Publications

by

New article: Misuse of Evidence in Sex and Gender Policy

The UK is currently sweltering through the hottest June on record. The Met Office has issued a “red warning” for much of England and Wales, highlighting an active danger to life. Trains have been cancelled, roads are melting, and we will likely see more deaths in coming days. Yet the media is talking little about climate change. Instead, one of the big stories of the week is that businesses and unions are uniting in opposition to the proposed appointment of Ed Milliband as Chancellor of the Exchequer, due to the belief that he is too committed to “net zero” emission targets.

How did we get here? And why are trans people once again to blame?

I have a new short article out in the International Journal of Feminist Approaches to Bioethics. It is co-authored with a range of international colleagues, variously originating from and/or based in Australia, Canada, Chile, Finland, Germany, the Netherlands, Switzerland, and the USA, as well as the UK. You can read it here:

Official, paywalled version (typeset and hosted by the publisher, University of Toronto Press)
Misuse of Evidence in Sex and Gender Policy

“Accepted” version (free access)
Misuse of Evidence in Sex and Gender Policy

In the article, we examine how evidence is being misused in debates and policy relating to sex and gender. Our authorship team holds expertise in a range of topics and disciplines, including figures such as clinical psychologist Dr Tomás Ojeda, neuroscientist Dr Dori Grijseels, criminologist Professor Sarah Lamble, and the sociologist and former Olympic athlete Dr Madeleine Pape (to name just a few!) We met at last year’s workshop on sex and gender policy at the University of Lausanne, and have been collaborating ever since.

Drawing on examples such as the UK’s Cass Review and Sullivan Review, US state hearings, and the global exclusion of trans women from sports competitions, we collectively identify six common pitfalls in the use of evidence:

  • presenting “expert” opinion as authoritative
  • excluding relevant expertise, especially from trans people
  • discrediting scientific consensus
  • setting unattainable standards
  • deploying decontextualized claims
  • positioning disinformation as science

We focus especially on how this misuse of evidence in sex and gender policy is causing direct harm to trans people. However, we also note the dangers for other contexts. Given the typical misogyny of anti-trans discourse, this of course includes all women, plus intersex people.

We further highlight how the strategies developed for undermining and misusing evidence in sex and gender policy can also inform a more general distrust of scientific endeavour. In the USA, this can be seen in the mass defunding of scientific programmes and institutions, which we note in the article. Here in the UK, examples include widespread disinformation about immigration, which is being used both to fuel and excuse racist policies and fascist riots… and of course, also public attitudes and policies on climate change.

I hope our new article will be a helpful tool for people wishing to identify and understand how evidence is misused and ideology prioritised – in sex and gender policy of course, but also in wider public debates.

Cover image of the International Journal of Feminist Approaches to Bioethics.


Did you appreciate this post? Want to read more?

Subscribe now to receive new posts for free whenever I write them.

by

New article: Pathologising Legacy Measures and over-assessment

I have a new peer-reviewed academic article out in the International Journal of Transgender Health, co-authored with my colleagues Cal Horton, Jaimie Veale, Lou Kerley, and Ken Pang.

Pathologising Legacy Measures and over-assessment:
reconceptualising ethical assessment and data collection practices in trans children’s healthcare

The article looks at a range of questionnaires which are in common use internationally in trans youth healthcare. These are designed as a type of data collection tool known as “Patient Recorded Outcome Measures”, or PROMs, in which patients are asked direct questions about their feelings and experiences, to track the outcome of specific treatments.

PROMs are common across healthcare and mental health interventions more generally. You may have experienced this yourself if you have ever seen a therapist, for instance. A widely-used example is GAD-7. This invites patients or clients to use a numerical scale to rate how often they have felt bothered by particular problems, such as “feeling nervous, anxious or on edge”, or “feeling afraid as if something awful might happen”.

If a patient or client fills out a questionnaire such as GAD-7 both before and after receiving a treatment or therapeutic intervention, the care provider can – in theory – test how successful their intervention has been.

In trans healthcare, PROMs have historically been used by clinicians for research purposes, as well as for tracking individual outcomes. This has often been problematic, especially when patients are presented with a great many questions, or where these questions are experienced as pathologising or intrusive. For example, in the mid-2010s the Nottingham Centre for Transgender Health notoriously subjected new patients to 27 pages of apparently mandatory questions, including about seemingly random topics such gaming. This caused a great deal of stress and confusion for people seeking care at the clinic.

However, with specialist trans healthcare provision increasingly facing political threats, many clinics currently present PROMs as necessary to demonstrate the benefits of the care they provide. With this in mind, Cal Horton set out to examine 36 PROMs used in trans youth healthcare, assessing them according to four aspects of pathologisation (authenticating transness, intrusion, delegitimisation, and transnormativity) as well as over-assessment. They then brought their findings to our research team, and we wrote them up collectively. We found that both pathologisation and over-assessment were widespread across a majority of these PROMs. For example:

“Tool BI2 asks children to rate how happy they are with 26 body parts, asking which body parts they would like to surgically change, including body parts that cannot be changed through medical intervention (e.g. hands). These questions do not adopt a trauma-informed approach, and many may be experienced as abusive. Tool BI1, for example, asks how children like to pee and how they feel about looking at their body naked, questions which are clinically unnecessary and likely to be experienced as a significant intrusion of privacy by service users.“

The central argument of our article is that numerous commonly-used PROMs are impacted by a wider legacy of pathologisation in trans health, in which young people especially were treated as objects of clinical curiousity, rather than subjects of care. Since these PROMs are well-established and scientifically “validated”, they continue to be used in clinics which profess to practice forms of affirmative care. We therefore named these “pathologising legacy measures”, and caution against their continued use.

We do recognise that many clinics continue to use pathologising legacy measures out of a genuine desire to evidence necessary, life-saving care in an increasingly hostile political environment. Our ultimately question to these clinics is: at what cost?

Did you appreciate this post? Want to read more?

Subscribe now to receive new posts for free whenever I write them.

by

Trans children’s rights and the UNCRC – new article and interview

I have a new article out, co-authored with Dr Cal Horton. It’s about the incorporation of UN convention rights into Scottish law, and what this should (in theory) mean for trans children in Scotland and beyond. The article is totally open access so anyone can read, download, and share it anywhere. You can peruse a copy right here:

The United National Convention on the Rights of the Child and the Rights of Trans Children in Scotland
The International Journal of Children’s Rights

In recent years I’ve felt increasingly critical of human rights as an artificial framework for behaviour, which is frequently ignored or manipulated by those in power. As Nat Raha and Mijke van der Drift put it, these are “human rights for human resources”. Nevertheless, the UN Convention on the Rights of the Child (UNCRC) is now part of Scottish law, and Scottish children and policymakers alike are being informed that this conveys certain expectations for how young people are to be treated.

Cal and I believe it is important to reflect on what this all means for people seeking to work in a humane way with trans children, in Scotland and beyond. In particular, we emphasise the importance of directly involving young people in conversations and decision-making about their own lives. We draw on the demands of young people themselves in doing so, including groups such as Trans Kids Deserve Better Scotland, who note that policymakers have actively ignored young trans people by “by shutting trans bodies and voices out of every room that matters [and] pretending we don’t exist.”

This weekend also sees the publication of an interview I did for the Herald about the UNCRC article. In this, I discuss the findings of my research with Cal. I also reflect more generally on the situation faced by trans studies researchers, in which it is increasingly hard to conduct trans-positive research even as the UK government and funding bodies throw millions of pounds at anti-trans researchers.

Screenshot of the Herald newspaper website. The article header reads: Expert says trans children's rights are not being respected. Exclusive by James McEnaney. There is a photograph of Ruth Pearce, a smiling white woman with shoulder-length brown hair who is wearing an Against Me t-shirt. Below the image is a quote from Ruth: "It is a difficult time to be doing any kind of research on trans or queer or even feminist topics, so I'm finding that I need to be quite cautious about media coverage.


We end the interview with key three takeaways regarding what can be done to protect the rights of trans children, in Scotland and beyond:

“Number one would be to genuinely consult with young trans people and ask what they want and need. They deserve real and meaningful consultation.

“Number two is that there is a huge amount of knowledge that already exists, both on young trans people’s experiences and on how to consult with young people. Draw on the knowledge that already exists.

“And number three is to acknowledge that there is a trans-eliminationist movement. Acknowledge that there is an active attempt to stop anyone from doing the first two things.

“There’s an active attempt to stop any anyone taking seriously what young trans people have to say about their own lives, and an active attempt to stop any accessing of existing knowledge, and that comes from a place of prejudice.

“One of your starting points has to be acknowledging that that exists.”

by

New article: Embodied Experiences of Trans Pregnancy

I recently had a new co-authored research article published in the journal Body & Society, titled Embodied Experiences of Trans Pregnancy. It is part of a special issue on Pregnant Bodies and Embodied Pregnancy.

For this piece of writing, we were particularly interested in how embodiment is gendered and vice-versa. In the article, we draw on interviews with trans men and non-binary people to explore the lived, bodily complexities of trans pregnancy. We consider the strategies trans men and non-binary people engage in to manage their gender presentation during pregnancy, and the degree to which pregnancy might disrupt their ability to control the presentation of gender.

The published article is currently behind a paywall, but you can download a free version here from the University of Glasgow’s Enlighten repository, or from the publications page of this website.

This is likely to be the last published article from the Trans Pregnancy Project, an international study which ran 2017-2021. Together we have written around 15(!) other articles and book chapters, and edited a special issue of the International Journal of Transgender Health. You can learn more on the Trans Pregnancy Project website.

Cover of the journal Body & Society.

by

New book chapter: By Us and For Us: Bringing Ethics into Transgender Health Research

I’ve co-authored a short chapter for a new book that’s due out in February. The book, titled A History of Transgender Medicine in the United States: From Margins to Mainstream, traces the development of trans medicine across three centuries, with writing from more than 40 contributors.

The book is currently on offer from the publisher, SUNY Press. If you order by 6th December you can buy the book for 50% off with the code HOLIDAY24. That means the paperback edition will come to $22.47 for those in the USA, or £24.12 with postage for buyers in the UK.

I should clarify also that, as usual with academic books, I won’t personally be seeing a penny from its sale. So if you’d like to read this publication, please do get it at a bargain price if you can!

Book cover for A History of Transgender Medicine in the United States: From Margins to Mainstream, by Carolyn Wolf-Gould, Dallas Denny, Jamison Green, and Kyan Lynch. The cover features an anatomical drawing of a heart in the trans flag colours of white, pink, and blue, against a white background.


Our chapter is titled “By Us and For Us: Bringing Ethics into Transgender Health Research“, and I wrote it collaboratively with Noah Adams, Jaimie Veale, Asa Radix, Amrita Sarkar, and Danielle Castro.

In this chapter we explore the context and subsequent impact of an earlier work, our co-authored journal article (with additional author Kai Cheng Thom) Guidance and Ethical Considerations for Undertaking Transgender Health Research and Institutional Review Boards Adjudicating this Research. That article is now one of the most highly-cited works I’ve contributed to. Since its publication in 2017, it’s been used to inform the design and implementation of hundreds of studies, becoming more influential than I ever could have imagined.

I’m really grateful especially to Noah Adams for leading on the process of both our 2017 article and new book chapter. I first met Noah, along with Jaimie and Asa , at the 2016 WPATH Symposium in Amsterdam, which saw the presentation of numerous extremely unethical studies on trans and intersex people. I learned a great deal very fast at that symposium, and through the subsequent writing process with Amrita, Danielle, and Kai.

Most importantly, I learned that it is possible to change research and practice for the better through interventions that centre community perspectives, mutual learning, and our collective responsibilities to one another. This is an important thing to bear in mind in our current age of disinformation and the abuse of scientific discourse: while abusive practices have a long history in trans medicine and medical research, another world is possible.

by

New article: ‘Why Is the Chubby Guy Running?’

2024 has been a good year for the publication of articles I’ve been working on with colleagues for a long time. Hot on the heels of recent pieces on microaggressions and domestic violence comes the latest peer-reviewed work from the Trans Pregnancy Project, published in the Journal of Applied Philosophy. It’s open access, which means you can read it for free or download a copy to share here:

‘Why Is the Chubby Guy Running?’: Trans Pregnancy, Fatness, and Cultural Intelligibility
by Francis Ray White, Ruth Pearce, Damien W. Riggs, Carla A. Pfeffer, Sally Hines

The article opens with the titular question, “why is the chubby guy running?” – drawn from a story shared by a research participant who ran a 5k race while thirty-nine weeks pregnant. We use this as the starting point for exploring the topic of fatness in respect to trans men and non-binary people who experience pregnancy, addressing the gendering of both pregnancy and fatness, stereotypes associated with fat men, and how certain bodies become legible or intelligible.

Cover of the Journal of Applied Philosophy.

A lot of research participants in the project described complex relationships to fatness during their pregnancy, especially where their bump was inaccurately read as a “beer belly”. The writing of this article was led by fat studies expert Francis Ray White; I really appreciated the opportunity to work with them on making sense of these stories, and thinking through what they might mean both for trans birth parents and for our understanding of gender and pregnancy more widely.

This is likely to be one of the last published works from the Trans Pregnancy Project (although we do have at least one more article on the way!)

The project originally wrapped in 2020, but we had such an enormous amount of data that we’ve been writing it up ever since since, addressing topics including media representation, midwifery, conception, pregnancy loss, sperm donors, testosterone use and cessation, racialisation and whiteness, partner abuse, and young people’s views about possible pregnancy. I’m grateful as ever for the trust offered to us by the research participants, and hope we can continue to expand and evidence society’s understanding of their experiences.

by

New article: The association between microaggressions and mental health among UK trans people

I have a new article out in the journal Social Psychiatry and Psychiatric Epidemiology, co-authored with colleagues at University College London. It reports on the findings of a study led by Talen Wright, looking at the mental health impacts of microaggressions on trans people.

You can download and read the full study for free here:

The association between microaggressions and mental health among UK trans people:
a cross-sectional study
by Talen Wright, Gemma Lewis, Talya Greene, Ruth Pearce, and Alexandra Pitman


What did we find out about microaggressions, mental health, and trans people?

Wright designed a survey of 787 trans adults in the UK, asking questions both about participants’ mental health and their experiences of microaggressions. When analysing the findings, we found that experiencing more microaggressions was associated with worse mental health, including increased severity of depressive and anxiety symptoms, and increased odds of lifetime self-harm, suicidal thoughts, and suicide attempts.

We also found evidence indicating an association between specific microaggressions and specific mental health outcomes:

  • Participants who reported more misuse of their pronouns by others were more likely to report increased thoughts of self-harm and suicide.
  • Participants who reported more experiences of their gender being denied by others were more likely to attempt suicide.
  • Participants who reported more experiences of people around them acting uncomfortably around them because of being trans were more likely to report increased symptoms of depression.
  • Participants who reported more experiences of people around them denying the existence of transphobia were more likely to report increased symptoms of anxiety.


Why is this study important?

With apologies to my co-authors, I consider this a form of “cat detector” research. I base this term on an image shared a few years ago by the Facebook page High Impact PhD Memes, purporting to show someone successfully wielding a cat detector:

The meme is labelled as follows: Interviewer: "How would you define your previous works?" Me: "Groundbreaking". Underneath this is an image depicting the researchers' previous works: a person holding a machine in a cat's face. The machine is labelled "cat detector", and has one face lit up green, labelled "Yes", indicating that it has successfully detected a cat.


The meme is funny because, well, it’s obviously a cat. The research is stating the obvious.

And so this research might quite reasonably seem to many trans people. We know that microaggressions are harmful: that when people deny who we are, it hurts. When researchers or journalists or politicians talk about high rates of poor mental health among trans communities, we know that it is because people are harming us, that entire systems are set up in ways that harm us.

At the same time, we live in a political and policy context where trans people’s voices are rarely heard, and disinformation runs rampant. A lot of cis people are getting inaccurate information about our lives and needs, including healthcare commissioners, doctors, nurses, therapists, educators, and civil servants, as well as our families, friends, and colleagues. Trans people are often portrayed as overly sensitive to other people’s transphobic behaviour, or living in denial of reality.

Given this context, I feel it is beneficial to demonstrate empirically – with statistical analyses! – that small actions add up, and “microaggressions” cause real harm.

I hope this research will be useful for countering non-evidenced transphobic policy approaches. For example, the UK government’s current guidance on “Gender Questioning Children” in schools directly encourages educators to undertake actions that are associated with harmful outcomes in our study. As more research is conducted and published in this area, we will have more information available to clearly demonstrate the risks of transphobic policy, and empower advocates fighting for change.

by

Out now in Scientific American: “The U.K.’s Cass Review Badly Fails Trans Children”

I have co-authored an article with Cal Horton for the science magazine Scientific American. We take a concise look at what the Cass Review is, what it found, why the methods used were troubling, and how it is being used to harm young people.

You can read the article here. I hope it will be helpful as a basic explainer for why trans community groups, academic experts, and clinical specialists are so concerned about the Cass Review.

Screenshot of Scientific American website.

Writing for Scientific American was a really interesting experience. It was of course radically different to publishing in a peer-reviewed journal: we put the piece together in a matter of weeks, and it was not scrutinised by academic experts from our specific field of study. At the same time, there was an extremely rigorous editorial, fact-checking, and copyediting process that also made it very different to publishing in most magazines or newspapers.

I was deeply impressed with the sheer amount of time and care the Sci Am editors put into this piece. On one hand, their contributions ensured the piece is written in accessible language, with an international (and especially US-based) readership in mind. On the other hand, we had extensive discussions to ensure that all points made in the article could be rigorously evidenced, including some very detailed exchanges about the specifics of UK law, and what exactly the Cass Review document does and does not have to say about exponential growth over different periods of time. We had to be able to strongly back up any even slightly contentious point.

It was a challenging experience, but one I felt very held by as an author committed to consciencious research practice. Publishing this piece in Sci Am definitely ensured that it was as good as it could possibly be.

by

Community Development Journal: Issue 59(3) out now

One element of my work I don’t talk about as much on this blog is my role as co-editor of the Community Development Journal. We put out four issues every year featuring amazing research from across the world, so I’m hoping to highlight this a bit more in future posts.

Volume 59, Issue 3 is out now and features articles on a range of topics from violent protest, to public art, to academic/voluntary partnerships – with contributions from South Africa, the Philippines, the UK, India, Canada, Vietnam, Mexico, Portugal, and Italy. As ever, it’s been hugely exciting to work with and learn from such a broad range of insight and expertise.

In addition to overseeing the peer review process, myself and co-editor Kirsty Lohman write an editorial for every issue. This editorial – one of five freely available articles in the latest issue – celebrates the launch of the new CDJ Plus website and reflects on the privileges and limitations of academic publishing. In particular, we discuss the importance and limitations of using our platform to speak out about the ongoing colonial violence in contexts such as Gaza and Ukraine.

You can read that editorial here:

Academic publishing and the privilege of a platform
by Ruth Pearce and Kirsty Lohman

by

New article: “Child rights in trans healthcare”

Image of the cover for the International Journal of Transgender Health

I’m pleased to announce that Child rights in trans healthcare – a call to action has just been published as an advance article in the International Journal of Transgender Health. I helped to co-author it alongside an international team of expert researchers and clinicians, including Cal Horton, Jaimie Veale, TC Oakes-Monger, Ken Pang, Annie Pullen Sansfaçon, and Sophie Quinney.

This article is an editorial, reflecting on the current landscape of policy and practice regarding children’s rights within trans healthcare:

In this editorial we first call attention to the importance of child-rights informed policy and practice in trans healthcare. We outline critical pillars of rights-respecting healthcare for trans, gender-diverse, and gender non-conforming children. We highlight the importance of embedding rights within service delivery, discussing the need for child participation in healthcare design, evaluation and accountability. In the second section of this editorial we articulate and call attention to a sector-wide ethical duty of care to children, building a sector where child rights violations are no longer tolerated. We highlight the responsibilities of all trans healthcare stakeholders and professionals, including those in adult trans healthcare, in ensuring a sector-wide shift to ethical and rights-respecting practice.

The article can be read for free here.