</a> It also raises a question: what does a BDD specialist have to say about transition that SEGM would want to hear? Jassi’s fellow panel members both write about transition as a maladaptive response to other mental health pressures.2</a> If Jassi’s focus was similar, this could represent a disturbing development in the incorporation of conversion therapy practices into NHS trans youth medicine. Paragraph 5.38 of the Cass Review stated that, following treatment for BDD, “some young people say they no longer feel ill at ease with their birth-registered gender”. In response to a freedom of information request, NHS England provided me with the following summary of a Clinical Expert Group meeting:

“This was acknowledged to be a complex area with wide ranging views. Members brought to the discussion their professional experiences of gender dysphoria as well as other areas, such as body dysmorphic disorder, as they discussed the patient cohort. Treatments to manage distress were discussed, e.g. Cognitive Behavioural Therapy and Dialectal Behaviour Therapy; as were considerations in relation to the changing epidemiology and the unknowns surrounding the medical pathway. </blockquote>
Perhaps this is coincidence - or perhaps there are a group of clinicians working within NHS BDD services who believe that some young people expressing trans identities are actually suffering from BDD, and that CBT and medication will resolve their desire to transition. 
On the 15th June 2024, Jassi published a paper (co-authored with Rebecca McLaren and Georgina Krebs</a>) providing ‘for the first time’, ‘criteria for differentiating BDD [body dysmorphic disorder] and GD [gender dysphoria] in young people’.3</a> The paper states that while medical body modification ‘may be indicated in GD’, ‘medical body modifications (cosmetic procedures) are generally contraindicated in BDD’. The purpose of the article is to provide ‘criteria for differentiating BDD and GD in young people, enabling appropriate care planning’. 
There are a lot of questions raised by the article. Is it reasonable to state that fear of being judged negatively or rejected because of one’s appearance is uniquely a characteristic of BDD not seen in GD? Are trans youth really unlikely to describe body parts as ‘ugly, abnormal or disgusting’ and ‘needing alteration’, instead saying ‘‘it’s not right for me or my gender identity’? In the current UK climate, it feels almost absurd to ask for ‘nothing about us without us’ - but a lack of (sub)cultural literacy runs through this paper like letters through a stick of rock. Perhaps more significantly, how is this diagnostic tool meant to be used? In light of Jassi’s involvement with SEGM, and the Cass Review’s troubling assertion that CBT for BDD can stop young people from identifying as trans, ‘differentiating BDD and GD’ starts to sound like creating space for a new way to tell young people who express trans identities ‘actually, you are mentally ill – and we can cure you’. 
As WPATH put it in their SOC8 standards of care, ‘while gender dysphoria (GD) is still considered a mental health condition in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5-TR) of the American Psychiatric Association […] gender incongruence is no longer seen as pathological or a mental disorder in the world health community’. The conditions under which a clinician might confuse a patient expressing a desire to transition with a patient not expressing a desire to transition are surely spectacularly niche. As research coming out of the NHS continues to spiral away from international standards of research and scientific consensus, we must watch for potentially serious abuses. Trans kids deserve better. 

^{1
Leslie Elliott Boyce, a counsellor specialising in ‘gender confusion, ‘detransition’, and ‘”DEI” discrimination’
</div>}
^2
'Taking the lid off the box': The value of extended clinical assessment for adolescents presenting with gender identity difficulties</a> </div>
^3
Georgina Krebs’ professional focus is on young people’s mental health and CBT. Rebecca McLaren is a practicing consultant psychiatrist - the fact that she worked in the Tavistock’s GIDS service</a> is not advertised on her professional profiles. </div>

“If advising kids to accept biological reality is conversion therapy, I am all for it” - Bayswater Support Group in their own words

2025-02-02T14:15:00+00:00

Following revelations by QueerAF</a> that Health Secretary met with a group of parents who advocate against trans healthcare, and who have been exposed previously as promoting abusive and coercive practices targetting children</a>, including restricting access to rape counselling to prevent trans children who have been victimised through sexual assault from accessing supportive therapists who might affirm their gender, Trans Safety Network has received leaks from a member of their internal forum.
Given that these shed a stark light on the intentions and the self-understanding of the group’s true pro-abuse ideology behind closed doors, we have chosen to make these leaks public.
After one user responded to the news saying, “I’m just checking that we don’t actually promote conversion therapy” another responded: “If advising kids to accept biological reality is conversion therapy I’m all for it.” 

Another responded: “I think most of us would agree is that we promote the opposite- namely that we want to help our loved ones to feel more comfortable in their own bodies rather then thinking that they can go through a process to convert them to the opposite sex”.
Other users tied themselves in knots trying to argue that transition is the real conversion therapy, and that they are against it.

In other words, what Bayswater Support Group consider to be normal internally, is that trans children should be encouraged to reject their trans gender identities and accept a cisgender identity and life pushed on them by their parents. Which is categorically what Gender Identity Change Efforts</a> are trying to do, as understood by health professionals researching the subject around the world.
Another followed up, saying “No ethical therapist these days would be telling people what to think - it’s listening, exploring, asking questions. But for some trans people even this is too much”. This erases the fact, exposed in prior leaks to the Bureau of Investigative Journalism showing how Bayswater parents do not only ask questions</a>, but destroy their trans childrens’ possessions and actively restrict their access to support.

Parents groups like Bayswater exist to create safe spaces for parents who reject their trans childrens’ identities to have their biases against trans people affirmed by other parents, and to create a feedback loop to normalise conversion practices and other forms of abuse in service to gender identity change efforts.
And Bayswater isn’t the only group involved in these sorts of practice. Trans Safety Network previously found evidence</a> of therapists associated with the anti-trans campaigning organisation Genspect encouraging parents to inject needles into their children to scare them away from transition. Youtuber Caelan Conrad found the same pattern when they went undercover</a> into a Gender Critical parents network, with parents routinely sharing tips and affirmation amongst each other in aid of isolating and degrading their trans children whose identities they profoundly disagree with.
We call on Wes Streeting, and the Labour Party more widely, to stop enabling harmful child abuse by legitimising these groups and compromising with their harmful agenda which is in direct contradiction of the human rights of trans children.
Proposed laws to ban conversion therapy may have some effect in deterring professional therapists from engaging in these harmful practices, the majority of gender identity conversion efforts, according to the Gender Identity Conversion Therapy Survey</a> (published in 2021) nearly half of trans people who undergo conversion practices were children when these happened.
Furthermore, family disapproval was found to be the leading factor in those who went through conversion therapy voluntarily, and family members were key participants in practicing conversion efforts.
Conversion therapy must be recognised as domestic or child abuse. It is urgent that safeguarding professionals are trained to recognise signs of conversion efforts, and that it is understood that these sorts of parents groups where these practices are normalised will grow and grow while the Health secretary and national health infrastructure continues to hold an ambivalent attitude to parental abuse of trans children.

Schools Guidance limbo cuts off trans students from interventions against hostile educational environments

2025-01-20T17:42:00+00:00

Since December 2023, trans schoolchildren have been in a strange limbo. The government has published but not formally adopted guidance mandating policies that are ostensibly intended to uphold child safety, but appear designed to compound the many issues children already face in schools across the UK.
Three documents (two of which will have statutory weight if adopted) pushing for a rollback of the rights of trans children sit on the government’s website alongside current statutory guidance that contradicts their recommendations in the strongest terms. 
Bridget Phillipson has been asked if the Labour government intends to adopt these pieces of guidance on sex education, child safety, and “gender questioning children” several times, but has always dodged</a> these questions, saying she is waiting for the results of the consultations around the guidance on sex education and accommodating trans children.
Further complicating matters, the broader statutory child safety guidance</a> is already in force, but the section recommending schools out trans children to their parents remains in draft form in the same document, pending the publication of the consultation on accommodating trans children</a>, which alongside the consultation on relationships, sex and health education should be published this year (though originally was set to be published last year).
While the year of uncertainty has no-doubt been interminable for trans pupils and their supportive families, it has not been long enough for academic literature to emerge on the effects of the presence of these documents on the government website. While I have heard isolated cases of schools insisting they need to follow the guidance – either mistakenly or disingenuously – I am also aware of schools that continue to make efforts to accommodate trans pupils in line with the previous guidance.
It is impossible to know how widespread adoption of the proposed guidance across schools has been and the impacts this has had on trans kids around the country, but by examining its recommendations and the existing literature on what interventions are beneficial to trans schoolchildren, we can understand its potential to do harm if formally adopted, as well as the harm it is already doing in schools that have chosen to follow it.
Schools have long been, and remain, a space in which anti-trans and anti-queer bullying is extremely common. 2017 research</a> from Stonewall found that two thirds of trans pupils were bullied for being LGBTQ+ at school, with one in eight being physically bullied and one in ten receiving death threats.
At the same time, trans schoolchildren often felt invisible in the curriculum. At the time of Stonewall’s research, less than a quarter of LGBTQ+ pupils said they had been taught about gender identity at school, and almost two in five had never been taught anything about LGBTQ+ people or identities.
Most trans pupils did not have access to their preferred toilets or PE changing facilities – which was also still the case for some cisgender LGB children.
This kind of environment has a profound effect on the mental health of all LGBTQ+ pupils, but trans pupils most of all. Five out of every six trans pupils had self-harmed, and forty-five per cent had attempted suicide.
Since the publication of the Stonewall report, it has become compulsory</a> to teach about LGBTQ+ identities in relationships, sex and health education. However, that doesn’t mean all schools provide comprehensive and well-integrated instruction about LGBTQ+ people, and in particular it seems possible for primary schools to exempt themselves from this requirement entirely if they have consulted with parents.
Studies indicate that trans pupils continue to face a range of challenges at school, with many of them caused by school policies as well as their treatment by other children.
Schools are often willing to let transphobic bullying slide, and trans children notice a difference in how it is handled relative to bullying based on other protected characteristics. Misgendering and deadnaming are common, and at times teachers engage in these practices</a>, which pupils find particularly threatening</a> as they do not feel equipped to stand up for themselves, and it models bullying behaviour to their classmates.
Trans children, especially those in primary school who are unlikely to have out cisgender LGB peers, often feel both isolated and singled out by their school environments. Even in the absence of verbal bullying, trans children face social exclusion</a>, with some parents of trans kids speculating</a> that other parents have warned their children to stay away. The loneliness that naturally results from this is poorly addressed by existing LGBTQ+ infrastructure, where most youth groups</a> begin from age thirteen.
The effects of this overall climate are profound. One study</a> of thirty families with trans kids found that a third of the children had missed over a year of school, moved schools or dropped out of mainstream education altogether because school was not a physically or emotionally safe environment for them. 
While this is not a representative sample, a larger 2022 study</a> of Scottish LGBTQ+ youth found that 13% of respondants had left education as a result of anti-LGBT bigotry, up from 9% in 2017. A specific figure for trans young people is not mentioned, but it is reasonable to assume it would be higher.
Teachers on the whole appear keen to tackle anti-LGBT bullying, and to teach required information, but may not be proactive about going above the bare minimum. 
Studies suggest that isolated interventions have limited benefit and creating a trans-inclusive education environment requires a “whole school approach</a>”. This means that school leadership is united in promoting inclusion throughout the curriculum, tackling bullying and exclusion, and accommodating the needs of trans pupils.
In the absence of that, interventions can read as performative – like LGBTQ+ themed posters</a> – or have unintended consequences, for example an LGBTQ+ club</a> that pupils do not feel safe to attend because bullying has not been adequately addressed.
Many teachers still have not had any training</a> on LGBTQ+ identities, and many schools lack resources to initiate this training, or choose to allocate limited resources elsewhere.
There is also active pushback against LGBTQ+ inclusion. Some school leaders, who are often older, may still hold ingrained attitudes from teaching under Section 28 – e.g. questioning whether it is appropriate for a lesbian teacher to mention her wife to pupils, or believing that LGBTQ+ identities are inherently sexual and thus inappropriate to teach about at primary school. 
There is also evidence that adults sometimes use the idea of “age-appropriateness”, to cover for their own prejudice</a> or discomfort. The real or perceived threat of parent backlash is also a barrier to implementing inclusive policies, as is teacher ignorance</a> about the degree of mistreatment some of their queer and trans pupils may be facing.
Teachers who work in schools that have implemented a whole-school approach view collaboration and steadfastness as key to their successes. A study of teachers in these environments reported parental objections were the most common form of pushback</a>, followed by objections from other staff members who insisted there was no problem and thus no need to address it, and the local diocese.
One primary school teacher reported that parental objections abated once it became clear the school was transparent about what children were learning, and could not cave to threats.
I only found one qualitative study conducted recently enough for subjects to make comments about the new school guidance, and no studies on the effects of the guidance itself, but their comments were concerning. Teachers reported that interventions from the Department for Education and Equality and Human Rights Commission heightened fears</a> of parental backlash and made school leaders more reluctant to be seen as publicly supporting trans-inclusive initiatives.
Given the factors known to protect LGBTQ+ youth from bullying, mistreatment and associated mental ill health, it is reasonable to be concerned that the guidance will remove access to these things.
Several studies discuss the benefits of LGBTQ+ clubs</a>, particularly if they are student led, but the RSHE guidance, if adopted, could easily be used to monitor, censor and shut down these clubs if they try to share information about trans lives.
Additionally, if the trans section of the statutory guidance on keeping children safe in school is formally adopted, teachers would be required to out trans children to their parents in all circumstances unless they can demonstrate significant risks of doing so; the guidance does not define these risks, and stresses these circumstances will be “exceptionally rare”, despite over forty per cent</a> of trans people experiencing abuse from relatives.
This is likely to make trans children wary of coming out to teachers, even those who are sympathetic, and may also make queer, and especially trans, teachers more wary of openly displaying their authentic selves to pupils.
Though the guidance on “gender-questioning children” does not have legal weight, it is nonetheless likely to influence how many schools treat their trans pupils with potentially disastrous consequences.
It recommends that pronoun and (gender-based) name changes should not be permitted in primary schools and should only be allowed with parental and clinical input, meaning that in schools that adopt it teachers may be forced to continually misgender and deadname their pupils, which we know they find even more distressing than misgendering and deadnaming from fellow pupils. 
It also allows for strict gender enforcement in uniforms (in schools where uniforms are gendered), which can in some schools include regulations about haircuts. The provision of toilets and P.E. changing rooms – common sites of bullying for trans pupils – is also expected to be based on assigned sex; alternative provision is at the school’s discretion, but a trans boy would not – in a school that adopts this guidance – be allowed to change with his male peers.
All these interventions, if adopted, will signal to other pupils that they do not have to respect the identities of their trans classmates, and studies suggest that cultures of bullying</a> thrive in environments where teachers engage in, ignore or dismiss homophobic, biphobic and transphobic behaviour. 
Currently, even in environments where a whole-school approach is not possible, individual teachers, particularly out LGBTQ+ teachers, are able offer support that trans pupils find invaluable. Being a visibly queer – or especially trans</a> – teacher at school gives trans pupils a person they know they can go to for advice and support, as does individual teachers actively incorporating trans stories into the subjects they teach: not just in RSHE, but also in History, English, Biology, and others.
Yet the statutory guidance will significantly impede both of these interventions, and the non-statutory guidance will – in schools that adopt it – functionally promote bullying.
In summary, the guidance reads as if its authors were not simply unaware of the academic literature about anti-trans school environments, but chose to promote interventions that would cut off access to mitigating interventions. Bridget Phillipson must be continually pushed to answer for her silence and lack of intervention on this issue before the guidance can be quietly implemented some time this year. 

BBC quote the conversion therapy activist organisation Bayswater Support Group as a credible source

2024-12-11T00:00:00+00:00

The BBC has published an article by Deborah Cohen on the NHS puberty blocker trial</a> that is due to begin in 2025. In this article, Cohen quotes a member of conversion therapy activist parent organisation Bayswater Support Group as a neutral source.
The article is heavily weighted with those opposing trans healthcare for children and young people. It quotes WPATH, yet all of the other medical opinions are from those opposing the use of hormonal treatments. The section on parent opinions includes an academic whose research involves parents of young trans people, but no quotes from supportive parents themselves.
Whilst we disagree with much of the opinion quoted, it is the inclusion of Bayswater Support group that Trans Safety Network are most concerned about. It is our view that the BBC should not be engaging in campaign journalism that misrepresents sources in this way.
The source from Bayswater Support group describes the organisation as “a collection of parents with children who are questioning their gender who say they are "wary of medical solutions to gender dysphoria"”. This is a wholly inaccurate representation of the organisation that leaves out important context about the nature and aims of the group and its indisputable promotion of conversion therapy.
Bayswater Support Group are a conversion therapy parent group operating under the guise of a support group for parents of trans children. The organisation's internal forums were exposed earlier this year</a> which uncovered evidence of parents preventing their children from accessing Childline, mental health resources and rape crisis centres for fear of those services affirming their children's gender identity. Parents in the forum openly admitted to destroying or damaging their children's belongings, such as accessories and clothing, behaviour that constitutes domestic abuse. Bayswater support group still link to a DIY conversion therapy manual</a> on their website</a>.
It is extremely misleading for the BBC to have failed to mention this in their article, instead allowing a member to present the organisation as a support group for parents who have concerns or doubts about the best approach to their trans children's healthcare. For a trusted institution such as the BBC to lend credibility to a conversion therapy organisation’s claims of being a mere support group is dangerous and highly irresponsible. This could lead worried parents to be directed towards conversion therapists or to be recruited and encouraged to abuse their trans children.
If you would like to complain to the BBC for including and misrepresenting this dangerous source you can do so here</a>.

Council of Europe expert committee say puberty blocker trial might violate rights of the patient

2024-12-02T00:00:00+00:00

A report by the ADI-SOGIESC</a>, a committee of experts on Sexual Orientation, Gender Identity, Expression and Sex Characteristics convened by the Council of Europe (of which the United Kingdom is still a member) has published a thematic review on the subject: “Right to the highest attainable standard of health and access to healthcare for LGBTI people in Europe”.

In this report the ADI-SOGIESC note that gender affirming hormone therapy for trans minors in the UK has become almost impossible to access, with puberty blockers being restricted to availability through a proposed trial. The CoE report says that the the total withdrawal of access to healthcare outside of this research trial may breach “the fundamental ethical principles governing research”:

e.g. Council of Europe Additional Protocol to the Oviedo Convention on Human Rights and Biomedicine, concerning Biomedical Research (2005) Article 13 e: “the persons being asked to participate in a research project shall be informed [...] of their right to refuse consent or to withdraw consent at any time without being subject to any form of discrimination, in particular regarding the right to medical care”, 114 and Regulation (EU) No 536/2014 of the European Parliament and of the Council Chapter v: “no undue influence…is exerted on subjects to participate in the clinical trial”,115) as for many young people the only way to receive treatment is to participate in the trial, therefore calling into question whether consent can be constituted as free and informed in these situations. </blockquote>
According to the CoE report, the Oviedo Convention is “the only international legally binding instrument on the protection of human rights in the biomedical field”.
This echoes a statement made by the British Medical Association in December 2022, which raised concerns that proposed trials as the NHS had indicated at the time, without access to healthcare via other routes, could be in violation of the Helsinki Declaration</a> set out by the World Medical Association, as well as paragraph 17 of the General Medical Council’s Good Practice In Research</a>, both of which require full informed consent for research participants.
Trans Safety Network have received suggestions from some healthcare insiders that this proposed trial may start in April 2025, with a plan to randomise treatment on a 50/50 basis between a cohort on puberty blocker medications (which were part of a standard range of treatments for young people who had been positively diagnosed with gender dysphoria up until 2020 when they were stopped in response to the Bell v Tavistock case), and a cohort receiving no medical treatment at all, with both groups likely to be accessing psychotherapeutic support of some kind.
It is not currently clear whether trial researchers intend to subject trans children to unnecessary placebo injections for the sake of “blinding” these research results. Puberty blockers are generally administered via intramuscular injection. Bioethicists have previously raised concerns</a> that any attempt at randomised testing of puberty blockers would be quickly unblinded (owing to the fact that the impacts of puberty are highly visible).
A full protocol for this trial has not yet been published, although some figures involved in it have identified themselves. Dr Michael Absoud, appearing as a speaker at a conference held by noted anti-trans hate group SEGM in Greece earlier this year, described in his biography that he is registered as Deputy Chief Investigator for the trial. Trans Safety Network reached out to Dr Absoud for comment regarding his role in the trial, with questions about the trial protocol, ethical concerns regarding the trial and his relationship with SEGM. No reply to request for comment was forthcoming despite efforts to contact Dr Absoud.
NHS England have been contacted requesting details of the research protocol and documentation of ethical oversight for the trial.

Anti-trans lobbyists pressing false dichotomy between “rights” and “evidence” following Cass Review

2024-11-14T00:00:00+00:00

Among many alarming features of the Cass Review final report was a statement made by Hilary Cass that “Although some think the clinical approach should be based on a social justice model, the NHS works in an evidence-based way”(page 20, para 5), seeming to imply that the NHS does not or should not consider the potential social justice ramifications of how it treats patients. Given the massive disparity in deaths of black women at the hands of the NHS in maternity</a>, or the recent scandals about failures to address the needs of patients with ME</a>, it is arguably correct that the NHS does not work in a way that respects social justice, but it is not clear that disregard for a concern for social justice is based in evidence either. This ironically uncited claim in the Cass Report now seems to have been capitalised on by associates of anti-trans pro-conversion therapy lobby groups such as Genspect and SEGM.
Writing in the Journal of Human Systems: Therapy, Culture and Attachments</a>, twenty-three coauthors, some of whom are public advocates and/or practitioners of conversion therapy targetting minors, claimed that “guidelines across different countries were progressively shaped by a rights-based approach that removed previous safeguards and increased availability of gender-reassignment medical interventions for children and adolescents”. In the paper they play up the significance of harm and regret experienced within gender affirming healthcare while labelling healthcare regimes which they describe as following a “rights based model”. The paper also spreads unsubstantiated fears about conversion therapy bans, which are contradicted by other evidence cited in the paper itself quoting the laws as specifically excluding any impact on neutral, exploratory psychotherapy.
What even is the rights-based model?</h1>
The authors do not attempt to define what constitutes a rights-based model, nor does the paper cite a pre-existing definition of what a “rights-based” model would constitute. Rather it collates a list of health governance documents where the rights of the patient are referred to at all. As an example of this practice by the authors, they cite the Norwegian National Professional Guidelines for Gender Incongruence related healthcare.
 Autotranslated excerpt from the Norwegian Professional Guidelines for Gender Incongruence related healthcare</caption>
As can be seen in the auto-translated screenshot, these professional standards guidelines remind clinicians that patients have a right to access care, including gender-affirming care:

if they need it</li>
in the best interests of the child,</li>
and with respect for their right to self determination.</li> </ul>
Another example they give of this claimed “rights-based” approach is the Australian New South Wales Model of Care for Gender Diversity. In this, the only reference to patient rights is a reference to the Australian Charter of Healthcare Rights, and its commitment to ensuring that all patients are cared for in a safe environment that respects their identity, beliefs and choices.
 Excerpt from New South Wales professional guidelines on trans healthcare</caption>
Respect for patients accessing a service is, by definition, not a question of evidence, but a question of quality of healthcare provision. None of these “rights” prescribe a particular universal medical pathway because these guidelines are designed to be flexible to the specific medical needs of each patient.
While the article does not rigorously define what it means by a “rights-based” approach, it is much more up front about prescribing what it considers to be an “evidence-based” approach, listing among other things the controversial Littman study of 2018</a> where a survey was gathered of parents linked to a ring of anti-trans activist groups, to gather speculative parental testimony about the root causes of their childrens’ trans identities. This paper gave rise to the pseudodiagnosis “ROGD” (invented on the parent anti-trans activist boards being surveyed) and has been subject to widespread criticism of its methodological basis</a> as well as its stigmatising nature, leading eventually to a large international coalition of 62 psychiatric and psychological professional bodies making a public statement denouncing the ROGD model</a> over the “lack of rigorous empirical support for its existence”, adding “There are no sound empirical studies of ROGD and it has not been subjected to rigorous peer-review processes that are standard for clinical science. Further, there is no evidence that ROGD aligns with the lived experiences of transgender children and adolescents.“ The preferred model of the self-identified “evidence-based” authors of this paper is anything but an evidence-based paradigm.
Trans Safety Network typically avoid weighing in on matters of unresolved scientific dispute, other than to highlight areas where established clinical consensus and the work of mainstream forums for clinical consensus has been marginalised by anti-trans lobbyists. We are not health researchers and do not attempt to present ourselves as such, but the widespread academic criticism of the quality of much of the research this paper is based on is the subject of considerable, noteworthy public and academic discussion</a> at this point. We leave academic and scientific discourse to the academics and scientists. However, we feel that it is necessary to highlight this paper as a form of unrigorous science-washing of a poorly defined rhetorical concept - this new argument about "rights based" healthcare - which is constructed mainly in this case to act as a bogeyman to aid lobbyists in wider attacks on the rights of trans patients. That is the only reason we can conceive of for attempting to draw a false dichotomy between “rights” or “social justice” and “evidence” in this fashion when trans patient rights have nothing to say about what healthcare is best for any given patient. Patient rights charters exist instead to prevent doctors arbitrarily imposing their preferences on patients without regard for evidence or the preferences of the patient. Patient rights are not a question of science but a question of ethical practice.
Conversion therapy scaremongering</h1>
On the topic of ethics, it is worth discussing the connection between several authors of this piece and harm to trans people. One of the authors, psychotherapist Stella O’Malley, was recorded in 2022</a> in a Twitter Spaces conversation publicly claiming that for young teenage trans girls, their trans identity is a fetish induced by pornography, and affirming to her interlocutors in the meeting that they do not deserve compassion. She stated clearly that her goal is to prevent as many children from transitioning as possible. Another, Kenneth Zucker, is known for having had his clinic shut down in Canada after the country banned conversion therapy, owing to his practice of attempting to prevent young trans people from identifying as transgender</a>. Patrick Hunter, also listed as a coauthor in this article was a key actor in campaigning for a trans healthcare ban in Florida</a>, in coalition with anti-trans hate group SEGM, who the Southern Poverty Law Centre have described as being part of a “pseudoscience network</a>”. Another coauthor, Rittakerlu Kaltiala who was a speaker at</a> SEGM’s conference earlier this year has been the subject of allegations of sexually invasive questioning</a> towards young trans patients in Finland. None of this bodes well for a respectful or sincere negotiation of the pros and cons of conflicting approaches to trans patients’ rights in healthcare.
It is notable that in one pararaph, the authors claim without citation “In a parallel process, “conversion therapy” laws, passed in many countries, closed access to exploratory psychotherapy that enables exploration of gender-identity issues from a neutral therapeutic stance.” That the authors were allowed to publish this claim without providing any citation of any jurisdiction where neutral exploratory therapy has been made illegal is startling. Later on in the same article, they define conversion therapy laws, saying “any therapist who engages in a practice that attempts to change or suppress a person’s sexual orientation or gender identity is, according to such laws, open to prosecution”. Given that efforts to change or suppress a person’s identity (or sexuality) are what is being described, this could hardly be considered “neutral” or meaningfully “exploratory” — these laws by definition ban a directed agenda-driven effort to effect change in identity. The article even quotes New Zealand’s conversion therapy ban as stating that “”facilitating an individual’s coping skills, development, or identity exploration, or facilitating social support for the individual” does not constitute a conversion practice". The contradiction here between the claim that these laws, which strenuously avoid banning genuinely neutral exploration and supportive non-directive therapy, are in fact banning neutral therapy, should be taken in the context of having been written by an array of authors including those with a known record of practicing and advocating non-evidence-based, agenda driven therapy to change the identities of trans subjects. This is crying wolf, with the intent of stirring up fear, uncertainty and doubt over protections for trans people against abusive clinical practices.
Summary</h1> All in all the fact that this paper has been allowed to be published in an academic journal poses a worrying indication of the future of pseudo-scientific anti-trans advocacy. Activists for the anti-trans pro-conversion-therapy lobby have been given free reign here to post a thinly veiled opinion piece which can then be cited at a later date as evidence for their spurious claims, while serious evidence-based critiques of speculation and deviation from proper scientific processes happening in trans healthcare made by independent academics like the Yale Integrity Project</a> are still yet to be taken seriously</a> by healthcare ministers in the UK. As things stand, it appears that this type of pseudoscientific material is less about constructing a body of evidence through legitimate research, than it is about preparing excuses for further trans harm in health policy, dressed up in the appearance of scientific practice based on credentials of the authors and publication in ostensibly academic literature, despite contradictions in their own work with the actual evidence provided. Policymakers are then able to cherry pick these sorts of paper, without any need to reference or consult mainstream professional bodies in the field such as WPATH, or numerous other non-activist clinical expert groups on trans healthcare such as BAGIS, AuPATH, EUPATH, APATH, and so on who policymakers ought to be taking as the appropriate bodies to develop and refine the existing scientific consensus.
It’s important that a false dichotomy between evidence and patient rights is not given false credibility when the claim itself lacks a meaningful evidence base or definition. After all, patient rights can only be secured through rigorous application of evidence-based healthcare practice, without which there is no pathway to safeguarding key ethical principles like informed consent or respecting patient agency and self determination. There is no contradiction between a rights-based, and an evidence-based approach, much as anti-trans lobbyists and Hilary Cass want to construct one.

'Nothing to offer': Training materials for new NHS CYP gender services raise serious questions, concerns about conversion practices

2024-11-09T00:00:00+00:00


Slide from training video produced by the Academy of Medical Royal Colleges</right>

Slides and video transcripts for the new NHS Children & Young People’s (CYP) Gender Dysphoria services seen by Trans Safety Network include claims that “safeguarding concerns” facing trans CYP include “coercion from parents and carers” into transition. The materials appear to suggest that clinicians should suspect a role for “fictitious illness” or “secondary gains” in trans youth, casting doubt on their account of their own identity.
One expert Trans Safety Network spoke to about the training materials raised major concerns about the training, stating that the materials had “nothing to offer” happy trans children and young people seeking support to transition and that the materials downplayed the harms of transphobia, made false claims about social transition and cited material by transphobic clinicians.
A clinician involved in delivering the training, Anna Hutchinson, was previously involved in delivering “gender exploratory</a>” training materials to NHS clinicians, which cited a number of pro-conversion therapy organisations and individuals. Gender Exploratory Therapy is regarded by many LGBTQ+ advocates as a euphemism for conversion practices</a>. Hutchinson was a speaker at the controversial CAN-SG “First do no harm” conference, which faced criticism alleging that it was promoting conversion practices</a>.
Hutchinson also spoke at an event at the 2024 Labour Party Conference hosted by the anti-trans organisation Labour Women’s Declaration</a>, which laid out, among other issues, the group’s opposition</a> to a criminal ban on sexual orientation and gender identity conversion practices. Hutchinson used her talk to scaremonger about a proposed conversion practices ban, misrepresented historical and contemporary conversion practices and suggested that a ban would interfere with implementation of the Cass review.
Training materials</h1>
Trans Safety Network obtained copies of the slides and transcripts of videos</a> used in the induction training for the new CYP Gender Dysphoria services via a Freedom of Information request. The training was delivered by the Academy of Royal Medical Colleges and commissioned by NHS England. According to the documents received by TSN, there were seven videos consisting of slides and spoken material which clinicians watched remotely. There was also a single face to face training day, which TSN was not given any detail on other than that the training days took place between February and June 2024.
TSN spoke to Cal Horton, an academic researching trans inclusion and vocal critic of cis-supremacist</a> approaches to trans health, about the training. Horton raised a number of concerns, stating that the training “provides a lot of miseducation” and fails to provide professionals with useful information to support trans CYP.

Lack of clarity on social transition: Social transition refers to any steps taken in transition that are not medical</a>, such as changing one’s name, coming out as trans or changing gendered presentation (clothes, personal grooming). Horton raised concerns with TSN about how the training materials discuss social transition. The materials claim that social transition is poorly defined, which Horton rejects, saying that “has a clearly accepted definition both in the academic literature, in clinical practice and in everyday usage.” According to Horton the training materials “misrepresent existing literature, which find zero harms and many, many benefits of social transition” with “No mention of the harms of denying social transition, no mention of the numerous studies showing very significant benefits.” Additionally, we at TSN would question the extent to which social transition is properly the business of clinicians, rather than a form of free expression that trans people undertake in order to live our lives in a way that makes most sense for us.</li>
Poor recognition of harms of transphobia: While the training does briefly mention that transphobia can do harm in a few places, it makes some notable omissions. Horton highlighted to us that the training frequently seems to gloss over the harms of transphobia, for example in a session on safeguarding (session 7), the training briefly mentions transphobia but in terms of direct harm from families only directly mentions “criticism, hostility or other physical or emotional abuse related to same-sex attraction or gender expression,” without mentioning rejection or abuse specifically for being trans, despite this being a significant cause of harm to trans CYP</a>.</li>
Inappropriate choices of literature: According to Horton, the training materials make some concerning choices with respect to drawing on existing research. In particular Horton points out that the training session that discusses models of care (session 2) “omit[s] all the most important texts that a new clinician in this area should read” and cites the work of highly controversial clinicians. TSN note that the materials cite Canadian sexologist Kenneth Zucker, who has been the subject of credible allegations of gender identity conversion practices</a> leading to the clinic he worked at being shut down</a>.</li> </ul>
Overall, Horton said that they did not think the training materials provided adequate information on how to support trans CYP.

“[F]rom the materials it is very clear that they have literally nothing to offer a happy trans kid, or a kid whose only problem is related to transphobia/cisnormativity/gender minority stress/dysphoria” - Dr Cal Horton </blockquote>
At various points, the training calls for a “biopsychosocial” approach, with the first video session calling for clinicians to “Ensure that all patients are offered a comprehensive biopsychosocial assessment.” In the final video, on safeguarding concerns, the training material appears to suggest both that trans CYP’s parents may be pressuring them into transition or that trans identity may be linked to “fictitious or fabricated illness” or driven by “secondary gains.”

“Coercion from parents and carer or the potential for secondary gains that can shape a child's gender understanding and expression. Parents or carers may have become heavily invested in one outcome and can drive a child’s social or medical transition.” - AoMRC, CYP gender service training materials </blockquote>

“Perplexing presentations such as functional disorders or fictitious or fabricated illness. These are amongst the most challenging clinical presentations that can occur alongside presentations for professional support with gender incongruence.” - AoMRC, CYP gender service training materials </blockquote>
The biopsychosocial approach refers to the biopsychosocial model, which is a model for understanding disability, illness and health.</a> There are multiple biopsychosocial models of healthcare, some of which are closely associated with medical gatekeeping and claims of fictitious illness and malingering, as discussed in previous TSN reporting</a>.
In theory, the biopsychosocial model incorporates biological, social and psychological domains to offer a more holistic approach to healthcare, including psychiatric care. Its origins in psychosomatic medicine affect its application across the board with the model frequently ignoring some of the domains to the preference of others</a>. In practice, it usually relies more heavily on psychological factors which in the case of the original version were primarily psychoanalytic</a>. The version in use today relies more on a cognitive behavioural approach</a>.
The biopsychosocial model was proposed as a means of</a> moving away from mind/body dualism</a>. Moving away from mind/body dualism is not a bad thing. However the biopsychosocial model fails to do this coherently</a>. This has left patients with medically unexplained symptoms who fall in the “mind-body borderlines” of psychosomatic medicine (where the original model came from) subject to treatments and practices that are afforded less scientific scrutiny than elsewhere in the medical system.</a> It is unclear how a biopsychosocial approach to trans healthcare is envisaged in this training, especially given that there is no singular biopsychosocial model.
Existing literature on the biopsychosocial model pertaining to trans people covers a wide range of disciplines and potential health factors. This ranges from factors for physiotherapists</a> to consider, to advice for anesthesiologists who may be dealing with trans patients</a> to literature by and</a> for gender</a> service clinicians</a>. Some of the literature in the gender clinician category is harmful and some not, with the latter study linked to having been criticised by AusPATH</a> as having a “clear agenda” against affirmation of trans CYP and allegedly misrepresenting its data to inflate youth detransition rates. The biopsychosocial model has also been cited by transphobic Catholic bishops</a> and used in guidance for schools in Australia</a> calling for teachers not to affirm trans students and describing being trans as a “psychological condition” for the majority of trans children. The emphasis on secondary gains elsewhere in the training materials suggests this more harmful biopsychosocial approach, and an implied link to functional and psychosomatic disorders, or that being trans is a form of this, mirroring disablist research discussed in our previous reporting</a>.
“Secondary gain” has multiple</a> meanings</a> and it can be difficult to know what is inferred without further context. In the context of functional disorders, it is likely to be in the original Freudian context of unconscious motivations</a> although some literature on functional disorders does define “secondary gains” as conscious and deliberate and links them to fictitious and fabricated disorders (for attention)</a> and malingering (for financial gain or exemptions</a>). Although others describe the same motivators as unconscious as discussed here</a>. In the context of trans CYP and their parents allegedly pushing them towards transition it is likely to both depending on the professional’s assessment.
Fictitious or fabricated illness was previously known as Munchausen's syndrome</a>. Fabricated or induced illness in another was previously called Munchausen Syndrome by proxy and is a serious form of child abuse. Safeguarding in educational and medical settings is crucially important particularly where a child has an existing disability as research estimates suggest that disabled CYP are three times more likely to face abuse or neglect</a>.
However, abuse involving fictitious or fabricated illness is thought to be extremely rare but accusations of it are not. Parents of disabled CYP are at particular risk of false allegations, particularly if the parent or carer is disabled themselves or makes a complaint about their treatment. According to a 2023 research report by the University of Leeds and the children's brain condition charity, Cerebra, NHS practitioners were the source of most allegations, followed by schools and then local authority children's services.</a> The report also found that most (84%) resulted in no follow-up action and that disabled parents were more likely to face allegations as were parents with other “protected characteristics.” The report found that 50% of allegations arose following a complaint against a relevant public body and that unsubstantiated allegations were traumatic for the entire family. The report called for a review of the 2021 RCGP guidance on Perplexing Presentations (PP) /Fabricated or Induced Illness (FII) in Children</a> and stated that its “alerting signs” on which the guidance suggests reports should be made, are not based on evidence and “unsupported by any peer-reviewed research.”
Trans CYP are more likely to be autistic</a> and autistic people are more likely to have chronic health conditions</a>, many of which are often inappropriately included in the “functional” or “psychosomatic” umbrella such as Myalgic Encephalomyelitis and Fibromyalgia. Autistic people are also more likely to have a condition in the considered rare class of connective tissue disorders including Ehlers-Danlos Syndrome</a> (EDS). EDS, particularly the hypermobile type, is difficult to diagnose and parents/carers are frequently accused of fabrication and/or abuse</a> due to injuries caused by the condition in undiagnosed children.
Therefore trans CYP are far more likely to be disabled CYP with “perplexing presentations”. We are concerned that supportive parents/carers, particularly should they complain about their children’s treatment regarding their gender from NHS or Education services are at serious risk of being accused of fabricating their child’s trans identity for “secondary gain”. This concern is amplified for trans CYP who are either disabled themselves or have a disabled parent/carer.
The suggestions of a link to fictitious illness and secondary gains in the training pathologise trans and gender diverse youth and prime clinicians to treat trans and gender diverse CYP's identifies with suspicion and skepticism. The suggestion that trans CYP are more likely to present with fictitious illness additionally poses a risk of disabled trans CYP not being believed when reporting symptoms of illness.
While a small number of documented cases of parental coercion in relation to transition do exist, this is an extremely rare phenomenon in comparison to harms from parental transphobia</a>, with some research suggesting</a> that a majority (56%) of conversion practices are carried out by family. Research by the LGBTQ+ housing charity AKT</a> has found that LGBTQ+ young people are disproportionately represented among homeless and precariously housed youth</a>, frequently related to rejection or hostility from family. Almost two thirds of LGBTQ+ youth with experience of homelessness responding to a 2021 survey by the charity</a> reporting that they “felt frightened or threatened by their family members before they became homeless.” The training has relatively little to say on specifically transphobic hostility from family members and nowhere is risk of homelessness, a major safeguarding issue for trans CYP, discussed in the training.

Parental rejection and abuse are a major causes of LGBTQ+ young homelessness, from AKT, LGBT Youth Homelessness: A national scoping of cause, prevalence, response and outcome, 2015</a></right>

Four out of the seven video sessions contained mentions of “gender-related distress.” This term, whose origins in conversion therapy were explored in Ilya Maude’s recent piece for Trans Safety Network</a>, is used within the training to suggest that clinicians should, in some cases, seek to “locate the issue” of a young person’s gender dysphoria in external factors. As outlined in Maude’s reporting for TSN, such rhetoric can easily serve as justification for a “love the sinner, hate the sin” approach to gender identity conversion practices. The focus on reframing the language by which CYP describe their experiences would fit within the CBT based modes of conversion practices discussed by Maude. We asked NHS England, the AoMRC and Hutchinson whether this is consistent with conversion practices, none provided any comment on this issue.

Slide from Academy of Medical Royal Colleges training video with accompanying transcript of audio</right>

“Gender-related distress” is a term relatively new to the training literature but features prominently within it. It also features heavily within the Cass Review and before that in the article by Canvin et al. (2022)</a> in the language of third-wave cognitive behavioural therapy as further discussed by Ilya Maude</a>. The appearance of this terminology appears to be a misappropriation of language from the disabled people and psychiatric service user movements</a> by alluding to the term “mental distress”. Some parts of these movements began using the term “mental distress” to refer to symptoms of psychiatric impairments exacerbated by social factors to reframe their experiences and shift the focus back onto the maddening aspects of society</a>, rather than individual pathology. As a result of that activism, this term is now commonplace within the language of mental health charities</a> and some psychiatric nursing literature</a>. This is sometimes used genuinely but often against the intentions of the usage by the survivor movement - still blaming the individual for social issues via a lack of “distress tolerance”. This use within gender service literature looks like an attempt to minimise the need to treat gender dysphoria by constructing a mental illness that presents like gender dysphoria but isn’t gender dysphoria. Calling this construct “gender-related distress” is a misleading use of language that will be familiar to healthcare professionals and gives harmful practices the appearance of progressiveness.
“Gender-related distress” also features prominently in training materials produced by Explore Consultation</a>, a clear throughline can be seen from this to this newer induction training produced with involvement of Explore Consultation members. While the newer training avoids directly mentioning organisations like Bayswater Support Group and Genspect, the previous training by Explore was far less cautious. Explore’s training materials, which list Hutchinson as an author, favourably cite:

Bayswater Support Group, a conversion practices advocacy organisation recently exposed by a TBIJ investigation</a> as engaging in a number of harmful practices, including isolating trans CYP from their friends, destroying their belongings and blocking children from accessing services such as Childline, mental healthcare and rape crisis services in order to prevent them from contacting services that may affirm their identity.</li>
Genspect, an umbrella organisation of pro-conversion practices groups whose director has stated that she aims to prevent CYP from being trans</a>. Genspect supports</a> a group who have called for the NHS to “target 100% desistence”</a> (essentially an explicit call for gender identity conversion practices for all trans people) and a blog site by anti-trans parents</a> that has claimed that the popular video game MInecraft can cause children to become trans</a>. Genspect have been described as an “anti-LGBTQ hate group” and one of the “key hubs of anti-LGBTQ+ pseudoscience” by the Southern Poverty Law Centre</a>.</li> </ul>
Labour Women’s Declaration</h1>
Content warning: The following section includes discussion of conversion practices, including physical and sexual abuse of children and young people. Some sources linked to describe abuse in explicit detail.
At the recent 2024 Labour Party conference, LWD held a meeting within the conference where Hutchinson appeared as a speaker and one Labour MP in attendance argued against a ban on conversion practices</a>.
Labour Women’s Declaration (LWD) are a gender critical organisation operating within the Labour Party that seeks to push party policy in an anti-trans direction. LWD are listed as a “supporting organisation</a>” of the extreme, eliminationist</a>, transphobic organisation Women’s Declaration International (WDI, previously known as WHRC) and have signed their “Women’s declaration”, a document that calls for banning trans women from all women’s spaces and for the defunding of medical research into trans women’s fertility. WDI have previously called for “transgenderism” to be “eliminated” in a bizarre submission to a parliamentary consultation</a> that claimed that niche pornography is responsible for trans women’s gender identity and have previously been involved in spreading misinformation</a> suggesting that major LGBTQ+ organisations seek to legalise child sexual abuse.
LWD have publicly attacked</a> the female Olympic boxers Imane Khelif and Lin Yu-Ting, who have been the targets of an interphobic harassment campaign</a> started by anti-trans far right website Reduxx. LWD shared quotes from an article that falsely describe the two women as “biological males punching a bunch of women in the face.” Speaking on a criminal complaint</a> lodged by Khelif regarding the harassment she has experienced, her lawyer described the campaign against her as “misogynist, racist and sexist.”

Labour Women’s Declaration shares attack on Khelif and Yu-Ting on Twitter</right>

LWD have made a public statement in support of failed Labour council candidate Laura Pascal</a> after she was briefly suspended</a> as a candidate by the party after complaints about transphobic</a> comments she had made, shared and boosted on social media, including one comparing trans influencer Dylan Mulvaney’s day to day existence to blackface</a>.
LWD’s website includes a briefing on conversion therapy</a> that claims that there is “no contemporary evidence that [conversion practices] are taking place in the UK,” despite research by Galop showing that 1 in 5 LGBTQ+ people responding to their survey had been subjected to conversion practices</a>, with younger age groups more likely to have experienced such practices, indicating what Galop describe as a “current and ongoing” issue.

Conversion practices prevalence by age, using data from Carlisle, E. & Withers Green, L. “There was nothing to fix”: LGBT+ survivors’ experiences of conversion practices.</a> Galop; 2022., pg 24</right>

It is troubling in the extreme that Hutchinson, a clinician directly involved in providing training to other clinicians working with trans CYP, would speak at an event by an organisation with a clear anti-trans bias that seeks to deny and minimise real and ongoing abuse of vulnerable trans and gender diverse people.
During her talk at the meeting, where she was explicitly named as involved in delivering training for NHS CYP gender services, Hutchinson claimed that conversion therapy was largely a thing of the past and had historically been done specifically to “same sex attracted adults,” suggesting that it is inappropriate to use the same terminology to discuss the treatment of “gender questioning children.” Hutchinson further suggests that it is inappropriate to refer to contemporary conversion practices as such, using the extreme harms of aversion therapy (the practice of torturing patients with electric shocks or emetic drugs to alter behaviour) as a baseline and implicitly denying that other conversion practices should be named as such. These claims minimise contemporary conversion practices. Evidence gathered by Galop</a> demonstrates that conversion practices are an ongoing issue that can include serious violence and in some cases sexual violence</a> (also known as corrective rape). The International Rehabilitation Council for Torture Victims’ Independent Forensic Experts Group has previously stated that “All forms of conversion therapy, including talk or psychotherapy, can cause intense psychological pain and suffering.</a>”
As to Hutchinson’s claims that only “same sex attracted adults” were subjected to aversion therapy, there is a wealth of historical</a> evidence</a> that trans people</a> were among those subjected to "aversion therapy" by the NHS</a> and that LGBTQ+ CYP were subjected to serious, violent conversion practices in the period discussed, with one paper identifying cases of LGB children as young as 13</a> experiencing conversion practices (including one case of sexual abuse of a 14 year old) and BBC reporting detailing the case of a trans woman who first underwent aversion therapy at the age of 17</a>. There are also many accounts of young adults being subjected to aversion therapy, including the account of one gay man who was forced to undergo the process under threat of expulsion from school at the age of 18</a>.
In TSN’s opinion, this denial of the seriousness of today’s conversion practices and dismissal of the experiences of some survivors of aversion therapy on the basis of their age or gender identity is disturbing from a clinician working with trans CYP.
In the meeting Hutchinson would go on to suggest that “malicious accusations” of conversion therapy are commonplace and a serious problem, suggesting that this is a reason for extreme caution and scrutiny of any state measures aiming to end the practice. This is incongruous with the reality that existing rules by regulatory bodies barring conversion practices appear to be largely unenforced</a>, with the GMC unable to even provide reliable numbers on how many complaints it receives in this area. Hutchinson stops short of openly opposing a ban on conversion therapy in her talk, but repeatedly calls for clinicians to be “protected” from possible accountability for their treatment of LGBTQ+ patients and scaremongers about the possibility that a ban on conversion practices would make the implementation of the Cass review more difficult.
TSN are deeply concerned about what Hutchinson, a clinician working with trans children and young people and involved in the training of other clinicians, considers an appropriate implementation of the Cass review to be if this would be potentially hampered by a ban on conversion practices. Hutchinson said in a statement to TSN that Cass herself has “concerns about the conversion practices bill,” citing a Guardian article quoting Cass</a>.
TSN reached out to NHS England, the Academy of Medical Royal Colleges and Anna Hutchinson for comment. NHS England declined to comment, referring us to the AoMRC as the providers of the training. The AoMRC declined to comment on questions about conversion practices, Hutchinson’s conduct or the risks of homelessness and abuse for trans CYP, but stated that the training materials were “produced wholly in accordance with the findings of the Cass Review.” The AoMRC employee TSN contacted referred to a statement</a> by the AoMRC calling for clinicians not to question "the validity of the evidence and consequently the findings" of the Cass review because this would risk "greater polarisation.” We asked the AoMRC whether this is consistent with the principles of serious scientific inquiry and evidence based medicine, at time of writing we have not received a response. Anna Hutchinson said in a statement that she supports evidence based medicine and that all of her work is “in line with the recommendations of The Cass Review.” Hutchinson did not provide any comment on the inaccuracies about historical and contemporary conversion practices in her talk, her association with an anti-trans organisation or the specific issues of abuse of trans CYP by family members.

Simon Wessely’s history of discrediting sick and disabled people could be bad news for trans health research priorities.

2024-10-23T00:00:00+00:00

Psychiatrist Simon Wessely has been appointed to chair the National Children and Young People’s Gender Dysphoria Research Oversight Board</a>. This board has oversight and leadership of the research program which aims to underpin the redesign and redevelopment of the children and young people’s NHS gender services. The research programme includes a data linkage study, a puberty blocker study and a living systematic evidence review study. The chair of the research oversight board has considerable authority over the entire research program, is a primary reporting line for researchers and will liaise with the principal investigators of individual research studies.
Simon Wessely is a psychiatrist and epidemiologist who has worked in numerous senior positions</a>. Wessely has a history of working closely with state bodies to promote contentious theories about issues of healthcare, disability and benefits and has been closely associated with discredited research in this area. He argues that belief in conditions contributes to their spread and continuation, using theories that often veer into pseudoscience. This has resulted in harm on an institutional level where he has influenced the policy of the DWP and argued against allowing for litigation for psychiatric harms related to trauma. Wessely frequently attacks and seeks to discredit patient advocacy organisations and disabled activists who criticise the effects of his work on their lives. Much of Wessely’s public statements stray into sanism</a>, disablism and other stigmatisation of marginalised groups.
Wessely was closely involved in the PACE trial, a highly controversial and deeply methodologically flawed study into the treatment of ME, that was marked by significant issues with research transparency.
In this context, Trans Safety Network is concerned about the role that he may play within the National Children and Young People’s Oversight Board.
Simon Wessely frequently attributes issues that he comments on to psychogenic origin, and where a psychiatric origin is the cause (as with PTSD) he looks to preexisting factors as an explanation. He frequently refers to historical diagnoses of hysteria and neurasthenia and suggests that a whole range of illnesses are modern versions of these Freudian neurotic disorders. Wessely coauthored a paper with Chiachana Nimnuan and Michael Sharpe (one of the principal investigators of the PACE trial) which argued that all of the conditions that fall under functional somatic symptoms or medically unexplained symptoms (MUS) are the same thing</a> - psychosomatic conditions with the same underlying psychiatric pathology presented to different medical specialists dependent on the somatic symptoms experienced. They included twelve different conditions in this argument including pre-menstrual syndrome, fibromyalgia and temporomandibular joint dysfunction (TMJ). The paper argues that a condition being more common in women is a reason to suspect psychosomatic origin, which in TSN’s opinion is deeply misogynistic. The paper also argued for reclassification into one syndrome rather than distinct classifications within medical specialities, mostly to reduce costs.

“Functional somatic symptoms and syndromes are a major health issue. They are common and may be persistent, disabling, and costly. Most of the current literature pertains to specific syndromes defined by medical subspecialties. We have put forward the hypothesis that the acceptance of distinct syndromes as defined in the medical literature should be challenged.” - Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet. 1999 </blockquote>
More recently, Wessely has applied the same theories to schoolgirls in Iran who fell ill in 2023 with suspected gas poisoning following a wave of anti-government protests. Amnesty International drew attention to the health authority’s failure to investigate the cause of their illness</a>.
Whilst the cause has not been proven or properly investigated, it was quickly and confidently attributed to a psychological, socially contagious source</a> by Wessely:

“Prof Simon Wessely, a psychiatrist and epidemiologist at King's College London, said several "key epidemiological factors" led him to believe these were not a chain of poisonings, but were instead a case of "mass sociogenic illness" - in which symptoms spread among a group with no obvious biomedical cause. The spread of cases across the country and the fact it has been predominantly affecting schoolgirls, with fewer boys and adults falling ill, were central to his conclusion, he said. The nature of the symptoms and the fact most patients quickly recovered were also key, he said.” - BBC article 03/03/2023 </blockquote>
As in Wessely's previous work on somatisation, he seems to suggest that a condition primarily affecting women or girls implies a greater likelihood of a psychogenic origin. Schoolgirls in particular had been taking part in anti-government protests and it was widely believed that students were being deliberately poisoned in attempts to close the girl's schools. Wessely’s conclusion is in alignment with that of the Iranian authorities who according to Amnesty International have dismissed the illnesses as stress and mental contagion. TSN is concerned that Wessely has once again engaged in what appears to us to be a misogynistic approach to the health of women and girls, in this case in the absence of any concrete evidence and at a considerable distance.
Conditions that Simon Wessely has attributed to psychosomatic causes include illness following water poisoning</a> accidents</a>, respiratory disease that led to cancer post 9/11</a>, Myalgic Encephomylitus</a> (ME) and Gulf War Syndrome</a>. Wessely also has concerning opinions on PTSD</a> and neurodivergence</a> and has claimed both have elements of social contagion fueled by the media.
Institutional harms</h1>
Simon Wessely advised the Department for Work and Pensions (DWP) to restrict ME patients’ access to welfare benefits and has misrepresented his role in doing so. In 1993, Wessely wrote to Mansel Aylward who at the time was the Chief Medical Officer at the Department of Social Security (DSS), now the DWP, complaining that ME would be listed under 'other neurological disorders' in the handbook of disabilities for Disability Living Allowance (DLA). This would have brought the definition of the condition in alignment with how it has been classified by the World Health Organisation since 1969</a> but Wessely complained about the 'partisan' influence of patient organisations, stating:

If CFS/ME is to be listed as a neurological disorder, I for one will begin to campaign via the mental health charities for schizophrenia and manic depression to be listed under the same heading. - Letter from Simon Wessely to Mansel Aylward, available in National Archives BN141/1</a>, pages 17-18 </blockquote>
Wessely’s letter did not read as mere concern about a categorical error he believed to be the detriment of a patient group. As a psychiatrist, he will have known and (hopefully) understood that the disabilities referred to, schizophrenia and bipolar (formerly called manic depression), can be enduring and can require long-term support. Yet his letter went on to say,

I believe that the Department is making an error if it accepts the partisan views put forward by pressure groups as a basis for making medical decisions. I also believe that it is a decision that the department will regret, since it seems likely the result will be an ever increasing stream of claims for permanent benefits in people who might otherwise have had a chance of recovery. - Letter from Simon Wessely to Mansel Aylward, available in National Archives BN141/1</a>, pages 17-18 </blockquote>
In an article on Wessely’s website titled ‘CFS Myths. Misunderstandings and Misperceptions’</a> he responds to several criticisms and claims regularly raised by ME patients and groups. In addressing the claims that he advised the DWP resulting in ME patients being denied benefits he quotes the DWP’s response to these allegations, a response which does confirm his advisory role in guidance.

“Professor Simon Wessely has not been involved in the development of CFS/ME guidance but has advised with guidance developed for some psychiatric conditions. He has served as a member of Dame Carol Black’s working group on employment”. </blockquote>
Wessely also addressed what he describes as misrepresentations of “a letter” written to Mansel Aylward at the DSS in 1992 which became available in the National Archives in 2012. Wessely claims to have forgotten about having written this letter and links to it “for completeness”, and to show that he was writing in support of patients and patient charities. The letter Wessely links to is another written to Mansel Aylward in 1992 regarding a previous version of the DSS disability handbook, ignoring multiple letters released by the National Archives that campaigners had raised concerns about, including the one quoted above. Whilst the letter Wessely refers to did express some concern that findings reported in medical literature considered by the committee at the time might be interpreted as meaning patients were not experiencing any (psychiatric) impairment, it does argue that longer benefit awards could affect the prognosis of the condition. Nevertheless, posting the least harmful of a series of letters as ‘the letter’ is misleading. This was one of several letters that can be read in the national archives and preceded the one quoted above. Likely, Wessely had not expected to be questioned about these communications as the files of communications between the DWP (then DSS), medical experts and patient organisations were redacted under Sections 40 and 41 of the Freedom of Information Act and not intended for release until 2072 but were released earlier due to the work of Valerie Eliot Smith in appealing these redactions</a>.
In 1993, Wessely spoke about ME at a DLA full board meeting. In this talk, Wessely claimed;

As regards benefits:- it is important to avoid anything that suggests that disability is permanent, progressive or unchanging. Benefits can often make patients worse. - Chronic Fatigue Syndrome: Summary of the talk given by Professor PK Thomas and Dr S Wessely on 2.11.93, available in National Archives BN141/1</a>, pages 6-10 </blockquote>
Whilst Wessely may well genuinely believe that patients being believed about their degree of illness and disability and receiving disability payments and healthcare per their level of impairment is somehow harmful to them on a subconscious level. It is demonstrably more harmful not to be able to afford to eat when too unwell to maintain employment.</a> It is also more dangerous to encourage healthcare professionals and individual support networks to withdraw support based on abstract ideas rather than concrete proof of this being in the person's best interests. Whilst it is doubtful that someone would seek to remain on such a low income should their health improve, pushing work before sufficient recovery could make a return to work less likely as evidence suggests that pushing to do too much activity, particularly in the earlier stages, contributes to worsening ME</a>. However, Wessely continues to contest this in his ongoing defence of the PACE trial, a discredited medical study on patients with ME that was partially funded by the DWP. Further issues with the PACE trial and dubious research practices are discussed later.
It is easy to see why such theories are of significant interest to the state when they offer a theoretical justification for reducing financial support to a patient group with limited energy to fight back. Wessely's ideas and those of his associates were and are of interest to the state to the point of significant financial investment.
Wessely’s paper at the 'Illness Deception and Malingering' conference in 2003 on historical perspectives of malingering</a> suggests that he views the role of doctors as gatekeeping welfare funds. Notably, this conference was partially funded by the DWP and insurance company Unum</a> (previously known as UnumProvident). The conference led to a published book of the same name</a>, including a chapter by Wessely with the same title and topic as his conference paper, the book featured a chapter by Professor Micheal Sharpe titled 'Distinguishing Malingering from Psychiatric Disorders' who also has contributed to reports on a wide range of medically unexplained conditions for Unum</a>. The book acknowledged Professor Peter White, who became the principal author of the PACE trial and Professor Micheal Sharpe, a lead investigator for the trial, which Wessely helped design as director of the Chronic Fatigue Research Centre at Kings College London.</a>
Wessely uses psychosomatic and psychiatric epidemiological theory to argue that people who develop PTSD following trauma should not receive financial compensation even if there is clear blame for the traumatic event. He calls into question the validity of the diagnosis entirely, questions the role of trauma in its development and blames the legal culpability cases and subsequent media coverage for the spread of the condition.
In 1995 Wessely wrote an editorial on liability for psychiatric illness in litigation claims</a> with recommendations for the Law Commission to consider following a symposium on psychosomatic medicine and the law. His paper called into question the validity of the diagnosis of PTSD from the perspective of psychiatric epidemiology.

“ I wish to draw attention to three areas that informed many of the papers presented at the conference held at the Royal College of Physicians, but have had less influence on the thinking of the Law Commission. The first is the subject of causation, and the differing concepts used in medicine, psychiatry and the law. The second is the epidemiology of psychiatric disorders and their relationship to life events. The third is the role of legislation and litigation in perpetuating psychiatric disorder. I shall draw on examples from the literature on post traumatic stress disorder, life events and psychosomatic disorders. I shall argue that by espousing a simple medical model of the causation of psychiatric disorders, and hence by failing to recognize the complex multifactorial models that operate in psychiatry, there is a risk of a considerable increase in litigation for psychiatry injury, which in turn will have an adverse effect on the public health.” </blockquote>
Wessely said that PTSD is unique in psychiatry because the cause of it is presumed to be known. However, he disputes traumatic events being the cause as not everyone who experiences such events develops PTSD. Wessely further argues that some people develop other psychiatric conditions and those who do develop PTSD have pre-existing factors such as poverty, parental divorce, childhood behavioural problems, neurotic disorders and possibly a genetic predisposition. Wessely claims that the intention of the diagnosis’ reliance on having experienced an unusually traumatic event is “to distance PTSD from other psychiatric conditions by implying that it is a 'normal' reaction”. He continues to claim that;

“The 'discovery' of PTSD was not the result of any careful hypothesis, epidemiological investigation or even serendipitous inquiry. It arose in response to America's own 662 Editorial traumas associated with the Vietnam War. PTSD was created 'consciously and deliberately' [11] by a section of the mental health community” </blockquote>
He draws comparisons between old Freudian diagnoses of neurasthenia and hysteria. Both of these were anxiety neuroses, but neurasthenia was more frequently diagnosed in men</a>, particularly men of higher social status such as military officers. Whereas hysteria was more commonly diagnosed in women and men of lower social status. Neurasthenia was associated with a previously more “mentally sound constitution” than hysteria.

“The history of nervous shock, traumatic neurasthenia and shell shock (and in particular the differences between hysteria and neurasthenia) remains relevant as an example of the role of social judgement in psychiatric diagnosis.” </blockquote>
Wessely argues that PTSD has been constructed to serve the same social role as neurasthenia - a way to avoid the stigma associated with psychiatric illness by constructing one that any person of ‘sound mind’ could develop in the right circumstances. He compares increases in PTSD diagnosis with increases in conditions he considers to be psychosomatic. In particular - repetitive strain injuries, back pain and whiplash, for which he blames the prevalence of litigation and subsequent media coverage. He then urges the Law Commission to consider the role of “eggshell personalities” in making individuals susceptible to PTSD rather than the traumatic events that clinical consensus would usually point to.

“Most people, even those outside the legal profession, are probably familiar with the concept of the 'eggshell skull'--you take your plaintiff as you find him or her. This principle applies to physical injury. The equivalent as regards psychiatric injury is the 'eggshell personality'--some people are particularly predisposed to develop psychiatric injury in response to events or injuries that would not necessarily have affected others” </blockquote>
His use of psychiatric epidemiology to construct theories of social contagion in ways that question longstanding clinical consensus suggests that we need to monitor carefully the objectives and outcomes of trans health research that Simon Wessely is overseeing.
In 2023, Simon Wessely was appointed to the board of NHS England</a>. Since 2017, Wessely has been sitting on the Judicial Appointments Commission as a lay commissioner</a>. This board selects candidates for judicial office in England and Wales and for some tribunals with UK-wide powers giving him a high level of influence in the UK legal and medical system.
False claims of psychogenic illness</h1>
Simon Wessely has a long history of incorrectly claiming pysychogenic origin for illnesses later found to have a physical cause. Wessely was consulted on the Camelford water pollution incident and worked to cast doubt on the resultant health consequences. In 1988, aluminium sulphate was accidentally added to the reservoir distal at a purification plant. This resulted in a massive aluminium load in the water supply and other metal salts, zinc, copper, and lead leached from water pipes.</a> The public was not informed of the incident for 16 days. Residents reported a wide range of symptoms, including green hair, vomiting, skin irritation, vomiting and bowel and cognitive problems. Problems that Wessely and Anthony S David attributed in a paper</a> to a media frenzy and pre-existing somatoform disorders in those reporting persistent symptoms. The first government inquiry in 1989 concluded that there would be no lasting health effects, with a second in 1999 suggesting there could be. South West Water was fined the same year, and then in 1995, 148 victims received out-of-court settlements. An inquest into the death of one resident concluded that aluminium found in the brain likely contributed to her death. There is no evidence that Wessely or his colleagues apologised for their speculative theorising.
In 2002, Wessely published an article in the right-wing publication Spiked blaming the high levels of illness in residents of Lower Manhattan and emergency workers following 9/11</a> on fear, anxiety and over-medicalisation of distress. Wessely blamed these illnesses on anxiety created by increased emergency preparedness following the anthrax attacks and subsequent hoaxes that occurred in the month following 9/11</a>, increasing awareness of general environmental concerns and clean air legislation.

“Anthraxiety and World Trade Centre Syndrome are the latest consequences of an ideology that tells us that our physical environment is responsible for most of our bodily discomforts and ills.” [..] “Who do I blame for this? In the UK, I blame generations of politicians who have been in charge of the health service, and who have found it hard to say ‘enough is enough’ – instead writing ‘patients’ charters’, which perpetuate the idea that unrealistic expectations can be met.” </blockquote>
However, these post-9/11 illnesses were very serious. In 2023, the BBC reported that over 340 first responders have died from 9/11-related illnesses.</a> Many of them went on to develop cancers and pulmonary fibrosis and were more susceptible to death from Covid-19</a>. Again, there is no evidence that Wessely issued any apology for his insulting statements dismissing these illnesses.
Military personnel who fought in the Persian Gulf War of 1991 reported lingering illness symptoms</a> that included headaches, memory problems, joint pains, fatigue and insomnia to a seriously debilitating degree. In 2003 Simon Wessely was commissioned by the British Army to investigate the syndrome and continued this work through the Kings Centre for Military Health Research</a> at Kings College London. After eliminating suspected initially proposed biological causes for Gulf War Syndrome, Wessely put forward theories of social contagion</a>, somatisation and false illness beliefs</a>. Wessely stated that “The strongest factor associated with the belief that they had Gulf War syndrome, it turned out, was knowing someone else who had it”.</a> This illness is now thought to be caused by Sarin Gas</a>, with a recent study suggesting that some people have more genetic susceptibility to illness following prolonged low-level exposure to the nerve agent.</a>
Whilst Wessely did state that those with Gulf War Syndrome were genuinely ill and this work led to war pension eligibility on psychiatric disability grounds</a>, his concerns about reducing stigma about mental illness are disingenuous, selective and inconsistent. In an interview for The Psychiatrist,</a> when asked about the most important lesson learned from working with veterans, Wessely answered;

“That those who have served in the armed forces and who are now experiencing problems or difficulties of whatever nature, remain proud people whose self-image is based on coping and resilience. Victim culture is not part of their nature, and we should ensure that we don't treat them that way. Most are neither hero nor victim, but professional.” - Simon Wessely, quoted in e-Interview</a>, The Psychiatrist, January 2018 </blockquote>
Yet as discussed above Wessely has claimed that PTSD was deliberately constructed as a way for soldiers to avoid the stigma of mental illness and blames a lack of resilience, rather than trauma for the condition’s development.
As with the Camelford water pollution incident and the high levels of illness and subsequent deaths in 9/11 first responders, Wessely has faced no consequences for being incorrect in attributing Gulf War Syndrome to psychogenic factors. In fact, in 2013 he received a knighthood</a> for this work.
The speed at which Simon Wessely attributes health conditions to psychogenic origins with a socially contagious aspect, despite having frequently been wrong in the past is deeply concerning.
Hostility to transparency</h1>
Simon Wessely has a history of opposing research transparency and claiming abuse in response to criticism. Wessely moved away from research into ME following claims of abuse and a need to install panic buttons and have packages x-rayed</a>. He calls patient campaigners militants who "abuse the Freedom of Information Act"</a> by numerous FOI requests to committees and departments. Whilst this arguably adds to workloads, researchers and the general public do have a right to request information via the act and using it in this way is certainly not abuse. It is particularly cruel to call the vital work done by patient researchers like Alem Mathees for the benefit of other ME patients, sadly to the detriment of his health, an abuse of the Freedom of Information Act.
Wessely disparages the work of patient organisations, who are pointing to concrete ways his work can be linked to the DWP and insurance companies (via his enduring professional relationship with Ayelward Mansel) in terms that suggest that they are conspiracy theorists. Wessely has further falsely suggested that patients think a cure is being withheld when they are pointing out the disproportionate amount of research funding allocated to ME that went into the PACE trial compared to other avenues of research into the condition. Wessely and some of his colleagues claim to have received death threats</a>, but a tribunal judge found the claims of threats towards ME researchers to have been exaggerated</a>. These alleged death threats were cited in the refusals from Queen Mary University in its refusals of Mathees FOI requests for the PACE study data.</a> Wessely has chosen to paint the whole patient community as militant activists based on the alleged actions of a small minority and thus shifted his research focus to Gulf War Syndrome and other medically unexplained illnesses. However, via his connection to the Science Media Centre, of which he was a trustee, he continued to defend the PACE trial</a> and criticise the new NICE guidelines</a>.
ME, the PACE study and dubious research practices</h1>
Simon Wessely is most widely known for his work on Myalgic Encephalomyelitis (ME), a condition that falls under the umbrella of ‘energy impairments’ within the disability community. However, exhaustion is only one of many symptoms of the condition, is not unique to ME and is seldom the most troublesome symptom</a> despite commonly being dismissively referred to as ‘chronic fatigue’. ME is widely considered ‘medically unexplained,’ with no clinical consensus on its origins. The dominant psychiatric opinion is that the condition is psychosomatic and Simon Wessely is a key proponent of this, arguing that ME is ‘the new Neurasthenia</a>’.
ME seriously impacts the lives of people with the condition,</a> and there are no medically agreed-upon definitions of severity. What is often referred to as “mild” ME in the literature still describes a high degree of debilitating symptoms. Many patients fluctuate between moderate and severe. Some remain severe</a>, usually house or bedbound</a> and some (25%) progress to a very severe state requiring full-time care and often hospitalisation and medical nutritional support. Some severe and very severe patients have been detained under the Mental Health Act, and some have died. Some of these deaths are due to suicide</a> and some are reported as directly due to the condition</a>.
Some doctors and researchers believe ME to be a post-viral condition, and there is some suggestion that some people have a predisposition to post-viral illnesses</a>. This is a theory that is gaining more traction following the prevalence of similarly presenting chronic illness following infection with COVID-19. However, psychiatric professionals and researchers, including Simon Wessely, have disputed this theory.
Simon Wessely has been criticised for his impact on research into ME, interventions around the NICE guideline changes and DWP assessor guidelines for the condition.</a> Sean O'Neill, the father of Maeve Boothby-O'Neill</a>, a young woman with ME who died in 2021, directly blamed Simon Wessely</a> for the results of his influences</a> on public narratives of disbelief about the condition in a statement during the inquest into her death</a>. O'Neill also called out the "medical orthodoxy" that ME is a "behavioural problem" in his statement, saying:

“This orthodoxy led to Maeve being stigmatised in a way that so many patients are. The view is taken that they are malingerers or feigning illness or somehow parents are responsible. It is a view held by many powerful individuals in the NHS.” - Sean O’Neill, statement to coroner The Guardian, August 2024 </blockquote>
The PACE trial</a> was a controversial randomised study into behavioural modification therapies for ME. Simon Wessely advised on the design and execution of the trial, contributed as a Centre Lead, and was acknowledged for commenting</a> on an earlier draft of the report.</a> Despite this Wessely claimed that his only role in the trial was recruiting a few patients</a>.
PACE is the only medical trial ever to have received funding from the DWP. Freedom of Information (FOI) requests revealed that Mansel Aylward agreed to the DWP funding for the trial</a> because:

“In his [Aylward’s] role as Chief Medical Adviser he felt it reasonable to support this trial, particularly as when the trial was initially being developed, consideration was given to exploring employment and social outcomes for people taking part in the trial. Additionally, one of the secondary measures considered as part of the trial was the impact that the trial would have on the ability for employment and study.
We believe that the findings of the trial will contribute to the continuingly growing evidence base, which informs the development of health and work-related policy, policy based on the large body of evidence showing that work is good for physical and mental well-being and that being out of work can lead to poor health and other negative outcomes”. - DWP Central FOI team, from Part funding of the PACE trial by the DWP</a>, WhatDoTheyKnow </blockquote>
Aylward was also an observer on the PACE trial steering committee</a>. The trial, published in the Lancet, compared standard medical care alone and in combination with Adaptive Pacing (energy management), Cognitive Behavioural Therapy (CBT), and Graded Exercise Therapy (GET) and reported that the CBT and GET groups saw the most improvement. The same authors reported these findings in other medical journal articles. However, patient groups raised concerns due to the number of patient reports of decline in function following GET and no benefit from CBT. Patients began to question the methodology and campaign for the complete anonymised data of the study to be released for further analysis. Alem Mathees</a>, an ME patient, submitted FOI requests that Queen Mary University London repeatedly denied until August 2016 when they lost at the appeal. Alem worked alongside health journalist David Tuller and ME experts to raise awareness of the methodological flaws</a> in the trial in an open letter to the Lancet before the tribunal’s ruling. Alem’s work to expose the issues with the trial contributed to a severe decline in his health.
The release of the anonymised data revealed significant flaws, including changes to the criteria for recovery that left the same groups simultaneously classified as disabled and recovered. In a breakdown of the poor scientific quality of the study Statnews said</a>

“Their revised definition of “recovery” was so loose that patients could get worse over the course of the trial on both fatigue and physical function and still be considered “recovered.” The threshold for physical function was so low that an average 80-year-old would exceed it…They found no significant improvement on any of their objective measures, such as how many patients got back to work, how many got off welfare, or their level of fitness.” - Julie Rehmeyer, Bad science misled millions with chronic fatigue syndrome. Here’s how we fought back</a>, StatNews, September 2016 </blockquote>
The methodological issues and lack of objectivity in the planning and statistical analysis of the PACE trial are considered to be so severe that it is taught by universities as an example of how not to conduct a randomised clinical trial</a>.
Following the debunking of the PACE trial and significant campaigning, the NICE guidelines for ME/CFS, as it is called within the NHS, were changed. There was widespread controversy in the medical community and lengthy discussions in the medical press</a> between researchers associated with PACE (including Wessely) and other experts. The changes to the NICE guidelines are slowly having an international impact and some slow effects within ME/CFS clinics. Still, there is uneven adherence to the guidelines, little outside of specialist care provision has changed, most GPs have outdated knowledge and many outright reject the diagnosis</a>. Simon Wessely, along with Peter White, Micheal Sharpe and other associates, is still objecting to the NICE guidelines</a> and defending the PACE trial findings.
That Simon Wessely advised on design, contributed to, and was less than transparent about his level of involvement in such widely discredited research suggests that he is not suited to have oversight of research involving trans children and young people, another highly stigmatised and vulnerable patient group.
Wessely led the most recent Independent Review of the Mental Health Act, upon which the 2022 draft legislation was based. His appointment in 2017 was the subject of a statement by</a> Disabled People’s Organisations who raised concerns about his work with ME, defence of the PACE trial and his work alongside insurance industry professionals in ‘malingering and illness deception’ and its impact on DWP policy. Disabled people and psychiatric survivor-led organisations criticised the review and the draft legislation backing away from full reform of the Mental Health Act and for not involving user-led organisations and people with lived experience</a> in the review process. It was also criticised for “falling short on human rights and protections for minorities</a>” as it is not in full compliance with the UN Convention on the Rights of Persons with Disabilities</a>.
In a recent article in the Times, Simon Wessely again complains that increasing mental health awareness is “creating demand that the NHS was not set up to meet”</a> without considering that perhaps the NHS was set up at a time when stigma and disablism were less frequently challenged and that it could and should adapt to this. The context of these comments was discussions with medical students in a training capacity and that the young people he spoke to were identifying social problems, such as loneliness, academic pressures and global issues such as climate change rather than clinical disorders. Wessely called on the health service to address the fact that “Gen Z” are supposedly more likely to talk about mental health problems and that this is creating a burden. He said there is a danger in “over-medicalising” conditions that are not really “the business of doctors and GPs”. Wessely frames this increased level of awareness as the over-medicalisation of everyday life yet the bulk of his comments in this article complain about increases in referrals for ADHD and Autism make it clear that his issue is actually with the neurodiversity movements’ resultant shift in self-awareness and advocacy aiming to destigmatise the diagnoses.
This mirrors concerns raised by Wessely in the Lancet in 2014</a> about increases in ADHD diagnosis in children and the role that he sees support groups playing in this. He also suggests that ADHD is both over and under-diagnosed, that ADHD medication is overprescribed and claims “it's psychiatry which is against the medicalisation of normality”. I think the majority of service users and neurodiversity theorists would disagree! Certainly, the more critical theorists would point towards the ways in which people have already been pathologised</a> and the conception of normality itself as the problem. As long as people require medical proof to obtain workplace accommodations and medication if it is helpful, then diagnosis-seeking will rise.
It is disablist barriers entrenched within society and medical gatekeeping that are the issue here, not reclamation and self-awareness. Casting the blame onto the wrong people re-entrenches the very stigma that he claims elsewhere to be concerned with. It is not affirmation that is the problem, but framing disability in terms of costs to the state. This seems to be nothing more than an objection to the questioning of medical authority over bodyminds</a> which becomes more apparent in his objections to neurodivergent artistic performance. In another recent article in the Spectator about the Edinburgh Fringe festival Simon Wessely took issue with performances that dealt with themes of neurodiversity.

“There has been an explosion since the pandemic of adult patients across the NHS demanding their lives are redefined by some hitherto undefined mental health diagnosis, such as autism, OCD or ADHD. Autism is a very serious illness, a terrible illness, the inability to read other people’s mental states. When I was a junior psychiatrist the idea that someone with autism would be doing stand-up comedy at Edinburgh would just have been ridiculous. But now it’s common place.” </blockquote>
The diagnosis rates of Autism, ADHD, and other conditions that fall under the neurodiversity umbrella had been steadily increasing long before the pandemic. Reasons for this are changes in clinical criteria following research into varied presentations and increased public awareness due to media coverage and education</a> rather than ‘an epidemic’ of new cases. With the shift towards remote working early in the Covid 19 pandemic, many people realised the extent to which issues like sensory overload had been impacting them in the workplace. This shift also increased awareness of how dependent upon routine some people are.</a> It is unsurprising that people who had not previously sought a diagnosis realised the need to access one to change how they work to remove barriers. Yet Wessely only frames this as misuse of services saying, “It’s not to do with medicine, it’s a cultural shift”. He frames what is fundamentally an issue of society's failure to adapt as an individual problem in the people seeking the only means available to force accommodations.

“These patients don’t want treatment just a validation for something else in their lives, a failed marriage, or their career gone wrong. The trouble is that this huge demand overwhelms the NHS’s limited resources and it now takes 24 months before anyone, even serious cases, can get an assessment.” </blockquote>
This makes the costs to healthcare services the disabled person's fault rather than the need for human resources departments to have proof before trusting that someone knows what accommodations they need as the issue. It is certainly not the fault of disabled people making art about their lived experiences. To suggest so is simply disablism.
Comments about neurodiversity like Wesssely’s are not uncommon. But when made in the national press by a leading UK psychiatrist with a high level of institutional influence and a history of promoting theories that favour gatekeeping and doubt, they are extremely concerning. Wessely’s primary objection is of patient groups challenging psychiatric and medical authority over their lived experiences and realising that problems that they have long struggled with have names.
By insisting that an increase in cases must be somatisation, social contagion and weakening of diagnostic criteria rather than indicative of actual levels Wesseley ignores the role that media can play in public education and the role that lived experience involvement in research plays in increased clinical understanding. His long history of this calls into question his suitability for oversight of research on trans health. There is a real danger that should Wessely view neurodivergent trans people researching and educating themselves, increased diagnosis rates or want of validation and self-determination in this way it could lead to increased measures to stop it in the form of conversion therapy and/or extreme gatekeeping.
Theoretical justifications for neglect</h1>
Wessely's claims that disability benefits or financial compensation would hamper a patient's recovery are based on the notion that such support is a form of 'secondary gains' that help to reinforce patients 'false illness beliefs,' incentivising them to remain in the 'sick role'. Both of these concepts originate in Freudian notions of hysteria</a>, with the 'sick role' being expanded upon by functional sociologist Talcott Parsons in his work on illness behaviour</a>. In psychosomatic disorders, a primary gain would be the experience of relief or protection from emotional pain and distress by its subconscious conversion into physical (somatic) symptoms. Secondary gains are social or personal advantages</a>.) thought to be gained from having an illness (physical or psychological) that can perpetuate its duration. Examples of secondary gains would be attention (from friends, family, spouse etc) time off work or school, or in more contemporary arguments such as Wessely's, financial motivations. For Freud secondary gains were not exclusive to physical illness or symptoms and were applied to neurotic disorders, but more recent versions include the 'conversion' of psychological illness into a more socially acceptable less stigmatised physical illness presentation. Whilst the Freudian construct of secondary gains considered motivations to be entirely subconscious, some contemporary theory suggests it can be conscious and/or subconscious. This would be the case for exaggerated or fictitious illnesses.</a> Whilst not previously drawn upon by Wessely there is a modern addition of tertiary gains in psychosomatic medicine. This is the idea of 'secondary gains' that benefit a third party such as a parent, spouse or medical professional</a> (also with either conscious or unconsious motivations) but is often simply referred to as secondary rather than tertiary gain.
The biopsychosocial model considers biological, psychological and social factors potentially impacting a person’s health. There are two main versions of the model and multiple, less widely known variations some of which Simon Wessely has co-authored. The original biopsychosocial model was developed by George Engel</a>, who specialised in psychosomatic medicine. Engel sought to develop a holistic approach to healthcare that considers social, psychological, and biological factors when theorising chronic pain, disability and illness. Whilst a holistic approach is positive this model has been criticised for philosophical flaws meaning it does not achieve its aims of holism</a> and theoretical underdevelopment to the point that any condition can be attributed to any cause subject to clinician bias.</a> Additionally, it has faced criticism for its justification of healthcare rationing</a> stemming from the expansion of psychiatry and psychosomatic medicine into other areas of medicine.
Simon Wessely co-authored versions of the biopsychosocial model</a> advocating behavioural interventions in treating postviral fatigue syndrome and ME</a>. He also suggested its potential use for other conditions with clear biological causes that have debilitating fatigue as a symptom</a>, including Multiple Sclerosis, Cancer and HIV. Wessely’s approach to the biopsychosocial model is clear in his work on the conditions discusssed above. The social, rather than considering social determinants of health</a> becomes social contagion via the media or “knowing someone else with the condition”. The biological is whatever is most useful to his aims i.e. in ME merely an initial infection, with the illness maintained psychologically. Yet in PTSD a possible genetic predisposition and the psychological is central to everything (except when psychological illness is claimed). Rather than a more plausible notion that a person’s mood may impact their physical illness, management of it and ability to cope, for Wessely mental states become the original cause of either the illness itself or its severity.
Wessely’s versions of the biopsychosocial model were highly influential on the Waddell and Aylward model, the second most widely known and influential version. In 2005, Mansel Aylward retired from his role at the DWP just after approving DWP funding for the PACE trial and began working as director of the then-new UnumProvident Psychosocial and Disability Research Centre</a> at Cardiff University. The centre, funded by UnumProvident insurance group, had close links with DWP civil servants and politicians. The DWP commissioned Mansel Aylward and Gordon Waddell, an orthopaedic surgeon and professor at the centre, for a report titled ‘The scientific and conceptual basis of incapacity benefits’, which laid the framework for the 2006 welfare reform bill</a>, which claimed to act in the interests of sick and disabled people by helping them into the labour market. This reinforced commonly held beliefs that disabled people who are unable to work are so due to internalised negative attitudes rather than impairment, fluctuating capabilities and the inaccessible nature of much available work. When this did not sufficiently reduce the number of claimants, it was combined with Gordon Waddell and Mansel Aylward's work on the biopsychosocial model to provide a theoretical framework to justify further welfare reform through the work capability assessment and the introduction of Employment and Support Allowance in addition to more recent pushes for further welfare reform.
Aylward and Waddell’s version of the model</a>, published in 2010, took Wessely's developments of the model even further, beyond other conditions with a fatigue element, and applied it to all disability and illnesses. Whilst both Engels's original version of the biopsychosocial model and Aylward and Wadell's version have faced strong criticism for their theoretical flaws and potential for abuse</a>. It is the Aylward and Waddell model, with its emphasis on the psychological component above others and a more explicit behaviouralist</a> lens of personal responsibility and blame for illness and disability severity, that is most pernicious. This version is a purposefully constructed model that serves an ideological agenda</a> that had, and continues to have, a detrimental impact on state policy pertaining to disabled people. This model laid the theoretical groundwork for justifying increased cuts to welfare spending in line with other austerity measures</a> and intensified the notion of work as a health outcome</a>. The health outcome of employment was also used as justification for the DWP's funding of the PACE trial.
Concerns for Trans Research Agendas</h1>
Once the notion of a patient group lacking credibility is in the public narrative it tends to stick, especially when this is ideologically useful and easily applied to other areas where a straightforward solution is lacking. Patients with Long Covid, a condition that, whilst it can include other more measurable symptoms, often has a similar symptom profile to ME, have been subject to the same disbelief and psychiatrisation. The government Covid-19 Inquiry session on Long Covid revealed that in 2020 Boris Johnson, who was still Prime Minister at the time, wrote ‘Bollocks this is Gulf War Syndrome Stuff'</a> on an expert report describing the condition and later made similar remarks on WhatsApp messages.</a> Simon Wessely has published on Long Covid</a>, been involved in Long Covid research webinars</a> and chaired panel discussions</a> for the REACT-Long Covid research study. Despite the widely discredited PACE trial, Simon Wessely has suggested functional disorder explanations and behavioural modification-based treatments for Long Covid research</a>. He also led a research project into the psychological impact of Covid-19</a> on healthcare workers. The published study found the incidence of PTSD and other mental health disorders in healthcare workers resulting from the pandemic to be lower than found in other UK studies</a>. This study has been criticised for the timings of the interviews (post-vaccination lower death rates and lifting of social restrictions)</a>, consideration of only three possible clinical disorders and non-inclusion of burnout, stress and moral injury, as well as a lack of longitudinal data.
We hope this history of serving ideological interests has not played a role in Wessely's appointment to the Young People’s Gender Dysphoria Research Oversight Board. However, given the widespread sharing of pseudoscientific social contagion theories and the discredited ROGD theory</a> by anti-trans actors, including clinicians, and the poor quality of the Cass review</a>, we are concerned about the quality and direction that research could take with Wessely's involvement and oversight. We view Wessely’s appointment in the context of the history of partisan appointments of others in positions of involvement and oversight in developing guidelines for gender care that have already created harmful levels of epistemic injustice. Transphobic actors also have a habit of weaponising sanism against trans people and patients, sometimes with eugenicist undertones</a>. They also often exhibit broader aspects of disablism.</a>
There appears to be a pattern of NHS bodies being populated by psychiatrists with a history of transphobia, institutional harm and undermining of patient groups. There is also a pattern of a lack of transparency in such appointments and in research practices and oversight. Trans Safety Network has previously reported on the appointment of anti-trans author and commentator Dr Az Hakeem to the NHS England Gender Dysphoria working group</a> that commissioned the NICE evidence reviews undertaken in 2020. We have also highlighted Carl Heneghan’s involvement with the same working group.</a> Heneghan appears to be an anti-vaccine activist who shared misinformation about the COVID-19 pandemic.
Combined with the recent revelation discovered via FOI requests that Dr Hilary Cass was selected from a group of one</a> to chair the review of children and young people’s gender identity service, we are concerned about the selection process of those overseeing trans healthcare policy. Dr Levy was also selected from a group of one</a> to conduct his review of adult trans services. Dr Cass has also spoken about alleged personal safety concerns</a>, disparaging an entire patient community with the alleged actions of a minority. Whilst any threats are unacceptable, there is a pattern of researchers who are challenged by the groups impacted by their harmful research claiming persecution by patient activists. Wessely’s history of pseudoscientific theorising, use of social contagion theory, undermining patient activism, and criticisms of NHS bodies that move away from his ideas means we must be vigilant and closely monitor the outcomes of his appointment to this role.
In Trans Safety Network’s opinion, there is a danger of Simon Wessely claiming that being trans is a form of socially contagious psychosomatic illness. The danger with this would be framing parental and clinical doubt as being in a child’s best interest. In trans and gender diverse youth, disbelief of this sort is linked to abusive conversion practices, such as cutting children and young people off from external support networks</a> or otherwise attempting to suppress gender exploration. We need transparency in trans healthcare research as well as in selection processes.

Chalmers GIC pauses all gender surgery referrals for under 25s, cites Cass review

2024-10-18T00:00:00+00:00


Trans Safety Network has been informed that the Chalmers GIC in Scotland has paused surgical referrals for under 25s, and for gender surgery conducted in England (vaginoplasty, masculinising top surgery, and phalloplasty/metiodoplasty</a>). The East Lothian Health and Social Care Partnership, which includes the Chalmers GIC, have stated in a letter to the MP of an affected patient that the pause in referrals for under 25s is a result of the Cass review. The Cass review did not review any evidence relating to surgical referrals in adults, or indeed any evidence relating to medical transition in over 18s.
In the letter, seen by TSN, NHS Lothian states that Referrals were paused from 2nd May 2024 and for those aged 25 and over will restart from 17th October 2024. There have been no public statements on this significant delay, despite the significant impact this will have on patients, many of whom have already waited years to be seen. For those aged 25 and over, the delay in referral will be approximately six months, but for those aged 18-24, referrals will not occur until a review of the referral process has been completed. NHS Lothian “hope to begin this piece of work shortly” but “do not yet have a timescale for this work”. For those under 25, this means that there is no available information on when it will be possible to join surgical waiting lists.
NHS Lothian states in the letter that this indefinite delay has been implemented as a direct result of the Cass review:
“In Scotland, the DCMO report, Cass Review - Implications for Scotland recommended that ‘Services in Scotland should review current transfer arrangements to ensure continuity of care and support over this potentially vulnerable period’. We understand that the reference to 17–25-year-olds was intended to refer to people up to their 25th birthday, i.e. up to the age of 24 years. In considering the wider implications of this recommendation and the Cass Review, NHS Lothian decided to review the service for those aged under 25 years at Lothian GIC. This process will assess the need for additional considerations and/or a different service design to provide the required continuity of care and support for those aged 18-24 years within adult gender services in Lothian. At the same time, the referral process will be reviewed in the light of the newly published NHS Scotland Gender Identity Healthcare Protocol and Gender Identity Healthcare Standards, published on 3rd September 2024, to establish what further developments and changes may be required to the existing assessment and referral process.”
It is unclear how an indefinite delay in surgical referral ensures “continuity of care and support” for under 25s, and NHS Lothian acknowledges that they are “aware of the potential impact of this pause on the mental health of patients awaiting assessment and referral for gender affirming surgery.” Despite this, patients were not provided with detailed information about the pause until the 13th of September, more than four months after referrals were paused.
Trans Safety Network are deeply concerned about the Chalmers GIC’s lack of transparency with patients around this decision. NHS Lothian states “The clinical team have responded to queries from individual patients and from 13th September have been provided with detailed information about the pause to share with those attending the clinic. Those contacting the clinic have been referred to a clinician for discussion and direct support.” This seems to indicate that affected patients are not being informed or provided with support unless they inquire about why their surgical referral is taking longer than expected or are attending an appointment. Prior to the 13th of September they were apparently not even provided with detailed information.
The Chalmers GIC patient who shared these documents with TSN had to go via their MSP to obtain any information about why their referral was taking so long, and had difficulty getting through to the GIC on the phone. When they did get through, they had difficulty accessing the support NHS Lothian claims is available.
“I have been trying to talk to a clinician about this and have yet to do so, I was always told no one was immediately available and someone would phone me back.”
TSN contacted NHS Lothian for comment on the reasons for halting referrals while the review is ongoing, whether impact assessments were conducted, and whether there is a timescale for the review. They sent us the following comment:
“Earlier this year NHS Lothian paused referrals for gender-affirming surgery undertaken outside Scotland. This was to enable a review of our assessment and referral processes to ensure they were supported by good clinical governance and to enhance patient safety.
“From the 17 October 2024, referrals for gender-affirming surgery for people aged 25 and over restarted, with surgical assessments at the Chalmers GIC recommencing from 18 November 2024.
“Patients were provided with information on the pause during clinic appointments, but we apologise to anyone affected by the delay in assessment and referral.”
NHS Lothian have declined to explain the decision to pause referrals during the review, rather than continuing current practice and making any alterations after the review is completed. This will disadvantage NHS Lothian patients in comparison to patients at other GICS, as they will be further down already long surgical waiting lists.
Trans Safety Network are extremely concerned by this development, which restricts care for under 25s indefinitely, with no clear evidentiary basis for the decision. We are further concerned that this has been done without clear public communication with current patients and those on the waiting list. NHS Lothian’s failure to define a timescale for the review leaves trans people, many of whom will have already spent years on NHS waiting lists, in limbo with no information about when they will be able to join surgical waiting lists.
We understand that this news is likely to be distressing for those affected, please contact one of the organisations listed below if you are struggling.
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Helen Joyce reveals plans to use fears around trans kids as stepping stone to eliminate “trans” in public life

2024-10-11T00:00:00+00:00

In a speech given to a conference in Lisbon held by anti-trans conversion therapy lobbying group Genspect, Sex Matters director Helen Joyce discussed a campaigning roadmap</a> to “a total end to the trans child”, and then following on from that the abolition of the concept and practice of transition among adults:

First in places where there’s someone who knows who everyone is and who has a duty of care – for example, prisons and workplaces. And then in other spaces too, because if men can’t use the women’s toilets at work, then why on earth are we letting them do so in the shopping centre?” </blockquote>
In the speech, Joyce lays out her motivations for a step by step campaign to radicalise society against transition, how to work around the empathy people have for trans people in society, and use existing concerns to lead them along a path to total exclusion.

They think doctors are screening out chancers and that “transition” means something – they use expressions like “if they’ve gone through the change” or “if they’ve had the operation” or “if they've fully transitioned”. An increasing number know someone trans or someone who has a trans-identifying child, and they clearly don’t want to get in any sort of argument with them. They may feel personal sympathy.
But there are two topics where people are almost automatically where we want them to be, and those are child gender medicine and sports. </blockquote>
Joyce acknowledges that puberty blockers are not and have not been being prescribed in large numbers, and instead emphasises a quite cynical and propagandist relevance for these as campaigning talking points saying:

This is the real importance of the UK’s ban on puberty blockers. They’re not really a serious treatment option in the UK – I don’t think more than hundreds of kids have taken them, certainly not more than a few thousand. What they are is a rhetorical and argumentative device. …
[T]o someone good and well-meaning working within medicine – someone like, say, an endocrinologist or child psychiatrist who has severe reservations about what’s happening in gender clinics but hasn’t freed their mind from the idea of the “transgender child” or “transition” – that seems like extremism. So it’s tempting, and probably essential, to work step by step. But the story of safeguarding failures shows that’s a big problem too. </blockquote>
This isn’t the first time Joyce has expressed a desire to eliminate trans people and trans recognition out of society. In summer of 2022, she appeared on a podcast where she appeared to promote a campaign of eugenics against trans people, called “reducing or keeping down the number</a> of people who transition” and described trans people as a “huge problem for a sane world”.
As well as being a director of advocacy at anti-trans charity Sex Matters, Helen Joyce is also the author of the book “Trans: When Ideology Meets Reality”. This was widely criticised on release for appearing to parrot antisemitic conspiracy</a> themes originating with gender critical author Jennifer Bilek. Philospher Christa Peterson said</a> the book “claims the trans “global agenda” is “shaped” by three Jewish billionaires”1</a>. Legal scholar Alex Sharpe reviewing the book</a> said it would “have been wiser and more balanced to have given more thought to the selection of wealthy funders” listing a number of non-Jewish philanthropists who were overlooked for Joyce’s book. Although Joyce deleted tweets encouraging fans to follow Bilek's work in the run up to her book, archive copies</a> surfaced online where she said “Details in my book! But in the meantime have a look at Jennifer Bilek’s pieces about the billionaire funders of transactivism”. Joyce has refuted</a> any link to Bilek’s work. However Bilek herself claims that Joyce interviewed her</a> in 2020 while she was writing it and accused Joyce of plagiarism when the book was released.
Compatible with democratic human rights?</h1>
Much has been made of the claim that gender critical views are “worthy of respect in a democratic society”. What this means in lay terms, is that in a liberal democracy such as the UK, it must be acceptable to have a diversity of views on important matters so long as they do not cross a line into being totalitarian and degrading the rights of others, following what are called the “Grainger Criteria</a>”. In the United Kingdom, especially following Forstater v CGD</a>, but also previously in cases such as Asher’s Bakery</a>, this has been interpreted liberally to include protection of potentially offensive views, so long as they do not cross over into actual practices of harassment or discrimination. That is to say, it is okay for a person’s sincerely held religious or philosophical beliefs to be protected even if others might find these offensive. A Christian baker does not have to make a cake celebrating same sex marriage when their religious beliefs hold that marriage is a religious institution involving a man and a woman rather than secular one. Similarly, a gender critical person can not be required to act against their belief that sex is immutable, real, and not to be confused with gender identity.
However, this protection is not a free pass to discriminate against other human rights. Lesbian, gay, bisexual and trans people are protected in British law from discrimination, under the categories of “sexual orientation” and “gender reassignment”. A Christian may refuse to write something on a cake they don’t believe in but they are not allowed to discriminate in general against gay people in service provision, for example in healthcare or retail more generally. A gender critical person is not (as was shown in the Mackareth case</a>) allowed to blanketly disrespect trans people who are using services they are working for by refusing to acknowledge their gender identity on the basis of their beliefs.
Trans Safety Network believe that while the Forstater case showed that Gender Critical views can be legally “worthy of respect” in limited circumstances, public bodies and institutions need to be aware that the leaders of key gender critical campaigning bodies like Sex Matters are openly laying out plans for the abolition of trans people’s civil rights. This at odds with the principle in human rights law that human rights are “universal and inalienable; indivisible; interdependent and interrelated</a>”. What gender critical activists are doing is working, as they openly say in speeches like Helen Joyce’s above, not to foster good relations of human rights protections between different groups, but instead to cynically create and amplify divisions between them, using cracks as points of leverage rather than points of healing, in order to abolish the entire construct.
^1
One of the three billionaires mentioned in Joyce’s book Trans is not Jewish, but is widely alleged to be Jewish, by antisemitic conspiracy theorists peddling theories about Jewish funding behind the trans agenda. We have quoted Christa’s words verbatim, and understand that this detail is likely an elision likely due to the short post format of Twitter. See for example this screenshot</a> from the conspiracy theorist blogosphere describing him as a gay Jew foisting Gender Dysphoria on society as part of a conspiracy by Cabalist Jews, using Bilek’s work. Nevertheless, the same group of 3 wealthy philanthropists - George Soros, Jennifer Pritzker and Jon Stryker - as are routinely targeted as a Jewish conspiratorial "cabal", are the villains of Joyce’s book as they are in Bilek’s writing, which Joyce promoted in the run up to her own book. Elsewhere neonazi writers have praised</a> Bilek’s single-minded focus on Jewish, or allegedly Jewish funders to the exclusion of others, and Bilek has expressed appreciation</a> of neonazi authors on the subject too. We are not alleging that Joyce is an antisemite, but we are highlighting the way that her work has facilitated antisemitic conspiracy theories about the source of funding of what she calls "gender ideology" into the mainstream. This is important contextually to understanding the ways that attacks on trans rights are both reliant on, and help accelerate wider attacks on dignity and human rights of other protected characteristics, whether intentionally or otherwise. </div>

New Draft EHRC Code of Practice shows a concerning shift in priorities

2024-10-07T00:00:00+00:00


The Equality and Human Rights Commission</a> (EHRC), the body responsible for promoting and enforcing equality law in the UK, has launched a consultation</a> on changes to its Code of practice for services, public functions and associations, as part of the consultation, a draft version of the code</a> has been published. On reviewing the draft code and comparing to the version currently in force</a>, published in 2011, Trans Safety Network have noticed some concerning changes that may indicate shifts in the EHRC’s priorities. Among the changes, we note that:

The draft code provides much fewer examples of unlawful discrimination against trans people. The current version of the code provides seven examples of unlawful gender reassignment discrimination by our count, all but one of these examples has been removed or changed to refer to other protected characteristics in the draft code, with only one new example added. This includes removing examples of discrimination by association and perception against cis women who support trans rights and cis women who are misidentified as trans.</li>
In the draft code’s section on exceptions for single-sex spaces, emphasis has shifted from protecting the rights and dignity of trans people to “balancing” trans people’s rights to equal access to public services and spaces against imagined conflicts of rights. Language that upholds trans people’s legal rights has been removed from the chapter at various points.</li>
While we welcome the draft code’s recognition that at least some nonbinary trans people have the protected characteristic of gender reassignment, the draft code strongly implies that some do not and shows a worrying lack of clarity on when this is the case.</li>
In the section of the draft code on religion and belief undue weight has been lent to the protection of “gender critical” beliefs with no detail on other political and philosophical beliefs that constitute a protected characteristic under the Equality Act 2010.</li> </ul>
As documented extensively in past TSN reporting, the EHRC has been the subject of a great deal of concern in recent years with respect to its relationship to anti-trans organisations</a>, interventions in policy debate about gender recognition law</a> and increasing bias against trans rights</a>. In this context, it is our view that the proposed changes to the code of practice reflect institutional transphobia and a lack of interest in enforcing trans people’s legal rights.
What is the Code of Practice?</h1>
Under the Equality Act there are 9 protected characteristics, 8 of which are covered by the Code of practice for services, public functions and associations (age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, sex and sexual orientation), the act protects people from discrimination or harassment because of these characteristics. Trans people have the protected characteristic of gender reassignment</a>, which refers to any person who “is proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person's sex.” For the purposes of the Equality Act, gender reassignment need not necessarily involve any medical procedure and includes non-medical forms of transition such as changes of pronouns, name or presentation. This means that it is unlawful for providers of services and public functions to discriminate against trans people, for example by refusing to serve trans people or providing us with a poorer quality of service because we are trans.
The Code of practice for services, public functions and associations is a document published by the Equality and Human Rights Commission that gives guidance to organisations providing services, public functions and associations on their obligations under the Equality Act. The code provides definitions of the various protected characteristics, who has those characteristics, what constitutes discrimination and harassment under the act (including some exceptions where discrimination is lawful) and how the act will be enforced. Because the EHRC is the statutory body which is responsible for enforcement of the Equality Act, this code of practice indicates the body’s priorities in terms of enforcement and can be used as evidence in court, although it is not in itself an “authoritative statement of the law</a>.”
Changes to examples</h1>
Both versions of the code of practice feature examples to illustrate how the code should be applied. While these examples are not the letter of the code, they provide organisations with context for how to apply the code and reflect what the EHRC recognises as lawful or unlawful in its role as promoter and enforcer of equality law.
Several examples in relation to gender reassignment discrimination from the current code of practice either do not appear in the new draft code, have been altered to refer to other protected characteristics or have otherwise been significantly changed. While these changes do not mean that gender reassignment discrimination as described would be lawful or within the letter of the code, the removals suggest that the EHRC sees gender reassignment discrimination as less of a priority than it did in 2011 and leaves organisations using the code to shape policy and procedures with fewer examples to prompt them towards respecting and upholding trans people’s legal rights. What follows is not an exhaustive list of all problematic changes with examples in the draft code, but a series of illustrations of the issues.
Some of the removed examples refer to crucial matters such as the right to equal treatment by public bodies (in chapter 11) and trans people’s use of public facilities (in chapter 13). We would urge the EHRC to restore these examples because they constitute clear guidance to organisations about our legal rights, which we note remain unchanged on these matters.

In a section of chapter 2 of the code of practice explaining the status of “cross dressing” (wearing clothing stereotypically associated with another gender) with respect to gender reassignment, the example given has been significant pared down in the new draft. Where the current example given clarifies both where “cross dressing” is protected by the law and where it isn’t, the new draft code only gives a clear example of were it is not legally protected. This is insufficient for giving organisations the full context of the law. Beyond the legal issues, TSN would also argue that no organisation should seek to police the gender presentation of people using their services and it is more important to highlight to organisations the legal risks of committing unlawful gender reassignment discrimination than to functionally give permission to police gender presentation in certain circumstances.

In the sections of chapter 4 of the code of practice explaining discrimination by association (where a person is discriminated against because they are associated with a person or people with a protected characteristic) and by perception (where a person is discriminated against because they are misidentified as having a protected characteristic), examples that relate to gender reassignment have been completely excised in the new draft code. The removed examples refer to a cis woman ally being discriminated against by a tennis club for supporting trans people and a cis woman “with a medical condition that makes her appear ‘masculine’” being discriminated against because she was perceived as trans. This is of considerable concern given recent, high profile examples of extreme harassment</a> of cis women who vocally support trans people</a>, the harassment of cis women in sports who have been misidentified by some as trans women</a> both at professional</a> and amateur</a> levels and the large number of recent examples of cis women being misidentifed as trans due to gender nonconformity</a> or medical conditions</a> and harassed while using women’s public toilets</a>. In the current atmosphere of increased anti-trans hostility</a> cis women who are associated with trans communities by speaking out for us or who may be misidentified as trans women are at real risk of experiencing unlawful discrimination, harassment and victimisation of exactly the sort described in the removed examples. TSN would further note that discrimination of this form may disproportionately affect LGB women, disabled women and intersex women and should be of interest to the EHRC because it exists in the intersection of a number of protected characteristics (gender reassignment, sex, sexual orientation and disability).

In one case, an example in chapter 4 of the code using the case of a trans woman treated less favourably in a restaurant has been changed to refer to a lesbian couple. In another, an example in chapter 8 of the code of when misgendering a trans woman can constitute harassment has been changed, also to refer to sexual orientation instead of gender reassignment. While TSN supports the legal right of LGB people to live free from harassment and discrimination, we are concerned by these changes in the context of the removals of other examples of unlawful anti-trans discrimination.


Exceptions for single-sex services and sports</h1>
The Equality Act contains a number of exceptions, situations where actions that would typically be unlawful under the act are allowable, these are discussed in chapter 13 of the code. The sections of this chapter of the new draft code on exceptions for single-sex services and sports have seen changes to the letter of the code and its emphasis.
The current version of the code of practice clearly and repeatedly emphasises the importance of trans people’s rights, safety and dignity, explicitly stating that when making decisions regarding trans people’s use of single sex spaces “The intention is to ensure that the transsexual person is treated in a way that best meets their needs” (paragraph 13.58) and that “the denial of a service to a transsexual person should only occur in exceptional circumstances” (paragraph 13.60). The current version of the code this section repeats the earlier call for exceptions to equality law to be applied “as restrictively as possible” (paragraph 13.60, repeating language from paragraph 13.2), the new draft code avoids reminding organisations of this when it comes to trans people’s rights, despite the earlier call for exceptions to be applied restrictively still appearing earlier in the chapter, now in paragraph 13.4.
Language upholding the rights of trans people has been largely removed from the new draft code, with a new emphasis placed on the basis on which trans people may be denied appropriate access to single-sex services. Where the current version of the code contains an example of a clothes shop lawfully deciding that changing rooms should be trans inclusive, the new draft version instead includes two examples, one of a dangerous and violent trans woman prisoner who must be housed in the male estate and one of a vulnerable elderly trans woman whose own right to single-sex care must apparently be balanced against the wishes of cis service users with no clear conclusion given. While in both versions the code is clear that trans people should be treated as the “gender in which they present” barring a strong justification for doing so, the new draft code seems heavily slanted away from the rights of trans people and towards providing organisations with justifications for blanket trans exclusion. TSN would reiterate that no part of the law with respect to single-sex spaces has in fact been changed.
In a concerning move, language stating that trans people may require use of medical services typically reserved for their assigned gender at birth, using the example of trans men’s access to cancer screening and gynecological services, has been removed altogether and neither version of the guidance discusses trans women’s access to breast cancer screening, despite comparable risk between the two groups</a>. Trans people’s health needs with respect to “sex specific” healthcare are complex and the NHS’ failure to adequately account for these needs is a source of serious healthcare inequalities</a>. TSN are concerned by the EHRC’s failure to address this in a code of practice that claims to clarify rights in service provision.
The section of chapter 13 that deals with gender reassignment and single-sex sports has seen similar changes. Where the current version of the code of practice states that exclusion of trans people from single-sex sports is lawful “if this is necessary in a particular case to secure fair competition or the safety of other competitors” (current code of practice, paragraph 13.45, emphasis added by TSN), the new draft code of practice states that such exclusion can be lawful “where an average person of one sex is at a disadvantage compared to an average person of the other sex” (new draft code of practice, paragraph 13.69). This change, moving the grounds for exclusion from a case by case basis to general exclusions based on averages derived from cisgender athletes, is a backwards step in the EHRC’s recognition of trans people’s right to participate in sports.
Lack of clarity on nonbinary and genderfluid people’s legal rights</h1>
In chapter 2 of the new draft code of practice, which provides definitions of the 8 protected characteristics under the Equality Act, paragraphs 2.42-2.43 provide some recognition of nonbinary and genderfluid trans people. This is not present in the current version of the code of practice. However the draft code caveats this protection of rights, saying that:

People with non-binary or gender fluid identities will only be protected if they meet the definition of gender reassignment as set out in the Act - EHRC, draft Code of practice for services, public functions and associations, chapter 2</a>, paragraph 2.42 </blockquote>
The draft code goes on to give the example of a person who is genderfluid in the sense that “they are transitioning from one sex to another and on some days they will present as female and on other days as male,” outlining an example of unlawful gender reassignment discrimination against such a person, this is the only new example of clear gender reassignment discrimination added to the draft code. The exact criteria necessary for a nonbinary or genderfluid person to meet the EHRC’s criteria is not made explicit and, with the example given, these paragraphs could be read as suggesting that genderfluid and nonbinary people who do not see their identity as an intermediate stage in a binary transition do not have the protected characteristic of gender reassignment. Such a reading would be at odds with the ruling in Taylor v Jaguar Land Rover</a>, a case where a genderfluid trans person made a successful claim for discrimination on the basis that she was genderfluid, in which the tribunal found that the clear intent of the Equality Act was that nonbinary and fluid modes of transition were covered by the language of the act, stating:

it was very clear that Parliament intended gender reassignment to be a spectrum moving away from birth sex, and that a person could be at any point on that spectrum. That would be so, whether they described themselves as “non-binary” i.e. not at point A or point Z, “gender fluid” i.e. at different places between point A and point Z at different times, or “transitioning” i.e. moving from point A, but not necessarily ending at point Z, where A and Z are biological sex. - Employment Judge Hughes, Ms R Taylor v Jaguar Land Rover Ltd - Reasons</a>, paragraph 178 [emphasis added by TSN] </blockquote>
While TSN welcomes the EHRC’s recognition that at least some nonbinary and genderfluid people have the protected characteristic of gender reassignment, the way in which this is phrased and the example given appear, in TSN’s opinion, to be at odds with case law. As it stands the draft code of practice fails in its stated aim to give clear guidance on the law and could mislead a service provider into believing it was entitled to discriminate against some nonbinary or genderfluid people.
Religion or belief</h1>
The section of chapter 2 of the code on the protected characteristic of religion or belief contains a subsection on manifestation of religion or belief. This subsection is largely unchanged from the current code of practice other than the addition of “expressing gender critical views online” to a list of examples of manifestation of religion or belief (paragraph 2.78).
The addition of the expression of gender critical views to the list is notable because it is the only reference to a set of political beliefs made in the list. In the context of other changes to the code that indicate a lack of interest in defending trans people’s legal rights the addition of expression of a set of beliefs regarded by some</a> as a set of dogwhistles for transphobia but not, e.g. belief in climate change</a> (at issue in the case that gave rise to the Grainger criteria</a> often cited in legal cases relating to religion or belief), support for Scottish independence</a> or ethical veganism</a>, could be read as suggesting a particular ideological slant. We would further note that the expression of “gender critical views” is not absolutely protected and whether any specific case of gender critical views constitutes a protected characteristic will depend on whether the views being manifested meet the Grainger criteria.
Positive developments</h1>
Despite a number of serious concerns outlined above, TSN would like to note some positives about the draft guidance. Some of these are positive aspects of the current code of practice that are retained in the new draft version, while others are new, positive developments.

The one example of unlawful gender reassignment discrimination retained from the current code of practice is one that clearly shows that employers have a duty to act to prevent their employees from discriminating against trans service users. In light of several recent high profile legal cases in which school employees have sought protection for discriminating against and mistreating trans students</a>, this recognition of the duty of employers to protect trans people from discriminatory conduct is welcome.</li>
The new draft code of practice repeatedly emphasises that a trans person need not have a gender recognition certificate (GRC) to have the protected characteristic of gender reassignment (paragraph 2.47). The draft code also states that excluding trans people from single-sex services without good reason is unlawful “whether the person has a GRC or not” (paragraph 13.113).</li>
The segment of chapter 4 on discrimination because of pregnancy and maternity now includes an acknowledgement that trans men “could also experience pregnancy and maternity” (paragraph 4.54).</li>
Language protecting the rights of trans children and young people in chapter 2 of the code of practice has been strengthened. The new draft guidance plainly states that “There is no minimum age for the protected characteristic of gender reassignment” (paragraph 2.41). This clear statement that trans youth have a legal right to the protections of the Equality Act is vital in the context of both the Department for Education</a> (in draft RHSE guidance) and the NHS</a> (in response to a legal challenge from Good Law Project) recently having falsely claimed otherwise.</li> </ul>
These positive aspects of the new draft code are useful and important. However TSN remain seriously concerned about the wider issues of the new draft code downplaying the legal rights of trans people. Human rights are not a “balancing act” but a legal tool that can be used to protect minority groups against hostile action by state actors and companies.
Editorial note: A previous version of this article incorrectly stated that there are 8 protected characteristics under the Equality Act 2010. There are 9 protected characteristics, one of which (marriage and civil partnership) is not covered by the code of practice discussed in this article.

For Women Scotland and Sex Matters advisor appear to confirm intention to target individual trans athletes

2024-10-06T00:00:00+00:00

Following revelations this week that gender critical charity Sex Matters were joining For Women Scotland’s sports campaign in launching a campaign to “map” trans women participating in women's sport there was a degree of public backpedalling by some, suggesting that this campaign was simply looking for teams and organisations which allow trans women's participation rather than creating an illegal database of trans individuals. 
However, further investigation makes it clear that both Sex Matters’ sport advisor Mara Yamauchi and FWS Scotland are clear that the intention of this campaign is to catalogue members of a vulnerable minority in particular participating in women's sport in general.
A few days ago on October 1st, Mara Yamauchi said “do you know of males competing in the female category in sport? Please tell FWSSport and Sex Matters about them - who they are, which sports, how many positions, medals etc they've stolen from females & injuries they've caused”.
Following this up, FWS Sport campaign on Friday 4th October responded thanking one anonymous supporter calling for a hunt for “Warlocks lurking in our midst. Ladies, if you know of a dude trying to hide in plain sight in women's sport, pass it on!”
There can be absolutely no doubt — this is not a debate over sports governance and policy, this is a targeted campaign to draw up watchlists hunting members of a minority characteristic. The followers and supporters of these GC organisations clearly understand this from their response to the call to action and the organisations themselves are thanking people for carrying this witch hunt out.
For trans people, this campaign represents an escalation from a pretence by GC activists of “reasonable concerns” compatible with human rights to differing beliefs in a democratic society into the territory of privacy invasion and attacks on human dignity of trans athletes and their access to sports.

Gender Critical organisations launch witch hunt for trans women in sport

2024-10-04T00:00:00+00:00

Gender critical organisations Sex Matters and For Women Scotland have launched a witch hunt to identify and map the identities of trans women participating in women’s sport around the United Kingdom. These groups call trans women “trans identified males” due to their “gender critical beliefs” objecting to trans women’s identities. This is generally considered offensive.

This is a clear violation of the privacy and dignity of women who will be targeted. Previous outings of trans women in women's sports have also empowered large online harassment campaigns targetting teams in which they play. We saw only this summer how rumours disseminated through gender critical activist groups can result in misidentification, and dangerous global hate campaigns</a> targeting women rumoured to be transgender within women’s sports. In the UK, previous hate campaigns have targetted trans women in football</a> causing match cancellations, and a cisgender woman who ran a marathon who was targetted by a massive hate campaign</a> orchestrated through Gender Critical social media network Mumsnet</a> (with threads organising this harassment and apologising for it later deleted after the fact).
To our knowledge, there are no known trans women playing in the highest level of any popular sport in the UK. All women’s sport in the UK is underfunded, but the harassment this campaign will inevitably stir up is most likely to impact grass roots women’s sports teams and organisations who lack the resources to deal with the security concerns that result from the abuse that follows.
Trans Safety Network call on all British sports governing bodies and anyone involved in organising women's sports to take a visible public stance against this clear threat to sport and its participants.

I'm scared to go back: Trans woman mistreated at Welsh NHS hospital

2024-08-02T00:00:00+00:00


A trans woman (referred to here as A for her privacy and dignity) has come forward to discuss the transphobic discrimination she experienced while attempting to access emergency healthcare on the NHS that left her with “zero trust with hospital emergency care” and “scared to go back” in future. A was admitted to an NHS Wales hospital in June of this year with a spontaneous haemotoma on her leg which left her in severe pain and unable to walk. Throughout most of her 12 day stay at the hospital, A remained in a bed in a corridor in A&E, before eventually being admitted to a side room on the final night. A’s account of her stay describes a disturbing lack of regard for her dignity and well-being and repeated misgendering by a member of nursing staff.
Inappropriate placement</h1>
Despite a lengthy hospital stay, at no point was A ever admitted to a ward for treatment, instead being treated in a hospital corridor. While this is an increasingly common issue in NHS hospitals</a> due to capacity issues, it is noteworthy that this state of affairs continued for over a week in A’s case. While A described the hospital as extremely busy, she noted that “other people needing to stay were taken to wards within a few days.” It seems possible in the context of increasingly hostile public discourse and proposed policy</a> on trans women’s treatment in hospitals that A’s status as a trans woman played a role in the decision to keep her in A&E while other patients were moved to wards.
Neglect and lack of dignity</h1>
For the first 9 days of her hospital stay during examinations, A was not provided with a privacy screen or any other means of maintaining her privacy from other patients and visitors to the hospital, instead having to be examined by doctors in a state of partial undress in full view in the corridor. One member of the hospital nursing staff repeatedly misgendered A within her earshot while speaking to other staff, despite staff having been made aware that this would cause A distress while already in significant pain and discomfort. A reported that while in severe pain, the same member of staff left her without pain relief for an hour and a half after being asked.
This treatment left A feeling that she did not receive the same quality of care that a cisgender patient would have.
“Scared to go back”</h1>
A was eventually discharged from hospital with a referral to secondary services, but was left still struggling to manage at home and has been unable to carry out basic self-care due to the inaccessibility of her home and the effects of her impaired mobility. A has expressed reluctance to seek help from the NHS in future, saying “I'm scared to go back, and I know I won't get cis patient levels of service.”
In TransActual’s 2021 Trans Lives survey</a>, 70% of trans people responding reported being impacted by transphobia while accessing general healthcare, with 57% of trans people reporting that they avoid seeking healthcare when ill. Transphobia in healthcare not only harms trans people through direct experience of mistreatment, but harms our ability to trust health services and drives a lack of engagement with services that may endanger our health.
Earlier this year, then Shadow Health Secretary and current Health Secretary Wes Streeting expressed a view that trans people should not be admitted to single sex hospital wards but instead admitted to “suitable, safe accommodation</a>,” effectively advocating for segregation of trans patients within NHS hospitals despite a total lack of evidence</a> of any serious issues arising from treatment of trans patients in appropriate single sex wards. Many in the trans community have expressed concern that segregation of the sort proposed by Streeting could result in harm to trans people, both in terms of our stigmatisation and in terms of the quality of care that we receive. A’s case, alongside other cases such as an alleged incident described by Translucent where a trans woman in a side room died</a> due to the staff’s inability to get a cardiac arrest trolley into her room suggest that these fears are well founded and if segregation were made official policy, serious harm or even deaths could result.
In a statement, a health board executive said that they are unable to comment on individual cases, but that they are “sorry to hear if a patient has not had a positive experience” and claim to have provided relevant diversity and inclusion training to staff. The health board claimed that staff are expected to be “non-judgemental” and “sensitive to the individual needs of all patients and service users and provide dignified care and treatment to all,” however it is clear that in A’s case this did not take place in practice.

Royal College of Psychiatry International Congress: Questions about trans health suppressed

2024-07-05T00:00:00+00:00


Following concerns raised about panels at the Royal College of Psychiatry (RCPsych) International Congress</a>, Trans Safety Network has seen evidence that submitted questions about issues with the evidence base and ethics of claims made by panelists about trans healthcare, conflicts of interests in the panel and exclusion of trans lived experience voices have been suppressed by the organisation.
According to a source who attended the conference, questions for the session “Treatment of gender dysphoria in children and adolescents: a review of the evidence base” were required to be submitted via an online form, with attendees able to vote for the best questions. Over 40 such questions were allegedly deleted from the website without explanation, this meant that not only were the questions not put to panelists, but no record of the questions being asked remained. One online attendee captured screenshots of the deleted comments and contacted Trans Safety Network with concerns about their deletion.
Questions of evidence</h1>
A number of the deleted questions related specifically to questions of evidence and methodology, some specifically with respect to the Cass Review.
"The Cass Review dismisses 48% of the research on puberty blockers as being low quality. It then cites as length research on mice, not replicated in humans and which used no puberty blockers to justify okay [sic] withholding them. This has led to international criticism that the research evidence was cherry picked. Is this criticism accurate?"
"What were [sic] the hypothesis for the demographic discrepancy from what was expected to what was seen?""
Other questions related to evidence on broader issues of trans young people’s mental health, for example one question asked the panel how researchers whether research on the affects of hormonal interventions on mental health adequately controlled for experienced of minority stress and transphobic discrimination.
"You state research shows that those who have significant psychosocial issues prior to starting hormonal therapy and prior to gender questioning, mental health did not with hormonal interventions - were these results adjusted for other factors that contribute to the mental health of trans people, including minority stress, discrimination, family issues, etc?"
"Could trauma which is caused by invalidation and having to develop secondary sexual characteristic [sic] also affect development of executive functioning"
Another deleted question asked whether there was high quality evidence to support “exploratory psychotherapy” as an alternative to medical transition.
"For how long is exploratory psychotherapy expected to last for the clinician to be certain of the child's enduring gender identity? What is the evidence basis for this approach compared to WPATH approach? Is it high quality?"
These questions appear to be examples of legitimate academic enquiry about the data used by a panel claiming to present “a review of the evidence base” in an area of medicine. We find it concerning in the extreme if RCPsych were preventing difficult questions of evidence from being asked while presenting themselves as taking an evidence based approach. The question of the evidence base for the Cass Review Final Report in particular is crucial at a time when the report is shaping NHS policy despite substantial issues with the report’s methodology</a> and evidence base</a> being raised, as summarised in a compilation of criticisms of the review</a> by academic Ruth Pearce.
Ethical issues</h1>
Some of the deleted questions related to issues of professional practice and research ethics, with attendees seeking answers from panelists on issues of conversion therapy, the purpose of psychiatric practice in relation to trans lives and patient ownership over their own data. This, again, is concerning for a panel on any form of healthcare, where unethical practice can result in serious harm to patients and research participants.
"Memorandum of Understanding on Conversion Therapy in the UK v2, to which RCPysch is a signatory, makes it clear that conversion therapy in relation to gender identity and sexual orientation (including asexuality) is unethical, potentially harmful, and is not supported by evidence. Are gender exploratory therapy, CBT for gender dysphoria, and other experimental therapies for transgender children not also forms of conversion therapy?"
"People make decisions about their health and life in various ways that are potentially dangerous such as eating behaviours, substance misuse, radical sports... why not let people decide for themselves? Why is the power of decision with us when transgender is not a mental health condition?"
"Could Dr Biggs explain how the GDCs could have shared their confidential patient records with the Cass review without a complex process of gaining all their patient's consent, where the would have been a serious breach of GDPR? Would you be happy if your health records were shared for research/review purposes without your consent?"
"How was capcaity [sic] assessed for young person's participated [sic] in the research? What info was given to weigh up the risks ans [sic] benefits of treatment?"
Other questions related specifically to the ethics of the panel itself and it’s composition, with attendees questioning whether panelists had relevant expertise, conflicts of interest and relationships to anti-trans political activity, pertinent issues when dealing with questions of trans health.
"Could our speakers please declare their conflicts of interest which has been standard across all other talks at conference"
"Why has the Royal College chosen to invite Dr Biggs to speak today, who has no professional expertise in trans healthcare, but has made an anti-trans film for notorious anti-Semite and conspiracy theorist David Icke's streaming platform, and has been investigated by Oxford University for posting a large number of vile and transphobic tweets? Why have the other speakers chosen to share a platform with him today?"
"The ICD-11 and DSM-5 both now recognise that, like homosexuality before it, being transgender is not a mental illness. Why then do many organisations that the speakers today are involved with [such as SEGM, GENPECT and CAN-SG], as well as the Cass review, seem to view transition as a less desirable outcome than becoming cisgendered? Do the speakers also believe that being heterosexual is preferable to being homosexual? If not, then why is being transgender different?"
Undisclosed conflicts of interest</a> (situations where researchers have a financial or non-financial stake in the outcomes of research) are a serious ethical issue in academic research. It is entirely reasonable for conference attendees to ask for openness in this regard and such disclosures are the norm in scientific research. According to RCPsych policy</a> speakers at RCPsych events are required to disclose any conflicts of interest (also called “competing interests”) and that this should be declared on RCPsych’s website</a> at least one month before the event. The policy requires disclosure “if a secondary interest exists which could be construed by others as influencing the individual’s judgement” (emphasis added). At time of writing Trans Safety Network could not find any such disclosure on RCPsych’s website for this panel, despite clear evidence of a perception among some attendees at the event that conflicts of interest existed.
Exclusion of trans voices</h1>
Two deleted questions asked panelists about “the voice of lived experience.” This refers to the inclusion of patients and potential patients in research and professional debate about their treatment. One of the two questions suggested that this issue had been raised with panelists ahead of the event.
"Where is the voice of lived experience, to hear what they want and need from service providers?"
"Why did Dr Cornwall say no to having lived experience on the panel when invited to do so by the Congress organising committee?"
The inclusion of lived experience voices in healthcare research is a measure to protect the interests of patients. Given the extensive history of anti-trans conversion therapy by psychiatrists</a> and psychiatric violence</a> against trans people, this is a legitimate question to ask of a panel on trans healthcare. The question of trans people’s voice in decisions about us was also a key issue raised by Trans Kids Deserve Better at their recent protest at an NHS England building</a>.
Trans Safety Network has reached out to RCPsych for comment on the issues raised in this article, at time of writing they have not responded.

Trans Safety Network calls on NHS England to talk to desperate Trans Kids

2024-07-02T10:15:00+00:00

Trans Safety Network have sent a letter to NHS England demanding that they properly consult with the daring and desperate trans youth who have been compelled to scale the front of their offices in London. At the time of writing these young people have been on the side of the building for 3 days subsisting off supplies provided them by supporters passing by.
Dear NHS England,
We were moved when we heard that young trans people have scaled the front of your offices in Wellington House to speak out against the shutting out of their voices from CYP trans healthcare. We have been concerned for a long time now about the growing problems faced by CYP accessing gender related care under the NHS.
Despite the repeal of Bell v Tavistock you have nevertheless functionally shut down</a> most routes to gender affirming medical interventions. Despite the immediate</a> and still</a> mounting</a> damning expert critiques of the Cass Report, the NHS continues to suppress young trans people’s desires for their own futures and instead push “exploratory” approaches, training new gender dysphoria professionals using materials designed by educators who have recommended hate groups and conversion therapy pushers</a> to psychiatrist trainees working with children.
We call on NHS England to talk to TransKidsDeserveBetter</a> and to consult with other members of the affected patient cohort, to cease threatening families supporting trans children with safeguarding referrals, and to reinitiate a patient-centred approach rather than the ideological agenda of anti-trans activists who appear to have infiltrated NHS gender care</a> policy processes.
Sincerely,
Trans Safety Network

Kellie-Jay Keen harasses disabled activists at election hustings event

2024-07-02T00:00:00+00:00

Disabled activists at a hustings event were harassed and filmed. They had their harassment posted to social media without their permission by anti-trans campaigner Kellie-Jay Keen (also known as Posie Parker).
Keen posted a video showing herself harassing disabled attendees at the Bristol Deaf and Disabled Peoples Hustings</a> held at the Lantern Hall in Bristol on the 25th of June 2024. This event was organised by WECIL and multiple other Disabled People’s Organisations (organisations run by and for disabled people, often shortened to DPOs), including the DPO Forum England. It was live-streamed on Inclusion London’s YouTube channel.</a> This event was a chance for disabled people to question electoral candidates standing in the 2024 general election about their commitments to disabled people’s rights so people could be better placed to make an informed choice when voting in the upcoming election. A source that Trans Safety Network spoke to said that Keen had initially been made aware of the event but was not invited to speak on the panel. Keen filmed herself complaining throughout the event complaining about delays in being allowed entry and that the chair wouldn’t let her ask a question. 
According to Disability News Service, Keen was initially refused access due to concerns that she would disrupt the event. Disability News Service also reported that Keens supporters were `swamping the comments section of the YouTube live-stream of the hustings with demands for her to be allowed to join the panel.'</a>
Keen took issue with some audience members pointing out that they had the word ‘inclusion’ on their t-shirts and saying it is ‘dystopian’, ‘Kafkaesque’, and ‘nuts’. She appeared to suggest that not having a question taken regarding ‘women's rights’ is at odds with wearing t-shirts with the word inclusion on them. The word “Inclusion” is in the name of several DPOs, including Inclusion London and refers to disabled people's inclusion in society.
Keen continued to film and confront audience members. She then began shouting about women-only spaces and concerns that a trans person might give intimate care to a disabled person (although Keen chose to use person-first language</a>). 
Whilst Trans Safety Network support any disabled person's wish to have carers of whatever gender makes them most comfortable (a right that already exists in care provision), it is our view that Keen's concern is a non-issue raised as a distraction for her transphobic agenda. The Disabled Peoples Manifesto</a>, which was developed collectively by DPOs across England by the DPO Forum and was central to the kinds of questions asked of candidates at the event, has a big focus on social care provision, demanding a task force to facilitate community-based independent living, an end to social care charging and prioritisation of funding for community-based support because the current situation leaves so many with inadequate care or in significant debt. Keens ‘intervention’ is a motivated distraction from these vital concerns that are already being ignored by political party manifestos. Yet as Disability News Service reports, candidates appear to be making disability policies up.</a>
It is Trans Safety Networks' view that Keen’s concerns for disabled people are disingenuous and an excuse to spread her transphobic views. Disabled people and transgender people face many similar and overlapping issues concerning accessing medical care, demonisation from political actors, poverty and workplace harassment. Many of us are trans and disabled and face unwarranted and unfounded speculation from anti-trans activists as to the origins of our impairment and capacity to consent to healthcare, particularly when it comes to autistic trans people. This is an issue we have previously campaigned on, with the support of numerous DPOs</a> 
Keen has a substantial history of harassing disabled trans people online, including this example below, of the previously described transphobic and disablist tactic of singling out and reposting images of disabled trans people in a stigmatising manner, to make unfounded speculations that hormones are the cause of impairment. Ignoring the fact some trans people (as with any other demographic) happen to be disabled and have the same rights to bodily autonomy as anybody else.

Keen infantilises autistic adults, comparing them with children whilst portraying all autistic people as inherently vulnerable and incapable of making decisions about who they are and what healthcare options they wish to pursue.

Here, she attacks an autistic trans woman by referencing a disablist series of sketches that have been criticised in the past for promoting disablist tropes.</a>

The above examples of online harassment and her disruptive behaviour at the Bristol Deaf and Disabled Peoples hustings leave us with no doubt that Kellie-Jay Keens' alleged concern for disabled people is an insincere cover for her transphobic agenda.
Whilst some disabled people may agree with Keen's transphobic rhetoric, the majority of the Disabled Peoples Movement works in solidarity with others on the sharp end of societal bigotry and hostile government policy. In this case, people wanted to attend the hustings event in peace, as disabled people. Many of them were women seeking to question candidates about their political intentions regarding the rights of disabled people and were disappointed to find themselves harassed by attempts to hijack the movement's concerns.

Call to Action: Anti-trans lobbyists Speaking at the RCPsych international congress

2024-05-08T00:00:00+00:00

On 17-20 June the Royal College of Psychiatrists (RCPsych) will host their 2024 International Congress at the Edinburgh International Conference Centre. The conference programme lists several speakers associated with anti-trans lobbying and the promotion of conversion therapy.
An anti-trans panel</h1>
On Thursday 20 June, a session will take place titled ‘Treatment of gender dysphoria in children and adolescents: a review of the evidence base’. Most of the speakers have worked with SEGM, an anti-trans pseudoscience</a> thinktank associated with the promotion of conversion therapy</a>.

Dr Lenny Cornwall (chair), of Tees, Esk and Wear Valleys NHS Trust. Dr Cornwall lost a closely fought election to the RCPsych Board in 2023, after promising to “end RCPsych’s partnership with Stonewall</a>”. Cornwall is a member of CAN-SG</a>, an anti-trans pseudoscientific group who promoted conversion therapy in their launch webinar in October 2023</a>. He has actively opposed measures to support men and non-binary people in perinatal care, for example through supporting a campaign to cancel trans equality training for midwives</a>.</li>
Prof Riittakertu Kaltiala, of Tampere University, Finland and chief psychiatrist in the Adolescent Forensic unit at Tampere University Hospital. Prof Kaltiala spoke at SEGM’s 2023 conference and introduced Dr Hilary Cass to SEGM member Patrick Hunter</a>. The psychiatric unit at Tampere University Hospital has been accused of abusive practices by young trans people</a> and their families, including unnecessary gynecological tests, subjecting young people to inappropriate questions and recommendations regarding their sexual practices, and refusing to use young people’s names</a>.</li>
Dr Michael Biggs, of the University of Oxford. Dr Biggs has no specific expertise in trans healthcare, but has extensively engaged in anti-trans disinformation campaigns. He is an advisor to SEGM</a>, a member of the Board of Directors for the anti-trans group Sex Matters</a>, and has appeared in anti-trans film for Ickonic</a>, the streaming platform operated by notorious antisemite David Icke</a>. In 2018 Biggs was outed as the owner of a prolific transphobic troll account on Twitter</a>.</li>
Prof Sallie Baxendale, of University College London. Prof Baxendale has written for the anti-trans campaign group Transgender Trend</a>, and spoken at a conference organised by SEGM</a>.</li> </ul>
Keynotes from Dr Hilary Cass</h1>
The RCPSych Congress will also feature a keynote address from Dr Hilary Cass, chair of the Cass Review on Tuesday 19 June. Dr Cass will also speak at a later event titled “Everything you wanted to know about transgender health but were too afraid to ask”.
While the final report of the Cass Review has been warmly received by NHS bodies and UK politicians, it has been extensively critiqued by trans healthcare experts and researchers from a range of disciplines. Critics have highlighted methodological and ethical issues including inconsistent use of evidence</a>, the exclusion of research expertise or oversight from people with lived experience of gender services</a>, and collaboration with proponents of conversion therapy</a>.
Despite this preponderence of controversial figures on the speaking programme, we are not aware that any proponents of affirmative trans healthcare, let alone actual trans people, have been invited to speak to our own experiences at the RCPsych conference.
Speak out against transphobia in psychiatry</h1>
Contemporary anti-trans campaigns within medical science thrive on partial evidence, disinformation, and misleading expertise. In this context, it is easy for certain voices to be lost: specifically, people with actual lived experience of transition and gender services, and trans healthcare experts who have actually worked with and listened to trans people.
Echoing the rallying cry of the disability liberation movement, “nothing about us without us”, we encourage RCPsych conference organisers to reconsider the promotion of conversion practices and absence of trans expertise at their World Congress. We further encourage keynote speakers at the RCPsych Congress – including Dr Hilary Cass – to consider whether they wish to be associated with the dangerous ideologies and practices of groups such as SEGM and CAN-SG.
Readers wishing to lobby conference organisers and speakers may find the information in this post useful as a starting point.
Official contact details for the RCPsych International Congress 2024 are available here</a>.
Keynote speakers include:

Dr Lade Smith</li>
Professor John McGrath</li>
Professor Arnoud Arntz</li>
Dr Ramaswamy Viswanathan</li>
Professor Andrew McIntosh</li>
Dr Rebecca Lawrence</li>
Professor Ramalingam N Chithiramohan</li>
Professor Kenneth A Kaufman</li>
Professor Sophie Scott</li>
Professor John Strang</li>
Dr Hilary Cass</li>
Dr Humphrey Needham-Bennett</li>
Dr Rebecca Cooney</li>
Professor Dacher Keltner</li>
Judge Tim Eicke</li>
Professor Helen Killaspy</li> </ul>
If you choose to contact any of these individuals, please be courteous and provide relevant evidence: they may not be aware that various event attendees are associated with anti-trans groups, or may not initially understand how or why these groups pose a real risk of harm to trans people.

Did the NHS ever stop funding conversion therapy?

2024-05-07T00:00:00+00:00

Recommendation 3 of the Cass Review contains a smoking gun for conversion abuse in the NHS. One of the sources cited in support of the recommendation is a 2022 research article by a group of Tavistock clinicians describing their attempts to treat ‘gender-related distress’ with CBT (cognitive behavioural therapy). The authors take great pains to distinguish their approach from conversion therapy, but they nonetheless suggest that they may be able to help some young people ‘manage their distress without physical intervention.’ CBT-based conversion therapy in the NHS has a long, sordid, and little-known history. In the light of that history, both the Tavistock’s therapies and Cass’ recommendations look shockingly familiar.
CBT and Conversion Therapy</h1>
UK histories of conversion therapy often focus on the 1950s</a>, 60s</a> and 70s</a>, a time when the state notoriously worked closely with the NHS to force violent aversive therapies on gay men 1</a>. The decriminalisation of some gay sex did not, however, spell the end of NHS conversion therapy. While Clockwork Orange-style aversives fell out of favour with clinicians in the 1970s, new approaches took their place. One such approach was cognitive behavioural therapy 2</a>. The British Association for Behavioural and Cognitive Psychotherapies</a> (BABCP) was founded in 1972, and acts as the accrediting body for CBT therapists in the UK and Ireland. When, in 2022, the organisation celebrated its 50th birthday, the podcast Let’s Talk About CBT</a> held a retrospective, featuring several founding members of the organisation. One of the founders, Howard Lomas, reflected on how important the founding of the BABCP in 1972 was to CBT’s subsequent success. By the 1970s, behaviourism had lost its sparkle. “Behaviour therapy”, Lomas said, “was known very much as behaviour modification, which has got an involuntary feel about it.” Aversive behavioural therapy was “being used for trying to change homosexuality in people”. But following a “big scandal” at Napsbury Hospital and a major government enquiry, the BABCP came together and formed new good practice guidelines. Public backlash against aversive behaviour therapies had set the stage for something new - and as the years went by, CBT would become a perfect rebrand for the increasingly unpopular behaviourists. But the backlash was primarily against aversives, not against therapists trying to make patients straight and cisgender - and the new CBT had not given up on this.
“There’s a few things I think are real problems in the history of our therapy. And probably the one that stands out the most is the role of behaviour therapy predominantly in conversion therapy for people that are LGBT identities. And if you look back at conference proceedings from BABCP conferences 30, 40 years ago this was something that was seen as unproblematic.”
— Andrew Beck, former president of the British Association for Behavioural and Cognitive Psychotherapies, July 2022, on the Let’s Talk About CBT podcast</a>
In the 1980s, conversion therapy had a new look. Behaviourists had become cognitive behaviourists, and choice and flexibility were their watchwords. In 1986, seminal US sex therapist Helen Kaplan published an article</a> covering treatment options for ‘ego-dystonic homosexuality’.3</a> The piece opens: “The patient coming in with a dysphoria over his or her homosexual feelings, fantasies or behavior must be given the choice of working through the homophobia or the heterophobia”. If the patient chooses homosexuality, the treatment is simple - work on reducing shame. If, however, ‘a move toward greater heterosexuality is chosen’ then psychoanalysis, time-limited psychodynamic psychotherapy, and behavioural techniques may all be used. The goalposts had shifted, but the game remained the same. Aversives were a barbaric mistake of a past age, but ‘dysphoria’ over ‘homosexual feelings’ could be alleviated with CBT. Who wouldn’t want to alleviate a patient’s distress?
The same thing was happening in the UK, seemingly on the NHS. In 1987, Patricia Gillan published Sex Therapy Manual, to a glowing BABCP journal review</a>.
“Nowadays the attitude towards therapy for homosexuals has changed and the days of aversion therapy are more or less a thing of the past. [...] Nowadays, when a client wants to change his or her sexual orientation, other methods like ‘orgasmic reconditioning’ are used.
Orgasmic reconditioning methods are more flexible as at the end of therapy the homosexual can make a decision himself and remain totally homosexual or try bisexuality. He has a choice.”
— Patricia Gillan, Sex Therapy Manual, (Oxford, 1987), p. 29.
Sex Therapy Manual contains explicit instructions on how to do conversion therapy - but presents itself as a new, kinder therapeutic approach. Gillan’s book draws heavily on case studies from her work in Maudsley Hospital in London, where she co-founded the Maudsley Psychosexual Clinic with Michael Crowe. This clinic, now the Maudsley Psychosexual Service, still exists</a>. Both Gillan</a> and Crowe</a> have retired from public practice. If (as the evidence suggests) orgasmic reconditioning methods were offered for ego-dystonic homosexuality at the Maudsley in the 1980s, it is unclear when they stopped - unsurprisingly, they are no longer advertised as part of their service</a>. ‘Psychological support for people experiencing gender dysphoria’, however, is.
Third-wave CBT and Cass</h1>
Gillan’s Sex Therapy Manual gestured towards the possibility of unpathologised gay identity, but it did not extend the same courtesy to trans people. The closest it comes is in the introduction, where Gillan remarks that ‘transvestites’ (grouped here with exhibitionists) are ‘probably regarded with less fear than by previous generations’. The public, we are told, could be ‘beginning to think of them as sick rather than dangerous’. While ‘ego-dystonic sexual orientation’ was finally removed from the World Health Organisation’s International Classification of Diseases in 2019, ‘gender incongruence’ remains. Patient reports suggest that coercive therapeutic approaches were still being forced on trans patients in the NHS throughout the 2000s</a>. So how new is the CBT approach cited in the Cass Review?
The first mention of CBT in the review is in the section titled ‘Specialist Mental Health Conditions’, where ‘exposure-based cognitive behavioural therapy’ is raised as an effective treatment for Body Dysmorphic Disorder (BDD). The review reports that when a patient experiences ‘distress about genitalia or breasts’, it can be ‘difficult to determine whether the distress is due to BDD or gender dysphoria’. After a course of exposure therapy, some patients ‘say they no longer feel ill at ease with their birth-registered gender’, while others ‘may have less distress about their genitalia or breasts but still have marked gender incongruence and proceed to a social or medical gender transition’. Several things stand out here. First, as Elia Cugini has reported</a>, this is not a neutral approach: a trans life is being treated as something to be averted. Perhaps more strangely, this omits a relatively common outcome: CBT not working at all. Even the most positive reports of CBT efficacy for BDD don’t say it works for everyone - and previous studies have found efficacy rates between 46% and 60%</a>.4</a> The possibility of trans patients undergoing distressing exposure therapy</a> focused on their ‘genitalia or breasts’ to no discernible benefit is simply ignored. The source for this information makes this more concerning - this is drawing on what clinicians have told the review, presumably about their existing clinical practice. Have trans children already been subjected to exposure therapies focused on their genitals within the NHS, in the hope this might make them cis?
The Cass Review gestures, in its own way, at this question. Under ‘Current NHS Practice’, the report notes that while some patients in the service have had 1 or 2 appointments, some have had ‘in excess of 100’. The report concludes that ‘this indicates that some practitioners must have been providing therapeutic input to patients, despite the fact that there was not a formal structured programme in place.’ Even with the best-intentioned clinical team, a total lack of transparency is a recipe for abuse. The context of this therapy also points to an unusually extreme power imbalance between therapist and patient. Assessment, according to the report, ‘formed the starting point for a therapeutic relationship which could continue over many sessions’. The report goes on to link this informal therapy with denial of access to medical transition: ‘It appears that, for those young people for whom an endocrine option was not the best option, staff at GIDS were doing their best to provide ongoing support, perhaps because local services were not able to offer this’. Can patients meaningfully consent to therapy carried out under these circumstances? And what does therapy look like when the aims of the patient and the therapist are at odds?
“I am really glad that I didn't go on testosterone, because I realized during like my 17 sessions at GIDS that that wasn't for me.”
— Anonymised ‘young person’ from a lived experience focus group, Cass 11.32
What kinds of ‘ongoing support’ are unavailable through local NHS mental health services? The next point gives us a clue. Cass 11.33 refers to clinicians’ concerns that long waiting lists ‘can be a barrier to having exploratory discussions with children and young people that could provide them with a broader range of options for addressing their distress’. This language is eerily evocative of exploratory therapy</a>, a paradigm that is repeatedly defended in the Cass Review, and has been critiqued for its lack of specific parameters, ethical issues</a>, and material links to conversion therapy groups</a>.5</a> The report goes on to make the purpose of this therapeutic intervention explicit: ‘by the time young people are seen they have often made their minds up that an endocrine pathway is their chosen option and do not want to consider other approaches’. The Cass Review is concerned about the efficacy of these therapies, but not the risk of adverse effects, or the potential for abuse</a>.
Without formal structure or transparency, it’s hard to estimate the nature and extent of these therapies. We can, however, get some insight from the following paragraph, which contains the first and only reference to published research in this section:
“The Review also heard that some staff had looked at how standard evidence-based treatments (in this case third-wave CBT) could be used to help young people to manage their gender-related distress, stressing that this can be achieved without pathologising or changing a young person’s gender identity (Canvin 2022). However, this was not developed into a full research study.”
— Cass, 11.34
‘Gender-related distress’: the new ‘dysphoria over homosexual feelings</h1> The full title of the 2022 article is ‘Supporting young people to manage gender-related distress using third-wave cognitive behavioural theory, ideas and practice</a>’. It was written by Lauren Canvin, Oliver Hawthorne and Holly Panting, a group of clinical psychologists working for the Gender Identity Development Service (GIDS) of the Tavistock, and published by the journal Clinical Child Psychology and Psychiatry</a>.6</a> It describes how the authors have attempted to apply CBT techniques to ‘gender-related distress’ in children referred to the GIDS, using an illustrative case study amalgamated from work done ‘with a number of young people’.
To a reader of the Cass Review, ‘gender-related distress’ will be a familiar phrase. It is used 47 times in the report, and its use has subsequently proliferated widely. At the time of writing, though, it was still very unusual (as opposed to the ‘more commonly used gender dysphoria’) so the authors explain their choice of language.
“In the DSM 5 (American Psychiatric Association, 2013), Gender Dysphoria in Adolescents and Adults is defined as having both ‘A marked incongruence between one’s experienced/expressed gender and assigned gender’ and ‘clinically significant distress or impairment in social, occupational or other important areas of functioning’. (American Psychiatric Association, 2013, p 452).
Our work focuses only on the second of these criteria; we do not believe it is ethical for therapeutic work to focus on changing someone’s experienced/expressed gender but do believe that it is ethically necessary for anyone working in this field to be aiming to reduce distress.”
— Canvin et al, 2022.
While they accept and affirm patients ‘self-reported’ gender identities, the authors seek to ‘bring a broader curiosity to understanding and managing gender-related distress’. Under the canopy of ‘gender related distress’, they group ‘a felt sense of dissonance between body and identity’ and ‘distress related to minority stress’.7</a> This unusual categorisation allows them to position their approach as neither affirmative nor explorative, but instead as a ‘third position’ between the two. Gender identity is sacrosanct, but the expression of that identity is not. The authors take great lengths to insist that they are not doing conversion therapy, but leave room in their model for a love-the-sinner-hate-the-sin approach to medical transition that would not be out of place in an anti-queer religious organisation</a>. As we can see from the history of diagnoses like hysteria</a> and drapetomania</a>, reducing distress and dissatisfaction is not an inherently ethical goal. Canvin et al pathologize distress caused by social realities - including waiting times in their own service. They justify this with reference to the use of CBT for chronic pain, stating that: ‘third-wave CBT models have been shown to be helpful in other areas where people are experiencing distress in relation to something which is not amenable, possible or ethical to change’.8</a> Put like this, an entire oppressive apparatus is simply an unavoidable ‘material reality’. The question is not what the authors of this study intend with their approach, it’s what could it let in. A definition of gender-related distress that groups frustrated desire for medical transition with minority stress makes space for conversion therapy to be laundered as simply ‘reducing distress’.
The paper presents a series of strategies for increasing distress tolerance using third-wave CBT methods - was this what the Tavistock’s ‘ongoing support’ for patients deemed unsuitable for medical transition looked like?
“The ‘Quicksand’ metaphor (Harris, 2011) can be helpful in thinking about the impact of fighting against thoughts, feelings, and material realities (e.g. waiting times) in potentially perpetuating and magnifying experiences of distress”
— Canvin et al, 2022, p.1249.
Distress tolerance is presented as especially important for ‘gender diverse people in the UK’, for a number of reasons. Access to medical transition may take years of waiting - so young trans people must learn to tolerate distress.9</a> Greater distress tolerance, we are told, may allow patients to ‘relate more flexibly’ to ‘safety-seeking behaviours’. Behaviours targeted for intervention include binding (which is presented as risking ‘creating a vicious cycle’ via intensifying ‘self-focus on the chest’), and ‘attempting to hide any indicator of their birth assigned sex’. The risk of pushing patients to abandon behaviours that genuinely keep them safe is acknowledged, but the risk of encouraging a dissociative relationship to feelings and experiences outside the norm is not. The final reason for inculcating distress tolerance is presented almost as an afterthought: ‘other young people may wish to find ways to manage their distress without physical interventions’. Like the second-wave CBT conversion therapists of the 1980s, the authors don’t want to make you live a straight, cis life on their own account - but if you want that, they’re more than happy to try and make it happen.
This paper is not an outlier. In its ‘Broader Reflections’ section, it cites an article by another group of Tavistock clinicians, in support of the statement ‘we would hypothesise that young people be [sic] less distressed about gender in a society which was more open, diverse and accepting of gender diversity’. It’s mostly focused on looking for an evolutionary reason for transition (unsurprisingly - it was written by the Tavistock’s evo-psychotherapy study group), but the section invoked by the citation makes another argument - that in a ‘queer’ society, medical transition might be less popular. With this context, ‘less distressed about gender’ starts to read like a palatable way of saying ‘less likely to transition’. Bernadette Wren, the lead author of the evo-psych paper and former associate head of GIDS, has said elsewhere</a> that: “we knew that for some young people a period of transgender or non-binary identification, coupled with intense body dissatisfaction, would resolve and we could then support them through a process of reconciliation with their birth sex”. A picture is starting to form of what has been happening in the Tavistock..
The Cass Review is critical of the informal and unstructured therapy that has thus-far been administered in the GIDS - but it does not seek to stop it. Instead, it proposes an expansion. All therapies administered to trans children in the NHS, regardless of the reason or the service administering them, should also be assessed on their impact on ‘gender-related distress’, recommends Cass 11.36.10</a> The risk of creating a perverse incentive for covert conversion therapy in non-specialist services goes unacknowledged. The formal recommendation makes the Cass position clear:
“Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress and cooccurring conditions. This should include support for parents/carers and siblings as appropriate.”
— Cass Recommendation 3
This is not a pitch for evidence-based medicine. ‘Associated distress’ is broad enough to be readable as ‘gender-related distress’. Fluoxetine</a> is a recommended treatment for depression, OCD, and bulimia, but that doesn’t mean it’s standard and evidence based when prescribed for ego-dystonic homosexuality</a>. Beyond distancing itself from conversion therapy, the Canvin paper did not discuss the ethical context of its research - nor did it mention seeking approval from an NHS Research Ethics Committee</a>. Following an informal enquiry, the editor of Clinical Child Psychology and Psychiatry has stated that a corrigendum will be issued showing that patient and parental consent were obtained prior to publication - that this could have been omitted in the first place tells us something.
“Alex spoke of initially being sceptical about the benefits of a therapeutic approach, as he felt only physical interventions would help to reduce his distress.”
— Canvin et al, 2022, p. 1258.
There are ethical and practical issues that must be addressed when offering therapy to children. How do you manage the greater-than-usual power imbalance between therapist and patient? What happens when a child and their parents or guardians want different things from the course of therapy? What factors might impact the process of obtaining informed consent? These questions are acutely significant to the Canvin study, and go completely unaddressed. It is impossible to tell whether subjects felt that they could refuse this novel therapy without compromising their access to gender-affirming care. In the section ‘setting up the therapy’, the authors say that it is ‘vital’ that ‘therapy is in line with a young person’s hopes and wishes for change’ - but the practical discussion that follows is entirely focused on persuading reluctant patients to take part, and overcoming their mistrust. If the team had devoted as much space to safeguarding against coercion as they did to defending themselves against accusations of coercion, the paper would look very different.
Only at the end of the article is the distorting pressure of the relationship acknowledged. A question is raised for clinicians, about where this type of therapy should take place: ‘would additional difficulties arise due to the gender service’s role in decision making around physical interventions?’ No answer is given. We don’t know how safe the young trans people whose experiences were amalgamated into this preliminary study felt. We don’t know whether they believed that taking part improved their chances of accessing transition-related care. We don’t even know how widespread this practice was in GIDS. But we know that the authors didn’t think to tell us. The Cass Review and many of its sources share a profound disinterest in autonomy, agency, or even the prevention of abuse.
Flexibility and Choice</h1>
The ‘voluntary’ conversion therapy of the 1980s was not ethical. Mark, a private patient included as a case study in Patricia Gillan’s Sex Therapy Manual, had never been attracted to women - but he wanted to be. ‘I’ve never had a male partner,’ he confessed. ‘It’s too late now with the AIDS scare. I don’t even want to try’. Mark’s deeply-religious fiancée did not know he was gay - she wanted to wait until she was married to have sex. But advances in therapy were here to help, and after a round of orgasmic reconditioning therapy, the two got married. No news was good news, and the case went down in the handbook as a resounding success.
The pressures on Mark’s decision were not unknown to Gillan - she comments earlier in the book that ‘since the arrival of AIDS many gay men have been increasingly worried about their behaviour patterns and have sought therapy’ - but they are treated as neutral, or even positive, perhaps heralding a cultural change. The therapist’s neutrality doesn’t quite hold - only heterosexual intercourse is treated as a goal, and Gillan’s language exposes her value judgments. ‘Many gay men’ she concedes, ‘do not indulge in sexual intercourse’.
It’s hard not to see parallels, reading about ‘homosexual dysphoria’ and ‘the need to be a biological parent and raise a family in the usual way’ and ‘homosexual arousal’ as ‘a persistent source of distress’ in Kaplan’s 1986 state of the field</a>.11</a> Against a background of hostility to queer life, therapists offer a ‘neutral’ therapy, directed by the needs of the client, that treats recloseting in short-term case studies as a kind of success.
But Mark was an adult - the stakes are different. The Cass Review has shown that children referred to the GIDS have been subjected to experimental therapies as the price of entry for seeking medical transition. Whether Hilary Cass wants conversion therapy to be institutionalised on the NHS again is immaterial: her recommendations have made space for it. Therapy is a caring profession, and despite the crueller parts of its history, good work happens under its banner - but so does violence. The NHS must set out a clear and actionable plan to keep conversion therapy out of its services, and investigate instances where it may have been allowed to take place. Anything else is complicity.

Footnotes</h1>
^1
In fact on many gay, trans, and intersex people</a> - this is rarely the focus of such histories. </div>
^2
Most accounts of the history of CBT treat Aaron T. Beck’s Cognitive Therapy</a> as its starting point, but according to founding member Howard Lomas</a>, the UK’s main professional CBT organisation was founded by ‘Behaviour Changers/Modifiers/Engineers/Therapists’. The BABCP was founded as the British Association for Behavioural Psychotherapy, and changed its name to formally incorporate cognitive therapies in 1992, but were engaged with cognitive behavioural therapy research for decades prior</a>. </div>
^{3
The paper was originally meant to be a chapter in an upcoming state-of-the-field psychiatric treatment manual, but was excised after the American Psychiatric Association voted to remove ego-dystonic homosexuality was from the DSM-III in June 1986 - it was instead published in the Journal of Sex & Marital Therapy. ‘Persistent and marked distress about one's sexual orientation’ remained in the DSM as part of ‘sexual disorder not otherwise specified’ until the DSM-V was released in 2013.
</div>}
^{4
E. Hogg, P. Adamopoulos, G. Krebs, ‘Predictors and moderators of treatment response in cognitive behavioural therapy for body dysmorphic disorder: A systematic review’
</div>}
^{5
‘Exploratory Therapy’ was coined by Anastassis Spiliadis, a systematic and family psychotherapist who resigned from the Tavistock’s GIDS after establishing an NHS ‘Family Therapy & Consultation Service’ for ‘gender-questioning young people. In this context, the Cass Review’s push towards family therapy could be read as a push for exploratory therapy.
</div>}
^6
Clinical Child Psychology and Psychiatry have several Tavistock clinicians on their editorial board</a>, including Bernadette Wren, the former associate director of GIDS, and Eilis Kennedy, the director of research and development</a>.) </div>
^7
The paper prominently cites a speculative blog post</a> in support of the use of CBT for minority stress. </div>
^8
The use of CBT for chronic pain is not uncontroversial</a> - nor is its wider presence in health psychology. Its use alongside ‘graded exercise therapy’ as a treatment for chronic fatigue syndrome was ruled unsafe and ineffective</a> by the British National Institute for Health and Care Excellence in 2022, despite huge resistance by NHS clinicians</a>. </div>
^{9
The examples used in the composite case study are generally innocuous, although they notably include a child being encouraged to respond to transphobic harassment in the classroom by ‘explaining in a calm voice why that was an inappropriate question to ask in class, and noticing his angry feelings but not reacting to them’, instead of ‘raising his voice’ or ‘storming off’.
</div>}
^10
Gender-related distress was not invented by Canvin’s team, or even by the Tavistock. Katrina Roen’s 2016 article ‘The Body as a Site of Gender-Related Distress: Ethical Considerations for Gender Variant Youth in Clinical Settings</a>’ uses the phrase, as part of her apparently queer and feminist critique of youth transition (Roen is not cited in either the Wren or Canvin papers, but her ideas and language are perhaps coincidentally evoked in both). </div>
^11
In particular, Kaplan’s thought-stopping techniques (twang a rubber band against your wrist, picture your wife watching you have sex) have an uncanny echo in Canvin’s third-wave CBT distress management techniques (immerse your face in cold water, distract yourself). Fascinatingly, the rubber-band snap is now sometimes used in DBT as a ‘distress tolerance tool</a>’. </div>
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The Cass Review, Independent review of gender identity services for children and young people: Final report</a> (2024). 
Florence Ashley, ‘Interrogating Gender-Exploratory Therapy’, Perspectives on Psychological Science (2023), DOI: 10.1177/17456916221102325. 
Erin Reed, ‘Unpacking ‘gender exploratory therapy,’ a new form of conversion therapy’</a>, Xtra Magazine (2023)
Mallory Moore, ‘NHS Trust uses “Gender Exploratory” training materials promoting conversion therapy lobbyists’</a>, Trans Safety Network (2022)
trickyspoons, ‘Asked if I was dom or sub during assessment years ago’</a> thread on Reddit
Lauren Canvin, Oliver Hawthorne and Holly Panting, ‘Supporting young people to manage gender-related distress using third-wave cognitive behavioural theory, ideas and practice’, Clinical Child Psychology and Psychiatry (2022), DOI: 10.1177/13591045211068729.
Tom Nash, ‘The Church’s Position on “Transgenderism”’</a>, Catholic Answers
May El Mantawy, ‘Hysteria: The Persistence of Patriarchy’</a>, The History of Emotions Blog (2021)
Oxford Reference, ‘Overview: drapetomania’</a>
Sannisha Dale, ‘Using Cognitive Behavioral Therapy to Assist Individuals Facing Oppression. [Web article]’</a>, Society for the Advancement of Psychotherapy (2018)
Alana Saltz, ‘How CBT Harmed Me: The Interview That the New York Times Erased’</a>, Disability Visibility Project (2021)
Raphael B. Stricker and Derek F. H. Pheby, ‘The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS’, Healthcare (2022), DOI: 10.3390/healthcare10050898. 
Natalie Grover, ‘UK Health standards body delays new ME guidance in therapy row’</a>, The Guardian (2021)
Bernadette Wren, ‘Epistemic Injustice’</a>, London Review of Books Diary (2021)
Bernadette Wren, John Launer, Michael J Reiss, Annie Swanepoel, Graham Music, ‘Can evolutionary thinking shed light on gender diversity?’, BJPsych Advances (2019), DOI:10.1192/bja.2019.35. 
Katrina Roen, ‘The Body as a Site of Gender-Related Distress: Ethical Considerations for Gender Variant Youth in Clinical Settings’, Journal of Homosexuality (2016), DOI: 10.1080/00918369.2016.1124688. 
James L. Elmore, ‘Fluoxetine-Associated Remission of Ego-Dystonic Male Homosexuality’, Sexuality and Disability (2002), DOI: 10.1023/A:1019834512443. 
Kathryn Geldard, David Geldard and Rebecca Yin Foo, ‘Ethical Considerations when Counselling Children’, in Counselling Children: A Practical Introduction (5th Edition), (London, 2018).
Thumbnail by Nik Shuliahin 💛💙</a> on Unsplash</a>

Do no harm? The trouble with Cass' therapy recommendations

2024-04-20T00:00:00+00:00

Elia Cugini investigates the ways in which the Cass Review recommendations diverge significantly from widespread professional recommendations around trans healthcare, as well as discussing the ways this aligns much more closely with a movement for psychological "resolution" of gender dysphoria that so far shows no evidence of success and raises significant concerns about harm.
In the wake of the publication of the Cass Review, the role that ‘therapy’ plays in trans healthcare – both the practical administration of therapeutic paradigms for trans youth, and the fraught invocation of ‘therapy’ as a way to resolve gendered distress – requires fuller treatment. Courses under the banner of ‘therapy’ may aid trans youth, stall them from transitioning for months or years,1</a> or actively attempt to detransition them (conversion therapy). Meanwhile, those hostile to transness often approach transness as a ‘mental illness’ which requires curative (conversion) therapy, and their perception of trans care assumes those terms. As such, unpicking the Cass Review’s model and guidelines around the therapeutic treatment of trans youth to identify potential sites of harm is essential.
It is widely accepted that gender transition, both social and medical, is an effective treatment for gender dysphoria 2</a>^,3</a>^,4</a>^,5</a>, and WPATH recognises hormone therapy and gender-affirming surgery as ‘medically necessary gender-affirming interventions’ for many patients in the latest edition of its care standards (2022</a>, p.18). Various kinds of therapy can also be useful to, and sought by, trans individuals; WPATH advocates psychotherapy as potentially beneficial for trans patients, particularly for anxiety symptoms, but recommends that it should not be mandatory to access gender-affirming care, saying that this can act as a ‘harmful barrier’ (2022</a>, p.176).
However, almost all trans youth in the UK are currently blocked from accessing medical interventions; the NHS UK page on dysphoria states that ‘psychological rather than medical’ treatments for children are advocated ‘because in many cases gender variant behaviour or feelings disappear as children reach puberty’, while treatment with hormone therapy must be prefigured by ‘lasting signs’ of gender dysphoria.6</a> Given the removal of access to puberty blockers for minors outside of a research protocol,7</a> therapy is part of a protocol here – alongside the standardised enforcement of natal puberty – that seeks primarily to test dysphoria, to see if it will or can resolve into “ease with your biological sex”.8</a>
The Cass Review 9</a> names the lack of pubertal resolution of dysphoria as a potential ‘harm’ of early social transition, saying that early social transition may result in an ‘altered trajectory’ that culminates in ‘life-long medical intervention’, losing the opportunity for dysphoria to ‘resolve at puberty’ (Cass 74</a>, p31). The desirability of ‘resolution’ of dysphoria reveals the conflict at the heart of the term: ‘resolving dysphoria’ can both mean transition and the disappearance of ‘gender variant behaviour or feelings’, and the negative mention of ‘life-long medical intervention’ positions option 2 as superior to option 1.
Accordingly, the explicit desirability of dysphoria ‘resolution’ heavily impacts the possibility of a neutral therapy paradigm. This is a key issue noted in discussions of gender-exploratory therapy, a paradigm that opposes the gender-affirmative model in ‘discourag[ing] gender affirmation in favor of exploring through talk therapy the potential pathological roots of youths’ trans identities’10</a> – a paradigm clearly relevant to Cass both in its recommendations to heavily restrict puberty blockers and hormones (Cass 84</a>, Cass Recommendation 8) and discourage full social transition (Cass 12.37), and its interest in potential ‘pathological roots’ of dysphoria, such as its comment that ‘at the end of a treatment package for BDD [body dysmorphic disorder] some young people say they no longer feel ill at ease with their birth-registered gender’ (Cass 5.38), or its comments on the high incidence of autism in trans youth and its suspicions regarding their ability to discern generalised feelings of difference from gender dysphoria (Cass 2.9, 5.41, 5.43, 8.29, 14.23).
Gender-exploratory therapy as a paradigm mandates gender exploration rather than offering it, occurs before rather than alongside medical options (and potentially vets suitability for said medical options), and is “predicated on suspicion toward trans identities and gender dysphoria”10</a>. Cass does not specifically mandate psychotherapy for patients, though autism and mental health screenings may be mandated at point of entry (Cass Recommendation 2), but ‘[e]xploration’ of ‘psychosocial challenges and/or mental health problems’ is stated by the review as ‘essential to provide diagnosis, clinical support and appropriate intervention’ (Cass 11.5) – meaning that NHS transition care is locked behind some level of ‘exploration’ – and ‘suspicion’ of youth dysphoria is covered by the aforementioned prioritisation of ‘resolution’. Patients are likely to engage inauthentically with therapy that is, in practice, assessing their performance, as the Review itself acknowledges (Cass 11.11). As such, gender-exploratory therapy cannot effectively provide authentic exploration to trans patients, is likely compromised in its ability to provide relief, and may be amicable to explicit attempts at encouraging desistence. The connections between gender-exploratory organisations and hostility to transness are well-evidenced: Therapy First – formerly the Gender Exploration Therapy Association – links entirely trans-hostile resources in its guide for parents and families,11</a> and explicitly endorses the trans-hostile concept of ‘Rapid Onset Gender Dysphoria’,12</a> despite CAAPS and 61 other associations recommending the concept be ‘eliminated’ from clinical and diagnostic application.13</a>
The Cass Review criticises psychological interventions in trans youth care being likened to conversion therapy, and the potential of this critique to ‘prevent young people from getting the emotional support they deserve’ (Cass 11.6). But the onus is on clinicians and policymakers, not critics, to evidence that their therapeutic paradigms are providing ‘emotional support’ to trans youth, that such a thing is meaningfully possible within a mandated exploratory model that bars most trans youth from medical care, and that conversion practice is being directly advised against and prevented, rather than passively assumed to not be present. ‘No formal science-based training in psychotherapy, psychology or psychiatry teaches or advocates conversion therapy’ (Cass 11.7) is a woefully insufficient response to the obvious threat posed by therapy paradigms that are amicable to transphobic hostility.
In addition to this, research into detransitioner communities can shed light on how cultural ideas around dysphoria therapy translate to self- and community-guided practice, and how inextricable therapeutic ‘alternatives’ to transition are from explicitly transphobic conversion rhetoric. ‘Detransitioner’ broadly describes people who stop or reverse gender transition, be that socially, medically, surgically, or legally,14</a> though the term is not synonymous with a return to cisness, with many detransitioners continuing to experience forms of dysphoria and gender dissonance 15</a>. Detransitioner communities are notably invested in dysphoria treatments outside of transition, as many describe continuing to experience dysphoria. However, detransitioners’ own community resources make clear how the idea of ‘therapeutic alternatives’ to transition relies heavily on rejecting the reality of transition. 
A 2021 pamphlet, created by two detransitioners and based on interviews with 75 more, includes a section on ‘alternative ways to deal with gender dysphoria’, collating resilience strategies to ‘handle […] bodily discomfort’.16</a>
The methods cited are:
a) various forms of therapy for other conditions that they believe could be ‘underlying issues’ behind dysphoria (p. 41).
b) generalised therapeutic activities like ‘mindfulness’, ‘working out’, ‘self-soothing talk’ and ‘journaling’ (p. 41). 
c) finding community (p. 44). 
d) ideological rejection that transition is possible, which they phrase as “full acceptance of one’s biological reality” and the belief that it is “rationally impossible to change [one’s] sex” (p. 42). 
This rejection of transition is implicit in the pamphlet’s conception of self-acceptance and ‘feminist consciousness’, which are premised on “being a woman does not require anything else than being female” (p. 43): the rejection of gendered stereotypes is falsely implied to rely on transphobic sex essentialism. Formalised detransitioner organisations, such as TDAN, Detrans Canada, Detrans Voices and GCCAN (all now-defunct) near-universally express the belief that sex change is not possible, reject established science on transition effectiveness, and partner with openly trans-hostile organisations such as TransgenderTrend and 4thWaveNow. Meanwhile, former detransition activist Ky Schevers has described her experiences with detransition movements as ‘anti-trans conversion therapy’, where ‘gender dysphoria is separated from trans identity and treated like a symptom to be managed, much like ex-gays draw a distinction from experiencing same-sex attraction and identifying as gay’.17</a> 
In the absence of effective treatments for dysphoria outside of transition, ‘alternatives’ rely primarily on impossibilising transition. Meanwhile, Schevers’ account indicates the harms of attempting self-reconciliation work when only a cis outcome is acceptable, which led her to ‘reinterpret, disconnect from and/or suppress my feelings’. Accordingly, any therapeutic paradigm for trans and gender-variant young people must explicitly centre the reality and accessibility of transition and affirm all potential genders/embodiments, and should provide information on what pseudo-therapeutic manifestations of anti-trans rhetoric look like, both in clinical and community settings. Models that do not include this risk endorsing the influence of transphobic hostility on identity formation, for instance, or affirming rhetoric that assigned sex is ‘reality’ when this coheres with a given young person’s identity. ‘Therapy’ is vague, covering a wide array of potential interventions as well as describing a desired outcome. Some therapeutic interventions can help some trans youth with navigating transition and addressing co-occurring sources of distress. However, attention to the conversion possibilities of purportedly ‘neutral’ therapeutic paradigms (including the engendering of transphobic self-regulation) is crucial for caring for trans youth in this time, as is knowledge that using mandatory therapy to test, vet, and/or stall trans youth degrades the status of said therapy as therapy. In addition, as the detransitioner accounts show, the idea of coping and resilience-building mechanisms for dysphoria can easily disguise self-policing and self-harm, particularly when ideological rejection of transness is involved. The desired inculcation of ‘resilience’ (Cass</a> 59, 101, 2.28, 10.40, 10.73, 16.39) and ‘flexibility’ (Cass 79, 12.36, 12.37) in young trans people denied healthcare, which are qualities that denote responsiveness to the impositions and desires of others, is symptomatic of a desire to police more than to ensure wellbeing; providing access to desired care and unequivocal affirmation is essential for the latter.
Correction: This article previously listed IATDD as a now defunct "detransitioner" organisation. However, IATDD though defunct, was a coalition of therapists promoting detransition support.

References
^1Unpacking ‘gender exploratory therapy,’ a new form of conversion therapy</a> </div>
^2
American Medical Association policy: Removing Financial Barriers to Care for Transgender Patients H-185.950</a>, passed as resolution 122 A-08 in 2008, reaffirmed in 2022 with Resolution 012, A-22. </div>
^3
Anton, B. S. (2009). Proceedings of the American Psychological Association for the legislative year 2008: Minutes of the annual meeting of the Council of Representatives, February 22–24, 2008, Washington, DC, and August 13 and 17, 2008, Boston, MA, and minutes of the February, June, August, and December 2008 meetings of the Board of Directors. American Psychologist, 64(5), 372–453. https://doi.org/10.1037/a0015932</a>. </div>
^4
World Professional Association for Transgender Health: Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (2022)</a>. </div>
^5
Cornell University: What does the scholarly research say about the effect of gender transition on transgender well-being?</a> </div>
^6
NHS Overview: Gender Dysphoria</a> </div>
^7
NHS England Clinical policy: puberty suppressing hormones</a> </div>
^8
NHS 111 Wales: Gender Dysphoria</a> </div>
^9
Independent review of gender identity services for children and young people: Final report</a> </div>
^10
Ashley, F. (2023). Interrogating Gender-Exploratory Therapy. Perspectives on Psychological Science, 18(2), 472-481. https://doi.org/10.1177/17456916221102325</a> </div>
^11
Therapy First: UNDERSTANDING & NAVIGATING GENDER DYSPHORIA IN CHILDREN AND ADOLESCENTS</a> </div>
^12
Therapy First: Rapid Onset Gender Dysphoria Teens: A Brief Guide for Parents</a> </div>
^13
Coalition for the Advancement & Application of Psychological Science: CAAPS Position Statement on Rapid Onset Gender Dysphoria (ROGD)</a> </div>
^14
Irwig MS. Detransition Among Transgender and Gender-Diverse People-An Increasing and Increasingly Complex Phenomenon. J Clin Endocrinol Metab. 2022 Sep 28;107(10):e4261-e4262. doi: 10.1210/clinem/dgac356. PMID: 35678284; PMCID: PMC9516050.</a> </div>
^15
Sanders T, du Plessis C, Mullens AB, Brömdal A. Navigating Detransition Borders: An Exploration of Social Media Narratives. Arch Sex Behav. 2023 Apr;52(3):1061-1072. doi: 10.1007/s10508-023-02556-z. Epub 2023 Feb 23. PMID: 36821061; PMCID: PMC10101886.</a> </div>
16</a> Post Trans: Our booklet about Detransition</a>
^17
An Injustice Mag: Detransition as Conversion Therapy: A Survivor Speaks Out</a> </div>

Sandyford Clinic puts “hold” on 'puberty blockers' and endocrine treatment for trans youth

2024-04-18T00:00:00+00:00

NHS Scotland have implemented a “hold” on patients accessing puberty blockers via the Sandyford clinic. A source told Trans Safety Network that this hold was implemented as a result of “a group of clinicians from Greater Glasgow & Clyde NHS”, meaning that there will be no further referrals to endocrinology from the Gender Identity clinic service.
Trans Safety Network understand that puberty blockers — more technically known as GNRH agonists — will continue to be available for young cisgender patients experiencing precocious puberty, and this ban is restricted to young trans patients. We also understand that this ban has been implemented for some weeks now ahead of the release of the Cass Review.
According to our source, young people who have already been prescribed GNRHas will continue to on their existing course of care, and there may be an option in the future for young trans patients to access GNRH agonists as part of a clinical trial.
The mechanism of action of GNRH agonists is well known and understood. They have been prescribed to prevent precocious puberty in young people since the 1980s. They have been used in the UK to forestall puberty in for young people with gender dysphoria during an assessment period while capacity to consent to cross sex hormones develops since 2011 in the UK. Trans Safety Network are concerned that in the last 4 years, since access to puberty blockers has been starkly reduced in the UK there has been a massive increase in the number of suicides of children and young people accessing trans healthcare services.
Responding to this situation, trans health academic and Lecturer in Community Development, Dr Ruth Pearce said: 
"NHS Greater Glasgow and Clyde appear to be acting on the basis of political expediency, rather than medical expertise, academic evidence, or the lived experiences of service users. This is a deeply irresponsible decision that will endanger the lives of young people whose hope of accessing care has been cruelly revoked, and deepen trans people's distrust of the NHS. I have no doubt it will also be celebrated by same journalists and politicians who have ignored or even embraced the staggering methodological and ethical flaws in the Cass Review. This is an appalling outcome for young people, and a bad day for medical science."
The Cass Review has been condemned by professional healthcare bodies in Canada</a>, Australia</a> and Aotearoa-New Zealand</a>, and widely criticised for prioritising unpublished anecdotal and hearsay evidence against puberty blockers over published and peer reviewed observational clinical data over large patient cohorts considered by the Cass Review research team as of “low quality” because it didn’t use blinded trials. The proposition of blinded controlled trials have themselves been criticised as unethical and impractical for use in trans healthcare provision.
Trans Safety Network have contacted Sandyford Gender Identity Clinic for comment.

Why do some GPs think they can take trans patients off hormones?

2024-04-14T00:00:00+00:00

Many GPs believe that prescribing hormones for trans patients is not their responsibility. Inconsistency between the planned remits of Gender Identity Clinics and GP contracts in NHS England has created ambiguity around final responsibility for patient care, which has allowed the Royal College of General Practitioners and the British Medical Association to frame refusal of care to trans patients as a labour rights issue.
On 26th February 2024, the Daily Mail ran a hit piece</a> on Charlie Craggs, a trans woman who had spoken out on social media about being denied a hormone prescription by her GP after moving to a new area. Stories like this are common, as doctors who have long refused to provide bridging prescriptions</a> increasingly also resist entering into shared care agreements with private clinicians</a>, or honouring recommendations from NHS Gender Identity Clinics</a>.
Charlie Craggs’ story quickly gained traction on X (formerly twitter). Amidst the predictable chorus of transmisogynistic hate, and the appeals for empathy from trans people and allies, a third group emerged: GPs, desperate to explain that their refusal to prescribe wasn’t transphobic, it was a labour dispute.

I respect right not to prescribe of based in resource allocation to GP rather than LGBTQ-phobia. Still crap innit?
It's clear that the likely GP strike simply needs to be us doing the GMS contract and no more... Secondary care cannot function without us!
— Seb (@SebPillon) February 29, 2024</a> </blockquote>
Some medics commented expressing sympathy, or caution</a> about cutting off prescriptions</a>. They were not the majority. Instead, doctor after doctor chimed in to explain that prescribing hormones for trans patients was not a contractual obligation</a> for GPs, that the GICs had “no excuse” for not prescribing themselves</a>, and that any suggestion of wrongdoing or comparison to conversion therapy was a shocking and offensive smear</a>. Several commenters also misrepresented the scope of GIC funding, suggesting that they were funded to prescribe</a> but were choosing not to.
The Service Specification</a> for NHS England’s National Programme for Gender Services</a> makes it clear that hormone prescriptions are expected to be administered by GPs, not by clinicians at the GIC. This is also true in Wales</a>. Hormone prescription is usually expected</a> to be handled by GPs in Scotland</a>, although service specifications allow for the possibility that GPs may refuse to enter into a shared care agreement. In Northern Ireland, where access to transition-related healthcare through the NHS is even more limited</a>, a 2019 review of the Gender Identity Service</a> recommended that “the role of the GP needs to be clarified and supported”. Although the details differ, this issue goes well beyond NHS England. Trans adults who get to the top of the GIC waiting lists (no mean feat</a>) and make it through the psychiatric gatekeeping inflicted on us are usually told to approach our GPs for hormone prescriptions – so why do so many GPs think it’s not their job to prescribe?
One answer can be found in the Royal College of General Practitioners</a> (RCGP) policy statement on Transgender Care</a>. The RCGP is a professional body representing GPs in the UK. It’s not a governmental organisation, nor is it a union – it provides recommendations to the General Medical Council</a> (GMC), the public body that regulates doctors in the UK, while remaining independent from it. As well as providing resources for professional development, it represents the interests of GPs via public statements. On issues of trans healthcare, the RCGP sets itself against the GMC’s recommendations.
There is a lot to be concerned about in the RCGP policy statement. Citations are shockingly limited, and while ‘trans people’ get a mention, there is no similar reference to trans children – only ‘young people with gender dysphoria’. The RCGP statement challenges the GMC’s advice to practitioners regarding issuing bridging prescriptions as failing to address “the ethical and safety issues around prescribing outside the limits of one’s competence”, while tacitly suggesting that GPs’ competence may include finding alternate explanations for ‘gender dysphoria’:
“However, GPs can contextualise a person’s presentation of gender dysphoria with other conditions, particularly autism, and within their broader environment. GPs may also be able to contextualise the distress felt by the individual against that person’s medical history and possibly relate it to the distress and discomfort often experienced by many young people during puberty and adolescence.”
— ‘Transgender Care’, Royal College of General Practitioners, June 2019
Regarding prescription, though, the RCGP is much cagier. They appear at first glance to support GP prescribing, arguing that the responsibility of a primary care team includes:
“Considering taking on the ongoing prescribing of medication for patients and the monitoring of any side effects, with the appropriate funding, after a patient has been discharged from a GIC.”
— ‘Transgender Care’, Royal College of General Practitioners, June 2019, 28 iii.
But the key word is ‘considering’. What the RCGP statement actually does is refuse responsibility for prescribing. The reference to ‘appropriate funding’ highlights a mostly unspoken dispute: prescribing hormones for transgender patients is not part of the service specification of the General Medical Services contract</a> that binds GPs in England, and this looks likely to continue in its next iteration</a>. Furthermore, many trans patients who need care from their GPs have not been discharged</a> and so are not covered by this guidance. As good as this sounds, it’s actually a near-universal opt-out. The statement goes on to make this explicit in another closely-related context:
“It is common for GPs to work under Shared Care Agreements (SCAs) set up between GICs and practices to provide joint care for patients. It is important that SCAs are agreed upon by all parties involved, ensuring the appropriate levels of resource, competence and expertise are established, as informed by the patient’s level of medical risk.”
— ‘Transgender Care’, Royal College of General Practitioners, June 2019, 28 iii.
NHS England have noted, in their guidance documents</a>, a list of situations in which it may be appropriate for a GP to refuse to enter into a Shared Care Agreement. One such situation, which is often cited as part of refusal to prescribe hormones for trans patients, is when “the GP does not feel competent in taking on clinical responsibility for the prescribing of a specialist medicine.” The British Medical Association</a> (BMA), a trade union representing doctors in the UK, emphasises the implications of this for the provision of hormone prescriptions in their own 2022 guidance on the role of GPs in ‘managing adult patients with gender incongruence’</a>. The BMA set the GMC’s advice (“that GPs should collaborate with a Gender Identity Clinic (GIC) and/or an experienced gender specialists to provide effective and timely treatment for trans and non-binary patients”) against NHS England’s shared care guidance, and conclude that:
“Participating in a formal shared care agreement is voluntary, subject to a self-assessment of personal competence, and requires the agreement of all parties, including the patient.”
— ‘Role of GPs in managing adult patients with gender incongruence’, British Medical Association, 2022
Both the RCGP and the BMA have produced guidance that appears to support the provision of appropriate care for (adult) trans patients, but actually allows GPs to take trans patients off hormones with minimal justification or recourse. When a doctor refuses a shared care agreement (or ends an existing one) on the grounds of not assessing themselves as competent to prescribe, patients are often left stranded. Even a well-meaning and supportive GP is under pressure to prioritise their contractual workload, and ‘personal competence’ is broad and ill-defined enough to launder any amount of practitioner transphobia or headline-induced anxiety. Although GICs are sometimes able to prescribe under these circumstances, they are not resourced to do so – and patient safeguards are focused on initial refusal of care</a>. Self-assessment of competence in this context ends up functioning similarly to conscientious objection</a> in abortion access.
NHS England's shared care guidance says that “good professional practice requires care for patients to be seamless; patients should never be placed in a position where they are unable to obtain the medicines they need, when they need them”. Trans people are routinely placed in this position when we move to a new area, change GP surgery, or when headlines affect our doctors’ personal comfort level with prescribing for us. As with other issues of bodily autonomy, like abortion access</a>, management of opiate dependency</a>, and access to ADHD medication</a>, the violence is built into the bureaucracy: the NHS prioritises continuity of control over continuity of care.
If your GP tries to take you off hormones, you can challenge this. The GMC is the ultimate regulator of doctors practicing in the UK, and their guidance conflicts with the BMA and RCGP opt-outs. This thread</a> is a useful starting point.

TSN statement on Cass Review Final Report

2024-04-12T00:00:00+00:00

The Cass Review final report has been met with condemnation, both from trans experts</a> and professional therapy groups</a> in the UK and around the world</a>. In the aftermath of its publication and inflammatory contents, despite concerns from experts, politicians are putting pressure on NHS clinicians to rush through recommendations and throw caution to the wind, as well as threatening to rush through laws banning standard healthcare practices in the private sector. This is a threat to the safety of young people accessing NHS health services. We urge politicians to stop grandstanding when childrens’ lives and wellbeing are at stake, and listen to the criticisms of the report.
Despite only being published 2 days ago, experts are already raising alarms about the methodological flaws in the research undertaken by the review. Trans Safety Network are still working on processing the review, but we believe there to be systemic biases in the ways that the review prioritises speculative and hearsay evidence to advance its own recommendations while using highly stringent evidence standards to exclude empirical and observational data on actual patients. This adds to the concerns we have previously had about Cass excluding trans people from the research oversight board</a> - that Cass was set up from the start to impose a particular perspective without input from the patient cohort affected by the outcome.
The report at one point attempts to use the correlation of puberty blockers prescribed to young trans people with the fact that they grow up to transition later in life as proof that it was puberty blockers that made them trans, without considering that they were prescribed puberty blockers on the basis of an assessment by clinical professionals that they were trans. In reality, one would hope to minimise the number of unnecessary prescriptions to young people who come to the conclusion they’re not trans and these figures showing that most grow up to be trans would be seen as a good thing. Unfortunately, the Cass Review final report seems to assume, as an unspoken starting point, that growing up to be a trans person is a bad thing, and the rest of the conclusions follow from that assumption.
The report similarly reports an “increasing number” of detransitioners in relation to GIDS treatment, as reported anecdotally by “clinicians” while only identifying less than 10 in a patient cohort of over 3000. These discrepancies and use of hearsay that doesn’t match up with the hard data in a report that has taken 4 years of work to produce are deeply alarming. While Cass used the report to derisively contrast “Social justice” approaches against the “evidence based” approach the NHS is supposed to be based on, the human rights of the patients in question are a key concern in ensuring that evidence is used fairly and in a way that centres the specific needs of patients rather than political grandstanding, lobbyists, clinicians or anyone else’s agenda. Lobby groups which Cass has chosen to approvingly include contributions from in the report very openly advocate</a> for expanding the target age range for preventing transition to 25 years old. This is a goal which Cass has effectively empowered through her recommendations.
Trans Safety Network are concerned that these discrepancies are not a matter of accident or error. We have previously identified a number of professionals involved in both the Cass Review and the NHS Gender Dysphoria Working Group</a> which helped commission the review who are involved either in lobbying efforts against trans affirmative healthcare, or who have actively promoted conversion therapy. These include one of the authors on the Cass systematic reviews, Tilly Langton, who produced a training which promoted conversion therapist organisations</a> to trainee psychiatrists working with children.
We caution that it will take a considerable amount of time for credible academic responses to process the 388pp of the final report as well as the several supplementary research papers published supporting it. Politicians need to step off the gas, listen to the early warnings being issued by both medical experts worldwide and by the trans community, and avoid rushing through political interference with existing clinical services.
We are especially concerned, in light of 4 inquests we are aware of initiated over the last year for young trans people who died by suicide while waiting for gender dysphoria healthcare. Those who are affected most by the decisions that are being made are being ignored and harmed by the ongoing violence of this effort to impose a health establishment order against trans people’s agency rather than in harmony with it. There is an extremely long history of medical violence which informed the disability rights slogan “Nothing About Us Without Us”.

Trans Safety Network condemn UKCP withdrawal from agreement against conversion therapy

2024-04-06T00:00:00+00:00

Trans Safety Network express our deep concern about the UK Council for Psychotherapy’s (UKCP) withdrawal</a> from the memorandum of understanding on conversion therapy</a> (MoU2). MoU2 is a document agreed by major UK psychological, therapeutic and medical organisations that “makes it clear that conversion therapy in relation to gender identity and sexual orientation (including asexuality) is unethical, potentially harmful and is not supported by evidence.” The UKCP also released a statement in November 2023</a> affirming the legitimacy of “exploratory therapy, rather than medicalised interventions such as puberty blockers, cross-sex hormones or reassignment surgery” as a therapeutic approach. Trans Safety Network say this constitutes an endorsement of gender identity conversion practices as defined by MoU2. This approach assumes that transition is a worse outcome to be avoided rather than being a person centred exploration of their identity.
This is widely recognised by human rights institutions. A recent Council of Europe issue paper on Human Rights and Gender Identity and Expression</a> expressed concern about the rise of “so-called “explorative therapies” which, under the guise of helping a person explore their gender identity or expression, fundamentally have the same objectives as conversion practices.”
Research by the LGBTQ+ anti-abuse charity Galop has found that 1 in 5 LGBTQ+ people and 2 in 5 trans people have been subjected to some form of conversion practices</a> aiming to “change, fix or suppress” their sexual orientation, gender identity or gender expression. According to Galop’s research, young people were most likely to report having been subjected to conversion practices, indicating that conversion practices are a current and ongoing problem. Research by the Ozanne Foundation</a> on gender identity conversion practices found that half of those subjected to these practices were children at the time and three quarters were under 24. The higher rates of exposure to conversion practices for children and young adults are of particular concern here given that the UKCP justifies their position, in part, by stating that the MoU2 currently applies to conversion practices against children.
According to the Independent Forensic Expert Group</a>, an international body researching torture, "All forms of conversion therapy, including talk or psychotherapy, can cause intense psychological pain and suffering" including PTSD and trauma related sleep disorders. A wide range of literature exists demonstrating that exposure to conversion practices is associated with mental distress</a> and suicidality</a>.
Given the strong evidence that conversion practices are harmful and widespread, it is extremely concerning that a major UK regulatory organisation has unilaterally withdrawn from an agreement that they should not be practiced, particularly by medical professionals in a position of trust and authority over patients. We also note that in addition to a lack of evidence of efficacy and strong evidence of harm from conversion practices, these practices are founded on transphobic and homophobic premises in that they assume that cisgender, heterosexual modes of sexuality, identity and expression are necessarily a better outcome than LGBTQ+ outcomes.
TSN have also seen evidence that UKCP chair Christian Buckland</a> is sympathetic to anti-trans ideology. In August last year, after conservative media figure and former therapist Jordan Peterson was required by his professional registration body to take a training course</a> after repeatedly and publicly abusing transgender actor Elliot Page, Buckland condemned the decision to require Peterson to undergo retraining, reaching out to him on Twitter.


As long as the UKCP continues to treat conversion practices as potentially legitimate under the euphemism of “exploratory therapy” LGBTQ+ people, as well as friends or family members seeking psychotherapeutic support cannot be confident that UKCP registration is an indicator that a therapist is safe for them or following the best quality evidence. The evidence shows that conversion practices are harmful and UKCP are in distant disregard of this fact. TSN call on the UKCP to reconsider their decision as a matter of urgency and supports the call from some UKCP members</a> for the decision to be reversed and for a vote of no confidence in current UKCP leadership.

Trans Safety Network statement on NICE evidence reviews on trans affirming care

2024-03-28T00:00:00+00:00

Trans Safety Network express our deep concerns about the transparency and integrity of the 2020 NICE evidence reviews into puberty blockers and gender affirming hormone therapy, as well as the NHS Gender Dysphoria working group which commissioned them. 
In June of 2023 it was disclosed to us by members of the Cass Review team that anti-trans author and commentator Dr Az Hakeem was part of “NHS England’s policy working group which commissioned the NICE evidence reviews undertaken in 2020”. Dr Az Hakeem has long been a partisan opponent of gender affirming medical treatments. While Hakeem disavows conversion therapy or trying to dissuade trans people from medical interventions, on his personal website he directs readers looking for specialist support for gender dysphoria to conversion therapy activist groups</a>, such as Bayswater Support Group, and the anti-trans pseudoscientific lobby group</a> SEGM. Hakeem is also a member of CAN-SG who have from their earliest webinars (link</a>) promoted the idea that trans people should be dissuaded from transition and instead either change their minds, or undergo therapy to live with the discomfort of gender dysphoria without accepting their trans identity — in other words, that trans people should undergo conversion therapy.
We note, with concern, that two other members of the anti-trans lobby group SEGM, Richard Byng and a Mr Richard Stephens, were in 2022 cited in a meeting with the United States government</a> as being members of the NHS England Working Group on Gender Dysphoria.
As part of the working group that commissioned the NICE reviews, Hakeem (and potentially other activists against trans healthcare) will have been involved establishing the parameters for the research questions being asked. In particular they may likely have had some influence in determining the acceptance criteria for evidence falling within the remit for the NICE reviews, meaning the ability to rule out evidence which is potentially inconvenient to his existing biases. As the NICE reviews were retrospective, reviewing historic research, this will have been an unparalleled opportunity for a staunch campaigner against trans healthcare to fix the criteria ahead of a strategic piece of research.
The NICE reviews have been controversial</a> - primarily because they elected in their approach to exclude numerous pieces of published clinical research around puberty blockers and gender affirming hormone treatments which address the specific concerns it sets out to answer. The reviews also then heavily criticise the quality of the small quantity they did opt to review while making only a passing recognition of long running concerns that high quality controlled studies are not ethically practicable</a>. Lower quality indicative evidence is routinely accepted in many areas of medical practice out of ethical necessity — experimentally choosing not to treat some patients when existing evidence indicates a course of treatment is likely to be beneficial is fraught with ethical challenges.
Freedom of Information Requests seeking to understand better how this research was shaped and what sorts of conflicts of interest may have been involved have been refused. In effect this hampers public understanding of a contentious piece of public interest research from those seeking to understand the results. It is only by chance that Trans Safety Network came into possession of this information via a third party.
In the interests of open science, transparency and accountability, we call on NICE, NHS England, and The Cass Review, to open up to the public those details which would allow public scrutiny of potential conflicts of interest in driving Gender Dysphoria health policy in England.

New study shows trans people more likely to live in deprived areas

2023-12-05T00:00:00+00:00


Bar chart of proportion with recorded transgender identity vs Townsend deprivation score group, based on data from McKechnie DGJ, O'Nions E, Bailey J, et al, Transgender identity in young people and adults recorded in UK primary care electronic patient records: retrospective, dynamic, cohort study, BMJ Medicine 2023;2</center> A new cohort study published in the British Medical Journal</a> attempting to estimate the proportion of trans people registered with GPs across different areas of the UK has found that trans people are far more likely, on average, to live in deprived areas. The study looked at data for around 7 million patients across 649 GP practices throughout the UK and found that patients from the most deprived areas were “more than twice as likely to have a recorded transgender identity than individuals in the least deprived areas.”
Deprivation was measured using the Townsend deprivation index</a>, a sociological instrument that scores areas based on levels of unemployment, car ownership, home ownership and overcrowding. These results are consistent with existing data on trans people in the UK who, per the most recent census</a>, are 81% more likely to be unemployed than our cisgender peers and 66% more likely to be on disability benefits.
Trans experiences of workplace discrimination</a> are well documented, with 1 in 3 employers in a 2018 survey admitting that they would be less likely to hire a trans person</a>, mirroring the experience of the third of trans respondents to a 2021 Totaljobs survey on behalf of Sparkle who have experienced discrimination while applying for a job</a>. In this context it is not exactly surprising that trans people are found in greater numbers in the poorest areas of the UK.
Trans identity was measured by looking at Read codes, codes used by GPs to identify which medical conditions a patient may have. As stated in the study, this measure is highly likely to underestimate the total trans population as some trans patients may be reluctant to disclose trans identity to medical professionals and some medical professionals may decline to record trans status for a patient who has not yet seen a specialist. Neither issue should be particularly surprising given the frequent experiences of discrimination and transphobia faced by trans people interacting with NHS services, 1 in 7 trans people responding to Trans Actual’s 2021 Trans lives survey</a> reported being refused GP care because of their gender. It seems unlikely that trans people who have not disclosed their status to their GP or whose GP refuses to recognise their trans status would be any wealthier than other trans people, on average.
The findings from this study reinforce, once again, the need for trans liberation politics to take the material, economic impacts of transphobia seriously. Part of fighting against harm to trans people must be fighting against the myriad ways in which transphobia impoverishes and the disproportionate burden of transphobia on working class trans people.

Royal College of Nurses condemns Health Secretary’s proposed ban on trans-sensitive healthcare

2023-10-06T00:00:00+00:00

The Royal College of Nursing have spoken out in the aftermath of vile statements and legally dubious promises made by Health Secretary Steve Barclay in speeches on the final day of the Conservative Party conference.
In a statement issued by the RCN — Britain’s national professional body for nurses — Professor Nicola Ranger, Chief Nurse of the Royal College of Nursing said</a>:
“The Health Secretary should not play politics and court controversy at the expense of people’s health and good care, including plans that can actively deter trans individuals from accessing services.
The single factor that has the greatest impact on the quality of your care and your experience as a patient is the number of staff on duty.
But things are headed in the wrong direction, despite an ambitious plan, and today’s speech did not address the nurse vacancy issue head-on.”
What was said at the Conservative Party Conference</h3> Health Secretary Steve Barclay proposed an outright ban on trans women</a> in women’s hospital wards; emphasising that this is just “common sense”. This has been met with concern by many members of the trans community that this will exacerbate already existing healthcare inequalities by making it harder for trans women to access treatment and increase harms already faced</a> by trans men in obstetric care.
Rishi Sunak threw his full weight behind this trans-hostile agenda, saying “we shouldn’t get bullied into believing that people can be any sex they want to be. They can’t, a man is a man and a woman is a woman. That’s just common sense”. 
The RCN’s response to these statements are a welcome reminder that the monstering of trans women will do nothing to address the desperate need for safe staffing on all NHS wards.

Irish Endocrinologist Claims Cass endorsed model ranked “Worst in Europe”

2023-09-29T00:00:00+00:00

Endocrinologist Donal O’Shea, who used to lead Ireland’s National Gender Service (NGS) reported to Irish national radio show Newstalk</a> that Hilary Cass, leader of the Independent Cass Review, has endorsed the Irish NGS model as the “gold standard for how it should be done”.
In response to a request for comment a representative for the Cass Review said:
"The Review is looking at how gender services for children and young people in England should be organised and delivered in future. The remit does not stretch to adult services and we have not reviewed such services either in the UK or elsewhere.
We have met with services across the UK and internationally to look at how they operate but we have not declared on any model beyond that described in the interim report and subsequent letter to NHS England."
Ireland’s National Gender Service was last year ranked the “worst in Europe” by TGEU’s Trans Health Map</a>. With this in mind, the revelation of Cass’ support for the Irish NGS is deeply concer future of trans healthcare in England and Wales. Among other things the Irish service has imposed bizarre and draconian requirements on patients like requiring adult patients to bring their parents</a> to appointments. It has also come under criticism for its use of unnecessary and inappropriate “barrage of personal questions”</a> as part of diagnosis. These can include such things as how patients “pick up men</a>” and other probing questions which patients described as “voyeuristic” about their sex lives and which have no obvious relation to their gender identity.
The Cass review was initially triggered after the Bell v Tavistock (2020) ruling. However, while Bell v Tavistock was overturned in 2021, the Cass Review has continued, gathering growing criticism over explicit bias against trans experiences</a> in defining how trans health reforms should happen, as well as hiring clinicians</a> associated with the “Gender exploratory therapy” model. The gender exploratory model as yet has no real evidence base and has been likened in academic writing to conversion therapy approaches</a>.
In the interview for Newstalk, O’Shea says
"That is, correct. Hilary Cass came over, met with our clinical team, looked at how we do it in the adult service. And said, this is, the gold standard for how it should be done. We're contributing to her expert review panel on on the design and delivery of care. We have repeatedly said to the HSE they need to stop sending our children and young people to affirming services, because we will see more of the disasters that we saw coming back from Tavistock."
The Cass Review have attempted to present a public face of balance and impartiality, albeit an impartiality which deliberately discriminated</a> against trans people participating in the oversight panel on the basis this would constitute a risk of bias. These recent revelations from O’Shea are perhaps the first really strong evidence of an ideological bias in the Cass Review specifically against gender affirmation for young people.
This article was updated on 5th October 2023 to include comment from a representative of the Cass Review

Family Education Trust issues copyright takedown against TSN reporting

2023-08-23T00:00:00+00:00


Yesterday (22nd of August 2023), Trans Safety Network (TSN) received a notification from YouTube that two videos on our channel had been taken down at the request of the anti-LGBTQ+, ultraconservative Christian organisation Family Education Trust</a>. The two videos were unlisted on our channel but embedded in our article "I quite like that violent resistance": Gender critical activist Harry Miller's speech at conservative Christian conference</a>. TSN regards this as spurious. YouTube’s terms of service</a> and copyright law</a> allow for the reproduction of small, limited parts of copyrighted works for the purpose of criticism and reporting on public events, known as “fair use” or “fair dealing”. The use of these short video clips in an article on the speech they were taken from clearly falls under this. We are currently appealing the take down through YouTube.

The email we recieved from YouTube
On the day that TSN received notification of the takedown, we saw that Harry Miller has claimed to have been the subject of a police report</a> in relation to the article. TSN played no role in any police report. As documented in our values statement</a>, TSN does not believe that policing of “hate crimes” or “hate incidents” is a viable solution to anti-trans harms.
Regardless of any police action against Miller, TSN considers the use of YouTube’s copyright system to censor parts of the evidence we use for our article reporting on Miller’s speech to be an attack on our freedom of expression. Transcripts of the deleted videos can be found here</a> and here</a>.

"I quite like that violent resistance": Gender critical activist Harry Miller's speech at conservative Christian conference

2023-08-09T00:00:00+00:00


On the 24th of June 2023, the Family Education Trust (FET), an ultraconservative Christian organisation with strong links to the anti-trans gender critical movement</a>, held its annual conference in London. One keynote speaker was anti-trans activist Harry Miller of the organisation Fair Cop. Fair Cop are an anti-trans organisation whose past activities have included their #SayYesToHate</a> hashtag and intervening on behalf</a> of James Goddard, a member of the far right</a> organisation Patriotic Alternative</a> after he was investigated by the police over a video calling LGBTQ+ Pride flags an “emblem of “nonces””. Goddard has previously promoted extreme antisemitic conspiracy theories</a> and has been convicted for assault</a> at a protest.
Telegram post by Goddard calling for his followers to be “awake to the [Jewish Question]”, a neo-Nazi slogan referencing the idea that the existence of Jewish people is, in itself, a problem.
In the nearly hour long speech Miller described Fair Cop’s role intervening on behalf of police officers facing disciplinary measures over allegations of transphobia and misogyny, as well as his personal history and how he feels his religious views relate to his activism. Miller also singled out a number of trans women for mockery over their appearance, including transgender advocate Freda Wallace, who wrote about her experiences of being targeted by the gender critical movement on her Medium</a>.
Miller took aim at “Love is love”, a mainstream gay equality slogan popularised during campaigns for legalising same sex marriage</a>, countering “God is love” before going on to falsely imply that the use of the slogan is part of an effort by “critical theorists” to normalise child sexual abuse. </iframe>
Much of Miller’s talk was taken up with the virtues of being a “fighter” with reference to Bible stories about battles and war and the religious justifications for anti-trans activism, stating “If God for with us, who can be against us?” In one alarming moment, towards the end of his talk, Miller extolled the virtues of “violent resistance” as described in the Old Testament, saying:
"I love the Bible but I'm very much Old Testament, as opposed to New Testament. It may come as a surprise that I identify less with Martha and Mary, for instance, than I do with Jael, the wife of Heber, because Jael, bless her soul, is the kind of woman who when her enemy is sleeping, drives a tent peg through their temple and does it in the name of God." </iframe>
Miller closed by extending an offer of support to FET members “defending the family” through their conservative activism, saying:
"If the police advise to you that you are on the verge of committing a crime or in fact have committed a crime then what you need to do is get hold of me."
Miller is not the only UK gender critical figure to recently cite violent Bible passages in relation to their anti-trans activism. Gender critical journalist Helen Joyce appeared on US conservative Megyn Kelly’s podcast last month where she suggested that a transgender politician would be better to commit suicide</a> than to continue to advocate for internationally recognised standards of trans healthcare with reference to a Bible verse often used by the US right to call for violence</a> against LGBTQ+ people. This increased engagement with violent religious rhetoric marks a concerning escalation by UK gender critical public figures, who have previously been less willing to engage in such extreme rhetoric in public.

New Young People's Gender Clinic hires controversial Gender Exploratory Therapist

2023-08-03T00:00:00+00:00


Last month, the originator of the controversial “Gender Exploratory Therapy” approach which rejects the gender affirmative therapy model celebrated being hired as a new Education Lead by Great Ormond Street Children’s Hospital. Anastasis Spiliadis was one of a team of three who led a training session for London NHS CAMHS staff earlier in the year, reported on by Trans Safety Network</a> at the time. The training contained alarming statements, including that “parents and carers should have access to a range of information to weigh up what may or may not fit or be helpful for each family” before listing two conversion therapy organisations and a group which has been criticised for promoting anti-trans bullying, alongside two mainstream trans support charities.
In this training, Spiliadis and his colleagues Tilly Langton and Anna Hutchinson promoted their “Gender Exploratory” approach to gender dysphoria treatment. This encourages inserting delays</a> into transition and trying to resist a patient’s preferences for changes of name or pronouns. At the end of the slide deck, trainees were encouraged to investigate a list of organisations that “offer different perspectives”, directing NHS CAMHS Psychiatry Trainees towards on the one hand, mainstream trans support charities Gendered Intelligence and Mermaids, but on the other hand, two conversion therapy advocacy groups (Genspect and Bayswater Support Group), and the anti-trans lobby group Transgender Trend, who also campaign against banning conversion therapy</a> for trans people. Transgender Trend who have also been described as a hate group and accused of promoting school bullying</a> of trans youth leading to warnings issued in the educational press. As context for the inclusion of these harmful organisations, the Gender Exploratory Therapy training advised that “parents and carers should have access to a range of information in order to weigh up what may or may not be fit or be helpful”. Although they deny endorsing any of the organisations that they list, it is difficult to see this as anything other than a suggestion to child psychiatry trainees that they should direct parents to consider conversion therapy and anti-trans resources as potential options.
“Gender exploratory therapy” has been subject to criticism from leading experts on ending conversion therapy who say that contrary to the apparently neutral name, it is instead biased</a> towards holding trans people’s identities in suspicion. This bias is also reflected in practices like those of the Gender Exploratory Therapy Association — co-founded by Genspect’s director Stella O’Malley — who preach resistance to anything other than psychological interventions for gender dysphoria</a>, and form part of a wider array of tightly intertwined dubiously scientific</a> lobbying groups connected to efforts to ban transition in the United States. 
Great Ormond Street Hospital previously had to cancel a training conference last year after trans healthcare experts raised safeguarding concerns</a> about the participation of leading figures within Genspect. Recent investigations into leaks from Genspect have described the group leveraging fears about transgender youth as part of a wider agenda in a campaign to ban even adult transition</a>.
Trans Safety Network have contacted Anastassis Spiliadis and Great Ormond Street Hospital for comment.

Exclusive: The Truth About the Far Right Attack on Honor Oak

2023-06-27T00:00:00+00:00

On Saturday morning, the far right violently attacked members of the Lewisham community who had gathered to protect children attending a Drag Queen Story Hour event in Honor Oak Pub.
During the attacks, the far right injured counter-protesters, and a Trans Safety Network reporter. The anti-drag protesters also broke the window of the pub whilst attempting to throw projectiles at the counter-protesters. Police later caused further injuries to bystanders providing community first aid during an attempted arrest. A local inclusive church was also attacked, its entrance and step smeared with faeces. 
Despite this serious violence, the community of Lewisham rallied together to reclaim the street, and to express collective queer joy. In a massive victory for the Lewisham queer community, the far right had to abandon their protest before the Story Hour had even begun.
Who Were The Protesters?</h1>
The protests against Drag Queen Story Hour at Honor Oak Pub have been primarily led by Turning Point UK. Turning Point UK are the UK branch</a> of far right organisation Turning Point USA. Turning Point UK’s previous claims to fame include speakers at their conference openly defending Hitler</a>. The group has links to the Conservative Party</a>, whose MPs have praised its work. 
The Chief Operating Officer of Turning Point UK, Nick Tenconi, was present first thing on Saturday morning. However, whilst TPUK has aimed to represent itself as a more ‘respectable’ face of far-right politics, on Saturday Tenconi was enthusiastically involved in the street violence, personally offering to fight individuals, and physically moving towards and grabbing at counter-protesters. This is evidence of a clear turn by TPUK towards unapologetic street fascism.
Also present were those with previous involvement in neo-Nazi organisations. For example, Lance Wright was present, who was previously a member of the groups Blood & Honour and Combat 18.

A picture of Lance Wright, credit to Bob From Brockley @bobfrombrockley on Twitter

The Official Blood & Honour Logo

Photo of weapons and a sign of the neo-Nazi group Combat 18 seized by German police.
The counter-protesters, on the other hand, were led by members of the local community. A group called South East London Love has formed in reaction to the far right’s presence, in order to protect and care for the local queer community. The group has been supported by many in the local community, including the local church. Ada Cable, a local activist, told me about those present in the morning:
‘We were mostly women and non binary people, almost all trans and queer. We're not the kind of people who like getting in fights, we just wanted to be there before TPUK.’
The Attack</h1>
When the Lewisham counter-protesters left for the pub at around 5:30 am on Saturday, the last thing they said to each other was “Whatever happens, look after each other”. The reason they had gathered at this time, the counter-protesters tell me, is because they had heard that the far right were planning to arrive much earlier than usual. They say the police have been clear that they won’t remove the anti-drag protesters from outside of the pub if they get there first - so the counter-protesters have to get there before them, to ensure a safe way for families to be able to enter the pub for the show later in the day.
I followed the counter-protesters to the pub, where they gathered outside the entrance in a line, seeking to guarantee that safe space for parents and their children attending the show. I was walking down the road to see if I could get a view of any of the anti-drag protesters. As I headed towards a vantage point, I saw them coming around the corner, and quickly headed back to the pub.
It was around 5.45 am when the first anti-drag protesters arrived. They were carting a PA and many of them were filming. All of them, from what I could tell, were men. They immediately started shouting insults and slurs at the Lewisham counter-protesters. Around five minutes later, another group arrived, including two women. There were no visible police on scene, although there was a single woman watching in her car, who I believe to have been a plainclothes police officer. There were no police on scene at this time, and no barriers. Just the counter-protesters stood in front of the pub, and the anti-drag protesters on the opposite side of the road.
Soon, the anti-drag protesters started to come towards us. Much of the incitement to violence was led by Nick Tenconi of Turning Point UK, who began offering to fight people one on one. This quickly escalated and they quickly advanced across the road to physically attack the counter-protesters. The aggressive nature of them crossing the road and trying to attack the defending counter-protesters with their backs against the wall can be seen in all the video footage, including that selectively chosen by their supporters.
The Lewisham counter-protesters were carrying flags and joined these together to form a defensive barrier. The anti-drag protesters charged at the group shouting threats including "We'll kick the fuck out of you" and “you are fucked”, and threw glass bottles and other objects. The anti-drag protesters threatened to follow counter-protesters home no matter what time they left. The far right began grabbing the counter-protesters who had no space to retreat, and so some of the counter-protesters began to hit back in very clear and measured self-defence. At this time, a TSG van drove past, seeing the counter-protesters being attacked, but did not stop to intervene.
One anti-drag protester repeatedly punched trans counter-protester Ada Cable in the face, leading to the injuries seen in our Twitter thread. Ada backed away and received first aid from another counter-protester. Ada was visibly injured to her head, which was bleeding, and also appeared to have a broken nose. Ada has since confirmed to me that they suffered a concussion, and are receiving treatment for a likely broken nose. The people receiving first aid were right next to me, behind the line. My picture of Ada’s injury was taken at 6.04 AM. The anti-drag protesters pulled another counter-protester from the crowd and started stomping on them. I saw another counter-protester who had been hit around the head, and whose inside of their ear looked mushed and bloody, likely broken.

South London activist Ada Cable crouched down, holding a piece of clothing on her head. Blood is streaming down her nose and from her mouth onto her trousers.
Since the events, accounts such as Turning Point UK have claimed that the counter-protesters were carrying sharpened flag poles as weapons. This was not what I witnessed, rather, I saw how the far right protesters began deliberately breaking the flag poles both to arm themselves and to try and break the counter-protesters’ defensive line. One of the broken poles was thrown towards me, nearly hitting me in the head. Another flag pole was taken and thrown hard towards the counter-protesters, luckily missing but instead piercing the pub window and sticking out of it. My photo of the broken pole which had been thrown towards me, and the broken window from the other stick were taken at 6.05 AM.

Snapped piece of broom handle lying on the street

Broken window pane from the Honor Oak Pub pierced by a pointed object
The anti-drag protesters made clear they were deliberately trying to break the line in order to separate people for individual attack. With their back against the wall, holding these flags to form a defensive line was the counter-protesters’ only means of protecting themselves, and me behind them. One individual announced, “If you keep hold of the [flags which formed the line] we’ll hit you, simple as”. You can hear in the turning point UK video that they seem to be acting strategically to target individual people, trying to break the line, saying “take this one”. I watched as the group strategically descended on one individual at a time. With more flags being taken and broken, it felt like it was only a matter of time before they managed to succeed in doing so, opening all of us to being beaten. I was genuinely terrified for my safety.
I was injured when the anti-drag protesters attacked the Lewisham counter-protesters, being crushed behind the counter-protesters as they were forced against the wall of the pub by their attackers, unable to retreat further. I still have significant swelling, bruising, and pain, including a bruise in the visible shape of a footprint. 
At around 6:15 am police arrived on the scene to separate the two groups. Initially, only one officer arrived, and the still-heated anti-drag protesters even began to jostle him around. Finally, other TSG officers arrived, and set up a cordon. As Ada tells me:
‘More TSG arrived and let them keep that space - TPUK were rewarded for attacking us by giving them direct access to the pub. I later saw that the windows in this area had been covered in transphobic stickers.’
The Police</h1>
After finally arriving on the scene and allowing the far right protesters to set up next to the pub, the police decided to make an arrest of one of the counter-protesters. It remains unclear why, given the individual was released shortly afterwards without charge.
It was at this time that Ada was injured for a second time. When making the arrest, a number of police officers suddenly pushed forward into the group of counter-protesters, and myself, who had been surrounded by the TSG following their earlier attempts to separate the group. I immediately flattened myself against the wall with my hands in the air as the police moved in. Ada, at the time, was sat on the ground performing first aid on someone next to the target for the arrest. When the police surged in, they hit her across the face, reopening her previous wounds and further injuring her cheek and eye.
As Ada tells me:
‘About 30m after I got punched, and after police had arrived, I was doing more thorough first aid for someone else who was injured. We were crouched on the ground, and a couple of people had stood between us and the road to give us privacy. The TSG decided that they wanted to arrest someone [then] TSG charged in and began grabbing and shoving people.
I was still crouched on the floor, but one of them punched me in the face. I can tell the difference between a shove and a punch. This was a punch, on my right eye- I've got a second black eye which I didn't have before the police tried to arrest that person.’
Although the police originally denied causing such injuries, they now admit that it is “possible”</a> they injured her whilst making the arrest. My picture of Ada’s second injury was taken at 6.30 am.

Ada Cable outside the Honor Oak Pub with a bloody nose a second time.
Turning Point UK have claimed several times that no-one from the anti-drag protesters was arrested. This is demonstrably false. The Police arrested Jamie Turvey, aged 33 from Farnborough, for using words to cause harassment, alarm or distress. He has now been charged with this offence. One of the counter-protesters present told me that Turvey had been shouting slurs, and also threats of rape. I watched as the police took some time preparing before making the arrest, entering a formation and doing a roll call. The arrest took place at 7.48 AM.

Jamie Turvey being arrested by the Met at 7.48 AM
Later on, Police were seen being very friendly with the far right protesters. For example, having a sit down with Nick Tenconi, who had been actively involved in the earlier attack on the counter-protesters.

Credit to Bob from Brockley @bobfrombrockley 
The Church</h1>
The Lewisham Counter Protesters were not the only members of the community subjected to horrific treatment by the far right on Saturday morning.
I spoke to Dorothy, an 89-year-old volunteer at the local Anglican church in Honor Oak. The church has been supportive of the local community in resisting the far right, for example, allowing the community to use the space for meetings about how to keep Lewisham safe.
When Dorothy arrived to open the church for morning prayers on Saturday, at 8 am, she found that the church door, and the step to the entrance, had been smeared with faeces. Dorothy was left to confront this attack on a place precious to her and her community.
Father David tells me that the far right had previously targeted the church, protesting one of the local community meetings. The church has been active in seeking to provide an inclusive space for the entire Honor Oak community, with Father David having previously attended the Honor Oak counter-protests to show his support for the local queer community.

Credit @TwiddleyT on Twitter
Turning Point UK have themselves posted in condemnation</a> of the church. It is reasonable to conclude that this attack was committed by the far right upon its arrival in Lewisham on Saturday morning.
Turning Point UK have relied heavily on an image of defending the Christian faith</a>. However, the reality shows that their hatred of the queer community far outweighs their supposed love of God.
The Joy</h1>
By around 7am, more people started to arrive. This included lots of members of the local community, as well as Trade Unions. Soon, the Socialist Workers Party also arrived, setting up their stalls of newspapers and materials for their front organisations. The SWP then proceeded to hand out placards plastered with their branding. Ada tells me that local organisers have asked them to stop doing this, but the SWP has refused:
The SWP arrived, with a load of placards with organisation names ("Stand up to racism" and "Socialist workers party") on, and hand them out so it looks like it's only organised by them. We keep asking them to stop doing this, and let people just be locals without needing to pretend they're from a group but they won't.
Soon, a big sound system arrived, and the atmosphere began to change from one of fear to one of joy. As the day went on, more and more people arrived to express their love for the queer community in Lewisham. People danced and hugged one another. By 11 am, the far right had left, and the Lewisham community took the entire street as a space for queer joy. It felt like a street party. The Drag Queen who was performing gave a speech to the crowd, calling on everyone to continue to protect the community and especially the trans community.

Demonstrators hoisting a progress pride flag carry a banner across the street outside the Honor Oak Pub, with the slogan “South London is Antifascist”
A couple of days after the protest, Ada tells me:
‘I walked back through forest hill this morning, and it felt much safer knowing that fascists and transphobes aren't welcome. It was joyful, and a load of people were really nice to me on the street, talking about the demo.
I don't want fascists in Lewisham, TPUK or otherwise- They attacked us without provocation, they're not safe, and they're clearly not welcome. Lewisham has a proud history of dealing with fascists despite the police trying to enable them. The police won't stop them standing next to the pub and harassing kids, or marching on our streets full stop, so it's up to us to do it.’
Further Police Failure</h1>
The street party, however, turned sour when police officers decided they wanted to remove everyone from the road. This was confusing, given everything was about to wrap up in a short while when the Drag Queen Story Hour ended. Despite this, the Police decided to needlessly turn the situation into one of violence. The Police arrested one of the queer protesters who was stood in the road holding a banner, for breach of a dispersal order.
Ada emphasises to me the pointlessness of this renewed violence:
‘Later on, after TPUK had left, we had a big party in the street, but I was absolutely knackered by then. It was going to wrap up after the drag queen story hour had finished, but the police began arresting people about ten minutes before that happened- I don't understand why, there was no danger to anyone, we were just celebrating that the fascists had gone from the neighbourhood.’
In this way, the Police turned what had been a celebration of queer joy in the face of far right violence, into another opportunity to use violence against the community.
We Keep Us Safe</h1>
The events of Saturday show the escalating violence against queer people in the UK, from both police and street fascists. It’s important that we learn from these events, and understand that we are strongest as a community when we come together to look after each other and defend ourselves. I have never been as frightened as I was reporting on Saturday morning - and I am someone who has previously survived significant violence. However, even though I was just a journalist who had travelled from halfway across the country to report, the queer community of Lewisham stood in front of me to keep me safe. I am grateful to them all, and I hope that their courage inspires the queer community across the country to come together, and to keep us all safe.
The Metropolitan Police have been contacted for comment.

Analysis: A Toxic Debate - But Could Be Good News For Trans People?

2023-06-16T00:00:00+00:00

What you need to take away</h1>
The recent debate on the proposed amendment to the Equality Act 2010 - to change the definition of ‘sex’ to ‘biological sex’ - caused much apprehension in the trans community. This article provides an in-depth analysis of that debate, primarily aimed at interested trans people, their allies, and experts. For many readers, this first section will tell you what you need to know.
Although the debate was framed as about ‘clarifying’ the definition of sex under the Equality Act 2010, the reality is that the proposed amendment to the definition of sex would constitute a significant legal change. The Gender Recognition Act 2004 establishes that a trans person with a Gender Recognition Certificate becomes the acquired sex for all legal purposes. The Equality Act 2010 was drafted with that legislation in mind, and the case law has similarly developed along this vein. The proposed amendment to the Equality Act 2010 thus constitutes as significant legal change - not a mere clarification.
The content of the debate itself was both toxic and often nonsensical, adopting framing which positioned trans people (and especially trans women) as predatory and violent threats, especially to children. This contained substantial transphobia, misogyny, and transmisogyny. The demonisation frequently relied on provably false or entirely imagined information. This culminated in the mocking of a trans person’s expression of suicidal thoughts. The section ‘A respectful debate?’ continues a detailed breakdown and debunking of much of this framing, and the various anecdotes and examples provided to support it.
However, trans people should be relieved by the speech of the Government Minister for Women, who emphasised the effectiveness of the law as it currently stands on single-sex spaces, and the need for the Government to take significant time before making any changes. This means we are unlikely to see any changes to the law in this area before the next election.
Table of Contents</h2>
The Context</a></li>
Opening The Debate</a></li>
Changing the Law, or clarifying it?</a></li>
A respectful manner?</a></li>

Painting Trans Women As Violent</a></li>
Painting Trans Women as Sexual Predators</a></li>
Suggesting Trans People Are A Threat To Children</a></li>
Mocking Trans Suicide</a></li></ol>
Misrepresentation of the Current Law</a></li>
‘Biological Sex’</a></li>
Positive Contributions</a></li>
The good news: a lack of Government appetite</a></li></ol>
The Context</h1>
On Monday 12th June, a debate took place in Westminster Hall concerning two petitions. The first petition, 'Update the Equality Act to make clear the characteristic “sex” is biological’, received 109k signatures. The other petition 'Commit to not amending the Equality Act's definition of sex’ received 139k signatures. 
In January 2023, the Government responded to both petitions stating that such a change was not necessary: ‘Under the Equality Act 2010, providers are already able to restrict the use of spaces/services on the basis of sex and/or gender reassignment where justified. Further clarification is not necessary.’
However, on Tuesday 4th April, the UK Equality and Human Rights Commission (EHRC) published a letter to the UK Government recommending an amendment to the Equality Act 2010 which would change the definition of sex within the Act from legal sex to ‘biological sex’. This was in response to a letter from the Minister for Women and Equalities, Kemi Badenoch.
Under the current law, the Gender Recognition Act 2004 states that upon acquisition of a Gender Recognition Certificate, a trans person becomes their ‘acquired’ sex for all legal purposes. There is no distinction between sex and gender in UK law. This means that trans people with a GRC are currently their acquired sex for the purpose of the Equality Act 2010. This is relevant for issues such as sex discrimination, single-sex spaces, and equal pay legislation. 
The proposed amendment to Equality Act 2010 would leave the Gender Recognition Act 2004 hollow, allowing trans people with Gender Recognition Certificates to have their acquired legal sex invalidated. Instead, service providers would be allowed to treat trans people as the sex they were assigned at birth. 
In line with most equality frameworks, the current law allows discrimination against trans people – excluding them from, e.g. single-sex sports competitions – if this can be shown to be a proportionate means of achieving a legitimate aim. Instead, this amendment would mean no balancing exercise need be undertaken at all. In other words, it recommends that trans people should be discriminated against to exclude them from single-sex spaces for any reason whatsoever, on a purely arbitrary basis. Service providers may even be obligated to exclude trans women.
What’s more, trans women would immediately lose access to certain mechanisms under the Equality Act 2010 that seek to address gender discrimination – for example, equal pay legislation. 
It was this proposed change which formed the subject of the debate.
For more detail on the EHRC’s proposal and the negative effect the proposed amendment is likely to have on the trans community, please see my previous analysis</a>.
Opening The Debate</h1>
The debate in Westminster Hall had a low attendance and can be understood as entirely performative. Many MPs were absent because they instead needed to attend to important Parliamentary work. Only MPs were entitled to speak, and Jamie Wallis, the only trans MP, did not speak and left without returning at one point - one can assume because of the level of vile rhetoric within the hall. The debate then, was one held by cis people, for cis people, but about trans people.
The debate was opened</a> by ‘gender critical’ Labour MP Tonia Antoniazzi, who began by emphasising that topic is one many people are ‘afraid to speak of’. In response to this, Liberal Democrat MP Layla Moran rightly highlighted</a> that the trans community were terrified of this debate happening at all, due to the fact that such debates can lead to a rise in hatred and violence against trans people. Antoniazzi dismissed these concerns</a>, stating that it was important to have an ‘adult conversation’ about the topic, and that this is ‘a set of issues on which views are held profoundly and with good intentions’.
The notion that ‘gender critical’ views are always held with good intentions is patently false. Trans Safety Network have extensively documented the links between the ‘gender critical’ movement and the far right</a>, as well as the movement’s other profound attacks</a> on human rights. I have elsewhere argued</a> that the suggested amendment to the Equality Act 2010 would violate trans human rights. More broadly, Dr Sandra Duffy has outlined</a> how ‘gender critical’ movements have sought to ‘misuse’ international human rights law in ways which are ‘regressive and contrary to current understandings of human rights’.
Antoniazzi herself has shown a lack of willingness to protect trans human rights. At a Parliamentary Assembly of the Council of Europe</a>, a draft resolution was proposed that condemned attacks on the rights of LGBTI people in the United Kingdom. Antoniazzi, amongst a small group of other Labour representatives, sought to amend this resolution to erase its condemnation of attacks on trans people. They proposed the deletion of the whole of the following paragraph:
‘The Assembly condemns the highly prejudicial anti-gender, gender critical and anti-trans narratives which reduce the fight for the equality of LGBTI people to what these movements deliberately mis-characterise as ‘gender ideology’ or ‘LGBTI ideology’.” It went on to suggest that such narratives “dehumanise” LGBT+ people and “falsely portray their rights as being in conflict with women’s and children’s rights.’
The group also tried to insert an amendment that would require certain support services to be ‘segregated where necessary according to sex’. Perhaps most egregiously, they proposed an amendment which suggested continued funding</a> of ‘actors that deny the human rights of LGBTI people’.
Antoniazzi is also a prominent proponent of 5G conspiracy theories</a>. Concerningly, this conspiracy itself can be linked to the far right</a>, and to broader far right conspiracies such as coronavirus denial and the WEF ‘great reset’.
The deep links between ‘gender critical’ views and those of reactionaries would only become more apparent as the debate progressed.
Changing the law, or clarifying it?</h1>
A particularly interesting thread which ran through the debate was the continual insistence by those supporting an amendment to the Equality Act that they were merely ‘clarifying’ the law, not changing it. This distinction was emphasised in particular by MPs Joanna Cherry, Jonathan Gullis, and Caroline Ansell.
The assertion is, however, patently false. The Gender Recognition Act 2004 establishes that upon acquisition of a Gender Recognition Certificate, a person becomes their acquired sex for all purposes. The Equality Act 2010 was drafted with this law in place, and thus the meaning of sex in the Act was always that of legal sex - including those trans people whose legal sex has changed to match their GRC. Any amendment to the definition of sex within the Equality Act 2010 would be to effectively disapply the Gender Recognition Act 2004, and cannot be understood as anything but a significant legal change.
This was identified by other MPs during the debate. Conservative MP Peter Gibson highlighted that</a>:
‘When looking at what these petitions call for, it is important that we note that changing the statutory definition of a protected characteristic is not “modifying” or “clarifying” the Equality Act; it is in fact changing it, and changing it in a way that alters its original intention and that could throw into question over 10 years of case law. The Gender Recognition Act 2004 establishes that a trans person with a gender recognition certificate is recognised in their legal sex for all purposes. It is already possible to exclude trans people from single-sex settings and services, where that exclusion is proportionate and has a legitimate aim. Many services already operate on that basis. What purpose would changing the definition of sex in the Equality Act serve, aside from allowing it to become even easier for people to discriminate against trans people?’
Likewise, SNP MP Kirsten Oswald questioned</a> the ‘narrative’ being developed around the amendment being a mere clarification of the law. Oswald emphasised that MPs were ‘entitled to look for that change’, but that they should be honest that it was change and not clarification that they were looking for.
A respectful manner?</h1>
The debate involved much back-patting from both sides on how important it was that the debate had been held in a sensitive way. Indeed, at the end of the debate, the chair thanked everyone for the ‘respectful manner’ and ‘respectful and thoughtful way’ in which the debate had been handled. The chair concluded</a> ‘people feel strongly about this issue, but it is no reason to be abusive, and I do not think that people have been’. 
Reading the transcript of the debate, you might be forgiven for thinking that the chair had been asleep throughout the proceedings. The debate was characterised by a complete lack of respect from many of the ‘gender critical’ participants, who repeatedly promoted toxic rhetoric about trans people. Here are some ‘highlights’.
Painting Trans Women As Violent</h2>
There were repeated seeming attempts to paint trans women as violent as a result of them being ‘biologically male’. 
Conservative MP Anna Firth ended her speech</a> by referencing the injuries suffered by an opponent of trans woman boxer Fallon Fox, stating that she suffered a ‘fractured skull’, and that this resulted from ‘a man fighting a woman’. This seems like a deliberate misrepresentation of the facts designed to demonise trans women. In reality, her opponent suffered an orbital bone fracture</a> - an incredibly common injury in MMA fighting.
Additionally, Labour MP Rosie Duffield pointed to</a> statistics which show:
‘One in four women will experience domestic abuse in her lifetime. Two women a week are killed by a current or former partner’.
Duffield then used these statistics to suggest that biological sex needed to be monitored:
‘Because of those and other differences in men’s and women’s lives, we need to be able to monitor sex discrimination and provide for the needs of women and girls, particularly when they are most vulnerable. The Equality Act is the law that allows for that, but confusion within and about the Act has led to a toxic debate where people have become terrified even to talk about women’s rights—but not all people.’
However, this is a clear non-sequitur which fails to identify the ways in which these statistics differ for trans women, who cannot be neatly captured (as Duffield tries to suggest) under the category of ‘men’. In fact, trans women may be subject to even higher rates of domestic violence</a> than their cis counterparts - in 2017, whilst 7.5% of cis women generally reported experiencing domestic violence in the last 12 months, 16% of trans women reported the same. A recent metanalysis shows</a> that rates of domestic violence are ‘dramatically higher’ for trans people, and are ‘comparably high’ for all trans people regardless of their assigned sex at birth.
Despite attempts by ‘gender critical’ MPs to suggest otherwise, misogynistic violence does not discriminate based on chromosomes.
Painting Trans Women As Sexual Predators</h2>
Moving beyond violence, there were also numerous statements which appeared to paint trans women as sexual predators.
Conservative MP Ranil Jayawardena drew a baseless link</a> between the inclusion of trans women on single-sex wards by North Bristol NHS Trust and the number of sexual assaults against women on hospital property. This is despite the fact that such assaults can be committed by women, male visitors, and male staff. 
Conservative MP Andrew Lewer went so far as to describe</a> a trans woman treating a female patient who has asked for single-sex care as ‘sexual assault’. Patients are, of course, entitled to reject care from any healthcare professional on any basis. This does not mean they are entitled to know said staff’s medical history.
Suggesting Trans People Are A Threat To Children</h2>
The accusation of predation was even stronger in relation to trans people and children.
Alba MP Neale Hanvey and Conservative MP Nick Fletcher both sought to undermine the idea that children could be trans, stoking fears of manipulation and grooming which could lead to regret in later life. This included the painting of imaginary horror stories of future trans regret, all resulting from being ‘allowed to use pronouns at school’.
MP Neale Hanvey said</a>:
‘Children should be free to be their own individual, carefree, special selves, without adults imposing their gendered stereotypes on them. Telling children there is something intrinsically wrong with them is absolutely unforgivable.’
Whilst MP Nick Fletcher stated</a>:
‘If we can stop the use of new gender pronouns in schools, we will stop many issues for our young people later in life, too.’
And:
‘I am standing up for the 12-year-old allowed to use pronouns at school who is being sold a story that she can be something that she never can. I am thinking of her after her transition, when she wakes up one morning when she is 25 and realises that she can no longer have children. She is growing facial hair, her health is generally poor, her bone density is down, her voice has broken, she has no real friends, and she has probably fallen out with mum, who is now broken for letting her take those puberty blockers and hormone replacement tablets. I am thinking of that girl sold a lie by the influencers who have now moved on to another ideology to make them money. No—in this place, we have to make the hard decisions to protect the vulnerable. I know the Government will make the right decision and clarify the Equality Act.’
Conservative MP Nick Fletcher further stoked the toxic atmosphere by painting trans women as potential predators who posed a risk not only to women, but to children too:
‘We are in a position where some biological males believe that they have a right to enter single-sex spaces—female changing rooms. I suspect that when many think of that they think of a grown man—a trans woman—entering a grown woman’s space. That to me is obviously wrong, but my real concern is what happens when a six-year-old girl is in that changing room—somebody’s daughter, somebody’s granddaughter, somebody’s niece. It just is not right.’
Similarly, Conservative MP Ranil Jayawardena stated his support</a> for the amendment was because of ‘two young daughters’ who he wanted to ensure were ‘safe’.
The most vile rhetoric of the evening came from</a> Miriam Cates, who appeared to be laughing whilst she claimed that trans women were a threat to the safety of women and girls and were using children to satisfy their sexual fetishes:
‘While academic elites cave in to aggressive and misogynistic trans activism, ordinary women are frightened to go to hospital, ordinary men fear for the safety of their daughters in public toilets, ordinary children are subjected to a psychological experiment in which they are told they can choose their gender, and ordinary toddlers are used to satisfy the sexual fetish of adult men dressed as eroticised women. Understanding the difference between male and female underpins society, safety and security. We must clarify the Equality Act, and give ordinary people the certainty that our laws can be trusted to protect women and children and that sex means sex.’
This vile rhetoric is perhaps unsurprising coming from Miriam Cates, a regressive who has adopted various far right talking points. Cates has been a vocal opponent of fundamental women’s rights who adopts an extremely regressive view on the role of women in society; she has spoken on the importance of women marrying and having children</a>, has established a think-tank committed to opposing</a> no-fault divorce and same-sex marriage, and has spoken against expanding free childcare because childcare ought to be undertaken</a> by mothers staying at home. She has also voted against abortion rights in Northern Ireland, sponsored an amendment</a> which would allow campaigners to harass women seeking reproductive healthcare in the form of ‘silent prayer’ outside of abortion clinics, and is now seeking to limit access to abortion pills in the UK. Beyond this, Cates has also helped push a moral panic concerning child sex education</a>, echoed racist rhetoric surrounding migrants</a>, and is on the board of a Church accused of conducting gay conversion therapy</a>.
Cates’s vile rhetoric was raised in a point of order by SNP MP Hannah Bardell, who identified</a> that Cates was characterising trans people as predators in a way that was ‘deeply undemocratic and deeply worrying’, using language which was ‘unparliamentary’. The Chair, however, refused to</a> take any action.
Mocking Trans Suicide</h2>
One of the most appalling aspects of the debate has already received significant attention on social media. This involved SNP MP Kirsty Blackman sharing that</a> a trans constituent had come to her and had expressed suicidal thoughts:
‘Another trans person came to me. They were not the first to come to me with concerns of this nature. I will paraphrase what they said. When they heard about biological sex being included in the Equality Act and this change being made, they said, “What hope is left? Should I just kill myself now and be done with it?”’
In response to this, MPs Joanna Cherry, Rosie Duffield, and Neale Hanvey were seen apparently mocking</a> this story by rolling their eyes and adopting other exaggerated gestures. Not ashamed by her initial response, Rosie Duffied MP has since responded to a gif of the eye-roll during the discussion of suicide with a laughing emoji.

As a survivor of suicide who was hospitalised following an attempt, I found this particularly galling. Most particularly in light of my initial reporting on the EHRC letter, when the level of panic in the community meant that I received a deluge of emails and direct messages expressing similar distress. This included both suicidal ideation and requests for help in fleeing the country. Trans people continue to be at a massively increased risk of suicide. Many of us will gather on the Trans Day of Remembrance this year to remember amazing members of our community who were lost in this way.
To ‘gender critical’ MPs, this continued tragedy acts as a source of amusement, which they believe they are entitled to publicly mock.
Of course, this is not the first instance of abhorrent behaviour from these MPs.
For example, Alba MP Neale Hanvey has signed an early-day motion</a> tabled by the DUP attacking abortion rights. Hanvey also compared the pro-trans rights position of the SNP</a> to the Taliban and their takeover of Afghanistan.
Rosie Duffield MP continues to maintain the Labour whip despite significant outcry from the queer community over her actions. The decision to retain Duffield has been the subject of much criticism, given recent incidents such as Duffield liking a tweet engaging in holocaust revisionism</a>, suggesting that trans people were not targeted by the Nazis</a>. During breaks in the debate for divisions in Parliament, Duffield could also be seen smiling and chatting with the ‘gender critical’ activists sat in the audience, including Maya Forstater</a>.
Misrepresentation of the Current Law</h1>
The debate was also characterised by a complete misunderstanding, or at least misrepresentation of the Equality Act 2010. 
In a particular moment of hilarity for the legally minded, MP Neale Hanvey spent much of his speech</a> referencing Aristotle’s conception of equality that ‘Equals should be treated equally, and unequals treated unequally’, stating that ‘as in the days of Aristotle, sex, who is male and who is female has been the bedrock on which we have accommodated fundamental differences.’
Aristotle’s formulation of equality is the classic definition of a ‘formal equality’ approach, whilst the Equality Act 2010 is notable for significantly departing from this approach in favour of a more substantive one. For examples of this, we can look to its prohibition of indirect discrimination, its allowance for ‘positive’ discrimination in certain cases, and in its equal pay provisions. The fact that an MP is unaware of how significantly the legislation departs from Aristotle’s formal approach is deeply concerning and shows a fundamental misunderstanding of the purpose of the Act. It is doubtful that an MP with such a misunderstanding should be proposing ‘clarifications’ (i.e. changes) to that law. Aristotle’s views on sex</a> also led him to conclude that women were inherently inferior to men.
The most common misrepresentation of the law throughout the debate was the pretence that the current law does not allow for the exclusion of trans people from single-sex spaces. As has already been addressed, the Equality Act 2010 already allows for this discrimination in certain cases, where it can be shown to be a proportionate means of achieving a legitimate aim.
The proposed amendment, therefore, does not seek to allow the exclusion of trans people from single-sex spaces but rather to make such exclusion automatic. This would apply to many spaces which trans people have used for decades, such as toilets. Such a change would see the exclusion of trans people from public life. Conservative MP Anna Firth made clear</a> that trans people should never be allowed to use the toilets many have been using for the majority of their lives:
‘Families, women and children in Southend West want to know that when the sign on the door says or indicates female, that is not up for negotiation. The only people who should be in that space are biological women. Biological males or trans women or non-binary people should simply not be in those spaces.’
One Conservative MP, Anna Richardson, suggested that</a> this could be remedied by a third unisex option for trans people — a “separate but equal” approach that would require trans people to out themselves and would likely see them subject to greater scrutiny and violence.
‘In simple terms, the law needs to facilitate: that employers and service providers offer separate facilities for male and female people in situations where sex matters, like toilets, changing rooms, dormitories and so on; and that they do their level best to accommodate people who do not feel comfortable in communal facilities for their own sex, without undermining the privacy and dignity of people of the opposite sex. That usually means a third unisex option. At this point, I must say that it does not mean converting the ladies’ loos, for instance, into unisex and leaving the number of men’s loos intact, as I have seen happen.’
Some MPs rightly noted that the policing of sex and gender in public spaces that the amendment would encourage is not just a threat to trans people, but also to all women. Labour MP Angela Eagle emphasised this</a> threat:
‘The hysterical media coverage that has accompanied this deliberately provoked war on woke has already led to increased policing in public toilets and harassment of non-gender-conforming women by those questioning their right to be there. I have spent my whole political life and my entire time in Parliament working to create greater equality for all and to reduce bigotry and prejudice, and I have always been a committed feminist. The safety of women and the opening up of economic opportunities to them on an equal basis to that for men has always been one of my priorities in politics.’
Labour and Co-operative MP Luke Pollard shared the story</a> of his lesbian friend who, despite being cis, was asked to leave toilets because of gender policing:
’One of my friends, who describes herself as a butch lesbian, has been asked to leave toilets countless times. All she wants to do is go for a wee. But she has been asked to leave toilets countless times because of a rise in hate. She was born a girl; she is now a proud woman—a proud lesbian. But the rise in hate in the debate and around our country means that she worries about going to the toilet because of what other people may think of her. That is not right.’
Some in the debate argued that the current approach, in which service providers have to justify exclusion, is inadequate. This is part of a clear attempt to make discrimination against trans people easier, based purely on prejudice rather than the legitimate aim service providers currently have to demonstrate. Conservative MP Anna Firth made clear</a> that she believes the ban should be automatic, regardless of whether it is proportional or whether such policies would violate the human rights of trans people:
‘“Case by case” simply does not work. Operating without clear rules simply shifts the responsibility to service providers to make very difficult decisions about who should have access to female-only spaces and services, and who should not. A simple search on the internet reveals the extent of the confusion that reigns. To give just one example, the NHS promises single-sex accommodation in hospitals, yet NHS England’s annex B policy tells hospitals to allow trans and non-binary people to choose whether they are housed with men or women.
’The situation is simply not clear. It is said that sporting bodies set sex-based rules, so clarification is not needed. I would say the exact opposite: the law must be clear about sex if sporting bodies are to feel confident setting sex-based rules.’
As I have argued elsewhere</a>, such an approach of automatic discrimination would be incompatible with the international human rights consensus on trans rights, including the case of Goodwin v UK, which forced the development of the Gender Recognition Act 2004 in the first place.
‘Biological Sex’</h1>
The debate was filled with references to ‘biological sex’, with little understanding or explanation of what that actually entails.
Many ‘gender critical’ MPs presented laughably reductionist interpretations of the term. 
Conservative MP Jonathan Gullis railed against</a> the idea that sex is assigned at birth, claiming everyone is born a man or a woman and everyone has either XY or XX chromosomes:
‘Someone is not assigned their gender at birth; they are born male or female. A man is an adult human male and a woman is an adult human female. We should not be disputing those facts in the 21st century—these are the basics of biology that we talk about in our classrooms.
’I want to make it perfectly clear: sex is not assigned at birth. You are born a man or you are born a woman. Those are indisputable facts. You have XY chromosomes or XX chromosomes. Again, that is not up for debate or discussion.
’To finish, it is biologically clear that a male has XY chromosomes and a female has XX chromosomes. This is a scientific truth that should not be conflated with any constructed truth.’
Similarly, Conservative MP Andrew Lewer characterised</a> sex as an immutable binary:
‘It is vital that everybody knows what the words “male” and “female” mean, and in which it is vital that those words have their natural meanings: the immutable binary characteristic that all humans, and indeed all mammals, possess from the beginning of their life to the end of it.’
Following this, Lewer stated:
‘Sex is not assigned at birth: sex is observed at birth, as determined by conception.’
Of course, such representations of sex are utterly false based on the science - intersex people exist, and are often coercively assigned a sex at birth. A study by Timmermans et al</a>, for example, highlights how entirely arbitrary ‘gender destinies’ are decided for intersex children based on the desire of the parents, with reassurance that the intersex child can always be reassigned as the opposite sex if desired. This was noted by Liberal Democrat MP Layla Moran in response to a similar statement from Conservative MP Ranil Jayarwardena, which he promptly ignored:
Ranil Jayarwardena:
‘I remember that when my first daughter was born we did not find out the sex before, so there was a 50:50 chance. That is basic biology. We all know what the two sexes are. We all know what sex we are and what sex our children are.’
Layla Moran:
‘Does the right hon. Gentleman accept that intersex people exist?’
Ranil Jayarwardena:
‘I am sure that the hon. Lady will deal with that in her comments and that she will be staying for the whole debate. I will conclude my remarks so that other Members can have their say. I want to talk about the fact that we all know which sex we are and what sex our children are. We know that the two sexes—male and female—are fundamental to our very existence.’
A number of MPs addressed this biological illiteracy. For example, SNP MP Kirsty Blackman stated:
‘We have talked about biological sex a number of times, but not one person has been able to explain what it is. The hon. Member for Stoke-on-Trent North (Jonathan Gullis) gave a good stab at it, talking about XX and XY chromosomes. I have no idea what my chromosomes are. I assume that they are probably XY [sic], but I do not know—I have not got a clue what they are. I have a fair idea of what my genitals look like and how they compare with how other people’s look, but if we are talking about biological sex there needs to be a definition that everybody in this room can agree with. Nobody has been able to provide such a definition.’
The descriptions of sex proposed by ‘gender critical’ MPs was insightfully summarised</a> by Labour MP Olivia Blake:
‘There is a risk in this House of us talking about GCSE biology rather than actually [sic] biology.’
Of course, the EHRC itself has been forced to admit</a> that it has not consulted with any biologists and has no definition of ‘biological sex’. Rather, ‘biology’ has little to do with the definition of sex being proposed by the EHRC, with the change instead representing a reversion to the definition of legal sex predating the Gender Recognition Act 2004</a> — simply what is recorded on an individual's birth certificate at the time of birth. The Gender Recognition Act currently allows the amendment of such birth certificates upon obtaining a Gender Recognition Certificate, at which point a trans individual becomes their acquired sex for all legal purposes.
More concerning than this complete misunderstanding of biology, however, was the regressive and essentialist conception of sex proposed by</a> MP Miriam Cates. I will supply it in full as I feel it speaks for itself:
‘Despite the semantic acrobatics employed by some to dodge the question, we all know, instinctively and intrinsically, what a woman is. The sex binary—the biological state of being either male or female—evolved hundreds of millions years ago, before we humans walked the earth. Being able to tell the difference between a man and a woman is not a matter of acquired knowledge. It is as instinctive as being able to tell up from down. Indeed, our survival as a species depends on it; if we want to reproduce, and to protect ourselves and our children, we had better know the difference between a man and a woman.
’Men and women are different physically, psychologically, sexually and socially. All civilisations are built on an understanding of these differences, creating structures, rules and boundaries to protect women and children from male violence and to preserve the dignity of both sexes. There is nothing more destabilising to society than to dismantle the legal, social and cultural guardrails that protect women and children by pretending that males become females and vice versa, and allowing that to creep into our law.’
It is deeply concerning that a supposedly ‘feminist’ ‘gender critical’ movement has chosen to ally itself</a> with those who adopt such explicitly sexist positions.
Positive Contributions</h1>
Trans people should be relieved to note that — despite this prevailing toxicity — there were a number of contributions made which were explicitly trans positive.
Labour MP Angela Eagle noted</a> the threat posed to trans people by such an amendment, stating:
‘It would practically disapply important parts of the Gender Recognition Act and be in breach of our international human rights obligations. It would take away rights that have been enjoyed for almost 20 years by the small minority of our population who are trans.
’Some 7,000 people have a gender recognition certificate. That is who we are afraid of in all this. A change to the Equality Act’s definition of sex to biological sex would have a huge effect on all trans people by effectively mandating their exclusion from public spaces unless they use facilities in their so-called birth gender, which would be humiliating and damaging to them. It would lead to the policing of women’s spaces, which would problematise non-gender-conforming women and girls who are not trans. That is happening now with all the hostility.’
Eagle also rightly identified</a> the current attack on trans people as a moral panic, similar to previous attacks on LGBT+ people:
‘I am also a lesbian. I was only the second out lesbian ever to sit in this place, and the first ever out lesbian Government Minister, so I have had some experience of bigotry, prejudice, misogyny and homophobia—and I recognise a politically induced moral panic when I see one. I also recognise a discredited Government unleashing a culture war for their own divisive ends when I see it. Those seeking to weaponise anti-trans fear for their own purposes have other issues in their sights: principally, inclusive sex education and women’s abortion rights, as we have seen in the USA, where over 400 anti-LGBTQ+ pieces of legislation have been introduced in state legislatures already this year.
‘The attack on trans people’s rights to exist and to live with respect and dignity in an accepting society is designed as a wedge issue that will open up the others. It is a gateway to wider homophobia, as the steady rise in hostility to LGBTQ+ people in the street attests to. I was around when it happened before in the 1980s with the enactment of section 28, which sought successfully to scapegoat LGBT+ young people and drive them into hiding. It caused untold misery for narrow political ends, wrecking the lives of LGBT+ people for generations. We should not be contemplating doing it again.’
MPs Nia Griffith and Hannah Bardell also identified this pattern. They further emphasised the importance they felt, as lesbians, in standing with trans people - as the vast majority of cis lesbians do:
Hannah Bardell:
‘I commend the hon. Lady for making a passionate and common-sense contribution to the debate. I am sure she agrees that some of what we have heard today is just feeding into the moral panic; some of the arguments are just cut and pasted from what gay and lesbian people faced decades ago. Does she agree, as a lesbian, that trans people do not threaten us? In fact, they enhance our existence.’
Nia Griffith:
‘Absolutely. As a fellow lesbian, I absolutely agree with the hon. Lady; they are absolutely not a threat. More importantly than that, they need our support now more than ever.’
The good news: a lack of Government appetite</h1> As I have previously outlined</a>, the proposed amendment to the Equality Act 2010 poses a significant threat to the trans community. It is with some relief, therefore, that this Government seems to have little appetite for bringing the change.
Minister for Women, Maria Caulfield emphasised</a> the need to:
‘consider, both in policy terms and in legal terms, the potential implications of this change before we take any further decisions.’
Caulfield further noted that:
‘As we have heard, there are many views on this issue. That is why it is important that we take the time to properly consider the policy around it and take in the legal considerations, too. There are clearly cases where people are struggling to make practical decisions on a day-by-day basis with the Act as it stands. However, we do not want to create additional unforeseen problems by changing or clarifying the Equality Act.
‘The hon. and learned Lady highlights the diversity of views in this space. That is why it is so important to take proper consideration and time before deciding our next steps. I know that Members will be eager to hear updates and reassurances, as well as the timeline for our next steps. However, the issues under discussion today are complex, and we need to proceed carefully and respectfully. As we have heard, a wide number of people will be affected by any change. I hope that Members will agree that it is only right and proper that we take timely consideration of the advice that we have been given before coming to any conclusions.’
Caulfield repeatedly emphasised that the Government was still ‘considering the next steps’, whilst emphasising that the current law already allows for the exclusion of trans people from single-sex spaces where this can be shown to be a proportionate means of achieving a legitimate aim:
‘I will touch on some of the issues that were raised in the debate, particularly around single-sex spaces. I would like to reassure Members that the Government are committed to maintaining the safeguards that allow organisations to provide single-sex services. We recognise that being able to operate spaces reserved for women and girls is an important principle, and—to answer the question from the hon. Member for Oxford East—should be maintained.
‘As many here will already know, under the Equality Act, providers are already able to restrict the use of spaces on the basis of sex and/or gender reassignment where justified. The Act provides protection against discrimination, harassment and victimisation across a number of grounds, including sex. We are committed to upholding Britain’s long-standing record of protecting the rights of individuals against unlawful discrimination.
‘The EHRC has published guidance on the existing legislation, which provides much-needed clarity to those offering single-sex spaces. It does not change the legal position or the law. As that guidance makes clear, it is currently entirely acceptable for providers of single-sex services to take account of the biological sex of their service users. Where it is a proportionate means of achieving a legitimate aim, the Equality Act is also clear that service providers can exclude, modify or limit access for transgender people even when they have a gender recognition certificate.’
Given the lack of remaining Parliamentary time before the next election, this insistence on the need to take time, and on the exclusion already possible under the law, should be taken as a reassuring sign to trans people that we are unlikely to see such legislative change until after the next election.

Open Letter on legal action against trans healthcare for autistic adults

2023-06-14T00:00:00+00:00


We are trans organisations, disabled people's organisations, academics, human rights defenders and professionals in related fields. We condemn in the strongest terms all attempts to undermine the bodily autonomy and medical choices of disabled people.
A recent legal action</a> by the parent of an adult autistic trans person is seeking to block an elective procedure the autistic adult has consented to. The proposed judicial review runs contrary to the most basic principles of disabled people's rights in healthcare. In particular, it goes against the first and third principles of the Mental Capacity Act 2005</a>, which state that a person should never be assumed to lack capacity simply because they are disabled (principle one) or because they are making a choice another person feels is unwise (principle three).
We note with concern that Paul Conrathe, the solicitor representing the parent in this case, is a conservative religious activist</a> who has previously represented a man seeking an injunction to prevent his ex-girlfriend from terminating a pregnancy</a> and was involved in the now overturned Bell v Tavistock judgement</a>, which sought to limit young trans people's access to treatment. This was in direct opposition to the legal principle of Gillick competency</a>, which also allows young people to access contraception without their parents being informed.
If the proposed judicial review goes ahead, it could seriously undermine the principle of disabled adults being assumed to have capacity to make decisions about their care until proven otherwise. It could also limit disabled trans and gender diverse people’s access to transition care.
Beyond the legal issues, we believe that bodily autonomy is a basic human right which nobody should be denied on the basis of disability or gender. Autistic adults have a fundamental right to make decisions about their own healthcare, regardless of the opinions or prejudices of their parents.
Signed
(Accepting new signatures until the 21st June 2023)

Trans Safety Network

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