I’m delighted (and slightly baffled) to announce I will be speaking at Greenbelt Festival at the end of August. I’ll be talking trans liberation and feminist futures, thinking through how solidarity and collaboration can help us build a better future for all.
On 4th April 2023 the Equality and Human Rights Commission (EHRC) provided advice to the UK Government on “clarifying” the definition of sex in law. Specifically, they recommended the protected characteristic of sex in the Equality Act 2010 be re-defined as “biological sex”. The proposals have been welcomed by the Labourparty as well as the Conservatives.
If adopted, the EHRC’s proposals would strip trans people of numerous legal protections currently afforded by the Equality Act as well as the Gender Recognition Act.
This is made extremely clear by the EHRC. Their own examples include the argument that it is a problem that trans women may be protected from sexism under current law, and (as “legal lesbians”) from homophobia if we have female partners. Most worryingly of all, they have doubled down on previous attacks on our right to access gendered spaces. If implemented, the proposals may result in the trans women being barred by law from women’s toilets, changing rooms, hospital wards, domestic violence shelters, rape crisis centres, and book clubs (the latter is a genuine example provided by the EHRC).
I am not going to get into the weeds with these proposals. Others will no doubt provide deep legal analyses. I have already seen “gender critical” commentators claiming that this will have no real effect on our lives in practice. To which I say: fuck you.
I am done with being polite, and reasonable, and rational. These proposals represent a blatant attack not just on our civil rights but also on our rights to exist as human beings in public. In practice, banning trans women from women’s toilets means that many if not most of us simply cannot use public toilets.
Trans women use women’s facilities because we are women. And when I say “trans women are women” I am not merely making some kind of abstract metaphysical claim. I am saying that we are structurally disadvantaged under patriarchy, and experience sexist violence every day from men. That is the material reality. Insisting that trans men use women’s toilets is equally stupid, especially if your supposed aim as a “gender critical” campaigner is to produce a space free of beards and penises.
But here I am disappearing once again into details. None of this is about details. It’s about terrorising trans people, and we are terrified.
It’s about making our lives impossible. Ideally, we will disappear; our oppressors don’t really care if we suffer or we die. And we know, trans people know, that people around us are suffering and dying because we are actually a part of that community. I’ve spent the past 13 years producing research that formally documents the oppression we face, because when we simply say what we know is true because we are living that truth every day, nobody in power gives a shit.
In the meantime, people in suits believe there are votes and clicks and money to be won through fighting culture wars, through distracting people from rising poverty and slow-burning climate collapse.
If you are cis, it is up to you, the reader, to do something about this. Over the past five years trans people have been systematically harassed and silenced by a hostile media. We have been pushed out of political parties and campaign groups. Supposed human rights protectors such as the EHRC have been institutionally captured by the far right. Academics happily write abstract theory about what a terrible danger we pose. Fascistgroups are rallying against us in the streets, trans healthcare is under attack, and trans children are being told they must be outed to their parents, all with the support of Labour and Tory politicians as well as popular children’s authors.
Obviously we will fight for our own liberation. We have always fought. We are so beautiful and so powerful, especially here and especially now.
But we need you to fight with us.
Here are some things you can do. Write to your MP, and then do it again. Make sure they are sick of hearing from you and then keep going. Go to a protest. Engage in direct action. Maybe sign a petitionif you’re into that kind of thing. If you are in a political party, fight like hell to ensure that party is actually on our side. Join a union and fight for us there. Join a human rights group. Join a small trans organisation and offer whatever you can, whether that’s volunteer time, small donations, or signal-boosting.
Think about how you or your organisation might productively break the law to help people. If the EHRC’s proposals actually make it through Parliament, we must make them unworkable. Section 28was only successful because teachers, administrators, and local authorities collaborated with an openly homophobic government. That doesn’t have to be the case again.
Finally, it’s important to note this is just the tip of the iceberg. Attacking trans people and defining women by “biological sex” are a part of a wider attempt to remove women’s reproductive rights. Our government is shredding the refugee convention and putting asylum seekers in camps. Our legal rights to protest and strike have been massively curtailed.
If you’ve ever wondered “what would I have done in the face of rising fascism?” then wonder no longer.
Last month my band wormboys released a new three-track EP, titled “smalltime”. It’s the second wormboys release I play bass on, after our 2022 single “weird“. I’m so impressed by the breadth of my bandmates’ songwriting: by turns sexy, beautiful, haunting, moody, and oppressive. As a self-taught, DIY musician, I was also excited how learning and refining these songs helped push the boundaries of what I can do.
We collectively created a zine as a physical artifact to accompany the digital EP. It contains artwork, lyrics, and advice on building a guitar effects pedal. I also wrote an exclusive new essay, titled “START A BAND”.
The zine comes with a download code, stickers, and a badge (which doubles as a circuit board for anyone who fancies following the advice on building a pedal!) You can buy a copy for £5from our bandcamp page.
Here are some nice things people have said about “smalltime”:
Beat In My Bones “Everything about this EP is worthy of your time and attention- the songs are just effortlessly slick, and that lo-fi sound, and that DIY ethic attached to it really comes across.”
Gina Maya “The three songs that form Smalltime (2023), the new EP by Wormboys, reverberate with the darkened sweat-soaked cellar sound that made their pre-release of the song Tree so attention-grabbing back in 2022.”
Get In Her Ears “The EP shows off a huge range of skill in just three short tracks, showing off both a mastery of popular styles as well as an undeniable talent for creating altogether new sounds.”
Rockambula “Questa nuova uscita è una conferma di quanto il il quartetto inglese possieda un ventaglio sonoro piuttosto ampio da cui attingere”
I bounced up to an old friend to share this important insight. All around, queer bodies danced and swayed to furiously enthusiastic music. We have always sought refuge in one another, in our in our art, in utopic dancefloors and community care. But something felt different.
The collective energy of the crowd was wild, strong, cohesive. The entire room was dancing – and among us, so so many out, happy trans women and transfeminine people. On stage, a non-binary person sang explicitly about their experiences of gender to an assertive ska beat. It was a joyful moment – but the true wonder of it for me was that it was far from unique.
This was the last in a string of winter tour dates for my band wormboys, at the brilliant Queer As Punk event in Edinburgh. But I’d experienced similar in Dundee, in Glasgow, in Newcastle, in Hull, in Leeds. At every gig, trans women and non-binary people were scattered throughout the audience; at most, there were also several of us on stage through the night. It’s a world of difference from when I encountered just the occasional trans man playing gigs in the mid-2010s; let alone from when wrote a blog post titled Trans/queer rock musicback in 2010, in which I desperately sought validation in questionable gender-bending tunes written by (largely) cis musicians.
While trans women (and trans people more broadly) have always been involved in DIY music, there’s a clear change taking place. We have taken our inheritance and run with it. There are more of us making our own art, telling our own stories, and celebrating one another more than ever before. We are more visible, we are more assertive, we are more respected within our scenes, and – collectively – we are having more fun.
The very night we enacted a better future on that dancefloor in Edinburgh, 16 year-old trans girl Brianna Ghey was stabbed to death in Warrington. Two other teenagers, a girl and a boy, have been charged with her murder.
For trans people across the UK – especially trans women and girls – this lethal attack was not unexpected. It feels like the culmination of a vicious hate campaign that permeates our media and politics. It’s also the tip of a vast iceberg of intentional violence and untimely death.
Suicide is endemic among trans youth driven to despair by the socially-sanctioned antagonism directed at them every hour of every day. I am tired of citing statistics. I have lost so many of my friends and peers. Words and numbers are insufficient for the raw anguish of my grief.
This is only compounded by the failures of bystanders who refuse to intervene, schools and employers who try to make us disappear, a National Health Service that inflicts harm upon us. England’s only child and adolescent gender clinic is due to close in a matter of weeks, with nothing ready to replace it. In an extraordinary open letter, the majority of clinical, research, and administrative staff at the clinic note an “increase in deaths related to the service” since the suspension of endocrine treatments in 2020.
Many of my friends have been threated or assaulted in broad daylight. One, for instance, had rocks thrown at her. Another was assaulted in front of the school gates. Another was raped by boys in the school playground. I frequently struggle with feelings of survivor’s guilt, having merely been publicly assaulted, stalked, harassed, and subject to threats of legal action and murder. Relatively minor matters, in the scheme of things.
How to understand joy in the face of so much hate and despair?
This is a question I struggled with throughout our tour. The night before Brianna’s murder, 400 people rioted in Knowsley outside a hotel that houses asylum seekers, spurred on by the fascist group Patriotic Alternative. This horrific event, too, did not occur in a vacuum. Racist and anti-migrant sentiment has similarly been stirred up by cynical politicians and journalists, as asylum seekers, economic migrants, British Black and Asian people, Gypsies and Travellers are repeatedly failed or directly targeted by our authorities and institutions. Patriotic Alternative have also repeatedly targeted LGBTIQ+ communities, through their campaign against Drag Queen Story Hour.
I could say so much more: about assaults on disabled people’s rights and livelihoods, about the demonisation of the poor, about attacks on pay, pensions, and the unions that attempt to defend them (I am writing this post while on strike). About how fascist violence is excused by sexist men in the name of “defending women and girls”. About how oppressed groups are played off against one another, while the effects of all this hateful discourse and action are felt most keenly at the intersection of multiple forms of persecution, such as by migrant trans women of colour.
Ultimately though, my point is this: what we are seeing is both a consequence of historic prejudices in our society, and of rising fascism.
Minority groups, women, migrants, and working class people in the UK have always faced a shared struggle against systemic discrimination and violence. Following a period of mild reform in the 1990s and 2000s, we are now experiencing a significant upswing in bold, blatant hate speech and violence, effectively condoned by every major political party and the majority of mainstream media publications.
This is the context of trans joy in the 2020s – and the reason why that joy is so necessary and vital.
Our tour reminded me that art is resistance, and resistance is collective. In recent days I have felt myself marinading in my own fear, a recipe for passive inaction. If we cannot experience joy, we cannot dream; if we cannot dream, we cannot hope; if we cannot hope, we cannot fight back. In the face of a world that wants so many of us dead, it is vital that we create reasons to live, and to thrive.
In Leeds, wormboys played to a rammed room in Wharf Chambers, a triumphant hometown crowd. We invited the brilliant Punjabi-Celtic-indie fusion trio Kinaara and gorgeous queer folk duo Serinto support us, building new friendships and cementing old ones. In Hull we debuted at the New Adelphi, where now-legendary acts such as Lizzo, Manic Street Preachers, Pulp, Skunk Anansie, and PJ Harvey played before they were famous. We shared the stage with Sandbox Mode – a solo hip-hop artist making deeply honest and funny songs about mundanity and despair – and Baby Flowers, an exciting young grunge group playing their second ever gig. This was the least well-attended, most male-dominated, and least obviously queer gig on our tour. And yet: the mood was vibrant, I noted at least one other trans woman in the audience, and Baby Flowers’ bassist was showing off a well-placed trans rights sticker.
In Newcastle, we found ourselves in the Little Buildings, a venue which has miraculously survived Covid-19 despite being founded just the pandemic began. The event was hosted by new dance party Queer Love. We played alongside the incredible hardcore group Disciplinary with their two bass guitars, and also the feminist dance-punk phenomenon of Fashion Tips. The whole night was amazing, but Fashion Tips were particularly exciting for me. Frontwoman (and Queer Love organiser) Esmé Louise Newman has a long history of involvement in groundbreaking queer feminist punk, metal and no-wave groups, including Penance Stareand Etai Keshiki. The new band were just as brilliant, with aggressive guitars and vocals underpinned by a powerful rhythm section, heralding a new era of revolutionary dancefloor divination.
Next to Glasgow, where I organised a well-attended gig at The 13th Note in less than a week, after our original promoter pulled out at the last minute. We booked the astoundingly powerful riot grrrl group Brat Covento play with us, along with HAVR, purveyors of gorgeous post-punk soundscapes. The latter band are fronted by Carrie Marshall, author of Carrie Kills A Man, who noted to cheers that she was a different gender the last time she played the venue. This was an event with plenty of trans women present, beaten only by brilliant gig in the same venue the very next night, which I went to see my soulful dyke folk pal Pictureskew play inbetween our own shows. That event might well be the first of its kind I’ve been to where there were at least as many trans women in attendance as anyone else. It was beautiful.
Then to Dundee, where Rad Apples and Make That A Takeput anarchist theory into practice by actively working to provide a safer punk venue and events for women, queer people, and migrants, through simultaneously building a welcoming space and promoting a zero-tolerance attitude towards discrimination and abuse. There I had two totally new life experiences. First, I witnessed somebody crowdsurfing in a shopping trolley during a storming set from banjo punks Alldeepends. Then, we were subject to the well-organised chaos of the “crowd surfing machine” by jubilant anarcho-folk headliners Boom Boom Racoon (a variant on the sat-on-the-floor rowing boat dance associated with songs such as “Oops Upside Your Head” and “Rock The Boat”, but with audience members encouraged to take turns in crowdsurfing along the boat).
Through the tour, I’d been carrying a trans flag to drape over my bass amp, and have often said something about trans liberation from stage inbetween songs. wormboys are a political band, but not in the same way as more in-your-face punk groups I’ve previouslyfronted. I’ve reveled in the ability to just be a musician and make that – rather than my status as a trans woman – the focal point of my involvement, leaving most of the talking to dual vocalists duo Sop and Harry. In the current political environment, that has increasingly felt untenable. It seems important to speak out, make myself visible, be obviously a trans woman making music.
But at Rad Apples I didn’t need to. There was already a trans flag up. There were plenty of other trans people there. There were placards in the bar opposing Section 35. I could just be.
And so to Edinburgh, where I found myself living in the future during a joyous set from opening act Bufandas. A future in which we experience the true paradox of trans visibility, in that we are both uniquely vulnerable, and uniquely strong. No longer hiding in the shadows, we are easier targets for those who hate us, but also have so much more potential to build power together.
Brianna Ghey’s killers may be convicted and jailed, but that will do nothing to stop the violence we face across these islands, and across the wider world. We have learned that we cannot trust the police to save us, or the courts, or politicians, or journalists, or managers, or human resources departments. But we don’t need any of these people or organisations. We owe it to Brianna to continue the grassroots work she did to improve other people’s lives, because another world is possible.
The headliners at Queer as Punk in Edinburgh were the fiercely feminist disco punk group The Red Stains. Their set included several explicit statements of support for trans people and especially trans women and girls, reflecting the attitude of most women active within actual feminist movements. This was an important reminder that anti-trans movements do not speak for all women, and never will.
My experience of sharing a stage with so many amazing musicians, from so many backgrounds, featured many such reminders. I was reminded of the sheer depth and range of human creativity. I was reminded of how much we can be inspired by our differences as well as shared experience. I was reminded of how far we have come, as well as how far we have to go.
There are so many of us. Today, we mourn. Tomorrow, we fight. Soon, we will win.
What The Commitments taught me about playing music
Like most women musicians, I’ve experienced a fair amount of sexism while playing in a band.
It can be insidious. Bands with women in often find they are more likely to put on stage earlier in the night, and paid less than other bands, regardless of skill, experience or size of following.
Other times, it’s entirely explicit. Like when men have shouted GET YOUR TITS OUT while I’m setting up on stage, or RAPE while we’re playing.
Sometimes, I downplay the impact of sexism in music, to focus on the positives. But it always gets to me – that sense that live music is for men and boys, that sense that it’s not for women and girls, that sense that we’re not really welcome – unless we are willing to be objectified and treated less seriously as performers.
I saw The Commitments musical with colleagues during its December 2022 run in Glasgow. After a difficult semester, I looked forward to being at the theatre with new friends from work, and enjoying a night of brilliant soul classics.
The Commitments is about a group of young (white) Irish people who form a soul covers band in the late 1980s. The musical depicts disparate personalities coming together, arguing a lot, playing a handful of gigs, and then going their separate ways. Most of the songs are performed by the cast on stage, although the production also used either off-stage musicians or a backing track.
The Commitments lived up to its billing as a jukebox musical. The band (on stage and off) were great. It was exciting to hear a series of well-known tunes re-arranged for the show, and performed with gusto. The architecture of the stage set was gorgeous, variously depicting a Dublin neighbourhood, small family houses, pubs, and bingo halls. The plot and characters were paper thin at best, but this didn’t detract from the overall experience – or wouldn’t have done, if it weren’t for the treatment of the handful of women on stage.
There were three women in the band. They were portrayed as backing singers, although often they actually performed lead vocals. They were collectively referred to as the “Commit-tits”.
Most of the male characters benefited from some basic level of characterisation: e.g. the drunk “prick” of a lead singer with a great voice, the older guy who claimed to have played in various famous bands, the manager with a grand vision. By contrast, only one woman had a character trait; she was the “hot one”. Literally every male character in the band made various objectifying comments about her. The other two women were implicitly pitted against her, and one another; the randy older guy had sex with all three, eventually resulting in a brief fight where they jealously pulled each another’s hair.
During the first half of the musical, the band members changed into stage wear, which they remained in for most of the rest of the play. The eight male performers wore smart white shirts, black suits and ties. The three women wore sexy black mini dresses.
Their characters were objectified in every sense, existing seemingly only as objects of desire and the butt of every misogynist joke. Meanwhile, I was surrounded in the theatre by the joy and laughter of an audience who enthusiastically clapped and sang along with the (genuinely excellent) music. The cognitive dissonance was wild.
Through the second half of the play, I felt increasingly physically sick.
Once the night was over, I reflect on why I experienced such a visceral reaction to the sexism of The Commitments. None of the musical’s misogyny was extraordinary or spectacular. On the contrary, it was low-key, continual, and passed off as normal: just like the everyday sexism women experience in our everyday lives. This makes it hard to identify as a problem, and hard to address in practice.
When I spoke about my feelings on social media, several people who had seen the 1991 movie told me that I misunderstood The Commitments. They told me this was a story of white working class experience in 1980s Dublin, that the characters’ behaviour was reflective of attitudes at the time, that the characters were represented honestly within a social realist narrative.
My issue is, however, is not with a film I haven’t watched. What I saw in the theatre was not social realism, but a jukebox musical where the story worked to loosely link one song to another. The setting was broad; the characters were one note at best.
The narrative of the play had nothing to say about the constant sexism to which women were subject. It was simply present in the actions and words of every male character. In this way, it was normalised, and legitimised.
The very structure of the play itself perpetuated sexist stereotypes about the roles of men and women within storytelling, within society, and within music. The male characters expressed desires and interests, organised events, played musical instruments, and provided commentary on one another’s decisions. The women sang nicely, looked pretty, and were a device for the characters development among the men who leered at them. That is what women are for. That is what women do.
The everyday sexism of The Commitments also reflected a wider failure of the musical to grapple with the political issues it hinted at. An apparently all-white cast performed music historically written and performed by Black women and men, for an overwhelmingly white audience. The musical’s only nod to this were some vague references to worker’s rights and the assertion by one character that “the Irish are the Blacks of Europe, and Dubliners are the Blacks of Ireland”. While I imagine the play was attempting to comment on class solidarity and the historical contingency of whiteness, the clumsy claim of comparative oppression treated the existence of actual Black Irish people as an impossibility (an assumption made all the more bizarre by a later brief reference to the Thin Lizzy version of “Whisky in the Jar”).
I felt sick watching The Commitments because I saw myself – the expectations placed on me as a woman, the possibilities available to me as a woman, the everyday impact of everyday sexism on me as a woman – in the experiences of those women on stage.
I felt sick watching The Commitments because I saw how my non-white friends are so often treated, especially women of colour – their creative endeavours diminished or appropriated, their experiences of racism ignored and erased.
As a bassist and singer, I saw the norms that have led to male musicians shouting stuff at me and my bandmates when we are playing, demanding to examine my fingers for calluses, and assuming that I am at a gig accompanying a man. I saw the hidden structures that made it hard for me and many of my friends to pick up an instrument in the first place. I saw how and why it is constantly so difficult for women and people of colour to simply turn up and play music in so many settings.
I felt sick watching The Commitments because I was witnessing the operation of power.
The stage musical version of The Commitments debuted in 2013: the same year myself and a couple of friends were organising Revolt, a feminist club night in Coventry which prioritised women and trans performers. We did this in reaction to male dominated line-ups, which perhaps had a token woman singing or (at a certain kind of indie rock show) playing bass guitar. We knew that having numerous women from a range of backgrounds on stage does something important. It undermines the assumption that women musicians can or should only play second fiddle to men, and builds a sense of possibility for women in the audience: that music is for us.
We can be more; we will be more; we are more. Creating space for many types of people on stage changes people’s worlds.
In doing so it threatens white male power, which can sometimes feel threatening for white men.
That is why certain promoters and musicians and audience members make life difficult for others in music, through intentional bigotry or unthinking bias. For women, it doesn’t matter how good we are, how we dress, or how we behave on stage. We are so often an alien presence in a space supposedly for men, not obeying the unspoken rules: shut up, don’t speak out, and don’t take up a male musician’s space on stage unless you’re prepared to be compliant and sexually available.
What does matter is context. I reflected on this, wondering why the clothing the women wore in The Commitments bothered me so much. I’ve worn very similar outfits on stage myself. Men have shouted RAPE at me when I’ve done so. But they’ve also shouted GET YOUR TITS OUT at me when I was wearing jeans, trainers, and a loose black band t-shirt. It’s not about what we’re wearing – it’s never about what we’re wearing. It’s about how male desire, male prejudice, and male power is projected onto us.
I realised my problem with The Commitments was that the women characters’ sexuality doesn’t belong to them. Within the context of the plot, they were only ever given the opportunity to be attractive for the men around them, not for themselves. Sex without power.
The Commitments musical wants women in the audience to enjoy the music while sucking up the sexism and ignoring the depth of anti-racist histories. By contrast, at Revolt we sought to build power for women – all women – on and off stage. We sought to bring into being a world in which we can dress how we want, and dance, and sing, and listen, and play, and there’s not a damn thing anyone can do to diminish us for having and creating a great time. It wasn’t perfect, but it was ours.
I love a good feminist space, but separatism won’t save us. If we want women musicians to prosper, we need an actual commitment to promoting respect in every context.
The biggest onus is on event organisers, writers, and musicians – especially those in a position of relative power. There is no excuse for endless all-male and all-white line-ups at events, for casual sexism or racism in lyrics, in event promotion, or in the lines of a jukebox musical. How many people involved in putting on The Commitments looked at the script or the choreography and thought, “hang on a moment”, but didn’t speak out? How many white men (or women) who put on gigs or tour in bands even bother to think about whether or not there are women or people of colour on stage?
Simply having women or people of colour in the room is also not enough. We deserve to be present without having to worry about discrimination or abuse. Campaigns such as Good Night Out and the Healthy Music Audiences project have loads of resources available oncreating safer spaces for musicians and audience members alike.
Ultimately, everyone can play a part in changing the world – that’s how cultural change happens. You can support minoritized musicians by taking us seriously and helping us to build power. Attend our shows, listen to our music, share it with other people, and have a great time. That, really, is what it’s all about.
A couple of days ago I joined Katy Montgomerie’s livestream to work through the current NHS England consultation on child and adolescent gender services. We discussed the background to the consultation, what the questions mean, and what some of the major issues are.
You can take part in the consultation here. It is open until 4th December 2022. Filling it in is a bit of an intense experience, but if you fancy some friendly company and catty cameos, I hope our video will help.
Three weeks ago, I wrote to the NHS England Gender Programme Board (of which I am a former “patient public voice” member) to raise urgent concerns about their consultation on a new interim service specification for children and adolescents.
The proposed service specification is deeply transphobic on numerous levels – from the dearth of relevant treatment pathways, to the assertion that being trans is likely a “phase”.
It is also probable that if implemented, this service specification will impact other young people more widely – especially girls and LGBTIQ+ youth – by undermining principles of autonomy and respect.
The consultation is open to anyone. If you have the time and energy, there is a guide to participating in the consultation here, prepared jointly by Gendered Intelligence, Stonewall, Mermaids, and the Trans Learning Partnership. If you are a community member, a healthcare practitioner, a researcher, or work with a relevant charity, it would be particularly useful for NHS England to hear from you.
Other things you could do to oppose the proposals include: organising a demonstration, raising awareness of this issue on social media, and/or writing to your MP or trade union and asking them to place pressure on NHS England to reconsider.
To date, I have not received a reply from NHS England. Given the danger the proposed service specification poses to the safety of young people, I have now decided to make my letter to them public.
I am emailing to share my great alarm at the proposed service specifications for child and adolescent gender dysphoria services. It is my expert opinion that, if implemented, these proposals will cause great harm to young people. Moreover, in opening such poorly designed and unevidenced specifications to consultation and media commentary, NHS England has already caused harm.
The fact that this consultation is happening at all represents an enormous failure on the part of every professional involved.
I stepped down from the Gender Programme Board earlier this month due to clashes with my teaching schedule. However, given the severity of this situation, I would be remiss in my ethical duties if I did not also email you directly to share my concerns.
My three main areas of concern are:
Social transition should not be subject to medical oversight. This would represent a gross abuse of power on the part of commissioners and practitioners. Choosing to wear different clothes, and possibly use a different name and/or pronouns – is a personal, non-medical decision related to a person exploring their identity and/or coming out. Preventing a young person from choosing a social transition amounts to an attempted conversion practice.
Punishing young people and their families by subjecting them to investigation if they access private services will not help them access healthcare. Young trans people who access private healthcare in the UK or abroad generally due so due to the severity of NHS failures. It will increase the likelihood of young people hiding the fact they are accessing external treatment from NHS clinicians, and of people turning to black-market hormone providers rather than private doctors. I am not sure that members of the Gender Programme Board are fully aware of how prevalent and dangerous the home-made substances already in circulation can be.
Requiring that young people become research subjects as a condition of accessing treatment is completely unethical. This is a well-established principle in the trans health literature. There is no way in which you can truly obtain informed consent for research participation from individuals who will be denied healthcare if they refuse to participate. I fully support the expansion of NHS-funded research into trans healthcare, but participants must not be recruited through coercion.
I will end by inviting all recipients of this email to reflect on what they do not experience, and what they do not know.
Most members of the Gender Programme Board have not experienced gender incongruence or gender dysphoria.
Most members of the Gender Programme Board are not members of a trans community. It is likely therefore that you – even if you are a clinician – have never found yourself in a position where you are confronted with the true impact of NHS failings on young trans people who rely on community support. You do not know what it is like to be trying to look after many extremely damaged members of your community dealing with complex trauma and self-harm from people who have been repeatedly abused by NHS clinicians and processes. We, in the community, are the ones left picking up the pieces of your failings, finding ourselves on constant suicide watch and scrabbling to keep people alive. Invitations onto bodies such as the Gender Programme Board, where we are expected to be polite while fighting for scraps – only to be ignored – do not right these overwhelming wrongs.
My book Understanding Trans Health is cited prominently in the new Philosophy Tube video on complaint, systematic inflexibility, and England’s NHS trans health crisis.
It’s a great video, which manages to capture the sheer horror of NHS failings while still delivering silly jokes, ridiculous costumes, and a strong analysis. In addition to drawing on my work, Philosophy Tube’s Abigail Thorne consulted me on the script for this episode, and I appreciated the opportunity to use my research in this way.
I am personally more optimistic than Abigail about the opportunities offered by the four NHS England ‘pilot’ clinics. These are beginning to slash waiting times, and several are now effectively run by trans people, for trans people. However, I do think it’s important to still critique the very logic that underpins many trans healthcare systems, especially the highly questionable ways in which the medical diagnosis of ‘gender dysphoria’ is constructed, and used to try and control us.
You can buy Understanding Trans Health directly from Policy Press here. It’s also available from all major booksellers, plus many independent queer book stores (e.g. Leeds’ brilliant The Bookish Type). I have also written to my publisher for permission to put a chapter of the book online for free – watch this space! In the meantime, free links to much of my other academic writing can be found here.