“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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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.

It was sadly inevitable that the AIDS crisis would exacerbate this ancient prejudice. A headline in The Sun declared that “perverts are to blame for the killer plague”. And while a writer for the Express held “those who choose unnatural methods of self-gratification” responsible for the disease, letters published in its pages followed suit. One reader called for the incarceration of homosexuals. “Burning is too good for them,” wrote another. “Bury them in a pit and pour on quicklime.” Someone had been reading his Dante.

I happened to come out in a much less hostile climate. In the early 2000s, we were enjoying a kind of Goldilocks moment, neither too hot nor too cold. We weren’t generally on the receiving end of homophobic slurs, but nor were we patronised by well-meaning progressives. My memory of this time was that no one particularly cared, and I was more than happy with that. Being gay for me has never been an identity, it’s simply a fact, as unremarkable as being blue-eyed or right-handed.

And so it has been troubling to see a resurgence in the last few years of the kind of anti-gay rhetoric that was commonplace in my childhood. Of course, it could be argued that the rise of social media has simply exposed sentiments that were previously only expressed in private. As Ricky Gervais has pointed out, before the digital era “we couldn’t read every toilet wall in the world. And now we can.”

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Yet the most virulent homophobia appears to be coming from a new source. Whereas we have always been accustomed to this kind of thing from the far-Right — one recalls Nick Griffin’s remark on Question Time about how he finds the sight of two men kissing “really creepy” — but now the most objectionable anti-gay comments arise in online spheres occupied by gender ideologues, from those who claim to be progressive, Left-wing and “on the right side of history”. The significant difference is that the word “cis” has been added to the homophobe’s lexicon. Some examples:

“Cis gay men are a disease.”

“Cis gay men are truly some of the most grotesque creatures to burden this earth.”

“I hate cis gay people with a burning passion.”

“If you’re a cis gay man and your sexuality revolves around you not liking female genitalia I hope you die and I will spit on your grave.”

“Cis gays don’t deserve rights.”

“There’s so many reasons to hate gay people, most specifically white gays, but there’s never a reason to be a transphobe.”

“It’s time to normalise homophobia.”

Of course, any bile can be found on the internet, but these kinds of phrases are remarkably commonplace among certain online communities. Even a cursory search will reveal innumerable examples of gender ideologues casually branding gay men “fags” or “faggots”, praising the murder of gays and lesbians, and claiming that the AIDS epidemic was a positive thing. Many thousands of examples had been collated on Google Photos under the title “Woke homophobia: anti-gay hatred & boxer ceiling abuse from trans activists & gender-identity ideologues”. The site was taken down last year, presumably because it violated Google’s policy on hate speech — or perhaps because it revealed the toxicity of the ideology the company has spent so long promoting.

If such ideas were restricted to the demented world of internet activism, we might be justified in simply ignoring it. But we now know that the overwhelming majority of adolescents referred to the Tavistock paediatric gender clinic were same-sex attracted. Whistleblowers have spoken out about the endemic homophobia, not simply among clinicians but also parents who were keen to “fix” their gay offspring. And of course there was the running joke among staff that soon “there would be no gay people left”.

And now a series of leaked internal messages and videos from WPATH (World Professional Association for Transgender Health), has revealed that clinicians in the leading global organisation for transgender healthcare have openly admitted in private that some teenagers mistake being same-sex attracted for gender dysphoria. The result of the “gender-affirming” approach has amounted to what one former Tavistock clinician recently described as “conversion therapy for gay kids”. Homosexuality was removed from the World Health Organisation’s list of psychiatric disorders in 1993, and yet here we are medicalising it all over again.

So how did we reach the point where gay conversion therapy is being practised in plain sight by the NHS? Much of the responsibility has to lie with Stonewall, a group that once promoted equal rights for gay people but now actively works against their interests. It has even gone so far as to redefine “homosexual” on its website and resource materials as “same-gender attracted”. It should go without saying that gay men are not attracted to women who identify as men, any more than lesbians should be denounced for excluding those with penises from their dating pools. What trans activists call discrimination, most of us call homosexuality.

Indeed, activists often claim that “genital preferences are transphobic”, or that sexual orientation based on biological sex is a form of “trauma”. The idea that homosexuality is a sickness was one of the first homophobic tropes I encountered as a child. Now it is being rebranded as progressive.

As for Stonewall, its former CEO Nancy Kelley went so far as to argue that women who exclude trans people as potential partners are analogous to “sexual racists”. She claimed that “if you are writing off entire groups of people, like people of colour, fat people, disabled people or trans people, then it’s worth considering how societal prejudices may have shaped your attractions”. It is worth remembering that Stonewall is deeply embedded in many governmental departments and quangos, as well as corporate and civic institutions. Anti-gay propaganda is being reintroduced into society from the very top.

Meanwhile, the Crown Prosecution Service has been meeting with trans lobby groups such as Mermaids and Stonewall to discuss changes to prosecutorial policy in cases of sex by deception. Since these meetings — only revealed after sustained pressure from a feminist campaigner who submitted Freedom of Information requests — the CPS has recommended what Dennis Kavanagh of the Gay Men’s Network has described as “a radical trans activist approach to sex by deception prosecutions that would see them all but vanish”. In trans activist parlance, the barriers to having sex with lesbians and gay men are known as the “cotton ceiling” and “boxer ceiling”. Now it seems the establishment is attempting to support the coercion of gay people into heterosexual activity.

Consider a recent post on X by Stephen Whittle, OBE, a professor of equalities law at Manchester Metropolitan University. In a reply to LGB Alliance’s Bev Jackson, Whittle took issue with the notion that “love is all about genitals” (an argument that Jackson has never made). Having dismissed this straw man as “a very hetero/homo-normative perspective”, Whittle then claimed that “a lot of gay men can’t resist a young furry ftm [female-to-male] cub”.

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While it is true that there are some bisexuals who identify as gay, it is simply not the case that homosexual men “can’t resist” certain kinds of women. As Jackson rightly noted in her response, this is rank homophobia, “disturbed and disturbing on every level”. Yet it has been expressed by an individual who has been described as a “hero for LGBTQ+ equality”. With heroes like these, who needs villains?

Another example is Davey Wavey, a popular online influencer, who has encouraged gay men to perform heterosexual acts in a video called “How to Eat Pussy — For Gay Men”. It may as well have been called “Gay Conversion Therapy 2.0”. We are firmly back in the Eighties, where gays are being told that they “just haven’t found the right girl yet” and lesbians are assured that they just “need a good dick”. And yet now these demeaning ideas are being propagated by those who claim to be defending the rights of sexual minorities.

The Government’s recent guidance on how schools are to accommodate trans-identified pupils — in which biological sex will take precedence over identity — has been met with horror from gender ideologues. One of the common refrains one hears from activists is that it represents “this generation’s Section 28”. But this is to get it precisely backwards. Gay rights were secured on the recognition that a minority of the population are same-sex attracted. In dismantling the very notion of sex and substituting it for this nebulous concept of “gender identity”, activists and their disciples in parliament are undoing all of the achievements of previous gay rights movements.

The widespread homophobia of the Eighties, epitomised by Section 28, was based on the notion that homosexuality was unnatural, dangerous and ought to be corrected. Present-day gender identity ideology perceives homosexuality as evidence of misalignment between soul and body. In other words, it seeks to “fix” gay people so that they fit into a heterosexual framework. It is no coincidence that so many detransitioners are gay people who were simply struggling with their sexuality. Gender identity ideology is the true successor to Section 28.

The proponents of this revamped gay conversion therapy dismiss our concerns as “transphobia” and “bigotry”, or as part of a manufactured “culture war”. Worse still, the new homophobia is being cheered on by those it will hurt most. While prominent gay figures continue to feed the beast that wishes to devour them, we are unlikely to see this dire situation improve any time soon. It was bad enough in the Eighties, when gay people were demonised and harassed by the establishment. Who thought we would have to fight these battles all over again?

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.

Are feminists welcome in the Labour Party? I mean the old-fashioned kind of feminist, who knows the difference between men and women. The answer appears to be that we’re not. Delegates to this year’s party conference in Liverpool will be able to browse stalls outside the main hall, talking to activists about everything from climate change to animal welfare. What they won’t be able to do is speak to representatives of the Labour Women’s Declaration, an organisation that advocates for women’s sex-based rights and single-sex spaces. It has been denied a stall at conference along with FiLiA, which last year organised the largest feminist conference in this country for decades.

Women hoping for an unequivocal statement from Sir Keir Starmer about our right to speak openly about biological sex will be disappointed. The Labour leader has repeatedly failed to condemn harassment of feminists in the party, who have been targeted by “pledges” and motions threatening “transphobes” with expulsion. Instead of standing up for free speech and women’s rights, as you might expect a former Director of Public Prosecutions to do, Starmer has proved himself anything but an ally. “Trans women are women,” he intones, holding to this line as firmly as devout Catholics preach transubstantiation.

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