Research

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Open letter to Yvette Cooper on dangerously flawed NHS research

In May this year I was one of 85 expert signatories to an open letter to James Palmer, NHS England’s National Medical Director for Specialised Services. The letter, organised by Trans Actual, raised serious concerns about the NHS evidence reviews of hormone therapy for trans youth, the subsequent prescribing policy (i.e. a ban on NHS hormone therapy for young trans people aged under 18), and an associated public consultation.

Three months later, Palmer responded. Unfortunately, he dismissed our concerns, and outright ignored most of the evidence we presented regarding the methodological and ethical flaws in the NHS England evidence reviews.

At this stage, we have no confidence in receiving an adequate response from Palmer. My personal view is that both Palmer and NHS England as an organisation have chosen to prioritise political convenience over both good research practice and patient safety (there is a longer history to this too). Following a consultation with signatories, Trans Actual therefore took the decision to escalate the matter to the current Secretary of State for Health and Social Care, Yvette Cooper.

I have reproduced the letter below – you can also read Trans Actual’s press release and the fully-referenced, signed version sent to Cooper here.

Dear Secretary of State,

We write regarding the series of evidence reviews commissioned by NHS England into masculinising and feminising (MAF) hormones for under-18s with gender dysphoria. Based on these reviews, NHS England has consulted on a policy proposal that would make these hormones for under-18s no longer part of the clinical commissioning policy.

In May 2026, a joint letter to Professor James Palmer was signed by 85 clinicians, researchers and academics raising significant ethical, methodological, and procedural concerns with these evidence reviews and the resulting policy proposal.

In August 2026, Professor Palmer responded to our letter (attached), but a number of concerns raised were not addressed to our satisfaction.

We now write to you directly to highlight the significant issues that remain, namely: the lack of clear rationale for these reviews, the significant methodological issues and risk of bias that is evident, and lack of any plan to monitor the impact of this denial of healthcare on young trans people.

1. Lack of clear rationale

Palmer was asked to clarify the exact rationale for these 2025 under-18 evidence reviews, given that NHS England had already updated the relevant clinical commissioning policy in 2024 in response to the findings (Recommendation 8) of the Cass Review of Gender Identity Services for Children and Young People, which included the systematic evidence review of hormones for under-18s conducted by the University of York.

In his response, Palmer explained that evidence reviews are commissioned as part of standard policy development, but provided no indication of any specific impetus for reviewing this policy just one year after it had already been updated.

Following a related FOI request to your own Department of Health and Social Care (FOI-1720493), we have determined that the most likely trigger for these under-18 reviews was in fact the out-of-scope and unvalidated concerns regarding adult services raised by Baroness Cass in her May 2024 letter to John Stewart and Professor James Palmer (see also para 19.34 of the Final Cass Review).

On the basis of these unevidenced concerns, John Stewart and James Palmer decided to “define the role of gender affirming hormones through the development of a new evidence based national clinical policy which will cover all people over the age of 16.”

We note that this work was launched outside of the already-commissioned Levy Review of adult services, which did not report any such concerns regarding hormone prescribing.

In the course of developing the scope of this “all ages” national clinical policy, the Policy Working Group “deemed [it] necessary” in April 2025 to split the evidence reviews into separate children and young people (CYP) and adult policy documents, due to “the significant variation in dosage of MAF between adult and CYP populations”.

At this point, it should have been recognised that:

  • a comprehensive evidence review of CYP hormones had already been carried out as part of the Cass Review;
  • NHS England had already produced an updated CYP hormones clinical commissioning policy following that Review;
  • an ongoing living evidence review into under-18 hormones had been commissioned by NHS England and was already funded and underway.

Instead, NHS England embarked on a redundant and duplicative review of the clinical commissioning policy for MAF hormones in under-18s, overriding and ignoring both the findings and original recommendations of the Cass Review, its own 2024 CYP policy update, and the funded EPPI living review.

We are extremely concerned that Palmer was not able to give us a clear answer as to the impetus for these 2025 under-18s reviews, and that as a result of this confusion, NHS England has spent valuable time and resources duplicating and overriding work it had already commissioned and / or completed.

2. Methodological issues and risk of bias

We are further alarmed by multiple methodological decisions taken in the commissioning of the under-18s evidence reviews.

In particular, we raised in our initial letter our concerns with the decision – taken not by the independent researchers, but the policy working group – to split what is effectively two interventions in under-18s (masculinising and feminising hormones) and at most two treatment populations (those seeking masculinisation and those seeking feminisation) into 10 separate PICOs.

While we agree with the statement in Palmer’s response that Cochrane advocates for a balance between overly-narrow and overly-broad search criteria when conducting evidence reviews, Cochrane also specifically emphasises (2.5.3) that review criteria may require modification in response to initial search results, particularly when dealing with sparse data:

“The ability to address the review questions will depend on the maturity and validity of the evidence base. When few studies are identified, there will be limited opportunity to address the question through an informative synthesis. In anticipation of this scenario, review authors may build contingencies into their protocol analysis plan that specify grouping (any or multiple) PICO elements at a broader level; thus potentially enabling synthesis of a larger number of studies.”

In our view, the fact that 6 out of the 10 PICOs returned zero (0) relevant studies should have been a strong indicator that the PICOs needed to be reconsidered, and that the initial protocols had erred far too far in the direction of “splitting”.

We also note that Cochrane differentiates between (2.3.1) review PICOs, and PICOs for comparisons between interventions or groups. NHS England appears to have entirely misunderstood or ignored this distinction.

Rather than beginning with one review PICO that would naturally be broad in scope, NHS England began with ten different PICOs already limited to specific sub-treatments (masculinising vs feminising, with or without concurrent GnRH analogues) and sub-populations (male, female, non-binary) – yet we note that NHS England has not generated 10 different clinical commissioning policies, only one.

This confirms that NHS England should have commissioned a far broader initial review PICO reflecting the actual review question — namely the safety and clinical effectiveness of MAF hormones for under-18s. Instead it appears that NHS England started with 10 different review PICOs, six of which resulted in zero studies being found due to their extremely narrow scope.

This leads on to one of the most unjustifiable methodological decisions made by NHS England in these evidence reviews.

Professor Palmer’s reply to us confirms:

“The use of GnRH analogues in this cohort is not routinely commissioned in England; therefore, any hormone regimen that could be commissioned cannot be based upon evidence of people who have already been treated with GnRH analogues because the treatment effects of masculinising or feminising medicines may be different for those who have received previous treatment with
GnRH analogues.”

Palmer uses the same justification to explain why dozens of studies that were included in the Cass-commissioned University of York evidence reviews were excluded from NHS England’s 2025 evidence reviews.

The law criminalising access to puberty blockers in England has been used by NHS England as a reason to exclude from its evidence reviews any and all international studies of masculinising and feminising hormones in which patients also received this treatment at any point prior.

This is despite the fact that puberty blockers followed by gender-affirming hormones has been a standard protocol globally for at least three decades, and as Professor Palmer himself admits: “many study populations include those who have received puberty suppression.”

We also note that, according to the March 2025 meeting minutes for the Policy Working Group, “Multiple members shared concerns raised of only having masculinising and feminising medicines (MAF) rather than the usual PSH [puberty suppressing hormones].” These concerns were seemingly overruled.

Adopting this bizarre exclusion criterion, based entirely on NHS England’s own unique and controversial policy position, inevitably led to the finding that there was a “lack of evidence” for masculinising and feminising hormones for under-18s, because so many studies were excluded.

All of this contributes to the exaggerated conclusion that there is an extreme lack of evidence regarding the use of MAF hormones in under-18s. This overstated scarcity has then been leveraged by NHS England to advocate for the removal of this aspect of gender-affirming care.

3. The appropriate response to “lack of evidence.”

Even setting aside the inconsistent rationale and significant methodological flaws we have highlighted above, there is the even more critical issue of how the purported “lack of evidence” is being used to justify the outright denial of care to trans people.

According to meeting minutes from 22nd January 2025, members of the Policy Working Group were assured that “in the absence of evidence, it is possible for specific policy areas to be informed by evidence-based decisions.” Despite this assurance, the proposed withdrawal of under-18 hormones appears to have been based solely on “absence of evidence” and, further, did not follow best practice approaches to evidence-based decision making.

We highlight statements from the BMA’s evaluation of the Cass Review regarding how evidential uncertainty is interpreted and actioned. While their points are in reference to the provision of puberty blockers, we believe they apply equally, if not more so, to the provision of under-18 hormones:

“The evidence base is limited and uncertain, with signals of both benefit and harm … A precautionary approach is consistent with this uncertainty. However, precaution in medicine typically involves risk mitigation alongside maintenance of care, rather than withdrawal of … treatment. … Alternative approaches (e.g. continued access with safeguards) are also consistent with the same evidence base.”

Instead of the precautionary approach and continued access originally recommended by Cass and adopted by NHS England on the basis of robust research, NHS England have now – for no good reason – overridden this, and are once again proposing a blanket withdrawal of treatment for trans people.

We also note that they are proposing to do so before any plans have been offered to monitor or mitigate the impact of treatment withdrawal, or develop any alternative systems of care.

4. Impacts of Treatment Withdrawal

In response to our concerns about the impact of treatment withdrawal, Palmer’s reply takes no account of patients currently on waiting lists or planning to seek referral to gender services in the hope or expectation that this might provide access to gender-affirming hormones.

As NHS England’s own Equality and Health Equalities Impact Assessment for this policy update makes clear:

“Patients who are already under the care of the NHS Children and Young People’s Gender Service and who have previously been advised that they would be referred for consideration of MAF hormones – but whose eligibility has yet to be clinically determined under the current policy – would no longer be eligible. This would mean that an existing aspiration for treatment will no longer be available for some individuals.”

The EIA also states that:

“Some stakeholder groups have previously suggested that withholding MAF hormones will lead to an increase in emotional and psychological distress, leading to risk-taking behaviour amongst children and adolescents.”

We remain extremely concerned about NHS England’s lack of articulated plans for monitoring the effect and impact of the proposed withdrawal of MAF hormones on young trans people.

Instead they have made the bizarre claim that “adoption of the policy [removing access to hormones] would in itself be a risk mitigation measure” “because of a lack of sufficient evidence relating to the safety and clinical effectiveness of MAF hormones for children and young people with gender dysphoria.”

In other words, without evidence, NHS England has adopted the blanket assumption that hormone treatments for under-18s are harmful, and therefore that the very act of denying this care reduces “risk”.

5. PATHWAYS Trial

We also note that if the decision is made to withdraw gender affirming hormones for under 18s from routine clinical commissioning, this will inevitably raise significant issues for the PATHWAYS (puberty blocker) research trial that is already underway.

The inability for young transgender patients to transfer onto cross-sex hormones with a reasonable time scale after beginning puberty blockers has already been a significant question raised in discussions of the ethical viability of this trial.

To date, we have been given no assurances as to how these issues will be addressed.

6. Expert statements

On reading Palmer’s response to our letter, Simona Giordano, a Professor of Bioethics at University of Manchester Law School, responded:

“One of the major concerns raised in our letter was that NHS England adopted review criteria that excluded a substantial proportion of the existing literature. In doing so, it risks repeating a longstanding methodological error in this field: attempting to separate the effects of puberty suppression and gender-affirming hormones as though they were entirely distinct interventions. In practice, many young people received these treatments sequentially as part of a single clinical pathway. This was especially true in England, where treatment with GnRH analogues was typically a prerequisite for access to masculinising or feminising hormones. Excluding studies involving such patients removes a large and clinically important part of the evidence base and may create a misleading impression about the amount of evidence available.”

Simona notes that Palmer’s response “does not adequately engage with several of the substantive concerns raised in the original clinicians’ and researchers’ letter, particularly those regarding the rationale for commissioning a further evidence review, the methodological choices underpinning the review process, and the implications of those methodological decisions for the evidence base considered.”

Chris Noone, a lecturer at the University of Galway who also read Palmer’s response, said:

“Guidance development and evidence reviews in Poland, France, Germany, and the Netherlands have all concluded that Gender Affirming Hormones are safe and effective as part of the care provided by gender services for young people. Furthermore, a recent paper in The Lancet (Doyle & de Vries, 2026) that considers the 13 systematic reviews that exist on this topic concludes that ‘gender-affirming medical treatment for adolescents does what it is intended to do—it shapes physical gender presentation in line with the affirmed gender of the adolescent. Research also indicates that gender-affirming medical treatment for adolescents is effective in terms of stabilising and improving the primary psychological target: gender incongruence (or gender dysphoria)’.”

He concludes that “the withdrawal of this intervention (1) does not follow from the existing evidence, and (2) does not consider the evidence on the risks of withdrawing this intervention.”

7. Conclusion

Our fundamental concern is that the provision of trans healthcare, including healthcare for under-18s, continues to come under immense external pressure from anti-trans actors, as well as being influenced by individuals within public institutions who approach policy and evidence-gathering from the presumption that gender-affirming care is inherently harmful.

In light of the above, we are calling on you as Secretary of State to:

  1. Meet urgently with James Palmer to seek answers to the unresolved ethical and methodological concerns raised in this and our initial letter, and ensure that these concerns are adequately addressed before any proposed change to the provision of MAF hormones for under-18s is finalised.
  2. Meet with trans healthcare clinicians and researchers and work with NHSE to ensure that future commissioning policy changes resulting from evidence reviews – like the forthcoming evidence reviews into MAF hormones for adults – are informed by a high respect for the expertise of clinicians, the autonomy of patients to seek care that reflects their goals and preferences, and a recognition of the risk of harm to trans patients of denying gender-affirming care.

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Review: Re-framing in Friction, On Trans-inclusive Enactment of Gender Equality

I entered the board room with some trepidation, amidst a gaggle of nervous colleagues. We were followed by the LGBT Equality Champion, and the Interim Head of Equality, Diversity, and Inclusion. The room itself was relatively mundane. Some chairs sat around a set of rectangular tables. A blank screen was linked to a computer in the corner. It could have been any room in the institution – if it were not for the view.

We were on the top floor of a shiny new building. Through floor-to-ceiling glass windows we could see a magnificent sweep of the city. I admired the soaring gothic tower of the university, the busy streets nearby, and the new blocks clustered around the river. A long march of tenement buildings to the south was ended by a wide semi-circle of high hills, with wind turbines working busily atop them.

We had gathered in this room to discuss national proposals for the mandatory segregation of trans staff and students. My colleagues had asked for the meeting to explore what – if anything – our employer might be prepared to do to counter these damaging proposals. We had taken time out of our busy schedules. There was no accounting for this in our workload. There was no guarantee we would achieve anything of use. We were concerned about the impact of the proposed segregation scheme on our work lives – but also about the impact of the meeting itself upon our wellbeing.

All of us, aside from the institutional equality leads, were trans ourselves. Many of us had previous experiences of equality schemes, having put countless hours into discussions intended to reshape policy to the benefit of minoritised staff and service users. We often felt isolated and bogged down in such conversations: finding it hard to explain the urgency of action, struggling to translate ideals into action, and fearing that we would be positioned as troublemakers.

As we sat down together, I found myself thinking about Toby Odland’s framing of the second law of thermodynamics:

Some input of energy is required to go between states of non-movement and movement. In large scale systems some of the energy put in to get an object to change state will be dispersed as heat into the environment. Not all of the energy put in is transferred to kinetic or static energy as may be the desire of the one providing the input. In other words, work wastes energy. (29)

In that room with the beautiful view, I was painfully aware of how inequalities can be reproduced in interventions designed to combat them. This phenomenon is a central concern of Toby Odland’s doctoral dissertation, Re-framing in friction: on Trans-inclusive enactment of gender equality aims. The dissertation offers a phenomenological interrogation of how gender inequalities persist for trans people in institutional environments, despite efforts to identify and tackle them.

The above is an extract from my review of Toby Odland’s PhD dissertation Re-framing in friction: on Trans-inclusive enactment of gender equality aims. You can read the full review, published in Tidskrift för genusvetenskap, through either of the links below:

[Re-framing in friction review: xml link]

[Re-framing in friction review: PDF link]

I was asked to write this review after acting as opponent in Toby Odland’s doctoral defence at Linköping University in Sweden, in June 2025. Unlike the UK’s PhD vivas – oral examinations which take place behind closed doors – Swedish doctoral defences are public events, usually taking place at a point where a committee of experts has already supported the provisional completion of the PhD. As such, the dissertation is distributed in print and in digital format ahead of the defence. You can download a free copy of Odland’s dissertation here.

The opponent’s role in a public defence at Linköping University is to present a short summary of the doctoral student’s work to the audience, before asking the student a series of scholarly questions about the work and its implications (you can download my presentation slides here). The student then takes questions from the audience, before an examination committee convenes to (hopefully!) confirm that the PhD should be awarded.

As you’ll see in the full review, I was extremely impressed with Odland’s account of gender equality work in Sweden, and I believe it will be highly relevant reading for people involved in equality work in other countries too.

Cover of Toby Odland's doctoral dissertation, Re-framing in Friction. It features an image of numerous people attempting to discuss, climb around, or repaint an abstract representation of an institution, with a trans flag in one corner.
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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.


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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?

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Talk: lambda nordica symposium, Göteborg

In mid-April I will be travelling to Sweden to speak at the University of Gothenburg. I will provide a keynote address at a symposium titled Academic Freedom and Collegial Solidarity in Times of Pressure, hosted by the academic journal lambda nordica. I am really looking forward to again meeting Swedish colleagues, and learning with them, after an extremely productive visit to Karlstad, Uppsala, and Linköping last year.

logo for lamda nordica

My talk, “From Birth Parents to Backlash”, takes the Trans Pregnancy Project as a starting point for thinking through how and why academics are facing specific types of social and political backlash, what this looks like in practice, and what we can do about this.

It will build on material I have previously delivered at events such as the BSA Medsoc annual conference, and last year’s Standards of Evidence workshop at the University of Lausanne. I will be linking long-term trends to more recent events, thinking through how recent attacks on academic freedom build on phenomena such as the international trans panic and debates over the teaching of critical race and gender theory within universities.

The public portion of the event will take place on Thursday 16 April, and details can be found here.

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I won an Emma Goldman Award!


Trans feminist scholar Dr Ruth Pearce honoured with prestigious Emma Goldman Award
Scene Magazine

Group photo of women posing with awards in a library


In January, I received an unexpected message. And at first, I thought I was being scammed.

Actually, I received several unexpected messages, over a couple of weeks. These comprised direct messages to my social media accounts, a comment on this blog, and – eventually – an email to my work account.

The purported person urgently trying to contact me was Mieke Verloo, Professor of Comparative Politics and Inequality Issues at Radboud University in the Netherlands, and Permanent Fellow at the Institute for Human Sciences in Vienna, Austria. I was familiar with her extensive feminist scholarship, especially her work on gender equality policies and anti-gender movements. Given the overlap in our interests, I wasn’t surprised she reached out. I speak with a lot of other researchers and activists on a pretty much daily basis. What was surprising was how keen and persistent she was to speak with me.

As a social researcher, my work is all about people – and our interactions with policy, institutions, and community organisations. To do my job well, I need to speak with people, all the time. Outside of teaching, this can consist of formally conducting a research interview, sharing advice or information, or just having a chat to maintain a relationship. I’m grateful that my research been highly read and impactful: that has happened because I have worked closely with others the whole time, to inform, design, undertake, and share my studies.

The problem is that academic employment does not leave much time and space for this people work. I do it on top of my teaching and administration load, plus reading, planning, writing, and so on. So I squeeze it in: a meeting here, a blether there. It’s increasingly difficult. I have a growing list of people who want to speak with me about their project idea, the latest insider scoop on NHS policy, next steps for their organisation, or their proposed PhD or postdoc. It takes me increasingly long to reply to emails, and I’m booking meetings months in advance. I am, to put it bluntly, overwhelmed.

So that’s a normal academic problem. It’s even worse for those of us working in fields such as gender studies at a time of far-right backlash. I have started to develop a trauma response to opening my emails. I am always anticipating the next terrible news, the next round of harassment, the next legal threat from a “gender critical” scholar who has decided I am a problem. There is, sadly, a reason why my work email can no longer be found on my university profile. Like many minoritised scholars, I have removed it, making it harder for hostile individuals to contact me.

This is a systemic issue, not just a “me” issue. Universities like to say that they value community engagement and impact. But we are never really provided time for it in our workload, especially if we are part of a targeted minority group. I feel like a one-woman gender clinic, gradually amassing my own ridiculous waiting list.

Professor Verloo did not want to wait. Her numerous messages indicated that what she wanted was clearly very important. I wondered, is this actually the real Mieke Verloo? Is this part of some elaborate harassment campaign? Am I being catfished?

Eventually, I set aside a bit of time, and asked Mieke to prove her identity – which, very kindly, she did. As a leading feminist academic who has studied anti-gender movements, she got it.

I had a flexible hour the next day, so I set up a Zoom meeting, to see what I could help her with.


On receiving awards

I don’t do the work I do to win prizes. I am not saying this to be humble – I am saying this because it true, and realistic.

While some of my work is highly-read, I think the most impactful things I’m involved in tend to be invisible. And that’s okay. I organise with others, and share ideas and information with various people and groups, without any of this ever being visible to the wider world (let alone seeing academic publication). This is the work of social movements, and untold millions of us do it.

Meanwhile, on the occasions when I have sought academic awards, it has been very difficult. I’ve really struggled to land research funding, in spite of my profile, in spite of cis mentors pulling baffled faces and saying things like “I have never seen a proposal this strong fail in the first round”, over and over again. Again, this is a systemic issue. I’ve seen enough trans studies scholars go through the same to know that we are being quietly discriminated against. The same is true of other marginalised groups, such as academics who are Black and people of colour.

I have also, very occasionally, won something that feels entirely hollow. A few years ago I received an “LGBT+ Advisor Award” from NHS England. This was announced in a ceremony I wasn’t invited to, and was not publicised outside of a tweet from someone who was there. I received a small badge in the post, which is now displayed on my office pinboard, a focal point for conflicted emotion. For several years, I put enormous amounts of time and energy into working for a more trans-friendly NHS. Now, many of the very NHS commissioners and policymakers I used to meet with are mainstreaming pseudoscience and conversion practices. It hurts.

So when I asked what I could help Mieke Verloo with, and she said, “we would like to give you a prize”, I went into shock.


Recognition and recovery

I think I have become too acculturated to the idea that there is no external recognition for trans liberation work. This is an important reminder that people outside of trans communities care about us, and care about our role in wider struggles for social justice.

I have been a part of a feminist movements my entire adult life. For many years I have campaigned for and within women’s services and women’s political spaces, and fought back against systemic sexism and misogyny. Nevertheless, as the anti-trans movement has grown more powerful, I have felt the walls closing in. Powerful forces are trying to separate women like me from our sisters in struggle.

In a world of divide-and-rule, it matters that we extend recognition to one another, in whatever ways we can. Often, this means just telling someone that they are seen, and that their work matters. It means so much when I hear this, and I try to make a practice of doing the same for others.

But Mieke Verloo is part of the FLAX Foundation, a Dutch organisation with some funding for Europe-wide feminist research awards. It seems that FLAX seeks to extend recognition in ways that are as useful as possible for prize recipients.

The recognition alone is the most powerful and beautiful thing about the Emma Goldman. I think it will provide me with greater strength going forward, a sense of togetherness with other feminist activist-researchers across Europe.

However, the award also comes with funding. So I will also be considering how best to use this to support my work going forward. My hope is to focus on finding more time and space for restoration and slowing down, for existing collaborations and research dissemination rather than starting something new. I hope to focus on writing up findings from work undertaken with colleagues in the Trans Learning Partnership, and finish my next book. I will also look into paying for services that might help me better manage my experiences of overwhelm, ideally in a way that puts money back into queer and trans communities. It is rare indeed to obtain funding for this purpose.


The Emma Goldman Award

Every year, between five and ten people receive an Emma Goldman Award. Several more can win a different prize given by the FLAX Foundation, the Snowball Award. Two weeks ago, we gathered in Vienna for an awards ceremony, and for a budgeting workshop to support the best use of the funding we have received.

It was quite overwhelming to be in a room with a group of such highly accomplished women. We came from a great range of backgrounds, in terms of nationality, heritage, culture, discipline, field, and medium. It was amazing to hear about the work everyone was doing: as academics, as journalists, as filmmakers, as comic artists – and, inevitability, as collaborators and organisers. Every one of us was involved in community-building in one way or another. And everyone seemed pretty shocked to be receiving an award, because each one of us feels the pain of oppression, and none of us do what we do to win prizes.

The award ceremony was filmed, and I’ve put a link to the youtube video at the bottom of this post. It’s worth a watch simply to hear about the exciting things every single award winner is up to. It expanded my sense of possibility, of what is happening in the world and can happen in the world, and who I might work with or be inspired by going forward.

It meant a great deal just to spend time with each other outside of the formal sessions, speaking and listening and learning together, building new friendships. This is something I have taken away from my time in Vienna, something I will sit with for a long time. I believe this is another intention of the Emma Goldman and Snowball Awards: to go beyond themselves, to support networks of research and activism, to enable new connections and collaborations across borders. In this sense, the prize couldn’t be better named.

The thing that struck me most after the award ceremony – and I mean this in a really good way – is that it made our collective achievements feel unexceptional. I don’t say that to talk down myself, or any other winner. Quite the opposite: I feel that recognising this kind of work collectively reminded me that none of us are alone, that we are part of a movement.

It is enough for any of us to simply do the work – of fighting for a better world.


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Going to California (with an aching in my heart)

When I received an invitation to speak about my research at the University of California in Davis, my initial, instinctive response was “heck no”.

It was December 2025, and the United States was looking an increasingly dangerous place to be both trans, and to be a critical scholar. The last year has seen anti-trans legislation introduced at every level across the country, while the influential Oversight Project at the Heritage Foundation and some in the FBI sought to brand trans activism as “violent extremism“. Meanwhile, attacks on academic freedom have resulted in massive funding cuts, the mass censorship of race and gender studies, and the kidnapping and detainment of students who protest the genocide in Gaza. One scholar seeking to flee the country with his family following death threats arrived at the airport gate to find their flights had been mysteriously cancelled.

Then there’s the international situation. Back in December, the US administration was beginning to escalate its rhetoric around Greenland. By January, I was genuinely concerned that a visit to California might coincide with a previously inconceivable outbreak of war between the US and its former European allies. It seemed that no possibility was off the table.

Don’t get me wrong, for all that Brits like to dump on Trump, I fear the UK is rapidly heading in a similar direction. While the dangers posted by the US administration are more blatant, thanks to its volatile and emotional rhetoric, the UK’s Labour government is pursuing a similarly authoritarian agenda. We can see this for example in deeply racist policies on migration and asylum, a crackdown on protest groups, attacks on equality and diversity policies, and the embrace of disinformation and pseudoscience in pursuit of an anti-trans agenda. And of course, our country too is entirely complicit in various conflicts and forms of state violence, including the ongoing genocide in Gaza.

Nevertheless, I have the considerable privilege of being a white UK citizen. I own a passport that enables me to freely leave and enter the country. I do not fear being detained on the UK border. I live in a diverse community where I feel safe and held by my neighbours. I am still – for now – able to maintain a university profile that openly states my commitment to feminism and equality work. And while I am increasingly afraid of facing violence at work, at least there aren’t many guns in this country.

So while I felt morally torn about potentially travelling to the USA, I was also aware that my home country is not exactly a great place. Thinking through the idea of complicity, Mijke van der Drift and Nat Raha encourage us to find “the right relation to what your position is in the world”. This “entails attending to where one is, and what one can do from that place”.

The question, then, was one of getting to California safely, and then ensuring that the trip would be worth it. What could my in-person presence offer that was not possible in my writing, or over the internet? What could I offer, and what would be worth the risk?

Photo of a flyer. Text reads as follows. Trans Freedom School. Vital relations: rethinking trans health and medicine. This two panel symposium brings together scholars, clinicians, and activists to examine how trans health has been shaped and contested through medicine, ethics, and political struggle. This symposium situates the contemporary moment's heightened scrutiny, backlash, and regulatory intervention within broader histories of trans medicine - from early gatekeeping and experimental care to community-led health activism to the current reconfiguration of "evidence," risk, and responsibility. What counts as care? Who gets to define it? How is medical authority produced and challenged?



The Trans Freedom School

It turned out that my colleagues at UC Davis really knew what they were doing. The event I spoke at, Vital Relations, was part of the Trans Freedom School. This is a series led by Ava Kim and Christoph Hanssmann, which brings together scholars to share knowledge and ideas on a range of extremely pressing topics.

Our event specifically addressed the past, present, and future of trans health and medicine. This included how trans healthcare might be defined, whose interests have shaped the development of the field, how to address threats to trans people’s health and wellbeing, and how all of this connects to wider struggles around the pursuit of truth and defense of free inquiry. The event format was a facilitated conversation, meaning that the speakers were in conversation with one another as well as the audience. This felt extremely generative given the range of knowledge and experience in the room.

I sat on a panel with Tankut Atuk, who is doing amazing work on pathogenicity: specifically, the social contexts and power relations which make minoritised people more vulnerable to illness and disease. Understanding these things can help us learn not only how and why people are disadvantaged, but also how we can organise against such disadvantage. We explored examples from Tankut’s research with trans sex workers in Turkey, my work on trans people’s experiences of perinatal care, and Glasgow’s strong community networks. A second panel saw Kadji Amin and Jacob Moses explore histories of trans healthcare, plus debates around identity and regret.

Importantly, these conversations are not limited to academic events. The panel discussions are bring professionally filmed, as are separate studio conversations with the speakers. The idea is to produce information and teaching resources for the long term. Other events associated with the Trans Freedom School take a wider look at current debates around gender and race, at a time when discussion on these topics is increasingly censored within media and scholarship, in the US and beyond.

In short, this was indeed vital.

Continuing to foster international dialogue and the free exchange of ideas is incredibly important, especially when these things are under threat. Teaching materials that challenge norms while tackling disinformation are desperately needed. I am grateful and honoured that I was invited to be part of this work.

I will of course be sharing materials produced by the Trans Freedom School when these are ready to go online. In the meantime, I was left with a great deal to think about, which will no doubt shape my own ideas and work going forward.

Tankut and Ruth in conversation
Tankut and Ruth in conversation



The right relation

As it turned out, the US did not invade Greenland while I was in California. Instead, as I flew home, the US and Israel launched a series of airstrikes on Iran. They killed the Supreme Leader Ali Hosseini Khamenei, along with members of his family, plus hundreds of civilians. This including over 170 people at a girls’ primary school, most of whom were children. This was an immediate reminder of how the world’s greatest superpower is also a rogue state, prepared to inflict death and suffering for seemingly little reason other than flattering the macho egos of its unchecked leadership.

Seeing sickening scenes of violence unfold across the Middle East in the following days made me feel extremely powerless. It is hard to know what to do, how to respond, in the face of such evil. I’ve had enough Iranian friends that I have no sympathy with the awful regime there. But the Iranian people will not be freed from tyranny by a racist foreign power murdering schoolgirls. I remember the slow, pointless horrors of the Afghanistan and Iraq wars, with hundreds of thousands of people killed across the long years. I remember joining a million people on the streets of London to oppose this violence in 2003, only to be entirely ignored by the Labour government of the day.

In countries such as the UK and the US, what we do with our complicity in state violence depends on what tools we have, and options are in front of us. Here in Glasgow I will be supporting protests against war and arms dealers. I will be sharing information with my friends and neighbours. I will be teaching about power and its abuses in my day job. I will be voting to keep Labour as well as Reform out of Scotland in the forthcoming Holyrood election. It probably won’t feel like enough, but it does matter to do what we can.

The same goes for confronting other forms of state and corporate violence. I focus much of my research, activism, and writing on addressing discrimination and violence against trans people, because this happens to be where I have developed my skills and knowledge. The Trans Freedom School reminded me that the benefits of such skills and knowledge can cross entire oceans. It mattered for people in California to learn not only about my research, but also about the work of UK and Irish groups I spoke about, such as Trans Kids Deserve Better and Trans Harm Reduction. These groups are not working in universities or speaking to government. They are meeting with others in their community and building connections and resources, step by step, conversation by conversation.

Here in the UK, anti-trans policies are killing children. As with the West’s imperial wars, it is easy to feel powerless. But as I argued last year in my essay about the UK’s anti-trans Supreme Court judgement and the Lesbian Renaissance, there is so much we have achieved – and can achieve – through activism, community work, and mutual aid:

“There are more of us publicly creating art and culture, more of us creating events and running nightclubs and playing in bands and writing essays (hi). There are more community groups providing mutual aid and support when charities and state bodies fail us. And, importantly, we are not alone.”

There are always things we can do. It is simply a matter of attending to where we are, and doing what we can from that place.

Photo of graffiti against a colourful background. It reads as follows. Develop enough courage so you can stand up for urself and then stand up for somebody else.



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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.”

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Call for abstracts: World Community Development Conference

In summer 2026 the World Community Development Conference will be coming to Scotland! I am part of a group of lecturers from the Community Development programmes at the University of Glasgow who are helping to organise this event.

Running from 29 June to 2 July 2026, the conference will be a space for connection, critical reflection, creative exchange, and global solidarity. It will be rooted in the values of justice, participation, community empowerment and human rights and underpinned by Community Development’s emphasis on collective initiatives for collective outcomes.

Conference Themes and Guiding Questions

We invite submissions aligned with one or more of the following core themes. To support your thinking, we offer the following open questions:

1. Challenge

This theme centres on critiquing and confronting systems of injustice and advocating for policy and funding to support rights-based Community Development.

  • What are the most urgent challenges facing communities and how is Community Development responding?
  • How are issues of power, inequality, technology, marginalisation or oppression being confronted and addressed?
2. Change

This theme is about co-creating new approaches through collaboration and future-focused dialogue, while strengthening the resilience of practitioners and communities in complex environments.

  • What new ideas, or practices are driving meaningful change in your work?
  • How is resilience being built in communities facing political oppression, social or economic inequality, or the ill effects of climate change?
  • How are human rights and Community Development being used as tools for accountability?
3. Collective Action

This theme explores community organising through inclusive, participatory, and justice-driven practices and connecting across borders to build solidarity.

  • How are people coming together to organise, mobilise, and demand justice?
  • What examples of effective collective action can you share, and what impact is it having?
  • How can we ensure that Community Development is oriented towards collective justice rather than exclusion?

Presentation Formats

We welcome a wide range of formats, including:

  • Conference Paper: Research or practice-based presentations (20 minutes)
  • Facilitated or creative workshop: Participatory, performative or creative workshops by individuals or groups (1 hour)
  • Lightning talk: A concise presentation highlighting a key issue or insight (5 minutes)
  • Poster presentation: Digital or multimedia posters showcasing projects or research
  • Creative and participatory formats: Including book launches, exhibitions, and cultural events

Submission Requirements

Please submit a 300-word abstract or a 3-minute video of your proposed contribution, including:

  • The topic and framing of your contribution
  • The format of your presentation
  • The relevance to one or more of the conference themes
  • Author/s name(s), organisation/institution, contact information (e.g. email address, mobile/telephone number).

Submissions should be submitted via this page.

Logo for the Glasgow World Community Development Conference 2026.
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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.