This week, the Origin Story podcast, hosted by indistinguishable journalists Ian Dunt and Dorian Lynskey, bravely shouldered the burden of analyzing Rowling over the course of two episodes. Do they succeed? Not remotely. But they do offer a fascinating insight into what happens when a certain kind of progressive man becomes radicalized by Bluesky.

And if you think I’m being patronizing and pathologizing, wait until you get a load of the podcast, which is predicated on the idea that Rowling has undergone a metamorphosis so bizarre, only psychological fracture can explain it. “It’s just such a weird story,” says Dunt. “She gets to say whatever she likes, but year by year, it gets quite a bit less kind until you just see this thing left over.”

Neither host notes that Dunt has referred to Rowling as “this thing”, as though a lack of appropriate “kindness” has turned her into something monstrous. (The “kindness” demanded only flows in one direction — there’s no expectation that trans activists could “kindly” respect women’s boundaries.) Nor do they seem to truly believe that Rowling, or any woman with gender-critical beliefs, should get to “say whatever she likes”. Any deference they pay to free speech is strictly pro-forma.

Despite a cursory show of aiming for balance, Dunt and Lynskey aren’t coming to this subject as neutral parties. They have a point of view, and their point of view is that trans activism is the decent, liberal, commonsense stance: any dissent is at best silly, and at worst (gasp) Right-wing. The assumption which shapes the entire podcast is that there is no legitimate way to be gender critical.

Ten years ago, when Stonewall’s “no debate” position held sway, this was the standard stance in most of the UK media. Today, it has substantially collapsed, but it persists in certain pockets. One of these is Bluesky — the X-replacement social media platform memorably described by Josh Barro as a “containment dome” for extremist Left-wing opinions, and a site where Dunt and Lynskey both enjoy hefty followings.

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On Bluesky, the gender argument never left 2016. Lynskey treats the idea that you can support trans people’s rights while criticizing the politics and precepts of trans activism as inherently bad faith: “It’s very hard to separate those two things considering that, without gender identity, how do trans people make sense?” In other words, if you don’t accept trans people’s understanding of the world, you’re a transphobe.

This is obviously ludicrous. There are innumerable creeds that I don’t share, while also believing that the people who hold them are entitled to freedom from discrimination: Christians, Muslims, vegans, even people who think “two male podcasters giving an etiquette seminar to a woman they don’t know” is an acceptable form of entertainment. If the belief in gender identity requires everyone else to adhere to it, that’s pretty totalitarian.

Dunt and Lynskey find it easy to embrace their own gender identities. In a moment of hearty masculine backslapping, they agree that it would be “mad” to object to the term cisgender. “We’re both cisgender. It’s like, whatever,” shrugs Lynskey obliviously. Oh, do you identify as naturally of the sex class that does less housework and isn’t expected to put other people’s feelings first? How nice for you! (Then, having agreed that “cisgender” is “a really valid and useful word”, neither uses it for the entire rest of the first podcast. Truly, an indispensable piece of language.)

They take the same attitude to the word “terf”. “It’s weird the way it’s treated like a slur and yet it’s not factually inaccurate,” ponders Lynskey, which is exactly the kind of thing racists have historically said about the P-word and the N-word. A word becomes a slur because of the way it’s used — and, as the linguist Deborah Cameron noted in 2016, “terf” is used to make violent threats like “slit their throats” and “every terf out there needs to die”.

But it’s a strange quirk of this podcast: listening to it, you’d have no idea that trans activism contains a long history of misogynistic abuse. At one point, Lynskey refers to Julie Bindel’s 2004 Guardian column, “Gender Benders, Beware” as “viciously transphobic” and “ugly stuff”. What he doesn’t mention is that the column was written in response to a grotesque trans activist attack on the feminist organization Vancouver Rape Relief, for the crime of trying to run a female-only service. (The headline was the Guardian’s own choice: Bindel doesn’t even use the phrase “gender benders” in the copy.)

When it comes to Rowling, there’s not even the tiniest acknowledgment that there may have been an element of sexism in the way she was hounded. The nearest Dunt and Lynskey come to sympathizing with her is in a discussion of the domestic violence she suffered from her first husband — and this comes with an intimation that the experience has made her fragile and unreliable. It’s the classic double bind for the female victim: your experience of male violence disqualifies you to talk about male violence.

And even to refer to “male violence” would likely send Dunt and Lynskey into apoplexy: accurate references to sex are a dreadful taboo here. Throughout the episodes, they act scandalized at anyone referring to a trans woman as male or a man. Lynskey makes an audible “oof” when Dunt quotes Maya Forstater calling Pips Bunce, the gender-fluid Credit Suisse executive who was anointed one of the 100 top women executives in the Financial Times, “a white man who likes to dress in women’s clothes”.

But to anyone not marinated in Bluesky, there is nothing shocking at all about calling Bunce a man. This is someone clearly male who, half the time, wears a suit; who has a wife and a career in finance; and who expects everyone to fall in line with his self-perception and treat him as a woman when he decides to wear a wig. Bunce’s behavior is as male-pattern as his baldness. If Dunt and Lynskey think “man” is the most insulting epithet that could be thrown at him, I’m happy to sit here and call them both men all day.

Dunt and Lynskey are the proverbial last Japanese soldiers in the jungle, still fighting a war that’s been settled elsewhere. According to them, rapid onset gender dysphoria is a discredited “clown car” theory: actually, the increase in girls identifying out of their sex in adolescence without a previous history of gender variance was confirmed by the Cass report. Ah, but Cass too can be dismissed: she’s “not a gender specialist”. (She is, of course, one of the most experienced and respected pediatricians in the country, but what does that weigh compared to a podcast?)

In Origin Story land, autogynephilia — the theory that some men transition because they are turned on by the idea of themselves as a woman — is similarly “discredited”. Who’s going to tell the American critic and trans woman Andrea Long Chu that he was wrong when he wrote that he transitioned “for Daisy Dukes, bikini tops, and all the dresses, and, my god, for the breasts”?

In the podcast, Imane Khelif is the “female Algerian boxer”, and it’s sheerest cruelty to point out that Khelif is actually a male athlete who, regardless of DSDs, therefore doesn’t belong in women’s sport. There’s even a throwaway reprise of the once-popular “Michael Phelps’s armspan” argument, which claims that being male in a female competition is no different to any other physical advantage an athlete might have. I wanted to ask Dunt and Lynskey to do clownfish as an encore.

When Dunt and Lynskey absolutely have to acknowledge that trans inclusion has costs for women, they can’t concede that this is built into the system they are endorsing. Referring to the case of the rapist Karen White, who reoffended while held in a women’s prison, they agree that this was an “insane” decision by the prison service: “however trans inclusive you are, it’s quite hard to [say] that a rapist who then transitioned should be put in there without any consideration,” says Lynskey.

Well, it should have been a hard argument to make. And yet trans activists made it, and prison policy was shaped by it. The women who were assaulted are not figments of a terrible Right-wing imagination — even though I and other feminists were called “terfs”, “transphobes” and “genital obsessives” for pointing out that self-identity made cases like this inevitable.

If the terfs had been listened to, a young female psychiatric patient who identified as male would never have been placed on a male ward, where she was raped. (The NHS trust that enforced this “inclusive” policy also deliberately obstructed the police investigation into the crime.) It’s the funny thing about being called trans exclusionary: I know perfectly well why trans people should be included in the services that fit their birth sex. The “kindness” Dunt and Lynskey demand in their idiotic podcast led, in this instance, to a vulnerable trans person suffering the worst kind of violation.

Even the fact that Rowling funds a center for female victims of violence is held against her, because Beira’s Place is women-only and therefore tarnished in the eyes of these reasonable men. Her greatest crime of all, though, is funding For Women Scotland’s Supreme Court case against the Scottish government, which ultimately clarified that the Equality Act protects sex, and not gender identity. The Equality Act also, separately, protects trans people, but apparently it’s intolerable for women to have even one clause of legislation to themselves.

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By writing this, I’m laying myself open to the charge of “obsession”. “Once I see a writer become obsessed with this issue, they cannot let it go. It becomes almost all they write about,” says Lynskey. But this reveals more about his fixation than mine. The gender-critical writers named in the podcast — Jesse Singal, Victoria Smith, Bindel, me, Rowling — all cover a vast number of other topics, from the Super Bowl to surrogacy to celebrity sex tapes to extremely long crime novels. It’s Lynskey and Dunt who are only able to see trans.

I’d be lying if I said I love everything about Rowling’s social media style: certainly I wish she’d spent less time beefing with India Willoughby, if only because it seems beneath her dignity to pay attention to a voluntarily castrated ex-weatherman. But there’s no hidden truth, no sinister “origin story”, about what happened to her. She’s always been fighty on social media. (Remember Indyref? Or Brexit? Or all the times she sassed Trump?) She’s always been committed to feminism.

This podcast is nothing but a whine of fury that Rowling has shown she values women’s rights more than pandering to men’s feelings. I’m sure that Dunt and Lynskey consider themselves as far from the manosphere as it’s possible to be, and yet the message of Origin Story is that defying men makes a woman subhuman. Such chauvinism has always been embedded in trans activism. That’s why so many feminists rebelled against the doctrine, and it’s also why some liberal men have such a hard time giving it up.

But the consensus was always a mirage — and this week, at least among major US medical groups, it officially vanished.

On Tuesday, the American Society of Plastic Surgeons came out in opposition to providing gender-transition surgeries to minors. The recommendation, the first of its kind from a mainstream medical association, was published in a nine-page policy statement that marks a watershed moment in these debates. It’s part of a broader rethink among many experts, a reminder that science can trump ideology when investigators follow time-tested, evidence-based processes.

To wit, the ASPS examined the thorny cross-section of scientific research and medical ethics that inform the question of whether to provide gender-transition interventions for minors. After considering the weakness of the relevant scientific evidence and the balance of risks versus benefits, the organization urged its 11,000 members to delay gender-transition surgeries — including breast removal and augmentation, penis inversions, and facial-feminization surgery — until patients reach age 19. 

The document — which, while addressed to plastic surgeons, is not a clinical-practice guideline — also cautions that the prospect of treating gender distress in minors with blockers and hormones raises serious ethical concerns due to the shaky state of the supporting science, the challenges of procuring  minors’ informed consent, and the irreversibility of hormones in particular.

While supporters of gender-transition surgeries often falsely characterize them as rare, approximately 1,000 minors received such interventions annually in recent years — overwhelmingly mastectomies for girls who identify as male or nonbinary.

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The ASPS’s position is grounded in systematic literature reviews — the gold standard of scientific evidence — and pays deference to Britain’s  mammoth Cass Review of the field. Accordingly, the document validates the evidence-based-medicine approach to this discipline advocated by the quietly influential — and much-maligned by transgender activists — Society for Evidence-Based Medicine. 

The policy document points to widely debated and criticized research that has suggested that, absent a gender transition, most youths with gender dysphoria will grow out of it. It goes on to point out that even highly experienced clinicians are unable to reliably predict which adolescent patients will persist in their gender-related distress. It then tips its hat to the massive report on pediatric gender medicine commissioned by the US Department of Health and Human Services, which was published in its final form in November and has been roundly dismissed as politically tainted, biased and therefore irrelevant by transgender advocates.

The ASPS continues: “The HHS report underscores that this uncertainty has significant ethical implications: when the likelihood of spontaneous resolution is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and nonmaleficence (i.e., promoting health and well-being while avoiding harm) requires a precautionary approach.”

Those bold assertions are all but guaranteed to enrage and demoralize transgender activists, especially given that this policy statement arrives amid attacks on pediatric gender medicine by the Trump administration as well as a larger fracturing of the global elite consensus about pediatric gender medicine. The cracks have fast expanded after multiple systematic literature reviews found that the evidence backing the benefits of giving gender-transition interventions to minors is weak and uncertain. 

Health authorities in a swath of European nations and the ruling Labour party in Britain sharply restricted minors’ access to gender-transition interventions. In the United States, just more than half of states, all of them red, have banned these practices. And on Friday, a jury in Westchester County awarded $2 million in damages to a detransitioner after her attorney convinced a jury that her psychologist and plastic surgeon had deviated from best practices and harmed her by removing her breasts when she was 16 years old. It was a landmark case — the first decision of its kind — and is expected to serve as a catalyst for others.

The ASPS’s position statement calls into question the logic pushed by many transgender activists that patient autonomy should be paramount  — even absolute — among minors seeking these interventions. The document states that “patient autonomy is more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk-benefit profile.” 

Wading into the policy debate, the ASPS asserted that it opposed the criminalization of gender-transition interventions for young people and other “punitive legislative approaches.” A few states — Idaho, Oklahoma and Florida among them — impose such harsh criminal penalties. And yet, the ASPS stopped short of explicitly opposing bans that impose only civil consequences, which comprise the vast majority of state bans on pediatric gender medicine.  

The ASPS policy document’s age cut-off of 19 for surgeries puts the ASPS in line with policies of the Trump administration as it has engaged in a whole-of-government assault on what remains of the pediatric gender medicine field. 

Yet leaders at the ASPS saw the new recommendations as necessary. Dr. Scot Glasberg is a plastic surgeon in private practice in New York and a past ASPS president. He was not directly involved with the new policy statement but said he was intimately familiar with its development. He said the organization selected age 19 as a cutoff because by that point young people are safely out of puberty. 

“This entire statement revolves around a vulnerable population,” Glasberg told UnHerd. “The ages of development are key.” And given the weakness of the evidence base, he continued, “we felt it would be best to recommend to wait until the age of 19” to allow young people time to mature. 

Facing what is sure to be considerable backlash from liberal groups and transgender advocates, Glasberg asserted that the ASPS’s work on this document was fully independent of the Trump administration. “We have the beauty as an organization to be out of the line of politics,” Glasberg said. “We deal with science and evidence and data, and that’s why we made the decision we did.”

The ASPS had telegraphed its discomfort with gender-transition interventions for minors during the Biden administration. In August 2024, the organization made clear that it did not endorse such practices. The organization’s president at the time, California plastic surgeon Dr. Steven Williams, said in an Instagram live interview the following month that he wouldn’t commit to the ASPS coming out in opposition to those bans.

Yet major LGBTQ and liberal nonprofits, including GLAAD, the Human Rights Campaign, and the ACLU, have continued to routinely make the false claim that all major medical organizations endorse what they call gender-affirming care for minors. 

As recently as December, the ACLU made this claim in a statement about its efforts to combat the Trump administration’s threats to strip Medicaid funding from hospitals that provide gender-transition interventions to patients under age 19. The ACLU release stated: “The administration’s proposal seeks to block the provision of evidence-based, medically necessary care for transgender people under 18 — care that is supported by every major medical association in the United States, including the American Medical Association and the American Academy of Pediatrics.”

After UnHerd challenged the ACLU over the veracity of its statement, a representative replied: “The ASPS opposes bans on gender-affirming medical care, like those the ACLU has challenged in court, so your claim is misleading at best.” Contacted for further comment after the ASPS released its new policy statement, the ACLU didn’t reply. GLAAD and HRC also didn’t reply to a request for comment.

The ASPS’s policy statement is already providing ample fodder for the legal profession.

Alabama Attorney General Steve Marshall, who has tangled with the ACLU in court, was eager to provide a comment. “For years, legal advocacy groups like the ACLU have worked hand-in-hand with medical interest groups,” he said, “to manufacture a narrative for use in court that providing sex-change procedures to children is medically necessary and recommended by every major medical organization,” he told UnHerd. “The claim has always been false, and I am glad that responsible medical organizations are finally beginning to put patient safety and evidence-based review ahead of ideology.”

 Legal experts said the ASPS appeared eager to ward off attempts by litigators to leverage its new policy document in detransitioner lawsuits against plastic surgeons. More than two dozen suits have been filed by such plaintiffs so far, including some that, like the case that won the judgment in Westchester on Friday, include a plastic-surgeon defendant. 

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 A critical statement in the ASPS document reads: “This position statement is not a retroactive judgment, but a forward-looking response to evolving evidence.”

 Yet Charles LiMandri — a partner at the California law firm LiMandri and Johnna, which is behind two of the most famous detransitioner lawsuits — still sees an opening. “What the opposition has always said,” LiMandri told UnHerd, is that pediatric gender medicine “is evidence-based medicine, and that the science was settled and supportive. Those were lies.” He continued: “The fact that people are coming out now and saying there never was good science to support this proves those were lies. So in one sense they could say, ‘Well, the new ASPS standards can’t be applied retroactively.’ But on the other hand, they can’t deny the fact that if there’s no evidence for it now, there never was. And they said there was.” 

 Adam Deutsch, a personal-injury attorney in White Plains who represented the plaintiff in the detransitioner lawsuit, referenced the difference, dissected during the three-week trial, between the 16-year-old girl’s desire for surgery and the responsibility of the care providers to determine whether it was in a minor’s best interest. He said that the ASPS position statement validated his successful effort to point the finger at the defendants.

 Deutsch noted another element of the policy document that dovetailed with his client’s lawsuit: what he interpreted as the ASPS asserting that plastic surgeons needed to conduct their own due diligence when screening patients and not merely rely on the independent word of a referring mental-health professional. 

The attorney suggested that the ASPS might be putting more doctors on notice than just those who care for minors. He said he thought such a position by the ASPS would place greater pressure on surgeons when considering performing gender-transition surgeries on adults, as well. 

The once-impenetrable edifice of gender activism is beginning to crumble.

She peppers her memoir with “why” questions, as if anxiously monitoring for things she might have missed. She also poses puzzled questions of her past self, though seems refreshingly untroubled by the answers. Of her temperament, she explains, “I was more interested in the paper people I could create than in doing deep dives into my own psyche, should such a thing exist”.

Being good at myth-making, the still fizzy 85-year-old seamlessly weaves her interpretative deficits into a vivid origin story: “One of my theories about novel writers is that they don’t know more about human nature than other people: they know less, and their novels are attempts to figure it out.” Her father was an entomologist; like him, she can’t stop mentally cataloging bits of the world, then cross-referencing. “If I watched carefully, I’d be able to find out how stuff worked, whatever that stuff might be. Sometimes it was mechanical devices, such as sewing machines. But usually it was people.”

But though minds were slippery things to master, in other informational domains Atwood was in her element. She relished learning about arcane codes and ciphers, then applying them. She became able to identify rare fauna and flora, read palms, do star charts, detect ghosts. For a time she did graduate work in English literature at Harvard, but the role of critically minded theoretician didn’t seem to fit; her interest in the world is much more practical. She loves building novels out of images and ideas, just as she also likes making dresses, cakes, puppet shows, comic strips, operettas, poems and jokes.

Though it isn’t clear where all that creativity came from, the practical bent appears to have been non-negotiable during an extremely adventurous childhood. Book of Lives cheerfully describes a dangerous existence in the company of intrepid parents and an older brother: living in remote parts of Quebec and Ontario, sleeping in tents, surviving near-drownings, casually seeing off snakes and bears, and always feeling cold. Any reader using a screen to bring up their child will presumably hang their head in shame.

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From her stoic Nova Scotian forebears, “Peggy” (her name at home) also inherited a now-unfashionable dislike of navel-gazing and self-pity. Her relatives would “think it bad manners to show off, to snivel and complain, or to express emotions to excess, or even at all”. Later on in life, she shows impatience with the depression of her husband, self-satirizing as “Ms. Fixit”. “Are you feeling better now? How about now? Look, we have a fondue pot! Doesn’t that make you happy?”. The marriage doesn’t last.

It is fun to cross-reference these personal insights with her novels. Like their author, the stories are madly creative; unsentimental and often macabre; crammed with fascinating empirical detail; fond of cross-referencing between domains. They are also short on psychological analysis, numinously infusing the natural world and manmade objects with unconscious feeling instead. Her most famous natural object is the female body: imagined as food (The Edible Woman); as decaying medical material (Bodily Harm), as breeding stock (The Handmaid’s Tale). The theme has made her enormously popular with feminists, a fact which she plainly experiences as a mixed blessing.

Certainly, Atwood is not an obvious candidate for leading the women’s movement. She loves chumming around with the male sex, and it takes until the account of her university days in her memoir to get a proper description of a female friendship. She has no truck with victimhood — the perpetrator of a grim sexual assault at graduate school gets a quick, heartfelt curse before the narrative moves on. And when, in the Seventies, a film director demands a “naked woman wrapped in cellophane” in a screenplay she is writing, she happily complies.

She is also markedly ambivalent about other women. Though she may not understand much about female psychology in detail, she is at least well aware of its toxic side. In Cat’s Eye, Atwood forensically detailed the brutality of nine-year-old girls to each other. In the memoir, we get the real-life version, with young Peggy as the hapless victim. She also knows from experience how envious and vindictive grown women can be. At one point, the protagonist of the dystopian The Handmaid’s Tale grimly accuses her absent mother, a second-wave feminist: “You wanted a women’s culture. Well, now there is one.”

Her political outlook is mostly liberal, which puts her at odds with the prevailing mood in modern progressivism — often to her credit. A big fan of freedom of expression, she introduced Salman Rushdie on stage shortly after the fatwa. She also signed the Harper’s letter against an “intolerant climate” in 2020. And she is very keen on due process, having no truck with the score-settling excesses of the #MeToo movement.

During this time, Atwood defended a University of British Columbia professor from what seems to have been a vicious witch-hunt. Afterwards, the witch-hunters tried to come for her as well, though she batted them off with her enormous fame, plus an acerbic essay entitled “Am I a bad feminist?”. In her memoir, she reflects that “when cults are at their height, fairness and human rights go out the window”, and is similarly critical of Trump’s lack of regard for legal process now.

Equally, though, she has been mostly silent on the authoritarian gender cult still operating in her Canadian backyard, except to disseminate some dodgy information about chromosomes and get annoyed when Hadley Freeman asked her about it. She has apparently reflected little about why chromosomally average teenage girls might be queuing up to get their sex organs surgically expunged. This has resulted in a lot of disappointed women shouting at Atwood on the internet. But there are suggestive clues to the blindspot in Book of Lives.

I would guess that Atwood can easily understand what’s wrong with the authoritarian coercion of people by outside forces — simply applying the mechanical model of “object x exerts force on object y”. But when it comes to minds that enthusiastically embrace damaging social norms inherited from the wider culture, it is quite possible she doesn’t really grasp the problem. Maybe this is because she is a classic liberal, uninterested in unverifiable claims about false consciousness; or maybe it’s because she struggles to place herself imaginatively within the mind of anyone sheep-like enough to succumb to social pressure — as she herself is manifestly not. And there is also the fact that in her work she often seems to exhibit profound unease about the female body. It’s part of what makes her artistic vision so compelling, even if it arguably compromises her politics.

I don’t really care about any of that; I like her books too much. But her memoir does rather undercut any flattering vision of The Handmaid’s Tale as a prescient forecast, peculiarly attuned to the authoritarian Right-wing future allegedly lying in wait for women, now that Trump is here. Atwood enjoys this image of herself as a far-sighted sage very much, referring to it several times. Perhaps it’s a small compensation for all those times her male pals laughed at her for not understanding something. But honestly, the idea that, in the near future, Western governments will need to use direct force to make women do market-friendly things against their own interests is now surely, definitively preposterous. The case of genderism — and surrogacy, and “sex work”, for that matter — shows that authorities only need to persuade enough women that certain activities are kind, or glamorous, or nobly self-improving; at which point, tender-hearted armies will rise up to ruthlessly punish dissenters themselves.

That bit about Bill’s rejection — the killer merely thinks he’s trans — is a relic from an earlier, hard-to-imagine age, when patients’ claims of belonging to the opposite sex were apparently subjected to rigorous scrutiny, rather than being readily affirmed. Yet the film’s dialog fails the test of verisimilitude in one respect. By the time the events in Silence of the Lambs take place, in the 1980s, Johns Hopkins University’s sex-change clinic had been closed down.

Dr. Paul McHugh, then head of psychiatry at the Hopkins School of Medicine in Baltimore, made the decision to shutter it in 1979. The move “wasn’t controversial” at the time, McHugh tells me in a Zoom interview this week. There were dissenters, to be sure, not least John Money, the sexologist who’d established the unit a decade and a half earlier. But “all the other people at the hospital, even including many of the plastic surgeons, agreed.”

A colleague’s systematic follow-up study found that subjects who’d undergone reassignment didn’t show much by way of improvement in their “interpersonal relations” and overall well-being. In those days, McHugh recalls, the specialists who pioneered trans surgery didn’t really imagine that they were “turning a man into a woman.” They simply thought they’d make life “easier, more comfortable” for the patient. 

But if the intended effects failed to materialize, what was the point? The enterprise, he reflected later, was akin to “collaborating with madness.”

In the ensuing years, McHugh maintained a distinguished career at Hopkins, even founded a program on human flourishing. Beginning in the late 1990s, however, gender-activist pressure mounted on medical researchers and practitioners across the West. The psychiatric field, in particular, was called to ratify a pair of highly speculative claims: that gender is largely a social construct, unmoored from biology; and that some people are “born into the wrong body.”

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Both can’t be true at once. The second claim rests on the idea of gender identity as a meaningful, immutable characteristic of which a person can have a deep inner awareness. How can it then simultaneously be socially constructed? Nevertheless, many in the medical profession forced their minds to submit, the Law of Non-Contradiction be damned. Paul McHugh refused. After his term as department chair ended, in 2001, he continued to critique the new gender science, both through academic research and popular advocacy.

McHugh paid a price. By the mid-2010s, he’d emerged as the trans movement’s Public Enemy No. 1. The Human Rights Campaign in 2017 launched an entire website to “debunk” his work. The advocacy group GLAAD created an “accountability” profile on him (complete with an unflattering portrait) that busted him for claiming, among other things, that “gender ideology harms children,” and that transitioning kids is akin to performing liposuction on anorexics.

In 2016, The Advocate, an LGBT publication, described McHugh as a “notoriously antitransgender psychiatrist,” singling out his statements that “‘sex change’ is biologically impossible” and that “People who undergo sex-reassignment surgery do not change from men to women or vice versa.” A 2017 Washington Post article cheered the resumption of reassignment surgeries at Johns Hopkins, under the headline: “Long Shadow Cast by Psychiatrist on Transgender Issues Finally Recedes at Johns Hopkins.” 

Then, in 2022, Johns Hopkins established a special board to rename programs and buildings that “recognize individuals whose legacies may now be considered antithetical to our values.” Soon enough, a postdoctoral fellow petitioned the board to rename the Paul McHugh Program on Human Flourishing on account of “his transphobic and homophobic views,” as a campus paper tsk-tsked.

But then, as the “peak-woke” fever broke, gender ideologues began to suffer setbacks. In Britain and across Europe, youth gender clinics have come under intense scientific scrutiny, in some cases leading the authorities to shutter them. Global athletic bodies, including the Olympic Committee, are rewriting rules that allow biological men to compete in women’s sports. 

McHugh’s public reception altered once more, in tandem with these developments. In 2023, the university’s president, Ron Daniels, intervened to preserve McHugh’s name on his legacy program. “‘You can’t take the name off a program [associated with] an active faculty unless he’s had some infraction,’” McHugh paraphrases Daniels telling the university community. McHugh had a spotless record. Then, on Wednesday, the 94-year-old McHugh received the Medal for Intellectual Freedom from the American Academy of Sciences and Letters.

McHugh has returned from the cold, in short. “In your mid-90s,” he tells me, “you expect people to not find you interesting. So the very fact that we’re talking is kind of fun for me.” 

When Paul McHugh entered psychiatry, the battle over evidence-based medicine took a very different shape. It was the mid-1950s, when an Americanized, and particularly dull, brand of Freudian psychoanalysis almost totally dominated the profession. At Harvard Medical School, he recalls, “the brightest classmates of mine were drawn into psychiatry, psychoanalysis in particular. And I wanted to be with the bright boys, so I went along.”

As with every other branch of medicine, psychiatric training involved the memorization of a mountain of facts — which in those days, he says, meant “psychoanalytic facts.” But a Harvard mentor urged him to go in a different direction. The Freudians, the mentor told him, “get so tied up with themselves. They don’t know anything about the brain. You know, the brain must have something to do [with mental illness].” 

McHugh was impressed enough to take a detour into brain science. He also had a stint at King’s College London, studying under the legendary psychiatrist Sir Aubrey Lewis, who “showed me exactly how to take a case … in such a fashion that you began looking for evidence to prove one thing right or wrong.” This, contra the Freudian method, which, he argues, starts with theory — the Oedipus complex, repression, and so on — and then searches for evidence in the case.

Upon returning Stateside, he became a champion of experimental, evidence-first psychiatry — and made enemies of swaths of the profession. “I began challenging things,” he says, “and people got really mad. I was surprised by the Freudian orthodoxy.” Each time he was up for a post, some half a dozen psychoanalysts would show up — in person — to militate against McHugh getting it. “Imagine giving up a day or two’s work to stop a guy from getting a job!”

He rose all the same. One early position was chairman of psychiatry at the University of Oregon, where he encountered his first trans cases. An Oregon colleague, Ira Pauly, a disciple of Money (who’d founded the Hopkins gender unit), was “encouraging sex-change operations out there.” Seeing the patients, McHugh says, “I thought they were caricatures of women. They were all men who wanted to be women.” His early conclusion: “I thought it needed research.” 

When the Hopkins chairmanship opened up, it offered an opportunity for just such research. Once more, his hiring faced ferocious opposition from the psychoanalysts. Yet when he got the job, it didn’t occur to him to “cancel” the Freudians. He continued to maintain a psychoanalytic presence in the department, and funded the expensive training analyses aspiring Freudian therapists must undergo. 

Beyond respect for differing scientific views, McHugh worried that if he ousted his intellectual opponents, the medical students he trained would come to suspect “that I had something to hide” — wisdom that would be lost on many others across academe in coming years, as censorship and cancel culture ramped up. 

It was one of the Freudians, an analyst named Jon Meyer, who did the follow-up study on the gender clinic, finding that transgender surgery didn’t noticeably improve the lives of the men who underwent it (the cases then were almost entirely male-to-female). Three decades later, a Swedish study discovered that, as McHugh summed up in a much-discussed Wall Street Journal op-ed, “beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population.” 

Meanwhile, he conducted research in many other areas, including schizophrenia, pedophilia, and what used to be called multiple personality disorder, among other conditions. As the years wore on, experimental psychiatrists like McHugh would find themselves in a curious alliance of sorts with the Freudians, as both faced the fury of the anti-psychiatry movements promoted by the likes of Thomas Szasz in America and Michel Foucault and his disciples in Europe.

The idea was that mental illness is an invention of the institutions that treat the mentally ill and valorize themselves in the process. “Get rid of the psychiatrist, and you get rid of mental illness,” as McHugh sums up the anti-psychiatric creed, which he likens to the view that crime is a social construct used by the police and justice systems to maintain and expand their institutional power. 

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As he recounts in an essay published in the ’90s, McHugh encountered a medical student besotted with such notions. McHugh’s solution: he had the student spend half an hour with a patient diagnosed with schizophrenia. Afterward, the student sheepishly conceded that schizophrenia, and mental illness more generally, are very much real. 

Yet too many others in the profession, McHugh worries, have gone along with such trends, culminating in psychiatry’s near-total surrender to gender ideology in the last decade. Instead of challenging patients’ misperceptions regarding themselves — something that, to their credit, orthodox Freudians also insist upon — “affirming” psychiatry actively colludes in the delusion and even justifies radical bodily modification to give it a semblance of “reality.”

“It’s the idea,” McHugh tells me, “that if your sense of yourself and the facts about yourself diverge, it’s the sense of yourself that [the clinician] has got to go with.” He adds: “That’s a kind of old idea, too. It goes way back to the Gnostics” — the Late Antique heresy — “where it was in a sense the spirit, not the flesh, that mattered.”

But what specifically explains transgenderism — the radical disjuncture between bodily sex and the patient’s subjective sense of his gender identity? As might be expected from an anti-Freudian, McHugh resists accounts based on hidden or distorted sexual desires. As a clinician, McHugh prefers to deal with conscious-but-deluded ideas that grip patients’ minds — especially dangerous in a cultural context that actively encourages the drive toward unreality.

In the event, McHugh believes that medicine’s knowledge of human sexuality is still in its infancy. “That’s really the problem,” he says. “We don’t understand the connections that tie us one to the other…. We should be studying and debating these things. But, you know, there are a lot of answers people don’t want to hear, so they don’t ask the questions that need to be asked.”

Nothing could’ve been more harmful to this project than the anti-scientific moralism that took hold of elite institutions in the 2010s. “In the old days,” McHugh recalls, “I used to have conversations with people who thought I was wrong now and then. But at the beginning of the 21st century, it was no longer that I was wrong. It was that I was evil.” You didn’t debate evil during peak woke — you extirpated it.

Yet as the fog of gender fanaticism lifts, McHugh looks like the one who remained clear-eyed. His triumph is a testament to the enduring capacity of rigorous, pluralistic scientific inquiry to self-correct, adjusting course in the light of the evidence, and withstanding even the most intense ideological agitation. “I think that really is the only way to go,” he says. “Realism and the recognition that all this disdain for traditional facts, biological facts in themselves, is not going to get anybody anywhere.”

Correction: An earlier version of this essay misstated the organization that awarded the intellectual-freedom medal to McHugh, and the day on which the award was presented.

Then, on Monday, Aaron Sibarium of the Free Beacon reported that the FBI is investigating a series of social-media posts published in advance of Kirk’s assassination that “appeared to indicate foreknowledge” of the shooting. Several of those accounts appear to be run by transgender individuals, and at least one of them apparently followed Robinson’s trans roommate on TikTok, Sibarium reported.

Among the most hyperbolic polemics on the Right about this quickly shifting story are those from Daily Wire pundit Matt Walsh, who took to X over the weekend to declare: “Transgenderism is a death cult.” He added that “trans militants” are “inherently violent” and insisted that the “threat they pose is very serious.” Then there was Donald Trump Jr., who before the shooter was identified, said in an interview with Fox News, “I can’t frankly name a mass shooting in the last year or two in America that wasn’t committed by a transgender lunatic that’s been pumped up on probably hormones since they were 3-year-olds.” (Donald Jr.’s grasp of the age a minor might start hormone therapy, even at the outer limits, is wildly inaccurate.)

It’s obviously tempting for some on the Right to claim Kirk’s murder as a general indictment of trans people — and equally, for their opponents on the Left, to fervently deny any connection between violence and trans identities. A better society, however, would tread carefully. Science on trans issues has indeed been politicised, not least by trans activists, but this is no reason to give up on it. Everyone is left poorer by each side’s rigidity and refusal to examine the facts.

Let’s start with the claim that transgender people are more likely to be mass shooters. Such figures are difficult to assess, since comparisons depend on a morass of diffuse and distortable data, including the definition of mass shooting and the size of the trans population. In fact, Kirk’s last words — “Including gang violence?” — addressed the issue of how difficult it is to define these matters, in response to a question from a student at Utah Valley University.

Assessing the per capita mass-shooting rate for trans people is also challenging, given the increasingly broad definition of what it means to be transgender and the inability for authorities to determine each shooter’s gender identity; such uncertainty leaves the door open for both sides of this issue to juice the numbers in favour of their preferred conclusion. Also, the population of trans youth has been growing faster than data analysts can necessarily keep up.

Caveats aside, the day before Kirk’s assassination, PolitiFact, a nonpartisan fact-checking organisation, published an examination of the claim that trans people are disproportionately represented in the mass-shooter population and found no evidence to support it. PolitiFact examined Gun Violence Archive data and determined that seven out of 4,147, or 0.17%, of mass shootings since 2018 were committed by people with a trans or nonbinary identity.

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PolitiFact calculated the mass shootings tally fairly broadly, which means it both included gang-violence incidents as well as the shooting at the Annunciation Catholic School in Minneapolis in August, which resulted in two deaths not including the perpetrator. According to the Williams Institute at the University of California, Los Angeles, considered the most reliable source of such data, about 1% of the overall US population identifies as trans or nonbinary; and among adolescents and young adults, the figure is just above 3%. So simply comparing those admittedly very rough figures, the claim that there is a disproportionate mass-murder trend among trans people is not supported by the evidence.

Importantly, there have been no academic studies that have analysed the available data to produce an estimate of the per-capita rates of mass shootings among trans people versus other demographics.

As for what the psychological research shows about whether trans people are more prone to violence, there’s a similar dearth of information. Researchers such as Amy Tishelman, a psychology professor at Boston College and one of the leading experts in the care of young people with gender dysphoria, suggest the reverse is largely true. “Youth who identify as transgender are actually more likely to experience internalising symptoms — anxiety, depression — than externalising symptoms, including aggression and violence,” she told me.

A Finnish study published in 2021 did find that transgender youth were more likely to be both victims and perpetrators of bullying. But overwhelmingly, the available scholarship has established that this population is disproportionately victimised, subjected to physical violence, bullying, dating violence, and forced sex.

What is abundantly clear is that the quickly ballooning population of youths with gender dysphoria also typically suffer from a host of other major psychiatric conditions. A 2021 paper found that, compared with their siblings, trans youth receiving care from military services from 2010 to 2018 were five times as likely to have a mental-health diagnosis. A 2018 paper found 30% to 50% of trans and gender-questioning youth reported a recent suicide attempt, compared with 18% of girls and 10% of boys. And a 2015 study of a Boston community health center found that, compared with matched controls of youth who were not trans, trans youth were three to four times more likely to have been diagnosed with depression and anxiety, to have experienced suicidal ideation, and to have engaged in self-harm.

Irrespective of their gender identities, this is a remarkably troubled population of young people. And it is substantial. According to Leor Sapir, a senior fellow at the conservative Manhattan Institute, between 2017 and 2023, some 320,000 to 400,000 minors received a gender-dysphoria-related diagnosis.

Interpreting these research findings to address the question of any greater potential for violence moves into the realm of speculation. Tishelman raised the question of whether there is a certain stratum of people who are indeed prone to violence and who profess to be transgender but who are not in fact genuinely trans. The Minneapolis shooter, after all, confessed in a diary entry shortly before the incident to regretting transitioning. 

This line of thinking rests in part on the fact that the profile of youth with gender-related distress has undergone a sea change. A generation ago, cross-sex identification among minors was very rare, and the youth who presented to mental-health professionals with what was then known as gender-identity disorder had lower rates of other psychiatric diagnoses than what is seen today, according to research by Canadian psychologist Ken Zucker and his colleagues.

Since then, profound cultural shifts have taken place in swift succession. In 2007, Boston Children’s Hospital became the first American clinic to offer puberty blockers and cross-sex hormones to treat paediatric gender dysphoria. The Occupy Wall Street movement, in 2011, heralded the dawning of the social-justice-warrior era, which saw dramatically overhauled mores about sex and gender among progressives in particular. And during the early 2010s, children first became exposed to smartphone-based social media, opening them to a new realm of online identity exploration and expression as well as myriad unprecedented hazards.

As psychologist Erica Anderson, who specialises in caring for youth with gender dysphoria, told me, “It changed from kids that I saw as likely persistently trans, and who didn’t have flagrant coexisting psychiatric problems, to a heterogeneity of cases and kids who clearly had psychiatric issues that needed, in my opinion, to be treated before we could sort out the gender issues.” She continued: “The appropriation of the word trans has come to include people who would not have been characterised as trans 10 years ago and would not have been encouraged to medicalise.” 

Almost all of the trans shooters included in the PolitiFact tally were under 30 and thus part of the surge in trans identification among youths that began in the early 2010s. 

All this is to say that while we obviously have a mass-shooter problem, there is no clear scientific basis to argue that it is a trans mass-shooter problem. There are too many other complicating factors at play.

Leading researchers have been eager to sweepingly blame the poor mental health of gender-dysphoric people on what’s known as minority stress, or the suffering spawned by stigma and mistreatment regarding an individual’s trans identity. This theory is similar to many others that color the progressive approach to societal problems: that external, or so-called structural, factors are overwhelmingly, or exclusively, to blame for disparate negative outcomes among disadvantaged populations. 

When applied to people with gender dysphoria, minority-stress theory is predicated on the notion that a trans identity is a fixed facet of the inner self and that hostility directed at that identity unidirectionally causes internal suffering. Leaders of the paediatric gender care field have fervently denied that trans identities are ever a product of social influence. 

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It may, however, be time to distinguish between the subgroups under the trans umbrella, and to acknowledge, as many detransitioners have attested, that factors outside of brain wiring could possibly lead some people to identify as transgender. Have some youth adopted a trans identity as part of a deeper psychopathology that is itself tied to violence? Is this identity misdirection being fuelled by an internet culture that foments violence and also intersects with spaces where young people cultivate their gender identities? Enterprising — and brave — researchers might consider addressing these admittedly hazardous questions.  

To do so could lend credence to a theory that is anathema in paediatric gender medicine: that for some, asserting a trans identity may be a maladaptive coping mechanism and a distraction from a deeper wellspring of psychological distress. If this is true, then at least in some cases, gender-transition treatment and surgeries might only exacerbate the individual’s struggles with mental health. 

“What’s totally unhelpful and unproductive, not to say petty and just false, is to say that anybody who identifies as trans is inherently a threat, and should be regarded as such,” Sapir told me. The question, he noted, is how to grapple with any possible connection between violence and a portion of the trans population without resorting to trans hatred. “To focus only on the people who actually pull the trigger, and not on all the systemic causes that enable and encourage that type of behaviour seems to be totally unhelpful,” Sapir said. 

Sapir faulted many trans activists for being what he called “agents of pessimism.” These activists, he said, tell their followers, “‘Your life sucks, the world hates you.’” Even amid aggressive pushback by the Trump administration against the goals of transgender activism, Sapir insisted such messaging is hyperbolic and that it could be radicalising.

Psychologist Erica Anderson added that when it comes to transgender issues, “too much of the chatter online is polemical, over-generalises, and demonises ‘the other side.’” She expressed concern that “someone who is seeing themselves as a victim and feels that they have an identified enemy may be more likely to lash out.”

Trans activists would no doubt characterise such a view as blaming the victim. However, the one thing science — and the epidemic of mass shootings of all types tell us — is that we have a generation of youth, trans and otherwise, in desperate need of better care. We should not be afraid to ask questions and answer them diligently with science in service of protecting both their well-being and society at large. 

Given the politics and personalities involved, it’s tempting to accuse both men of being as deliberately offensive as possible — even to Roman Catholics, who won’t love the performative and irreligious tone of their materials. And as one straight man I know said, Yiannopoulos’s and Yardley’s new trad-bromance “looks pretty gay”. Yet Yardley seems to represent an incipient trend. He is one of a handful of detransitioners I personally know of who have turned toward Catholicism’s restrictive sexual dogmas (still no blowjobs, folks) and teachings on biological sex in order to change their lives.

While not all insights gained from the experience of being trans and back again are reliable — especially when staged for an online public — their voices are worth hearing for what they reveal about the so-called vibe shift, a younger generation’s turn away from sexual-liberationist paradigms, and the role of Christianity in it. This, even as the attention-seeking quality of their discourse recalls nothing so much as the gender trend just a few years ago — only now in the opposite direction.

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Yardley is of the first generation of young people to launch their medical transition during puberty as part of the Tumblr-fueled gender revolution, and believes he will face permanent fertility consequences as a result. He says that he was a feminine-looking boy, who liked female things and had mostly female friends, and who was often misgendered. He didn’t know why he was different, but “other people informed me of it”. Around the time Lady Gaga’s “Born This Way” came out, in 2011, he wondered if being transgender might be the answer. He went to the Children’s Hospital of Philadelphia and says he was goaded into transgender care. The therapist recommended by the clinic “immediately bought into it that I was really a girl”.

Today, he is graceful, tall, and girlish in photos, and easily passes as a biological woman. But he has grown to regret his transition for a host of what are becoming the usual reasons: concerns about how cross-sex hormones were affecting his health; physical pain; fatigue with what other detransitioners have called “trans OCD”, an obsessional focus on one’s body; and a dawning realization that the desire for transgenderism spawned from an original mental-health issue that being transgender wasn’t fixing. “I was never comfortable with it,” Yardley tells me.

Like some male-to-female transitioners, he says that at least part of his attempt to become a woman was in order to cope with same-sex feelings of attraction without having to declare himself as gay. He now objects to the characterization of sexual orientation as a fixed and immutable identity. He also rejects the idea that being a feminine boy meant he was actually a girl. “Gay and trans are the same thing”, he tells me. “Both result from an original trauma to your gender that can be healed”.

It’s fairly easy to diagnose a swing from one utopian extreme to another, which comments like that exemplify. But it’s less easy to dismiss the critique of categories of sexual identity and sexual orientation, acknowledged by scholars on both the Left and the Right to be a fairly recent invention. For most of human history, as Michel Foucault pointed out, heterosexuality or homosexuality did not exist as identities; both were invented in the late 19th century as a means of normalizing heterosexual behavior, while treating same-sex-attracted people as “abnormal”. That the invention turned on its makers and ended up providing the grounds for gay liberation is one of history’s delicious ironies. Today’s proliferation of increasingly niche identities and orientations, and the practice of changing them as a person evolves, supports the argument that these identities aren’t as hard-and-fast as they appear.

Some of the excesses of Yardley’s and Yiannopoulos’s publicly performed hard-Right Catholicism seem like they could be trolling. But Yardley’s explanation over the telephone sounds heartfelt. He was raised nominally Catholic, he says, and as early as 2020, when it became clear to him that being trans wasn’t making him happier or more socially comfortable, he began to research dissenting opinions. A Catholic priest was the first person ever, he says, to tell him something most human beings have believed throughout history — “No, you’re a man, and you can’t get out of it.”

Another outspoken detransitioner, Ray Alex Williams, has run a YouTube channel on the subject since 2023, and published an essay on Substack on 24 February headlined, “How Catholicism Solved My Autogynephilia Problem.” Williams’s essay begins with the acknowledgement that people will think he has “gone off the deep end” and has gone “from one extreme cult to another”. During a follow-up phone conversation, he reveals that he isn’t officially Catholic yet; his religious-conversion experience is fewer than two weeks old; and his girlfriend broke up with him over it. The headline, in this case, seems like a deliberate distortion in a bid for clicks. However, as he tells it, his “desperate search for moral clarity” has been years in the making, and he believes he needs such clarity to help him combat the destructive role his sexual desires have played in his life.

Autogynephilia, or AGP, is contested cultural territory. Defined by the eminent Canadian sexologist Ray Blanchard as “a man’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman”, it generally involves not just the erotic desire to be a woman, but accompanying fantasies of being used and abused for being female, often these days following the tropes of the “sissy” subgenre of pornography.

When they don’t deny autogynephilia altogether, transgender activists object to the term because it pathologizes the set of sexual desires it describes, and opens the door to the claim that trans people with these desires are not women, but just men with an obsessive paraphilia. (Yardley explicitly disavows AGP as having had any role in his experience.) One thing is certain, though: the set of desires itself is fairly common.

New York magazine books critic Andrea Long Chu has been open that such impulses fueled her transition, and discussed how sissy porn shaped her identity in remarks at the New York Public Library in 2018. Chu said that she started watching “a lot” of pornography as a middle-school boy, and described a progression in her tastes from “run-of-the-mill, mainstream pornography” to “JOI” (jerk-off instruction) videos, in which a female performer demeans the male viewer. From there, Chu “went down a humiliation track … until I hit sissy porn…. My porn addiction had all along been waiting for something like sissy porn … because now if I’m reading in retrospect, the whole thing was about trying to access a kind of sexuality that wasn’t about being a man”. Trans actress and Euphoria star Hunter Schaefer wrote along similar lines in a now-deleted Instagram post the same year: “My sexual orientation was not gay. It was not straight. Nor pan. It was an attraction, is an attraction, always, to misogyny. My gender was SO influenced by a need to be used by men.”

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Detransitioner Williams chronicles a lifelong struggle with a similar set of feelings and desires, which led him to transition to female in 2015, at the age of 28. He says he didn’t have “an underlying predisposition to hate my male body”, though that started after he became trans. Williams lived as a woman for eight years, which he says decreased the sexually fetishistic aspects of his behavior (and his libido), but had other negative consequences, such as extreme social anxiety. He also, in 2020, developed a pulmonary embolism and almost died, he says, which he attributes to taking cross-sex hormones. Attempts to detransition and manage his resurgent AGP in a healthy way, along lines suggested by Phil Illy’s book Autoheterosexual: Attracted to Being the Other Sex, were a failure, despite finding a bisexual, kink-positive partner who accepted his sexuality.

The activist stance on these desires is that they are neutral in themselves and can be considered a sexual orientation, and that any negative consequences come from social stigmatization. Williams’s experience could bear that out. Despite finding willing partners and accepting circles, he continued to feel shame, confusion, and social discomfort from his gender urges and sexual practices. However, he also found that indulging his desires oriented him towards masturbation and away from his partner, and that his desires followed patterns of other addictions in his life, requiring ever-greater stimulus for diminishing rewards, and ultimately bringing unhappiness instead of pleasure.

One day, high on cannabis — another persistent addiction struggle, he writes — and ready to engage in his fetish, Williams had the revelation that both his marijuana smoking and his sexual behavior were self-destructive and pathological in the same way, and had to stop. “Immediately”, he writes, he had the desire to get back into religion, which he had experimented with before on his detransition journey, but this time, he was drawn to Catholicism, specifically for its intensity of pageantry and ritual and its strict sexual doctrine. He understands that his new convictions might seem suspect or “mentally unstable”, he says, but he now believes that the inner voice of shame and disgust that he hasn’t been able to silence has a transcendental cause, and is distinguishing a fundamental right from wrong.

Not all of the new detransitioners are drawn by Christianity’s oldest branch. Sierra Weir, 37, who goes by the name Exulansic on X and Substack, has since 2021 devoted herself since to exposing the ugly side of the gender trend, for simpler but similar reasons of mental and physical health. Weir did a double-major in gender studies and linguistics at the University of California, Berkeley, and says she was once “really into” transgenderism. She transitioned medically to male when she was 23 but began to have ideological disagreements with the trans orthodoxies and experienced harmful and dangerous health outcomes from hormone therapy. She says she now has osteopenia (low bone density, a precursor to osteoporosis) which is a known risk factor with Depo Provera, which she took to suppress menstruation, and she has been recently diagnosed with lumbar degeneration, which she believes is related. She is vituperative against her former doctors, whom she believes misdiagnosed her and exacerbated her problems. “It just ruined my life”, she says.

Weir’s social media channels circulate lurid news items about crimes by transgender women, and frequently discuss suicides by distressed transgender people all genders and ages — material that can legitimately be read as stigmatizing for transgender people seeking public acceptance. She also writes and films disturbing stories on mostly biological female victims of terrible mental and physical health outcomes and botched surgeries. However, she says, “I’m not against individual people who are trans, and I have a great deal of compassion and empathy. I’m speaking out because I don’t want harm to come to them.” (She may or may not now be on the right side of history, but once again, it’s the scare tactics of the original trans movement: if we don’t all believe this right now, people will die.)

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In addition to believing that hormones and surgeries are physically risky and damaging in ways people aren’t told about, she believes that cross-sex hormones can cloud a person’s thinking — making them more likely to opt for risky procedures — and exacerbate previous mental health issues. “The hormones were affecting my ability to think and my ability to remember”, she says. Having detransitioned, she feels like “I don’t have brain fog anymore.” She believes that people suffering from gender dysphoria from any of these conditions “deserve to have optimal health and to understand their predicament”, and that medical providers are “abdicating that responsibility.”

Prior to Elon Musk’s purchase of Twitter, now X, Weir was “being banned from all platforms of note”, she says. Now she’s free to critique the movement she was once a part of, and with the same zeal. Yardley, for his part, attributes the wave of detransitioners not to the vibe shift or a trend, but merely to the passage of time. It’s been several years since the transgender tipping point, he says, and people have “passed that first sense of euphoria that people get from accomplishing any goal” and begun to have doubts. “So many people are detransitioning because so many people transitioned”, he says. That conclusion, as least, sounds reasonable, and like something we should be open to learning from.

But let’s hope the pendulum doesn’t merely swing from one brand of too-certain conviction to another. The Roman church, in addition to its prohibition of most sexual acts, asks adherents to cultivate lives of silence, contemplation, and prayer. Those who have embraced the Church as a refuge from online ideologies might want to take up these practices — instead of plunging head-long into the next performative mania.

Former vassal states of Stonewall, once enmeshed in one or other of its EDI schemes, also fell strangely mute. There was nothing from the Labour Party, previously so assiduous in its solemn commemorations; nothing apparently on the BBC, whose emotive headlines on the tragic shortness of trans lives were once a mainstay of late November. And what about that time four years ago when the Bank of England building in Threadneedle Street was lit up in the colours of the trans flag? Or the time in 2022 when the Welsh Parliament’s social media manager seemed to confuse the day with Remembrance Sunday, writing a touching eulogy to “the trans individuals who have lived, loved, fought and fallen”? All gone now. Perhaps it was just a dream.

But no. For nearly a decade, as FOIs have since made clear, Stonewall encouraged hundreds of private and public sector organisations to mark Trans Day of Remembrance (TDoR), on pain of losing points in its annual workplace rankings. The most craven performances of fealty came from universities, where vigils would be held on campuses across the country. At the trend’s zenith, vice-chancellors would give awkward introductions, circles would be formed, and candles would be lit. Slowly, haltingly, movingly, some anointed young spokesperson would start stumbling over the pronunciation of the names of hundreds of Brazilian and Mexican people working in the sex trade.

For somewhat inconveniently, every year records would reveal that around three quarters of reported murders came from gun-loving Latin America and the Caribbean — where general murder rates were already horribly high — and around half of victims would be in prostitution, probably the most dangerous occupation in the world anyway. Even so, committed celebrants somehow knew that the root cause of every single death was that ubiquitous phenomenon, “transphobia”, while all other circumstances were just downstream effect.

Even today, despite consistently and thankfully tiny murder rates for trans-identified people in the UK and Europe, the habit of such ceremonies occasionally lingers. Wednesday’s ceremony at University of Central Lancashire involved the trans flag being “lowered to half mast”. A spectacularly mawkish vigil in Reading, streamed live to YouTube, included poetry, sermons, and secular hymns sung by a choir. Still, even in strongholds of the declining empire, it seemed as if hearts are not entirely in it. Cambridge University’s LGBT+ society reminded its members this week that, though it would be offering a service, “You are not any less valid if you don’t come, TDoR is a lot of feelings and we each grieve in different ways”.

Perhaps, now that that this very weird day of observance is apparently on the way out, we have a bit of room to stand back and ask ourselves what exactly was going on there. In an age when Millennial and Gen Z participation in formal religious services is at an all-time low, and mainstream public commemorations such as Remembrance Sunday show similar patterns of decline, how did such a patently ridiculous event ever get embedded in the national calendar?

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In fact, these points are probably linked. Fervent LGBT+ activism does appear to perform a quasi-religious function in a mostly secular world — with its sacred texts and chants, commitment to soul-body dualism, and obsession with resurrection into a new life. But perhaps just as important as the absence of religious doctrine is the attendant diminishing of rituals in modern life — that is, a structured, repeatable ceremonial act with a familiar format, shaped by tradition. The ceremonial aspect to TDoR, repeated annually, seems for a while to have helped fill that gap.

Consider the wedding service: no longer a predictable rite, it has been hacked into a million pieces by high status individualists in search of an event that truly “represents” their coupledom. The actress Rebecca Hall, told The Observer last weekend that her wedding was a deliberately improvised affair, during which one friend “leapt out of the shrubbery dressed as a werewolf” to sing a song by The Smiths, and another “called everybody out to the pond as a blood moon was rising and gave them a candle to hold”. Hall summed up: “It was about saying, ‘This is our world, these are our people and we will define ourselves exactly how we want to’.”

Equally, there are hundreds of resources on the internet about how to write the perfect personalised ceremony. One “professional vow writer” briskly advises Vogue readers to “Address your partner and briefly recap your love story, communicate traits that you admire about your partner, describe what you appreciate about your relationship, list three to six specific promises, and close with how you envision your future together.” When a marriage ceremony stands in need of an accompanying PowerPoint, you start to wonder what was so very wrong with the Book of Common Prayer.

Since organised religion has been the main means of inserting ritual into our lives for centuries, it is not surprising that both are simultaneously in retreat. Christenings, already unfashionable, were given a further blow by church closures during lockdown and have yet to recover. At the other end of the life cycle we now have individualised funerals, where attendees must do things like wear bright colours and try hard not to sob through Another One Bites the Dust by Queen. And in between the major life events, we have largely lost the old Christian rituals: Sunday as a day of rest; Lent as a time of fasting and reflecting; Advent as a time of looking forward. Easter is now mostly for children, and every December there is a spate of media extolling the virtues of spending Christmas alone or otherwise “doing it your way”.

In his superlative book The Disappearance of Rituals, philosopher Byung-Chul Han describes the stabilising role that rituals used to play in human societies, independently of their religious value. They would give the passing of time a structure, acting as comforting rejoinder to Heraclitus’s terrifying observation that no one ever steps in the same river twice. Repetition and the recognition of familiar words and objects, met again and again as a particular ceremony unfolds and repeats, would offer shelter from the exhausting deluge of disconnected experiences and random bits of information. Life would be given a meaningful shape. And in reciting words and performing actions you did not personally invent, but only inherited, you could get a rest from the narcissistic demands of self-creation, as well as experiencing a sustaining sense of connection to those who had practiced the very same rituals before you.

Neoliberalism’s emphasis on the ceaseless consumption of new and transient things — purchases, experiences, bits of information, identities, selves — discourages such unflashy memorialising. Viewed in this context, it doesn’t seem so very farfetched to think that, in the annual histrionic performances of TDoR, and perhaps also in things like annual Pride parades — we can detect a secret hankering for older, steadier rhythms of life. Further evidence for the prosecution includes many sentimental references in LGBTQ+ circles to “trancestors” and  “trans elders”, a practice just as ludicrously hyperbolic as TDoR  and yet perhaps also betraying a longing in spiritually deracinated people for a genuine connection with the past.

And then, of course, there are all the tattoos: not exclusive to the LGBT community by any means, but especially beloved of them. As Han observes, in the context of a ritualised society, tattoos used to symbolise “the alliance between individual and community”. Nowadays, he says, “the neoliberal hell of the same is populated with tattooed clones”. Still, the choice of such an ancient — not to mention, stubbornly permanent — medium for queer (supposed) self-expression seems significant.

The demise of the transactivist empire is going to leave many vulnerable victims bereft — irrevocably marked, both physically and psychologically. Alongside appropriate forms of punishment for the cynical opportunists who literally and figuratively took their cut, it would be good if we noticed the surging emptiness in our culture that made nonsensical dogma look so appealing in the first place. For a few years in the early 21st century, lighting a candle and solemnly incanting a mysterious holy name in the dark clearly felt good to a surprising number of atheist-identified people. The next time a quasi-sacred moral fad grips us collectively, we should hang on tight to the remembrance of things past.

It looked like a man punching a woman because, according to the International Boxing Association, Khelif is not a woman. In 2023, Khelif was disqualified from the World Boxing Championships along with Taiwan’s Lin Yu-ting  — “a result of their failure to meet the eligibility criteria for participating in the women’s competition”. This decision was based, not on testosterone levels, but on “a separate and recognised test, whereby the specifics remain confidential”.

A Russian-language statement (the IBA is Russian-led) put it more bluntly: “Based on the results of DNA tests, we identified a number of athletes who tried to deceive their colleagues and pretended to be women. Based on the results of the tests, it was proven that they have XY chromosomes.” Lin did not appeal, while Khelif initiated an appeal and then withdrew it, meaning that in both cases, the judgement became legally binding.

But not binding on the Olympics, which withdrew recognition from the IBA earlier this year over multiple concerns over governance. That means the International Olympic Committee (IOC) is free to apply its own rules on sex categories in sport. IOC spokesperson Mark Adams warned against starting a “witch hunt… These are regular athletes who have competed for many years in boxing; they are entirely eligible and they are women on their passports.”

Which would be a totally acceptable way to classify sex, if the fight was between passports, rather than two bone-and-sinew bodies. Khelif is apparently not female, in a category designed for female athletes. And while the IOC has been keen to emphasise that this controversy is wholly unrelated to the contentious matter of trans women in sport, that is an impossible separation to maintain. The question of how sex should be defined — by chromosomes, by hormone levels or by legal marker on a passport — is the heart of the argument over inclusion.

What happened in the ring in Paris is a riposte to all the absurd claims that sex is immaterial to athletic performance. Witness, for example, the writers Rebecca Jordan-Young and Katrina Karkazis, who argued in a 2012 New York Times op-ed for “letting go of the idea that the ultimate goal of a fair policy is to protect the ‘purity’ of women’s competitions”. If inclusion is the objective, “then sex-segregated competition is just one of many possible options, and in many cases it might not be the best one”.

And anyway, doesn’t the enforcement of sex categories simply re-instil bad old stereotypes about female weakness and vulnerability? That, at least, is what the American Civil Liberties Union (ACLU) believes. “Excluding women who are trans hurts all women,” says the organisation’s self-identified factsheet on sports. “It invites gender policing that could subject any woman to invasive tests or accusations of being ‘too masculine’ or ‘too good’ at their sport to be a ‘real’ woman.” History professor Johanna Mellis even suggested in The Guardian that women’s sports categories might have been invented by men “to limit our athletic success and opportunities by reinforcing sexist notions of cisgender girls and women as the ‘weaker, slower sex’”.

From there, it’s a short distance to travel to the often-repeated claim that, as an article in LGBTQ+ magazine Them put it, sex differences should be viewed “much like the way we view Michael Phelps’s abnormal wingspan”. Athletes are, by definition, physical exceptions. A male person who has been legally recognised as female is simply another example of biological variation, and — claimed sports correspondent Jonathan Liew (now of The Guardian, but then writing in The Independent) — perhaps one to be celebrated: he claimed that, “in a way, it would be inspiring” if trans women came to dominate women’s sport.

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So far, chromosomes notwithstanding, Khelif has not dominated women’s boxing. XY chromosomes notwithstanding, Khelif lost in the quarter-final of the Tokyo Olympics to Kellie Harrington of Ireland, who went on to take the gold: BBC 5 Live boxing analyst Steve Bunce pointed out that Khelif is “not a devastating puncher” and has ever only achieved five stoppages. The implication, perhaps, is that Carini could have fought on, and maybe even beaten Khelif if she’d been good enough. Maybe so.

But genetically male athletes do not only become a problem in women’s sport when they’re successful. Every XY athlete “included” means an XX athlete pushed out. In combat or collision sports, they also imperil the female athletes they compete against. According to the organisation Women in Sport, male athletes have (on average) 40-50% greater upper limb strength and 12kg more skeletal muscle mass when compared to age-matched female athletes at any given body weight.

A technically accomplished woman might win a fight against a man, but the risk of injury she takes in the process is immense. So Casini had every right to weigh her own safety. After the bout, she said: “It could have been the match of a lifetime, but I had to preserve my life as well in that moment.” Boxing is inherently dangerous — but there is a very different level of exposure in agreeing to be punched by another woman, and agreeing to be punched by a man.

This is the difference that proponents of eliminating sex categories in sport cannot acknowledge. Some, like Liew, may tacitly accept it while being fundamentally unconcerned about what that would mean in practice for women in sport — perhaps because they consider women’s sport to be fundamentally unserious. (“Sometimes we forget that there are bigger things than sport,” wrote Liew in his Independent piece, which is not an observation he ever appears to have made about men’s sport.)

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But for others, particularly for women, and perhaps most particularly for women who are not actively involved in physical pursuits, there is a kind of hope in this denialism. They would like to believe that women’s physical disadvantage compared to men really is a purely, or at least largely, social phenomenon. They recognise women’s inferior status, and they understand that this is tied to the body; but they believe that the body is the cause of the inferiority, and so the body becomes politically inconvenient. They choose instead a tactful fiction of physiological equality — if not in the here and now, then in the inclusive Jerusalem to come.

The female body can, certainly, do more than the male authorities who run sports have historically liked to believe: there is a long and weird tradition of claiming that exercise will cause a woman’s uterus to fall out. Given fair access to training and competition (something which is still very far from assured), women do become faster, stronger, more aggressive. I know this from personal experience. I started powerlifting in my late thirties, and in my forties can pull weights I once thought cartoonishly huge. But I also know that the same weights pulled by a man would be much less impressive, which is why comparing myself to men tells me nothing at all about my progression.

Mixed-sex sports simply lead to exceptional women being forced out by mediocre men: brute strength besting accomplishment. The Olympics’ failure to protect women’s sport is a tragedy for female athletes, but it also makes a travesty of the competition overall. What should be a celebration of excellence becomes, through the IOC’s contempt for fairness and safety in women’s sport, the elevation of the mediocre. After decades of obfuscation and inanity over gender and sport, the truth of it all became clear in an entirely unnecessary meeting: between an apparently male fist and a female face.

The 21st-century battle began in 2019, as Scotland was on the verge of introducing a law that would allow men to self-identify as women. That same year, Katie Dolatowski, a six-foot-five transgender paedophile, was convicted of sexual offences against two girls aged 10 and 12 in a women’s toilets in Fife. Dolatowski, born male but identifying as female, was placed in a women-only hostel, putting vulnerable women at risk. Despite this, First Minister Nicola Sturgeon, the self-professed “feminist to my fingertips”, forged ahead with self-ID legislation that most of Scotland either didn’t understand or didn’t want. Dolatowski, meanwhile, praised her for being a “great first minister”.

Around the same time, a new hashtag was born: #WomenWontWheesht. It was coined by a mother worried that her disabled daughter, given the proposed legislation, might be given intimate care by a male carer. In response to her voicing such concerns, she was accused of being a pearl-clutching transphobe. Her worries for her daughter’s dignity and safety were effectively deemed not inclusive enough of the sensitivities of adult men. And she was told to “weesht”. As a result, the hashtag became a battle cry: the symbol of the feminist resistance to being silenced. And this week, their book was published. The Women Who Wouldn’t Wheesht tells the stories of the individual women who fought to protect women’s sex-based rights, with testimonies from an SNP MP, a prison governor and J.K. Rowling.

As the book details, Mumsnet was an unlikely forum in which women would organise. In response to Swim England’s new guidance, released in 2018, Mumsnetters organised “Man Friday” events, in which they self-identified as men and rocked up to men-only swimming sessions bare-breasted and sometimes even sporting fake moustaches. Within two weeks, the new guidance had been withdrawn. Such demonstrations were akin to the Reclaim the Night marches, Greenham Common and the Lesbian and Gay Liberation Movement, marking a return to grassroots feminism. This was an antidote to the horrors being visited on women under the cloak of transgender rights.

Yet such movements were often hindered by financial constraints. The pro-gender ideology organisations were often funded by the Scottish government, while the women resisting did so on a shoestring. Women had to resort to shaking tins asking for donations to pay the lawyers, and crowd-funders were plastered all over social media. In the time-honoured tradition of feminist activism, this work was unpaid.

Female campaigners during this period faced appalling abuse. In 2018, the then-newly appointed rector at the University of Edinburgh, Ann Henderson, was plagued by baseless and vexatious complaints supported by the University and College Union. In the new book, she reflects on her experience: “Lesbian staff members felt excluded from networks. Women-only events were increasingly difficult even impossible — to arrange, and women were concerned about losing their female private facilities.”

Then, in June 2019, I spoke at Edinburgh University about the feminist campaign to end men’s violence towards women. As I was leaving the venue, I was attacked by a six-foot male transactivist, who was shouting that I was a “cunt” and responsible for the suicide of several trans people. The next day, Scottish Green MSP Andy Wightman caved into pressure from his party and apologised for attending the event.

That same month, poet Jenny Lindsay took to Twitter to complain about an article published in an arts publication, the Skinny, which advocated for violence against lesbian activists at Pride. The backlash was abhorrent — one friend turned against her, writing an “Open Letter on Transphobia” that more than 250 people signed. Lindsay recalls: “Every name I recognised was an emotional stabbing.”

A major boost to the feminist campaign came at the end of 2019, when J.K. Rowling publicly expressed support for Maya Forstater, who had lost her job after tweeting gender-critical views. Rowling recalls: “I’d watched in silence as girls and women with everything to lose had stood up in the face of a modern-day witch hunt, braving threats and intimidation, not only from activists in black balaclavas holding placards promising to beat and murder them, but from institutions and employers telling them they must accept and espouse an ideology in which they don’t believe, and surrender their rights.”

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But even she couldn’t make the world see reason. Rowling was cancelled, as were all her supporters. After expressing her admiration for Rowling on Twitter, Young Adult author Gillian Philip was cast out of publishing circles and has since retrained as an HGV driver. She says: “I’m a great believer in fantasy fiction for children, but I draw the line at telling them it’s reality — especially when it threatens to do them actual physical harm.”

Together, these women who wouldn’t wheesht contributed to the downfall of Nicola Sturgeon. In early January 2023, the UK government prevented Sturgeon’s Gender Recognition Reform Bill from becoming law, arguing that it illegally impacted the Equality Act. Days later, Adam Graham (also known as Isla Bryson) was convicted of two counts of rape, both of which he committed before he decided he was a woman. Graham was sent to a women’s prison: a photograph emerged of him wearing a blonde wig and tight leggings — his male genitals clearly visible. In a car crash of an interview, Sturgeon was grilled about whether Graham was a man or a woman. Just over two weeks later, she resigned, giving no reason.

It is not my style to be precious, but I found reading this book exceptionally hard in parts. It reminded me of the dozens of hellish scenarios I have had to endure in the 20 years since I first spoke out against gender ideology. The memories of the physical attacks and threats, the humiliation of being de-platformed, the betrayals by women I had thought were committed feminists.

But the book also reminded me of the enduring strength of the feminist movement. Despite facing the worst men’s rights backlash in more than 40 years, feminists from all generations are uniting to fight back. This is a story of a war, written while the bombs are still exploding. But it’s also the story of the resistance — and it isn’t over yet.

Given Sturgeon’s much vaunted twin loves — novels and being a “voice for inclusion” — the venue was a perfect match. Not far from Brighton, we were at Charleston Farmhouse; a place where, for much of the 20th century, core members of the Bloomsbury Group — Vanessa Bell, art critic husband Clive Bell, and fellow painter Duncan Grant — lived experimentally with various illustrious literary and philosophical figures orbiting around them. Immersed in endlessly complicated romantic liaisons, this was a queer pangendered polycule before the SNP had even heard of one. (More simply, though not inaccurately, relatives of mine by marriage who farmed the land nearby would refer to the Bloomsburies as “those funny people up the road”.)

In the present day, those now in charge of Charleston try to capitalise on the frisson of inherited sexual dissidence with lots of queer-themed events, including a recent fashion exhibition sponsored by Christian Dior. Indeed, an event poster displayed onstage directly before Sturgeon’s interview showed a naked female standing crotch-deep in a lake, elective mastectomy scars glinting where breasts used to be. But despite management pretensions to be running a modern-day Weimar salon, the reality of the audience at Sturgeon’s talk was somewhat more prosaic: scruffy middle-aged people dressed in violently clashing prints, their LRB tote bags stuffed with books by George Monbiot and Judi Dench. Only a few bright young things were scattered here and there, paying homage to their second favourite politician. Their first favourite, former Green Party leader Caroline Lucas, swept in just before the start and sat at the front.

To the sound of applause, festival director Nathanial Hepburn introduced the main attraction, effectively warning off audience members from airing “their own views on politics” during the question period — a sentiment which drew further appreciative applause from some. Dawson began the softball questioning, and we were soon immersed in a touching fairy tale: about a shy working-class girl from Irvine who had joined the SNP to “try and make a difference”, and then challenged male dominance and discrimination in Scottish politics by rising to the top. Over time she became the great feminist champion who led her people through their darkest hour during Covid. But in the end, weary of acting as a lightning rod for unjust toxicity — including from those angry with her for being a steadfast supporter of marginalised people — she had altruistically stepped away from power, for the good of her country.

There is a mental delusion called Capgras Syndrome, during which a person becomes convinced that someone in their life has been secretly replaced with an identical duplicate. During my hour in the Charleston tent, I started dimly to understand what this must be like. For in many ways the version of Sturgeon in front of me seemed to bear only the vaguest of relations to her historical doppelganger North of the Border.

Not least, the cause of Scottish Independence — to which I was sure I could remember her devoting almost her entire political life — was mentioned briefly only once, with a reassurance that she had an English granny and wanted the two countries to be the “best of friends”. The ongoing police investigation into SNP finances was similarly glossed over fast, albeit partly for legal reasons. When asked what she had been most proud of during her time in office, she said her government had done “a lot to try and shift the dial on child poverty”, referring to increased funded childcare and the Scottish Child Payment, but not to the fact that child poverty figures overall had remained obstinately static on her watch.

Mistily recounting the Covid years — during which her government closed schools for months, and imposed tougher lockdown regulations than in England yet with no real difference in death rates — she seemed to suggest openness and transparency had been key: it had been important “to stand up every day and explain exactly what we were asking people to do, why we were asking people to do it”. Could this be the same woman, I wondered, who was unable to produce any WhatsApp messages from this period at the Covid Inquiry, having deleted them all?

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And having arguably stuffed her party full of young activists hellbent on promotion within the system — including presiding over a jaw-dropping NEC rule change in 2020 that saw younger candidates with newly self-identified disabilities promoted to the top of regional MSP lists — this Anglicised version of Sturgeon advised young people never to see politics “as a route to a job or a career” because “if that is your motivation, then you are doing it for all the wrong reasons”. In her view, “politics, including in my party, now is probably too full of young people who have just gone through the political ranks”.

By the time she got to the bit about how toxic the public discourse about “trans rights” had become, and how trans people had become a public scapegoat, because citizens “struggling” with “a cost of living crisis” and “rising levels of poverty” — “particularly young people who suffered during Covid” — were looking “for somebody to blame”, I started to check what was in my drink. “I just have this belief that people should be allowed to be who they are, feel comfortable, respected, safe and able to live with dignity as who they want to be,” said the premier who had overseen the putting of violent male felons in terrifyingly close quarters with impoverished, vulnerable female prisoners, with no apparent thought to the safety or dignity of the latter.

Was it really she who had closed her ears to any possible problems with introducing self-ID at age 16 upwards, arguing that some opponents would “cloak themselves in women’s rights to make it acceptable, but just as they’re transphobic you’ll also find that they’re deeply misogynist, often homophobic, possibly some of them racist as well”? Who had personally insisted that puberty blockers would still be used for physically healthy children in Scotland’s youth gender identity service even after serious concerns emerged in 2021; and whose Party was defending clinical standards at the service as late as last month? Did she really not understand why all of this might get reasonable people riled? Apparently she did not.

The audience mostly seemed to lap it up; partly, I assume, because they knew practically nothing concrete about the speaker’s nine years in government. Nationalists often complain that the English media ignores Scottish concerns, but in this case it has clearly worked in their former leader’s favour. Still, it was also obvious that this deeply middle-class and well-heeled bunch mostly didn’t want to know about any potentially complicating factors that might temper their adulation, for that would spoil all the fun of the festival: paying £65 per day ticket to feel appalled about the state of the world and the Tories, but rather better about themselves. To this end, they needed a suitable moral heroine to side with, mentally speaking: preferably someone with a charmingly authentic regional accent, getting intermittent jabs in at their favourite hate figures while decrying toxic masculinity, and whose stated values otherwise were vague enough that you could read almost anything positive you liked into them. And it seems that they found one.

During the Q&A, as instructed, political questions were indeed mostly eschewed, in favour of fatuous queries about who Sturgeon might like to do a podcast with (Theresa May, apparently) and which books she might leave on the desk of an incoming Prime Minister (the crime novels of her good pal Val McDermid, in case you were wondering). Towards the end of the session, a sonorously voiced male admirer seemed to encapsulate the general mood of histrionic unreality by imploring the politician: “Will you promise us, whatever the result of the Police Scotland investigation, that you will find a continuing role to speak out?”

By then, I had heard more than enough. As I left, I reflected on the strangeness of what I’d just witnessed: the creation of an utterly fantastical world, bearing practically no relation to the actual one, being wrought in real time via the psychological co-dependency of two highly unlikely parties: on the one hand, a former Scottish National Party leader; and on the other, the sort of deeply unself-aware, affluent, self-satisfied and soft-minded Southerner who for decades has been a source of both mockery and fury to most Scottish Nationalists in practice. When that memoir eventually does come out, she’ll know exactly where to go to sell it.

Instead, time and again in Cass’s report she is forced back into the conceit that the most pressing problem for contemporary gender medicine is the lack of good evidence for such interventions either way. It is as if a modern-day medic had been tasked with reviewing the efficacy of trepanning, and then ordered to defend her findings in front of fanatical fifth-century devotees. “It’s not that drilling a hole in a child’s skull to release demons is necessarily harmful, you understand — indeed, it may be the best outcome in some cases. The main issue is the lack of long-term follow up.”

Alongside Cass’s cumulatively devastating account of reckless decision-making, poor evidential standards, and patchy record-keeping at Gids and elsewhere, a whole section of the report gently attempts to educate its readership about “the components of evidence-based medicine” — complete with basic explainers about randomised controlled trials, blinding processes, and the possibility of bias. She might as well be addressing an archaic people who have just emerged blinking from a time capsule, still convinced that disease is God’s punishment for insufficient acts of propitiation.

In a sense, though, this is indeed very like one group to whom the report is addressed: those clinicians, parents and patients immersed in bubbles of identity affirmation, and cognitively isolated from any reasoning or evidence that would confound their worldview. Perhaps unusually for a medical review, it is clear from Cass’s overtly respectful tone and at times still-euphemistic language that her aim is not just to inform these readers but also to deprogram them.

The very first sentence of her report begins with a weary disavowal of Stonewall-endorsed paranoias (“This Review is not about… undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people’s rights to healthcare”). Somewhat nonsensically, references to “birth-registered females” are scattered throughout the text, as if the author were somehow only concerned with those with birth certificates — presumably an attempt to build bridges with child-like souls still convinced sex is something coercively assigned to neonates at random. Generally, there is a sense of gingerly addressing a group of emotionally labile people who are not quite ready to face the whole truth.

And no wonder: nearly every indicator of cult membership is present among so-called affirmative clinicians and their hapless patients. Among the most telling signs are a fervent belief in a transcendent new way of life; induction into a mystical world of occult symbols, flags and lanyards; the love-bombing of new recruits with affirmative language and talk of “queer joy”; and the replacement of traditional support systems (one Pride post on the South London and Maudsley NHS Trust  website  — a hospital involved in creating the new youth gender services to replace Gids  — talks about “the fight for LGBT rights” as something “to be won against your family or your neighbours or whoever is directly around you”).

Relatedly, there is a lot of what cult specialists call “hate-bonding” — that is, framing critical voices as evil enemies to be automatically discredited, a process which neatly shuts down intellectual curiosity while solidifying group cohesion at one fell swoop. A recent example of such attitudes was the intensely hostile protest last month at a clinician-organised conference critical of child transition, purportedly led by an NHS doctor. When considered alongside other obvious signs of religious commitment — the mantras and incantations, sacred texts, citations of high priests, annual holy weeks, and so on — it is not hard to conclude that, for many in the medical profession, transactivism is based on faith not reason. Consider, for instance, the astonishing levels of religiosity in this 2023 publication from the NHS Confederation, at one point encouraging “allies” to “recognise the privilege afforded to them as a cisgender person and uses this to uplift the voices of trans and non-binary colleagues”.

Cults are not unusual, as human phenomena go; the unusual point is that one came to control parts of the NHS. As Cass relates, again euphemistically, “for this group of young people expertise has been concentrated in a small group of people, which has served to gatekeep the knowledge”. Suitably translated, so that “expertise” means “power” and “gatekeep the knowledge” means “deflect real scrutiny”, she is effectively pointing to the fact that much damage can be done in an institution by only a few zealots, as long as they are the ones presumed in charge of things by others.

There is no better evidence of this than the fact, also highlighted in the report, that according to current NHS guidelines, a newly socially transitioned young person can be given a different NHS number in alignment with their preferred identity. As well as affecting the provision of sex-appropriate screening and other kinds of differentiated care, this change alone has made it very difficult to track long-term outcomes of gender treatment. When first mooted, it would not have been hard to anticipate problems; but such petty worries obviously paled in comparison to the thrill of achieving metamorphosis-by-bureaucracy.

Another clue to the level of ideological capture emerges when Cass describes a proposed data linkage study, originally envisaged as culling information about 9,000 patients from “Gids, hospital wards, outpatient clinics, emergency departments and adult gender dysphoria clinics”, and so providing “a population-level evidence base of the different pathways people take and the outcomes”. In the end, the much-needed study didn’t happen because clinicians in existing gender services nearly all refused to cooperate. (An inquiry into adult clinics has since been announced.)

Reasons for refusal included that the Cass Review would be politically biased; and that “[t]aking part in a study of this kind could bring into question the integrity of clinic staff and the relationships they have with patients”. It is hard to imagine such a self-serving affront to patient safeguarding being considered acceptable in any other healthcare context. Another reason offered, also with an apparently straight face, was that “the study outcomes focus on adverse health events, for which the clinics do not feel primarily responsible”. Once you have fixed the problems with a young person’s soul, apparently what happens to their body afterwards is not your concern.

One could be forgiven for thinking that medical culture should easily be able to condemn bizarre physical interventions performed upon children in the name of religion, without having to undertake a four-year clinical review first. Indeed, lawmakers have previously criminalised practices such as FGM without requiring any such tests. But one instructive thing we can learn from the wreckage of gender medicine is that, with the right kind of institutional and rhetorical scaffolding, doctors can become unsure about what their goals are supposed to be. It’s no good telling them to first do no harm, when they can’t work out how to reliably detect it.

A superficial reason for this confusion is that the harms taken to fall squarely under the medical profession’s remit include negative psychological impacts as well as physical ones. And indeed, this looks like the right result: we can all think of obvious cases where mental suffering causes real damage to a person, and going to see a doctor is an appropriate response. But the downside is that, in a culture very picky about physical looks, or in the grip of some other body-related derangement, a person’s perceptions of her own healthy body can cause her severely negative psychological impact too; and then what is the clinician supposed to focus upon first? Cass herself talks about the rise among teenage girls in “Body Dysmorphic Disorder”, an obsessive preoccupation “with body image and with compulsive revisiting or avoidance of thoughts to manage distress”.

At least in theory, the doctor then has a choice: changing the mind to be better able to cope with the body, or changing the patient’s healthy body to relieve the mind. Cosmetic surgery opts for the latter strategy. Though described as “not routinely provided”, the NHS will sometimes fund implants for uneven breasts, reduction for large ones, or ear-pinning, as long as these things are causing “significant distress”. This, then, is a case where psychological feelings are taken to justify an assault, quite literally, upon physically healthy flesh.

Transactivists tend to ramp up this strategy, often baselessly suggesting that early physical interventions to change children’s bodies will avoid devastating psychological consequences and perhaps even suicide later on. Inflated figures have been disseminated by mainstream sources for years about the prevalence of suicide attempts in trans-identified young people, and weaponised in order to motivate medical “affirmation”. Dr Christine Mimnagh, clinical lead at the Merseyside adult gender service CMAGIC and a member of an influential Clinical Reference Group at NHS England for gender dysphoria services, was recently caught on camera telling listeners at Dorset Healthcare University NHS Foundation Trust that if child services “worked as they should” we would induce “menopause” in some nine-year-old girls before menarche.

But a deeper reason for medical confusion about what counts as harm these days is widespread acknowledgement that judgements of harm are often or even always value-laden — that is, that they implicitly depend on background assumptions about what sort of life is worthwhile. People can put up with all sorts of physical discomfort, on their own behalf or that of their children, when the cause is placed in a moral or religious framework making it look better than the alternative. Some Christian Scientists will avoid all medical treatment for sick children, failing to shield them from great pain in the process; some Roman Catholics will put their mortally ill children through invasive medical procedures to keep them alive a bit longer. More mundanely, many parents vaccinate their children, circumcise baby boys, or pierce girls’ ears — not because they are sadists (of course), but because they believe that benefits outweigh somewhat painful costs.

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The Cass Report's cowardly converts

By Julie Bindel

Acknowledging that judgements about physical harm are not always straightforward, and often depend upon background values, can make the use of puberty blockers, cross-sex hormones and radical surgery disappear into an ethically confusing fog; and especially when the doctor herself has no strong intuitions about the prioritisation of bodily integrity over mental wellness to call upon. Certainly, there are other adults who swear that such physically damaging treatments — for what else can we call them? — have made their lives better overall in terms of other goals: mental health, or aesthetics, or self-expression.

But there are obvious differences when it comes to children and young adults — differences that apply well beyond the age of majority, to at least one’s mid-twenties. One is that so-called affirming procedures are far more physically debilitating, for longer, than things like ear-piercing, tattoos, or even most kinds of cosmetic surgery. Another is that each of them negatively affects what a recently published journal article has argued is a child’s “right to an open future”: roughly, important freedoms or capacities that can only be exercised as autonomous adults (such as biological parenthood or a fulfilling sex life), and whose value is unlikely to be recognised by an individual until later in life. When Cass writes that “the central aim” of treatment “is to help young people to thrive and achieve their life goals”, she does not of course mean the life goals they have now, but the ones they may well have afterwards.

The liberal ideal that each adult individual should be free to pursue her own conception of a good life, as long as it doesn’t impede others from doing the same, takes a bashing these days from both Right and Left. But one thing the ideal can do — at least when properly understood, and robustly applied — is protect our children from fanatics with mad glints in their eye, wishing to imprint their religious ideals, quite literally, upon children’s healthy developing bodies. In her report, Cass encourages a much wider range of people with relevant specialties to get involved with the care of trans-identified youth, moving forward; by which she presumably means, clinicians whose personal value systems won’t have such perilous physical consequences for their young charges. We can only hope that right-minded people answer her call.

Opened in 1989, and closed following a litany of scandals last year, GIDS — the UK’s only specialist service designed to help children questioning their gender and/or identifying as transgender — drew on just one, since widely critiqued, study to underpin its practice. This, despite the fact that it has treated roughly 2,000 young people with hormone blockers and in some cases cross-sex hormones.

“The Dutch Protocol” describes a three-step treatment pathway for children with gender-related distress or incongruence. It starts at the brink of puberty with puberty blockers to prevent the development of secondary sex characteristics, is followed by cross-sex hormones that help to feminise or masculinise appearance, and then concludes with genital and/or breast surgeries in adulthood. The Dutch reported that, after puberty suppression alone, their cohort of 70 young people experienced a reduction in behavioural and emotional problems, decreased symptoms of depression and a significant improvement in functioning. Despite choosing to make medical treatments available to younger children from 2014 anyway, GIDS were not able to replicate the Dutch findings — a fact they didn’t share with the world until 2021.

Given the increasing polarity among professionals on the matter, Dr Hilary Cass, a former President of the Royal College of Paediatrics and Child Health, was employed by the NHS to conduct a review of the published evidence on the use of puberty blockers and cross-sex hormones in children and young people with gender dysphoria. In March 2021, she concluded that they had not been able to find evidence “strong enough to form the basis of a policy position”. It was clear then, at least to those paying attention, that the evidence needed to justify the existing clinical practice in Gids did not exist. And yet, it wasn’t until last month that the NHS announced it would no longer be offering puberty blockers to young people in England and Wales.

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Today, as Cass finally publishes the results of her wide-ranging review, the reason seems obvious: her 388-page report concludes that, for most young people, up to the age of 25, “a medical pathway will not be the best way to manage their gender-related distress”. Commenting further on the lack of evidence, she states that not only is there no way for a clinician to accurately determine who will continue to identify as trans for life and who won’t, but that the fundamental rationale for using puberty blockers in the first place “remains unclear”. She speaks of the need to balance medical innovation with the potential “creep of unproven approaches into clinical practice” and calls for the use of “standard evidence-based” interventions instead.

Cass also makes it clear that the factors influencing gender-related distress might be as much social as psychological or biological, with a particular focus on the new cohort of adolescent girls who now make up the majority of gender clinic patients. Instead, she suggests, we need to draw on bio-psycho-social thinking to ensure that future child patients receive the safe and effective care they deserve.

The motivation behind this isn’t hard to glean. The sociological “broken windows” theory hypothesises that, once something becomes damaged just a little, it sends a message that the thing is no longer of value at all, and leads to further vandalism. At heart, the Cass Report is an attempt to prevent this from happening: it punctuates a process that, left unchallenged, might have led to further extraordinary practices creeping into other areas of psychology or medicine.

For those of us working in the field of gender, the influence of social media on adolescent mental health, in multiple and complex ways, has been undeniable. What gets less attention is the impact on us, the adults and professionals. After all, we are just as vulnerable to social influence, including misinformation. One of the factors that has led to the increased demand for medical interventions from gender-distressed young people are the ideas, widely shared on social media platforms as facts, that the medical pathway is not only safe but effective, even life-saving, for all.

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Despite the absence of face validity or the long-term data needed for such certainty, some have claimed that regret rates for the surgeries many Gids patients received during early adulthood are lower than for knee surgeries. Yet, as the Cass Report highlights, some of the “facts” shared online are not certainties but myths. Sadly, for example, some young people do later experience profound regret — a reality that Cass acknowledges in her recommendation that “NHS England should ensure there is provision for people considering detransition”.

Yet rather than accept Cass’s rational, evidenced conclusions, a number of professionals and institutions will no doubt continue to argue with certainty that access to medical interventions is both a necessity and a human right. They already call for their colleagues to join them in becoming “practitioner-activists”. Others openly describe their motivation to pursue the medical approach Cass wishes to end as being “based on how passionate we are about the work”. Passion can be a good thing, of course, when aligned to evidence and fact. But when passion becomes untethered to these, or worse tethered to misinformation, it risks transporting us into a troublesome arena. Such an approach has already led to serious lapses in best practice and governance, particularly in relation to the use of puberty blockers for children. The question now is: will such extraordinary practices be able to continue post-Cass?

This is where a sense of concern starts to creep in. For while NHS England has refocused on the need for evidence-based interventions in recent years, some practitioners have already made clear their resistance to this. Last year, we heard that the endocrinologist responsible for prescribing to Gids patients had questioned whether the Cass Review was necessary in the first place. Leaders in the field of clinical psychology have also challenged the need for the review, and splits in the UK’s two psychology associations have been apparent for a while now, with one publicly criticising Cass. Remarkably, as today’s report discloses, the NHS’s adult gender clinics have also set themselves up in opposition to evidence and research, by refusing to participate in the Cass Review’s centrepiece longitudinal research study — an attempt, albeit retrospective, to follow into adulthood the 10,000 young people who’ve been through GIDS’s doors.

In an attempt to explain away such behaviour, some have sympathetically described GIDS as a “justice project”. Yet, in her interim report, published in February 2022, Cass made clear that the implications of GIDS’s approach were far more serious than this: its clinical approach, she wrote, had “not been subjected to some of the usual control measures that are typically applied when new or innovative treatments are introduced”. Just over two years later, she ends her final report by remarking that, while GIDS clinicians were “passionate and wholly committed to their care, [they] had developed a fundamentally different philosophy and approach compared to other paediatric and mental health services”. This deviation from best practice was, in other words, an injustice, and resulted in one group of children receiving less robust standards of care than others.

To mitigate this, Cass invites a return to the ordinary, and an embrace of the scientific method. And this requires sensitivity: after all, understanding why gender-distressed and non-conforming people might have been reluctant to trust ordinary science, medicine and psychology/psychiatry should also be part of the post-mortem to come. Medical approaches and institutions haven’t always been a safe place for them. Sadly, this is not the first time that gender non-conforming people have been considered so different as to require extraordinary treatment. Perhaps Cass’s recommendation to offer regular treatments to our distressed, but still ordinary, children and young people is where the true justice will begin.

In hindsight, it’s now accepted that the therapists were frequently implanting these “memories” in their suggestible patients. Recovered memory was a social mania — a.k.a. a moral panic, social contagion, mass formation psychosis, or mass hysteria. In the throes of the popular delirium, many people found this exercise in psychic archaeology wholly convincing (and no little titillating). For a few years, recovered memories were even accepted as factual testimony in American courts. Only from a distance does the sordid psychological dowsing look barmy.

For me, since roughly 2012, what has therefore been more disturbing than the content of any given hysteria is our continuing susceptibility to collective derangement, which can spread and take hold with alarming rapidity in a digital era. To examine the unnerving phenomenon of the communal fever, often destructive but rarely contested at its height, in my most recent novel Mania I invented my own. Suddenly everyone accepts that all humans are equally intelligent, and “cognitive discrimination” is “the last great civil rights fight”. In other words, there’s no such thing as stupid. Because that assertion is itself stupid, my concocted mania seems apt.

Within the astonishingly short time frame of 10 years, I count four real-life collective crazes: transgenderism, #MeToo, Covid lockdowns (which spawned sub-crazes over masks and vaccines), and Black Lives Matter. I also worry we’re already in the grip of social mania number five.

Take trans. Gender-identity disorder was not that long ago an extraordinarily rare psychiatric diagnosis largely constrained to men. Abruptly circa 2012 — on the heels of such a successful crusade for gay rights and even gay marriage that homosexuality became passé — a profusion of television documentaries hit our screens about little boys who wore dresses and played with dolls. Fast-forward to the present, and the renamed diagnosis has exploded by thousands of percent across the West and now pertains abundantly to girls. Teachers tell toddlers that they have to decide whether they’re a girl or a boy or something in-between. We’re subjecting children to powerful, life-altering experimental drugs and surgically removing healthy breasts and genitals, even at the cost of permanent sexual dysfunction and infertility. “Some people are born in the wrong body” has become a truism, which sounds to me as medically credible as phrenology or bloodletting.

The social mania displays a few consistent characteristics. First and foremost, it never seems like a social mania at the time. In the thick of a widespread preoccupation, its precepts simply seem like the truth. Trans women are women; get over it. Or: masculinity is toxic; virtually all women have been subject to sexual torment and male abuse of power; regarding any accusations they make, no matter how far-fetched or petty, women must be believed. Or: Covid-19 is so lethal, and such a threat to our endurance as a species, that we’ve no choice but to shut down our whole economies and abdicate our every civil liberty to contain the disease. Or: all Western countries are “systemically racist”; all white people are genetically racist; the police are all racist (even if they’re black) and should be defunded or abolished; the only remedy for “structural racism” is anti-meritocratic, over-compensatory racial quotas in hiring and education.

While the seeds of a mania have often been planted earlier, for most ordinary people it comes out of nowhere. Transgenderism rocketed to a cultural fetish over a matter of  months. After one fully fledged creep was exposed as a serial sex abuser, #MeToo spread on Twitter like potato blight. Literally overnight, citizenries in March 2020 took it for granted that their “liberal democracies” could justifiably deny them freedom of movement, assembly, association, press and even speech, while many became eager enforcers of the chaotic, despotic, and sometimes positively silly new regime. It took only a few days for George Floyd’s death to trigger huge protest marches all over the world. This hyperbolic response to a single undeserved killing in a one mid-sized American city was partially fed by the pent-up frustrations of whole populations under house arrest during Covid. But for Koreans to troop down the streets of Seoul chanting, “Black lives matter!” when the country has hardly any black people was insensible. Likewise, Britons chanting “Hands up, don’t shoot!” when their constabulary is unarmed. Moreover, all these recent examples illustrate how moral panics have become more international in scope than ever before.

Manias are fuelled by emotion. The cult of trans has capitalised on our yearning to seem enlightened and compassionate.  It has been presented as the logical next step after gay rights, the movement plays on our craving to feel ultra-contemporary. #MeToo both fed off and promulgated resentment, self-pity, and vengeance; in standing up to abuse of power, it tempted some women to abuse their own power to ruin men’s lives. Covid lockdowns stirred primitive terror of death and contagion, until we came to view other people as mere vectors of disease. BLM stimulated the nascent Christian proclivities for guilt, repentance, and penitence even in the secular, while offering black people opportunity to vent frustration, self-righteous fury, and even hatred. All manias thrive on our desire to be included by our own herd and on our anxiety about being exiled — or, if you will, about being UnHerded.

Because a proper mania brooks no dissent. In its grip, everyone believes the same thing, says the same thing, and even uses the same language. A quasi-religious fervour makes anyone outside the bubble of shared obsession seem heretical, dangerous, insane or outright evil. Opponents of lockdowns were granny killers; the unvaccinated were pariahs who shouldn’t be allowed to fly, eat out or obtain healthcare, while some argued “anti-vaxxers” should be imprisoned or put to death. Their rhetoric and affect often violent, transactivists tar critics as murderers; not long ago, writing a single discouraging word about the mutilation of children would end your career. (Self-protectively, I kept my own journalistic mouth shut for a good four years; most journalists are still prudently bumping along on the trans bandwagon.) Women who expressed reservations about the indiscriminate sweep of #MeToo were traitors to their sex. In 2020, even tweeting “All lives matter” got you sacked.

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Manias are prone to grow increasingly extreme, accumulating evermore casualties before collapsing from their contradictions. Stalin’s show trials, Cambodia’s killing fields, Mao’s cultural revolution, obviously Nazism; the eugenics movement in the West (which we like to forget), the rage for lobotomies, and the paranoia about Satanism in day-care centres and the contagion of multiple personality disorder of the Nineties — all these misguided infatuations got worse before they imploded.

Hula hoops were harmless, but most manias are malign. The trans movement has warped primary school education, demented our culture with confusion over biological reality, condemned thousands of children to painful surgery and pharmaceutical side-effects, encroached on women’s privacy, and corrupted female sports. #MeToo contaminated relations between the sexes with such mistrust that it may have alone lowered the Western birth rate, while destroying the careers of countless men whose sins were at most venial. Covid lockdowns ravaged our economies, fuelled inflation, and exploded sovereign debt, while damaging the prospects of a generation of school children. BLM has exacerbated racial animosity, demonised meritocracy, and fostered a wasteful, parasitical managerial class of DEI enforcers whom it will be laborious to get shed of.

Yet both the priests and disciples of moral panics are driven by good intentions. They genuinely believe they are doing God’s work. Aggressively virtuous, “wokeness” is one big bundle of mania.

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Some hysterias die an easier death than others. Although the fragile, whiny accuser of a US Supreme Court nominee was once heralded as awesomely “courageous”, Christine Blasey Ford’s recent memoir has drawn weary disdain. Ergo, #MeToo is over. Nevertheless, a social frenzy seldom subsides because its agitators announce they were addled, just as the masses of ordinary people caught up in the derangement seldom acknowledge having been led astray. Everyone simply moves on, only to become consumed by something else.

There’s rarely an identifiable point at which a mania is debunked (barring a world war or counterrevolution). Few will recant, much less apologise to the victims of their excesses. A funny amnesia sets in, as forgetfulness is more palatable than shame; the Chinese have simply erased the cultural revolution from their history books. Occasionally, when folks outside the dogmatic bubble prosecute, the cheerleaders of utter tosh are called to account. We did have Nuremburg, and the belated Pol Pot trials in Cambodia. By contrast, the UK’s farcical Covid inquiry is conducted by the same establishment it’s investigating. The subsequent report may criticise single politicians for not having locked down sooner, but it can’t conclude that the lockdowns were a cataclysmic mistake, lest practically everyone at the top be implicated.

Once manias die down, most people pretend they never believed these things to begin with. Having contracted Covid five or six times post-vaccination, multiply boosted mRNA fanatics aren’t prone to advertise their vicious denunciation of the unvaccinated only two or three years ago — any more than recovered memory patients are inclined to advertise that they destroyed their relationship with their parents over an erroneous psychiatric fad. We like to think that we’re “modern” (and what peoples in the present have ever fancied themselves otherwise?) and that we base our beliefs on fact. But we’re just as prey to mass delusions as we ever were.

Accordingly, how’s this for mania number five. It isn’t a mania; it’s just the truth: check. It’s suddenly all anyone in the media seems to talk about, and they use all the same language: check. It’s powered by emotion: check. It brooks no dissent, refuses to acknowledge there’s even a debate to be had, and doghouses all sceptics as evil “deniers” who will bring about the end of world: check. It’s malign, getting increasingly extreme, and is driven by the very best of intentions: check, check, check. I’m not about to get into the argument here, but the escalating hysteria over climate change — or the climate “emergency”, climate “crisis”, or climate “collapse” — displays all the markers, does it not?

Back in January 2004, the year I left academia to become a full-time journalist, I wrote a column for Guardian Weekend Magazine on the issue of transsexuality. It was entitled “Gender Benders, Beware”. It wasn’t the first time I had written about the issue. But this piece in particular lit the touchpaper for a fire that is still burning even today.

I wrote it on the suggestion of the magazine’s editor, Katharine Viner. She wanted, she said, something about the trans issue. At that point, I mainly wrote about male violence, and sometimes lesbian politics. I had no other direction from her, except the deadline. So I wrote about how a bastardised version of “human rights” was being used against women, with Vancouver Rape Relief (VRR) as an example.

In August 1995, two of VRR’s employees had asked Kimberly Nixon, a trans-identified male, to leave its counsellor training as they thought it might not be appropriate for a man to be treating abused women. Nixon immediately filed a human rights complaint and began suing VRR. The legal battle was long and arduous. In 2002, Nixon won $7,500, the highest amount ever awarded by the tribunal, for injury to “her dignity”. But when I wrote my piece, that decision had just been overturned.

Here’s a taster: “…having not experienced life as a ‘woman’ until middle age, Nixon assumed ‘she’ would be suitable to counsel women who have chosen to access a service that offers support to women who have suffered similar experiences, not from a man in a dress! The Rape Relief sisters, who do not believe a surgically constructed vagina and hormonally grown breasts make you a woman, successfully challenged the ruling and, for now at least, the law says that to suffer discrimination as a woman you have to be, er, a woman.”

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It was like a bomb going off. The letters page exploded. Two-hundred-odd complaints landed and, in his weekly column, the readers’ editor felt bound to apologise on behalf of the newspaper, claiming my words had: “…abused an already abused minority that The Guardian might have been expected to protect”.

This was my Rubicon. The gay press, which had never been fond of me, pretty much declared war and I became a figure of hate for transactivists. The Guardian was and is the only newspaper that employed a dedicated “readers’ editor” to whom complaints can be made about anything that appears in the publication. The organised lobby of transactivists availed themselves of the opportunity to make a huge scene about my piece, claiming that it was an incitement to violence and warning that no LGBT person would read the paper again unless I was fired.

Viner defended me to the hilt and continued to commission me. But these were just the starting salvos in a war of attrition waged by the transactivists: I received death and rape threats, and would be met by a baying mob of protesters wherever I appeared to do a public presentation.

If I thought things were bad, I drew some comfort in being shortlisted for the 2008 Stonewall Journalist of the Year Award. Back then, I was still the only out lesbian journalist in mainstream media and I was writing about issues that were vitally important to lesbians and, indeed, women. Alas, what should have been a moment to actually celebrate my achievements for the under-represented became an opportunity for transactivists to target me. One Stonewall insider told me they were getting up to 20 calls a day demanding my removal from the shortlist. And as I arrived at the ceremony, I was greeted by a 200-strong picket made up of trans people and allies, all screaming “Bindel the bigot!”, “transphobe!” and other such terms of endearment. This, it later transpired, was the largest ever transactivist demo in the UK: effectively, the dawn of the modern trans rights movement.

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And no, even though I was the firm favourite, I didn’t take home the prize — it went to Miriam Stoppard, the Daily Mirror’s Agony Aunt who had offered decent advice to a reader whose son had come out as gay in one of her columns. A win by me, I was told by one insider, could have “ruined Stonewall”.

Instead, the mob tried to ruin me. Invitations to prestigious events were withdrawn. I was shortlisted for awards, only to be un-shortlisted when the organisers found themselves under pressure. And in 2009, I became the first individual, alongside six fascist organisations, to be no-platformed by the National Union of Students. And as my name became dirt, the influence of transactivists grew.

By 2011, the media had begun platforming transwomen. Juliet Jacques was charting their “transgender journey” in The Guardian, and Channel 4 screened the reality series, My Transsexual Summer. In 2012, Trans Media Watch (TMW) a tiny charity with massive power gave evidence to the Leveson Inquiry, claiming that coverage in the mainstream media was almost always prejudicial. TMW began flexing its muscles with the big news outlets, offering “training” and “advice”. And, suddenly, the trans issue was everywhere. Activists were pushing to do away with the requirement for a rubber stamp from medical professionals in order to be allowed to access cross sex hormones and surgery, and the murmurings of “self-identification” as a way forward were getting louder. At the same time, the T was increasingly attached to the LGB acronym.

So, it was a surprise when, in February 2014, the acting Stonewall CEO, Ruth Hunt, emailed asking if I’d like to meet her for a drink. I was by now a loud critic of the organisation, considering it assimilationist and conformist, as well as focused far too much on gay men. Almost immediately, the conversation turned to the trans issue. Hunt told me there was “no way” Stonewall was going to add the T to the LGB if she was offered the permanent post, and that she would go no further than help set up and support a separate organisation for trans people.

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Well, what happened next? When, that summer, Hunt was revealed as the new CEO of Stonewall, she met with transactivists to discuss how the organisation could become more trans inclusive and apologised for my nomination in 2008.

Then, in 2015, I was invited to debate the question: “Does modern feminism have a problem with free speech?” by the University of Manchester Free Speech and Secular Society. My opponent was Milo Yiannopoulos, a far-Right agitator and misogynist who opposed abortion rights and blamed women for rape. Following the predictable trans activist pile-on, the Women’s Officer decided I should be publicly disinvited because my presence could “incite hatred towards and exclusion of our trans students”, and my views were “dangerous for trans people and…for feminist and liberation movements in general”. A feminist activist was being silenced while a self-proclaimed misogynist was welcome. Yiannopoulos was eventually disinvited after feminists kicked up a fuss. People were beginning to finally twig that trans activism was a front for woman-hatred, otherwise, why treat the actual transphobic bigot as far less of a threat than the left-wing feminist campaigning to end male violence?

It was a lonely time, despite a handful of other feminists speaking out and organising against transgender ideology. But the growing grip of gender ideology was a force to be reckoned with. And they had made me a pariah. When, for instance, I was invited in 2016 to speak to the Salford Working Class Movement Library about growing up as a working-class lesbian in north-east England, hundreds of mainly middle-class students petitioned the library to de-platform me, claiming I was a bigot. They even went after the library’s funders, who were told I was “transphobic”, “biphobic”, “Islamophobic”, “hateful,” and “anti-sex work”. I was also a Terf (Trans Exclusionary Radical Feminist) — a nasty term coined by self-described “trans ally” Viv Smythe, bemoaning what she considered to be “anti-trans” coverage in the British press.

Undaunted, the library volunteers stood their ground, and the event went ahead in February 2017. It was standing room only. I hadn’t intended to mention trans ideology (strangely enough, it wasn’t much of an issue on my run-down council estate in the Seventies). But, once I was in that room, having been escorted by security guards past yet another baying mob, I cracked and spent 15 minutes talking about the rising transactivist hatred towards women, especially lesbians. And then we moved on to my lesbian awakening.

It has been a torrid two decades. I have been physically threatened and attacked on several occasions. Obscenities and threats are hurled at me. The irony escapes these activists — generally trans-identifying males — that I am a feminist who campaigns to prevent violence against women.

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I’m lucky, though, that unlike some women, such as my friends Kathleen Stock, Jo Phoenix and Maya Forstater, I had no job to be hounded out of. I work as a freelancer. And despite being slowly frozen out of writing for The Guardian over the past decade, I have always had plenty of work. But these past 20 years have not been easy.

What hurts most is being labelled a bigot, homophobe and fascist. After all, I have chosen to spend all my life, since coming out as a lesbian at 15, campaigning to end bigotry. And I like to think I still do. Last September, I was back in Vancouver, meeting the brilliant women I wrote about all those years ago, many of whom are now close friends. They are still under attack by transactivists, and have had cuts to their funding, and even a rat nailed to the door of their centre by blue-fringed misogynists. But they, like me, persist.

Though she has published prolifically on adjacent topics, it’s been a while since Butler spent a whole book dedicated to her own thoughts on gender. A few things have changed in the interim, including her pronouns (she is now a “they”, though generously prepared to tolerate the former designation) and her sentence lengths, which — at least for the time being — no longer stretch epically to cover whole pages at a time. Still, despite the apparently mass-market ambitions of the new publication, some familiar habits remain.

Not for her the pedestrian business of going through critics’ arguments, providing non-partisan evidence, and patiently exposing internal contradictions and gaps in an understated but cumulatively devastating manner. In the book’s lengthy introduction, she tells us that “of course” she could “provide good arguments as to why looking at gender this way is wrong, which would be useful for educators and policymakers”; indeed, “as an educator” herself, it is “tempting to try and expose and puncture this inflammatory caricature of gender through an intellectual exercise”. Tempted as she might be, however, it turns out that she’s not going to bother with that stuff much. Instead, she wants to give the people what nobody was really asking for: a deconstruction of the “syntactical elements” of the “anti-gender movement”, understood as a “phantasmic scene” according to the “theoretical formulation of Jean Laplanche”.

Translated into ordinary English, Butler is going to put the anti-gender people on the shrink’s couch. She seems unruffled by the fact that, in prosecuting her case, she can’t define “gender” clearly — her most definite pronouncement is that it is “a felt sense of the body, in its surfaces and depths, a lived sense of being a body in the world in this way”. But never mind the pesky details: if you are anti-gender (whatever that amounts to, exactly), then you are very probably a patriarchal racist Christian nationalist nutjob, and also secretly gay. She is probing your unconscious, remember, and understands you better than you do yourself.

Or perhaps — and this is about as charitable as it gets — you are simply a naïve and credulous fool, for whom getting in a moral panic about gay marriage and LGBTQ+ library books acts as a psychic substitute for reasonable fears about climate change and neoliberalism. As such, you are being played by the reactionary rhetoric of various deplorables, including Orbán, Trump, Bolsonaro, various Popes, and er… J.K. Rowling, Holly Lawford-Smith, and Kathleen Stock. (A whole chapter incomprehensibly passes on the heading “More Sex Please, We’re British”, and goes instead for “TERFs and British matters of sex”.)

Though at times the author feigns charitable curiosity about some of her argumentative targets, the attitude never lasts. A sentence about gender-critical feminists that starts with “To be fair” ends up, a mere clause or two later, talking about their supposed affinities with “fascist politics”. There isn’t a single objection lodged against opponents that does not come freighted with the implication of moral taint and/or stupidity. Of course, painting one’s intellectual enemies as cartoon characters is a known tactic of modern transactivism; still, it is shocking to see it done so crudely by someone who retains a high reputation in many quarters.

It is also striking how hackneyed some of the thought is. Butler’s writing in her heyday at least displayed a bit of panache and originality, assuming you could parse it successfully. In contrast, here she comes over as in thrall to established activist tropes, and with all the depth of a TikTok video in places. She even cites Pink News as a source of data. Indeed, if you have spent much time hanging around the so-called “queer community” in the last decade, you will have read many of the talking points in this book already.

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Whereas she used to insist, admirably, on fluidity and impermanence in the expression of gender identity, now she exhorts “affirmation” and recognition of “the reality of trans lives”. The chapter on British so-called TERFs is a compendium of smears culled from online teenagers about their gender-critical mums: they are not real feminists; they are effectively racists focusing on a white ideal of womanhood, on the side of “colonialism and empire”; they spread “baseless fears” about vulnerable transwomen; and so on.

Her evidence is carefully cherry-picked and often from partisan sources. There is no real attempt to take seriously the mounting evidence from hospitals and whistle-blowers of medical malpractice against children and teens in the name of “affirmation”; the rising numbers of assaults against women and girls as a result of self-ID; the demoralisation of displaced women athletes; or the physical and psychological pain of detransitioners. (On the latter, she claims that “the regret rates for people of all ages is very small”, based on a single 2021 study that has been heavily criticised since.) Also familiar from arguments with anime avatars on Twitter, we find fatuous whatabouttery: you say you are interested in stopping violence against female prisoners, but why don’t you care about male prison guards raping them? (Er… we do?) As usual, the message seems to be that these things aren’t really happening; and even if they were, they wouldn’t really matter.

Equally though, Butler declares that I personally am bringing “toxicity” and “cruelty to the table” in insisting that a male who declares he is a woman is still not a woman. “Imagine if you were Jewish and someone tells you that you are not. Imagine if you are lesbian and someone laughs in your face and says you are confused since you are really heterosexual”. As a Jewish friend laughingly observed when I first told her about this, there are Jews who spend their whole lives insisting that certain other pretenders are not really Jewish. And, as I ruefully know from personal experience, something similar goes for lesbians too. But in Butler’s histrionic calculations, failing to affirm someone else’s identity claims is apparently more traumatic than anything a surgeon could do to a confused, unhappy trans-identified teenager, or a trans-identified rapist to an already traumatised female prisoner.

She also objects that critics have misconstrued the nature of social construction in previous writing about her work; and that she can and does, in fact, hold that biological sex is “real” (at least, sort of), even if it is also “mutable”. I’ve done my time in the academic salt mines trying to make sense of the contradictions in Butler’s writing so I’ll leave it to others to adjudicate who is right. Instead, I prefer to turn to a more interesting question, made perfectly legitimate by the precedent she herself sets. In producing such a terrible book, what is going on for Butler psychoanalytically? What is she really scared of?

Given their known volatility, one plausible answer is transactivists; a fear also indicated by the author’s submissive observation that her own previously published views on gender have proved “questionable in several ways, especially in light of trans and materialist criticisms”. After all, if what passes for acceptable methodology in your own academic discipline includes shaming others in print for unquantifiable harms to a much-mythologised community, sooner or later a grandee like Butler is bound to fall victim to the practice herself. The more venerable you get, the more likely it is that young pretenders will come for your throne, and they have some scary tools at their disposal. If I were her, I would be frightened too.

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But there is also, I suspect, a deeper fear at work here, and an unconscious desire to sublimate guilt. (See how annoying this is, Professor Butler?) The level of projection in this book — by which I mean, attribution of unrecognised features of one’s own behaviour to others, in the Freudian and Jungian sense — is off the scale. Butler sees authoritarian cancellers and enemies of critical thought everywhere, though apparently not so much among those closest to home.

She tells us that in the anti-gender movement, there is a hatred of rational discussion. To say gender is an ideology is, in itself, “an ideological move par excellence”. Whereas gender studies — gender studies, for gods’ sake — is a “diverse field, marked by internal debate”, by contrast its enemies refuse to “read the texts they oppose — or to learn how best to read them” and they “do not hold themselves to standards of consistency or coherence”. It is impossible to convince members of the anti-gender movement “with good arguments because of the fear that the reading will introduce confusion into the reader’s mind or bring her into direct contact with the devil”. To anyone who has ever been no-platformed as a result of transactivist complaints, been put through a disciplinary or worse because of gender-critical views, or even just laboured through one of Butler’s previous sentences, this aspect of the book should come with a health warning.

Still, there is something correct in Butler’s observation that critics of transactivism are getting increasingly intolerant and illiberal. The dominant emotion she attributes to them is fear, but a more accurate description would be fury. It is obvious that many across the world have become angered by the grandiose, narcissistic overreach of academics like her: thinkers indifferent to the real-world havoc wrought by their barmy ideas and impenetrable speech codes, and who pillory all objectors as badly intentioned or deeply confused, no matter what the background reasoning. Butler is right to fear increasing threats towards LGBT people and women across the globe but fails to notice her own significant responsibility in the aetiology of the problem. Speaking personally, I’m not remotely afraid of gender, understood blandly as sexual and bodily expression; but I am very afraid of what Judith Butler has done with it.

Neurobiologists there have discovered that a specially designed “deep neural network”— that is, an AI presumably devoid of the misogynist prejudices of ordinary mortals — can reliably sort brains into male and female categories based on the detection of “hotspot” activity patterns. Worse, it seems that the AI can also use these differences to reliably predict different cognitive performances in men and women on certain tasks, suggesting that functional brain variations have behavioural implications. Though it’s a bit early to say, perhaps we can now look forward to a more harmonious future, where a woman can be proudly unapologetic for her inability to reverse park, and a man gets to blame his brain for repeated failures to notice that his wife is crying. Meanwhile, for the many thinkers who have staked their professional identities to the non-existence of two kinds of brain, now might seem like a good time to move some eggs into a different career basket.

Indeed, some feminist researchers already appear to have got that memo, with their provocative stances becoming noticeably more diluted as the years pass and new evidence for the opposition’s case stacks up. Back in 2019, British neurobiologist Professor Gina Rippon — author of the brashly-titled The Gendered Brain: The new neuroscience that shatters the myth of the female brain — felt confident enough to dismiss the idea that there were any systematic brain differences based on “sex alone” as “neurofoolishness’. Furthermore, she said, any limited differences that did exist between men’s and women’s brains were “much more a function of experiences”, and a result of contingent exposure to “our gendered world”, than the predictable result of background chromosomes and hormones.

Yet this week, we encountered Rippon in the Telegraph, responding to the Stanford findings in an apparently more conciliatory vein: wondering whether it might be that “almost all brain–shaping factors are dynamically entangled products of both sex and gender influences”; and whether perhaps, with the new research, we are “looking at what should be called sex/gender differences” rather than “sex differences” or “gender differences”. Given widespread acknowledgement of the importance of social environment for brain development, and also of the existence of neuroplasticity — including by all those who insist that underlying biological factors make a systematic difference to some of what human brains are, and what they can do — it is unclear which of Rippon’s opponents would disagree with her. As is often the case, what started life as two spicily hot contrasting takes have ended up occupying so much shared territory that it’s no longer clear what exactly is being argued about.

In retrospect, for researchers to rule out systematic brain differences largely caused by biological factors in a sexually dimorphic species like ours — and, even more boldly, before adequate technology had been developed to spot them — was always going to pose a reputational risk; a bit like 16th-century astronomers pronouncing themselves absolutely positive there are no further planets in the solar system just before telescopes are invented. What could explain such apparent recklessness? Partly to blame must have been the fear that modern scientific confirmation of the existence of such differences would be used against women in the long run.

As with progressive arguments about reality generally, sometimes the most pressing task is not to establish what is true or false, but rather to lure people away from accurate apprehension of a socially dangerous idea. And it’s not clear that dire predictions in this respect are wrong. Although now a cliché, it’s still true that, throughout history, a raft of excuses for female ill-treatment and subjugation have been predicated on claims about their supposedly more inferior brains. In many countries, the already parlous state of women’s equality would surely be propped up by any scientific-looking discovery of non-negotiable cognitive and behavioural variations from the male norm. Equally though, in countries like the UK where feminised skills like verbal reasoning and emotional intelligence are increasingly demanded in the jobs market, it could be that the discovery would end hurting men’s life chances more.

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Whatever problems might result in either direction, these would be compounded by general statistical illiteracy and an inability not to hear a claim that there are certain patterns across a huge population as an invitation to draw the same conclusions about each and every member. And then there’s also an apparent temptation to start treating some sex-typical behavioural patterns, averaged across a general population with many exceptions, as representing a kind of template definitive of the “male brain” or the “female brain” itself — which can even be lifted from its original genetic context and attributed to individuals of the opposite sex, should their individual qualitative characteristics seem to fit the bill. Bizarrely, given his intellectual background, this appears to be the approach adopted by former mathematical physicist Eric Weinstein, who in a widely circulated clip this week claimed that “there are people with male brains in female bodies, and conversely”, arguing that society should be more compassionate towards them.

Of course, many of us by now are very familiar with the general gambit of adjusting claims about reality to fit better with perceived moral commitments. For its basic form is also present in the progressive doctrine that self-identified transwomen should indeed be classified as women, because it would be very harmful for them if people said otherwise. Indeed, there is an increasingly popular narrative amongst anti-feminist commentators such as Matt Walsh that the current transactivist derangement still gripping many institutions started with feminism. In most ways this is diabolically unfair, especially since radical feminists were at the forefront of fighting transactivist ideas years before Walsh cottoned on. But it’s true that certain feminist academics wrote the playbook for wishful thinking about reality. Time and again in scholarly writing, you encounter the bizarre thought that if an idea has consequences that are helpful to women, that must be a point in favour of its truth; and if unhelpful, it’s a point against.

This isn’t just the more benign claim that some inconvenient truths can safely be ignored. There are lots of facts in the world it would be pointless or detrimental to pursue. It’s not even a deliberate fake-it-til-you-make-it strategy, self-consciously pretending to others that something is true because a widespread commitment to the existence of that thing would better fit some group’s interests. Rather, it’s the mad idea that the anticipated social undesirability of something being widely believed to be true can be recycled into a positive epistemic reason as to why that thing couldn’t actually be true in the first place.

For instance: there can’t be consistent sex differences favouring mathematical reasoning abilities in males, on average, because if there were, this would keep talented females out of STEM subjects. (Argue away about the differences by all means, but don’t pretend this is a good reason to think there aren’t any.) Or: women must be understood as a socially defined “gender” and not as a biologically defined sex, because if women were a biologically defined sex, unscrupulous men would treat their biology as destiny, and oppress them on that basis. The latter argument appears in feminist writing from at least the Seventies onwards, and is still being regurgitated by philosophy professors with a supposedly advanced grasp on logic to this day.

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Quite apart from the fact you are likely to end up spouting gibberish if you proceed in this way, there are other pitfalls too. One is that, since your assumed noble aim is to avoid harm to others by reasoning as you do, you are more likely to start uncharitably misrepresenting intellectual opponents in a particular factual dispute as if their primary aim must be to commit harm — when of course it need not be at all. This partly explains not just the unjust accusations of “transphobia” so easily launched at sex realists, but also the weirdly spikey feminist mentions of neurofoolishness and the like in the context of brain research.

And relatedly, since you have now lost touch with reliable truth and evidence-seeking methodologies at least some of the time, you are more likely to have to resort to histrionic misdirection in arguments with your opponents: not just unfair ad hominems, but also objections that they have not read or understood “the literature” or paid suitable deference to elders in the field; accusations of mansplaining when they quite reasonably argue back; complaints that you are too exhausted to carry out the emotional labour of “educating” them all over again; and so on. Again, such manoeuvres are by now a well-known staple of reality-denying transactivism, but arguably, reality-denying versions of feminism got there first. Ironically, such guilt-tripping, heartstring-pulling rhetorical devices are still sometimes employed by self-proclaimed feminists, partly in the service of insisting that women could not possibly be more emotional or irrational than men by nature. And I hate to be the bearer of bad news, but it does not come across as particularly convincing.

Of course, this didn’t actually happen, because people don’t talk like that in real life. Many do, however, engage in this way on social media, typically towards total strangers. This week I’ve been trending on X (or Twitter, as I stubbornly still call it) following a mass pile-on instigated by several gender-critical activists. This particular bombardment resulted in my decision to temporarily deactivate my Twitter account, to the glee of my critics and transactivists alike.

Having since been contacted by friends within the gender-critical movement, I have learned that many of them are exasperated by the “intolerant elements” within their community who seek to destroy anyone who does not conform to every single aspect of their worldview, even if it means that the cause is fatally undermined. They describe a “civil war” being waged by a small but intimidating minority who maintain that any slight point of disagreement is a form of heresy, that language has the capacity to shape reality, and that those found guilty of wrongspeak ought to be publicly shamed and alienated. Remind you of anyone?

This civil war within the gender-critical movement is, of course, a boon to the high priests of gender identity, those authoritarians who have been conducting a frighteningly effective campaign to reorganise society around the metaphysical belief that “gender” should take priority over sex when it comes to spaces, sports and human rights. Given that the stakes are so high, not least for women, children, and gay people, it might be worth considering what this in-fighting is all about and how it might be avoided in the future. In order to do this, I should first explain the background to this week’s furore.

I host a weekly show on GB News called Free Speech Nation, which explores all aspects of the culture wars and has a particular emphasis on the ongoing attacks on women’s rights in the name of “progress”. Even before last Sunday’s show had aired, I was contacted by regular viewers who had taken issue with me for inviting the trans writer and teacher Debbie Hayton to appear for an interview. As an admitted autogynephile — a heterosexual man who presents as a woman out of an erotic attraction to himself — Hayton is something of a hate figure for many in the movement. By conducting this interview, I was deemed guilty of “enabling” and “promoting perversion”, in spite of Hayton’s gender-critical beliefs.

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Further context is required here. The day before my show, a profile appeared in The Times in which the interviewer, Janice Turner, referred to Hayton with female pronouns. Turner clarified her reasoning in a tweet: “The issue of pronouns is becoming absolutist on BOTH sides. Stonewall demands even bearded rapists be called “she”, GC ultras refuse to call any trans woman “she”. I reject both positions. I never call male sex offenders she/her. But I will be courteous to those who respect women.”

For many, the issue of pronouns has become a red line in the gender wars, and Turner’s efforts at compromise are seen not only as wrongheaded, but traitorous. It is widely held that trans-identifying individuals must never be described as anything other than their true biological sex, and cries of “hold the line” are often heard. Not only are the likes of Turner demonised for attempting to find a middle ground, but they are also told that they have been “groomed” by the men who are insisting that other people’s language must be modified in deference to their sense of self.

This tactic, of suggesting that an opposing view is the result of a delusion, is common to all ideological movements. Marxist theorists have often dismissed unbelievers as suffering from “false consciousness”. Similarly, many transactivists insist that those of us who believe that sex is immutable have been “radicalised online”. Yet this is also the identical approach of those gender-critical campaigners who deny the individual agency of their comrades and claim they are the victims of “grooming”. I suppose it is easier to explain away disagreement as the product of some collective fantasy rather than accept that not everyone thinks the same way as you.

The inevitable firestorm following Turner’s piece provided the backdrop to my own interview with Hayton on Sunday night. Initial feedback was cordial and productive: many feminists were pleased that I had listened to their concerns and asked questions about the use of toilets, single-sex spaces, and a schools guidance policy that Hayton had co-authored for the teachers’ union NASUWT in 2017. There were also many critical comments, which I welcomed and took seriously.

The first signs of trouble occurred when one of my critics began repeatedly railing against “the gays” in her posts. She complained that I had used the pronoun “her” in relation to Debbie in one of the introductory pieces to camera (as it happens, this was simply because the producer had written it that way in the autocue). I explained that I use pronouns to denote biological sex, and certainly when it comes to reporting on the news, because I do not believe in gender identity. But I also said that when it comes to personal friends who identify as the opposite sex, I have occasionally adopted their preferred pronouns and names. I have done this to avoid needless distress, not to signal that I share their belief-system. It would be like bowing my head for a prayer at a friend’s family meal, even if I didn’t believe in their particular god.

I respect and understand criticisms of this approach. Women are facing the erosion of their spaces and rights, and this is being actuated by gender-identity ideology and the compelled use of pronouns. I have written previously about the need to resist this pressure to conform to pronoun declaration, and I am particularly vexed by the tendency of journalists to describe rapists, paedophiles and other male criminals as “she” or to use nonsensical phrases such as “her penis”.

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Therefore, I answered many of my critics by agreeing that my view may be flawed, and that I was open to persuasion regarding their “slippery slope” argument. It was only when multiple anonymous accounts starting branding me a liar, a grifter and a hater of women, and outright telling me to “fuck off” that I realised this was beginning to turn nasty.

One of my traducers claimed that I lacked credibility and integrity because I adhere to “a deranged homophobic, sexist ideology”, even though I have consistently and outspokenly opposed it over many years. This struck me as an absurd overreaction, the kind of “you’re either with us or against us” purity demand that one has come to expect in these tribalistic times.

From there, matters escalated at a dizzying rate. I was repeatedly accused of being a misogynist, something which I find odd, given that over the past few years I have covered the rising threats to women’s rights on my show with a tenacity that has been notably absent in other media outlets. Every week I have invited women to appear, including Helen Joyce, Maya Forstater, Jo Phoenix, Julie Bindel, Alka Sehgal Cuthbert, Milli Hill, Kellie-Jay Keen, Dr Jane Clare Jones, Jo Bartosch, Mara Yamauchi, Holly Lawford-Smith, Sarah Phillimore, Kate Coleman, Rosie Kay, Ayaan Hirsi Ali, and Sharron Davies. If my critics are correct, and I am indeed a rabid misogynist, surely I at least deserve some credit for going to such elaborate lengths to disguise it?

Many of my detractors took the view that my homosexuality was the issue. One self-declared feminist confessed to being “a raging homophobe” and wrote: “I don’t like gay men anymore. I think most of them are miso[gynist] pieces of shhh [sic] that mock women and platform AGPs”. Another was more direct: “The gays are definitely to blame as well. First off, sticking a penis inside a man’s asshole is unhealthy. If you can’t admit this then you are part of the problem.” Another went with “I hate men in general”, and then clarified her misandry in an oddly specific way: “Gay MEN. Straight MEN. White MEN. Black MEN. All MEN. I don’t discriminate. I view you all with equal amounts of derision”. Then there was an especially malicious attack from law scholar Dr Alessandra Asteriti, who called me a liar and resorted to the defamatory claim that my objective was to “harm women and children”.

Despite the onslaught, I should emphasise that this kind of sociopathic behaviour is far from typical in the gender-critical movement. Yes, there exists a small contingent who despise gay men and seek to bully and harass anyone who takes a different view. But this is most definitely not the norm, and the overwhelming majority of women I have encountered in this fight have been generous, compassionate and incredibly courageous in the face of threats and wholly unfounded accusations of “hate” and “transphobia”. It is only thanks to their hard work that we have seen a recent sea-change in public understanding of the dangers of this ideology.

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Naturally, at the time, I found it difficult to distinguish between legitimate criticisms and outright abuse. And once I started becoming defensive, it of course made matters worse. It’s always worth bearing in mind that, in the eye of a Twitter storm, one does not see individuals, but rather an army determined to see you crushed. At that point, nuance becomes impossible.

And while I am fully aware that most of those participating in the pile-on would have been appalled by the excesses of the few, that isn’t much consolation. This had all begun with one woman griping about “the gays” and ended hours later with complete strangers on my timeline discussing why gay men are so vile, invariably misogynistic, and have a tendency towards paedophilia (the most repugnant and common prejudice of them all). By the time someone posted an audio recording of one of my detractors saying that she would enjoy murdering gay men, I was out.

And of course, transactivists noticed the abuse I was receiving and were quick to weaponise the situation. One of them emailed me directly: “I don’t want to say ‘I told you so’ but… ha.” Many have since boasted on social media that the attacks were karma for my stupidity in associating with this brood of reactionaries. They have shared screenshots of the worst tweets and taken this as confirmation of what they have been alleging all along: that the gender-critical movement is a front for far-Right homophobes.

My experiences this week have certainly alerted me to a dark element within gender-critical circles, one that has become a source of considerable concern for many women in the fight. I have retreated from Twitter and instead launched a Substack, in the hope that I may continue these conversations with those who are able to remain civil even while robustly disagreeing. I now understand that serious discussions about this issue are simply not possible on Twitter, and my mental health has to come first.

For all that, gender-critical feminism remains an essential force in protecting our rights in these maddening times. The genuinely bigoted elements of the movement may be aberrations, but they are increasingly being perceived as the norm. If this cannot be rectified, it will prove a disaster not just for women and gay people, but for truth and sanity itself.

It is hard to shock me these days — but as I moved around the World Professional Association for Transgender Health’s symposium in Montreal in September 2022, I often felt as if I’d slipped sideways into some strange universe that operated in accordance with other laws: where up is down and girls are boys and medicine has left its modest brief — healing — far behind in its breathless pursuit of transcendence.

I wasn’t really supposed to be there. I hadn’t misrepresented myself — I am what I claimed to be: a graduate student researching gender identity — but this was a convocation for believers and I’m a sceptic. When WPATH, the world’s most prestigious and influential gathering in transgender healthcare, came to Montreal, I couldn’t resist the opportunity to see up close the people and ideas I had pursued through so many articles and books.

I wanted to know what gender clinicians were saying behind closed doors. I wanted to see how they understand the work they do, the patients they serve, and the criticism they face. That’s why I began attending WPATH conferences, starting with the symposium in Montreal, followed by the European Professional Association for Transgender Health conference in Killarney, Ireland, in April, and the US Professional Association for Transgender Health conference in Denver, Colorado, just a few weeks ago.

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After years of flying under the radar, the field of transgender health care is facing serious questions about whether minors can consent to life-altering interventions; what role factors like autism, sexual orientation, and social influence may play in the explosion of children and young people identifying as trans; and what to make of mounting evidence of medical harm, regret, and detransition. In response, the field of trans healthcare is becoming ever more secretive. There is a sharp demarcation between what gender clinicians say in public and what they say in private.

At these conferences, the big questions confronting transgender health care hardly feature. Instead, these conferences serve a different purpose: to shore up the faithful and cultivate a revolutionary vanguard within medicine. To this end, the proceedings revolve around a strange set of parables: that of the good gender clinician and the bad gender clinician.

In this world, being a good gender clinician means deferring to patients’ self-understandings and having the humility to serve even what one does not understand. The mark of a good gender clinician is her credulity in the face of brave new manifestations of gender.

“People outside this room get hung up on questions like ‘How can we make sure people are really trans and are not going to regret their transition later?’” one gender clinician in Denver mused. “I’m interested in giving the very best possible care to trans young people, the care that they need and deserve… it’s easy to roll down this pathway of ‘how do you know if somebody’s going to change their mind?’ or ‘how do you know if somebody’s really trans or not?’ and that’s not the conversation I’m really participating in.”

It’s difficult to imagine clinicians practising in other areas of medicine not asking such basic questions, especially when the basis for treatment is so murky. But a good gender clinician, looking at a patient, does not see what non-believers like you or I might see. A good clinician falls under the sway of the same fantasy as the patient and conspires with her to bring her transgender self into existence. Under this framework, there is no “really trans” or not. There is only what the patient says and the readiness of the clinician to put herself at the service of the patient’s vision.

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A bad gender clinician, by contrast, feels an “entitlement to know” why a patient feels the way she does or why she seeks a particular intervention. She clings to a traditional conception of her role as a “gatekeeper” who evaluates and prescribes. She thinks she can “discern a ‘true’ gender identity beyond what is articulated by the patient”. She may believe she can “identify the ‘root cause’ of a transgender identity”, which is seen as pathologising. She may try to leave the door open to desistance — the most common outcome before gender clinicians started interfering with normal development by deploying puberty-blocking drugs — in which case she is guilty of “valuing cis lives over trans lives”.

A bad gender clinician is easily “intimidated” by complicated patients, while a good gender clinician knows how to secure consent even in the trickiest cases. Mental health difficulties become “mental health differences”. Severe autism or thinking you have multiple personalities living inside your head become empowering forms of “neurodiversity”. When it comes to assessment, “careful” and “comprehensive” have become dirty words: “The answer always seems to be more assessment and more time. That’s gatekeeping.”

During the Denver conference, presenters role-played how to secure informed consent for a hysterectomy and phalloplasty in the case of a schizophrenic, borderline autistic, intellectually disabled “demiboy” with a recent psychiatric hospitalisation. At no point do the role-players encounter any real barriers. Instead, they persevere. At first, the patient struggled to understand why a phalloplasty might require multiple surgeries, but then the clinicians “explained everything” and the patient understood. This is called “lean[ing] into the nuance of capacity”.

The moral of this story is clear: failure to achieve informed consent is a failure on the part of the clinician, a failure of imagination and flexibility, not a recognition that some patients — whether because of age or mental illness or intellectual disability — will simply not be able to consent.

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On WPATH’s private forums, clinicians occasionally express reservations about what they’re being expected to do, such as the social worker who wondered whether she should write letters for surgery for “several trans clients with serious mental illness… Even though these clients have a well-established trans gender identity, their likely stability post initiation of HRT [hormone-replacement therapy] or surgery is difficult to predict. What criteria do other people use to determine whether or not they can write a letter supporting surgical transition for this population?”

Her colleagues quickly put her in her place: “My feeling is that, in general, mental illness is not a reason to withhold needed medical care from clients,” an “affirming, anti-oppressive” gender therapist responded. “My assumption is that you’re asking this question because you’re taking seriously your responsibility to care for and guide your clients. Unfortunately, though, I think the broader context in which this question even exists is one in which we, as mental health professionals, have been put inappropriately into gatekeeper roles. I’m not aware of any other medical procedure that requires the approval of a therapist. I think requiring this for trans clients is another way that our healthcare system positions gender-affirming care as ‘optional’ or only for those who can prove they deserve it.”

Another gender clinician referred dismissively to the recommendation that mental illness should be “well controlled” before initiating hormonal and surgical interventions: “I am personally not invested in the ‘well controlled’ criterion phrase unless absolutely necessary… in the last 15 years I had to regrettably decline writing only one letter, mainly [because] the person evaluated was in active psychosis and hallucinated during the assessment session. Other than that, everyone got their assessment letter, insurance approval, and are living [presumably] happily ever after.” Everything hinges on that “presumably”.

For years, gender clinicians have reassured patients and parents that the evidence would eventually bear out the lofty promises of transition: that transition is life-saving; that psychotherapeutic approaches to gender distress don’t work and instead constitute unethical “conversion therapy”. But as the data starts to come in, transition appears unlikely to live up to these high expectations.

During the Ireland conference, researchers bracketed discouraging findings with upbeat statements of belief such as: “We all know gender-affirming care is effective.” A Swedish researcher who found that psychiatric hospitalisation increased after patients initiated puberty blockers or cross-sex hormones told the audience that she was “really concerned”, not about the results themselves, but “about how results will be interpreted” because, “as you all know, there are improved mental health outcomes following puberty blockers and gender-affirming hormones” — even when the research can’t find those benefits.

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“There’s an expectation that gender-affirming hormones will improve somebody’s mental health problems,” Johanna Olson-Kennedy, one of the leading US gender clinicians, said on the opening night of the Denver conference. Why? Because “they improve gender congruence”. In other words, if a patient doesn’t want breasts and a surgeon removes her breasts, the treatment was a success, even if her mental health deteriorates and even if she experiences regret down the road. Clinicians dismiss detransition as one of multiple possible “attenuations” of gender identity, alongside “elf”, “fairy”, and “friendly non-intimidating woman”. If a patient changes her mind later, clinicians can simply treat this new manifestation of gender incongruence by the same means: no harm, no foul.

Meanwhile, gender clinicians speak with remarkable frankness about overcoming their reservations, including the plastic surgeon who recounted the alarm he felt the first time a patient requested gender nullification surgery: an intervention that involves removing all external genitalia to create a “smooth” Ken doll-like appearance. But this surgeon soon conquered his hang-ups: he now performs “a lot” of these surgeries and promotes the procedure to his more cautious colleagues. These kinds of stories frame doubt as something to be vanquished, not investigated.

And if doubts persist, there’s always emotional blackmail. In Denver, an obese patient berated the plastic surgeons in the audience, telling them “you wouldn’t be hearing from me today” had the patient not found a surgeon willing to bend the rules and perform a double mastectomy: “I had contacted over a dozen plastic surgeons in the state of Colorado, all of them telling me they refused to do surgery on me. The surgery I so, so desperately needed so as to not kill myself. Only because of my BMI.”

So if a clinician dares to enforce standard medical practices or exercise her professional judgment, she may drive her desperate patients to suicide. The most questionable sessions end with no questions at all.

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But what about the rest of us? What are we entitled to know about this bold new frontier in medicine? In Denver, public-relations specialists cautioned clinicians to spare reporters, policymakers, and parents the details of what “gender-affirming care” entails. In fact, even the use of the term “gender-affirming care” is discouraged: “When [people] hear it, they think ‘trans kids in the driver’s seat,’” health policy expert Kellan Baker said. “Many of us here, we all support trans kids in the driver’s seat because it’s their bodies, their lives. But when you think about folks who don’t know trans people, they are very scared by the idea that young people are making irreversible decisions and that nobody else has any oversight over these decisions. The term “medically-necessary care” is better, he said. “Essential medical care. Prescribed medical care.”

Presenters also recommended that gender clinicians avoid specifics. Avoid ages (“this care is highly individualised and age-appropriate”). Avoid giving information about the effects of puberty blockers and hormones. Avoid discussing the ins and outs of surgeries. In practice, “holding [the public’s] hands and helping [them] understand” looks more like covering their eyes and telling them whatever they need to hear to feel at ease. “The dinosaurs are scared,” Baker deadpanned.

This is how an entire field of medical practice became committed to virtuous obscurantism. Gender-affirming clinicians feel misunderstood by their critics. They don’t trust outsiders to put the work they do in the right light. There’s always a risk that someone will look at life-saving reconstructive chest surgeries for transmasculine minors and see the wrong thing: doctors performing breast amputations on troubled teen girls. Therefore, in order to defend the “life-saving” work they do, they must dissemble, obscure, or practise other forms of “heavenly deception”.

Critics of gender-affirming care fall somewhere along the spectrum of transphobia — with dinosaurs at one end, genocidaires at the other. In Ireland, a keynote speaker described “the gender-critical movement [as] a totalitarian and genocidal force that targets not just trans people but all institutions that uphold democracy and individual human rights”. In Denver, a state legislator announced that policymakers passing restrictions on youth gender transition “will kill children. Not with their own hands. But they will.”

The result of this Manichean worldview is that there is no possible dialogue with critics and no room for serious dissent within the movement itself: “If we are fighting amongst ourselves the forces of oppression have won,” as outgoing USPATH president Maddie Deutsch put it. No one, at any conference, discussed the risks and unknowns around puberty blockers and their possible effects on brain development, or the evidence that suggests blockers may change the course of a child’s life by turning what may have been a developmental phase into a permanent condition.

In one of the most extraordinary moments in Ireland, outgoing EPATH president Jan Motmans said: “We respect everyone’s freedom of speech, but we choose not to listen to it.” The auditorium burst into applause. But the speech they’re choosing not to listen to is the mounting evidence that something has gone wrong in the field of gender medicine.

The conviction of being on the right side of history is why criticism doesn’t stick. Clinicians don’t see themselves reflected in critiques. They are, for the most part, decent people, capable of feeling genuine horror when they accidentally say “hey guys” instead of “hey folks”. Their best impulses — their empathy, their humility in the face of what they don’t understand, their sincere desire to help distressed patients — have been hijacked by an ideological movement within medicine. In the process, they have lost sight of what they do.

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Why I stopped being a good girl

By Hadley Freeman

This blindness sets in more or less the moment a patient sets foot in a gender clinic — when a distressed girl transforms into a “boy” in need of affirmation. Gender clinicians see empowerment in overlooking a patient’s limitations. They have come to believe that medical responsibility to their patients requires them to dismantle the guardrails that stand between vulnerable patients and life-altering interventions.

Nothing illustrates this more clearly than a session on “neurodiversity-affirming gender-affirming care” in Denver, which overflowed with suggestions for clinicians working with autistic patients to achieve their surgical goals. To make autistic patients more comfortable, clinicians should dim the lights, keep an assortment of fidget toys on hand, drop the small talk, don’t try to make eye contact, avoid open-ended questions. If a patient won’t — or can’t — speak, the clinician should ask for a thumbs up or thumbs down. A good gender clinician helps patients anticipate the sensory reactions they might have to injections, surgeries, stitches, blood, and pain.

Over and over again, I’m struck by the realisation that these clinicians have thought of everything. Everything, that is, except: what if they’re wrong?

By the time I became aware of her, in 2014, she had become notorious in circles where sex research and journalism overlap. What appears to have curdled her is the work of Ray Blanchard, the sex researcher who proposed the theory of autogynephilia, which posits that some trans women are motivated to transition by sexual arousal at the thought of being a woman. It is seen by some trans people as offensive because, in their view, it pathologises and/or sexualises their identity. An apparently smaller group of individuals, most famously Anne Lawrence, believe it accurately describes their own experiences.

Back in the Noughties, Blanchard and the psychology professor J. Michael Bailey — who popularised Blanchard’s ideas in his 2003 book The Man Who Would Be Queen — became the subjects of a smear campaign that, whatever one thinks of the theory, became abusive. Andrea James was one of the worst offenders. Her behaviour has been well-documented by the medical historian and bioethicist Alice Dreger, who in a 2006 blog post observed that “Ms. James was notable for the way she decided to go after Bailey’s children to extract revenge. She posted on the internet photographs of Bailey’s daughter and labeled her a ‘cock-starved exhibitionist.’”

After she published her blog post, Dreger described in an update how James sent a series of hostile emails, including one referring to her five-year-old son as a ‘precious womb turd’: “She also came to my departmental office (I was not there) and then emailed me, subject line ‘Mommy Knows Best,’ saying, ‘Sorry I missed you the other day. Your colleagues seem quite affable, and not as fearful as you. […] Bad move, Mommy. […] We’ll chat in person soon’.”

These incidents are described in more detail in Dreger’s book Galileo’s Middle Finger, published in 2015, by which point James’s influence appears to have waned. I began reporting on youth gender medicine around that time, and I didn’t get any sense that other prominent transactivists, or LGBT groups, took James seriously. Her name didn’t come up as someone you should talk to, if you wanted to better understand these issues. So why, a few years ago, did she experience a partial reversal in her fortunes?

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The media is spreading bad trans science

By Jesse Singal

It all started in 2018, when The Atlantic published a cover story about the debate over youth gender transition — written by me. The story included quotes from a number of people, including teens, who explained how profoundly transitioning had benefited them. However, it also included quotes from detransitioners, and dug into some of the controversy over youth transition. James was outraged that I would shine a light on the subject’s nuances, trade-offs and difficult questions. From some trans activists’ points of view, it is settled science that youth gender medicine works — indeed, saves lives. To suggest otherwise is heresy.

Because of that view, plenty of people criticised the article, some harshly. But James’s response was something else. She was so outraged that she launched a Kickstarter called “The Transphobia Project”. It went live about a year after the publication of my article — which, in the FAQ section, she called “one of the most disgraceful moments in American journalism this century”, and credited with motivating her entire endeavour. As for the endeavour itself, she described it as “an interactive data visualization of the platforms and people creating biased content about gender identity and expression”. James explained how it would work: “Any time someone publishes media on these topics, a score called a t-index is generated for that work. That t-index also gets applied to the creator, any co-authors or editors, the platform where it appeared, and the organizations that support that platform. … Those with a high t-index become more prominent on the chart.”

And yet, nowhere on her Kickstarter does James clarify how her system would determine someone’s transphobia. Indeed, “appearing on the chart does not necessarily mean a person or organisation is transphobic.” In fact, if you look past the various buzzwords, it’s very hard to figure out what, exactly, the then-proposed project would do, other than show how various writers and editors are connected via the publications they work for (hardly a state secret). Yet despite the vagueness of The Transphobia Project’s actual, well, project, James enthuses on her fundraising appeal that it “will help us identify and expose bias, and maybe even get a few people fired along the way!”

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Why I stopped being a good girl

By Hadley Freeman

When The Transphobia Project’s Kickstarter launched, Donald Trump was still president, and liberal institutions were understandably preoccupied with his frequently ugly attempts to get journalists harassed and fired. James’s project didn’t hide the fact that it had similar goals, but, perhaps because James was going to target morally bad journalists for harassment and firing, rather than morally good ones, a cohort of progressives decided to hold her up as a champion in the noble fight against transphobia.

Kickstarter, for example, highlighted The Transphobia Project on its “featured projects” page, and published an article about it in the official Kickstarter Magazine by Rebecca Hiscott. In Axios, the respected tech writer Ina Fried published an article headlined, “Exclusive: Using data to track transphobia in media”. It was effectively a press release. The website Journalism.co.uk published a similarly hagiographic writeup by Daniel Green, which was subsequently promoted by Harvard’s Nieman Lab, one of the most important media-criticism institutions in the country.

None of the articles mentioned that the woman they were championing had once publicly called her enemy’s young daughter a “cock-starved exhibitionist”. None reached out to me for comment, despite James noting that my article had inspired the whole project (though Green, to be fair, posted part of my response at the bottom of his article after I complained). Nor did they interrogate James’s self-professed credentials. (I contacted all the authors — as well as Mike Allen, cofounder of Axios — to ask why they had failed to dig up James’s history of intimidating behaviour, and whether they planned any followup. I didn’t hear back from any, save for a brief note from a Journalism.co.uk editor who didn’t respond to my queries except to note that they wouldn’t be writing about James further.)

A close read of James’s proposal, combined with knowledge of her background, raised serious questions about whether she had the experience or technical chops necessary to pull off The Transphobia Project. And yet various outlets produced prime examples of a growing genre of journalism, geared not at establishing the truth, but at showing you’re on the right side of a raging controversy.

Probably partly because of this coverage, James’s fundraising was successful: 252 backers provided her with $23,302, more than ten times her $2,000 goal. The estimated delivery date, still visible on her Kickstarter, was July 2019. More than four years on, the Transphobia Project still doesn’t exist, and there is no sign James will deliver on her nebulous promises.

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The fictional world of trans activism

By Kathleen Stock

But even if The Transphobia Project remains unrealised, James has been busy. In the past four years, she has vastly expanded and updated her website, Transgender Map. And what she has added is not more data analysis of transphobic networks, but rather shockingly detailed webpages on what appears to be every enemy she has accumulated in recent years — an ever-growing list. These pages include personal information not only about them, but also about family members who are almost always wholly uninvolved in the fight over sex and gender.

The page dedicated to one editor at a mainstream site — who doesn’t appear to ever have written anything about transgender issues, but has edited pieces James dislikes — not only lists their spouse’s name but is, in fact, one of the spouse’s top Google results. The journalist Helen Lewis, a friend of mine, said that her page initially included photos from her first wedding, which James took from Flickr. When Lewis made the page private, James noted the change. Indeed, she seems to keep a very close eye on how her victims respond to their pages. Many of the entries also include caricatures that James has commissioned, likely at considerable cost, given the sheer number of them. In one of the creepiest cases I found, James commissioned a cartoon of not only my podcast co-host, Katie Herzog, but also her wife, who is unconnected to any of this. UnHerd also has its own page, listing many of its contributors and editors.

Many of the people featured have been deeply disturbed by it. “Does anyone know who runs the TransgenderMap website?” asked Prisha S, a detransitioner, on Twitter. “There are web pages about detransitioners with personal info and hate. The page about me is the longest. Whoever runs it seems to hate me a lot. It’s freaky, honestly. Can anything be done?”

Being featured didn’t really bother me initially. But I did become concerned when I received an upset email from my brother asking why the site was showing up near the top of his search results. It transpires James had compiled the most detailed biography of me that exists on the internet, the vast majority of which had nothing to do with my output on youth gender transition. Bringing my family into her perceived conflict with me crossed what felt like a line that would be obvious to most people. The page included the full names of my mother, my father, both my brothers, and everything she could find about all of our work histories. She even included the date my mother died. While accuracy isn’t James’s strong suit — at one point my page stated I am half-Hindu — it felt like an intimidation tactic: Look how much I know about you.

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Journalism is being eaten alive by opinion

By Jesse Singal

Recall that one of James’s goals of the Transphobia Project was “get[ting] a few people fired along the way”. The updated version of Transgender Map seems to be operating with very similar motives: the pages seem designed to trigger negative personal and professional repercussions.

“The first time my 11-year-old daughter googled me, this was the first thing that came up,” said Lisa Selin Davis, a friend of mine who has also written at length about gender identity and youth transition. “It includes the names of my children and two family members… It’s designed to silence and humiliate us. I can handle it, but it’s a little heartbreaking to me that my kid had to see this instead of anything else about me.”

Another one of James’s victims is Paul Garcia-Ryan. He is a therapist who trained at a leading gender-affirming clinic in New York City. He is concerned about the quality of care that gender dysphoric youth receive and is seeking to improve it. He recently spoke at the first conference held by the Society for Evidence-Based Gender Medicine (SEGM), a group with similar aims, in New York. (I was in attendance as well.) This alone was enough to rouse James’s ire, and soon Garcia-Ryan discovered his newly published page, which falsely describes him as an “anti-transgender activist” and explicitly instructs any minors who find themselves in his care to break off their therapy with him.

“Efforts to damage the reputations of clinicians creates a chilling effect amongst medical and mental health professionals, deterring them from speaking up, even when their concerns are grounded in legitimate scientific, medical, and ethical considerations,” Garcia-Ryan said in an email. “Clinicians hold an enormous responsibility and thoughtful work with gender dysphoria requires professionals to be courageous and stand firm in their clinical integrity.”

James has targeted a number of other responsible and careful clinicians in the field of youth gender medicine. She has also created a page for Gordon Guyatt, a legend within the field of medical research. He is one of the founders of evidence-based medicine, a (genuinely) lifesaving movement to improve the quality of medical research. Because Guyatt spoke at SEGM, he’s now a transphobe, according to the unerring moral judgment of Andrea James. He is tarred as an “anti-transgender activist” — ironic, given that when I asked him about the claim that questioning the evidence for transgender medicine is itself transphobic, he replied: “You’re doing harm to transgender people if you don’t question the evidence.”

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The doctors profiting from trans surgery

By Miquel Missé

But James’s website is more about rage than reason. Really, all it takes to land oneself on it is to have said something publicly that she disagrees with, or to have associated, in any way, with any institution or any person she dislikes. For example, she has a page dedicated to a European academic — a far-Left trans man who couldn’t be more in favour of trans people’s dignity and right to medically transition — simply because he has published some (rather excellent) work criticising certain mainstream strains of trans activism, including on this website. This is someone who has dedicated years of his life to radical trans activism, and now his second-highest search result in Incognito mode on Google Chrome is a webpage that suggests he is enabling transphobia.

Garcia-Ryan’s page ranks highly if you search his name, too. That’s the whole point: to scare people off talking about this issue. I’m telling you a tiny fraction of the stories I’ve heard from individuals targeted by James, many of whom don’t want to come forward. In short, very little has changed since Alice Dreger published her first long expose of the Michael Bailey affair back in 2008: “Almost universally those who wrote to me [about their run-ins with James] — including sex researchers — asked that I not ever quote them or mention them by name,” she wrote. “They feared being attacked by James, as Bailey and others had been.”

For that reason, and because of my own involvement, I have been deeply conflicted about writing this piece. But it’s a perfect 2023 story, in a way. It epitomises an approach to social justice and to journalism that is so anti-intellectual, and unforgiving that it’s impossible to imagine it making the world a better place. But perhaps most disturbing is that there’s no accountability. No one can control whether they’re included on James’s site. There’s no one to appeal to other than James herself, and she has proved herself time and time again to be unreasonable. (I emailed James about this piece. She sent a brief response, which didn’t address any of my points, and has not commented further.)

But our information ecosystem doesn’t reward reasonableness — it rewards reaction and outrage. And particularly when the subject is social justice, media outlets are all too eager to abdicate their basic responsibilities as guardians of the truth.

It was supposed to be a haven for young people experiencing gender-related distress. Instead, following a string of complaints by whistle-blowers, an “inadequate” rating by the Care Quality Commission, a high-profile judicial review and, finally, a damning independent review, it was deemed unsafe.

In its place, two new regional hubs were set to open, with several more centres to follow. For Gids’s long-standing critics, concerned about the distress its tumult was having on children, this came as a huge relief.

The story, however, does not end here.

Kathleen Stock has spent the past month speaking to a range of clinicians, NHS professionals and parents of dysphoric children — to find out whether Gids’s new service will be an improvement.

The portrait she paints is stark: her findings suggest that the NHS gender services are yet to become a clinically safe space for children and teens, with senior figures still pushing an activist ideology. Only last week, NHS bosses internally announced that they are significantly delaying the launch of one of the hubs. And as she reveals in the below investigation, it is unlikely to be the final twist in Gids’s new chapter…

Read on to learn about:

What happened to Gids?
The ideology in the new hubs
A new Wild West for patients

***

In 2014, the head of the NHS Gender Identity Development Service, Dr Polly Carmichael, appeared on a BBC children’s television programme billed as the story of “an extraordinary boy… born with a girl’s body”. Soothingly addressing the tomboyish young protagonist sitting across from her, Carmichael was filmed saying that a “puberty blocker” — or to give it its proper name, a gonadotropin-releasing hormone (GnRH) analogue — “pauses the body and stops it from carrying on to grow up into a man or a woman”.

She continued: “The idea of the blocker is that if we can take away that worry about your body doing something that you don’t want it to, then it gives you and us more time and space to be really thinking about what’s going to be best for you now, but also in the future.” As she spoke, a cartoonish pause button symbol was projected onto the child sitting opposite her, whose moving image was then frozen to a still, to reinforce the point.

Back in 2014, Carmichael’s service — known as Gids, and based at the Tavistock and Portman NHS Foundation Trust in London, with a satellite clinic in Leeds — was still riding relatively high in public opinion. The clinical psychologist was often in the media, describing the challenges of treating a highly mysterious new being — the “transgender child” — to fascinated and relatively uncritical audiences. Indeed, the children’s television programme in question, My Life: I Am Leo, went on to win a Bafta.

But times change. These days — thanks to a string of whistleblowers, a high-profile judicial review involving a former patient, a rating of “inadequate” by the Care Quality Commission (CQC), and a cumulatively devastating book by investigative journalist Hannah Barnes — the name of Carmichael’s service is now synonymous with mismanagement and medical scandal. The closure of Gids was announced by NHS England in July last year, and an independent review is now well under way, also known as “the Cass Review” after its chair, the distinguished paediatrician Dr Hilary Cass.

Following Cass’s interim recommendations, published in February last year, two new regional services are being formed to treat “gender incongruence and gender-related distress” in children under 17, with several more centres planned for launch afterwards. Slated to open next month, the “Southern hub” involves teams from Great Ormond Street Hospital, the Evelina Children’s Hospital, and the South London and Maudsley NHS Foundation Trust. The “Northern hub” partners Alder Hey Children’s NHS Foundation Trust with the Royal Manchester Children’s Hospital.

Many long-standing critics of Gids have been reassured by these developments, and by the principled and cautious approach apparently taken by Cass so far. It seems she aims to examine trans-identification in children and adolescents systemically, applying what is known about wider paediatric health rather than sacralising her patients as exotic anomalies. One parent of a Gids patient, seeking anonymity for the sake of protecting the privacy of his child, as so many parents of trans-identified children do, told me with enthusiasm: “Gender has been exceptionalised as a clinical speciality, but Cass wants to weave it back into paediatric practice.”

But the story does not end there. Over the past month, I have spoken to a range of clinicians, other NHS professionals, and parents of dysphoric young people to understand how Cass’s guidance is being enacted on the ground. I have discovered that there are deep ideological tensions and conflicts within the very institutions — clinics, hospitals, trusts, commissioning boards, adjacent adult services — whose responsibility it is to implement Cass’s new vision. Moreover, it seems NHS systems are still influenced by activist thinking; in particular, by the idea that a sex-incongruent gender identity is something to be “affirmed”, either as a matter of social justice or as personal liberation.

Considered together, my findings suggest that the NHS gender services are yet to become a clinically safe space for children and teens. Last week, NHS bosses suddenly internally announced that they are significantly delaying the launch of the Southern hub — after months of preparing training materials for clinicians recruited into the new service, and only a few days before the materials were due to be used for the first time. In line with I Am Leo’s original metaphor, it seems that senior managers too are pressing the pause button, in order to have more time and space to think. In the meantime, thousands of distressed children and their worried parents wait anxiously for a resolution.

***

What happened to Gids?

Despite the common belief that Gids closed following the announcement last year, it is still open, providing what it describes as “continuity of care” for around 1,000 existing young patients, including some on puberty blockers. (Cass recommended that in this interim period, any referrals to endocrine services by Gids staff should be reviewed by a multidisciplinary external panel).

It is unclear to outsiders exactly how patient care is now being managed at Gids, but what does seem true is that attempts have been made to improve existing processes since at least 2021. Published in February, an open letter from Gids staff concerned about Cass’s plans for the new services reveals that, after the CQC rating of “inadequate”, something called the “Gids Transformation Programme” was developed — separately from the Cass review, according to them — in order to make “wide-reaching changes to the running of the service”. The letter claims that external consultants were paid over £1.5 million to advise on the Transformation Programme, with some changes yet to be implemented.

At the heart of the controversy about the original service was its increasingly positive attitude to “gender affirmation”: roughly, the idea that a clinician should “believe” a girl who declares she is a boy (or vice versa), and so accede to her way of describing herself in clinical encounters. Though advocates deny it, critics insist that this practice precludes genuinely critical exploration of what may well be a passing phase. Without the capacity to gently challenge such a child in a therapeutic setting, an outcome involving lifelong medication is thought to become much more likely.

Even under the most scrupulous of arrangements, treating psychological distress in a physically healthy child or teen by administering experimental, powerful hormone-blockers carries risk. At Gids, that risk was increased severalfold by the organisational chaos of the service. During Keira Bell’s judicial review in 2020, High Court judges expressed surprise that clinicians did not seem to know how many young people had been referred there for blockers since 2011, nor of what age distribution. Only in 2022 — when Gids clinicians got round to publishing an analysis of outcomes for medicalised patients for the first time — was it announced that 1,151 children had been referred to the endocrine clinics in London and Leeds for puberty blockers and/or cross-sex hormones between 2008-21. According to Barnes, what proportion of them received puberty blockers still remains unknown.

There were other failures too, made clear in the course of Keira Bell’s judicial review and appeal, and in Barnes’s book. They include a startling absence of curiosity about certain recurring characteristics of patients — for instance, why so many of them were female, same-sex-attracted, and/or autistic. And there was also the close working relationship with the transactivist lobby groups Mermaids and Gendered Intelligence; inadequate preliminary assessments, both in quantity and quality; and a shocking lack of post-discharge follow ups.

In the past year or so, this impression of institutional disarray has been reinforced by Cass. In her interim report, she criticised management for having no standardised approach to patient assessment; no routine contact between psychologist and endocrinologist; no consistent safeguarding processes; poor record-keeping; and too-infrequent monitoring of medicated patients. She also seemed critical of affirmative approaches, noting with apparent disapproval: “From the point of entry to Gids there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations.”

In June, guided by Cass’s analysis, the NHS published an “Interim specialist service specification for children and young people with gender incongruence”, laying out the broad features of a new clinical pathway for this cohort — including standardised, genuinely exploratory assessment by multidisciplinary teams. Separate service specifications for puberty blockers and hormones are to follow. Cass has also insisted that, in future, puberty blockers should be administered in the NHS only as part of a properly managed clinical trial.

Despite the many criticisms of her management career to date, Carmichael remains in post as director of Gids. One of the main whistleblowers at the Tavistock, former staff governor Dr David Bell, told me: “Gids was found in the judicial review to be profoundly deficient in terms of clinical governance and record keeping. It is thus extraordinary that Polly Carmichael has been allowed to remain in position as director.” He described this as “a shocking message to parents and families who have been so damaged by this level of neglect”.

It is hard to find out which other clinicians still work at Gids, but many are assumed to be affirmative in their approach. In a second open letter from late last year — written from an affirmative perspective, in order to criticise the relatively positive response from the Association of Clinical Psychologists to the Cass Review — 13 signatories named their current workplace as Gids, including Carmichael herself.

One of the Gids-affiliated signatories was non-binary author and therapist Dr Jos Twist. Twist has edited an anthology, Non-Binary Lives: An Anthology of Intersecting Identities, which includes “stories of… how it feels to be non-binary and neurodiverse, the challenges of being a non-binary pregnant person, what it means to be non-binary within the Quaker community, the joy of reaching gender euphoria”. Another Gids signatory was clinical psychologist Dr Lorna Hobbs, who told The Guardian in January that, “for me, affirmative is starting from a stance that says gender diversity isn’t a disorder but has existed across cultures through history. It is saying ‘I believe you’ when you tell me about your experience.” Along with Twist, two other signatories who also claim to work at Gids — Dr Claudia Zitz and Dr Josh Goulding-Talbot — are now also listed as working at GenderPlus, a recently registered private provider with ambitions to prescribe hormones to teens (more on this below).

Such evidence suggests that the remaining patient cohort at Gids are not receiving the sort of care of which Hilary Cass would thoroughly approve. However, when it comes to the new services being built at the moment, it is not entirely clear that things will be much better…

***

The ideology in the new hubs:

Certainly, the presence of Professor Gary Butler in the new Southern hub does not instil great confidence that things have changed. For much of the service’s history, Butler was the endocrinology lead for Gids. In 2017, apparently with all the zeal of a true believer, he told The Daily Mail that, under his supervision, his clinic at University College London Hospitals NHS Foundation Trust “routinely” prescribed puberty blockers to children with “life-long” gender dysphoria: “When the team feels the young person is genuinely transgender they welcome [the use of] puberty-blocking drugs right from the early stages.”

Butler has also co-authored articles with Carmichael and others at the clinic. In one from 2018, he observes that “around 35% of referred young people [to the clinic] present with moderate to severe autistic traits” — apparently untroubled by the thought that he might be contributing to the premature sterilisation of autistic youth. For it is now recognised that, when combined with cross-sex hormones later, giving blockers to dysphoric young patients early on in puberty can inhibit the development of adult sexual function permanently — a fact occasionally openly mentioned by clinicians supportive of medical intervention but most of the time glossed over.

Yet Butler has now been recruited onto the team based at Great Ormond Street Hospital (GOSH) charged with developing training materials for clinicians in the new hubs. (Insiders I have spoken to believe that Polly Carmichael was initially on the recruitment panel, though the BBC reported that the decision to have her there was later “reversed”.)

Butler advertised his new role at a conference for gender medics in April, during a speech in which he also accused Cass of “nepotism” and said that the hospitals he was working with had no relevant experience with gender incongruence. He said he had “fought back” to “continue to be able to provide endocrine services for trans young people”. He has since rowed back on his comments and expressed support for Cass. But for David Bell, Butler’s presence in the new service still rings alarm bells: “Butler was responsible for being part of a service penetrated by trans ideology and neglecting the safeguarding of children; he is part of the Gids debacle and shouldn’t be involved in the new service.”

And Butler is not the only Gids clinician involved in the new hubs. I’m told that Dr Lorna Hobbs — the Gids psychologist who extolled the virtues of “believing” a trans-identified child to The Guardian in January — has advertised online that she is involved in the new service. Hobbs often reposts material from trans activist lobby groups on her public LinkedIn profile, and declares, on the website of a private therapy provider she also works for, that she applies a “social justice and equalities framework” to all the work she does.

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One person working in the Southern hub told me that some clinicians recruited into the service “only believe in an innate notion of identity rather than one developing over time”. They added that involving such different voices on a single team was causing dysfunction. “The official position is that diversity of opinion in a team is a good thing, in order to mirror the fact that people don’t all agree in real life. But it doesn’t work. You can’t say yes and no at the same time.”

In the Northern hub, meanwhile, there is also a risk of repeating old mistakes. Buried within the July 2023 meeting minutes of the Alder Hey Board of Directors is the news that Leeds Children’s Hospital has now entered into the Northern hub partnership “as the existing providers of endocrinology services for children and young people under the care of the current Gender Identity Development Service”. In other words, endocrinology appointments for patients in the new service will apparently be managed by the very same hospital department involved with Gids Leeds, the satellite clinic of the Tavistock. On the current website for the hospital team, staff all list their pronouns.

Why were affirmative clinicians who were already tarnished by an association with Gids recruited into the new hubs, even after Cass’s recommendations? According to NHS sources close to both hubs, the most common explanation is cock-up rather than conspiracy. Managers at the relevant trusts don’t know much about the area, I was told, and when recruiting and setting up new structures, were likely to be impressed by a lot of mentions of “gender” on a CV. From this uninformed perspective, having already worked at the main NHS gender identity service for children presumably looks like an unimpeachable background.

Whatever the explanation, what does seem clear is that transactivist lobby groups and networks are strongly vocal in all of the trusts involved in the new hubs. Across the NHS, activist clinicians and support staff are pushing the idea that gender identity affirmation is a minority rights issue, and a way of furthering Equality, Diversity and Inclusion (EDI) goals. With “inclusive” policies about pronouns, changing rooms, and hospital wards already in place in a trust, the job of any clinician who wishes to resist affirmative narratives for dysphoric young people becomes that much harder. For fellow staff naively unaware of the potential clinical repercussions, it can easily seem that “respecting identities” is a simple matter of courtesy.

So, for instance, GOSH’s existing “Privacy and Dignity policy” instructs clinicians that “Trans and gender variant young people should be addressed and accommodated according to their self-defined gender or presentation e.g. the way they dress, and the name and pronouns that they currently use”. Guy’s and St Thomas’ NHS Foundation Trust’s trans policy says: “Asking and correctly using someone’s pronouns is one of the most basic ways to show your respect for their gender identity.” In other words — wider hospital policy in both trusts instructs clinicians and support staff to “affirm” any non-standard gender identity automatically, wherever it is encountered. It is unclear how such policies could possibly be maintained in the sort of genuinely exploratory clinical setting Cass apparently envisages.

Over at South London and Maudsley NHS Foundation Trust, meanwhile, all job adverts have Stonewall Diversity Champion branding. Freedom of Information requests also reveal that Mermaids provided EDI training to Childhood and Adolescent Mental Health Services (CAMHS) staff at the Maudsley Hospital last year. (The training this year was cancelled after adverse press attention.) Moreover, the hospital also has a vocal LGBTQ+ Staff Network, which seems to have some influence with management. I’ve been shown a copy of an email written by their leadership team in September this year, warning members of a visit to the Women’s Staff Network from Lynn Alderson, a lesbian feminist speaker with gender-critical and sex-realist views. After complaining that the speaker’s views were “divisive and hurtful, and in contradiction of our network’s gender identity statement”, the authors continue: “We have been assured that strict protocols have been put in place to prevent the speaker stating her views on gender, and that she will be ejected from the meeting if she does so.”

South London and Maudsley Trust also participates in the NHS Rainbow Badge scheme, described as “an assessment and accreditation model for NHS Trusts” and a “partnership between the LGBT Foundation, Stonewall, LGBT Consortium, Brighton & Hove LGBT Switchboard and GLADD”. (The Rainbow Badge scheme was actually founded by a medic working at the Evelina Children’s Hospital — the third hospital involved in the Southern hub partnership.) In a recent assessment, the Trust was given a Bronze Award, with particular commendation for its trans policies and for having “awareness posters across the site that reference microaggressions relating to homophobia, biphobia and transphobia” — though it was also marked down for a maternity policy that “uses gendered language throughout”.

A similarly ideological picture emerges in the North. Manchester University NHS Foundation Trust — which includes the Royal Manchester Children’s Hospital, one of the two children’s hospitals in the hub — also advertises its membership of the NHS Rainbow Badge Scheme, and in the recent past has used another scheme from the explicitly transactivist charity LGBT Foundation for training. The other one, Alder Hey Children’s Hospital Trust, is a member of the “Navajo Charter Mark” scheme — the North West’s equivalent of the Stonewall scheme, founded in 2010 to assess organisations in terms of “LGBTIQA+ friendliness” with a remit that includes “practices and policies” and “training”. Alder Hey was reportedly accredited by Navajo this month.

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The content of Navajo training for organisations is unavailable to outsiders, but a 2019 Navajo newsletter perhaps gives us a sense of the organisation’s sympathies. It carries posts about banner-making workshops for Trans Pride, and regurgitates the persistent falsehood that “Almost half the trans kids of school age in the UK have attempted suicide”.

When it comes to implementing the recommendations of Cass, then, it is not inconceivable that local LGBT+ networks and transactivist groups within hospitals and trusts will put up resistance, whether active or passive. In April 2023, a NHS-sponsored analysis of responses to the public consultation on Cass’s interim service specification was published. Of the 411 clinicians who responded, 49% of them (the largest group) fell into “Group A”, described as “largely opposed to the proposals outlined in the interim service specification”, for reasons that included the perceived “transphobia” of some clinicians and the equation of “mental health treatments” for trans-identified youth with “conversion therapy”. Though obviously there was self-selection bias here, nonetheless the findings suggest there is a problem.

This sense is reinforced by the contents of a series of FOI requests made earlier this year to every NHS Trust in England and Wales that provides CAMHS, asking: “What if any training in gender, gender identity and equality your Clinical staff and practitioners have received in the last 4 years?” Some trusts replied that they paid explicitly trans activist organisations such as Mermaids and Gendered Intelligence to give them training; but even where trusts used less obviously partisan sources, it was clear from responses that the majority of them are employing a minority rights and inequality lens to look at gender identity, and not a psychological one.

And there is also evidence of at least partial capture in other powerful NHS bodies. NHS England was placed 68th in the Stonewall Top 100 Employers this year — an intensely fought competition with hundreds of entrants, in which a high placing indicates close policy compliance with Stonewall’s transactivist goals. The Care Quality Commission, in charge of regulation, proudly advertises on its website that it is a Stonewall Diversity Champion — as does the National Institute for Health and Care Excellence (Nice), Health Education England, and the NHS Confederation.

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Elsewhere, the British Medical Association has come out in favour of affirmation, and published a response to Cass that criticises the new service specification for failing “to recognise the highly individual nature of children and young people’s experiences or their own developing autonomy in relation to exploring their identity”. The Chair of the Sexualities Section at the British Psychological Society, Dr Rob Agnew, frequently writes or endorses transactivist content on his public LinkedIn profile, including one post claiming that “[k]ids receive cis gender ‘grooming’ from the moment they are born” and that “[s]upposedly ‘experimental’ blockers are fully approved by the medical establishment and readily prescribed to cis kids for a variety of reasons”.

But this is not so. Some analyses suggest that blockers can negatively affect the bone density levels of young patients, and perhaps their renal and cognitive functions too. ​​A 2020 Nice evidence review — later acknowledged by Agnew after pushback — has concluded that the quality of evidence for the positive impact of blockers on “gender dysphoria, mental health and quality of life” is of “very low certainty”. There is also increasing doubt about whether blockers are beneficial or even just neutral for mental health.

Indeed, one NHS research trial manager I talked to expressed strong scepticism that a properly described clinical trial for puberty blockers — as mandated by Cass — could ever meet statutory regulations for what is known as “Good Clinical Practice”. She told me: “The Tavistock’s original application for their Early Intervention Study wasn’t regulated as a Clinical Trial of an Investigative Medical Product (CTIMP) but this one would have to be.” She added: “Children get classed as a vulnerable group. They need to have very special protections, and the rationale is just not there. The possible impacts [of blockers] on a child are so high that the moment that this was recognised, the study would be shut down. If you had a healthy child, and you recognised that medication could confirm sterility issues, or fertility issues, or bone density issues, the trial would be stopped at that point.” It would be “completely insane” to run such a trial, she concluded.

Meanwhile, even within the National Programme Board for Gender Services, the body ultimately in charge of service specifications for both adults and children with gender dysphoria, there are worrying signs for those seeking a clinical approach that situates dysphoria in the realm of paediatrics and psychology.

The Chair of the Board is Dr James Palmer, Medical Director for Specialised Services, a consultant neurosurgeon who has overseen all gender services in England and Wales in the past decade, both for children and adults. In 2018, he told a conference that the NHS needed to design “a healthcare service that will allow somewhere around 1-3% of the population at some point in their lives to have a discussion about their gender”. Talking about the drop in average age of Gids patients, he added: “It’s got to be a good thing that there are people out there that want to explore their gender. The fact that it’s in the younger age group has got to be a good thing. For a young adult, to be able to come forward, to seek that expertise, earlier [rather] than much much later in life, that’s got to be a good thing.” The lack of curiosity about why so many younger people were suddenly arriving in his services is marked. And in fact, there is evidence that early social and medical transition for a child experiencing gender dysphoria — carried out, of course, by adults — tends to solidify a sex-incongruent gender identity in the child that otherwise might well have passed.

Meanwhile, on the Clinical Reference Group for Adult Gender Dysphoria Services, described as providing “independent expert advice to the National Programme Board for Gender Dysphoria Services on the various aspects of the Board’s work”, two out of five of the members are openly affirmatory of children. Dr Laura Charlton, a clinical psychologist, works at Gids Leeds and was the first author of the open letter signed by Carmichael last year, defending affirmation. At one point, the letter complains of the use of “male” and “female” for trans-identified children because it “undermines the lived experiences of the people being referenced”.

The second affirming clinician on the board, Dr Christine Mimnagh, is clinical lead at the Merseyside adult gender service CMAGIC, and also a GP and private practitioner. In an interview last year, worth quoting at length, Mimnagh said about trans-identified children: “The first thing you get taught in safeguarding for children is, if a child comes up to you and says, you know… ‘I don’t like the way they touch me’, or whatever, what you do is go ‘OK, yeah, tell me more, I’m listening’… what you don’t do, is say, ‘Oh no they didn’t, that’s Mr Jones the gamesmaster, he would never do that!’ There’s a difference between affirmation and dismissal and with everyone whose trans, affirmation is kind of the name of the game; you can’t deny people’s reality just because their reality is different from yours.”

In other words: just as we should believe a child who says she or he is being sexually abused, we should also believe a female child who says she is a boy.

***

A new Wild West:

It appears, then, that despite the apparent good sense of Cass’s interventions so far, contemporary gender medicine in England and Wales remains somewhat chaotic. Within relevant services and wider NHS institutions, there are clinicians with directly clashing views about what sex-incongruent gender identity is, what it means, and what clinical decisions should be made as a result. And it seems that the cracks are starting to show.

I have seen evidence that, only last week, clinicians in the Southern hub — getting ready to launch in a month’s time, and to trial the new training materials with clinicians that very week — received a wholly unexpected internal announcement: the November launch had been postponed. Rising clinical, legal, and communication costs were cited, as was the insufficient time for senior clinicians to sign off the training materials in line with the proposed delivery schedule. I’m told that a manager of the team in charge of producing training materials resigned. Though teams within the Southern hub continue to be employed, their work is now paused, with no revised schedule yet in place.

What will this delay mean? With Gids closed to new referrals and the hubs not yet established, waiting lists will inevitably grow longer by the day. Now taken out of Gids’s hands and managed separately by a NHS Commissioning Support Unit, as of July 2023 7,902 children and young people were on the national waiting list. It is widely acknowledged that any child who is 16 is unlikely to be seen by a children’s service before she turns 17 (the cut-off point for care under childhood and adolescent services).

In desperation, some parents with enough means are turning to private providers to buy puberty blockers and hormones for their child. GenderGP is the most well-known of these, notorious for its close links with Mermaids — even to the extent of employing former CEO Susie Green for a few months this year — and for its historical run-ins with the General Medical Council.

But there are others who also see waiting lists as a business opportunity. The “Yorkshire Gender Endocrinology Services clinic” offers blockers on its website, though it’s unclear whether its clinicians would dispense these to under-17s. And last month, a new private clinic — GenderPlus — arrived on the scene, overseen by former Gids clinician Dr Aidan Kelly, with stated ambitions to start prescribing hormones to teens in the next couple of months. Several other former and current Gids clinicians are involved in this venture, most notably Paul Carruthers — lead nurse at the NHS Gids clinic still based at Leeds Children Hospital, and described as the person who will be “leading the hormone clinic” at GenderPlus.

For some parents, this is an attractive option. One told me: “I know there are parents who want to do it by the book and feel that GenderGP is not doing it properly. They want to go to a Harley Street clinic, get a diagnosis, and feel reassured by having a clinician registered with the NHS.”

Yet while GenderPlus is presented by Kelly as a new project, focused on hormones not blockers, it seems he might already have experience in prescribing blockers to children under the auspices of another of his businesses, Kelly Psychology. As an anonymous comment on the TransgenderUK Reddit put it a year or so ago: “There is another provider to GenderGP but it’s probably more expensive. I use Kelly Psychology and have a private endocrinologist who prescribes puberty blockers to my 13-year-old child. The process is the same as Gids but private.” (Kelly Psychology did not respond to a request for comment.)

Whatever the truth here, it is clear that Kelly is aiming GenderPlus at the parents of dysphoric children and adolescents, and that he anticipates big business. The company already lists 17 staff members on its website, including a research manager.

Given the acknowledged lack of a solid evidence base, to prescribe such poorly-understood drugs privately could be seen to be incautious. Cass’s new interim service specification is very explicit, with added red lettering for extra emphasis: “Children, young people and their families are strongly discouraged from sourcing puberty suppressing or gender affirming hormones from unregulated sources or from on-line providers that are not regulated by UK regulatory bodies.” Though GenderPlus has told The Times it is seeking registration with the Care Quality Commission regulator, its website currently says that it has “clarified” with the CQC that its service “does not fall under their remit and as such is not eligible for CQC registration. If in the future we do provide services which will require CQC registration then we will seek registration.”

Another major worry for many parents of children currently on the national children’s waiting list is the increasing proximity to adult services as their child gets older. In August this year, letters were sent directly to all 17-year-olds on the list, encouraging them to opt for referral onto the adult list instead. They were told that the original date on which they were placed on the children’s list could be transferred to the adult one, so that they could be seen more quickly. The letters were signed by James Palmer.

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Since adult services tend to be uncritically affirmative, the letters have profoundly alarmed some parents desperately holding out for a non-medicalised resolution to their child’s dysphoria. In practice, it seems that a 17-year-old might self-refer to an adult clinic and be put on hormones on the day of her second appointment, without any psychological intervention; indeed, one clinic proudly advertises the possibility of prescription at this speed.

What makes this possible is the existing NHS adult service specification, written in 2019. It is a document that governs standards of care in all adult services, and is a world away from Cass’s careful formulations. Gender dysphoria, it states, is “not, in itself, a mental health condition” — making it somewhat obscure why the NHS should pay for treatment. Equally, “psychological interventions will not be offered routinely or considered mandatory”; and “the majority of individuals will have two core assessment consultations” (and no more). Individuals can also self-refer to a clinic without any intermediate referral from a GP. For breast removal, a patient will need the sign-off of one clinician within the service. For genital surgery, she will need two.

There are eight NHS gender clinics for adults in England and Wales, plus four new “pilot” services, brought in more recently to bring down adult waiting lists in local areas (one of these was mentioned earlier: C-Magic in Liverpool, run by Dr Christine Mimnagh — the clinician who made an equation between believing a child’s disclosure about sexual abuse, and affirming a child’s incongruent gender identity). The new pilot services tend to be embedded within sexual health services, are run by predominantly LGBTQ+ clinicians, and appear to be even more affirming than the already fairly ideological norm.

For instance, the website of Indigo, the pilot service in Manchester, says: “We know that trans and non-binary people are the experts of their own experience… Our services are trans and non-binary-led, with trans and non-binary people guiding and feeding into them at all levels.” An NHS commissioning document for the pilots says that Indigo is “testing the role of Care Navigators, a non-clinical role typically staffed by individuals with lived experience, to support patients before their first appointment with the specialist team”. Somewhat unusually for a primary care provider, Indigo also has a “Leave this site quickly” button on its website, taking browsers to Google if necessary.

I talked to Anna, the mother of a trans-identified daughter currently on the Gids waiting list who is nearly 17 and is seeking medical transition. Her daughter formerly identified as a lesbian. Over lockdown, she began to identify as a boy, having discovered transactivist websites. The teenager, who also has ADHD, is now living with an affirming father who supports her transition.

Anna told me: “I’m frightened that without any evidence of benefits, and with a high rate of neuroconditions and traits — bearing in mind that girls will be more undiagnosed than boys — without consideration for all of that, and with only one pathway in the adult services, our kids have no hope. I don’t want to say mutilated but that’s what is happening. There is so much regret, I don’t want our kids to have regret. They are only on one path, without any mental health considerations. I don’t understand how they can do it.” Along with another mother in a similar position, she is now seeking permission to pursue a judicial review against the NHS, “for providing unsafe treatment advice for young people from 17 years old and vulnerable adults”.

For David Bell, what is happening to dysphoric 17-year-olds is the “biggest area of concern”. He told me that, in light of their incomplete cognitive and emotional development, there is plenty of precedent already for 17-25 year olds to be treated separately from adults in mental health services; pointing me to guidelines from the Royal College of Psychiatrists and elsewhere in the NHS that have established this. He described the failure of adult gender services to recognise this as the “trans-exceptionalism” already familiar from elsewhere in the NHS. Indeed, with what another former Tavistock clinician described to me as a “beautiful irony”, the Tavistock and Portman Trust itself has an adolescent and young adult service in general mental health that covers 14-25 year olds — just not in Gids.

Cass’s interim service specification states that, when a child is moved to an adult service, “a co-ordinated transfer to appropriate local adult services will be needed where complex presentations continue”. It seems that, at the moment, such a rational arrangement is some distance away. In effect — thanks to the collapse of the old service and to delays within the new ones — a void has opened up in the systems supposed to care for gender dysphoric young people. And until it is filled, a cohort of highly distressed children and their desperate parents will continue to pay the price.

***

A spokesperson for the NHS Children’s and Young People’s Gender Service (London) said:

 “The NHS Children’s and Young People’s Gender Service for London — a partnership between Evelina London Children’s Hospital (part of Guy’s and St Thomas’ NHS Foundation Trust), Great Ormond Street Hospital and the South London and Maudsley NHS Foundation Trust — is working towards full mobilisation of the new service by the beginning of April 2024

“The set-up of this completely new service is complex. In advance of full mobilisation, we will be working with colleagues on the safe handover of current patients. We are also focused on recruitment, training and ensuring good data collection which supports the developing research, and progress made in these areas will determine how quickly it will be possible to start seeing new patients off the waiting list.”

Vaishnavi Sundar, an Indian feminist filmmaker, has long been furious at the way women and girls are treated in India. Not only do many of them live in fear of rape and sexual assault, but there is still a staggering gender disparity when it comes to education and workplace equality. This, combined with honour killings; abusive menstruation huts; child marriage and the dowry system, leaves many women longing for a way out.

When Sundar set up her charity Women Making Films (WMF) in 2015, in response to widespread sexism from male film technicians, she was celebrated as a darling of the liberal Indian elite. “Years before Hollywood paid attention to this issue, I encouraged women to work with other female filmmakers and technicians,” she tells me. Yet in 2020 she became a pariah in the film world for a series of tweets questioning gender identity. One of those was: “There are no identities. There is only sex. Male and female.”

She was swiftly punished for her defiance. The film she had spent three years making, But What Was She Wearing? — which is about sexual harassment towards Indian women in the workplace — was pulled just before its screening in New York in February 2020 because the Polis Project had deemed it transphobic. “To block a screening of a film about an urgent topic that affects women across all social strata in society is obscene,” Sundar says. “And all because I say sex is real, and men in women-only spaces can pose a danger to women.”

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Since then, Sundar has been ghosted by several liberal media outlets that once asked her to write. “Friends have completely abandoned me; film friends who used to collaborate with me have all stopped responding to my messages. Screenings of my films that used to happen regularly have all been called off even when the film is not about the transgender issue.”

With the well of donors drying up, Sundar began to crowdfund her work. By January 2021, she had raised enough to write and direct a four-part documentary series called Dysphoric: Fleeing Womanhood Like a House on Fire, which interviewed women who regretted transitioning. It was then that she began to see the spread of gender ideology in India as part of a wider international context, with a universal language and terminology. “I learnt that it is just as pervasive in India as it is in the rest of the world, maybe India was just a few years behind,” she says. “I wanted to shine a light on what’s going on in Anglo-Saxon countries and consider how this might impact developing countries in about five or six years.”

It was while working on Dysphoric, that Sundar started wondering about the suffering experienced by the families of trans women. “I was starting to wonder what it feels like for a wife when their husband announces that they are going to live as a woman, and they are just expected to affirm it.” It was then the idea for her latest documentary, Behind the Looking Glass, was born. The pioneering film tells the story of 18 “trans widows” from Europe, Asia, and America whose male partners transitioned and left misery in their wake. Eight of these women have to remain anonymous because of potential danger from ex-partners. As one interviewee says: “This is the untold story no one wants to hear.”

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The story is one of humiliation and sexual abuse. What unites all these women is the sense that the person they had married had disappeared, and been replaced with a totally different individual, with a new name. Some women in the film speak of being pressurised into validating their husband’s “womanhood” and being told they were in a “lesbian relationship”. Then there are accounts of the horror of discovering a male partner dressed in female underwear, and of husbands going outside dressed in “pornified” feminine frippery. “These men often force their wives into unspeakable pornified sexual violence”, says Vaishnavi.

There are notably no Indian trans widows interviewed in the film — but this doesn’t mean they don’t exist. (Instead, the film conveys their predicament through images and voiceovers.) “The regions in India where women experience the life of a trans widow are mostly rural,” explains Sundar. “‘Kothis’ — intact males who live a double life, one with family, children and a home, and the other with a cross-dressing fetish, where they may or may not prostitute themselves — are largely prevalent in rural India.” This means it is more difficult for trans widows to speak publicly about their ordeals for fear of shame and ostracisation. It is also harder for them to get a divorce, as it is considered a mark of shame in rural communities.

Many of the women whom Sundar interviewed feel extremely isolated. Their friends don’t dare to say, “That’s horrible, you should just leave”, because the cost — in terms of social capital — is too high. Instead, they have to affirm the husband’s choice and say: “Your husband is stunning and brave — why don’t you just cooperate and become a lesbian now?”

The overwhelming majority of stories from the widows describe husbands enjoying the act of “wearing a woman”, says Sundar. In other words, they are deriving some kind of sexual pleasure from dressing up as women. But the women she has spoken to are no longer willing to keep up the facade of a happy, progressive married life; they are saying, “No, my husband is not stunning and brave.”

Sundar is also interested in the tragic fate of their children. Some are being forced to call their father “mother”; others have experienced being “breastfed” by them. One woman talks about the pleasure her husband takes in “passing” when he is out and about dressed as a woman and posing as a mother. Sundar believes that what excites these men is the idea of having a child and of “being a lesbian mother” — rather than the child itself. The child is simply an accessory to help realise their fantasy.

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Not only has the Indian legal system failed to stop violence against women, but the entire apparatus, along with much of Indian society, appears to have capitulated to trans ideology. In February this year, a man was sentenced to seven years for raping a minor in 2016. But because he had transitioned following the rape, female pronouns were used to refer to him in court, and he was subsequently placed in a women’s prison. “Men are being given even more opportunities and excuses when it comes to rape and sexual assault,” says Sundar. Meanwhile, even though many women do not even have a functioning toilet in their homes, laws and policies are being introduced that allow men to enter the few public toilets available to women.

Meanwhile, in a country where gay and lesbian marriage is still illegal, “upper-class so-called feminists have become fixated with trans and non-binary marriage rights”. “They’ve removed the words ‘same-sex’ from this entire debate.”

The trans lobby’s latest tactic, according to Sundar, is to compare the battle for trans rights to the dismantling of the caste system in India — both being about “freeing individuals from the cage into which they were born”. She says that many trans activists have “very cleverly, actually strategically” bound up the issue with that of caste. Yet it takes quite a leap of logic to compare the two: “Caste oppression is the most sinister form of human discrimination ever.”

Dalit women, previously known as “untouchables”, are among the most maltreated women in the world. Not only are they part of India’s lowest class, but they are also considered inferior for their gender, and so are often raped, beaten and abused by men across all caste groups. And yet, Sundar tells me incredulously, there is now a group named “Dalit Trans Lives Matter”, which claims to be an even more oppressed group than Dalit women.

Sundar despairs at the ideological capture of the LGBT and feminist movements in India, which she would ideally like to be working alongside to achieve women’s liberation. Instead, so-called liberal feminists are busy defending pornography, the sex trade, and trans ideology rather than oppressed women. “These women dare to claim that the campaigns to end male violence towards women and girls are a ‘Western import’,” says Sundar. “These upper-class women ignore the fact that rape and domestic abuse is a fact of life for so many women, and that pole dancing is not going to liberate them.”

In this way, India’s struggle is not dissimilar to the West’s. “Women and girls are dying, are raped, on a daily basis,” says Sundar. “We are in a state of emergency and need a united front to even begin to solve the problem of male violence.” With so much work left to do to improve the lives of Indian women, she doesn’t think this is the moment for a feminist civil war.

The answer, it seems, lies in a shift in the global HIV response, one that the United Nations hopes will finally “end Aids by 2030”. To push HIV out of the “crisis” stage, in which it has been stuck for decades, and shrink the rate of new infections, health practitioners want a massive roll-out of the preventative medications that are no longer protected by drug company patents or exclusivities. And they want to target that specific sub-population that is disproportionately affected by HIV: transwomen who have sex with men.

In parts of the world, trans prostitutes are up to 80 times more likely than anyone else to be HIV-positive. It is estimated, for example, that in Brazil, as many as a third of travestis — male prostitutes with a female identity — are HIV-positive. Elsewhere, hijra, kathoeys and waria — names used in different cultures for males who adopt female names, clothing, hairstyles and pronouns — are a significant concern for health officials, since they are tricky to monitor and tend to have risky sex with men who often have a female partner at home.

To encourage these at-risk individuals to take part in HIV testing and treatment programmes, global health experts want to offer them a form of integrated care, which could include hormones, reassignment surgery referrals, and other “affirming” services alongside PrEP. As a study in The Journal of the International Aids Society made clear as far back as 2016: in scaling up PrEP for trans women, it is essential to engage trans communities, utilise trans-inclusive research and marketing strategies and identify and/or train healthcare providers to provide gender-affirming healthcare to trans women.”

In India, for instance, a recent white paper detailed a scheme to incentivise hijra and “transgender persons” to take part in HIV screening that involves a comprehensive package of services including gender-affirming care. In Thailand, one programme found that kathoeys were more likely to show up to clinics if they were staffed by transwomen — inspiring trials of similar initiatives in the Philippines, Myanmar and Nepal. It is a strategy that has been adopted in the developed West, too, albeit one that lacks transparency. In 2021, the US Department of Health and Human Services ordered HIV clinics to start offering “gender-affirming care” — a move celebrated in March this year, when the White House made clear that the federal government’s strategy “to end the HIV epidemic” included providing “access to gender affirming care and treatment services to transgender and gender diverse individuals with HIV”.

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It is not unusual for health authorities to group services together, or incentivise individuals to make healthy choices. But we have known for at least two decades that transwomen are inordinately at risk of being exposed to HIV. As long ago as 2009, doctors in community clinics in California reported that the availability of hormones and other affirming care would make trans patients more likely to show up to clinics for prevention.

The shift in attention may be down to the fact that, in recent years, with lesbian and gay equality effectively secured in much of the West, LGBT organisations have started to champion transgender causes. But it may also be down to the fact that, in some countries, HIV transmission is beginning to occur at a faster rate among heterosexuals than gay and bisexual men. And this is perhaps in part due to a subsection of heterosexuals, who have transwomen as partners.

Gynandromorphophilia was first coined in 1984 to describe the sexual preferences of ostensibly heterosexual men who are also attracted to males with exaggerated female features, such as big breasts, hips and lips. Gynandromorphophilic males (or Gamps for short) play a role in the transmission of HIV to the general population because their sexual relations with these often high-risk men put their own female partners at risk, which can also result in the virus being passed to unborn babies. We know, too, that heterosexuals tend to be diagnosed late, once their immune system has already been compromised. This also applies to their female partners, who might never suspect that they have been exposed.

In 1995, when Belgian virologist Peter Piot was entrusted with leading the global Aids response at UNAids, it didn’t take him long to realise that stigma relating to sex was the real barrier to ending the epidemic. Shaming “people with diverse sexuality”, Piot said, forces them into the shadows and keeps the virus in circulation.

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By Jarryd Bartle

In an effort to address the estimated 4,500 undiagnosed HIV cases in the UK and halt the virus, the NHS now recommends that certain at-risk groups “may benefit” from taking the now widely and freely available PrEP medication. These at-risk groups include “trans or non-binary person [who] are regularly having condomless sex”. And with this group, “gender-affirming” incentives will increasingly be a part of that medicalising strategy.

While there is an urgent and noble objective here — the eradication of HIV — my worry is that it is taking place without any serious public debate about the consequences. With so much still unknown about the effects of transitioning, gender-affirming therapy is being made more accessible. And at what cost? Only when the HIV epidemic finally ends, will it become clear how subtly it has reshaped the world it’s left behind.

War tends to increase social cohesion, leaving those statistically at the edge, exposed. And in the aftermath of World War Two , discrimination against gay people reached its zenith. “Homosexuals” were thought too different to be tolerated: they were criminalised and given a psychiatric diagnosis and “treatment”. Considered relatively benign, the so-called “conversion therapy” was deemed a way for troubled people to avoid worse fates and social rejection. Some gay men and women requested the “therapies”, presumably with the hope of passing through life more easily and being socially affirmed as “acceptable”.

Today, conversion therapy is at the heart of another war, as the Government attempts to ban it. Again it involves a marginalised cohort, who despair of fitting in. But this time, “conversion therapy”, which was always ill-defined, has taken on several different meanings.

The term is used to describe a range of medical and psychotherapeutic interventions, early versions of which were offered to gay men and women on the NHS during the Fifties — although these were focused on aversion more than conversion. Pavlovian attempts were made to disrupt any association between (same-sex) sexual stimuli and sexual responses, with electric shocks or medically induced vomiting. Later therapists attempted to actively re-orientate people’s sexuality towards heterosexual stimuli. Methods also included religious counselling, talking therapies, and finally, for some gay men, hormonal treatments.

These attempts to either avert homosexuality or convert lesbian, gay and bisexual (LGB) people to heterosexuality didn’t work — and even killed people. Alan Turing committed suicide two years after opting for “chemical castration”, rather than imprisonment.  Eventually, though, society started to shift. In 1967, homosexuality was decriminalised in England. In 1973, the term was removed from the 2nd version of the Diagnostic Statistical Manual (DSM-II), a handbook used by healthcare professionals to guide the diagnosis of mental disorders. Outside of LGBT communities, the concept of conversion therapy may have comfortably drifted out of consciousness for a while.

The collective amnesia did not last long. In 2011, The Guardian reported that some religious therapists were still trying to convert gay men. This forced therapy organisations in the UK to confront their history, and in 2015 the first Memorandum of Understanding (MOU) on Conversion Therapy was signed by 16 organisations. All agreed that it was unethical for a therapist to try to change someone’s sexual orientation via any means. Two years later, a second memorandum — the MOU2 — was announced. This one had expanded the concept of conversion therapy to include any “therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other”. The inclusion of “gender identity” is significant.

Gender identity is the term used to describe the profound internal sense that some people have of their maleness, or femaleness, or neither. Gender non-conformity didn’t escape diagnosis for long; when the updated DSM-III was introduced in 1980, the concept of “gender identity disorder”, previously absent, slipped into the gap left by homosexuality.

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In July 2018, the day before the MOU2 was officially launched in parliament, the government presented the results of its National LGBT Survey. The online survey of more than 108,000 self-selected respondents stated that, overall, 5% of respondents had been offered conversion therapy, and 2% had taken it up. This rose to 9% and 4% of transgender respondents.

The idea that conversion therapy could still happen in modern Britain is abhorrent to most. And this is why there has been a move to ban it in parliament.. Yet feelings and facts matter. The LGBT survey did “not provide a definition of conversion therapy”. As such, the survey measures whether people perceived something to have been conversion therapy. Furthermore, for those who did feel they had been offered it, only 19% said that it was via a healthcare provider or medical professional. No one knows how many of these were in the NHS.

It is easy to think we understand what we are talking about when it comes to conversion therapy when maybe we don’t. And given the controversy over Government’s decision to include trans people in criminalisation of the practice, it’s vitally important that we do.

In 2018, no one claimed to be receiving electric shock treatments, or medically induced nausea. These interventions are of course already and rightfully illegal. So what is it exactly that people are experiencing? In the NHS, the only conversion therapy treatments that are still offered — albeit not with the aim of “converting” homosexuals — are talking therapies and hormonal interventions.

Let’s address talking therapy first. There is no doubt that some “therapists” will have actively tried to alter their patients’ gender and sex-related thoughts, feelings and/or identities. We have troubling anecdotal evidence that this has happened to some trans-identified people in modern Britain. Whether this is happening away from religious settings — in the NHS or mainstream clinical or psychological practice — is harder to ascertain, but it is possible. After all, potentially damaging interactions between mental health professionals and trans- or gender-questioning people aren’t a new phenomenon.

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Treatments attempting to convert gay and lesbian people to heterosexuality were just as unethical and also failed. But they gave rise to an affirmative practice which has taken hold today and which includes medicalisation. “Gay Affirming Therapy” was developed in the early Eighties as a reparative response. This approach wasn’t intended to be a whole-scale model of care, but a therapeutic position wherein the clinician demonstrated warmth and acceptance of a client’s non-heterosexual identity to counterbalance negative messages from society.

It is this affirmative position which has been adopted, and adapted, by clinicians working with transgender adults and gender-incongruent children. But the term “affirmative care” has changed. It has morphed to include, the offer at least, of “medical affirmation” — or hormonal intervention. Medical gender affirmation aims to help reduce an individual’s suffering by trying to better align their physical body with their felt gender identity. The World Health Organization defines it thus: “Gender-affirmative health care can include any single or combination of a number of social, psychological, behavioural or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.” Note here how the idea of hormonal interventions has been turned on its head, previously offered as a “conversion therapy” for gay men.

Despite the fact that there is no consensus or good quality evidence to demonstrate that — on balance, on average and over time — these novel gender-affirming medical interventions do reduce suffering, and despite the evidence that they will certainly harm some, many people report that for them, personally, they have felt “life-saving”. These evocative first-person narratives have led some to argue that access to gender-affirming medical interventions should be a human right. From this vantage, anything other than immediate affirmation can be considered equivalent to conversion therapy. As a result, psychotherapy, which might explore different ways of understanding ourselves and in doing so may delay medical intervention, is now understood by some as inherently harmful.

This leaves us in a position whereby offering a medical intervention to someone who identifies as LGB is very clearly understood to be conversion therapy, while not offering the (sometimes same) treatment to someone who identifies as transgender is also understood, by some, to be conversion therapy. Meanwhile, offering psychotherapy that aims to reduce distress by increasing self-acceptance without the need for change is seen as the right approach for LGB people but, sometimes, the wrong one for transgender people.

To complicate things even further, the population of people understood to be transgender has broadened. “Trans” has become an “umbrella term” under which a broad range of experiences are collated. As well as those who identify as the opposite sex, the category now includes gender-questioning people, gender non-conforming people and the gender fluid, among others — depending on who is defining it. The term non-binary, used to describe people who identify as neither male nor female, entered the clinical literature less than a decade ago, but is already being medically treated in the NHS.

We must also note that the demographics of those who identify as trans have also changed significantly over the recent years. No one yet knows why. These changes are particularly striking in younger people, with the number of adolescents and young adults questioning their gender and sexuality has increased exponentially in recent years in particular among young women.

On top of this, sometimes the same individuals move between identity categories — from LGB to T or T to LGB for example — increasing the risk that a treatment felt to be right, lifesaving even, the first time can be experienced as devastatingly wrong for the same person the second time. One person’s affirmation therapy might be another person’s conversion therapy — but no one can agree on which is which.

History doesn’t repeat but it often rhymes. And the NHS is once again trying to reduce the suffering experienced by some gender non-conforming people. Once again, it is offering a range of treatments that don’t — yet — have sufficient evidence to allow us to guarantee any outcome. Once again, people seeking to pass through their lives with more comfort are requesting treatments. And once again, the profound uncertainty about what will work for whom leads to inevitable medical risk-taking. If a patient can’t always predict how they will feel about something in the future, then a doctor or therapist certainly can’t.

No one can envy Dr Hilary Cass, the paediatrician charged with delivering an independent review of the NHS’s gender identity services and find a way forward, for children and adolescents at least. She finds herself on a battlefield where people are fighting over how to define key clinical terms, not least the concept of conversion therapy itself. Yet a quick search of her interim report makes it clear that Cass isn’t too worried. The word “conversion” doesn’t feature once. Instead, without taking medical treatments completely off the table, she calls for the NHS to increase access to psychotherapy. According to Cass, then, gently supporting people to explore identities in therapy is not akin to conversion therapy as most people understand that term.

As we turn our minds to the future, we must keep one eye on the past. Wars, cultural or otherwise, aren’t good for anyone, particularly minority groups. No ethical clinician wants to repeat history and inadvertently hurt the very people they are trying to help. We must focus now on developing therapies that will be acceptable to and appropriate for everyone who might seek them, minimising the risk of current or future harm. To do this we must accept that when it comes to issues of sex and gender, uncertainty and cultural change are the only things we can predict.

In the interests of “balance”, an opposing view was deemed necessary. The counter-argument, published last week, was made by Jacqueline Rose, a professor at the Birkbeck Institute for the Humanities. According to Dawkins, her response does not make any “coherent sense”, which he suggests may be a badge of honour among postmodernists.

I am a long-time admirer of Rose. Her insights on psychoanalysis have suffused my own writing and I loved her book Mothers, which, as it happens, I reviewed in the New Statesman. I described her as “one of our very best cultural critics”.

Yet even I was surprised at how poor her recent article was. I understand that, unless you are Zizek, you have to sign up to a lot of nonsense if you are to survive on the international academic circuit. Unlike Dawkins, though, I am weirdly steeped in postmodern theory. In the Eighties, I got an interview with Baudrillard and tried to sell it to The Guardian, but they had never heard of him.

From early on, I could see how much of this fashionable theory — rooted in a rejection of “grand narratives” about the truth — does not accommodate feminist politics. When I was teaching American students about postmodernism and Judith Butler, it became even more apparent that much of her argument was a response to Marxism; that postmodernism was born of the failure of revolutionary politics.

But there were good bits. And the Rose article reminds me strongly of something I wrote in 1988: “If the whole question of power cannot be tackled, it is because these new hysterics with their male bodies and optional female subjectivities cannot speak of a desiring subject who is actually a flesh and blood woman.” I was talking here about male theorists, rather than trans people. But I return to it in an attempt to understand how, in a call for “generosity”, Rose has written a piece that is so completely dismissive of women, our concerns, rights, bodies and fears.

She begins by claiming that a “central goal of feminism is to repudiate the idea of womanhood”. Is it? What is womanhood if there is no such thing as a woman? Does she mean “femininity”?

On the threat of sexual violence, she suggests that it is “the category of women as much as the safety of women that needs protection”. That category, she thinks, should include women who were once men. Let’s take this idea for a walk, shall we? Out of the academy and to Iran and Afghanistan, to places where women die in menstrual huts or undergo FGM, where women-only spaces are compelled. She complains that “the idea of female” is “some kind of primordial condition… as if it were the bedrock of all the limitations to follow”. She’s actually right here: this is the unfortunate reality in many parts of the world.

Of course, she uses the de Beauvoir quote — “One is not a woman, one becomes one” — but, predictably, chooses to ignore the rest of it: “No biological, psychological, or economic destiny defines the figure that the human female acquires in society; it is civilization as a whole that develops this product, intermediate between female and eunuch, which one calls feminine.” The second part of the quotation is key. The construction of gender is social and there is a difference between being female (sex) and femininity (gender) which is learnt.

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Rose’s preference for referring to “females” as opposed to women, she says, is because Andrea Long Chu argues that “female” was developed in the 19th century as a way of referring to black slaves. As a result, it is “historically naive and racially blind” to assume it is a “neutral biological category”. Woah!

“Female” was in common usage long before the 19th century and I think Rose does Long Chu down here. Long Chu is a controversial, often witty, trans author who starts her book Females with: “Everyone is female, and everyone hates it.” For Long Chu, a female identity is one of self-negation and fuckable porn-addled passivity, which is precisely why she transitioned. If the answer to “What is a woman?” is this person, then the majority of the population — women — are tragic failures. Perhaps we are, but at least I know that male babies are not born “with spermatozoa”, as Rose asserts.

Rose goes on to argue that the act of transitioning challenges a binary which “reinforces the most regressive of gender stereotypes”. For her, it is an “imaginative leap”. Others might call it a fiction and listen to the accounts of detransitioners who can never experience parenthood or sexual pleasure. Others might say they are being sold a fantasy, that the sexed body has limitations whatever the imagination says, and that cynical drug companies and surgeons are cashing in on this.

Still, Rose insists there is no bedrock on which “sexual differentiation can securely ground itself”. Perhaps she has not read Dawkins or perhaps she knows more about biology than him. I couldn’t possibly say, but she goes into the familiar refrain that because some women don’t have a uterus, biology cannot be the gatekeeper of what she would call “femaleness”. This is true, but every one of us, however sexually interesting we may be, was born from someone who did have a uterus. There is no way of escaping this.

Transwomen, she says, have “a feeling that biology and a core, lived, sexual identity have been woefully misaligned”. What, pray, is “a core, lived sexual identity”? Is it a soul? Is it an orientation? Is it changeable? The issue with this Butlerian perception of gender is that, if it is nothing but performative, why is anyone compelled to repeat the performance repeatedly and permanently?

The dissonance between who you feel yourself to be and a sexed body is dysphoria, and I don’t know a single feminist who is not sympathetic to those who suffer from it. It’s just that, on the whole, we’re more worried about distressed, often gay, teenagers doing it.

The goal of transition is to simulate femininity, not femaleness because it cannot be done. The liberatory aspect of this, which Rose refers to as “discarding the straitjacket of masculinity”, is actually done by many men without them claiming to be women. But Rose doesn’t address the attendant power grab of women’s spaces and language. Instead, up comes Stuart Hall and his important work concerning moral panics in the Seventies, with a focus on “muggers” and young black men.

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Trans people, she is right to say, have become political footballs when we should be thinking about other things. Yet no other “civil rights” movement has had the dominant group identify into the oppressed group and then tried to take away their rights. Rose doesn’t dirty herself with such issues.

“‘Reality’ for feminism”, she argues, is something that has to be negotiated, and to dictate on this matter is patriarchal. Rose, you have to understand, is coming from a place where discourse always trumps objective reality. Postmodern theory depends on us seeing ourselves as formed only in and through language. Meaning is never settled; it is always contested. This is a fine and interesting philosophical argument, but as a politics it stinks. Postmodernism is patriarchy in drag.

What is a woman? “In the end,” we’re told, “it is a matter of generosity and freedom.” Well yes, that will go down well with the Taliban. Where is the generosity towards women who have lost jobs and reputations because of this “debate”? Where is the freedom for women to define themselves? If oppression is not rooted in biology, where does it come from exactly?

One is not born a woman but becomes one. And then one becomes an angry woman — not because we are gatekeeping an essentialist position, but because we cannot individually identify our way out of trouble. Feminism is a collective struggle or it is merely cosmetic.

What is a woman? I suspect Rose knows. She just also knows which side her bread is buttered on: the side that holds the power in academia, publishing and literary circles. They have stopped dreaming big and kid themselves they are radical in their safe spaces. Yet most women don’t get to choose our safe spaces: we are too mean and unsophisticated. Thankfully, unlike Rose, some of us remain unkind, unpersuaded, unbound.

Gids had been established in 1989, to help distressed teenagers navigate their feelings of gender dysphoria, but changes in leadership along the way led to a dramatic shift in its clinical approach. In recent years children routinely found themselves on a medical conveyor belt before the psychological effects of early adverse experiences were fully explored. Much has been written about the blanket application of an “affirmation-only” approach to a complex caseload, which too often put children on a single pathway to life-long medicalisation. By 2020, Gids had prescribed puberty blockers to more than a thousand children. 

In most academic discourse, a “no-debate” approach, such as the one described at Gids, will be stifling and unproductive — but in medicine, it will inevitably result in harm. All clinical practice should be centred around the careful consideration of competing possibilities. It is unsurprising that children were harmed at Gids when a single-minded certainty usurped clinical curiosity.

One year on, Gids remains open, although it no longer accepts new referrals. The plan is to replace the moribund service with regional hubs offering the holistic care required by young people struggling with their gender identity. The promised new services are still taking shape, but before they have even opened their doors to the ever-accumulating backlog of referrals — last rumoured to be upwards of 8,000 young people — concerns have been raised about history repeating itself. Some of the senior clinicians from Gids have seamlessly transferred into new leadership positions, despite appearing to have learned little from its terminal failings.

In April 2023, Prof Gary Butler, the lead endocrinologist at Gids and a clinician appointed to a leadership role in its replacement service, questioned any need to rethink the model. He told a conference audience that Gids was already working in “exactly” the way that Dr Hilary Cass had called for in her thorough review of services for children and young people with gender incongruence. It is difficult to see how anyone could reconcile the service described in Time to Think — BBC Newsnight reporter Hannah Barnes’s careful and balanced account of the failings reported by multiple Gids clinicians — with the holistic approach recommended by the Cass Review.

Its recommendations tear down the exceptionalism that allowed things to go so wrong at Gids; evidence-based practice will be the bedrock of the new service, just as it is in every other NHS clinic.  Those working within the new services will be contractually committed to follow Dr Cass’s recommendations, which place a new emphasis on integrated models of care and evidence-based treatments, recommendations that should be as uncontroversial as motherhood and apple pie.

But, then, motherhood and apple pie aren’t quite as uncontroversial as they used to be. And an evidence-based practice may not be quite the unifying foundation if the clinicians involved cannot agree on the evidence base.

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By Sallie Baxendale

Earlier this month, a group of 21 eminent clinicians working across nine countries in the field of gender distress wrote an excoriating open letter in response to a bold claim from Stephen Hammes, president of the Endocrine Society. In a letter to the Wall Street Journal, Hammes had stated that more than 2,000 studies had provided a clear picture that gender-affirming care improved the well-being of gender diverse people and reduced the risk of suicide; if that were true, it would be very reassuring and closer to certainty than we often get in many medical specialities. The authors of the response, who included Dr Anna Hutchinson and Dr Anastassis Spiliadis, two of the original whistleblowers at Gids, noted that this claim had been contradicted by every single systematic review of the evidence, not least one published by the Endocrine Society itself. They noted that recommendations for clinical practice should be aligned with the best available evidence, rather than a position that exaggerated the benefits and minimised the risks.

Not all evidence is equal. There are hierarchies of evidence in science, often represented as a pyramid. The lowest level is “expert consensus”, which is barely evidence at all. Who decides who is an expert? The process of reaching a consensus can result in a compromise where lots of people agree collectively what nobody actually believes individually. Consensus may have nothing to do with empirical truth. Expert medical consensus can be very wide of the mark, sometimes disastrously so: in the early 1900s, it was expert medical consensus that smoking cured asthma and other lung diseases. It is well within living memory that the expert consensus for treating back pain was bed rest and plenty of it. We now know this is likely to increase pain and prolong recovery.

The history of medicine is littered with these examples, and there are treatments we are recommending now with the full blessing of expert consensus that will eventually prove to be ineffectual at best, fatal at worst. But perhaps the biggest problem with consensus, particularly in the area of gender medicine is the chilling effect it has on debate. As Michael Crichton, the physician and author of Jurassic Park, said: “The claim of consensus has been the first refuge of scoundrels; it is a way to avoid debate by claiming that the matter is already settled.”

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Fortunately, most branches of medicine now rely on more rigorous forms of evidence to inform their practice. Further up the “evidence pyramid” are case reports and studies that compare the outcomes in patient groups before and after treatment, with and without control groups. Close to the top of the evidence pyramid are the results from randomised controlled trials. All of these kinds of research can provide valuable information (some more than others) but no study is perfect and no study design can control for all of the biases that might have influenced the results. So sitting right at the top of the evidence pyramid are the meta-analyses and systematic reviews. These studies systematically evaluate the quality and quantity of all of the relevant evidence that has been published in peer-reviewed journals. These independent reviews summarise what we really know and how confident we can be in that knowledge. Bodies such as the National Institute for Health & Care Excellence (Nice) produce the gold standard in clinical practice guidelines based on these kinds of independent meta-analyses.

In 2020, Nice examined the evidence for puberty blockers. They concluded that “the results of the studies that reported impact on […] outcomes of gender dysphoria and mental health (depression, anger and anxiety), and […] body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria were of very low certainty”. In other words, there is no good quality evidence supporting the use of these drugs on these outcomes.

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It seems likely in the heated debates that surround gender medicine that many people are confusing “expert consensus” — the evidence right at the bottom of the pyramid — for the gold standard in clinical practice guidelines, which are based on evidence and right at the top.

This conflation appears to have been responsible for the mutual bafflement in the heated exchange between Republican Dan Crenshaw and Dr Meredithe McNamara earlier this month, in a debate in the US House Committee on Energy and Commerce on gender-affirming care. While Dr McNamara insisted trans healthcare was based on “standards of care”, the senator countered with the stark lack of evidence from any systematic reviews. Both appeared exasperated with the failure of the other to grasp the importance of their incontrovertible evidence. Just as not all evidence is equal, neither are all clinical guidelines or standards of care. They can be developed from evidence at the top of the pyramid (as in Nice guidelines), but more often come from the bottom and simply represent expert consensus with all its inherent flaws and biases. The stamp of approval from a learned society does not trump the rigours of a Nice review.

Since no high-quality evidence for the benefits of puberty blockers has been found in systematic reviews, it is unsurprising that even the doctors who work in this field have described themselves as building the plane while flying it. With mounting concerns for the possible harms associated with medical pathway of puberty blockers and cross-sex hormones (including reduced bone density, disruptions to neurodevelopment, impaired sexual function and infertility) — not to mention the growing numbers of detransitioners for whom this was never an appropriate treatment pathway, one might extend their aviation metaphor as an attempt to build a plane while flying it while someone else throws out all the parachutes and sets an engine on fire.

Who would put any children on that plane? Or volunteer to pilot it?

The only rational response in such a situation would be to ground the plane immediately. The interim recommendations of the Cass Review combined with the upcoming closure of Gids effectively do this, but the pressures on a new service to immediately take to the metaphorical skies again will be significant.

However, there is another way. Practice guidelines based on expert consensus cannot be mistaken for those based on systematic reviews. Where the systematic reviews indicate little evidence for benefit and potential for significant harm, the service should proceed with the caution that would be applied in any other branch of medicine.

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Cass has emphasised that just as there are many pathways into gender dysphoria for young people, so there could be many ways out. For some, that may still be a medical pathway, with its unevidenced outcomes and multiple inherent risks. The new teams will be tasked with explaining these uncertainties in uncompromising detail to ensure the truly informed consent of those who wish to embark on this experimental approach. Fortunately, the new service model means that other treatment pathways will now also be available.

Bringing gender distress firmly back into the fold of mainstream mental health services for children and adolescents means that these vulnerable children can finally begin to benefit from the therapeutic input and safeguards they have been denied for far too long. It can’t begin soon enough.

Under leader Giorgia Meloni, it has been decided that only the name of the biological mother within a lesbian couple may appear on their child’s birth certificate, reversing the previous decision of certain Italian municipalities to include both partners. Some town halls are stripping existing parental rights from lesbian partners retrospectively. The grand total of couples involved is said to be 33 — a perfect number, when you want to send a shot across the bows without hitting too many voters along the way.

Luca Ciriani, the minister for parliamentary relations, insisted last month: “In Italy, marriage is only between a man and a woman, and therefore only the biological parent is the parent whose surname can be registered.” (Civil unions, but not marriages, have been around for same-sex-attracted people in Italy since 2016.) Given the international climate, it’s predictable that her party would go in this direction. What is perhaps less predictable, given the heavy presence of lesbians and atheists among them, is that the move has also gone down well with some in the UK fighting for women’s rights.

Tired of the erasure of biological motherhood on multiple fronts these days — whether from activists renaming trans-identified fathers as “mothers”, or from surrogacy enthusiasts presenting a birth mother as a fancy kind of packaging from which a beautiful baby can eventually be unboxed — campaigners such as Kellie-Jay Keen (aka Posie Parker) and others have endorsed Meloni’s conclusion. Any concessions to the renaming of biological reality are “the thin end of the wedge”, Keen argues — where the thick end presumably involves schoolgirls believing they are boys, transwomen photographing themselves “breastfeeding”, and other forms of present or future definitional anarchy.

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As it happens, I’m named on my youngest child’s birth certificate, though I didn’t give birth to her. My lack of contribution in that respect is made clear by my categorisation as “parent”, while my partner is named, accurately, as “mother”. Such an entry became legally possible in 2009 for lesbians in civil partnerships, bringing parity with what had already been possible for years for heterosexual males, as long as they were in a couple using donor sperm for fertility issues. If there is a wedge here, it started with infertile men being registered as parents of children they did not conceive.

I don’t object at all to the fact of criticism of either practice, and I certainly wouldn’t hurl accusations of homophobia around because of it. Not every objection to the liberalisation of traditional family structures in favour of gay people is homophobic in origin. In an ideal world, I agree, we would each know where — or more specifically, who — we came from, though the world is far from ideal in that respect. According to the Office for National Statistics, in 2021 nearly 5% of birth certificates issued in the UK didn’t record any father at all.

But this isn’t the only point of a birth certificate in any case. The named presence of an adult there also officially gives him or her the set of legal rights and responsibilities associated with being a parent. It is these that have been removed from one half of lesbian co-parenting couples in Italy. In order to be able to do things like pick up a child after school or take over childcare in the event of the birth mother’s death, the excluded partner must now go through a lengthy adoption procedure.

Viewed in this light, naming a second lesbian parent on a child’s birth certificate is a family-friendly move. Arguably, if you squint a bit, it’s even a socially conservative move — though agreeing probably depends on whether you take, as your baseline, a society where lesbians will have children anyway; or whether you think of it as a cultural aberration that could, with discouragement, be stopped. Either way, putting a second lesbian partner on a birth certificate officially defines and legitimises her parenting relation within the family, allowing the burdens and joys to be shared between two adults, and adding a second layer of protection for the child. Family stability is important for good childhood outcomes, and this measure seems to provide some.

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By Kathleen Stock

Coincidentally, the Marriage (Same Sex Couples) Act was passed in the UK a decade ago this week. With the benefit of hindsight, it is interesting to revisit the associated parliamentary debate of the Bill, as politicians discussed whether lesbians and gays had the right to nervous breakdowns over table settings and canapé choices like everybody else.

Much of the progressive case for same-sex marriage centred on the notion that the game of marriage — its pleasures and its wider benefits — did not require the pieces on the board to have any particular shape. As Yvette Cooper declared at the time: “We all love the idea of a wedding, we all support the idea of a strong marriage and, clearly, we all like a good party.” The conservative case, meanwhile, focused on sexual difference as the essential basis of a Christian marriage, specifically for the purposes of bringing up children. Yet it seems to me that, as is often the case, both sides overstated things.

Back then, progressives tended to follow the lead of LGB activists in avoiding all discussions of how lesbian or gay partnerships might meaningfully differ from the heterosexual versions. There was a similar code of silence over how lesbian relationships might differ from the gay male kind — bizarrely, since in many ways a female-female couple is the opposite of a male-male one. The general conceit, for the purposes of equality narratives, was (and still is) that any differences — either with heterosexual couples, or with homosexual couples of the opposite sex — are superficial, and that we are all the same really.

Any diversion from this approved line tended to result in immediate cries of homophobia, and still does. It’s a shame, for — as well as having presented a suffocatingly authoritarian blueprint for future transactivists to follow — this strategy has also been counterproductive for child development. Specifically, it has removed any possibility of having constructive, non-judgemental public discussions about how the needs of same-sex parents and their offspring might somewhat differ from those in heterosexual contexts.

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For instance, children growing up in lesbian households ideally need strong emotional connections with adult males as well, whether via family or friends, while kids growing up with gay male parents also need positive relationships with women. This is not something that many progressives are prepared to talk about. Also hard to acknowledge — but still true — is that, like straight male counterparts, gay male parents are on average less likely than females to feel confident in caring for young children. A society that could mention these things easily could also offer more support for those that require it.

It would also be good to freely discuss the potential costs of unknown paternity or maternity for children generally, without getting worried about the sensitivities of gays and lesbians in particular. Relatedly, the gay male use of surrogates is an ethical minefield. It requires an open discussion without kneejerk accusations of bigotry.

Progressives have often steered clear of such points because they fear that a slippery slope is invited towards the conclusion that gay people shouldn’t have children at all — a point on which many Christian contributors to the 2013 parliamentary debate doubtless would agree. But most constituents these days are not practising Christians; and even those who are, are usually pretty liberal. Shorn of a religious framework insisting that, by definition, both a marriage and a family must contain one man and one woman, any ensuing draconian policy implications would be unattractive to most. We aren’t in Catholic Italy.

Recently, I’ve been glued to a Netflix reality show called The Ultimatum, where couples swap partners for three weeks, ostensibly in order to assess whether they are ready for marriage in their own couple. It’s a genius idea that could only attract deliciously watchable dysfunctionality, a promise on which it totally delivers. There’s a lesbian version and a straight version — and it’s fascinating to inspect each series with an eye to differences and similarities.

Yes, lesbians seem to cry more (but only just); and yes, heterosexuals seem to have more sex (but only just); but even so, watching the two series consecutively also reveals the deep similarities between humans looking for lasting love. (Indeed, after watching the first one, only featuring females, I struggled not to read the men in the second as particularly successful butch lesbians.)

If it’s a basic aim of society to produce well-adjusted, happy children in the context of stable, long-lasting romantic relationships — and a lot of evidence suggests it should be — then it would be a wasted opportunity not to offer lesbian and gay couples policy tools that help them contribute to this process. We don’t have to choose between traditional complementarity narratives about marriage or parenting, and a structureless free-for-all in which any permutation is permitted in order to prop up fantasies of exact sameness. Paying attention to real differences between sexual orientations should not preclude keeping our eye on the bigger picture — nor vice versa.

Trepanning (drilling a hole in someone’s skull) has been conducted for millennia, with evidence of the oldest procedure dating back several thousand years. Archaeological finds of skulls with multiple holes in various states of repair indicate that at least some of our ancestors survived these treatments and came back for more. Opening a space to let the demons out of someone’s head makes sense, if you believe the pesky things have taken up residence and are running amok inside. At least this treatment was in the right anatomical ballpark, according to our current understanding of epilepsy as a neurological condition. Less than 130 years ago, surgery for epilepsy had “advanced” (or regressed) to the extent that the head was no longer the sole target of the surgeon’s scalpel.

They had branched out to recommend limb amputation. The rationale was straightforward: if someone’s arm keeps shaking, what more effective cure than to cut it off? Other surgical approaches to epilepsy in the 1890s included clitoridectomy and castration — both attempts to curb the immoral sexual appetites that were “well known” to cause epilepsy at the time. For the squeamish patients who wished to retain their sexual organs, alternative treatments included admonitions to avoid coffee, chocolate and amorous love songs. Late Victorian treatments for epilepsy were nothing if not eclectic.

Into the mid-20th century, people with epilepsy were once again the unwitting participants in a dark era of medical experimentation. In an enterprising spin-off, the radical surgical techniques developed in the Forties’ psychosurgery movement were trialled as treatments for epilepsy. All undergraduate psychology students (and fans of the film Memento) will be aware of Henry Molaison, better known by his initials. In October 1953, Mr Molaison underwent surgical excision of the right and left temporal lobes of his brain. In a short paper delivered six weeks after the surgery, his surgeon reported that the operation had resulted in no real changes, “with the exception of a very grave recent memory loss”; H.M. was unable to remember where his room was in the hospital, or how to find the toilet.

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Why the Tavistock won't talk to me

By Hadley Freeman

H.M.’s profoundly disabling amnesia persisted for the next 55 years, until his death in 2008. He became the most famous neuropsychological case study in the history of the profession. But he was not the first person to undergo this procedure and suffer this devastating outcome. Scores of others were discovered in a retrospective review, triggered by Mr Molaison’s case. His memory loss could have been anticipated and prevented if the outcome of this procedure had been fully evaluated in his predecessors. More shocking still is that a similar fate was allowed to befall a number of other patients after his amnesia was discovered. Ignorance is one thing, inertia something entirely different.

The lessons from this sobering history are clear. When doctors fundamentally misunderstand the cause of a condition and treat the symptoms instead, and fail to properly monitor outcomes, and modify their practice in response to known adverse outcomes, our patients suffer — often greatly and for the rest of their lives — if indeed they survive. These fundamental errors underpin the depressingly regular scandals that punctuate the history of medicine. (The stakes are particularly high if surgery is involved.)

It is naïve to think that all these scandals are in the past. Our descendants will look back at some aspects of our current medical practice and wonder that we could have been so stupid. They will shudder at how barbaric and crude some of our current treatments are. So where might the next medical scandal be brewing?

The increasing visibility of detransitioners suggests it may lie in wait in gender-affirming medicine. Many detransitioners are young women who underwent treatment for psychological distress that has left them with irreversible, life-long changes to their bodies: a deep voice, a beard, and compromised sexual function. Some have had their breasts surgically removed; some may be infertile. Others are young men who have been castrated.

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Why I stopped being a good girl

By Hadley Freeman

This is not an argument about the pros and cons of these treatments for trans-identified young people. Nor is it an argument about the percentage of people who may “regret” undergoing these procedures. The existence of just one detransitioner suggests that an individual was not offered the correct treatment for their condition by the doctors charged with their care. It is a clear case where the medical profession caused harm. We are ethically bound to learn, and widely disseminate, the lessons from these cases.

For many detransitioners, the cause of their distress as a teenager was misattributed by their clinicians to the notion that they had been born in the wrong body, and that they would be helped by the surgical creation of the “correct” body. Regardless of the validity of this treatment for some — on which I make no comment — this assumption was incorrect in the case of many detransitioners. Once these fundamental errors of misattribution had been made by the treating clinicians (who in the case of GIDS were primarily psychologists, and not medically qualified), surgeons and endocrinologists embarked on a procedure akin to that of limb amputation for epileptic seizures. The detransitioners’ discomfort with their body was a symptom of psychological distress, not a cause, but their medical team prescribed treatments with an irreversible impact and surgically removed healthy tissue in an effort to cure their symptoms.

In most other fields of surgery, this would be classified as a “never event”, and an exhaustive investigation would be launched. But in the case of many detransitioners, their treating medical team has failed their patient at every stage. They have fundamentally misunderstood the nature of the condition the patient has presented with and have treated the symptom rather than the cause. The astonishing failure of the Tavistock & Portman NHS trust to monitor even primary outcomes were laid bare in the original trial of Bell vs Tavistock, with further shocking details subsequently presented in Hannah Barnes forensic account of the collapse of the service. This failure means there is no opportunity to modify practice in response. It is unsurprising that the results have been catastrophic for some.

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The tragedy of becoming a woman

By Sarah Ditum

However, in the case of detransitioners, there is an additional, darker layer to this cascade of medical errors. The patients themselves are being held responsible, by the very doctors who made them. The term “post-treatment regret” appears to abrogate any responsibility on behalf of the treating clinicians for these outcomes. Some argue that there is some degree of regret associated with every medical procedure. However, there is a fundamental difference between patients who are unhappy with the outcome of elective treatments recommended for their condition, and those who have been misdiagnosed, and have had healthy tissue surgically removed as a result. Many detransitioners were given the wrong treatment for their condition. These people are not experiencing post-treatment regret, they are responding appropriately to the consequences of a grave medical failure.

Advocates of gender-affirming care argue that “no one can know whether post-treatment regret will occur; therefore what matters ethically is whether an individual has a good enough reason for wanting treatment”. This is a remarkable position to take. Surely what matters ethically is that the medical profession offers appropriate, evidence-based treatment to patients who will benefit from them. Others argue that young trans people have “the right to be wrong”. They do indeed; doctors, less so, particularly when they are wielding a scalpel. Just as trans youth deserve access to the very best in evidence-based medicine, so doctors have a fundamental duty not to offer harmful treatments to young people who will not benefit from them. It is not good enough to shrug and say, “no one knows whether this will occur”. We know that poor outcomes do occur, and are duty-bound to find out as much as we can about these in order to predict and prevent them.

Since 2014, there has been a phenomenal increase in young women referred to specialist services for gender dysphoria. There is, therefore, a greater number of people who are at potential risk of receiving inappropriate treatments. To respond by creating a “fast-track” to medical transition is to ignore everything history has to teach us. Meticulous assessment of a young person’s symptoms is not transphobic, nor does it invalidate anyone’s identity. It is good medicine, and ensures that the right treatment is given to the right patient.

No branch of medicine can be exempt from rigour. Exceptionalism lies at the heart of many medical scandals. That way catastrophe lies and, as ever, it will be our patients who suffer. This is not hypothetical: detransitioners stand before us as living, breathing examples of people who have been harmed. To change nothing as the result of their experience — or, even worse, to make changes that mean similar errors could potentially harm even more people — is immoral. Upholding scientific principles is the least we can do to protect our current patients and honour the thousands who have been failed by the medical profession in the past. The history of surgery can teach us that much. It is our responsibility to take note.

But enough of my mash note. Dr Stock is such a fascinating figure because she represents everything about being a lesbian that men — no matter how much they stamp their massive feet in their stripper heels — can never possess. It’s nothing to do with pornography and lipstick, the twin pillars of this strange new faith; she highlights the profound emptiness of their performative fantasy of femininity.

Where once society was defined by Penis Envy, Lesbian Envy is today’s driving force. So much performative thespian-lesbianism has taken place in popular culture that you’d think every woman was at it, but if we regard the history of lesbianism, most of it has gone on in secret.

Many lesbians point out that, historically, there has been little overlap between the problems and pleasures of lesbians and homosexual men. Men are reviled for it in the Scriptures and have had laws passed against them, while women are more likely to simply be ignored, culminating in Queen’s Victoria’s refusal to believe that lesbianism existed. Yet, at the same time, homosexuals had great power in the Greek and Roman empires, while lesbians certainly didn’t. While Oscar Wilde could be a tragic martyr to The Love That Dare Not Speak Its Name, lesbianism has long been easy to reduce to titillation and entertainment. If you admire the female form, the onanist logic goes, why not admire it times-two? And, unlike with straight porn, there won’t be any well-hung male hanging around to make you feel bad about yourself.

This can lead a certain type of man to feel that, even for them, lesbianism can be a little something on the side, even something which adds to their own appeal. In the Nineties, I had an idea for a Bateman-style cartoon that portrayed a man being shunned by his contemporaries: The Man Whose Wife Wouldn’t Do Girl-On-Girl. It was around this time, during my second marriage, when I fell for a woman and my second husband gave me “permission” to see her, even doing a humorous routine for his friends: “Lesbians make such fascinating wives!” He wasn’t laughing when I left him for her, whereupon I uttered the classic line to the Evening Standard gossip column: “Miss Raven and I are not lesbians — we are simply in love.”

I wasn’t being super-straight or shy in saying this. Rather, I was aware that being the capricious creature I am, I didn’t feel morally worthy of bearing a name which brave women had suffered for, simply because I was following a whim which I was pretty sure I wouldn’t be indulging in for long. (Sure enough, I soon ran off with her brother.) Today, by contrast, straight people stampede to call themselves queer, so prevalent is the idea that “heterosexual equals bad” and “homosexual equals good”. There are so many young women holding up their baby boys on social media and pronouncing them “Gay!” that I’ve often thought that if a certain sort of young woman could be guaranteed to have a gay baby, the moribund birthrate of the West would shoot up.

But lesbianism has been ditched by those with the most claim to it and who could be most inspired by its history — a dirty word among young girls who prefer to be acceptably queer or trans. As the young American pop and reality TV star JoJo Siwa said last year: “I don’t like the word [lesbian] itself. It’s just like a lot. At the end of the day, that’s what I am… but it’s like the word moist. It’s just like… ugh!”

Meanwhile, contemporary gender activists do their very best to make lesbianism sound not “sexy fun”, as it was from Tallulah to Tatu, but just another workaday drudgery of dealing with the worst sort of pervy, grope men. As no less than John Hopkins University this month noted in its online glossary of LGTBQ terms, a “lesbian” is someone who is a “non-man attracted to non-men”.

Amid this erasure of women from lesbianism, there was something particularly lovely — and not just for lechers — about the case of the lesbian beauty queens Miss Argentina Mariana Varela and Miss Puerto Rico Fabiola Valentin who met at the Miss Grand International pageant in 2020 and married last year; supernaturally beautiful, both had surveyed the men of the entire planet and found them inadequate. And yes, of course it’s a proper pay-day for capitalism when two brides decide to outdo each other in the grandeur of their marital meringues — but it’s also gorgeous to see femininity unbound.

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Why should lesbians sleep with men?

By Kathleen Stock

It confirmed that modern lesbianism, far from being the furtive trauma of the past, has the potential to be a hen-night that never ends, avoiding that morning-after let-down when one of the giddy girls is given away by one sober suit to another and must now knuckle down to the humdrum habits of adult life. Even when lesbianism begins as little more than a cheap thrill or a style tip, it has the power to bring down worthless heterosexual unions, which can only be a relief all round. All that disposable income and free time can’t help but give a happy couple a head start when it comes to fun — and, of course, the unshakeable advantage of doing something that society doesn’t really approve of, which has a way of keeping people young like nothing else. Which is all the more reason why it must be guarded from incursion from the male sex. When I was a youngster, the sure sign of a creepy man was that he would refer to himself as a lesbian trapped in a man’s body; it still is, only this time they don’t slink away nursing their semi when you laugh at them, but call you a fascist.

So, back to my adored Doc Stock, hated so often not for her words but because she shows what a woman is; not the way you dress, or sit, or present. It can’t be bought. A woman is whatever a woman wants to be — and what a man cannot be. And, most of all, what a man cannot be is a lesbian.

I had joined the paper’s staff around the turn of the century as a trainee journalist, progressing to social affairs reporter, senior writer, leader writer and, most recently, weekly columnist. For the most part, my views aligned with the paper’s superego, which fluctuates between soft Left and small “l” liberal. And there was always space for dissent, even when my opinions sharply diverged from The Age consensus — more on that soon.

About two years ago, my harmonious relationship with the paper began to deteriorate. The tension reached its climax last week when the editor, Patrick Elligett, sacked me as a columnist. The breakdown in trust was down to one issue: gender-identity politics, the trans debate — or severe lack thereof.

My dismissal was linked to a feature I wrote on youth gender transition that had been commissioned by a previous editor, Gay Alcorn, and which Elligett had refused to run. In response, I told Elligett that I intended to publish the piece on my new Substack and would disclose that he rejected it. He looked uncomfortable, but said The Age would take it on the chin.

And so, early this month I published the feature, announcing to the world that if they wanted to know why the piece was rejected, they would have to ask Elligett himself. A standing army of gender sceptics on Twitter did just that, under the hashtag “gutless” . This can’t have been pleasant for Elligett. But he attributed the sacking to another remark in my launch statement where I flagged that in future posts I’d be writing on gender-identity politics more broadly, “without the copy being rendered unreadable by a committee of woke journalists redacting words they deem incendiary, such as ‘male’”. Elligett responded: “Obviously we can’t have our columnists publicly disparaging the publication like that so we won’t be commissioning further columns from you.”

In the piece he refused to publish, I discussed the growing debate around “affirming” care for children and teens in gender distress, and the use of puberty blockers and cross-sex hormones. While the controversy attracts regular coverage in Australia’s Murdoch-owned press, it remains taboo in the progressive media, where the “no-debate”, “the science is settled” mantras are consistently reinforced by stories of young people blossoming post-transition. The worst offender is the ABC, Australia’s equivalent of the BBC. The public broadcaster has even been rebuked by its own Media Watch programme for failing to report on the closure of the NHS’s scandal-hit gender clinic for children in England and Wales, the Tavistock; and for its partnership with Australia’s Stonewall equivalent, Acon, on the grounds it could lead to “perceptions of bias in coverage, or bias itself”.

Yet here’s the interesting part: Elligett said very little to me about my piece, other than that it was “good”. We had discussed it in late March, about a fortnight after Melbourne’s Let Women Speak rally, which was gatecrashed by neo-Nazis and which I had attended out of professional curiosity. The problem, he said, was not the piece, but its author: me.

He said I had nailed my colours to the mast on trans issues, so my byline would create a perception of bias. I said I had no firm view on paediatric transition. (You don’t have to believe in unicorns to see the affirmation model as an attempt to save kids from life-crippling distress and stigma.) He said that, nonetheless, publishing the piece under my name would damage the reputation of “the masthead”.

Let me attempt a translation: I had been pegged as a “Terf”, a trans-exclusionary radical feminist, a category into which many a reality-based woman, or indeed man, self-identifies. And this meant I was considered partisan where a veneer of neutrality was required.

I’m sad about what’s happened; as I know Elligett is, too. In writing this piece, I’m not seeking vengeance or vindication. Nor is this a “woe-is-me” story. On the contrary: I’m hugely grateful to the people I worked with. They saved me from howlers, and fixed my sloppy prose and wobbly reasoning more times than I care to admit.

But I feel a sense of obligation to commit to the historical record yet another account of a newsroom buckling under the challenge of gender-identity ideology: the belief system that deems “male” and “female” as more a state of mind than of body, and casts even the most gentle questioning of the doctrine tantamount to bigotry.

In this, I can’t help but be reminded of Hadley Freeman’s fate, save that she left The Guardian voluntarily. She started there at around the same time I started at The Age. Like Freeman, I’m a veteran Left-leaning campaigner for the rights of sexual minorities. Like Freeman, the main tension I found myself navigating in my early years in the newsroom involved Israel. Like her, I’m Jewish and a Zionist. As a leader writer, I was sometimes asked if I was sure I could write “objectively” on Israel and Palestine. As with Freeman, the odd colleague would lecture me about what I should and should not consider to be antisemitism.

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By Kathleen Stock

But as a columnist, I found no issue off-limits. Sure, sometimes an editor would disagree with me. Some had little appetite for edgy, post-9/11 critiques of the Left’s accommodation of political Islam. And most merely tolerated my regular meltdowns about government funding of private schools; they didn’t relish the blowback from the well-resourced private school lobby, or, indeed, from the great many Age readers who sent their kids to posh schools. I’m also yet to live down effectively backing the US invasion of Iraq long after the original liberal hawks had issued their mea culpas. Still, in no universe could I have predicted that ground zero of the culture wars would be the definition of a woman as an adult human female.

My first foray into the transgender debate was in February 2021 when Readings, Australia’s largest independent bookseller, apologised for having hosted an event three years earlier with Julie Bindel, the British radical feminist. This was a post-facto cancellation. In my column, I affirmed both sides of the discussion. “Each is mighty and indivisible,” I wrote. I saw the fight between the subjective (gender identity) and the objective (embodied sex) — a bit like how Amos Oz saw the fight between Israel and the Palestinians as a war between “two rights”.

My piece was well-received, but mostly ignored. Recently on Twitter I saw someone cite the column as evidence I’d once belonged to the #BeKind brigade, which was a bit harsh. I still subscribe to the views I expressed; to even speak of a conflict of rights is to acknowledge there are, in fact, two legitimate sides. I not only accept that trans people “exist”, but also that their right to dignity and equal opportunity requires the rest of us to affirm their identities to the greatest possible extent, at least in so far as the affirmation doesn’t undermine others’ sex-based rights. When these two rights conflict, it’s surely the job of governments to ethically adjudicate between the competing interests.

But gradually it dawned on me that Labor governments around Australia weren’t just failing to adjudicate between conflicting rights — they proudly disavowed a conflict even existed. “Anyone who identifies as a woman is a woman,” said Queensland’s Minister for Women and then Attorney General, in May, to the widespread indifference of the media.

Then, a year ago, Rohan Leppert, a senior member of the Victorian Greens, inadvertently laid bare the serious ructions in his party over trans issues. Members were calling for Leppert to be disciplined after comments he made in a private Facebook group came to light; shockingly reasonable comments, needless to say, about the affirmative care model, the state’s sledgehammer conversion-therapy laws and the conflict over single-sex spaces. Should I have held back?

I filed a column in which I defended Leppert’s views and his right to express them. The editing process was hell. I had referred to the pressure on women to cede their spaces to “males who have not medically transitioned”. Intense pressure from an unknown number of journalists further down the food chain saw the word “males” become “people” in the final copy. Hence the crack that got me sacked.

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By Hadley Freeman

This was my first encounter with the self-appointed queer caucus. As to how many journalists sit on it, I’ve heard conflicting accounts. Less than a handful of zealots. Everyone aged under 30. Half the newsroom, when putsch comes to shove. The article ran under the headline “Trans rights shouldn’t automatically trump the rights of other groups”. This one got noticed.

The response to the piece was overwhelmingly rapturous, if only for the sheer relief that a Lefty journalist was saying the usually unsayable. But on Twitter, transactivists and their allies made chopped liver of me. I had interviewed two of these activists for my as-yet-unpublished paediatric transition story. They redacted their interviews, claiming — falsely — that I had deceived them about the story’s angle. (I would later learn that two female candidates for the Animal Justice Party in Australia’s upcoming federal election were ordered to undergo re-education after sharing or “liking” the column on social media. They resigned instead.)

A formal complaint was made about the piece to the industry body, the Press Council. It’s a frequent tactic of the trans lobby, aimed at keeping the progressive media on message. By contrast, it isn’t too exercised about Sky News and the Murdoch empire running “anti-trans” stories; in fact, such coverage helps them deter principled critics of the transactivist agenda who fear playing into the hands of “the Right”.

The Age began desperately hawking space on its opinion page for a “pro-trans” piece to “balance” mine. The transactivists refused: I was beyond the pale, too hateful to be savaged with intellectual argument. Ultimately, the takedown fell to the “Victorian Commissioner for LGBTIQ+ Communities”, in his words, “a young, queer Wiradjuri cis-man”. He accused me of creating a false divide “between women’s rights and the rights of trans people”, but didn’t explain why the divide was false. Nor did he address the concerns of “L”s within his remit who believe he’s sold out their interests to the “T”s.

In August, I learned that a detransitioner in Sydney — who had had testosterone treatment, as well as a mastectomy and hysterectomy before re-identifying with her birth sex — was suing her psychiatrist for negligence. The Age and stablemate The Sydney Morning Herald were keen on the story. Once again, the editing process was hell. This time, transactivist talking points appeared suddenly in my copy: “Trans groups say that the highlighting of those who de-transition is part of a campaign by anti-trans activists to de-legitimise gender dysphoria.”

Hilariously, they couldn’t even get their propaganda talking points right. Almost no one denies that gender dysphoria is a thing; they had meant to say “de-legitimise trans identity”. My critics were themselves trying to de-legitimise a straightforward report about a legal case, not to mention the testimony of a traumatised woman.

After I pointed this out, the lines were removed and the story ran on the front page. The following day, the mood in the newsroom was described to me as “edgy”. The day after that, the paper published a letter to the editor accusing me of “transphobic rhetoric.” This was a bit much. It was one thing to be called a transphobe on Twitter; quite another to read the accusation in my own paper. I raised the matter with the editor, who apologised, citing a breakdown in internal processes.

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By Suzanne Moore

Before learning of the detransitioner’s case, I’d filed an entertaining column about Scotland appointing a bloke as its inaugural “period dignity officer”, his stated ambition to make menstrual products available to “anyone of any gender”. The column, being trans-adjacent, was spiked. I was told I couldn’t violate the church-and-state divide between commentary and reporting; I had started reporting on trans issues so now I couldn’t commentate on them.

The editors were, in part, trying to save me from myself. I was told they didn’t want me to end up “a Suzanne Moore” — a reference to The Guardian columnist martyred after her colleagues waged a campaign against “transphobic” content. And yet, just as The Guardian had done, The Age invited an LGBTQI+ organisation to address the newsroom about avoiding “harm” in their reporting on trans issues.

I went on sulk leave.

On my return, by which time Elligett had taken over as editor, I found the de facto gag order still in force. The state of Queensland was ushering through Parliament a gender self-ID bill similar to Scotland’s Gender Recognition Act, at roughly the same time that a doomed Nicola Sturgeon was tying herself in knots over whether a two-time trans-identified rapist — initially housed in the female prison estate, post-conviction — was “a woman”. (The bill was passed last week to the usual triumphal reporting.)

Similar legislation. Identical propaganda lines. And here, also, violent sex offenders were being sent to female prisons. I was told no. There was no “news trigger”.

But the mother of all news triggers came in March, when Kellie-Jay Keen-Minshull, aka Posie Parker, the British women’s rights campaigner widely credited for popularising the term “adult human female” to define a woman, staged a Let Women Speak rally in Melbourne

I was — still am — looking to write a book on gender-identity politics in Australia. I thought the rally might yield a dynamic narrative, what we journalists call “colour”. I got colour all right: armed and mounted police several columns deep, two frontlines of counter-protestors of varying and bewildering political tendencies, and neo-Nazi gatecrashers performing a Sieg Heil on the steps of Parliament.

The Age published a very fair report in the immediate aftermath. But among the newsroom editors, a clear “line” took root: Parker was clearly linked with “far-Right” groups — the black-clad neo-Nazis had turned up to “protect” her. Never mind that in the week before the rally, far-Left groups had plastered the city with posters urging the comrades to turn up and fight the “far-Right”. Never mind that such rhetoric lures neo-Nazis to the scene just as flies are lured to shit.

Having been at the scene of a huge story, I pushed to write an op-ed on the rally. I explained to the editors that I was incensed at the response of Victorian Premier Daniel Andrews, whose pro-trans government was the primary target of the protestors’ anger. The women who came to speak came from all walks of life: Christian conservatives, butch dykes, Jewish Leftists, disaffected Greens, health workers, women in hijab.

But in the rally’s aftermath, Andrews tweeted: “Anti-trans activists gathered to spread hate. And on the steps of our Parliament, some of them performed a Nazi salute.” I told the day’s op-ed editor that, in saying this, Andrews had at best slurred the women as hateful bigots; at worst, he’d conflated them with the neo-Nazis. “Well, that’s your interpretation,” the editor responded.

Frankly, I’m happy the column didn’t run: the pressure to describe Parker as associated with the “far-Right” strained the logic and the tone. (And, oh, it also happened to be wrong.) The piece wasn’t good enough, I was told. There were too many holes. The timing was wrong. I had glossed over “the Nazis’” appearance. “And then,” the editor said, “you have these… paragraphs of Terf rhetoric.” I think we both knew there would be no coming back from that moment.

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The Labour Party has a woman problem

By Rosie Duffield

The shockwaves from the rally were felt in the Liberal Party, the Greens and Melbourne University, bringing repercussions for many of the women who had attended and, I’m sure, for plenty who didn’t. By the time Parker arrived in Auckland, the ugly rest is history: her dousing in tomato juice, the slack policing and crowd surge, a woman in her 70s punched in the face. The placards reading “Suck My Dick” and “Get off our land, CUNT!” This — apparently — is what progressivism looks like in the 21st century.

After Elligett said he wouldn’t run my piece on paediatric transition, it became clear that I could neither report nor commentate on the trans issue, even as it made headline news day after day. When Barry Humphries died, for instance, I was told I was allowed to write about his cancel-culture controversy with the Melbourne Comedy Festival — so long as I didn’t focus on the anti-trans comments that had prompted his cancellation.

In the end, like Freeman, I felt I could no longer write about anything that viscerally mattered to me. Hoping against hope, I pitched a column that would advocate for nationalising the education system. That weekend, half the Saturday magazine was a paid advertisement for the private school sector.

My mood darkened. I went on sulk leave. Indefinitely, as it turns out.

My last column for the paper was pegged to Mother’s Day. It tackled the female body and ageing, the intergenerational feminist struggle. I wrote about Victoria Smith’s book Hags: The Demonisation of Middle-Aged Women, and how it had “radicalised” me. Smith speaks for us middle-aged Gen Xers; how it’s now our turn to wear the age-old slur of “hag”, “witch”, or a contemporary variant such as “Karen.” There’s another slur I could have used, one that Smith writes about at length in her book: “Terf.” But I knew I had to leave that word out.

At the start of November, an assortment of 29 high-profile UN representatives, human rights lawyers, academics and LGBTQ lobbyists flocked to the sultanate city to attend a conference at the Gadjah Mada university. There, over four days, they hunkered down to craft a document they would call the Yogyakarta Principles.

Having tried and failed to convince conservative countries to include protections based on sexual orientation and gender identity in UN resolutions, the drafters, led by Irish ex-priest Michael O’Flaherty, sought to demonstrate how any country that had signed up to the Universal Declaration of Human Rights was obliged to grant them anyway. Their ambitious interpretation claimed “the right to recognition as a person before the law” automatically included the right to legal gender self-ID, while “the right to health” obliged states to “facilitate access by those seeking body modifications related to gender reassignment”.

The Principles were not legally binding, nor did they cite any legislation. Indeed, according to one of its signatories, O’Flaherty insisted that his fellow drafters ignore the legal reality. The Yogyakarta Principles, then, were simply a wish list. Perhaps it was hoped that the heft of the reputations of the drafters would be enough to cajole NGOs, legal professionals and governments into taking them seriously. If so, they seem to have been right.

Sonia Onufer Corrêa, a Brazilian activist and one of the attendees, later admitted that Indonesia was only chosen because the drafters wanted a Muslim country, so as to avoid the impression that the edicts came from the decadent West. It bears noting that the Sultan of Yogyakarta himself never adopted the Principles for his own city; in fact, the situation for LGBT people there had become so untenable by the time the Principles came up for review in 2017 that they had to find a friendlier host city, Bangkok.

Never mind. The location was always just a smokescreen. The real unveiling of the Yogyakarta Principles came in 2007, when they were officially launched in New York and Geneva. It was undoubtedly a triumph. While O’Flaherty and his crew were unable to convince conservative African and Islamic countries to adopt the Principles, Western nations were more than eager to get on board. Pick a country and evidence abounds; from legal self-ID, to hate speech laws, to conversion therapy bans, the drafters have had more success than they surely could have hoped for.

At the heart of their campaign was a raft of evidence alleging to show the use of torture against gay, lesbian and trans-identifying people. Such abuse had been reported as early as 2001 by Amnesty International, who described the brutal violence suffered by the travestis of Central and South America at the hands of police and the johns who paid them (or not) for sex.

According to Article 5 of the UN’s Declaration of Human Rights, “no one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment”. The Yogyakarta drafters interpreted this to cover conversion therapies based not just on sexual orientation or sex characteristics, but also gender identity and even gender expression. Expanding on their rather short interpretation, one of the key organisations behind the Principles, the International Commission of Jurists (ICJ), helpfully provided a more detailed technical guide for legal professionals in 2009.

There was one problem, however. “International human rights systems,” warned the ICJ, “have not yet dealt with an individual petition or communication specifically relating to issues of sexual orientation and gender identity in relation with the prohibition of torture.” In other words, there wasn’t sufficient evidence.

But a group of lawyers in the US, led by the National Council for Lesbian Rights (NCLR) in collaboration with the Trevor Project, was working on it. Since 2009, a movement to expose the horrific practice of conversion therapy against gays and lesbians (though not trans-identifying people) had been underway in America. And in 2013, the NCLR began planning a campaign to convince lawmakers that conversion therapy constituted a breach of the Convention against torture, to which the US was a signatory.

With the support of the UN’s special rapporteur on torture, who had just issued a report on ill-treatment in healthcare settings that included “reparative therapies” carried out on LGBT people, they sought an audience with the bodies that oversee the UN Convention Against Torture (UNCAT). These were made up of committees of experts in torture from around the world, one of whom was Victor Madrigal-Borloz.

At the time, Madrigal-Borloz was secretary-general of a Danish NGO called the International Rehabilitation Council for Torture Victims. According to an anonymous source, once in the job, he began planning an expensive multi-day showcase event in Mexico City which plunged the NGO into an extremely precarious financial situation. The situation was exacerbated by the fact that the NGO was not producing results, and funders were pulling out.

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An FOI request by journalist Dorte Toft later found that the Danish development ministry, DANIDA, ordered an external investigation that concluded IRCT’s travel budget didn’t make sense based on the activities of the organisation. They also said the secretary-general’s salary was too high and that he had too much power over budget decisions. Overall, they concluded, the management of IRCT — financial and otherwise — was a disaster. By this point, however, Madrigal-Borloz had skipped off to this next appointment as the UN’s “independent expert”.

In November 2014, around the same time that the IRCT was haemorrhaging money intended for torture victims, the NCLR had been granted an audience with Convention Against Torture treaty experts in Geneva. They brought along a star witness, who tearfully spoke of the horrific electric shocks and beatings that his therapists and parents had subjected him to in an effort to turn him straight. His name was Samuel Brinton, and he would later become known as the non-binary Biden staffer caught stealing women’s suitcases from airports.

According to one of the lawyers who brought Brinton to Geneva, his testimony elicited gasps from the UN panel. How could this still be going on in 2014? After all, state-level efforts were already underway to outlaw conversion therapy. And media reports from the time suggest that existing bans covered “ex-gay” practices familiar to most people: the religious ministries and pseudotherapy sessions that sought to turn homosexuals straight.

But this wasn’t just about gay conversion therapy. “Gender identity” had also started to appear in legal texts around the subject, despite the fact there was scant evidence that praying away gender identity was a thing. This was about to change. Just a few weeks after Brinton’s performance in Geneva, the contents of which journalist Wayne Besen has convincingly called into question, a trans-identifying teenage boy allegedly walked out in front of a tractor-trailer on a highway in Ohio. In a Tumblr suicide note, Leelah (born Joshua) Alcorn criticised his parents, who chose “biased” Christian therapists to help him deal with depression, and who wouldn’t allow him to medically transition.

His mother, a Christian, was vilified for misgendering and deadnaming him. She told reporters that he had only mentioned being transgender once, that she had never even heard him use the name “Leelah”. She also claimed that he was deeply depressed. His neighbour, apparently a close friend, also used male pronouns throughout his TV interview.

But while it wasn’t the Brinton-style torture story the transactivists had perhaps been waiting for, it was enough. A few days after his death, a White House petition calling for “Leelah’s Law” was launched. By March 2015, Obama said he would support a federal ban. By September, UN agencies officially began officially referencing torture in relation to violence against LGBT people.

Malta was first out of the gate in December 2015 with a ban; Germany, France, Belgium and some parts of Spain have all since followed. Mardrigal-Borloz, who had by this point taken up a gig as the UN’s independent expert on sexual orientation and gender identity, immediately started pushing for states to legislate for conversion therapy bans.

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In 2017, the UK first commissioned research into the practice. Organisations such as Stonewall exaggerated the results of that research, even leading their coverage of polling on the subject with the claim that one in five trans people have suffered conversion therapy, when the data reveals nothing of the sort. The proportion, according to the survey results, of LGBT people “pressured to access services to question or change their sexual orientation when accessing healthcare services” was 5%.

Interestingly, after a failed first attempt to introduce a ban in 2018, Ireland is now having another go. This time it is backed up by an all-island (including Northern Ireland) group called the Anti-Conversion Therapy Coalition. While, from the outside, this might look like an inspiring cross-border initiative, it’s more likely to be because no evidence was found in the Republic, leading Irish activists to look forlornly to the North’s fire-and-brimstone protestants who have been known to offer (though not force) pray-away-the-gay services.

In France, things were even more weird. Lawmakers wanted proof that the country was suffering from an epidemic of conversion therapy that would necessitate a new law. In response, Laurence Vanceunebrock, parliament’s rapporteur on the subject, insisted that they had to pass the law in order to reveal the crime. As evidence, Vanceunebrock repeatedly claimed that there was a secret clinic carrying out electroconvulsive therapy on homosexuals in Montpellier. This drew the ire of the region’s medical association, which claimed that such a clinic would require specialised equipment and expertise that couldn’t possibly have passed under their radar. No witnesses ever came forward, despite an appeal.

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Then, in 2021, when the law was already a done deal but not yet in force, a teenage trans-identifying female called Enzo was kidnapped, brought to a barn in the French countryside and tortured, in order to exorcise her of her transness. The rainbow NGOs kicked into high gear; #LiberezEnzo trended on social media, activists scoured the countryside looking for the barn, and Vanceunebrock was finally vindicated.

It soon transpired, however, that Enzo was at his grandmother’s house the whole time, and the family were working through their issues. The police, and Enzo, asked everyone to calm down and leave them alone. The barn was never found. Yet the law is now in force in France; efforts to modify or reprimand a person’s sexual orientation or gender identity can be punished by up to €45,000.

As for the Yogyakarta Principles, they received an upgrade in 2017, when Victor Madrigal-Borloz came on board as a signatory. And the newer version is even more extreme; it explicitly calls for an end to sex registration at birth.

Madrigal-Borloz, meanwhile, will step down from his UN mandate at the end of this year, and the extent of his success is currently being evaluated. All the signs suggest he will be lavished with praise. But as the 16 years since that fateful meeting in Yogyakarta have demonstrated, making a crime out of conventional therapy for gender-distressed teens has hardly been a victory.