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.

Burke’s story has been something of an odyssey, and so commentators have been apt to seek shortcuts to make sense of it all. His defenders claim that he has been persecuted by the state for his Christian faith and opposition to trans ideology. His critics insist that he was suspended for gross misconduct at a school chapel service, that he has persistently flouted the rule of law, and that his imprisonment has nothing whatsoever to do with transgenderism. Both of these positions contain elements of truth, but they are also incomplete. 

The dispute began in early 2022, when the school’s principal, Niamh McShane, emailed staff instructing them to refer to a male student by a female name and the pronouns “they/them”. The following day, Burke wrote to McShane to raise his objections, and to seek clarification on whether parents had been informed that staff and students were required to adopt this change.

His concern was uncontroversial: in a Christian school, social transitioning runs directly against the institution’s ethos. Since the findings of the Cass Review into pediatric “gender-affirming care”, we also now know that the practice of adopting preferred pronouns and names at school is “not a neutral act”. It can have the effect of “locking in” perceptions of gender and identity that make future medicalization more likely. It is, in other words, a perilous psychological intervention by teaching staff who are completely unqualified to make such decisions.  

Burke wrote again to challenge the policy and state that he would pursue the matter further. He additionally raised it with the Bishop of the Diocese. At a later meeting with the principal and her deputy, he reiterated his objections. McShane responded on 27 May, insisting that the child be addressed according to the preferred name and pronouns, citing the Equal Status Act 2000. She acknowledged that this might be difficult given Burke’s beliefs, but required compliance nonetheless. In effect, this amounted to a case of compelled speech.

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On 21 June, Burke challenged McShane at a chapel service attended by staff, alumni, governors and a handful of current sixth-form students. He reiterated his religious objections to transgenderism and, according to one report, ‘followed the principal and publicly harangued her’. Commentators have repeatedly claimed that it was this outburst, and not his position on gender ideology, that resulted in his suspension by the Board of Trustees. However, the Court of Appeal has confirmed that Burke’s refusal to use the pupil’s prescribed name and pronouns was a fundamental factor in his suspension.

Burke insisted that his punishment was unjust, and that his constitutional rights to freedom of religion were being infringed upon. He continually returned to the school, insisting that he be allowed to continue teaching his classes, until the school sought a court order to prohibit him from entering the premises. Burke defied the order repeatedly, and his time in prison has now totaled in excess of 500 days. The courts have also tried to prevent him from returning to the school by fining him for every day he turns up. Of the approximately €222,000 of fines he has accumulated, €40,000 has been taken from his salary, leaving him in considerable debt to the state. 

Burke’s protest is not simply against the school, but against a legal system that he sees as complicit in a broader societal takeover by gender ideology. On this, he has a point. When I was in the Dáil (the Irish parliament in Dublin) for a free speech summit last June, I noticed that a Progress Pride flag had been etched permanently onto one of the glass doors that all parliamentarians must pass through. The message is clear: irrespective of your politics, you must pay fealty to this divisive new orthodoxy.

The tortuous legal battles between Burke and the state have obscured the original problem. We have a state-funded school enforcing a doctrine that is in direct opposition not only to the Christian beliefs on which it was founded, but to the views of a substantial proportion of the Irish population. The creed is propagated largely by members of the ruling class, with little regard for its unpopularity among the people they are meant to serve. Moreover, the school’s claims to be upholding the “welfare” of its pupils are incoherent given the findings of the Cass Review, and the fact that “social transitioning” puts young people at risk.

Had the school been a private institution, and had Burke voluntarily signed a contract which incorporated an expectation that he should promote a belief-system that was antithetical to his own, then he would have no case. But the school is guilty of promoting highly contested theories as fact, endangering pupil welfare, and compelling the speech of its staff. Moreover, the school authorities appear to have failed to recognize their own ideological capture, or to take on board the validity of the criticisms. This is a serious breach of their responsibilities and is highly unethical. Burke was entirely right to object.

His manner of protest is more dubious. His family has been accused of disruptive behavior in court, with the judge claiming that they have systematically attempted to derail the proceedings by repeatedly hurling invective and abuse. Burke’s tactic of returning to his place of work in spite of the suspension might have been a powerful form of peaceful protest, but the presence of children makes the approach ethically unsound. Some pupils have greeted Burke outside the school with warmth and offered him their support, but the principle of safeguarding means that trespassing on school property cannot ever be tolerated.

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All of which brings us back to the key question: how is one to oppose unjust systems while being expected to live and operate within them? Perhaps a better tactic would have been for Burke to simply refuse to comply with the speech edicts following the meeting on 19 May. The principal had no right to impose a new policy that bears no relation to Burke’s agreement terms of employment, let alone one that endangers pupil welfare. Burke would have had every right to take a stance of non-compliance and, had he been suspended for this, his case would have been much stronger.

By continually appearing at the school, he has enabled the focus to shift from the school’s misconduct to his own disregard for court authority. His protest became the issue, rather than the policy he was protesting. Yet he is also perhaps right that extreme forms of peaceful protest might be necessary in a climate of such stifling orthodoxy, even if that means imprisonment. Typically, such actions would be necessary in tyrannical regimes. One example would be Narges Mohammadi, the Iranian women’s rights campaigner who has been arrested on 13 occasions and sentenced to 31 years in prison. But to see an Irish citizen so determined to spend time in jail to prove his point is remarkable. 

There is a long tradition of civil disobedience that supports Burke’s view. In his “Letter from Birmingham Jail” (1963), Martin Luther King, Jr, makes the case for a specifically liberal method of tackling unjust laws: “One who breaks an unjust law must do so openly, lovingly, and with a willingness to accept the penalty. I submit that an individual who breaks a law that conscience tells him is unjust, and who willingly accepts the penalty of imprisonment in order to arouse the conscience of the community over its injustice, is in reality expressing the highest respect for law.”

​​The law is no guarantee of morality, and unjust laws undeniably exist. To take the UK as an example, there are currently laws on the statute books that are overtly antithetical to the principle of free speech. For example, Section 1 of the Malicious Communications Act 1988 outlaws the sending of a “letter, electronic communication or article of any description” which is “indecent or grossly offensive”. Section 127 of the Communications Act 2003 likewise prohibits words that are deemed “grossly offensive”, but adds another authoritarian twist by stating that a person may be found guilty if he or she has caused “annoyance, inconvenience or needless anxiety”. Such vague legislation is a gateway to exploitation by a state that might seek to silence its critics.

Burke takes the view that the Irish government has embraced an unpopular but fashionable ideology and insisted that it be baked into its legal system. After all, the notion of self-ID has led to violent men being accommodated in women’s prisons. To break the law in the service of a moral cause seems counterintuitive, but it is one of the mechanisms by which awareness of bad laws can be raised, thereby increasing the possibility of their repeal.

Burke doubtless considers himself to be very much in this tradition of protest, but this is not necessarily a compelling justification for his actions. Just Stop Oil campaigners who have been incarcerated for their protests think of themselves as “political prisoners”, and yet this view is unlikely to be shared by those who disapprove of their cause. When it comes to Burke, it is surely legitimate to ask whether his strategy has undermined rather than strengthened his case. With children caught in the middle, and the legal proceedings overwhelming the central ethical issue, the school’s outrageous behavior has been overshadowed. But it is also true that Burke has engaged in a form of peaceful protest, motivated by conscience, and undertaken with full willingness to bear the consequences.

I am not qualified to say whether Burke’s method of protest is the right one, whether it has been effective or counterproductive. Of course, whether a cause is worthy of civil disobedience is a matter of opinion, and just because someone believes a law or system to be unjust, that does not automatically make it so. But amid all the clamor and commotion, we shouldn’t lose sight of why this protest was necessary in the first place. A school was enforcing a creed it had no moral right to impose, and one employee refused to comply.

Despite the recent Supreme Court ruling, some parts of the UK seem more stuck in transactivist delusions than ever. But this week, tantalizingly, I discerned signs of imminent collapse. The Scottish media appears gripped by the Sandy Peggie tribunal, with daily revelations of unsympathetic NHS managers defending the presence of a male doctor in the nurses’ female-only changing room. One newspaper even referred to the man at the heart of the case as “he”. Down south, the NHS has announced the terms of reference for a rapid investigation into a Brighton GP practice that prescribed puberty blockers to minors, and it sounds like it is not messing about. And in academia, Oxford philosophers Daniel Kodsi and John Maier just published an excoriating takedown of the Yale philosophy department’s own attempt to prop up child transition.

I am obviously particularly fascinated about what is happening in my former discipline. For years, I watched as a small number of philosophers, on both sides of the Atlantic, took a barely comprehensible proposition from the internet — “trans women are women and trans men are men” — and tried to build a system around it. The central proposition was treated as non-negotiable; any datum that didn’t fit would have to be jettisoned. Those who objected were either insufficiently well-read, too stupid to understand complexity, or simply bad actors. Quiet lifers across the Anglosphere quickly read the seminar room and went along with things.

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The logician W.V.O. Quine argued that beliefs exist in holistic webs: each belief is interconnected and mutually supported by lots of others. If you reject one, you normally have to make adjustments elsewhere. Faced with a new, apparently confounding piece of evidence — say, the sight of a friend in London, who you believe to be in Dundee — you are more likely to update beliefs near the periphery of your web (“she is not in Dundee”; or “I mistook someone else for her”) than its center (“people can be in two places at once”).

Still, it is always possible to work from the center outward. Genderists in philosophy parachuted “transwomen are women” into the middle of their webs, defined a “woman” as anyone who said they were, and renamed the ensuing epistemological anarchy “progress”. And they were perfectly open about it. In 2020, for instance, Sally Haslanger, the Ford Professor of Philosophy in the department of linguistics and philosophy at MIT, told an interviewer: “if we wanted to include trans women among women, the body wasn’t sufficient… the pressure was to find a conception of woman that would enable us to accommodate all these differences”.

Once in the semantic upside down, there was a lot of profitable work for these web-spinners to do: not just to re-theorize every human idea and practice formerly conceived of as sex-based; but also to build up a satisfyingly dark story about the women and men who would not comply. Haslanger became a fan of authoring open letters, and other heroines in philosophy rose to the occasion too. “I hesitate to attach the label feminist to any view that is committed to worsening the situation of some of the most marginalized women,” wrote Jennifer Saul, a senior philosopher of language at the University of Waterloo, putting a typically charitable gloss on dissenters’ attitudes to trans-identified males. “No one really wants a mercy fuck, and certainly not from a racist or a transphobe,” wrote the Chichele Professor of Social and Political Theory at All Souls, Isaiah Berlin… only joking, I mean Amia Srinivasan, reframing erotic attraction toward a single sex as ethically problematic, whether hetero or homo.

Even during my most depressed phases in academia, I knew that these people were taking a big risk — albeit one they apparently didn’t notice. The higher they flew in daring reconstructions of familiar concepts, the further there was to fall, should their central proposition be later rejected. And surely it eventually would be. For “woman” and “man” are categories associated with distinctive visual appearances, and the adaptive capacity to discern the difference between them has been honed over millennia. Sometimes you just know you are looking at a man, despite what the people with the fancy titles are telling you. Indeed, it is a testament to the awesome chutzpah of the latter that they ever thought they could persuade people otherwise.

The risk for them, to be clear, was not merely that they would be proved wrong, a common enough occurrence in philosophy; but that they would be revealed as quite thick. If trans women are women, then not only are there surprisingly high numbers of children in the wrong bodies, women rapists, and mediocre female athletes etc, but those far-sighted philosophers making the case are bravely speaking truth to power. If trans women are in fact men, and have been all along, then the only major revelation is just how many gullible idiots have got into prestigious positions in academic philosophy.

Circa 2019-2022, these women — and they were mostly women — were trying in their own way to be what Cass Sunstein has called “norm entrepreneurs”. Their preferred norms quickly cascaded through a mostly male discipline, one made timid by several high-profile scandals, and with a general air of scary feminine malevolence floating about post-MeToo. Acolytes flocked, grants flowed, invitations proliferated, and their critics were silenced or exiled.

But the thing about norm cascades is how rapidly they can collapse. In a situation of pluralistic ignorance, each member of a particular group believes that every other member of that same group endorses some particular norm, even if very few still actually do. Still, private skeptical thoughts remain hidden as long as most people pay lip service to the norm for fear of reputational cost. If you don’t know what everyone else really thinks, chances are you will continue to keep quiet, especially if an example has previously been made of dissenters.

This situation can go on for a long time, yet should a tipping point of public dissent be reached, things can change fast. (The news that Gen Z are now reportedly abandoning sunscreen en masse looks like a good example.) Overnight miracles can occur: the most marginalized women can suddenly become men again, and formerly insightful thinkers revealed as deeply unserious people.

Of course, this possibility is not confined to academia. In every hospital, school, or civil service department, local transactivist gurus and witchfinders currently being treated like emperors by colleagues may eventually turn out to have no clothes. But apart from fanatics posting on the internet, most will be able to deny they ever really believed any of it.

The wonderful thing about philosophy, however, is that genderists wrote it all down. For this reason, perhaps, attempts to suppress discussion in philosophy seem to be ramping up, even as the rest of the world starts to come to its senses. Haslanger’s colleague in the MIT department, Alex Byrne, has recently disclosed in the Washington Post that he is the author of a report highly critical of pediatric transition, written for the Department of Human and Health Services. A hostile open letter has duly followed by an unnamed “concerned colleague”. One wonders who that might be. Meanwhile Justin Weinberg, the academic webmaster of one of the profession’s two main websites — the Daily Nous — is point blank refusing to host an open discussion of the Kodsi and Maier piece, reportedly responding to queries with the claim that the piece does not “merit attention”. As someone who has hosted hundreds of transactivist pieces masquerading as philosophy over the years, one can certainly see why he is nervous.

Perhaps the reign of genderism will truly be over when philosophers of sex and gender start acting like philosophers again: no foot-stamping about incontrovertible axioms, no smearing opponents, no anonymous open letters, no refusal to platform uncontrolled discussion. In an alternative scenario, it will end when the general public gets thoroughly fed up with universities altogether, no longer seeing the point of supporting supposed intellectuals who can get things so obviously wrong. Unfortunately, this possible world seems to me an increasingly close one. There are many philosophers who have so far kept quiet about genderism to save their jobs, but for the very same reason they should probably start talking.

From Santhouse’s perspective, it’s less likely that individuals and their doctors have got better at recognizing ADHD, and more likely that something has happened to the concept of ADHD itself. Like depression, autism and a whole raft of other conditions, it has become far more widely discussed than ever before. As its parameters have been loosened. That allows more people to be labeled, but it also means the nature of the label is changing.

Most people will identify with some of the traits of ADHD — restlessness, fatigue, struggling to focus on essential but unengaging tasks. Now, though, individuals who would once have been considered within the range of normal are being rounded up to confirmed cases, while the most seriously affected have become outliers within their own diagnosis. The name for this process is “overdiagnosis”, and Santhouse’s critique is controversial in itself, because it says something that has become borderline taboo: identifying labels need limiting criteria. Otherwise, they don’t identify very much at all.

The opposing view to Santhouse’s is that ADHD has been historically under-diagnosed: what we’re seeing now, according to this point of view, is correction rather than excess. You’ll find that argument in books such as It’s Not a Bloody Trend: Understanding Life as an ADHD Adult by the journalist Kat Brown, who was herself diagnosed with ADHD at the age of 37. First, though, she had to diagnose herself, which she did on social media, after she began to recognize her own behavior in the posts she saw about ADHD.

I’m not interested in questioning Brown’s ADHD status. But I am interested in how deeply she was invested in getting it. “So many people, including me,” she writes, “report feeling deeply anxious ahead of our assessments in case it’s found that we don’t have it and we are ‘just like this’.” When she received the confirmation she was hoping for, Brown felt “vindicated, triumphant — normal… The rest of my life stretched before me, golden and glorious, and bathed in a glow of understanding.”

Had she been denied the diagnosis, she would also have been denied that gratification. In her book, Brown advocates for a definition of ADHD that is as expansive as possible. You can understand why: if getting the diagnosis was so important for her, denying it to somebody else would be a commensurate form of harm. “ADHD is a wondrous constellation that is as specific to the person as their life story… As the recovery saying goes, listen to the similarities and not the differences.”

But what if the differences matter? What’s at stake here isn’t just the reality or otherwise of adult ADHD. It’s also a contest between two different modes of encountering the world — modes which have been falsely, but firmly, politicized. For Santhouse, as a clinician, there is a responsibility to be precise. Loose, capacious definitions lead to individuals receiving multiple overlapping diagnoses with no clear treatment pathway; they can also lead to people who are not particularly unwell being swept up into the category of “sick”, causing them to seek medical solutions to what were not even problems in the first place.

In Brown’s moral universe, those who doubt adult ADHD are on a par with (and probably identical to) those who are skeptical about “climate change… sexual harassment, depression, suicidal thoughts, homophobia, transphobia, sexism, classism and racism”. Even to query diagnostic creep is to put yourself on the side of the bigots. If you think you have ADHD, then who are the so-called experts to countermand you? (Although other, supportive experts should of course be deferred to.) As a campaigner and a journalist on the liberal Left, Brown’s prime virtue is inclusion, and from that perspective, any insistence on limitations is perceived as Right-coded.

Leaving people out is axiomatically a bad thing. In the 2013 book Excluded, trans activist Julia Serano opens by saying “All of us have been excluded at some point in our lives”, tweaking the universal monkey-brain fear of being ostracized. So when Serano’s main argument comes — which is that “sexism-based exclusion within feminism and queer activism” exists and should be dismantled — the issue has already been decided. Exclusion is bad, therefore someone like Serano (a self-described “bisexual femme-tomboy transsexual woman”) should be included, within both the category “female” and the “queer umbrella”.

In the age of inclusion, the idea of the “umbrella term” has become particularly dominant. “Queer”, as Serano uses it, is an umbrella term, containing everyone from gays and lesbians — the people who originally campaigned for their freedom from legal and state-sanctioned persecution for their relationships — to the moderately sexually unorthodox. Umbrella terms, writes Serano, “are primarily used to form alliances between disparate people who share some obstacle or form or discrimination in common”.

Perhaps so. But the tendency to lump various groups under one label also serves to define the “obstacle or form of discrimination” in question. When a femme-presenting male insists on his inclusion in the feminist movement, he is defining sexism as oppression of the femme-presenting, rather than oppression of women on account of their femaleness. It turns feminism into a movement that should spend more time defending the concept of a “female penis” (the better to be inclusive) than it does on abortion and maternity rights.

In other words, it hijacks feminism for men’s interests. Nonetheless, the injunction to include has been embraced by some feminists, such as the philosopher Amia Srinivasan. In The Right to Sex, Srinivasan warns that “trans women… often face sexual exclusion from lesbian cis women who at the same time claim to take them seriously as women”. In “exclusionary” terms, this means that some lesbians refuse to have sex with men, even having been willing to state that those men were women.

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Where the injunction to include doesn’t produce outright perversities like telling lesbians to have sex with men, it often generates a hopeless fug of vagueness. CN Lester, a non-binary natal female and author of Trans Like Me, ran into this problem while trying to write an “inclusive” definition of the term “trans”. “Any person who has had to challenge or change the sexed and gendered labels placed upon them at birth to honour their true selves can, by their own or others’ volition, find themselves under this trans umbrella,” writes Lester.

By such a definition, the suffragists were trans: women were not allowed to vote on account of their sex, so to campaign for the franchise was by definition to “challenge… the sexed and gendered labels placed upon them at birth”. Arguably, it’s politically helpful to Lester to corral the widest possible constituency — in the same way that, arguably, it is politically helpful to Kat Brown to corral the widest ADHD possible constituency. The more people your movement can represent itself as acting for, the stronger your democratic case, at least superficially.

But a category also has to share some essential characteristics for it to be a basis for politics. The impulse to inclusion above all is, fundamentally, anti-political because it is insistent on finding sameness when politics is a system for recognizing (and perhaps reconciling) difference: different needs, different claims to resources, different beliefs. Flatten those into the mush of inclusivity, and politics can have no function. If we’re all the same, what could we have to disagree about?

Declining to assert boundaries is, ultimately, an act of radical irresponsibility. You can see that most starkly in one of the most extreme applications of this tactic within the Left: the assertion that even national borders are illegitimate and should be obliterated. This might sound like a belief that no one could hold in earnest. Nonetheless, as some have argued for no borders between the category of male and female, others have argued for no borders between countries — or, rather, no countries at all.

In Against Borders: The Case For Abolition, writers Gracie Mae Bradley and Luke de Noronha attempt to make the case that “immigration controls are obsolete and should be abolished”. Their argument is not that migration policy should be more liberal or humane. It is that the nation state should be abolished: “borders are used to surveil and control whole populations, migrants and citizens both… Borders harm us all, which is why we must all be committed to their abolition.”

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How liberals killed the talk show

By Sarah Ditum

This is a case they make in all sincerity but not, ultimately, a case they make seriously, because what they are proposing is so nebulous, they cannot fully imagine it. “We do not provide a roadmap for how to get to border abolition. We do not know what that world will look like, and there is no single route to get us there,” they write. The large rhetorical gesture (“abolish borders”) distracts from the need to think about the detailed, difficult issues around statehood. Migrants, it’s worth noting, are often especially attached to the idea of citizenship: they know what it means to be without it.

The creeping idea that simply to have boundaries is a form of harm has cost the Left, in particular, dearly since the start of this century, and forced many of a liberal inclination into untenable positions. You can see, also, the failure of inclusion as a prime value in the confused response to the government’s proposed welfare reforms. If enacted as planned, it seems certain that these will be both chaotic and cruel; but a commitment to the inclusion principle means that, rather than criticize the execution, some on the Left have launched an assault on the very possibility that anyone currently defined as disabled might not properly belong in the category. Overdiagnosis is treated as a Right-wing tool rather than a potentially serious harm to individuals.

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Letby Truthers want a good story

By Sarah Ditum

This is a foolish way to argue, and a doomed one. No class can be defended if it cannot be defined. To make the argument that disabled people deserve state support (an argument that the majority of the country would agree with), it’s necessary to accept that there is a group of people who are disabled — and to be able to distinguish them from people who are not disabled. Inclusion may feel like an act of kindness, but the refusal to exercise judgment is really cowardice.

There are many ways of defining a group, and there are kinds of exclusion that are unethical — if they didn’t exist, the charge of “being exclusionary” would have no force. To exclude someone from citizenship on the grounds of race or religion is wrong. To deny that someone is a woman because she fails to be feminine is wrong. To misdiagnose someone is wrong. The mistake the Left has made, however, is to suppose that any of these mean borders, boundaries and definitions are in themselves wrong. Instead, they are proof that they matter. Not everyone can be welcome in every group. Without some exclusion, there is no group.

Seeing an opportunity in hysterical claims that the country is “under attack” from its neighbor, the Liberal Party has rebranded as Team Canada, rallying the country around a patriotism it treated with disdain just a couple of years prior. Rather than lead with prudence, Conservative Party leader Pierre Poilievre has echoed the anti-Trump rhetoric. The propaganda machine is in full swing.

With an election coming in a few weeks, Canadians have been offered little more than political theater. The two parties competing for power seem to have joined forces against an invented American enemy, allowing Canadians a distraction from the very real problems that exist in their own country. How have our memories been wiped clean so quickly?

Just a few months ago, the ruling Liberal Party appeared dead in the water. Trudeau had become the most hated Prime Minister in Canadian history and calls for his resignation were deafening. By June last year, polling showed that a majority of Canadians wanted him to step down. He couldn’t even go out in public without being screamed at by angry citizens.

Even former Prime Minister Stephen Harper, who had avoided criticizing Trudeau to date, said the government had “denigrated” the country. Repeating what many of us had noticed, Harper said that Trudeau managed to stay in power thanks to a “media conglomerate” that “erased his every error” and “misrepresented his opposition.”

He was right. The already tiny Canadian media landscape was unabashedly biased in favor of Trudeau’s government, and against not just Poilievre’s Conservative Party, but any Canadian who did not subscribe to Trudeau-approved narratives. As the only party to mount a serious and unapologetic challenge to issues viewed as untouchable in Canada, the PPC was almost entirely erased from the conversation. Bernier was taking on many of the sacred cows politically homeless Canadians have been desperate to see addressed — things like gender identity ideology, climate change alarmism, and mass immigration. The PPC is a small party, but one Poilievre might take a page from: if he genuinely wants to lead the country down a different path.

Canada became evermore censorial under Trudeau’s reign, as dissent against the Covid mandates, gender identity ideology, and unevidenced claims about the supposed discovery of “mass graves” at old residential school sites was framed as dangerous hate speech.

Rather than encourage Canadians toward unity, Trudeau labelled those protesting the vaccine mandates as women-haters, racists and, science-deniers. Those of us fighting for parental rights and women-only spaces, and against the transitioning of children, were violent extremists akin to terrorists. Pointing out that no remains of buried indigenous children had been discovered at old residential school sites was referred to as “denialism,” rather than the truth.

Liberal authoritarianism peaked in 2022, when Trudeau famously went so far as to invoke the Emergencies Act and freeze the bank accounts of Freedom Convoy participants and supporters, all in an attempt to shut down the protests against the ongoing draconian mandates.

The Emergencies Act had never been used before in Canadian history. Its predecessor, the War Measures Act, was invoked only once during peacetime — by Justin’s father, then-prime minister Pierre Trudeau, in the Seventies. The Acts give sweeping powers to suspend civil liberties and democratic processes in the face of a dire threat to the security of the country.

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At the time, Bernier spoke out unapologetically against “a series of violations of our fundamental rights and freedoms that a tyrannical government wants to keep in place by crushing dissent”. He made it clear that this was “not a state of emergency”.

And we are now seeing the same tactics being used again. In January, the Prime Minister announced he intended to resign. But only he didn’t, instead proroguing Parliament in order to avoid a vote of no-confidence. This gave him the opportunity to install his pick for the new leader of the Liberal Party, Mark Carney, and drum up yet another “emergency” in the form of a trade war. While party members are meant to vote on a new leader, it was immediately clear that Carney would be picked no matter what. He was suddenly giving interviews across North America as a “Canadian Official” (odd, considering no one had elected him as an official of anything).

Indeed, Carney was installed as Trudeau’s successor in March. Canada had a new Prime Minister, and with that, all was apparently forgotten by Canadians who simply didn’t like the idea of voting Conservative and were relieved to have an excuse to fall back into their comfort zones. There was “no turning back” now, Carney explained dramatically. “The old relationship we had with the United States based on deepening integration of our economies and tight security and military cooperation is over.” It appeared half of Canada was thrilled at the prospect of a “war” with its bigger sibling.

In truth, as Bernier explained to me, “Trump does not want to invade our country militarily”. What Trump wants is a new deal — he wants to reopen the free trade agreement. And rather than sit down at the table and make a deal, the Liberals took the opportunity to fear-monger Canadians into believing they were the innocent victims of an unfair attack. In fact, it is the Liberal Party, not Trump, that started a commercial war — “a trade war that we won’t win” as Bernier put it.

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This is merely another distraction at a time when we need a national reckoning. I told Bernier that I saw there was no PPC candidate running in my old riding in East Vancouver, one of the most Left-wing electoral districts. I had lived in the neighborhood for 15 years, but eventually felt unsafe there. After I began speaking out against gender identity legislation and in defense of women’s spaces, the attacks on me were relentless. I’d been screamed at, threatened, and stalked while out and about — walking my dog or having drinks with friends. Many of my old friends refused to be seen in public with me anymore for fear of being canceled by association. I left East Vancouver in early 2021, during the Covid lockdowns, foreseeing a dark future. Despite addiction, homelessness, mental health crises, and crime spreading across the area, the progressives who dominated politically held firm in their approach, which offered little more than clean pipes and free drugs. Issues like women’s sex-based rights had been completely wiped off the table. Once I left, it seemed that my efforts to force a debate left with me.

At the end of our conversation, I asked Bernier if he thought I should run, unsure in that moment if I was joking or not. He responded enthusiastically.

And because I’ve never been one to sit back and let the bullies win, I’ve decided to run as a PPC candidate. In a democracy, people should have the right to vote for something they believe in. And if I don’t show up and force a conversation, it just won’t happen. Women’s sex-based rights deserve to be an election issue and a topic of debate, whether the Leftist authoritarians of Canada like it or not. Free speech is only a lost cause in Canada if we don’t fight for it. There has to still be some fight left in us.

For far too long, Canadians have accepted a status quo where expression is suppressed and democracy stifled. There’s only one way to fix that: stand up, speak out, and refuse to be erased.

Another, younger woman, is being dragged along by a man who is clearly a pimp. She sways as he shouts that she is “Only $20!” No one responds apart from a dealer who asks if he wants “Apache” (fentanyl).

Canada may have stringent alcohol restrictions and licensing in place in every province, but, on this street running 10 blocks, people turn a blind eye to addicts shooting up. And they are left to overdose on the street outside the legal “safe” injection site which has destigmatized the taking of illegal substances. The death rate here is 30 times higher than the national average. I hear tales, too, of young, mainly indigenous women who are marched into clinics by their pimps to access opiates for free; they become addicted and compliant.

There is a place here, though, which is supposed to provide respite for these women. The Downtown Eastside Women’s Centre purports to offer support, a bit of warmth and a free meal for anyone needing shelter, along with “safe washrooms”. Perhaps they aren’t quite as safe as some vulnerable women might wish, though, since female-only services for abused women and girls are illegal. And as the welcome sign reads: The Centre is inclusive of all self-identified women which includes trans women and two spirit people.

It wasn’t ever thus. One of the most inspirational and successful feminist organizations I have ever encountered was founded here in 1973. Vancouver Rape Relief and Women’s Shelter was led by the indomitable Lee Lakeman who sadly died last year. And she, along with her team, fought hard to protect that safe space for women.

But the self-declared “male feminist” Justin Trudeau fought back. And not for women’s rights. Although a big fan of posturing about indigenous people’s rights, he did little to protect these women and girls from the abuse they suffer. Meanwhile, he removed their right to safe spaces and decriminalized prostitution. In any case, in Canada anyone can be a woman.

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Vancouver has laws and policies in place that allow for men to self-identify as women. You may remember the case of the ball waxer supreme (then known as Jessica Yaniv, now known as Jessica Serenity Simpson). In 2019, Yaniv filed complaints against beauty salons in Vancouver run by women of immigrant background, for having refused to provide him with a “Brazilian” bikini wax (that is, the waxing of the female genital area). Yaniv lost — but only by the skin of his scrotum. The women lost too — in terms of both their livelihoods, and their peace of mind. One woman had to close down her home-based business as a result of the stress of the Yaniv case.

Aside from a small handful, all of the so-called feminist institutions and organizations go all out to support transgender ideology. The Women’s Legal Education and Action Fund (LEAF), established in 1985 in order to fight cases on behalf of women relating to male violence and discrimination, is now full-throttle transactivist. Indeed, the first sentence under LEAF’s Mission and Vision section of its website describes it as a charity that works for “all women, girls, trans and non-binary people”, meaning everyone. “In Canadian society, cis and trans women, trans, intersex, gender diverse, gender nonconforming, gender queer, genderfluid, agender, bigender and non-binary people all experience discrimination based on their gender.”

Gender ideology has taken hold here in a way that makes Britain’s trans activists look meek, with liberal feminists welcoming the opening of domestic violence services to everyone. And any push-back comes almost exclusively from Right-wingers and radical feminists — who are roundly castigated.

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As a result, I know exactly the sort of abuse I am liable to be subject to whenever I do an event in Canada. There is screaming, jeering and intimidation. Sometimes there is spitting. There is always anger and the threat of violence. So the crowd that greeted me at an event about safe spaces for women (the irony escapes them, obviously) was no surprise.

But what was a surprise this time was that along with the jeers of “Nazis, bigots, fascist cunts”, some people were actually barking. And many of them were wearing animal masks. Since their aim was to intimidate, I wanted to show them that they hadn’t. So I approached them to quiz them about their feminism, only to have a placard shoved in my face by one young man that read: “Real feminists support ALL women.” The contrast between these privileged “feminists” with those tragic women I saw on the backstreets couldn’t have been starker. So much for the great successes of women such as Lee Lakeman.

During my visit, Trudeau was replaced by Carney. I wondered whether getting rid of him would change the landscape in Canada when it comes to the rights of women. Carney, though, is certainly keeping his mouth shut on the divisive issue. A firm believer in open markets and free trade, he is doubtless more focused on the economy rather than whether he is free to get along to the Pride parade. But the women I spoke to read that as cowardice; they suspect this man has no backbone when it comes to dealing with anything trickier than Trump’s tariffs.

They’re also very clear that the last thing they want is a Canadian Trump in the shape of Poilievre, the leader of the Conservatives. “He would do exactly what the orange man is doing,” said Sara, a long-time activist who works in a women’s shelter, “which is posturing about reversing all of the trans stuff, like men in women’s sports, whilst taking all of the other rights away, from abortion, to funding for Rape Crisis centres, and everything in between.”

Perhaps those young protesters who’ve grown up in Trudeau’s Canada, refusing to listen to what we aged feminists had to say about men’s violence, might learn something if they got out of their echo chambers and took a bus down to Downton Eastside. There they would see the damage done by men empowered by Trudeau’s policies, they would see vulnerable women victimised, abused and denied shelter.

“Cool Japan”, the policy that resulted, was an attempt to mobilize the soft power of anime, manga and J-pop in the West. The country’s economy had been in the doldrums since the asset bubble burst in 1991; its geopolitical heft now seemed contingent on its role as the homeland of Sailor Moon, Naruto and Hayao Miyazaki’s beloved Studio Ghibli. Foreign policy aside, the finances of anime were not to be sniffed at either — the global industry will be worth more than $60 billion by 2032.

Western children and teens — particularly in France and Russia — were by now already hooked on the absurd, dreamlike aesthetics of anime and manga, with their narrative worlds so different from the rigid Christian morality of Disney. In this, they mirrored the Japanophiles of the 19th century who, after the country reopened to Western trade following two centuries of isolationism in 1853, fixated on Japan as a land of mystique, with its “charming, artistic, doll-like inhabitants”. Then, Van Gogh, Degas and others were among the European sophisticates who hoarded lacquered cabinets and ukiyo-e prints. This time, 4Chan christened the white Japanophiles calling each other senpai in school cafeterias “Wapanese”, then Weeaboo — and finally, Weebs.

Twee governmental efforts to push Cool Japan — including appointing a cartoon cat as an anime “ambassador” — belied the strangeness of the Western appetite it courted. Very soon, things would get very weird. By the time the initiative began, the scourge of offputting dorkiness had already taken root among Weebs, with young men embracing otaku culture — obsessive fandom — and feminists balking at the eroticized little girls of manga, notoriously printed onto dakimakura pillows to be embraced by undeodorized, undersexed disciples. From the 2010s, more and more Western cosplayers packed out miasmatic comic-con events, their bright pink and blue wigs, peace signs and puff-cheeked duck pouts becoming shorthand for a certain type of internet nerd — obsessive, horny and curiously alienated from the mainstream. For them, Japan represented a sort of aestheticized dreamland, a refuge from the blows of high-school jocks.

In 2025, the “manga accent”, with its accompanying hand gestures and bouncy body language, has become a staple of American dorkdom. Alongside this, the hikikomori lifestyle has taken hold: in 2022, there were about 1.46 million such people in Japan — recluses who have not left home for six months or more, wrapped up in virtual worlds and living from bed. Now, the nihilism of hikikomori seems to appeal to alienated Americans who might once have been goths, with anxiety-wracked bloggers emulating the lifestyle with their own videos of snack-strewn beds, figurines and drawn curtains.

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At the same time, there is increasing alarm within Japan around the rise of soshoku-danshi, or “herbivore men”, who have little interest in sex or relationships. Their abstinence is often connected with the lure of hyperstimulating anime porn, or hentai, the supreme weirdness of which has done little for Japan’s global reputation. The subset of much-whispered-about “tentacle porn”, initially an Eighties ploy to circumvent censorship rules, crystallizes the Western fixation on Japan as a land of paraphilias. In this strange sexual environment, around a third of Japanese men and women aged 18-34 show no interest in having a relationship — a figure borne out by a plummeting birth rate, a trend to which the West is rapidly catching up.

The Cool Japan initiative certainly didn’t intend to play up the nation’s reputation as a fantasyland of intense, intoxicating fandom and alienated, fantastical hypersexuality. But Weeb culture has latched upon this vision of Japan, making it synonymous with social disengagement, strangeness, sexlessness and aggressive introspection. Japan has always been a site of Western anxieties — think of Ridley Scott’s neon-lit Blade Runner vision of dystopian LA, based on the Shinjuku district of Tokyo — but what’s new is the heavy identification of homegrown anime fans with a lifestyle of imagination and isolation.

There is a curious irony in this. A progressive generation of Westerners raised with the hot breath of Edward Said forever on its neck has come to see rhapsodizing over distant lands as a cardinal sin — but Japanophilia is a notable exception. Japan’s figurative power as an otherworldly site of eroticism is the textbook example of Orientalism — yet this blind spot is everywhere, perhaps owing to Weebism’s close associations with queer culture. Recently, a white trans X user pulled the pin on a grenade in announcing they would be adopting the name Saeko; this month, a TikToker made a viral appeal: “Just because you’re non-binary doesn’t mean you’re also Japanese.” The confluence between gender discourse and anime is not a coincidence; despite springing from a highly conservative country where even gay marriage is not yet legal, anime is replete with boyish sylph protagonists, as in Revolutionary Girl Utena and The Rose of Versailles. The iconography is all languorous androgyny, shaggy hair and slender bishōnen, or “beautiful boys” — modeled on the effeminate princeliness of Tadzio in Visconti’s 1971 adaptation of Death in Venice.

Meanwhile, yaoi and yuri — “boys’ love” and “girls’ love” — are distinct anime genres beloved by women and men respectively; these are melodramatic, idealized homoerotic romances which typify “Japanese sexuality” as a category all its own. This is a sexual world unanchored from politics or even real-world lust, all playing out in two dimensions. Nowhere is anime sexuality’s fantastical remoteness demonstrated better and more disturbingly than in a viral video of a “VTuber” (virtual YouTuber, god help us all) concert from 2023, in which an audience of parasocial teen girls screams at the “face reveal” of an animated manga-style singer.

Boy and girl-love romances are excruciatingly slow-burning and structured around heterosexual formulas — seme, or dominant, characters emotionally wrestle with uke submissives. They are designed, in the case of “boys’ love”, for the titillation of shy young straight women who are more comfortable with the unthreatening, dreamlike symbolism of two boys exchanging whispers than the real prospect of sex with a man. The politics of the genre is complicated; upon the opening of a manga exhibition at the British Museum in 2019, the academic Susan Napier told the BBC that the medium “held up very progressive models”, and in Japan, yaoi and yuri might fairly be interpreted as inevitable sproutings of liberalism in an undersexed and highly formal culture. But as these genres bobbed over oceans to the West and became incorporated into mainstream queer movements, they have become Weebish totems of alternative gender identities, something you’ll notice if you spend five minutes auditing profile pictures on X — a curious departure from their culturally conservative provenance. Both the androgynous aesthetics of anime and its atmosphere as an outsiders’ club lie beneath the Weeb-gender overlap, one which has produced viral X accounts whose sole purpose is to post “a canon/implied trans person a day” — mainly plucked from anime.

All of this is important, because it situates the very real field of Western sexual politics in the realm of dreams and imagination, and explains in part the conceptual disconnect between Trump’s generation and the young trans people he is legislating against. The American Right and gender-critical feminists are in an uncomfortable alliance in their preoccupation with physicality; for the young, online Left, and particularly that sizeable Weeb-queer nexus, imaginative potential and identification with figurative avatars — I identify with, even worship, this character, therefore I am them — has unmoored them from the politics of the body. So it is that Japan’s soft power has weaned a generation of Americans which has, according to plan, grown-up enraptured by anime — but never grew out of it. So it is too that the generation most concerned about the diktats of Said is willing to project its dreams onto Japan, imagining it as the ultimate sexual utopia; the Japanese exception to Orientalism, it seems, relies on the green light of queer, nerdy and compulsive Weebery.

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Japanese critics have long lamented the Orientalizing gaze of Weebs, with Hiroki Azuma namechecking Said’s theory in 2005 and writing that “what is behind the image … [is] completely erased when they are exported overseas”. There are fascinating analogues of this deracination in all realms of media: in the world of house music, white Western DJs are using Japanese-coded avatars. The San Franciscan DJ Dr Gabba uses the image of an evil scientist from Sailor Moon, while the Georgian musician Osean World has created a vocaloid (a synthesized singer) called Yameii, a pink-bunned anime girl who layers accented, eerie vocals over the 2020 hit Baby My Phone, which has nearly 16 million views on YouTube. Last week, the singer FKA Twigs released a collaboration with Kanye-Kardashian royalty North West, in which the 11-year-old sings in Japanese (“My name is North-chan”) for no apparent reason. All very strange, and no doubt frustrating to Japanese observers — but wasn’t it the government’s aim to spread the aesthetics and catchphrases of anime worldwide? Is this power, in the end, a little too soft?

The critical characteristic of Weebism is its situation within fantasy — which the lead singer of The Vapors presciently captured in his song Turning Japanese, written from his Guildford bedroom in 1980. In it, the singer obsesses over a photograph of his lover — “I sit there staring and there’s nothing else to do” — and embraces the slow creep of isolation: “No sex, no drugs, no wine, no women”, maddened by his own private idol-worship. Though unconscious — David Fenton said he’d heard the phrase “turning Japanese” in a dream, and had even written a motif which “is more likely to be Chinese, so I got that completely wrong!” — the song captures the shut-in, engrossed individualism of Weebery decades before its time, the tentacles of which have spread into Western youth politics, conducted not from the streets but from a lonely bedroom.

Given all this, has the experiment of Cool Japan failed? Of modern-day manga creators, Miyazaki Hayao said in 2014 that “some people spend their lives interested only in themselves. Almost all Japanese animation is produced with hardly any basis taken from observing real people.” In this, Weebs are the perfect cognate. A decades-old Japanese government initiative around soft power has instead produced a sort of soft Orientalism, one which reduces the nation to an eroticized cartoon fantasy. This is how Cool Japan was transfigured from the real-world politics of diplomacy to the splintered, bedroom-bound dreamworlds which now characterize the young Western Left. Progressive youth movements, weaned on screens and taught morality by the internet, are beginning to creak in the face of a nastier, more robust camp intent on dashing every trace of Weebish woke. The heirs of Cool Japan are a generation those ministers in Noughties Tokyo would hardly recognize. And the Weebs themselves? They are culturally at sea, now that the jocks are back in charge.

What is stranger still is that, outside of Maréchal Le Pen’s posting about the film’s trans star, Sofía Gascón, on X “So a man has won the Best Actress prize…”, the criticism of the film has come from those it purports to represent. “Emilia Pérez is a glorious disaster,” wrote trans critic Drew Burnett Gregory, for Autostraddle, while GLAAD, a non-profit media monitoring organization devoted to LGBTQ representation, called the film a “step backward for trans representation”. You mean to say that a song-and-dance number set in a sex-change clinic with nurses twirling their gurneyed patients around them, singing “Mammoplasty! Vaginoplasty! Rhinoplasty!” isn’t the step forward the trans community have been waiting for? Huh. There’s no pleasing some people.

It wouldn’t be the first time that Hollywood rushes to self-congratulate over a terrible film about a marginalized group, while the group in question says, “will you please stuff it?”. Back in 2018, Green Book won at the Academy Awards only as it was simultaneously demolished by younger critics-of-color for its retrograde white-savior narrative — but the heat-haze of confusion around Emilia Pérez is revealing of the fact that the film is itself a very confused film. Like always breeds like at the movies — films labelled “divisive” are often so because they are divided against themselves. Emilia Pérez is really two films, the first of which was the one Audiard pitched to the film’s star when they first met in Paris to discuss the project, a libretto in four parts adapted from a chapter in Boris Razon’s Écoute, which introduced, in passing, the character of a drug trafficker who signs up for gender-affirming surgery in order to evade capture by the authorities.

“The day we met in Paris, he asked me, ‘What do you think?’” Gascón told Rolling Stone. “And I said, ‘I like this, I don’t like that, I like this, I don’t like that…’” Chief among the objections were that the trafficker transitions solely to flee justice. “The entire thing would’ve been a joke,” Grascon said, and suggested instead that Manitas transitions because his desire is sincere. “She led me to understand that, well before transitioning, we’re already what we want to become,” said Audiard and duly changed his script accordingly. That is the film that we see, by and large. The drug-lord fakes his own death, stashing his wife Jessi (Selena Gomez), and their two young sons in Switzerland, undergoes secret gender reassignment in Israel and, unbeknown to anyone but his lawyer, begins a new life as Emilia Pérez, a human-rights campaigner clad in Saint Laurent who atones for past wrongs by means of a charity locating the graves of the “disappeared”.

Is Pérez’s atonement sincere? It’s hard to say because we know next to nothing about what prompted it. Having eliminated all cynical motive from Pérez’s transition Audiard’s screenplay inadvertently creates a new problem for itself: why does a murderous drug trafficker jack in his highly lucrative trade? Audiard has no idea, except to imply that the moral redemption is somehow a consequence of the gender-reassignment. “Changing the body changes the soul,” argues the lawyer, Rita (Zoe Saldana). “Changing the soul changes society.” It’s here that the film stirs up a whole bee’s nest of trouble for itself. For transitioning is rarely a moral or ethical choice; it’s the result of a dysphoria from which sufferers long to escape. (“I’m happy now,” says Emilia. “I’m myself.”) The only people for whom transitioning carries a moral charge are the trans community’s champions, for whom the cause of trans rights has the same halo of righteousness as that for any such social justice campaign.

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In short, Emilia Pérez, as a character, is fashioned almost entirely from the imagined liberal audience’s feelings when contemplating trans women — and the problem with projecting onto others the feelings they inspire in us is that those feelings have a habit of coming unstuck. Whom we first deem a saint we later turn on as a demon. And so it proves in the second half of the film, where Emilia, missing her children, inserts herself incognito into the household of her widow Jessi in Mexico City, posing as an Aunt, only for the disguise to crumble. Emilia, in the middle of an argument with Jessi, throws her bodily onto a bed and chokes her using a man’s full strength and voice. It is this scene that has caused most problems with trans critics, understandably, because in terms of “representation”, it is not just unflattering, but something of a nightmare: an onscreen depiction of a trans woman who is “secretly”, underneath it all, still a man, possessed of a man’s murderous strength and instincts, who, when push comes to shove, snaps right back and plays dirty. “If he’s a he, she’ll be a he. If he’s a she, she’ll be a she,” says the Israeli surgeon who performs Emilia’s surgery. “If he’s a wolf, she’ll be a wolf.”

The implications of this hardly need spelling out. Emilia Pérez is a film which, for all its aura as a trans champion, comes down squarely on the side of those who argue that trans women should not be allowed access to women’s bathrooms, prisons or sports fields. “[The film] presents Emilia as a nesting doll of gendered selves,” wrote trans critic Harron Walker, perceptively. “She is a woman trapped in the body of a man, then a woman in denial of the man she still harbors within.” Far from being, as Hollywood seems to want to think, a champion of trans rights, the film lends strength to the argument of those women who fear for safe spaces and fight for sex-based rights.

It’s a measure of just how baffling the film is, and how effectively the musical numbers skate by any real psychological or moral depth, that it is hard to say what the intention was, exactly. I suspect that the musical form was chosen by Audiard for precisely this reason, in fact, to avoid answering questions that he sensed he couldn’t, or didn’t want to, answer. That doesn’t seem to be stopping its momentum: the academy loves a musical, particularly one that makes history. But there are so many better films in contention such as James Mangold’s terrific Bob Dylan biopic A Complete Unknown and Sean Baker’s excellent Anora, which has barely a naysayer out there? But the Academy of Motion Picture Arts and Sciences has a remarkable tendency to mistake itself for the Nobel Peace Prize committee, and Emilia Perez is riding a train few will want to stand in front of.

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.

Yet after all this noise, you would be hard pressed to find evidence that gender recognition reform and trans rights were ever an election issue. Kelly-Jay Keen’s Party of Women — the terf-ultras running on a platform of repealing the Gender Recognition Act (GRA) and removing “gender reassignment” as a protected characteristic from the Equality Act — not only failed to elect a single candidate (to be expected for a small, new party); it lost its deposit in all 16 seats it contested.

Transactivists, however, have equal reason for disappointment. Yes, the Liberal Democrats saw a huge surge with a pro-GRA reform manifesto; but the SNP, who actually attempted to put that reform into practice, suffered an equally remarkable collapse. Meanwhile, Reform only won five seats but took a larger vote share than the Lib Dems: their “contract” with the electorate promised to “ban transgender ideology” in schools.

There has been some talk that the success of independent candidates against Labour incumbents represents a “Left revolt” against Labour. But it’s notable that those takes don’t mention trans rights — and understandable, given that four of the five independent MPs in the new Parliament are conservative Muslims who ran on a pro-Gaza platform, and not natural allies of the gender-nonconforming (the fifth is Jeremy Corbyn).

For trans people, this apparent irrelevance after a decade as the hot button topic du jour must be disconcerting. For Labour, it’s probably a relief. Throughout Starmer’s leadership, gender ideology has been the sole issue on which the party could consistently be made to look weak. Indeed, the more that Labour demonstrated competence and discipline on the economy and foreign policy, the greater the incentive for interviewers to hammer the “but what is a woman?” button and see what headline-generating inanities would fall out of the shadow cabinet.

But by the time of the election, that had been substantially defused. Front benchers including Wes Streeting (for health and social care) and Shabana Mahmood (for justice) showed that they had engaged deeply and seriously with the problem of balancing rights between women and trans people. The Stonewall-endorsed thought-terminating cliches were out. Labour’s 2019 manifesto had committed to introducing gender self-declaration. In 2024, that pledge was gone: there was now a promise to protect single-sex exemptions, and implement the Cass Review’s recommendations.

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From the vantage point of government, with a gargantuan majority and the first female chancellor, Labour may wish to flatter itself that its woman problem is over. Labour would be wrong to do so. Just because an issue is not electorally decisive, that doesn’t mean it’s politically unimportant. And although an issue may appear to have been neutralised at the ballot box, there is no reason to believe it will stay that way.

Trans issues can be classed as what the writer Helen Lewis has called a “brown M&M” test, after the band Van Halen which included a demand in their rider for “M&Ms with the brown ones removed”. This was once seen as evidence of spoiled rock star indulgence, but the M&Ms themselves were irrelevant: it was a way for Van Halen to check whether venues had read and followed all the band’s instructions, including the safety-critical ones about pyrotechnics. If there were brown M&Ms in the bowl, the band knew everything on stage needed to be double-checked.

In the same way, a politician’s ability to comprehend the detail of the Equality Act and the GRA should be taken as a test of their seriousness as a legislator. With a few honourable exceptions, Labour remains some way from passing. The manifesto, welcome as it was, also pledged to introduce a “trans-inclusive ban on conversion therapy” — something that is simply incompatible with the Cass Review’s insistence on preserving exploratory options for youth. This suggested that the Cass Review had perhaps not been fully absorbed by the manifesto’s authors.

Another commitment was to “simplify” the Gender Recognition Certificate (GRC) process. Subsequent briefing suggested this meant moving to a model where one doctor’s diagnosis of gender dysphoria was sufficient to change legal sex — more rigorous than self-ID, but barely so. There was also mention of removing the so-called “spousal veto”, which in reality is simply a provision for spouses of transitioners to annul the marriage before the GRC is issued, meaning no one has their sexuality unilaterally changed by state fiat. It’s an elegant solution to a difficult situation, and one that is much valued by the many wives of men who transition in midlife.

The unhappy implication is that Labour has been writing policy without listening to the people affected. This is a step up from the “government by Stonewall” that was the case up until very recently when it came to policy around gender identity, but it still betrays a sloppiness about the detail and a lack of care when it comes to women’s rights — an impression that is only reinforced by Labour representatives’ ongoing commitment to misunderstanding the Equality Act in public.

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Take, for example, Margaret Hodge’s insistence that the Equality Act unambiguously protects women-only spaces, and any suggestion otherwise was “deliberate misunderstanding by the anti-woke establishment”. On the contrary: it is Stonewall rather than any “anti-woke establishment” that has been spreading an interpretation of the Equality Act which insists male people have legal access to female spaces. Meanwhile, the fact that there is an active case over whether women have the right to single-sex services (specifically, rape crisis counselling) shows the law as it stands is far from clear.

Gallingly, one of the many Labour spokespeople failing to understand the Equality Act is the same politician who originally piloted that law through parliament. In a 2022 interview, Harriet Harman pledged her allegiance to the belief that trans women are women, and went on to say: “We also need to recognise that in some respects there need to be same-sex services, which can be delivered and you can’t have a blanket exclusion of trans women, but in certain circumstances, in narrow circumstances, you can restrict those services.”

This is, generously, entirely incoherent. Harman seems not to understand that same-sex services are only possible through the “blanket exclusion” of trans women; nor is there any suggestion of how the “certain circumstances” would be determined. Speaking to Woman’s Hour this week, she continued to maintain in the face of all evidence that the Equality Act simply needs “guidance”, even though the legal meaning of sex is contested. Ideally, an inability to understand legislation you helped to draft would be considered disqualifying for high office; instead, in another sign that Labour does not take women’s rights altogether seriously, Harman has been tipped as the next head of the Equality and Human Rights Commission.

Labour’s ongoing discomfort with the woman issue is manifest in the fact that it took three days after the election to appoint a minister for women and equalities. The trans issue has made this a poisoned brief. Whoever was appointed, it was guaranteed to outrage either LGBT Labour or the party’s gender-critical faction. Once again, Starmer appears to have found a third way. It was eventually announced on X that the job had gone to Anneliese Dodds, who shadowed it in unimpressive style, dismissing criticisms of GRA reform as “culture wars”.

Less fanfared is the fact that Dodds will be junior to Bridget Phillipson, Secretary of State for Education and Minister for Women and Equalities, and someone who has shown a more robust grasp of the issues. This looks like a way to give transactivists a visible win, while holding the actual political power closer to the ideological centre. That’s positive, but Labour needs more than savvy optics here: the implications of gender identity run too deep to be ignored.

The infected blood and post office scandals should be a warning that ethical derelictions by the state only become more grievous with time. The harms done to children who received unevidenced medical care under the guise of treating gender dysphoria, or to female prisoners forced to share accommodation with men for the sake of “inclusion”, will not disappear because the Government prefers not to see them. And, bluntly, many of the groups most afflicted by bad gender policy are relatively young and physically fit. Unlike haemophilia sufferers or retired postmasters, the Government will not be able to evade any eventual financial liability by simply waiting for them to die.

But alongside the policy tangle around gender identity, these election results point to another dimension in Labour’s women problem. Though the party’s losses to independents in the midlands and north look like shocking upsets, in reality they are the outcome of Labour’s longstanding reliance on male-dominated “community leaders” in Muslim populations to mobilise the vote — networks known as biraderi, meaning “brotherhood”.

Although the biraderi were partly a reaction to Labour discrimination against Asian members, they perpetrated their own discrimination against Muslim women: in a 2016 Newsnight interview, female Muslim members of the Labour Party described how the biraderi had mobilised to slander and harass them in order to keep women out of local politics. But because the biraderi were helpful to Labour, they were allowed to go largely unchallenged.

This meant that Labour constituency parties had already ceded a large part of their local networks, and failed to build links with the younger Muslim community. When the biraderi decided to go their own way against Labour (mobilised through the Muslim Vote campaign), it was relatively simple to divert their campaigns to their preferred candidates. Had Labour paid attention to Muslim women’s own warnings about the stifling anti-democratic influence of the biraderi, perhaps this could have been mitigated. But women were ignored, and the consequences are now apparent.

Labour should not have to learn the same lessons over and over again. Women’s rights and interests are not a mere add-on. They are fundamental to a functioning society, and when women are disregarded, deeper problems follow. Starmer may be congratulating himself for now on having equally displeased both sides of the argument about gender. Instead, he should be asking himself how to make law and policy that is actually fit for purpose — for women, and for all. Trans issues did not decide this election. But a failure to reckon with them seriously will be an indictment of Labour’s future fitness to govern.

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.

But this is nonsense. As we’ve seen in the wake of the Cass Report, what actually happens is a mixture of magical thinking, conformism and moral grandstanding coalesces under a thin veneer of rational objectivity — and everyone except the most stubbornly reality-oriented falls obediently into line. And amid the chaos of frantic back-pedalling and rewriting of history, this consensus can form and re-form in real time without its basic structure ever changing, or lessons ever being learned.

Most egregiously of all, Ruth Hunt, former CEO of Stonewall, denied to the Times that on her watch Stonewall fostered a stifling climate of “no debate” on gender ideology. On the contrary, she said: “I’m absolutely someone who has always been working in the middle ground, trying to build consensus.”

Let’s leave aside the fact that, as the Times points out, under Hunt’s leadership Stonewall called for schools to “shred” the only schools guidance on gender even remotely in line with Cass recommendations. Let’s ignore the testimony of veteran gay rights activist and one-time Stonewall spokeswoman Anya Palmer, who reports that Hunt promised her Stonewall would never embrace trans activism, before pivoting to focus on almost nothing else. Let’s instead consider, for a moment, what it actually means to “build consensus”, in the Hunt sense.

Perhaps the most succinct literary anatomy of Huntish “consensus” was written more than two centuries before Hunt assumed leadership of Stonewall. In the first sentence of Pride and Prejudice (1813), Jane Austen informs us that “It is a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a wife.”

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It’s a one-line joke, that juxtaposes two distinct, and very differently coded “ways of knowing”. In the process, too, it reveals that far from being distinct, these two ways of thinking actually operate in lockstep.

“It is a truth universally acknowledged” stakes a claim to objectivity: the kind of fact that, as “classical liberals” such as Ben Shapiro like to put it, doesn’t care about your feelings. This mode of knowing, central to the Enlightenment privileging of reason and objectivity, was (and still is) masculine-coded. It gains its power from asserting that its truths will remain true whether or not you acknowledge them as such.

Austen ironises this, by exposing the process of consensus-formation that lies beneath many such claims: a dynamic less concerned with facts than social, contextual meaning and desirable behaviour, captured in “a good fortune” and “must be in want of a wife”. These phrases are loaded not with objectivity but context: an intricate and intimately feminine world of 18th-century social hierarchies and sex roles, afforded narrative urgency by the real privations that faced unmarried “gentlewomen” excluded by social custom from paid employment.

The punchline lies in the implication that what lurks under the bonnet of “truth universally acknowledged” is often not truth but this feminine-coded matrix of embedded meanings. Any effort at detached objectivity will be leavened by status-signalling and aspirational manoeuvring.

Meanwhile, what holds this together is less the fact of its “truth” but that it’s “universally acknowledged”. That is, we’re reading a normative statement disguised as an objective one. And not just normative but prescriptive: “universal” has a faintly threatening undertone, suggesting that anyone who matters acknowledges this truth, and by extension you probably should if you don’t want to be shunned.

Austen’s one-liner is the gently ironic opener to one of the greatest modern love stories. But it points to a truth that today seems more pertinent than ever: that many modern truth-claims follow this structure, and are enforced through very similar social mechanisms.

Perhaps the most totalising recent instance of this was Covid consensus-formation. It’s dizzying now to read press reports from just before the Great Covid Panic took hold. Before this happened, Ian Bremmer approvingly describes experts doing “an impressive job of calmly and professionally setting out the factual framework behind the government’s coronavirus strategy”, while Boris Johnson accepts the moderate expert advice provided by Chris Witty to wash hands, protect the elderly but otherwise carry on with “business as usual”.

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It’s yet more extraordinary to remember that in the 20 days after this article was published on March 3, we witnessed a screeching media 180 from encouraging “business as usual” to near-universal calls for lockdown.

Over the period that followed, competing Covid claims and counter-claims were all larded with “experts” and “evidence”. Reviewing these now makes one thing clear: Austen’s assessment of TUA remains true. Moral consensus precedes rationalisation. The Covid vibe shift may have been presented as scientific and factual; but what powered it was a chaotic tangle of magical thinking, fear, and the threat of social ostracism. The statement made by epidemiologist Sir Mark Woolhouse to the Covid enquiry captures the social pressures boiling beneath the claimed objectivity: “The emphasis on consensus and clear messaging,” he said, “plus a sense of not wanting to ‘rock the boat’, made it difficult to discuss these issues openly at the time.”

No one likes being ignored, scorned, or shunned. No wonder so many Sensibles fall obediently into line on every TUA. Take TV presenter and quintessential Sensible Kirstie Allsopp, who last year waded vigorously into the what she called “the trans moral panic” on the Stonewall side. Her reward was a pat on the back from the Daily Stormer of gender woo, Pink News, for opinions “backed up by science and facts”. It’s more accurate, though, to describe her opinions as (at the time) robustly supported by the moral hive-mind that determines and then enforces the Truth Universally Acknowledged.

Here, again, the comparison with Austen is instructive. In Austen’s day, genteel moral consensus-formation happened within a social world of dinners, balls, picnics and other social events. Today, though, it’s been professionalised, via what author Matt Goodwin calls a “New Elite” comprising an “epistemic class” which dominates institutions such as TV, journalism, museums, charities and academia, and uses their influence to shape the public conversation in line with approved opinions.

And yet, in some respects, nothing has changed. For many of these elite women who, in Austen’s time, would be eyeing one another over their fans at Lady So and So’s, now work in New Elite industries, many of which are markedly female-dominated. Allsopp is a case in point: her parents are Lady and Baron Hindlip, and she is a Hon., though doesn’t usually use the title. She has parlayed old-elite status into National Telly Treasure status, whence she holds forth on moral issues with an unwavering moral certainty Austen would have recognised, and probably lampooned.

So, now the winds have changed, we find Allsopp also back-pedalling. It was never true, she asserts, that there was “no debate” on the issue of medical experiments on gender-confused children. Puberty blockers, Kirstie informs us, were bad all along. But we could always talk about it: “it is, and always has been possible to debate these things and those saying there was no debate are wrong”. All the people (mostly women) unfairly fired or bullied out of jobs, all the grannies punched in Hyde Park by men with special identities, the no-platforming, the intimidation, the threats, and the censorship — that wasn’t actually a thing.

Allsopp is the clearest indicator yet that at least where child gender vivisection is concerned, at least some of the grandes dames of Truth Universally Acknowledged may have paused broadcasting a TUA in order to convince themselves, in the light of a new emerging groupthink, that the new consensus is what they believed all along. And because moral consensus precedes its “expert” rationalisation, so we also find that those who purport to stand for science and reason are also curiously quiet.

On Sunday, for example, Sex Matters founder Maya Forstater (herself notoriously a victim of the “No Debate” consensus Kirstie Allsopp says never existed) called on science communicator and Humanists UK president Adam Rutherford to defend systematic scientific reviews, against the trans activists spreading misinformation about the Cass Review. Did he come out swinging for science and reason over gender ideology? Reader, he flunked it: “It’s not something I know much about.”

Last November, Humanists UK welcomed a Private Members’ Bill banning “conversion therapy” — in a formulation that would, in effect, ban anything but the “affirmation” approach to gender identity, recently decried by the Cass Review as unsupported by evidence and potentially harmful to children whose sense of self is still developing. Perhaps Rutherford is waiting, as many commentators did during Covid, until it becomes obvious which Truth Universally Acknowledged was always obviously supported by the evidence.

We can hardly blame him. I don’t doubt his vaunted commitment to even uncomfortable scientific truth. But if Covid taught us anything, it’s that scientific truth can be — with the best of intentions — somewhat ductile, especially weighed against the risk of ostracism by every desirable dinner-party hostess in medialand. But should those hostesses resume broadcasting their TUA, having agreed that they always believed puberty blockers were bad, perhaps the Rutherfords of our public discourse will feel able to hop back in the trenches on behalf of science, objectivity, and Dr Hilary Cass.

Overall, though, no lessons will be learned. None was learned from Covid, for all that Woolhouse described the lockdown policy bluntly as a “failure”. Not even a recent report showing the appalling and preventable harm lockdowns did to a generation of children seems to have prompted much soul-searching among those who advocated loudest for such measures.

And this is because the unhappy inference is that we’re still stuck in the same paradigm: the chattering-class two-step of moral groupthink masquerading as science. Just like Johnson in 2020, we’re still looking to “experts” as a means of outsourcing moral judgement — and as someone to blame when things go wrong. Even Hunt, on whose watch Stonewall helped entrench gender ideology in public health, is now busy describing her “regret” at having naively “trusted the experts”.

In truth, though, “experts” are a front for the TUA: the chattering-class moral consensus. And this is manufactured by people who care less about being right than looking virtuous. Career moral entrepreneurs such as Hunt; vacuous grandes dames such as Allsopp; “communicators” such as Rutherford whose job is to make consensus look sciency. Downstream of their posturing, children were irreversibly harmed. They didn’t care; they wanted to look kinder than you. They should not be allowed to forget how wrong they got it.

So, either she was being disingenuous, or she doesn’t know what a woman is. Or perhaps she was just doing what many other indulgent parents do and was appeasing her transactivist son. Whatever the answer, it’s unforgivable. She is a public servant.

In the aftermath of the Cass Report into the state of Britain’s youth gender care services, I have little interest in condemning people for stupid things they have said in the past — but I am angry about those who only changed their stance once it becomes unavoidably obvious that they were wrong all along. One obvious candidate is Labour shadow health secretary, Wes Streeting — though, admittedly, he did reposition himself in the months before the Cass Report was published.

In the past, Streeting has resorted to what I call “the Joni Mitchell diversion tactic”, attributing the toxicity of the “debate” to “both sides”. Yet Streeting himself hasn’t always been so even-handed. In 2017, he called for “specialist GPs” to be trained to prescribe “bridging hormones” while patients waited for a referral — a practice starkly at odds with the conclusions of the Cass Report.

Yesterday, though, Streeting hailed Cass’s review as “a really important” piece of work. “[It] does raise some serious concerns that are pretty scandalous. Actually I think we’ve got to ask ourselves: why is it that we’ve seen medical interventions that have been given on the basis of very weak evidence? How is it that clinicians have been silenced for coming forward?”

Really, Wes? You don’t understand how these people — including your own colleague, Rosie Duffield — have also been silenced? Of course he does. But then yesterday, disingenuity was the order of the day. Even Stonewall — that rainbow-resplendent Garden of Eden — was forced to change tack. In its statement about the review, it said: “What is important, above all, is that trans and gender-diverse children get the quality healthcare that they need and deserve. The Cass Review can play a vital role in achieving this aim, if its recommendations are implemented properly.”

Coming from an organisation that has repeatedly extolled the benefits of making puberty blockers available for children, should we take this seriously? Probably not. But regardless, the fact they have been forced to even utter such words cannot be dismissed.

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Twenty years a Terf

By Julie Bindel

In a similar vein, the prickly princelings at PinkNews published an uncharacteristically low-key piece — possibly the site’s most neutral article about the review since it was commissioned four years ago. In place of its usual fare — incoherent rants peppered with spelling mistakes — it set out some of the report’s recommendations, almost without comment. It even said that the World Professional Association of Transgender Healthcare (WPATH), an internationally recognised body for trans healthcare guidance, lacks “developmental rigour”.

It can’t be stressed enough how out-of-character this is. For years, PinkNews has been a key cheerleader for puberty blockers for children, repeating myths about trans kids being at major risk of suicide if denied such treatments. Yet here it simply reports: “The review also claimed that, while research suggests that hormone treatment “reduces” the elevated risk of suicide, there is ‘no clear evidence’ that social transition has any positive or negative mental health outcomes.” On a normal day, its reporters would be screeching “transphobia” and “bigotry” from the comfort of their keyboards, but then yesterday was no normal day.

And yet, for all of yesterday’s almost-mea-culpas, it would be delusional to hope that these people will ever genuinely admit their roles in the scandal, let alone their own contributions to the horrendous damage that has been done to children. I even doubt that any regret will register — other than in terms of how it might backfire on them personally. Politicians will change their tune because they want to be popular and get elected; organisations such as Stonewall know that their funding will soon dry up, their expiry dates growing ever closer.

In 2008, I was officially “no-platformed” by the National Union of Students (NUS), becoming the first individual deemed so offensive and dangerous that I was blacklisted alongside five fascist groups. At the time, Streeting was president of the NUS, and I called him and asked for his help. When he refused, I asked if he would simply denounce the allegation that I was transphobic, even if he couldn’t do anything officially to get me removed from the list. He would not. Six years later, when I was considering whether to take some kind of legal action against the NUS for reputational damage, I contacted him again. He initially agreed to an off-the-record chat, but then stopped replying to my emails about a suitable time to speak. It’s funny how things change.

If I sound bitter that’s because I am. Thousands of kids have been harmed by this ideology, along with many, many adults. Those of us who have been shunned, lost jobs, friends and reputations as a result of accusations of bigotry and transphobia are, of course, secondary victims. And as for those who have played it safe? Inevitably, they will now stay silent or pretend that the evidence of harm contained in the Cass Report is a shocking revelation. The truth, of course, is that the evidence has been there all along. To those new converts now pretending otherwise: we see you.

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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The murder trial that broke me

By Julie Bindel

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.

In the more hyperbolic echo chambers of social media, the decision was cast as a lifeline withdrawn for no other reason than state-sanctioned bigotry and transphobia, possibly as part of a covert programme of eugenics. The hysterical pitch of this suicide narrative eventually prompted Professor Louis Appleby, head of the national Suicide Prevention Strategy, to stage an intervention on X. He stated that invoking suicide in this debate was both “mistaken and potentially harmful” and called time on “that line about choosing a living daughter or a dead son” — a line that has terrified so many parents into submission when presented with a medical pathway as the only option for their distressed children. So what does the NHS withdrawal of puberty blockers as a treatment for gender distress actually mean?

Every drug prescribed by a doctor requires a licence issued by a relevant regulatory authority. These bodies carefully review the data from clinical trials to ensure that the drug is effective, safe and meets manufacturing quality standards. However, once licensed for one purpose, these drugs can then be used off-label for another. Off-label means the drug can be prescribed for a condition (or at a dose) other than that for which it has been approved. Off-label prescribing is common, particularly in paediatric medicine, as children are rarely participants in clinical trials for ethical reasons. Up to 20% of drugs may be prescribed off-label. Puberty blockers are licensed in children to treat precocious puberty, a condition where children hit puberty years before their peers, sometimes before the age of five. Although the impacts on bone density are recognised, the drugs are effective at preventing the short stature and ameliorate the significant emotional and behavioural difficulties associated with such an early onset.

Once a drug has a licence for one condition, doctors are free to prescribe the medication for an off-label use, if they have a reason to believe it might help. This is how puberty blockers came to be prescribed to children with gender related distress. The announcement last week effectively put an end to this practice in the NHS.

For as long as puberty blockers were being offered as an off-label treatment by the NHS, clinicians were both ethically and duty bound to monitor their effectiveness. This fundamental duty was largely ignored by the clinicians at Gids who failed to collect adequate data, and rolled out the experimental treatment regardless. In a sign of just how far outside the bounds of normal clinical practice Gids was operating, one senior clinician appeared to be under the impression that auditing the outcomes of the experimental treatments they offered would actually be illegal.

As a result of their failings, we are left with a vacuum of data on the safety and effectiveness of puberty blockers and are back to square one when it comes to evaluating the medication as a prospective treatment for children with gender distress. It’s one thing to attempt to persuade an ethics committee to allow you to monitor the impact of a treatment already in use, albeit in an off-label capacity, quite another to convince them to give the go-ahead to experiment in children with a powerful treatment that will interfere with a critical stage of maturation. Following the withdrawal of off-label prescribing, anyone attempting to design an NHS trial to explore the efficacy of these drugs will need to convince an ethics committee of a sound rationale for reintroducing the drugs in the first place.

In most clinical trials, identifying the target or primary outcome of the treatment is the easy part: antibiotics reduce infection, epilepsy medications stop seizures, cancer treatments eliminate malignancy. No one needs a trial to prove that puberty blockers block puberty — the drugs are unequivocally effective in this regard. But puberty is neither a disease nor an illness. It is a vital stage in the transition from childhood to adulthood, marked by changes that extend far beyond the development of secondary sex characteristics. The brain undergoes extensive rewiring during puberty, creating the adult capacity for nuanced thought and complex decision-making, a process that isn’t complete until well into the third decade of life. Changes in the brain also allow sexual identity to develop. And elsewhere in the body, respiratory and circulatory systems undergo rapid growth and development. The skeletal system changes, increasing in bone density and musculature. Puberty blockers interfere with all of these processes in ways that may or may not be completely reversible — we can’t be sure, as many have not been studied.

But the importance of puberty as a critical developmental stage is such that any case to block it would need to be exceptionally strong to convince an ethics committee to green light a clinical trial. The bar will be set even higher, given the vulnerability of the target population: children who often present with multiple other psychiatric difficulties.

The rationale for using these drugs in gender clinics has undergone a highly unusual evolution over the past two decades. Initially prescribed to a very small number of boys to help them “pass” more easily as adult women, the drugs later began to be prescribed to the increasing number of adolescent girls presenting to these services. With the change in clinical caseload, the rationale for prescribing puberty blockers morphed into the notion that pausing puberty would give these distressed young people “time to think”. However, it is very clear from the data in the UK and Holland that the drugs did anything but, since more than 97% of children who took the puberty blockers went on to take cross-sex hormones. As Dr Anna Hutchinson, one of the original Gids whistleblowers, pointed out: “What are the chances that everyone given time to think, ends up thinking the same thing?”

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Doctors have failed detransitioners

By Sallie Baxendale

As a neuropsychologist, the irony of stopping puberty in an effort to give young people time to think is not lost on me. Puberty is the neurodevelopmental process that literally constructs the neural architecture that allows people to think about complex and nuanced issues. Blocking puberty prevents the critical rewiring in the brain that underpins the ability make complex decisions. Puberty blockers may give children time to think but they simultaneously rob them of their developing capacity to do so.

In a pivot away from the “time to think” narrative, proponents currently argue that puberty blockers are vital to relieve the intense, even life-threatening psychological distress that trans and gender diverse people experience when puberty begins. This positions the treatment as a mental health intervention for acute psychological distress. Yet this distress may be anticipated rather than acute in those started on the medications as young as eight.

This is a world away from the original rationale. Chemically preventing a vital stage of maturation as a pre-emptive treatment for acute psychological distress also represents a major paradigm shift away from every other approach to treating psychological distress. This rationale is even more extraordinary given the evidence that puberty itself may be the best “cure” for gender related distress in many young people. The proportion of children diagnosed with gender identity disorder in childhood who persist into adulthood is contested, but most studies report that the majority (70% or more) no longer meet the diagnostic criteria once they have gone through natural puberty.

For a clinical trial to go ahead, an ethics committee must first be convinced of a solid rationale to override the safety concerns that were significant enough for the NHS to call a halt to off-label prescribing in this a highly vulnerable group. Researchers will also need to present a strong argument for trialling such an unprecedented treatment paradigm for psychological distress in young people.

If the researchers get this far, there is one final ethical barrier to overcome — and it is huge. The presence of detransitioners demonstrates that this medical pathway has the potential to cause significant, irreversible and lifelong harm. This is often minimised by gender clinicians as “treatment regret”, something which is common in many areas of medicine: many patients regret undergoing treatment when something has gone wrong with a procedure, or the results are not as they hoped. This is an inevitable part of all medical practice; results can never be guaranteed. However, detransitioners were given the wrong diagnosis and the wrong treatment for their distress. They represent the failure of the doctors treating them, not the failure of the treatment.

Even the fiercest advocates for puberty blockers acknowledge that there is no way of knowing who will or won’t be helped by medical transition. There is no middle ground; those who aren’t helped are harmed. Without a reliable clinical test to identify those who will benefit in the long run, an ethics committee that gives the go-ahead for a clinical trial does so in the knowledge that at least some of the children who take part will be unnecessarily put on a pathway of lifelong medicalisation with all its attendant risks and harms. Will any ethics committee in the land be persuaded that this is a price worth paying?

In the meantime, the new NHS gender services have a chance to right some of catastrophic wrongs of the original Gids service. Starting afresh, clinicians can ensure the careful record keeping and clinical audit that should be hard baked into every NHS service. Rigorous, standardised assessments and continuous monitoring of outcomes will provide much-needed information on the holistic treatments, including exploratory therapy that will be offered in the new services for young people with gender distress, since these, too, need to be evaluated.

If a puberty blocker trial ever gets past an ethics committee, we will face a further wait for the results. In the meantime, it is likely that vulnerable children will continue to seek these medications in the private sector, a place where puberty blockers have been  marketed anew as “necessary, safe, effective and life-saving” since the NHS announcement. At least parents now have a choice. When it comes to their children, they can believe the experts in the NHS who, having examined all of the evidence for both the safety and clinical effectiveness of puberty blockers, found it sufficiently lacking to withdraw the treatment. Or they can believe those who frame access to these drugs as a fundamental human right, while profiting financially from every prescription they issue. Rights do have a place in the treatment of children with gender distress: these children deserve the same evidence-based treatments as everyone else.

“When I saw her,” wrote Sante, referring to Lucy, “I felt something liquefy in the core of my body. I trembled from my shoulders to my crotch. I guessed that I had at last met my reckoning.” This was not a sudden whim for Sante, then aged 66, but a longstanding fixation made finally undeniable. As evidence, Sante included in the letter a list of recurrent “masturbation scenarios”, all of which involve coerced feminisation: “cast as a girl in the school play, then persuaded to go out on the town in costume; hired as an assistant by a wealthy society woman who amuses herself by dressing me up as a girl; new roommate assigned to me in college has been dressing as a girl for years and has a full wardrobe.”

Sante’s friends were uniformly warm and positive in response. One female colleague wrote back to say it was “exciting to have another great female writer”. Only one person replied critically — a trans woman, who told Sante: “My only note so far is that I wouldn’t mention your crotch in connection with a realisation about your gender identity, because any mention of genitalia or crotches instantly brings up all sorts of bizarre paranoid delusions that trans women are just transitioning as part of some kind of sexual fetish.”

Sante bridled a little at the judgement, given that this was a private letter to a small group, but changed the word “crotch” for “belly”. And then — this is the fascinating part — reverted to “crotch” for the least private possible audience, republishing the original letter in a new memoir, I Heard Her Call My Name. In fact, Sante seems entirely blithe about the crotch mentions, announcing near the end of the book that: “my dysphoria was never centred on or even especially concerned with genitalia. (Although it is extremely exciting to have tits.)” Bottom surgery is presumably not on the to-do list.

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How Elliot Page escaped womanhood

By Sarah Ditum

It hardly seems to require any “bizarre paranoid delusion” to see evidence of a fetish at work. But for Sante’s trans woman correspondent, the anxiety was presumably about saying the quiet part out loud. Since the start of this century, trans activism has pushed a “born this way” narrative of gender identity — and at the same time, aggressively rejected any implication that a man might have a sexual motivation for identifying as a woman.

This is despite the fact that we are supposedly in a more permissive era than ever before. “Kinkshaming” is the great taboo: it’s a worse faux pas to wrinkle your nose at someone else’s peccadillos than it is to flaunt your own. And yet this is also an era with a great intolerance of male displays of sexuality in culture. While the underworld of pornography propagates unchecked horrors, the oversexed male mainstream writer is a subject of open derision. There are few more crushing satires than the “men writing women” meme: “She breasted boobily to the stairs and titted downwards…”

A lot of men’s writing about women has been ludicrously sexist, and in recognition of that fact, a great many male authors today — who come, on the whole, from the nice liberal side of the tracks, and would be alarmed at being cast as “anti woman”, especially in a heavily feminised publishing industry — have tended to stow their libidos. By contrast, the big filthy beasts of the 20th century look tawdry and dated: Philip Roth, John Updike, Martin Amis, standing awkwardly in the corner with their dicks in their hands. In the mid-to-late 20th century, their openness about desire was revelatory — part of the great post-war liberation. In the 21st century (and especially after #MeToo) they’re treated with more suspicion: less literary explorers of the libidinous underworld, more cringy self-pleasurers. The only heirs left to that literary tradition seem to be trans women writers, such as Sante or Torrey Peters, whose novel Detransition, Baby is a riot of sissy porn and flopping testicles. Perhaps the stigma about “breasting boobily” goes away when the male authors in question have grown their own.

Male desire can be a forbidding subject for women. Whether as a consequence of nature or nurture, men’s sexuality tends to be a more consuming presence in their lives than it is for women. In a bell curve distribution, there will be significant overlap — but men in general have higher sexer drives than women. Men also tend to have weirder sex drives than women: paraphilias, the fancy sexologist work for “kink”, are considerably more common in men than in women.

This is uncomfortable knowledge, and for women it can be nicer to ignore it.  For men, meanwhile, sustaining a “decent” life while suspecting yourself of being thoroughly indecent within can become intolerable. Sante writes often about the strain of repression. And the trans writer Debbie Hayton described managing autogynephilia as “like someone trying to hold down a beach ball underwater, only for it to force its way to the surface”. Alasdair Gray — author of Poor Things, and one of the greatest of all literary perverts — wrote that “unless we bring one of our wicked little dreams just a wee bit to life we live like zombies”.

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Women, often, would simply rather not know about this aspect of men. It is disturbing, alien, disruptive. That perhaps explains why Sante’s woman colleague was able to skip past the “crotch” sentence and arrive at the comfortable conclusion that Sante was now “female”. It explains why many female readers of Detransition, Baby seemed to overlook the dirty bits and neuter it into being a novel about “womanhood”.

But it explains too why there was a response of unmitigated disgust from some women who recognised Detransition, Baby for the work of honest filth it is. When Peters was long-listed for the Women’s Prize in 2021, the objection from some gender critical campaigners was not only that it should have been ineligible by dint of Peters’ sex (a fair point), but also that its content made it illegitimate.

“Had a female author submitted a culturally regressive, sadomasochistic, misogynistic ‘surrendered wife’ narrative to the Women’s Prize, it would rightly have been ignored by the judges,” said one angry open letter to the Women’s Prize. Actually, Sally Rooney’s Normal People, with multiple scenes of sadomasochistic sex between its two protagonists, was long-listed in 2019, so this criticism doesn’t ring true. What was objectionable about Peters’ book was maybe that, unlike the melancholic Rooney novel, it appeared to be written by someone who was having a thoroughly good time getting mucky.

Yet men’s sexuality seems, on the whole, to be something women ought to be interested in. After all, almost all of us live with or alongside men. Some of us sleep with them too. The truth should be more valuable than the nice-guy mythology: knowing what a man wants entails no obligation to consent to it. To respond with disgusted calls for men to censor themselves — or worse, with the ladylike self-censorship of Butler — is to wilfully choose ignorance.

There’s a complication, though. Desires are not just inherent: they’re also imitative. Part of Sante’s journey to transition is the slow-burn of a lifetime of fantasy; part of it is the easy access to an online community that reinforces the wish. For most of Sante’s existence, “becoming a woman” was an impossible urge. Only when technology makes it tangible did it become a consuming obsession. There should be space in the world for the honest — and hopefully intelligent — disclosure of the male libido, as for the female. But it may be men who pay the highest price for that knowledge.

The sheep studies were particularly interesting as they used twin lambs, administering the puberty blockers to only one in the pair. More than one year after stopping the medication, the sheep who had taken the puberty blockers had still not “caught up” with their untreated siblings in their ability to complete a test of spatial memory. It can, however, be fairly argued that we can only extrapolate so much from the abilities of sheep to remember the way through a maze of hay bales. It is really the studies in humans that are of most interest to those considering prescribing or taking these drugs.

Yet such studies are hard to come by. There are only five that have looked at the impact of puberty blockers on cognitive function in children, and only three of these have looked at these effects in adolescents given the medication for gender dysphoria. In one of these studies, the researchers didn’t measure how well the children were doing before they administered the drugs, so it is difficult to know whether the subsequent difficulties they had on a strategy task could be attributed to the medication. A second study established an excellent baseline, and the researchers employed a gold-standard measure to test the cognitive abilities of the children in the programme before they started the puberty blockers.

Unfortunately, they didn’t re-administer these tests to assess the impact of the medication, but chose instead to report how many of a subset of these children completed a vocational education and how many completed a higher vocational education years later. No outcomes at all were reported on 40% of the children who started out in the study. The final study, however, was beautifully designed: the researchers assessed IQ prior to the administration of puberty blockers and regularly monitored the impact of the treatment over 28 months on a comprehensive battery of cognitive tasks. The results were concerning and suggested an overall drop in IQ of 10 points which extended to 15 points in verbal comprehension. But regrettably, this was a single case study, and while alarming, the conclusions we can draw from one person’s experience are limited.

Last year, I wrote a paper to summarise the results of these studies. The paper explained in relatively simple terms why we might think that blocking puberty in young people could impact their cognitive development. In a nutshell: puberty doesn’t just trigger the development of secondary sex characteristics; it is a really important time in the development of brain function and structure. My review of the medical literature highlighted that while there is a fairly solid scientific basis to suspect that any process that interrupts puberty will have an impact on brain development, nobody has really bothered to look at this properly in children with gender dysphoria.

I didn’t call for puberty blockers to be banned. Most medical treatments have some side effects and the choice of whether to take them depends on a careful analysis of the risk/benefit ratio for each patient. My paper didn’t conduct this kind of analysis, although others have and have judged the evidence to be so weak that these treatments can only be viewed as experimental. My summary merely provided one piece of the jigsaw. I concluded my manuscript with a list of outstanding questions and called for further research to answer these questions, as every review of the medical literature in any field always does.

As a scientific paper, it was not ground-breaking — reviews rarely are. But by summarising the research so far, I thought it would serve as a convenient resource for the numerous authorities currently examining the efficacy of these treatments. It also provided key information for parents and children currently considering medical options. Every patient needs to be aware of what doctors do and do not know about any elective treatment if they are going to make an informed decision about going ahead. Doctors have a duty of candour to provide this.

I was surprised at just how little, and how low quality, the evidence was in this field. I was also concerned that clinicians working in gender medicine continue to describe the impacts of puberty blockers as “completely physically reversible”, when it is clear that we just don’t know whether this is the case, at least with respect to the cognitive impact. But these were not the only troubling aspects of this project. The progress of this paper towards publication has been extraordinary, and unique in my three-decades-long experience of academic publishing.

The paper has now been accepted for publication in a well-respected, peer-reviewed journal. However, prior to this, the manuscript was submitted to three academic journals, all of whom rejected it. “Academic has paper rejected from journal” is not headline news. I have published many academic papers and have also served on the editorial boards of a number of high impact scientific journals. I have both delivered and received rejections. In high-quality journals, many more papers are rejected than accepted. The reasons for rejection are usually a variation on the themes that the paper isn’t telling us anything new or that the data is weak and doesn’t support the conclusions that the authors are trying to draw. In a paper that is reviewing other studies, reasons for rejection typically include criticisms of the ways the authors have looked for or selected the studies they have included in their review, with the implication that they may have missed a big chunk of evidence. Sometimes the subject of the review is too wide, too narrow or too niche to be of value to the wider readership.

While imperfect, anonymous peer review remains the foundation of scientific publishing. Theoretically, the anonymity releases reviewers from any inhibitions they may have in telling their esteemed colleagues that, on this occasion, they appear to have produced a pile of pants. When it works well, authors and editors receive a coherent critique of the submitted manuscript, with reviewers independently highlighting — and ideally converging — on the strengths and weaknesses of the paper. If done sloppily, or if the reviewers have been poorly selected, the author may be presented with a commentary on their work that is riddled with misunderstandings and inaccuracies. Requests for information already provided are common, as are suggestions that the author include reference to the anonymous reviewer’s own body of work, however tangential to the matter in hand. I have been on the receiving end of both the best and worst of these practices over the course of my career. However, I have never encountered the kinds of concerns that some of the reviewers expressed in response to my review of puberty blockers. In this case, it wasn’t the methods they objected to, it was the actual findings.

None of the reviewers identified any studies that I had missed that demonstrated safe and reversible impacts of puberty blockers on cognitive development, or presented any evidence contrary to my conclusions that the work just hasn’t been done. However, one suggested the evidence may be out there, it just hadn’t been published. They suggested that I trawl through non-peer reviewed conference presentations to look for unpublished studies that might tell a more positive story. The reviewer appeared to be under the naïve apprehension that studies proving that puberty blockers were safe and effective would have difficulty being published. The very low quality of studies in this field, and the positive spin on any results reported by gender clinicians suggest that this is unlikely to be the case.

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Another reviewer expressed concerns that publishing the conclusions from these studies risked stigmatising an already stigmatised group. A third suggested that I should focus on the positive things that puberty blockers could do, while a fourth suggested there was no point in publishing a review when there wasn’t enough literature to review. Another sought to diminish an entire field of neuroscience that has established puberty as a critical period of brain development as “my view”.

In a rather telling response, one of the reviewers used religious language to criticise the paper. They argued that the sex-based terms I had employed to describe the children in the studies — natal sex, male-to-female, female-to-male — indicated a pre-existing scepticism about the use of blockers. They suggested that the very presence of these terms would cause people who prescribe these medications to “outright dismiss the article”, and went on to say that by using these terms the paper was “preaching to the choir” and would do a “poor job of attracting new members to the fold”. However, the most astonishing response I received was from a reviewer who was concerned that I appeared to be approaching the topic from a “bias” of heavy caution. This reviewer argued that lots of things needed to be sorted out before a clear case for the “riskiness” of puberty blockers could be made, even circumstantially. Indeed, they appeared to be advocating for a default position of assuming medical treatments are safe, until proven otherwise.

Yet “safe and fully reversible” can never be the default position for any medical intervention, never mind a treatment that is now deemed experimental by authorities in Europe and the UK. Extraordinary claims demand extraordinary evidence, and the only extraordinary evidence here is the gaping chasm of knowledge, or even apparent curiosity, of the clinicians who continue to chant “safe and completely reversible” as they prescribe these medications to the children in their care. It is not the job of a scientific paper to “bring people into the fold”; it is the job of clinicians to understand the evidence base of the treatments they offer and communicate this to the patients they are treating.

I sincerely hope that any arrest in brain development associated with puberty blockers is recoverable for young trans and gender diverse people, who are already facing significant challenges in their lives. I would welcome any research that indicates that this is the case, not least for the significant insights that would present to our current understanding of puberty as a critical window of neurodevelopment in adolescence. Puberty blockers almost invariably set young people on a course of lifetime medicalisation with high personal, physical and social costs. At present we cannot guarantee that cognitive costs are not added to this burden. Any clinician claiming their treatments are “safe and reversible” without evidence to back it up is failing in their fundamental duty of candour to their patients. Such an approach is unacceptable in any branch of medicine, not least that dealing with highly complex and vulnerable young people.

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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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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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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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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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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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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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.

Distras has been expressing concern about gender ideology in private since late 2021, but the first time she went public with her opinions was in May of this year. “I’m a woman, and a woman is an adult human female,” she said in an interview with Louder than War, a music website. “I’m a woman that’s experienced domestic abuse.” She later made comments, on Twitter, about how women are silenced for questioning gender ideology: “No amount of rainbows and ‘kindness’ can hide the authoritarianism and misogyny and homophobia that’s on display here, especially in the arts.”

Born in Wakefield in 1987, Distras ran away from home in her teens and, she told me, “stayed with a lot of dangerous people who took advantage of me”. She turned to song writing as a form of escape. Her bravery is remarkable. But as soon as her straightforward resistance to gender ideology became known, she was met with horrendous abuse. Distras has been called every name under the sun, including anti-trans, Nazi, scum, prostitute, grifter, child serial killer, and witch. She soon realised that she had been “marked for life” as a “disgusting terf” — that no redemption would ever be possible. She was told she deserves to be chucked out of the music industry. Her booking agency has said that her attitude towards transwomen could “have detrimental effects on [her] musical career”. Radio stations have stopped playing her songs and venues cancelled her gigs. “If I go back to the industry as it stands,” she says, “if someone had the balls to book me for a gig, I would likely be physically attacked. It’s not safe.”

Having been rejected by the majority of her contacts in the music industry, Distras decided she might as well use her voice to speak out. Alongside five other women, her testimony featured in the Daily Mail about the experience of being ostracised for daring to question gender ideology. One of the first derogatory reactions was from Bragg. “What??”, he tweeted, linking to the feature, which included a photograph of Distras — who usually wears black and leather on stage — wearing a formal dress. “Louise Distras hates trans people so much that she’s willing to dress in a style acceptable to Daily Mail readers in order to have a go at them. What does this have to do with feminism Louise? Or punk rock?”

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Bragg fancies himself a bit of a trans ally. And prides himself on being an all-round anti-sexist bloke. In 2014, he posed with a sign, “I pledge never to commit, condone, or remain silent about men’s violence against women in all its forms,” as part of the White Ribbon campaign.

Back in the early days of her career, Bragg championed Distras as one of a “new breed” of singers, tweeting in 2013 that her song Love Me The Way I Am should be our next Eurovision entry. Another of her songs, The Hand You Hold, is about how what women say and do should matter more than how we look, and she tells me that “Billy for some reason loved that song and that’s why he invited me to go play on his stage” — which she did that year, at Glastonbury, and again in 2017. “So for him to now take a pop at me and start criticising what I look like instead of actually listening to what I have to say means he is the biggest hypocrite.”

But it is not only men who have gone after Distras. In a recent interview with Kerrang!, Phoebe Lunny of the Lambrini Girls reacted to Distras speaking out against trans ideology and the silencing of women: “I will scrap any Terf, any day, in person, with my fists.” In a tweet, Distras pointed to the hypocrisy of claiming to be progressive while “inciting violence against women”. She also condemned Kerrang! for publishing the remarks, saying she is “ashamed my face was printed on its pages. Vile!”

Spoken word poet Amelia Vandergast also responded angrily to Distras’s public statements about being cancelled by trans activists. In a feature entitled, “Wipe away the terf tears: freedom of expression was never permission to perpetuate hate in the music industry”, published in A&R Factory website, she wrote:

“In the recent Daily Mail article, which attempted to portray women as the victims of their transphobic hate, Louise Distras bemoaned the journalists, radio stations, and her booking agency who rightly refuse to have anything to do with her for the self-piteous bile spewed across her social media platforms (anyone got a tiny little violin I can borrow?)”

For Distras, the hypocrisy within the so-called radical music scene is appalling. While the misogyny of trans activists is ignored, women are viciously attacked for daring to defend their sex-based rights. She is one of a growing list of female artists criticising cancel culture — a phenomenon of which Bragg denies the existence.

But Bragg has form. He has dismissed feminist concerns about self-identification and argued that, owing to our incompatible “hardware”, lesbians are biologically ill-equipped for sex with other women and should therefore understand the plight of men claiming to be female. When Maya Forstater was harassed by trans activists in the street, Bragg suggested that she could not possibly have been scared or upset, because she appeared to be smiling. This is a classic sexist trope. Too often, women are told by men to “Give us a smile” when we complain about being sexually harassed by them, and yet women are informed we must have enjoyed the harassment if we attempt to laugh it off.

“I think he’s a misogynist,” Distras says, of Bragg. “I think it’s just plain to see for everybody and the way he is — the way that so many men are in the music industry.” She talks about how uncomfortable she has felt with him, describing him as “creepy”. “He’s everything he says he’s not. His words and his actions just don’t match up for me… The way he goes after women over the trans issue has made it really clear to me that he’s just a misogynist, and that he just doesn’t care about women”. She says what many feminists have said of many men in recent years: “The trans thing is just an excuse for him to bully women with impunity and do it publicly and get applauded for it.”

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Bragg also showed no sympathy for Róisín Murphy, another female singer-songwriter who has faced the wrath of trans activists. After a private Facebook conversation in which she criticised the policy of giving children puberty blockers was leaked, she was admonished by Bragg for holding the wrong opinion. “Them’s the breaks,” Bragg tweeted when it was suggested that Murphy was being punished by having BBC coverage and concerts cancelled. “Think before you post is my advice, especially on issues that are contentious.” This is cowardice.

Distras strongly feels that the music industry used to be about “freedom of expression and freedom of speech”, but is currently in thrall to gender ideology and “totally monotheistic”. “There’s an urgent need to build a new one, with a proper counterculture that isn’t dominated by misogynists like Billy Bragg, where women have actually got a proper say,” she says, telling me she has had numerous messages from female musicians who are too scared to speak out — especially after seeing what happened to Murphy. “It’s well established that violence towards women is a massive problem in the music industry,” says Distras, “and here they are inciting more violence, and the rest of the music industry just applauds them for it and tells them they are stunning and brave.”

“We need more musicians to come forward courageously and without apology. There’s been so much support for me, and there will be for the other women. And the more of us that stand up, the more these men like Billy Bragg will not be so dominant.”

Under the leadership of Justin Trudeau, Canadian policy has hewn quite close to the transactivist’s ideal: gender identity has become a protected characteristic under the Canadian Human Rights Act, and gender reassignment surgery is now often covered by the country’s universal healthcare system. Meanwhile, school boards and teachers’ unions have been quick to adopt some of the most extreme tenets of gender ideology — for instance, not telling parents when their children start to socially transition. 

Now, parents are pushing back. Last month, parents marched in almost 100 cities under the banner of #1MillionMarch4Children calling for the removal of material from school curriculums that sexualises children. Trudeau had claimed the protests were being “fuelled by the American right-wing”, but the alliance includes all political stances — from Liberty Coalition Canada, a Christian conservative advocacy group, to Blueprint for Canada, a non-partisan platform advocating “classical liberal” values. Some are issue-based, such as Our Duty Canada, a support network for families struggling with the impact of gender ideology. Plenty are grassroots, springing up in villages and towns in response to specific local events.

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The protests, though they have been criticised for being anti-LGBT, are actually about protecting minors from harmful content in schools. At the protest I attended — in Durham, just outside Toronto — there were marchers of all races and religions. And their motives varied. Two young moms with children going to kindergarten soon held up placards that read “Education, not indoctrination” and “Stop sexualizing our kids”. A young girl sat next to a poster that read, “No boys in my bathroom!” A father of five children under the age of 15 was there with his wife and kids to protest against Ontario’s sex education curriculum, which he felt introduces material on sexual orientation and gender identity to children too young to understand the concepts. And three Pakistani brothers — one in high school and the other two in university — gave an interview to a local media outlet about why they felt they should not be required to partake in pride activities that went against their beliefs as Muslims.

Conservative Muslims have been overrepresented at recent protests, with a noticeable number of women in hijabs or niqabs. And as a result the movement as a whole has received accusations of being motivated by Muslim extremism. Protests against gender ideology in schools took place over the summer in Ottawa and Calgary, organised by local Muslim parents groups, with reports of young Arab boys stomping on rainbow pride flags while others cheered them on. There was a flurry of progressives questioning Muslim values and attitudes that clash with their beliefs in multicultural Canada. Several hundred people were present at the march I attended, and I’d estimate that 60-70% of them were Muslims.

It would not be fair to assume that all these Muslims were marching in opposition to same-sex relationships as well as in support of parents’ rights; but the Canadian Muslim community is known to have more negative views of LGBT rights than the general population. One transgender protestor I spoke to was in Durham because the chapter in her own town — led by conservative Muslims — was advocating not only for parental rights, which she supports, but also for the eradication of all gay and transgender people. So, the accusation that the movement has an anti-LGBT strain is not entirely unfounded.

There was also a conspiratorial minority at the protests. Anti-vaxxers complained about “shot deaths”, and told tales of what “really” happened during the pandemic. One former nurse who lost her job because she wouldn’t get vaccinated, believed that people were getting sick because of radiation poisoning from 5G towers. The trucker Freedom Convey was also present, waving “Fuck Trudeau” flags; one vehicle was covered in news stories about people who died after getting the Covid vaccines. These conspiracists were not representative; most people really were there to protest against the school boards and advocate for reform of the education system. Indeed, some parents were surprised to see people discussing vaccines and lockdowns. One mom told me: “It’s a free country, they can come here and protest too if they like.” But these fringe elements could be undermining a movement that should, in theory, have mainstream support.

The presence of more extreme groups has doubtless contributed to the Conservative Party of Canada keeping its distance from the march. The more Right-wing, less popular People’s Party of Canada did participate — which would have given the Conservatives another reason not to engage. Pierre Poilievre, leader of the Conservative Party, sent a memo out to his caucus before the march warning them not to speak publicly about the issue — even though, at the recent convention in Quebec City, delegates voted in favour of a future Conservative government prohibiting “life-altering” medical and surgical interventions for gender-diverse and transgender people under the age of 18.

Poilievre is trying to strike a delicate balance here: he has indicated to his base that he’s on the same page as them about parents’ rights and gender ideology, but he doesn’t want his party to be associated with unsavoury characters. It might threaten his current lead over Trudeau in the polls. Poilievre tweeted in support of parents’ rights without explicitly mentioning the protests, which have continued across cities in Canada. Trudeau meanwhile came out firmly in opposition to the march, claiming it was promoting hate against “2SLGBTQI+ Canadians across the country”. It seems that for now, parents are going to have to fight it out with local governments, teachers’ unions and school boards, without the explicit backing of a national party.

The march, for all its issues and contradictions, has managed to unite a huge range of Canadians to come together in support of a common cause: a right to have a say in their children’s education. Most of the participants are trying to stay laser-focused on this cause, putting aside their differences to help pass legislation that will protect kids from being exposed to what they see as inappropriate content — and, in some places, from irreversible surgeries. Public opinion is on their side, but it remains to be seen whether party politics will catch up.

Now, we live in a radically different world. A world in which a generation of young women is being taught to disregard the fear they might feel in a threatening situation. They are told not to trust their intuition. And they are called bigots and sent death threats if they suggest that they feel uncomfortable in their bathrooms and changing rooms — or even in shelters for survivors of sexual abuse.

As a sexual assault survivor myself, I fought back tears while watching Paula Scanlan testify before a House Judiciary subcommittee about her experience of being on the University of Pennsylvania’s women’s swimming team — with the transgender athlete Lia Thomas. “I know of women with sexual trauma who are adversely impacted by having biological males in their locker room without their consent. I know this because I am one of these women.”

I felt rage, too. How outrageous that Scanlan should have to defend her desire to be free of biological males in a female changing room. How dare her university send her to psychotherapy in an “attempt to reeducate [me] to become comfortable with the idea of undressing in front of a male”? I find it hard to believe that, five years ago, feminists’ rallying cry was #BelieveAllWomen.

Clearly, Scanlan does too. “Let us not forget the viral #MeToo movement that empowered female victims to speak up,” she said. “It trained a spotlight on the widespread prevalence of sexual assault and abuse, including in scholarly and educational institutions … many policies pushed today completely ignore my experiences and many women like me.” In the space of five years, we’ve gone from #BelieveAllWomen to: “Believe all women, especially if they are men.”

How have we regressed so rapidly? Everyone from Oprah downwards preached to my generation of women to listen to your gut; listen to your instinct; listen to that voice whispering “Get out!” Back in 1997, she interviewed Gavin de Becker, whose book The Gift of Fear — a guide to understanding how your instincts about other people can keep you safe — became a bestseller. During her show, he summed it up like this: “Someone who doesn’t hear ‘no’ is trying to control you.”

Oprah looked out at the audience. “Did y’all hear that? Gavin, you need to say it again.”

Such was the impact of the book that, in 2008, Oprah did an hour-long show to commemorate its tenth anniversary. During it, de Becker repeated a line from his book, distilled from a Margaret Atwood lecture: “At core, men are afraid women will laugh at them, while at core, women are afraid men will kill them.”

I understood this. I was taught to get out of any threatening situation as soon as possible. If you’re alone in a room and a man enters and you don’t feel safe? Leave. If you’re walking at night and feel the instinct to escape? Just run. It doesn’t matter if you’re wrong, because what if you’re right? I was told to ignore that little voice at my peril. My mother raised me and my sisters to scream and run like hell if a stranger asked us to get in their car. “Because if you end up in a trunk, you’re dead.”

As de Becker says: “Can you imagine an animal in the wilderness overtaken with fear and saying ‘Oh it’s probably nothing.’ But we do that every day.” In his 1997 Oprah appearance, he argues that the real information we should be giving women and children is: “Honour your own fear and teach them that it’s important, that their own internal voice is important.”

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The message today’s young women are getting is that if their inner voice says it feels wrong when someone with a penis undresses in front of them, or is present when they undress, in a space designated for women, there is something wrong with them. Scanlan said in her testimony: “We, the women, were the problem, not the victims. We were expected to conform, to move over and shut up. Our feelings didn’t matter. The university was gaslighting and fearmongering women to validate the feelings and identity of a male.”

It appears that institutions, politicians and progressives are happy to sacrifice women at the altar of inclusivity. They demand we keep quiet when we feel uncomfortable or unsafe. Ironically, instead of teaching us to keep ourselves safe and fear violation, the women’s movement teaches us to fear being labelled as bigots. Paula Scanlan and collegiate swimmer Riley Gaines have been called transphobes for objecting to someone striding around with his penis on show in a locker room designated for women.

We are setting a dangerous precedent. Think about the young women watching the way that Scanlan and Gaines are being treated. They will surely conclude that they must suffer to accommodate the small handful of males that want to make everything about them. They are now being given access to female prisons, domestic abuse shelters, rape centres, locker rooms, spas and public toilets, as well as changing rooms.

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It would be absurd to assume that all trans-identified male-bodied people are looking for ways to abuse girls or women; it is equally absurd — and naïve — to think that male predators won’t exploit this system. But what I find particularly alarming is that it teaches women in general not to trust themselves. It tells us to ignore the discomfort triggered at a subconscious level. It encourages us to ignore our instincts. When a woman senses danger the last thing she needs is for her judgment to be clouded by another fear: the fear of social death if she acts to protect herself.

And all of us who witness the abuse that women who speak up are being subjected to are expected to remain silent. All of us whose little voices are telling us that there’s something wrong with prioritising men’s feelings over women’s safety are told we are wrong.

But my gift of fear is telling me to resist being intimidated into submission. To teach young women and my own daughter to honour that voice, that intuition. To stand behind women like Paula Scanlan who are also resisting. And to say, “No.”

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.

Given that Covid tends to affect men more than women, why would long Covid affect women more than men? And given that Covid complications are extremely rare in the young, why would teenage girls be disproportionately affected by long Covid? Finally, given that we can’t accuse a virus of transphobia, why would long Covid affect transgender people most?

The answer lies in the fact that long Covid is not a strictly physical phenomenon. A study of nearly two million people published in Nature found that people who reported three or more symptoms of long Covid included: 4.9% of people confirmed to have had Covid, and 4% of people with no evidence of having had Covid. So, reporting the symptoms of long Covid is only moderately associated with a prior Covid infection. In fact, long Covid correlates about as much with mood disorders as with Covid itself. One study found that people prone to anxiety and depression before Covid infection were 45% more likely to develop long Covid after infection, and the Nature study found that having anxiety and depression before getting Covid almost doubled the chances of reporting long Covid.

This would help explain why women and trans people are disproportionately reporting long Covid: these two demographics have particularly high rates of anxiety and depression.

But why exactly would mood disorders increase the likelihood of long Covid? Some experts have speculated that stress may affect the immune system’s response to Covid and lead to more serious infections. However, a Turkish study found no evidence that anxiety or depression alters the body’s immune response to the virus. A much likelier explanation could be that, since symptoms of mood disorders overlap with those of long Covid, people are mistaking psychological distress for the side-effects of viral infection.

This is part of a broader phenomenon. Young people are reporting despair and distress at an unprecedented rate, and this mental health crisis is a symptom of a malfunctioning society — a society that is making people sick, by teaching them to feel sick. The tendency for people to misdiagnose their despair as a medical disorder can be observed far beyond reports of long Covid. Consider the surge in cases of gender dysphoria. Between 2012 and 2022, the number of adolescents referred to the NHS’s Gender Identity Development Service (GIDS) increased by over 2000%. If the increase were simply due to decreasing stigma around being trans, it wouldn’t be mostly restricted to a single sex and age range, but it has been driven almost exclusively by young people and natal females.

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The group that’s disproportionately reporting gender dysphoria — adolescent girls — appears to be the same demographic as the group deemed in the German study to be disproportionately at risk of long Covid. This is also the group, besides trans people, deemed most at risk of mood disorders. So, again, it seems many young people, particularly girls, are confusing general distress for another illness.

And it’s not just reports of gender dysphoria that have multiplied among young people. Increases have occurred for major depressive disorder, attention-deficit disorder, obsessive-compulsive disorder, social anxiety disorder, generalised anxiety disorder, autism spectrum disorder, and various eating disorders. It seems that young people, and their doctors, are viewing personal issues as medical disorders: we are living through a pathologisation pandemic.

Why are so many people confusing sadness for sickness? It’s human nature to look for single causes to complex problems. The physician’s habit of ascribing all a patient’s symptoms to just one diagnosis led to the formulation of Hickam’s dictum, which states: “A man can have as many diseases as he damn well pleases.” Likewise, it’s tempting to look for a neat and simple reason for people blaming their troubles on a single disorder, but to do this would be to make the same mistake as them. Pathologisation can have as many causes as it damn well pleases.

One may be cyberchondria, the phenomenon whereby people anxiously google symptoms, and, due to confirmation bias, ignore those that don’t apply to them while focusing on those that do, until they become convinced they have the disorder they’re reading about. Another cause may be social contagion, whereby panic spreads through the power of suggestion. According to a UK study, adolescents who reported parents suffering from long Covid were almost twice as likely to report experiencing long Covid symptoms themselves, regardless of whether they’d actually had Covid.

It’s known that social contagions tend to affect girls more than boys, a disparity that could be exacerbated by girls tending to use social media more than boys. But the problem with social contagion as an explanation is that it’s a how, not a why; it offers a means without a motive.

Some have attempted to discern a motive. One is that girls are trying to escape unattainable ideals of femininity. As the arms race of plastic surgery and beauty filters ramps up, natural bodies seem ugly by comparison. This “selfie dysmorphia” may lead to anxiety and depression, as well as symptoms of gender dysphoria, as pubescent girls become desperate to defy the metamorphosis of their bodies into sexual objects. But this explanation doesn’t shed much light on the rise of conditions like long Covid, autism, and obsessive-compulsive disorder. However, a deeper dive into the data does.

When we include politics in the mental health data, it becomes clear that this isn’t simply about gender. A 2020 Pew survey of over 10,000 people found that self-described liberals aged 18-29 were more likely than self-described conservatives of the same age to report suffering psychological problems over the last week. They were also more than twice as likely to say they’d ever been diagnosed with a mental health disorder. Furthermore, those who were “very liberal” were more likely than those who were just “liberal” to report poor mental health. The group most likely to report poor mental health was white liberal females, an alarming 56% of whom reported having received a mental illness diagnosis.

Crucially, controlling for worldview narrowed the gender gap considerably: liberal men were more likely to report poor mental health than conservative women. It would seem, then, that the mental health epidemic among girls and young women is associated with their tendency to have a more Left-liberal mindset than boys and young men — a difference that’s becoming more pronounced over time.

But why would Leftism be associated with poorer mental health? An analysis of data from 86,138 adolescents found, in line with the Pew survey, that between 2005 and 2018 the self-reported mental health of liberals had deteriorated more than conservatives’, and that this deterioration was worst for girls. The researchers blamed this on “alienation within a growing conservative political climate”. However, the New York Times’ Michelle Goldberg debunked this explanation by pointing out that liberals’ mental health woes began while Obama was in power and as the Supreme Court voted to extend gay marriage rights — hardly a conservative political climate.

The real reasons may be deeper. One idea, more than any other, underpins the difference in outlook between liberals and conservatives. Central to Leftism is equality, backed by the idea that people’s fortunes and misfortunes are not their own doing, and therefore undeserved. As such, Leftism de-emphasises the role of human agency in social outcomes, while overemphasising the role of environmental circumstances. As the West has shifted culturally Leftward — due to most writers and artists leaning Left — the depiction of people as hapless puppets has become dominant.

Today’s Left-liberal culture teaches young people that their problems are not their own fault, but rather the product of various systems beyond their control. These systems may be sociological — late capitalism, systemic racism, the patriarchy — but increasingly, they are medical. A common example is “trauma”, a psychiatric term that has become a knee-jerk justification for everything from street crime to silencing opposing views on campus. It’s a word so overused that even clinicians fear it has lost its meaning. Most people, however, are happy to have their personal failings blamed on medical issues, because it absolves them of responsibility. It’s not your fault you violently lashed out, you have trauma. It’s not your fault you lack energy, you have long Covid. It’s not your fault you hate the way you look, you have gender dysphoria.

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Pathologisation is also an effective way to manufacture sympathy. The co-founder of Black Lives Matter, Patrisse Cullors, responded to accusations she’d used donation money to enrich friends and family by claiming that the accusations had given her post-traumatic stress disorder, a diagnosis once reserved for rape survivors and war veterans.

Claims like Cullors’s are instinctively met with sympathy and even awe on the Left, where overeager attempts to destigmatise mental illness can end up glamorising it. On social media, young liberals now engage in “sadfishing”, a kind of digital Munchausen’s Syndrome, where people fabricate ailments for pity and clout; some, such as the TikToker “TicsAndRoses”, fake Tourette’s, while others fake multiple personalities. The power of mental health disorders to attract attention online has turned them into fashion accessories, cute quirks to help kids stand out from the crowd, or “part of my dating appeal”.

Unfortunately, these designer disorders are not just harmless labels; intentional pathologisation by influencers is causing unintentional pathologisation among viewers. Reports tell of adolescent girls suddenly developing “TikTok tics” after viewing videos of alleged Tourette’s sufferers. Others tell of adolescents presenting with multiple personalities after watching videos of people claiming to have dissociative identity disorder. As atomisation makes people more desperate for sympathy, and competition makes them more desperate for attention, it’s likely that sadfishing and its consequences will only worsen.

But as disturbing as all this is, victimhood culture is not the only force behind the pathologisation pandemic. It’s been abetted by a medical industry that has its own incentives for exaggerating the prevalence of mental disorders.

Medicalisation — the tendency for clinicians to recategorise ever more things as medical issues — occurs because clinicians are just as human as their patients, and are therefore just as influenced by culture and their own personal biases. The 1973 Rosenhan experiment showed that psychiatrists who have been told that a healthy person is insane will begin to reinterpret that person’s ordinary behaviours, such as note-taking, as manifestations of their mental disorder. We saw this in the Tavistock scandal, where the staff of the infamous Gids clinic, conditioned by ideologues to look for gender dysphoria, became increasingly hasty to diagnose it.

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The ability of clinicians to see precisely the symptoms they’re looking for is facilitated by concept creep, the tendency for the definitions of disorders to gradually expand to encompass more people. The rise in autism diagnoses, for instance, can be largely attributed to a diagnostic widening of the autism spectrum. Concept creep occurs largely due to the Shirky principle, which states: “Institutions will try to preserve the problems to which they are the solution.” The motive is often financial; the number of pregnancies deemed to require caesarean sections has increased because this method of delivering babies is more profitable. Likewise, if you’re simply sad then medical companies can’t monetise you, but if your distress is reclassified as, say, gender dysphoria, those companies can sell you puberty blockers or surgical procedures. By 2021, GIDS accounted for a quarter of the Tavistock trust’s income. In the States, the sex reassignment surgery market was valued at $1.9 billion and is projected to have a lucrative annual growth rate of 11.23%.

So, we have a medical industry that is both financially and ideologically motivated to overstate the prevalence of illness, and we have a victimhood culture that encourages people to view themselves as oppressed by things they can’t control. In the middle of this we have ordinary people tempted to blame their problems on medical issues for the sake of easy answers.

These three entities together form a mutually reinforcing system. The late philosopher Ian Hacking, in his book Rewriting the Soul, details how in the 20th century, the press, the public, and the medical industry operated in tandem to create new forms of madness out of mere gossip. Prior to 1970, there were almost no cases of multiple personality disorder (now known as dissociative identity disorder), but after one case was well-publicised by the media, people began using the concept of multiple personalities to make sense of their own problems. In so doing, they began to conform, wittingly or otherwise, to the official symptoms of the disorder. When clinicians speculated that people may invent multiple personalities to deal with childhood sexual abuse, people began to do just that. Some even suddenly “remembered” being sexually abused, even though the concept of repressed memories has no basis in fact. Initially, patients reported having two or three personalities. Within a decade, the average number was 17.

Thus, patient reports influenced clinicians’ diagnoses, but clinicians’ diagnoses also influenced patient reports. Diagnostic criteria became prescriptive as well as descriptive; they told patients how they were supposed to feel and act. Hacking called this cycle of mutual reinforcement a “looping effect”, and it proved so powerful that it turned a couple of isolated cases into an epidemic. A similar looping effect, facilitated by a hyperconnected world, seems to be driving the rise in reports of mental illness today.

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This is a problem because imagined sickness can cause real sickness. This occurs in two ways. The first is direct: in rural India, folklore tells that being bitten by a pregnant dog can make one pregnant with the dog’s puppies, and this urban myth has created a new illness: puppy pregnancy syndrome. Victims become so convinced they’re pregnant with puppies that they suffer panic attacks and even manifest symptoms of pregnancy, from persistent nausea to the sensation of puppies crawling in their bellies.

But the second way fake sickness becomes real is far more common and insidious.

Remember how Leftism de-emphasises human agency in the name of equality? Research shows conservatives tend to have an internal locus of control, which means they believe that their decisions, as opposed to external forces, control their destiny. Liberals, meanwhile, tend to have an external locus, which means they believe their lives are determined by forces beyond their control.

The American psychologists Jonathan Haidt and Jean Twenge used national survey data of adolescents to map their locus of control. Their findings were based on the proportion of respondents who agreed with statements such as: “People like me don’t have a chance at a successful life” and “Whenever I try to get ahead, something stops me”. They concluded that, since the Nineties, the locus of control for all teenagers has become more external, but the shift has been greater for liberals, and greatest for liberal girls. Further, when the self-worth of teenagers was mapped, using responses to statements such as “I feel my life is not very useful”, the data showed a universal decline in self-worth since 2012. Again, the decline was stronger for liberals, and strongest for liberal girls.

People with an internal locus of control, believing they control their destiny, tend to be happier and have healthier habits, like good diets and frequent exercise, while people with an external locus of control, believing they’re at the mercy of fate, have higher rates of anxiety and depression and are more likely to abuse drugs and neglect their health. When you believe you have no control, you don’t.

And thus, as society has liberalised, and medicalised, young people have lost both self-belief and resilience. Many have subsequently become trapped in a cycle where they feel distress, and pathologise it, causing more distress, leading to more pathologisation and more distress, which eventually becomes textbook anxiety and depression. The rise in diagnoses is therefore not simply an illusion caused by medicalisation; society is teaching kids to develop real dysfunctions.

This is the greatest danger of the pathologisation pandemic: belief in one’s sickness is self-fulfilling. It’s a disease not of any bodily organ but of hope itself, and it harms its victim by crippling their immunity to everything else.

If there’s a vaccine for the pathologisation pandemic, then the best candidate is Cognitive Behavioural Therapy (CBT). This is a form of talk-based treatment based on the Ancient Greek philosophy of Stoicism. Contrary to modernity, it teaches that our feelings are not always valid, but often deluded and self-destructive. The aim is to reframe harmful thoughts into alternatives that are more accurate, agentic, and soluble. So, instead of “The world sucks”, one could think “I feel like the world sucks right now”. Where pathologisation places problems outside your control, CBT places them within your control. Where pathologisation bundles many small issues into one giant insurmountable problem, CBT breaks down giant problems into small manageable pieces.

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No form of psychotherapy has been as rigorously tested as CBT, and its effectiveness in restoring agency and reigniting hope is documented by decades of research. Some studies suggest CBT is gradually losing effectiveness, but this is mostly because CBT, like everything else in the social sciences, has been corrupted by amateurisation and the desire to be “inclusive” and inoffensive. The newest forms of CBT, such as “Transgender-Affirmative CBT”, are the opposite of classic CBT because they seek not to cultivate strength but to validate feelings.

More than ever, a return is needed to the original, Stoicism-based form of CBT, which has helped everyone from the philosopher-emperor Marcus Aurelius, who governed Rome during a time of war and plague, to Vietnam POW James Stockdale, who used it to withstand torture at the notorious “Hanoi Hilton”. The ultimate cure to rampant pathologisation is to prepare the young to do battle against their greatest foe — their own minds — and to teach them a time-tested truth, bequeathed to us by history’s survivors: you are more than the things that happen to you. And you have as much control over your life as you believe you do.

Many of the misfortunes that befall you will not be your fault, but if you seek explanations for your suffering in things beyond your control, you risk falling prey to a culture and industry that are motivated to keep you feeling ill. Look within for the causes and, most times, you’ll find the cures. Modern society will tell you otherwise, of course, but it’s within your power to defy it, for you are not a helpless leaf in the wind but a mind that holds a world, which, depending on how you think, could be a Hell in Heaven, or a Heaven in Hell.

Earlier this week, he visited the UnHerd Club for a wide-ranging interview about God, his love for WB Yeats, the heroism of JK Rowling, and how he changed his mind about vaccine hesitancy. Below is an edited transcript.

Freddie Sayers: Richard Dawkins, welcome to UnHerd. You’re launching a podcast, “The Poetry of Reality”. Why?

Richard Dawkins: I’ve always felt that science is poetic, and deserves to be treated as a part of our culture. The magnificent fact that the universe has given rise to us, supremely complicated beings capable of even understanding where we came from, ought to be a topic of great literature. Science is the poetry of reality.

FS: Am I wrong to detect a softening in your later years? The choice of podcast name seems designed to give the impression that you’re a more romantic, less rigidly rational spirit than people realise?

RD: I think I’ve always been a romantic spirit and I think that’s what science inspires, or ought to inspire, as opposed to the cold, hard, dispassionate image that science can be mistaken as projecting.

FS: We’re talking at a time in which once-unassailable scientific ideas have become… complicated. Gender is an obvious one. Do you worry that the scientific institutions you cherish have become overly attuned to faddish politics, and that science risks compromising its reputation?

RD: Certainly, I have noticed that some of the leading scientific journals have capitulated to political pressure to become unscientific, and to betray what is an obvious scientific dichotomy between male and female. This seems to have been betrayed for political reasons by people in editorial positions in leading scientific journals who ought to know better.

FS: Another example might be Nature magazine, which has stated that part of its mission is to work to correct racial injustices — it seems to be a political agenda rather than a scientific one.

RD: There’s an analogue of original sin, that white people are expected to feel guilt for what their ancestors — or maybe just people of the same skin colour — did to other people of a different colour. It’s as though we are supposed to inherit the guilt of people of the past, just because we have the same colour skin as they did. And that is, I think, racism. It is actual racism to confer guilt upon people because of the colour of their skin.

FS: So would you prefer a completely colour-blind world, as far as institutions are concerned? This is controversial in the United States right now, with the Supreme Court reconsidering whether affirmative action has a place in education. For years, admissions criteria for university science departments have considered an applicant’s race. Where do you stand on that?

RD: If I were in favour of any sort of affirmative action, it might be in favour of those who have been disadvantaged in their own past, through poverty. And if they happen to be black, fair enough — but simply because they’re black? No, that’s the wrong sort of affirmative action. That is racism.

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FS: And if that resulted in fewer black people going to elite colleges, you’d be fine with that, on the grounds that places would be going to the most deserving candidates?

RD: Well, they would probably be the people most able to benefit from those places, yes. But there is also something to be said for bending over backwards to help people from a disadvantaged background who have a genuine ability that hasn’t had a chance to flourish — and if they were to get to Harvard, then they might be able to. And so I am in favour not of affirmative action but what I would call ‘intelligent looking’ for talent, which is what we try to do at Oxford. In my time, we did, anyway. We tried to recognise that somebody might be not so well groomed for an entrance exam or for an interview, but who showed signs of genuine talent.

FS: You’ve also been critical of New Zealand schools including indigenous origin stories in science classes. How do you think people of a scientific mindset should treat the irrational, or intuitions for which there is no clear proof? Is it not possible that poetic and symbolic ways of describing such things get us close to a different kind of truth? 

RD: My favourite poet is W.B. Yeats, a notorious mystic. Obviously, I have no sympathy whatsoever with his belief in fairies and things like that, but I resonate with his poetry. I think it’s wonderful. It’s hard for me to explain what I mean, but I suppose that’s the point. I’m not trying to be a scientist when I do that. I’m resonating as a human being. In the early poems — “The Wind Among the Reeds”, for example – I empathise with this lovelorn young man, struggling with his feelings of lost love. And I get that, but not as a scientist.

FS: But those feelings of being a lovelorn young man are true, are they not? They exist in the universe?

RD: They are true for this subject, what’s going on in his own mind, yes.

FS: Hearing you talk about a Yeats poem, you don’t sound that different to religious people. Just as when you talk about the beauty of the natural world and the miracles of science — although you might not use the word “miracle” — it feels as though you’re moved by that. Perhaps the difference between you is more a question of language?

RD: I think there’s something wrong with that idea. According to supernaturalism — which is what I take to mean religiousness — there is something beyond physics, beyond the material world, which I do not believe. I do not believe in anything beyond the material world, no matter how poetic you feel, no matter how much you’re in love, or no matter how deeply you feel emotionally about looking at nature, looking at fields of wheat, looking at the stars. These are all human reactions, which I feel as strongly as anyone. But there is nothing supernatural about that.

As a human being, when contemplating the Milky Way, I get a feeling in the pit of my stomach. There’s nothing supernatural about that, it’s something in my nervous system. That’s not to demean it — it feels real to me. But it’s not truth in the scientific sense, which really is actually physically true about the material world.

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FS: In the realm of theoretical physics, for example, there are whole dimensions of the universe that we simply don’t know how to describe yet. Is there not a chance that some of those feelings might be perceiving physical realities that we don’t yet have a way to analyse?

RD: As it happens, this evening I’m going to a meeting in London with Lawrence Krauss, the American theoretical physicist, who has just written a book called The Known Unknowns, which is about all that we don’t yet know. And physicists are proud to admit that there’s a lot that they don’t know, but they’re working on it. It is entirely possible — probable, even — that there are beings in the universe who already do understand things that are beyond our understanding, and that our brains simply aren’t big enough to understand these profundities about the universe. But to somehow equate those with mystical feelings that you get when you’re in love, or when you contemplate a rose, or religious feelings, that’s a naive confusion.

FS: Your work on evolution and natural selection holds that most things about human nature and the human body, in our evolved cells, are there for a purpose.

RD: Yes — and I might be in a minority of biologists for believing that. For that reason, I’ve been called an ultra-Darwinian. Quite a lot of other biologists feel there’s a lot in life that is not actually Darwinian, in the sense that it’s not actually designed by natural selection, but is there by chance.

FS: In which case, should we not view the religious impulse, or mystical impulses, and those feelings that we were just talking about, with more respect? Should we not view them as more likely to be more intelligent than purely a kind of mistake, possibly being wiser and more purposeful than you have been prepared to admit?

RD: Not wiser and more purposeful, but possibly there for a reason. I readily agree that, because it’s a human universal, pretty much, and therefore logically that means that it is highly probably that it is of Darwinian advantage. That, I get. It doesn’t mean religion is true, though. I mean, you could say, the tendency to be religious, the tendency to believe in something supernatural, the tendency to think there’s something higher than you, the tendency to think that people also can connect… all this could have been built in by natural selection.

I often suggest that this could be because children have been naturally selected to be respectful of what their parents tell them, what their culture tells them, because they need that in order to survive. Religion flourishes because children who are vulnerable, in a dangerous world, need to be instantly obeying their parents advice, not to endanger themselves. You don’t question what your parents say, you just believe what they say, which means the child mind is pre-programmed by Darwinian natural selection to be credulous of what elders tell them. And that is fertile ground for falsehood, as well as truth.

FS: But if it’s there by natural selection, it must be a net positive?

RD: A net positive in a survival sense, yes – but it doesn’t make it true. It’s not true that if you sacrifice a goat at the time of the full moon, you will cause the crops to succeed. But it’s a net positive in the sense that it’s a by-product of the impulse to obey authority, because the impulse to obey authority, in general, is a net positive.

FS: In that context, the latest mostly secular generation could be seen as a species-wide experiment. It hasn’t happened before in history — and you had a fair bit to do with bringing it about. Judging on the evidence, how do you think the secular experiment is going?

RD: The statistics I’ve seen suggest it is slowly getting better. The statistics I’ve seen suggest that the number of people who profess some kind of religion is going down. It’s now below 50%, which is the first time that a British census has shown that to be the case, which I think is good. Similarly in America, which is lagging behind, in this respect, but it’s still going in the right direction. Those are the only figures I’ve seen and, all I can do is offer you my intuition, which is worthless.

FS: There’s a book by Tom Holland called Dominion, which has been very influential in suggesting that a lot of what we consider to be secular Western ways of thinking on morality is still drenched in Christian thinking. So perhaps, although people aren’t describing themselves as religious in the census, they’ve just moved those religious intuitions into other realms?

RD: Yes, I think that’s very likely true. You can make a good religious case for the trans debate. I make an analogy with the Catholic doctrine of transubstantiation, whereby the wine in the Aristotelian accidentals remains wine but, in its true substance, becomes blood. Similarly, the trans person: he has a penis, but that’s a mere accidental, and in true substance he’s a woman. I mean, that’s a perfect analogy to transubstantiation. It even begins with the same prefix.

FS: So which is better, then? We’ve gone through this whole process, we’ve had a whole generation who’ve now been brought up reading your books, and Christopher Hitchens, who are now ardent and proud atheists, and then they end up believing things like you just described. And that has all sorts of societal repercussions. Should we now look back on the New Atheist movement with regret?

RD: No, I don’t get that at all. It’s just an interesting analogy to point out that there is a strong religious element to a current political fad. So what?

FS: The question is: empirically speaking, between conventional religion and what appears to be its successor ideology, which will be proven by history to be better for the flourishing of the species? Early signs are that this new kind of religion, which thinks it’s secular, has some major problems.

RD: Well, if you care about the flourishing of the species, yes, but I care about truth.

FS: So you don’t care about the flourishing of the species?

RD: Well I do care about it as a human being, but more deeply I care about truth.

FS: And if your sense of truth would lead to the annihilation of the species, would you be content with that?

RD: No I would not be content with that. But I’m pretty sure it wouldn’t happen. I think that truth actually is a genuine value. I believe that a true scientific outlook on the world would actually be best for the flourishing of humankind.

FS: We have to talk about the most recent scientific controversy of our age: Covid. It feels like we are now emerging from the Covid years, when our trust in science was enormously damaged. Millions of people now intuitively distrust what they are told by scientific authorities. Do you think Covid was a moment of scientific glory, or something more problematic?

RD: I think glory, with regards to the unprecedented speed that vaccines were developed. And that is a tribute to molecular biology. It was possible, almost instantly, to sequence the genome of the virus, and to transmit the genome directly to labs all over the world, who set to work developing vaccines with, as I said, unprecedented speed. That is magnificent. Whether humans mistrust or trust science, that’s their business.

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FS: But the vaccines were enormously over-promised in terms of their efficacy. They were originally sold to us as being 95% effective in preventing infection. That was then endlessly revised downwards and, in the end, we were told vaccination didn’t stop transmission, it only improved outcomes for vulnerable patients.

RD: The speed with which things were happening means that it’s very difficult for people entrusted with authority to give advice. And normally, there’s much more time in order to examine all the evidence and give balanced, wise advice. When you’re required to give advice almost instantly, there inevitably are going to be mistakes.

FS: During the pandemic, you condemned people who were sceptical about the pandemic response. You tweeted that: “Some faith heads have a ritual of handling snakes, believing faith will protect them. When they’re bitten, they deserve it, they alone suffer. Vaccine refusal is different. Others are endangered. It’s as though their faith told them to release rattlesnakes in supermarkets.” This was April 6, 2021. Your vilification of people who were hesitant about taking the vaccine, in retrospect, seems too much, doesn’t it? Do you take that back?

RD: Well, I had become aware of the conventional wisdom about vaccination, which is that it’s a matter of altruism, because it’s not simply a matter of saying: “This is my private business, whether I’m vaccinated or not.” And in the case of the measles vaccine, for example, it really is a matter of altruism, because if you don’t get vaccinated, then then you are part of the problem if there’s a measles epidemic. And I thought that that would be the case with Covid. Now, it’s not entirely clear that that was right. And so, to that extent, I would take that back, yes.

FS: Do you also think that Covid showed how vulnerable scientists and institutions such as universities have become in this social media age — to peer pressure, to a fear of being cancelled and of being on the wrong side of mainstream thought?

RD: Yes. There are some heroic scientists who go off on their own and don’t need grants and just get on with their research — people like James Lovelock, who I’ve criticised on other grounds, but…

FS: Recently, universities have not been good at defending their own when they come under assault, on social media and elsewhere, for taking an unpopular position. The trends we saw with American universities during Covid, but there are lots of other examples. Professor Kathleen Stock springs to mind. Surely we can be constructively critical of universities for this?

RD: I think we can, and I think Kathleen Stock is a very good example of somebody who’s been appallingly treated. I think she’s a real hero. I think J.K. Rowling is a real hero. She’s not at a university, but she’s another one. Yes, I’ve been rather shocked at the way universities have not stood up to a rabble, a lynch mob, really, going after people like Kathleen Stock. But you can also sympathise with a university vice-chancellor with a baying mob of students after their blood. It’s difficult, but I think in that case they should hold the line.

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FS: Another concept you’ve defended recently is AI, and whether we might be leaving human nature behind altogether, either through some kind of AI future, or via extraterrestrial life. With your materialist hat on, explain how you think AI could supplant organic life?

RD: Well, the brain is a material object — and what it does is, although we don’t understand it fully yet, it must have a scientific explanation. And it must be the case that whatever the brain can do, in principle, could be done by an AI simulation. So, an artificial intelligence must be capable of doing what the human brain can do — and there’s no obvious reason why it shouldn’t be greatly superior to it.

It is conceivable that an artificial intelligence could greatly surpass what the human brain can do. And in many ways, that’s a very frightening prospect. People, many people, are very frightened of it. I haven’t decided whether I’m frightened of it or not. I think I could imagine it going both ways. But, as a materialist, I can’t deny that it’s possible.

FS: People might also be surprised by how much credence you give to the possibility of extraterrestrial life. How likely do you think it is that life exists on other planets?

RD: Very likely — especially when you think of the sheer number of opportunities in the universe for it to exist. It has arisen here and evolved to the point where it can understand its own existence. That was a ridiculously improbable event, but it happened. So why deny that it has happened anywhere else in the universe?

FS: So, on the balance of probabilities, we’re talking more than 50% likely, in your estimation, that there is life beyond our own planet?

RD: Yes. And I would make a distinction between life existing elsewhere, which is far more probable, than actual intelligent life, because one’s got to come from the other. We might well discover intelligent life through radio communication, but we will never be visited by it. Flying saucers, no — very unlikely. But visitation by radio communication, electromagnetic waves , that’s not totally unlikely. And I think that SETI, the search for extraterrestrial intelligence, is a worthwhile enterprise that should be pursued and funded.

FS: You don’t think interstellar travel will become possible through some breakthrough in physics?

RD: Well, that’s very, very far off in the future, because of the huge distances involved. So far, we are waiting for interplanetary travel within the solar system. Light years is a very long distance for solid, physical objects to travel.

FS: So if Elon Musk succeeds at getting human beings to Mars in your lifetime, would you volunteer for his next flight?

RD: No, I wouldn’t volunteer… actually perhaps yes. If I knew I was dying, it might be the last thing I’d do.

* “The Poetry of Reality” With Richard Dawkins is available to download now.

For Maria, the chance to work for one of Oxfam’s global outreach programmes, helping to end violence against women in the workplace, was a dream come true. And for a few years, it was — right up until the moment a fellow co-worker asked on an internal messageboard if Oxfam shops should ban the sale of J.K. Rowling’s books.

Three years ago, the Harry Potter author found herself accused of transphobia for having supported women who have “concerns around single-sex spaces”. During a discussion on Oxfam’s intranet, Maria had come to the defence of Britain’s most popular living author, asking for evidence of Rowling’s supposed transphobia. It was a decision that prompted a gruelling internal investigation, one in which Maria struggled to clear her name, led to her having a nervous breakdown and leaving both her job and the country.

Oxfam eventually offered a grovelling apology for the “procedural mistakes” that caused Maria such upset, but she is still struggling to make sense of it all. Speaking for the first time about the episode, she reveals: “My life has been torn apart. It drove me to a breakdown, I lost my confidence and, worst of all, I began to doubt myself.”

What Maria endured is part of a wider woke culture in the charitable sector, where female employees are silenced and treated like bigots for believing that sex-based rights matter. Certainly, Maria is so convinced that her career remains in danger — that any woman accused of transphobia will be blacklisted by much of the charitable sector, even when they have been exonerated — that she has agreed to speak to UnHerd under a pseudonym. “This will hang over me for the rest of my life,” she says. For decades, Oxfam — which was formed in 1942 to send food supplies to starving mothers and children in Nazi-occupied Greece — was one of the UK’s most respected charities, providing international aid to end hardship around the globe. But in recent years, its reputation has been tarnished. In 2018, evidence emerged that senior staff had paid survivors of the 2010 Haiti earthquake for sex, and that the use of prostitutes during the relief effort was covered up by the charity, allegations that Oxfam denies.

It was Maria’s concern for vulnerable women that first drew her to work for Oxfam: “I have experienced rape and domestic violence in the past, so I wanted to help others in the same situation.” Born in Spain, where she had worked as a pre-school teacher and volunteered at a sexual assault centre, she moved to the UK in 2017.

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“I loved my job,” says Maria, “being able to see how Oxfam’s work improves the lives of other women and children.” Three years after joining the charity, she was promoted to a co-ordinating role within the women’s rights team, whose remit was to ensure that female equality was reflected in Oxfam’s work.

She realised almost immediately how impossible that aim would be, given the growing dominance of a pro-trans mindset within Oxfam. Along with many other charities and institutions, it had capitulated to gender-based ideals, ones that asserts that “trans women are women” and that the categories of male and female are on a spectrum, rather than biological realities. On the advice of Stonewall — the discredited charity whose workplace diversity scheme sought to “recognise and celebrate the efforts of leading employers to advance LGBT inclusion” — Oxfam advised its employees to state their pronouns in meetings and on correspondence. “It was regularly using Stonewall materials to advise staff on LGBTQ+ inclusion in the workplace, with a heavy emphasis on transgender ideology above all else.”

Maria says that she initially toed the party line on the matter, staying silent when trans issues were discussed. “But then I began to see how women’s rights were attacked, particularly because it was obvious that single-sex spaces, such as rape crisis centres, were labelled as ‘anti-trans’.”

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Oxfam staff were invited to join company-wide online groups related to their interests, and Maria joined the LGBTQ+ group. In September 2020, a charity shop manager asked the group: “What is your opinion on selling J.K. Rowling books?” The employee, who is a transwoman, worried that the writer’s latest thriller, Troubled Blood, written under her pseudonym Robert Galbraith, might be “highly transphobic”. She wondered whether it might be covered by Oxfam’s “unsuitable for sale” policy.

Several staff engaged with the forum thread, widening the debate to include Rowling’s suitability as an Oxfam-stocked author, and added their concerns about her supposed transphobia, until Maria asked the question: “Can you explain why she is transphobic or why the book is transphobic?” When her query went unanswered, Maria went on to express concerns about banning books by “one of the most important woman writers in the UK”, before adding: “Actually, we are selling books from paedophiles and rapists. We are selling religious books. Stopping selling something we don’t like is called censorship and is the opposite of freedom of speech.”

The manager then left the conversation, and Maria thought that was the end of the matter. “She had said she was uncomfortable with the conversation and did not want to discuss it any further.” But following the exchange, Maria discovered she had been labelled in private chats as a transphobic bigot by other members of the LGBTQ+ group. Another manager sent her private messages, suggesting that Maria could lose her job after posting her comments. “They felt threatening to me,” says Maria. “She said my views were ‘incredible’, and that she would be reporting me. There is absolutely no way I am anti-trans. I am merely pro-women’s rights.”

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In the next few days, members of the LGBTQ+ group encouraged colleagues to complain about the discussion, stating that “transphobia is not tolerated here”. “They did not name me, but it was obvious who they were referring to,” says Maria. Next, a petition signed by 70 staff members was sent to all staff via the intranet, calling for Oxfam’s leadership to “take a stand” and “communicate a zero-tolerance approach to transphobia”.

Senior management replied to the petition authors, saying: “No one in our organisation should be subjected to hate speech, discrimination or other forms of harm” and “It is of great concern that members of the wider LGBTQIA+ community have felt intimidated by workplace conversations.” Oxfam’s CEO got involved, and gave a “no-debate” steer, adding: “We value the experience of our trans and non-binary colleagues, friends and partners and we do not expect their experience to be debated in our workplace.”

Three days later, Maria was invited to a meeting with her line manager and a member of Human Resources and told that she was under investigation because of her “transphobic comments”. Maria says: “They should have told me what the actual topic of the meeting was, and I could have brought a union representative with me. I apologised for upsetting anyone and tried to outline the rationale for my views and beliefs, but they refused to accept it.” Signed off sick with anxiety and depression, Maria felt alone and scared of losing her job, particularly in the middle of a pandemic. “All my family and relatives were in Spain and the borders were closed.”

Six weeks later, two days before Christmas, Maria learned that she’d been found guilty of misconduct and was issued with a final warning. Oxfam told Maria that her comments online “breached the requirement of the Code of Conduct to treat all persons with respect and dignity”, and reminded her that “transgender people are protected from discrimination under the Equality Act 2010”. The letter did not give a definition of transphobia or say how her posts were transphobic. Refusing to accept that finding, Maria appealed. “As a woman I have always had to fight for everything,” she says. “I knew that if they beat me then they were trampling on all of us.”

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Three months later, Maria was informed she had lost her appeal. The letter informing her of this decision also offered, for the first time, a definition of transphobia (not for want of asking): “Oxfam refers to Stonewall definitions to support our understanding, which states transphobia is the ‘fear or dislike of someone based on the fact they are trans’.” Feeling she was left with no choice but to resign, Maria took Oxfam to an employment tribunal. “I became determined that this should not happen to another woman,” she says.

Maria claimed constructive dismissal and belief discrimination. In July last year, during judicial mediation, both parties agreed to settle, with Oxfam issuing a public apology for its handling of the process. “We believe that each member of our community has a right to their own religious or philosophical beliefs, including the belief that ‘sex is immutable’ and ‘sex is important’. We acknowledge that in dealing with your case and during the disciplinary process we made mistakes. We acknowledged that it was not appropriate to give you a final written warning, and we would like to offer our sincere apologies for the upset that this has caused you.”

Earlier this year, Oxfam updated its language guide, which is an internal document advising staff how to speak about its work. The document includes the instruction that, rather than using the phrases “biological male” and “biological female”, “AMAB and AFAB” (assigned male/female at birth), should be used instead; and when talking about “expectant mothers”, use the phrase “people who become pregnant”.

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“I hope every single woman, especially those stronger and richer than me, fight every time this happens within the charity sector,” Maria says. “Oxfam is supposed to be protecting women and girls in the most vulnerable situations all over the world, and this ideology will ruin it.”

In response, an Oxfam spokesperson said: “We are sorry for the procedural mistakes we made in the handling of this case and we have apologised to the individual concerned. We fully support both an individual’s right to hold religious and philosophical beliefs and a person’s right to have their identity respected, regardless of their gender identity and expression, sex, or sexuality. We believe LGBTQIA+ rights are human rights.”

Now back in Spain, Maria has just finished an internship at a refugee camp in Greece, with the aim of a career in humanitarian work. “I lost so many friends,” she tells me. “I lost my job. My mental health suffered. Enforcing the views of the trans lobby, at all costs, seems more important to Oxfam than meeting their actual charitable aims.”

She says she often thinks of the author who changed the course of her life — and believes the way Rowling has been vilified for simply supporting and defending the rights of women who have suffered domestic abuse and rape is proof that misogyny has no limits. “No matter how much money or power you have achieved, if you are a woman, you will always be a target,” says Maria. “I fought my case so that all women know they can fight, and win, against this crazed ideology.”

Ceri-Lee is a bright and confident 24-year-old who juggles taking care of her young child with training to be a paramedic. In contrast to the loving family and happy life she now has, her childhood was pure hell. For nine bleak years, she was sexually abused and raped by her father, an ordeal that began when she was just eight years old.

But Clive Bundy, the man that subjected Ceri-Lee to unimaginable hurt and terror, has recently discarded his old life and now identifies as a woman. Ceri-Lee has felt compelled to speak out, in condemnation of a justice system that helps dangerous sexual predators to evade detection and to potentially target other child victims in female-only facilities.

In 2016, Bundy was arrested by police that had been monitoring his activities online. When they searched his laptop, they found numerous child abuse images, including a record of his abuse of Ceri-Lee. Bundy was jailed for 15 years but served half of that sentence, before being released a few weeks ago on licence.

Prior to his release, Bundy announced his decision to leave prison as a woman, stating that he has changed his name to Claire Fox.

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It may not be coincidence that his chosen name is that of a high-profile campaigner who has used her seat in the House of Lords to argue that transgender activism endangers free speech and women’s rights.

Last month, Baroness Fox asked — in an online article entitled “A ‘Trans’ Paedophile Stole My Name” — why Bundy chose to troll her in this way. “I can only speculate. One commentator suggests that sex offenders, specifically paedophiles, select the names of well-known people so that an internet search will only turn up the famous person, and not them.”

There is, however, she explained, one small consolation in what she sees as Bundy’s trolling. “Should Clive Bundy ever start using social media under the name Claire Fox, he might find himself subjected to anti-Terf trolls, who routinely target gender-critical women like me, barraging us with misogynistic abuse.”

It is largely thanks to a second British parliamentarian that Bundy’s new name is in the public domain at all. Under Section 22 of the Gender Recognition Act 2004, it is against the law to expose the former name of a person that has changed gender. But in March this year, Labour MP and women’s rights campaigner Sarah Champion raised the case in the House of Commons, where legislators are granted protection against civil and criminal liability.

Feminists have long pointed out that men who wish to sexually abuse women and children will seek out and exploit loopholes and opportunities in order to find new victims. Former convicts have been known to change their name by deed poll, for instance, and while they are required to inform the authorities immediately on doing so, many do not, and simply build new identities.

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With gender reassignment more commonplace — and easy — than ever, it offers a new opportunity for dangerous sexual predators to change both their name and their sex, and then to hide in plain sight.

These fears are well founded and well documented. Look, for example, at the case of Karen White, a convicted child sex offender and rapist who, while legally still a man, was put in a female-only prison where he went on to sexually assault two inmates.

Then there is the more recent case of double rapist Adam Graham who, prior to his conviction, declared himself to be a woman and changed his name to Isla Bryson. Having been sent to Cornton Vale, Scotland’s only all-women’s prison, he was only moved as a result of a massive feminist protest.

Ceri-Lee wants the names of Clive Bundy and Claire Fox to be linked on official records. But the law requires us all to pretend that no such link exists — that, essentially, the convicted serial child sex offender no longer exists.

Since hearing about her rapist’s release, Ceri-Lee has experienced flashbacks to her own abuse. “Him doing this has caused me terrible anxiety,” she tells me. “I am worried about the girls in my family being targeted by him.”

She is also distressed that, yet again, Bundy has successfully manipulated the system. When she was told about his decision to assume a new identity as a woman, “it was a real shock”, she says. “I had no idea that he would be allowed to change his name and his identity in law when he was on the Sex Offender Register.”

Before this child rapist declared his intention to live as a woman, Ceri-Lee was “fairly liberal” about gender reassignment, taking a “live and let live” approach. More recently, however, she has discovered for herself the implications and unintended consequences of self-ID, the law that permits adults to change their gender without a medical diagnosis. In a world in which men can now legally enter single-sex spaces once earmarked for women and girls, Ceri-Lee’s opinions have shifted.

When she told her family members about Bundy’s transition, “at first, all we could do was laugh”, she says. “It’s so ridiculous… There’s just no way a man like him feels like he is a woman. He is so macho. He was always very proud of how manly he was.”

At the time of his arrest, Bundy denied every offence he was charged with. “The police said they’d never been faced with anyone as manipulative and coercive,” says Ceri-Lee. “Why can’t they see this is just him, again, trying to trick the system?”

Ceri-Lee was at home with her child when the Victim Support Officer called her out of the blue to let her know her father hadn’t been considered for parole because of an altercation in prison, before casually adding: “‘Oh, and by the way, he’s given us permission to tell you that he’s now female and calling himself Claire Fox…’ It was as if [the officer] was telling me what was for dinner.”

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Had Bundy not given permission for Ceri-Lee to know his new identity — more power-play, and an example of his coercive and controlling tactics — neither she or the rest of her family would have had any idea that Bundy had “disappeared”, replaced by a woman called Claire.

Inevitably, Ceri-Lee has been accused of transphobia. “Somebody asked on Twitter how long it’s going to be before I’m convicted of a hate crime,” she says, “because I will never, ever refer to him as female. When he made me handle his male genitalia, he definitely wasn’t a female then — and he will never be a female in my eyes.”

Horrified that a sex offender such as Bundy could now freely visit a public swimming pool full of children, Ceri-Lee asks: “He didn’t abuse little boys, he abused girls — why should he ever be allowed to go into female-only spaces?”

She insists her motivation is not transphobic — “in fact, I feel an affinity with these people: I know what it’s like to be a child faced with a secret that feels wrong but [you] can’t tell anyone. I know the bravery it takes to come out and say something. I felt wrong in my body because of being sexually abused, so I understand what it feels like to want to escape it.”

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Aware that to criticise anything to do with transgender ideology can have adverse consequences, Ceri-Lee admits she was worried about the effect that going public might have on her medical career. She was hoping to go to university to become a paramedic when she was told of her father’s release from jail.

The NHS has certainly been captured by trans ideology, with some Trusts having issued guidance which states that patients should be admitted based on the ‘gender they identify with’ and therefore can choose which ward, toilet and shower facilities they use.

Ceri-Lee is determined to continue her campaign, but waiving her right to anonymity, in order to go public about the identity of her abuser, has already cost her dearly. “It was the most difficult decision I have ever made. I think of myself as quite a confident person. I can walk the streets and people don’t know about the little girl that was abused and who wanted to kill herself.

“He told me I could never reveal what he was doing to me, or other family members would get hurt,” she says. “But I am done with being scared of him.”

Appalled that Bundy’s new persona has, with the stroke of a pronoun, all but erased from the public record what he did to her, Ceri-Lee is now determined to ensure that any medical transition will not give him access to vulnerable female victims. “He will do it to other girls,” she says, “I just know he will. I have to get the message out. But if I can stop one girl from having to go through this then it’ll be worth it.”

Favaro dared to study whether women in academia feel able to express their views on transgender issues. For doing so, she says she has been hounded out of her university, barred from publishing her findings, and branded transphobic. In other words, she has been censored for asking questions about feminists being censored.

When Favaro was asked, in the summer of 2019, to lead a vital new research project, she was a rising star in academia. Her PhD in sociology had been awarded at City, University of London in 2017 without a single correction. Examiners described it as “one of the best Doctoral Dissertations they had ever read”. Now, there was funding to carry out a sociological study of the “gender wars” in academia within the Gender and Sexualities Research Centre at City. “My dreams came true,” Favaro tells me, “I was so excited to lead such an important project.”

She moved back to London from her native Spain, with a baby and a toddler in tow, and her research began in March 2020. She carried out an extensive literature review, and an 18-month observation of Twitter. She also included case studies, such as an event at City during which a lesbian feminist was subjected to physical intimidation and removed by security for asking a question perceived as transphobic.

Of her 50 interviewees, 20 described themselves as “gender affirmative”, 14 as “gender critical”, and 16 were from “unknown” perspectives. Feminists who saw themselves as “gender critical” spoke about having been ostracised, removed from networks, disinvited from events, subject to complaints to management, insulted, and accused of not only transphobia but Nazism. There had been letters and petitions against them. They had been blocked from job prospects and promotion. There had been threats of violence and intimidation. Unsurprisingly, the majority of the “gender critical” feminists who agreed to be interviewed were late or mid-career: what woman in the early, insecure stages of a career in academia would feel able to admit to a viewpoint that is met with such abuse?

Favaro’s findings paint a damning picture of academic freedom. The women who stayed silent about their views on trans issues said they felt anxious, depressed and alienated. They were terrified of being subjected to the same fate as those who had spoken out. Some reported feeling paralysed, ashamed and upset, while others admitted to having secret conversations with like-minded women. Meanwhile, the ”gender affirmative” interviewees were either in denial about the bullying, or believed that TERFs deserved it.

Favaro tells me she came to the project “with great curiosity and genuine openness. I wanted to capture a whole range of views.” To make her research as representative as possible, she applied to the British Academy for funding to conduct a broad survey of social scientists in Ireland and England. She asked her interviewees about sex and gender, as well as working conditions and censorship in academia, and their thoughts about how to resolve the conflict. All interviewees were female — with the exception of one transwoman — and involved in gender studies. Favaro actually “interviewed more academics supportive of what I call genderism”, she tells me. “It would have hugely benefited me to find their perspective convincing.”

But by the time she had completed her survey data, her conclusion was unequivocal. “Having approached the topic with an open mind,” Favaro wrote for Times Higher Education in the summer of 2020, “my discussions left me in no doubt that a culture of discrimination, silencing and fear has taken hold across universities in England, and many countries beyond.”

Her work did not go down well. Indeed, the response has, says Favaro, been characterised by “disturbing disappointments”. After she presented the university with a 200-page document evidencing the aggressive silencing and persecution of feminists, for instance, management suggested she needed to offer a “both sides” narrative. Favaro found that even some academics working on violence against women would excuse rather than condemn extreme threats of violence coming from certain trans activists — or, for example, call rape survivors not wanting to be examined by a male doctor “bigots”.

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Favaro started to feel that support for her work was being withdrawn. Her line manager told her the project had become too contentious. A number of complaints were made — including one accusation of “ethical breach”, lodged by a former participant. The university investigated this, and Favaro was exonerated. But, as Favaro has written, “further such baseless accusations have been taken at face value, leading to the suspension of my research, and the withdrawal of access to my data.”

The phenomenon Favaro later described, in her THE article, as a “remarkable coupling of condemnation and ignorance” was clear from the outset. One early note in her research diary recalls a colleague — who was completely oblivious to the arguments and concerns she was researching — saying: “I’ve never met a TERF, have you?” Her tone expressed palpable repugnance. This was, of course, important data in and of itself. The whole experience served as “a painful reminder [of] how little women matter”.

Unfortunately, the public has been denied the opportunity to make up its own mind about Favaro’s research. The survey, entitled “The Gender Wars Survey: A Case Study of Working Life in Academia”, has been deemed “dangerous” by City University management. Both Favaro’s 50 interview transcripts and 700 survey responses have, she says, been confiscated. While working on the survey, Favaro contacted the Equality and Human Rights Commission (EHRC) to tell them about the forthcoming research. They decided to commission a report on Favaro’s interview findings, which was submitted in April 2022. It, too, remains unpublished.

The response to Favaro’s work, of course, rather proves her point. The one thing upon which Favaro’s interviewees all agree is that there is a toxic climate in academia today, and that it has hugely detrimental effects on research and teaching, as well as the health and welfare of academics themselves. Feelings of stress, anxiety and exhaustion are disturbingly commonplace — especially among female academics. It is almost exclusively women who are the targets of bullying and harassment in the gender wars.

Favaro feels that the ethos of social media — which is shaped by the “outrage economy” — is penetrating academia. “Rather than evidence, innovation, critique and discussion, this is an academia of safe ‘hot topics of the day’, ‘soundbites’ and ‘compelled speech’ with ‘populist’ inclinations, as participants themselves explained to me.” Universities now foster groupthink, enabling only mediocre, timid scholarship.

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“There are some serious systemic issues in academia that need urgent attention,” Favaro says. “I would love to be able to stay and contribute to creating positive change.” But at the moment, she’s fighting to have any kind of future in academia. “This job was meant to boost my career,” she tells me — “I left my life in Spain for this… I lost my support networks” — “and it has threatened to destroy me. This is the ultimate cancellation. It’s a publish or perish situation within academia.” In other words, if her data remains buried, her career could be seriously blighted. “I worry constantly that my work will never be published.” But the data belongs to City, which she says has threatened her with data laws.

And so, as a last resort, Favaro is taking legal action against City. “I hate the media attention,” she says, “but I have to take this case.” Like so many of us who have gone to court in similar circumstances, she is fighting not only to protect her own rights, but also for others. “I feel I have let my participants down because I have failed to keep hold of their data,” she says. “We are talking about more than 700 individuals taking the trouble to talk to me or fill in the survey. I find the decision to suppress this evidence nothing short of a scandal.”

City has said it is “unable to comment on employment matters relating to individual members of staff”, but also stated: “We refute the allegations made against us and reject the context in which they are presented.”

It seems that Favaro has become a victim of the very problem she was hoping to solve. But anyone with the guts to do this research in the first place is obviously courageous. It is time to send a message to institutions that silencing, censoring and bullying women because we refuse to capitulate to gender ideology will bring consequences. “I am fighting for my data, and to get it published,” Favaro tells me. “I will not give up.”

But for some reason, this basic principle doesn’t seem to apply to the hyper-politicised subject of gender medicine. On one side, Republican states are attempting to ban youth gender medicine — and, in some cases, to dial back access to adult gender medicine. On the other, liberals maintain that there is solid evidence for these treatments, and that only an ignorant person could suggest otherwise.

Whether or not you agree with the GOP’s stance (I do not), the latter view is simply false. The trajectory of youth gender medicine in nations with nationalised healthcare systems has been relatively straightforward: these countries keep conducting careful reviews of the evidence for puberty blockers and hormones, and they keep finding that there is very little such evidence to speak of. That was the conclusion in Sweden, Finland, the UK, and, most recently, Norway. As a recent headline in The Economist had it: “The evidence to support medicalised gender transitions in adolescents is worryingly weak.”

Yet despite this evidentiary crisis in Europe, and despite multiple scandals vividly demonstrating the downside of administering these treatments in a careless way, liberal institutions in the US have only become more enthusiastic about them. In recent years, everyone from Jon Stewart and John Oliver to reporters and pundits at the New York Times, The Washington Post and NPR have exaggerated the evidence for these interventions.

The logic seems to be that if activists, doctors and journalists repeat “The evidence is great!” enough times, regardless of whether the evidence actually is great, the controversy will go away — as though the state of Arkansas could be shamed into reversing its policy on trans youth because Jon Stewart made fun of them. Meanwhile, as I can tell you from experience, if you openly question these treatments or highlight just how little we know about them, you’re going to have a bad time.

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But look a little closer, and it swiftly becomes clear that the evidence for both adult and youth gender medicine is frequently drawn from alarmingly low-quality studies. Almost invariably, when you examine the latest study to go viral, there’s much less there than meets the eye — whether because of serious overhyping and questionable statistical choices on the part of the researchers, outright missing data, flawed survey instruments, more missing data, or just generally beyond-broken methods.

Since any individual study or group of studies can suffer from these issues, serious researchers know that you can’t just take a few that point in the right direction and herald them as evidence. Rather, you need to sum up the available evidence while also accounting for its quality. This is what European countries have done, and they have all come to roughly the same conclusion: the evidence supporting these treatments isn’t there.

But even at the level of sweeping summaries, America’s conclusions are often distorted. A prime example came in a recent New York Times column by Marci Bowers, a leading gender surgeon and the president of the World Professional Association for Transgender Health (WPATH). Bowers paints a very rosy picture of the evidence base:

“Decades of medical experience and research since has found that when patients are treated for gender dysphoria, their self-esteem grows and their stress, anxiety, substance use and suicidality decrease. In 2018, Cornell University’s Center for the Study of Inequality released a comprehensive literature review finding that gender transition, including hormones and surgery, ‘improves the well-being of transgender people’. Nathaniel Frank, the project’s director, said that ‘a consensus like this is rare in social science’.

“The Cornell review also found that regret… became even less common as surgical quality and social support improved. All procedures in medicine and surgery inspire some percentage of regret. But a study published in 2021 found that fewer than 1% of those who have received gender-affirming surgery say they regret their decision to do so… A separate analysis of a survey of more than 27,000 transgender and gender-diverse adults found that the vast majority of those who detransition from medical affirming treatment said they did so because of external factors (such as family pressure, financial reasons or a loss of access to care), not because they had been misdiagnosed or their gender identities had changed.”

Here we have a leading expert (Bowers) citing a leading institution (Cornell) and relating astonishing claims (what medical procedure has a 1% regret rate?). The case appears to be closed — until you actually click the links and read Bowers’s sources. (Bowers and WPATH did not return emailed interview requests.)

Let’s start with Cornell’s data. According to a summary at its “What We Know Project“:

“We conducted a systematic literature review of all peer-reviewed articles published in English between 1991 and June 2017 that assess the effect of gender transition on transgender well-being. We identified 55 studies that consist of primary research on this topic, of which 51 (93%) found that gender transition improves the overall well-being of transgender people, while 4 (7%) report mixed or null findings. We found no studies concluding that gender transition causes overall harm.”

If you are familiar with systematic literature reviews, you will find the above unusual. Researchers don’t generally ask whether a procedure works or not in such a vague a manner, then tally up the results. To usefully gauge the level of evidence, a review has to carefully define its research questions, and factor in the potential biases of the existing studies. The Cornell project does none of this.

I emailed Gordon Guyatt, one of the godfathers of the so-called evidence-based medicine movement, to ask him whether he thought the Cornell project qualified as a systematic literature review. His response was: “It meets criteria for a profoundly flawed systematic review!” When we later spoke, he explained why he didn’t trust it. “Presumably, they are trying to make a causal connection between what the patients received and their outcomes,” he said. “That is not possible unless one has a comparator.” In other words, if you’re only tracking people who received a treatment, and don’t compare their outcomes to another group not receiving the treatment, you simply can’t learn that much. Guyatt offers the example of someone taking hormones and saying afterwards that they feel better. “That does not mean that the hormones have anything to do with your feeling good.” 

This is a very basic, very well-understood problem in both medical and social-scientific research. If all you have is before-and-after measurements of how someone who received a treatment changed over time, there are all sorts of potential confounds, from the placebo effect to regression towards the mean to the possibility that receiving the treatment coincided with some other salutary intervention, such as therapy, that wasn’t accounted for.

Because the Cornell team made no effort to even evaluate the risk of bias in the individual studies it evaluated, the final product tells us very little. It’s roughly analogous to coming upon a pile of coins and trying to determine its worth simply by counting how many coins there are, rather than sorting the pile by denomination. When I raised this with Nathaniel Frank, the head of the Cornell project, he said via email that “we don’t publish traditional systematic reviews”, but rather web summaries of important research questions. So the first words of its overview might confuse readers: “We conducted a systematic literature review.” 

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If Bowers had wanted to cite a carefully conducted, peer-reviewed systematic review of the gender medicine literature, she actually had one at her fingertips: her own organisation, WPATH, funded one a few years ago. The results, published in the Journal of the Endocrine Society in 2021, revealed that there is almost no high-quality evidence in this field of medicine. After they summarised every study they could find that met certain quality criteria, and applied Cochrane guidelines to evaluate their quality, the authors could find only low-strength evidence to support the idea that hormones improve quality of life, depression, and anxiety for trans people. Low means, here, that the authors “have limited confidence that the estimate of effect lies close to the true effect for this outcome. The body of evidence has major or numerous deficiencies (or both).” Meanwhile, there wasn’t enough evidence to render any verdict on the quality of the evidence supporting the idea that hormones reduce the risk of death by suicide, which is an exceptionally common claim.

Oddly, though, the authors of this systematic review conclude by writing that the benefits of these treatments “make hormone therapy an essential component of care that promotes the health and well-being of transgender people”. That claim completely clashes with their substantive findings about the quality of the evidence. So, when Bowers cited the Cornell project, she was citing a review that is of very limited evidentiary value — while also ignoring a much more professionally conducted, and much more pessimistic, though strangely concluded, review that her own organisation paid for.

But what about the study which, she claims, “found that fewer than 1% of those who have received gender-affirming surgery say they regret their decision to do so”? Here’s where things get downright weird.

The study in question, published in 2021 in the journal Plastic and Reconstructive Surgery Global Open, has dozens of errors that its nine authors and editors have refused to correct. Indeed, it appears to have been executed and published to such an unprofessional standard that one might ask why it hasn’t been retracted entirely. 

Before we get into all that, though, it’s worth pointing out that even if it had been competently conducted, the review could not have provided us with a reliable estimate of the regret rate following gender-affirming surgery: the studies it meta-analyses are just too weak. Many of those included did not actually contact people who had undergone surgery to ask them if they regretted it; rather, the authors searched medical records for mentions of regret and/or for other evidence of surgical reversals. Yet this method is inevitably going to underestimate the number of regretters, because plenty of people regret a procedure without going through the trouble of either reversing it or informing the doctor who performed it. In one study of detransitioners — albeit one focusing on a fairly small and non-random online sample — three quarters of them said they did not inform their clinicians that they had detransitioned.

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The surgeons exploiting trans misery

By Debbie Hayton

The studies included in this review also failed to follow up with a very large number of patients. The meta-analysis had a total sample size of about 5,600; the largest study, with a sample size of 2,627 — so a little under half the entire sample — had a loss-to-follow-up rate of 36%. If you’re losing track of a third of your patients, you obviously don’t really know how they’re doing and can’t make any strong claims about their regret rates. And yet, the authors don’t mention the loss-to-follow-up issue anywhere in their paper. No version of this meta-analysis, then, was likely to provide a reliable estimate of the regret rate for gender-affirming surgery.

Even so, the version that was published was particularly disastrous. Independent researcher J.L. Cederblom summed it up: “What are these numbers? These are all wrong… And these weren’t even simple one-off errors — instead different tables disagreed with each other. The metaphor that comes to mind is drunk driving.”

To take one example, the authors initially reported that the aforementioned largest paper in their meta-analysis had a sample size of 4,863. But they misread it — the true figure was actually only 2,627. They also misstated other aspects of that report, such as how regret was investigated (they said it was via questionnaire but it was via medical records search) and the age of the sample (they said it included some juveniles, but it did not).

Not all the errors were significant, but they were remarkably numerous. And because of the abundance of issues, the paper attracted the attention of other researchers. “In light of these numerous issues affecting study quality and data analysis, [the authors’] conclusion that ‘our study has shown a very low percentage of regret in TGNB population after GAS’ is, in our opinion, unsupported and potentially inaccurate,” wrote two critics, Pablo Expósito-Campos and Roberto D’Angelo, in a letter to the editor that the journal subsequently published. In her own letter, the researcher Susan Bewley highlighted what appears to be an absence of vital information about the authors’ method of putting together the meta-analysis. 

The authors and the editors decided to simply not correct any of this. They did publish an erratum, in which they republished seven tables that still contained errors, while maintaining that all those errors had no impact on the paper’s takeaway findings. But the paper itself remains published, in its original form, complete with those 2,200 ghost-patients inflating the sample size.

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How to treat gender dysphoria

By Lisa Selin Davis

Bewley and Cederblom have continued to ask the journal to reveal the process that led to the paper getting published, and to address why so many of the errors remain uncorrected. In an email in January to Bewley, Aaron Weinstein, its editorial director, claimed that because critical letters to the editor had been published, and because the corrected data was reanalysed by a statistical expert, “the Publisher and the ASPS [American Society of Plastic Surgeons] feel that PRS Global Open has done due diligence on this article and this case is closed”. He also claimed, curiously, that he had no power to force the authors to address the many serious remaining questions raised by the paper’s critics, saying “there is no precedent for an editorial office to do so”. Neither Weinstein nor the paper’s corresponding author, Oscar Manrique, responded to my emailed requests for comments.

Finally, there is Bowers’s claim that “a separate analysis of a survey of more than 27,000 transgender and gender-diverse adults found that the vast majority of those who detransition from medical affirming treatment said they did so because of external factors”. This is technically true, but is also rather misleading because the survey in question — the 2015 United States Transgender Survey (which has profound sampling issues) — was of currently transgender people. It says so in the first sentence of the executive summary. Research based on this survey obviously can’t provide us with any reliable information about why people detransition, because it is not a survey of detransitioners. If you want to know how often people detransition, you need to follow large groups of trans people over time and check in to see if they still identify that way later on — and we don’t have high-quality research on that front.

It’s also worth bearing in mind that the vast majority of studies being discussed here concern adults, while the legislative discussion mostly centres on adolescents. The most recent version of WPATH’s Standards of Care is very open about the lack of evidence when it comes to the latter: “Despite the slowly growing body of evidence supporting the effectiveness of early medical intervention, the number of studies is still low, and there are few outcome studies that follow youth into adulthood. Therefore, a systematic review regarding outcomes of treatment in adolescents is not possible.” Again, WPATH is Bowers’s own organisation — surely she is familiar with its output?

Despite the backbreaking errors of that nine-authored paper, the severe limitations of the Cornell review, and the near-utter-irrelevance of the United States Transgender Survey, all three are chronically trotted out as evidence that we know transgender medicine is profoundly helpful, or that detransition or regret are rare — or both. It’s frustrating enough that these lacklustre arguments are constantly made on social media, where all too many people get their scientific information. But what’s worse is that many journalists have perpetuated this sad state of affairs. A cursory Google search will reveal that these three works have been treated as solid evidence by the Associated Press, Slate, Slate again, The Daily Beast, Scientific American and other outlets. The NYT, meanwhile, further publicised Cornell’s half-baked systematic review by giving Nathaniel Frank a whole column to tout its misleading findings back in 2018.

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Can science ever debate trans issues?

By Jesse Singal

Why does such low-quality work slip through? The answer is straightforward: because it appears, if you don’t read it too closely, or if you are unfamiliar with the basic concepts of evidence-based medicine, to support the liberal view that these treatments are wonderful and shouldn’t be questioned, let alone banned. That’s enough for most people, who are less concerned with whether what they are sharing is accurate than whether it can help with ongoing, high-stakes political fights. 

But you’re not being a good ally to trans people if you disseminate shoddy evidence about medicine they might seek. Whatever happens in the red states seeking to ban these treatments, transgender people need to make difficult healthcare choices, many of which can be ruinously expensive. And yet, if you call for the same standards to be applied to gender medicine that are applied to antidepressants, you’ll likely be told you don’t care about trans people.

As Gordon Guyatt, who has done an enormous amount to increase the evidentiary standards of the medical establishment, told me: “You’re doing harm to transgender people if you don’t question the evidence. I believe that people making any health decisions should know about what the best evidence is, and what the quality of evidence is. So by pretending things are not the way they are — I don’t see how you’re not harming people.”

For many women though, both in the UK and elsewhere, things are very different. Whether in Uganda, where same-sex encounters are a criminal offence, in Iran, where some lesbians have been threatened with state execution, or within the religious enclaves that exist in a number of US states and in which lesbian conversion therapy is widespread, being a lesbian can mean a hard, lonely life. I am keenly aware that 45 years after coming out, and despite decades of campaigning for lesbian rights, much remains to be done before lesbians can feel truly liberated. Which is why, with Kathleen Stock and Martina Navratilova, I have set up the Lesbian Project. The idea has been brewing for a number of years — ever since I began to realise that the word “lesbian” was yet again becoming a dirty one, as many gay men and trans activists accused us of bigotry for seeking out our own spaces and setting boundaries.

We want to explore why our needs and issues have been so thoroughly deprioritised that we are ignored, presumed indivisible from gay men and heterosexual “queer”-identified kinksters, and even — according to other “letters” of the ever-growing alphabet – the baddies?

The rot started to set in when the Gay Liberation Front split. Lesbians, despite having taken the lead in many ways, soon found that their own concerns were coming second to those of men. Sick of being marginalised and asked to make the tea, after three years the majority of the women walked out and began organising independently. These lesbians had become the stuff of legend by the end of the Seventies. And their struggle for liberation was indivisible from that of women everywhere: one of the seven demands of the Women’s Liberation Movement was “The Right to a Self-Defined Sexuality. An End to Discrimination Against Lesbians”.

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The emptiness of being queer

By Kathleen Stock

I was at the first autonomous public lesbian event — the Lesbian Strength March — in London, in 1981, and the exhilaration that my 19-year-old self felt is hard to describe. Back then we understood that the one thing we did have in common with our gay brothers was discrimination on the basis of our same-sex attraction. We also recognised that one common anti-gay trope, namely the suggestion that gay men were not to be trusted around children, was also said of lesbians. But we were also well aware that a number of gay male campaigns, such as those targeting the legal penalties against cottaging and cruising, did not concern us.

Our issues included resisting what the lesbian writer Adrienne Rich called compulsory heterosexuality. Many of us were feeling coerced into marriage with men. I know I was. As a working-class girl hitting my teens in the mid-Seventies, my life had already been mapped out. I was supposed to marry and have kids with one of the men on my estate, and stay with him regardless of how unhappy or unfulfilled it made me.

At that time, and indeed well into the Eighties, it was commonplace to hear of lesbians who, having split with their husbands, then lost custody of their children through the family courts because they were lesbians. At one stage, up to 80% of the women dragged through the courts by disgruntled ex-husbands lost their children this way. It was clear that the issues affecting lesbians were worlds apart from those affecting gay men.

Coming out as a teenager was not my choice. Every girl at my school was deemed either a lezzer or a slag. And because I had rejected the boys in my class, and was clearly more interested in my female friends, by the bullies’ logic I must be a lezzer, so they stared to call me it. For once, they happened to be right. I was bullied and threatened, until my older brother stepped in. But being a teenaged lesbian was also a joy: going to nightclubs with the gay boys and observing the older butch/femme couples was fascinating.

The Lesbian Project is seeking an amicable divorce from our gay brothers. Being lumped in with men is neither appropriate nor useful when it comes to our priorities, and we can no longer pretend that it is. We have only once been targeted by the same legislation — Section 28 — and as women we need to ask ourselves whether we are being afforded the same attention as our male counterparts.

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The return of lesbian pride

By Julie Bindel

Not that all the issues affecting lesbians are the same. We are not a hegemonic group. If I were cast away on a desert island, with 50 indiscriminately chosen lesbians, we would fight like cat and dog and agree on next to nothing. But we would still share something precious and fundamental: our resistance to the path set out for us by whichever community and nation we were raised in.

There are other things we share. We are all gender nonconforming (despite the fact that prior to queer theory and trans ideology we didn’t ever use that term). We have defied sex stereotypes, and all of us have been major disappointments to those hoping we would grow up looking to marry a handsome, successful man and produce a brace of children. We were supposed to behave differently, even if raised within liberal or socially progressive families. We weren’t supposed to wear scruffy dungarees and play pool in backstreet bars.

Many lesbians will disagree with, even actively dislike, my views on certain issues. Some lesbians won’t be feminist. Others might prefer the term “queer” or “gay” — terms I won’t use to describe myself. But like it or not, we are a tribe. Our enemies are not discerning. We are bound together by our refusal to play by the rules. Every out lesbian has defied sex stereotypes and taken a huge risk in being public. Heterosexuality is not just the norm — it is also the method by which patriarchy flourishes. Whether or not we are conscious of it, lesbians are both a threat and a direct challenge to men’s superiority over women.

Today, I live a privileged, middle-class life, with a media career and a supportive family and friendship circle. Although I am relatively safe from bigotry and violence, I still feel that knot in my stomach when asked by a stranger, “What does your husband do?” Then there are the times I hear direct anti-lesbian sentiments expressed by colleagues, neighbours and others, and I can’t keep quiet. If we can come together to fight the oppression that affects us all, our differences will matter less than they otherwise might. A few weeks ago I was walking my dog in the park when a man, resplendent in tattoos, biker jacket and shaven head, approached me. For a split second, I wondered if he was friend or foe. But as we stood face-to-face, he broke into a big smile, and told me he recognised me “off the telly” and that “my mum loves you! She’s a lesbian too.” I was walking on air for the rest of the day.

Everyone involved in this project has their own history and perspective on what it means to be a lesbian. Joanna Cherry, one of the Scottish National Party’s most high-profile MPs, has been treated appallingly within her own party over her views on single-sex spaces (not just for lesbians but also for women facing domestic and sexual abuse). And Lucy Masoud, a former firefighter turned barrister, has spoken out about biological men identifying as lesbians on online dating apps, for which she was labelled a “bigot” and a “transphobe”.

These women join a long list of those who are fighting back against the new bigotry that has rebranded lesbians as irrelevant or not deserving of attention. Our enemies are the same as when I came out decades ago: misogynists. Above all, men who hate the fact that we reject them sexually and get on just fine without them. Some of our enemies are, unfortunately, young women, although we would never condemn or reject them. Having spoken to dozens of them, I fear these women are motivated by a desire to stay on the right side of the men in the LGBTQ+ rainbow, so they put their own needs aside in order to be accepted. One day they may come to us older lesbians for advice and support. We are here for them if they do.

The Lesbian Project will put us back on the map. Lesbians who are able to be out and proud share bravery, tenacity — and enemies. Whatever our differences, we all want things to be better for future generations of girls. Being a lesbian is to refuse to bow to convention. It is an act of resistance and resilience. And I for one am proud to use that label.