I started writing this posted back in bonnie Scotland! Back to work, back to endless emails, back to doing my absolute best that all the masters dissertations are marked in good time. I finished it on an aeroplane to Lisbon, for my second major international event of September: the 2024 World Professional Association for Transgender Health Scientific Symposium, and am posting it from a conference centre in Lisbon.
As such, and as you might have noticed, I have slowed down with my writeup from the International Trans Studies Conference. Still, I have plenty more notes and reflections, and hope to continue writing these up over the next week or two.
My conference account left off halfway through the morning of the third day. After the sheer emotional onslaught of the session on political economy (no, really) I decided to slow the heck down and not rush off to the next talk. I went to the front desk where I managed to catch two of the conference organisers, Avery Everhart and Erique Zhang. I’ve known Avery and Eri online for years and long admired their work from afar, but we’d never previously met in person. I have really, really missed making these deeper human connections at conferences. Much as the organisers were clearly exhausted from firefighting technical and access issues to keep the conference running, it was wonderful to meet them and take time for a chat.
I therefore missed the first two papers from the next session I attended. This was a bit of pity given how amazing the rest of the session was, but self-care is important, and I regret nothing!
B{ending} Trans Game Studies
I don’t really do any work in game studies, so chose this session mostly because it seemed fun, and interesting. An opportunity to expand my horizons. This was the right choice – I had an incredible time.
I turned up partway through a presentation from Madison Schmalzer of Ringling College of Art and Design (USA), titled Circuit Bending, Trans Play, and the Death of Game(!) Schmalzer introduced circuit bending as a practice of “tinkering and seeing what happens”. Examples from her art, research, and teaching included rebuilding children’s keyboards, and messing with old Mario games to create something entirely new. Controls shifted, the sky changed colour, characters ran unexpectedly across the screen. Through the destruction and reconstruction of corporate entertainment products, students discovered entirely new modes of play.
Analysing this process, Schmalzer drew parallels between digital games and social constructs including gender and race. She argued that circuit bending raises important questions about digital products, such as: why does this game exist? whose interest does it serve? And finally: how might we “bend” other social systems in the same way that we might do with games?
Some possible responses to these questions were offered in the next paper: “We Can A̶l̶w̶a̶y̶s̶ Never Tell”: Giggling Faces, Gender Machines, And Un-Recognizing Play, by PS Berge of the University of Albert (Canada). Berge introduced the concept of “ludoarsony”, which variously refers to breaking, burning, or destroying a game (including technical or cultural rule sets), or to playing with fire, creating and playing through the act of destruction. Berge posited that ludoarsony, like play more generally, is a trans thing to do: “play and transness are of kin: both are transformational movements that weave in and out of rigid cultural and computational systems that they are ultimately ambivalent to”.
Berge’s paper drew on a number of case studies in which trans people play with the claim commonly made by transphobes that “we can always tell”: the notion that trans people are inherently clockable as such, that we are always reducible in behaviour and appearance to our sex assigned at birth. The first of these was Giggle for Girls, the now-defunct trans-exclusionary social networking app “for females” (recently central to the groundbreaking discrimination case Tickle vs Giggle…no, really).
Giggle’s verification system for female users relied on so-called gender-recognition technologies. Berge observed that on launch, Giggle was not simply criticised by trans people, but also played with. Examples included trans women testing the verification system (“I’m proud to announce that apparently I’m cis now. I’d like to thank Satan”), and revelling in negative reviews from cis women who were not recognised as such (e.g. “I can’t even access this app […] I was so looking forward to a female-only space, but now I just feel alienated. Thanks for that.”).
Further undermining the logic of “we can always tell”, Berge discussed the work of algorithmic artist Ada Ada Ada, showing us an example of a video in which the artist changes the response of facial recognition software in real time by pulling different expressions. Ada Ada Ada followed this up with “The Misgendering Machine”, an app available to anyone with a phone camera or webcam, which encourages people to play with how they are gendered by the machine.
Berge concluded by arguing that there is play in the unmaking, and to find play in the unplayable helps us find life in the unliveable: “we do not play in spite of the world being on fire – we play because the world is on fire”. Central to this is a project of mutual recognition: “we can never tell”, an acknowledgement of the ways in which we are all fundamentally unknowable, a promise not to rat each other out.
My horizons suitably expanded, I headed out to grab lunch.
Picturing Trans: Studies of Trans Visual Culture
In the afternoon I again wanted to attend a session that offered a different perspective to the material I normally encounter in my work on trans healthcare, both to expand my horizons and take something of a break from the slow creeping horror of my own area. So I want to a session on trans visual culture.
The first two talks offered radically different perspectives on trans people’s self-representation: one looked at self-portraits of trans bodies, and the other very intentionally looked at why we might avoid portraying our own bodies. The third talk then looked at how we might be represent and be represented by other trans people.
In Beyond Representation: Photographic Methods in Trans Myth-making, June Saunders of Washington State University (USA) offered a beautiful, poetic reflection on trans photography and representation that elides direct representations of our bodies. Saunders presented numerous images of landscapes, buildings, and everyday medical paraphernalia to accompany her talk. She encouraged us to be present in the moment without our devices, reflecting the themes of the presentation.
Sanders focused on how we might sit within and create photography that captures specific experiences and moments in time, without simply using this to produce commodifiable content. She examined the tension between the power of self-representation and exploration on the one hand, and the use of images in the service of surveillance and control on the other.
Ace Lehner of the University of Vermont (USA) looked instead at bodily self-portraiture in Transing Identity in Contemporary Photography: Zackary Drucker and Rhys Ernst’s Relationship. Noting that trans visual culture has played a crucial role in political representation and social change since the 1990s, Lehner looked at the “accidental” historic art project undertaken by Zackary Drucker and Rhys Ernst as they depicting their transition and relationship. Echoing Berge’s morning presentation on trans play, Lehner argued that trans visual culture can enable us to challenge dominant cultural logics that assume seeing is uncomplicated, and that we can easily read gender, sexuality, and race onto images.
Given the enormous number of contemporary visual transition diaries posted online by transmasculine people, it was interesting to hear Lehner argue for the importance of work by artists such as Drucker and Ernst in the 1990s, when transmasculine individuals were often ignored or erased in the media. Of course, as Lehner noted, transfeminine people have hardly benefited from historical media interest in bodies, which are sensationalised as objects of heightened sexualisation, and non-consensually aligned with dominant cultural ideologies.
The final presentation in this session was by AC Panella of Santa Rosa Junior College (USA), titled I Got 99 problems and Objects of Trans Memory Are Some of Them. Panella asked what we are teaching each other about what it means to be trans and “do” transness, especially given the limitations of existing trans archives. Said archives are typically derivative of lesbian and gay archives in their approach, and/or subsumed within wider LGBT collections, leading to misguided ideas about trans history. They can also contribute to US-dominated approaches to trans history, with celebrations of Pride (for instance) often marking Stonewall, rather than localised celebrations of trans uprising. These issues are compounded by the economic insecurities experienced by many trans people, with housing issues (for example) meaning individuals are less likely to hold on to items from their past. This spoke to a conversation I recently had with a fellow activist who lost much of her personal archive during a period of homelessness.
Panella outlined how these issues might be addressed through localised community projects, and the involvement of artists. The presentation included several examples of Latinx trans projects in Mexico and the west coast of the USA. They incorporated approaches including community storytelling through writing and arts workshops, intimate portraits of people in their homes, and memorial or celebratory pieces (e.g. fashion displays) based on the lives of community members that activists felt were important to remember. In this way, it is possible to create archival material which captures the complexity and nuance of local experiences, tying these both to cultural history and to contemporary struggles.
Transnationalizing Trans Studies: Building a Truly Global Field
The final session of the day was a plenary panel in the main conference hall. Titled “Transnationalizing Trans Studies”, it offered a refreshing alternative to the North American perspectives that dominated much of the conference, but also once again highlighted the limitations of the conference’s internationalism. We were meant to hear from a scholar-activist in Zambia – the only planned plenary speaker from Africa – but unfortunately she was unable to join us due to energy shortages. I truly hope future events can address this oversight: a matter addressed by the chair, Francisco Fernandez Romero (University of Buenos Aires, Argentina) in his introduction.
The panel therefore featured three speakers who responded to questions from Romero: Madi Day of Macquerie University (located in what they intentionally highlighted as the occupied territories named “Australia”), Alyosxa Tudor of the School of African and Oriental Studies, University of London (UK), and Michelle Ho of the National University of Singapore (Singapore).
The discussion opened with a question from Romero about what trans studies looks like across these contexts. Day began by explaining that, as an Indigenous scholar, they approach the field from an Indigenous studies perspective. They emphasised that Indigenous studies should not be understood as the study of Indigenous people, but rather as a critical examination of the colonised world. This approach understands settler colonialism as a global apparatus, with some Indigenous lands directly occupied (as with Australia), and others exporting their resources to the colonial centre (as Romero described earlier in the day with reference to Argentina). In this context, “colonialism is the condition of possibility”. Day therefore distinguished between white settler trans studies in Australia, and Indigenous trans studies. They spoke to the importance of drawing (appropriately and with due credit) on Indigenous approaches in trans studies, to better address the problem of material from the Global South being always used as data, and never as theory.
Tudor spoke to their context as an academic of Eastern European heritage living in the UK. They argued for a transnational approach to trans studies that goes beyond the “national” in understanding global-local connections, and embraces anti-nationalist principles, insisting that transnationalism is “not about all the small nations sitting down with the big ones for a nice chat!” This is important for interrogating discourses of Eastern European exclusion in trans studies: simply creating a series of national sub-fields is not an adequate solution. Relatedly, Tudor emphasised that a transnational trans studies cannot escape the current moment of genocide in Gaza, and must name the violence inflicted on the Palestinian people.
Ho discussed questions of multiple marginalisation. Citing the TSQ: Transgender Studies Quarterly special issue “Trans in Asia, Asia in Trans”, she observed that trans studies remains marginal in Asian studies, just as Asian experiences are marginal within in US-dominated trans studies. She also emphasised the difficulties of difficulty of translation in terms of both language and experience, with an enormous diversity of “trans” possibilities present across the Asian continent.
Romero followed these comments with questions that followed up on the topics of translation and transnationalism. Day argued that if trans studies is to be truly transnational, the goals and ambitions should be determined the global Southern majority. The problem in only calling on Indigenous knowledge when it’s directly relevant to Indigenous experiences is that you maintain a colonial viewpoint: if you are a white settler leading a research project, group, or institution and are not actively resisting settler colonialism, you are conducting a white settler project.
Day highlighted how shared experiences across Indigenous communities in different parts of the world have informed shared resistance and productive modes of thinking, and asked: “what would happen if we started thinking of transness as an identity rather than an identity?” But to be in a community, you need to act like a community. Community is non-extractive, and if you have more of something, you need to use it to help others.
Tudor returned to the question of nationalism. Contrasting with Day’s account of community, Tudor argued that nationalism rests on logics of opposition and competition, and resists complexity. In additional to critiquing white, Western nationalisms, they observed that decolonial, diasporic, and minoritised nationalisms also deserve scrutiny, as contemporary counter-hegemonies may become future hegemonies. That is to say: a people’s historic experiences of violence and oppression may not present future violence against others in the name of a new nation, as seen in the example of Israel. Tudor suggested that queer and trans studies might offer a vehicle to highlight the violence of nationalism, through challenging and deconstructing categories, from gender to nation. In this context is important that decolonialism is a mode of action, not a metaphor. Tudor noted they have used their platform as an academic speaker to highlight the growing death toll on Gaza, but this kind of speech act alone is insufficient: “it is clear none of my previous papers have saved a single life”
Ho focused especially on the topic of translation, exploring what might get lost through simply assuming that the language of one context might adequately explain another. She emphasised that to be adequately in conversation with a context, we need to learn their language and culture. This creates real problems for “international” publishing in the English language. Echoing Day’s comments earlier in the plenary, Ho noted the pressure to use Western theory to analyse Asian case studies, and described how a peer reviewer insisted that there were too many “non-English words” in her manuscript: the implication being, “can you do something to avoid alienating your largely US readership?”
Ho concluded by reflecting on the difficulties in attempting transnational approaches to trans studies in Singapore. What compromises are necessary in a very conservative society? She described the example of trying to get funding to bring in a trans studies scholar to speak at her institution, noting that the question is in part one of framing: “I could invite Jack Halberstam to come, and say ‘Jack Halberstam is an established scholar in cultural studies’”. However, given how Western-centric “transnational” scholarship is, this strategy is more effective with US academics than, for example, experts from India. Ho ended with two open questions for us to consider: if trans studies is effectively underground in a specific context, can it be considered trans studies? And how can Western scholars learn from people in these contexts?
The following Q&A session included some interesting reflections on the binary of Global North / Global South given the experiences of Indigenous people in settler-colonial nations. On this note, Day stated their appreciation for the Trans Studies Conference operating within established protocols for Indigenous engagement, for example through inviting Indigenous contributors to speak first: this could be seen bothin Kai Pyle’s opening statementson the first day of the event, and in the structure of this very plenary.
There is something about seeing your experiences accurately represented in research. This can be very emotional if you are used to seeing people like you ignored, erased, or otherwise grossly mispresented. Much like media representation, research representation can be powerful in putting a mirror to our experiences and suddenly making them a lot more real.
I dislike the vast overuse of the term “valid” in trans discourse, but there is something very important about being actively validated, about being seen, when the entirely of society feels like it’s set up to deny or gaslight you. It’s a consciousness-raising moment, in which you become capable of truly acknowledging or naming what is happening to you. It is meaningful and authentic and it enables action. But it is also very painful.
As a trans health researcher, I think I’ve developed a pretty thick skin. I see a huge amount of bad trans health research, built on cis ignorance and a fundamental inability to engage with the reality of our lives. I also see growing amounts of painfully real research from researchers who are engaging with care. For better and for worse, I feel I’ve learned to carefully manage my emotions and let all of this wash over me, in order to engage consistently and “professionally”.
But on Thursday morning, a series of presentations made me cry.
Global Struggles, Local Solutions: Transgender Perspectives on Economics and Welfare
The morning began with doughnuts, piled high in the reception area of the conference, a very extravagant seeming American breakfast. From there I headed to the first session of the day, which explored trans political economy. This might seem like the dryest topic imaginable, but for me it gets right to the core of how systemic transphobia and cisgenderism operate, how we feel about that, and what we might do about it.
The study of political economy is concerned with how economic systems interface with social and political systems, and vice-versa. The first paper in this session, by Yukari Ishii of Sophia University (Japan), looked at homeless trans people’s access to welfare systems. In Reasons Underlying Gender-diverse Individuals’ Need for Public Social Welfare Support in Japan, Ishii reported on findings from the 2009-2020 consultation records of Moyai, a non-profit voluntary sector welfare provider, plus interviews with service users.
Ishii’s paper mapped in detail how trans people find themselves accessing welfare systems after being failed by heteronormative and cisnormative systems throughout their lives. She described trans people being rejected by their parents, dropping out from school due to the hostility of the heavily gendered environment, which limited their formal educational attainment. Participants in her research struggled to find work, or were otherwise fired for being trans. More tolerant work environments either required skills or an education background that trans people were less likely to have, or were deeply insecure, as in the case of sex work. Trans people who struggled to hold down a job also struggled to find places to live, with many sleeping at friend’s houses, in Internet cafes, or in the streets.
Ishii’s research showed up vulnerability is created through structurally embedded cisgenderism, impacting people from families to schools to workplaces and even to apparent sites of last resort; for example, she described how Internet cafes did not allow trans women to stay overnight if they were sex workers. She further noted that the consultation records at Moyai were limited where consultants didn’t have a lot of knowledge about queer people, or didn’t know what questions to ask about (for example) family violence. She concluded by recommending that welfare professionals gain knowledge of gender and queer issues, to ensure they are best placed to provide advice and support to service users, and keep better records for improving long-term understanding of the problems faced.
The next paper similarly traced the deep context of economic disadvantage, this time looking to history for a deeper context. In Trans-cending Barriers to QTPOC Labor in the South, Anthony Belotti of Virginia Commonwealth University (USA) focused on the US South’s historical legal landscape, linking this to the region’s racism, homophobia, and transphobia.
Belotti argued that “the history of the South has created an environment where QTPOC (queer and trans people of colour) do not have equal access to labour opportunities and class mobility”. Various legislation effectively criminalised queer, trans, and Black existence, including the Jim Crow laws, “decency” laws which banned wearing clothes not associated with sex assigned at birth, and anti-union “right to work” laws. Belotti argued that while there is relatively little archival material on QTPOC experiences in the South, these laws provide an important insight into people’s experiences, especially given the existence of legislation such as the decency laws implies a perceived need for them from authorities. The concrete impact of all this was that QTPOC had difficulties finding and keeping legal employment.
By the time Dan Irving presented, I will admit I was already feeling pretty vulnerable. In Ishii and Belotti’s excellent papers, I heard about contexts both very different to the UK, and remarkably similar. Beyond the broad importance of their findings, I recognised in their accounts the experiences of so many of my friends and colleagues – a meaningful and painful experience that underpins so much of my engagement with good work in trans studies.
Irving, of Carleton University (Canada) presented a paper titled Sensational Disruptions: Affective Economic Justice at Work. Building on his previous work on trans political economy, this presentation reported on findings from two large qualitative research projects on unemployment and underemployment among trans and non-binary people in Canada, conducted in 2012-16 and 2020-24.
Irving’s paper focused on exploring one anticipated finding from these projects in depth: the “I can’t put my finger on it” feeling. This theme involved participants encountering difficulties in the workplace or in attempting to land work, but finding it hard to articulate why they couldn’t get the job, or had hours reduced, or were laid off, even when appropriately skilled – or overqualified. There was something about getting through the door and finding the vibe was off. These experiences were especially likely to be detailed by trans people from racialised minorities, and/or trans women.
I immediately recognised what Irving was describing. How could I not? He had just described years of my experiences in the workplace as a trans woman. And of course, this isn’t really a new insight: the problems he named have been discussed in feminist literature for decades (especially Black feminist and womanist literature), and indeed within the consciousness-raising group I joined shortly after moving to Glasgow. These findings also related to the phenomenon reported by people from many marginalised groups, whereby we always have to be the very best to succeed in a basic manner in the workplace.
What was most useful about Irving’s paper, however, was his theorising of the phenomenon. In a manner that resonated with Nat Raha’s comments on the second day of the conference, Irving turned to affect theory (explanations that centre feeling and emotion) to explore what is happening to us in the workplace.
Irving described how trans people (especially racialised minorities, and women) often find ourselves constantly doing the additional work of ensuring that managers, co-workers, and customers feel comfortable with us. This causes a “sensate disruption” in our lives, shaped by the “corrosive impact of fear, repulsion, anger on the part of cisnormative employers, co-workers and customers and the violent impacts of rage, depression, exhaustion on trans jobseekers and workers”. Even worse, there are few outlets for these emotions: neoliberal discourses of personal responsibility mean that feelings are expected to be quarantined within the body of the (marginalised) worker, for example through us taking responsibility for our transitions and bodies and carefully managing our relations with others.
It was at this point that I started to cry.
I feel so, so tired and alienated in my work, all the time. I have some amazing colleagues and students, but I am still working in a system where I can feel myself being discriminated against while also finding it hard to always articulate the exact ways in which it happens. I am tired of being advised to refocus my energies in the workplace even as an eliminationist movement works against trans existence. I am tired of my research being erased or dismissed, I am tired of being asked to meetings where I am ignored, I am tired of being asked how the institution can best protect me, I am tired of being told that my failed grant applications are the “most impressive unfunded bid” that people have ever seen. I am tired of having little language for these experiences, and of pushing my feelings down every day.
I am tired of seeing as much, and far far worse, happen all the time to my trans colleagues and friends.
Responding to these findings, Irving asked: “how do we begin to grapple with the ‘affective byproducts’ of post-industrial demands for affective labour?” How do we reckon with the unsayable in our felt experiences? And quoting Deborah Gould, “what kind of political context do we need to build that actually listens to what many people are feeling and that cares about people’s disappointment, despair and furies?”
Drawing on the work of Hil Malatino, Irving proposed “infrapolitics” (low-profile, informal, undeclared forms of resistance) and community care as a basis from which to build solutions. Drawing from participant narratives, he argued that this can include political acts of resistance that are “not on the oppressor’s radar”: examples included zines and phone lines distributing information among workers and applicants, building community connections, and forms of entertainment and commentary such as comic strips. Like Ishii, Irving also highlighted the ways in which trans people effectively provide welfare services for one another, for example by providing beds or housing for homeless community members. What this all amounts to are forms of anti-capitalist resistance that amount to a collective recognition and addressing of the problem.
Sticker spotted at the conference. An example of infrapolitical resistance.
The session concluded with another extremely powerful and nuanced presentation, from Pato Laterra of the Interdisciplinary Centre for the Study of Public Policies, and Francisco Fernandez Romero of the University of Buenos Aires (both Argentina), titled A Trans Political Economy from Elsewhere: Reflections from Argentina. Like the other presenters, Laterra and Romero sought to use the concept of political economy to understand how trans lives are embedded in existing political structures, and propose alternatives for survival. They emphasised that in Latin American contexts, there is a strong tradition of research on travesti and trans people’s living conditions, with travesti-trans politics prioritising mutual support and resource distribution. It is within this context that they looked at implementation and impact the travesti-trans labour quota within Argentina’s public sector.
The travesti-trans labour quota is a form of reparative politics, in which 1% of federal jobs are reserved for trans people. This policy represents a response to the deep, systematic discrimination faced by travesti and trans people in Argentina, which reflects that reported from Japan, the USA, and Canada through the rest of the session. It was implemented in response to radical political demands from campaigners, with the presenters sharing a photo of a flag featuring a slogan they translated as “quota and reparation, we want redistribution”.
To understand how effective the travesti-trans labour quota is in practice, Lattera and Romero insisted on a rethinking of trans political economy, going beyond just thinking of trans people as workers or consumers. They wished to emphasise:
everyday reproductive and care relationships, in terms of that which sustains life beyond income or the market;
social policies that enable or do not enable certain lives, especially for people with an insecure relationship to the market;
situated perspectives, for example through acknowledging how labour (and theory!) from the Global South is extracted by the North.
Lattera and Romero argued that the labour quota partially subverts trend towards assimilation regarding trans people’s inclusion in labour markets. This is because the quota aims to achieve economic redistribution, and positions access to work as a human right. Moreover, it supports the employment of the “least employable”, i.e. trans people who are more likely to be without educational qualifications, or have a police record. In this way, it offers a response to many of the issues outlined by the previous presenters, and an alternative to typical liberal capitalist logics that involve capturing the economic benefits of trans labour.
However, as one intervention within a wider network of unequal systems, the labour quota has significant limitations. Lattera and Romero noted that the “right to work” reifies labour normativity: that is, it upholds the idea that our value as human beings is dependent on being able to have paid jobs, and that paid work is more important than unpaid care work, community work, or domestic labour. Moreover, in practice, the trans people actually hired under the labour quota are most often the most privileged, being predominantly young, white, and highly educated; and once in role, they face a significant pressure to assimilate.
Lattera and Romero urged against any simplistic reading of the labour quota’s benefits or drawbacks, in a manner that forced me to reflect on my aforementioned feelings that “other trans people have it worse”. The “more privileged” trans people hired under the labour quota still face significant disadvantage in their lives. For many, this is their first job, and it is not well-paid. Moreover, those who do tend to land these roles within the public sector tend to regard it as a job they are gaining not (just) for themselves, but for their wider community. The introduction of the quota has also resulted in increased trans labour organising and trade unionism, including increased collaboration between trans and cis colleagues in service of their shared interests. This has been especially important given the mass firings of public sector workers by President Javier Milei since his election in 2023.
The presenters concluded by arguing that trans people’s concerns should be understood within transnational political-economic processes. For example the recent firing of trans workers is a part of wider processes of extraction, in which the Argentinian government is “giving away our wealth to the Global North”. At the same time, there are always lessons to be learned from different parts of the world, so long as we properly acknowledge where these ideas come from and show care in doing so. The Argentinian labour movement invites us to imagine other ways of trans participation in the economy, beyond capitalist productivity.
Game studies, visual culture, and transnationalising trans studies
I’ve had a lot to say about trans political economy, and I have had a very specific story to tell about how my own experiences intersect with what I learned. At the same time, this was just the first session I attended on the third day of the Trans Studies Conference. I’ve therefore decided to split my notes on this day across more than one post. I have yet to write about playing games with Giggle, trans photography and archives, or resisting settler colonialism – and that’s before we get onto Day 4. Watch this space!
I began my second day at the conference Chicago-style – breakfasting on an enormous slice of leftover deep dish pizza. Suitably fortified, I strolled the sunny streets of the Northwestern University campus to the Technological Institute, a massive building in which the various conference sessions are taking place.
I was keen to arrive early for the first full day of the conference, as I had been asked to chair an early session. As described in my first post, the huge scope of this event means there are normally eleven simultaneous sessions at once, so there is sadly no way any one person can keep up with everything that’s going on.
Fortunately, the conference organisers planned long lunch breaks and multiple evening receptions, meaning there was plenty of time to meet and catch up with other people even if you hadn’t been able to see them present their paper.
In this post and others I’m therefore going to focus on the sessions and papers I did get to see. Bear in mind that this is just a tiny proportion of the material presented at the conference, and it reflects my own interests and ad-hoc decisions rather than the full scope of the event. It is also my interpretation of the papers I heard, so I may have missed nuance or got some things wrong! I’ve organised this post by the title of the sessions I attended, so do scroll down to whatever interests you most.
TERF Wars: The Battle for Feminist Futures
The danger of writing a book titled TERF Warsis that for years afterwards, people invite you to speak, write, and host events on the topic of trans-exclusionary feminisms. I suppose it was therefore almost inevitable that as a member of the steering group for the conference, I would be asked to chair this session! Fortunately, we were graced with a series of extremely interesting papers which shed new light on how best to understand and work through conflicts over “TERF” politics and essentialist ideas of womanhood, especially given their increasing alignment with far-right politics.
The first paper in the session was titled The Metaphysics of the Natural in TERF Discourse, and was presented by the American-Mexican independent scholar Julianna Neuhouser, based on her collaborative work with Siobhan Guerro Mc Manus. Neuhouser began by acknowledging the significant rise in opposition to trans people’s civil rights over the last decade, with an impact in turn on how a large portions of society think and speak. She argued that trans-exclusionary radical feminism (or “TERF” politics) has played an important role in this, enabling racist, ecofascist and anti-choice positions historically associated with conservative or far-right thinking to be presented as “legitimate” or even feminist within mainstream contexts.
Neuhouser traced a brief history of this process, beginning with the role of ecofeminist approaches which present women as more “naturally” connected to nature than men. In this context, trans women are positioned as a dangerous technological phenomenon, not fully women and perhaps not even fully human. Neuhouser noted the influence of Mary Daly – who infamously compared to trans women to Frankenstein’s monster in her 1978 book Gyn/Ecology – on later writers including the antisemitic conspiracy theorist Jennifer Bilek, and the UK journalist Helen Joyce. Antisemitism and transphobia are also entwined within ecofascist thinking around population control. Neuhouser discussed the example of Derrick Jensen, who turned to conspiracy theories about Jewish influence on trans-inclusive feminism to explain the collapse of his own political project.
Similarly, Neuhouser noted how trans-exclusionary logics have enabled religious right perspectives to be positioned as feminist, outlining the example of INAARGIT (the Feminist International Network Against Artificial Reproduction, Gender Ideology and Transhumanism). INAARGIT promotes the protection of women’s “natural” sexed bodies against “artificial” reproductive and body modification technologies, with consequences for assisted reproduction as well as trans existence. Neuhouser argued that this approach is tacitly associated with fears regarding a supposed Jewish and/or Muslim “replacement” of the white race, much like ecofascist perspectives that embrace the devastating impact of the AIDS epidemic in African countries as a net positive for humanity.
The second talk in the session was by Heng Wang from the University of British Columbia (Canada), on Cyber Trans Panic: The Transnational Circulation of Transphobia and the Mobilization of Vulnerability Among Chinese Trans-exclusionary Feminists on Social Media. Wang began their talk by noting the significant rise in anti-trans feminist discourse on Chinese social media in the last two years. She argued that while many contemporary arguments mirror those of Western trans-exclusionary radical feminists active in the 1970s and 80s, social media has enabled greater circulation of misinformation and disinformation in the present.
Wang explained that when queer and feminist community groups and NGOs first emerged in China in the 1990s, these were broadly trans inclusive. However, online debate and educational programmes led by these groups were restricted in the mid-2010s. Young women are now therefore turning to social media influencers for feminist understandings of sex and gender.
Wang identified the politics of translation as a key issue for influencers’ impact on both trans people and feminism. “Gender” is frequently translated into “social sex” (shehui xingbie). In the Chinese linguistic context, definitions such as this effectively work to essentialise sexual difference as natural, in opposition to the social. It has led to growing numbers of Chinese feminists defining womanhood in essentialist biological terms, and potentially confusing translation of Western commentary on trans women and feminism. Meanwhile, only a minority of individuals have access to Western social media platforms, meaning that content by figures such as JK Rowling as well as responses from trans-inclusive feminists are mediated by the influencers capable of both accessing and translating it. These acts of translation can be shaped by misunderstandings and a projection of the influencers’ own ideological positions.
Consequently, transmisogyny in China is on the increase due to an entanglement of global far-right politics, disinformation on social media, and the specific Chinese national context. Wang therefore argues for the importance of a localised Chinese vision of trans feminism.
The final talk in the session was by Alex Colombo and Gonzalo Bustamante Moya of the University of Oregon (USA), titled The feminist empire: toward an anti-fascist trans politics. The presenters’ starting point was a question posted by Ana Seresin: how might contemporary antifascist organising be strengthened by acknowledging that some feminisms can be fascist? In speaking of fascism, they drew on Aimé Césaire’s portrayal of fascism not as an exceptional form of politics, but as the application of colonial projects and procedures against a white population instead of colonised peoples outside of Europe. In this sense, fascism can be understood potentially as a logical extension of liberalism, rather than external to it. The presenters explored these ideas through a deep engagement with Judith Butler’s book Who’s Afraid of Gender? and Jules Gill-Peterson’s A Short History of Transmisogyny.
Butler’s book positions gender as a phantasm: a psychosexual phenomenon, a site where anxieties and fears are mobilised to incite passions. This causes a blockage of critical thinking and imagination. Butler demonstrates that anti-gender movements have successfully positioned gender minorities as a “threat to the nation” in many parts of the world, and have used fascist strategies to contain this threat: stripping people of their civil rights, and expanding the power of state control and surveillance. Butler’s proposed solution is to develop a “counter-imaginary” that organises reality differently and creates alliances against anti-gender movements. However, the presenters argued that this approach retains some reliance on the “liberal institutions” of the state, which do not provide the necessary resources to truly confront fascism.
Drawing on Gill-Peterson, the presenters argued for a colonial origin of trans-exclusionary feminist fears and anxieties. Gill-Peterson positions transmisogyny as “a mode of colonial statecraft”, used for the creation and management of sexual minority populations. In identifying some people as transfeminine and labelling this as a problem, colonisers gain a new rationale for surveillance and control. Transmisogyny can therefore be understood not simply as a form of individual prejudice, but as a mechanism of the liberal/colonial cis state, intended to ensure a “fear of interdependence and “refusal of solidarity”.
Consequently, anti-trans feminism’s alignment with anti-gender movements is not simply a matter of hatred, and liberal institutions cannot be relied upon to oppose this process. In mobilising the phantasm of gender there is a clear rationale for transphobic feminists to ally with fascists within liberal contexts. Consequently, trans politics must be explicitly anti-fascist, and anti-fascist politics must address trans liberation.
Mother Knows Best: Families and Parents of Transgender Children
I next decided to attend two different sessions about trans children and their families. In the first session, I heard two papers on how parents might actively support their trans children.
In How do parents become sensitive to their Nonbinary child’s identity? Noah Sweder of Tufts University (USA) reported on the findings of a research project looking specifically at pathways to support within families. They identified four themes from their interviews with parents:
Parents hear and support their child’s nonbinary identity. Sometimes they might find it hard to adjust, but making their best effort makes a real difference.
Parents learn about the ways cisnormative society harms their child. This can involve observing children’s experiences of joy in their identity and expression, and experiencing frustration at societal stigma and barriers to social participation.
Parents take significant and proactive steps to affirm their child. This can involve identifying who needs to know that the child is trans in order to better support them and make their lives easier, with key examples being schools and doctors. It can also involve taking strong action against transphobia, including being prepared to challenge family members.
Parents recognise that gender is just one aspect of their child’s life. The child has not essentially changed, but instead wishes to be seen and understood.
The biggest takeaway from these findings is that parents do not necessarily need pre-existing knowledge and understanding to be supportive of their child. Instead, they need to be prepared to listen, learn, and take action.
The second paper I caught in this session was by j wallace skelton of the University of Regina (Canada), titled Strong Parental Support From Parent-Advocates. Drawing on a larger dataset looking at parents’ experiences across Canada, skelton focused nine interviews from the largely rural province of Saskatachewan. In 2023 the Saskatachewan government introduced a policy requiring parental permission for name and pronouns changes in schools. This was repealed following a legal challenge in 2024, only for the legislature to hold an emergency session to bring in new policy.
skelton explained that while the researchers didn’t ask about the Saskatachewan’s anti-trans legislation, parents inevitably brought it up. They highlighted the emotional difficulty and exhaustion of receiving constant news around transphobic legislation, and the heartbreak of their children feeling unwelcome in the province.
In spite of this difficult backdrop, I found the paper optimistic in its focus on parent advocacy, echoing [NAME]’s research. skelton observed that the participant cohort had mixed experiences of advocacy before knowing they had a trans child, and many were targeted for supporting their child, for example being called “groomers” or “paedophiles”. In spite of this, all parents forefronted child agency, naming their child’s experiences as valuable basis for learning. Parents saw their children as educators, balancing this with a “team effort” approach to advocacy within families, and centring their children’s consent in acting on their behalf. For example, skelton cited a parent who said, “I think that’s the biggest advice is that you need to check with your child too if it’s okay”.
Often parental advocacy changed people’s relationship with their communities, for example through leaving unsupportive churches, or no longer meeting with hateful family members. Notably, this was typically positioned as a loss for the transphobes rather than their targets; as skelton put it, “what a shame for Aunt Bertha”.
At this point, I ran over to another session to catch part of a paper by my colleague Cal Horton from Oxford Brookes University (UK): Trans children and state violence: Solidarity and resistance in the UK. As the title indicates, Horton highlighted the horrific injustices young trans people are increasingly facing in the UK (see e.g. my commentary on the Cass Review). At the same time, it was great to see them emphasise the power of resistance from young trans people and their allies, especially the dramatic protests undertaken by Trans Kids Deserve Better.
Exhausted but full of ideas, I headed to the courtyard for lunch, presented in convenient little paper bags labelled according to dietary need and preference. This was a great chance to do the most serious work of the conference, which can sadly never be truly captured in a post such as this: meeting new people and catching up with old friends. I then headed to a session all about detransition.
Cease and Desist: New Perspectives on Detransition
This session opened with a paper by Leor Baldus of the University of Marburg (Germany), titled Detransition: Decisions, Perspectives, and Life Paths of Detransitioned Individuals. Baldus noted that there is very minimal community-based research on detransition, with discourse around the topic dominated by medical and psychological studies. This research therefore focused on detransitioners speaking for themselves, through interviews with six detransitioned people assigned female at birth.
The most interesting part of the paper for me was Baldus’ discussion of what she called the “paradox dynamics of gatekeeping”. This reflected my own observations that gatekeeping practices in trans healthcare can often cause rather than prevent forms of regret.
Baldus observed that diagnosis and therapy within gender clinics always takes place in a context shaped by societal norms, including sexism, heteronormativity, and transnormativity. As noted by numerous trans studies scholars over the decades, gatekeeping entails a feedback loop of verification to diagnose transness, as the person seeking transition has to intelligible to the gatekeeper, which reinforces the gatekeeper’s pre-existing assumptions regarding trans existence. This process inevitably insists on certainty on the part of people seeking transition, which creates little space for ambivalence or exploration. Baldus quoted a participant who said, “the demand for certainty during and in the process […] created a pressure I felt I needed to meet”.
Baldus also described how participants internalised “maladaptive coping mechanisms” in response to misogyny and lesbophobia they experienced while growing up. Where expansive gender options did not seem possible, trans identities offered an explanation and way of making sense of participants’ experiences prior to detransition. In this context, being male was seen as an alternative to being a woman (as opposed to being different kind of woman – or, presumably, a non-binary person, although Baldus did not discuss this).
Kincaid Moberly from the University of Idaho (USA) offered an entirely different angle on the topic of detransition in his paper Trans and detrans representation in the Remothered series. This paper explored the unusual portrayal of a “trans man bad guy”, Richard Felton, in the survival horror video game series Remothered. Moberly noted that where transmasculine people appear in video games, they are typically portrayed as friends or allies, often in victim roles that motivate cis characters. By contrast Felton is a violent adversary, playing the role of a male psychosexual killer and (when wearing a dress) fulfilling the transmisogynistic trope of a “lethal gender bender”.
Felton also, unusually, has a detrans narrative. According to the game series’ storyline, he/she was forcibly transitioned into a male role as a young person, and his/her experiences of manipulation and abuse led to their own violence towards others.
Moberly describes the games’ portrayal of Felton as an example of detransphobia: a phenomenon in which detransitioned people are exploited for their actual or supposed pain. He argued that the demeaning of detransitioned people’s bodies and experiences, as in Remothered, takes place in the name of protecting white cis children, rather than actually finding ways to support detransitioned people. A possible response to this can be found in the rejection of cisnormative expectations regarding both the body and life trajectories. Moberly highlighted media by and for detransitioned people that emphasises empowerment, fluidity, and agency, in stark contrast to discourses of pain and disempowerment.
Media portrayals were also explored by Kat Fuller of the University of Nevada (USA), in Gendering, Detransition, and Abjection: News Media Coverages. Fuller’s study analysed 130 media articles on Chloe Cole, a detrans activist and “former trans child” who positions herself as inherently damaged by her former detransition, stating “I feel like a monster”.
The articles in Fuller’s sample which were identified as aligned with centre-right and far-right perspectives emphasised discourses on “gender ideology”, “silencing”, and “cancel culture”. Cole’s experience was used to support idea that LGBT experiences should be criticised, and any kind of pushback on homophobia and transphobia in the media represents an attack on free speech. Narratives around a person’s original transition tended to represent this in terms of trauma and loss, highlighting (for example) a supposed loss of infertility or attractiveness, and decisions being made by children who are too young to understand.
Echoing Moberly’s paper Kinnon MacKinnon’s research on detransition/retransition, Fuller reminded us that Cole’s experience is not representative of all detrans people, given the great range of detransition narratives and retransition experience.
The final paper in the session offered a more reflective space. bush bashing, an excavation of detransition, was presented by Tait Sanders of University of Queensland, Australia. There was a great deal of visual imagery of the Australian bush in this presentation, encouraging attendees to be present in the story. In this mediative account, Sanders explained how bush bashing is an approach to foliage clearance and cutting that provides space for choices around what is cut back and what is not; which plants are removed and which are left or given more space to grow.
Sanders contrasted notions of “add on detransition” – in which non-binary or genderfluid understandings of the body are added like sticking plasters – to an approach in which “gender [is[ imagined as emergent in the space created by the cut”. In this context, a meaningful approach to detransition might involve the creation of space: “gender is embodied […] and all we need do is follow it”.
(Re)imagining Transness with Decolonial Theory
It is inevitable that a conference based in a country will feature many contributions from that country, and Anglophone trans studies has always been US-dominated. However, as one person noted in the Q&A for this final session I attended on the Thursday, a problem with this is that many US scholars fail to localise their own work. In this way, US perspectives stands in for the universal, whereas contributions from other parts of the world become peripheral. White perspectives in trans studies perform a similar function; as observed once again in the Q&A, “if you’re going to work on white transness, you need to name it”.
I felt like the first paper in this session, by Nat Raha of Glasgow School of Art (UK), happened to offer some insights on how to address these problems, drawing on material from her forthcoming book with Mijke van der Drift, Trans Femme Futures. In Transfeminism and affective economies: collectives contra separability, Raha reflected on how researchers and activists in trans studies and beyond might “stay with the trouble” and pursue abolitionist approaches. She encouraged us to think through the complicity inherent in our work, especially given dominant logics get reproduced. A practical example of this would be how to engage with Palestinian liberation activism within and beyond institutions hostile to it, for instance through participation in the boycott, divestment, and sanctions (BDS) movement against Israeli apartheid. Raha outlined two key concepts for theorising the problem: separability, and affective economies.
Separability describes the reproduction of cultural difference through othering, as seen for instance in racist or xenophobic language or actions. Separability is enacted materially as well as in discourse, as seen for example in state borders, the arms trade, and deportations. Parallelling arguments made in the “TERF Wars” session at the start of the day, Raha explained that transphobia is part of the contemporary dynamics of separability, with gender norms folded into the enactment of white supremacy.
Affective economies describe how emotions and feelings provide motivation and structure for certain kinds of social order. Drawing on Franz Fanon, Raha provided the example of how emotional responses to the presence of Black, Indigenous and Brown people emerge in the context of specific histories and foundations of racialisation and inequality. In the context of these histories, mainstream conversations about racism tend to centre the feelings of white commentators. Similarly and relatedly, contemporary conversations about sex/gender are centring feelings of cis people. The structural impact of this is that the actual needs and perspectives of marginalised peoples are directly excluded.
Raha posited that a solution to these problems can be found in practices of abolitionist care. She encouraged us to think about our care practices in relation to separability, and invited us to consider how separability is reproduced in our personal and social lives. For example, who are we excluding in our work, and (to draw on the insights of the prison abolition movement) how might we stop treating people as disposable? How do we work through our affective investments in a way that manifests possibilities and togetherness?
In Conceptualizing Cuy(r)ness: Knowledge Production Regarding Gender & Sexuality in Ecuador, Nathan Campozano of SUNY Purchase College (USA) noted the oversaturated presence of the Global North in international conversations surrounding gender and sexuality. Relatedly, Andean perspectives are somewhat sidelined within Latin American studies. Campozano sought to counter this by exploring how people have challenged pre-conceived notions of gender and sexuality in Ecuador.
Campozano introduced “cuy” and “cuyr” as Ecuadorian responses to “queer”; unfixed terms that refuse direct translation. Understanding cuy(r) from a located Ecuadorian perspective enables a recontextualization of trans feminist activism from peoples including enchaquirados, a cuy(r) Indigenous community on the Ecuadorian coast. Campozano argued that a proper documentation of Ecuador’s cuy(r) history must cenre on localised language and understandings, lest these be displaced by Eurocentric or Americanised understandings of queer identity.
Two presentations then followed on the topic of Indian trans rights legislation. First, Sanjula Rajat of the University of Oregon (USA) presented their paper Beyond ‘Third Gender’: Coloniality and Hindu Nationalism in Indian Trans Rights Legislation. Rajat argued that the British colonisation of India required complicity and collaboration from portions of the Indian population, including in the imposition of the colonial moral order. An example of this was the “anti-eunuch” campaign which aimed to eliminate the hijra, culminating in the banning of their perceived cross-gender communities in the Criminal Tribes Act of 1891. While this law was repealed shortly after Indian independence, colonial logics remained in the new state. This can be seen broadly in continued processes of population surveillance and control, and specifically in continued state harassment and violence towards hijra.
In 2014, the NALSA judgement theoretically granted new civil rights to hijra and trans people, including a right to self-determination regardless of surgical status, and affirmative action to support employment. In practice however, hijra and trans communities continued to be targets for state criminalisation and control, especially in the wake of the ironically named Transgender (Protection of Rights) Persons Act in 2019. Rajat argued that the Transgender Act represents a continued expansion of state power, through the conflation of hijra and trans identities as “third gender”, and the logic for this made legible through appeals to nationalist myths of an accepting pre-colonial Hinduism. In practice, the Transgender Act has also made many people’s lives more difficult, for example through reversing elements of NALSA relating to matters such as affirmative action and legal recognition, and criminalising begging.
Rajat therefore positioned the law as a form of pinkwashing by the Indian government. They argued that British colonialism cannot be blamed alone for the difficulties faced by hijra and trans people in India, and that doing so obfuscates the ongoing impact of caste-based violence through Hindu nationalism.
Further analysis of NALSA and the Transgender Law was provided by Chandrasekhar Venkata Durga Sepuri of the University of Maryland (USA), in Weaving an Ambedkarite Theory of Transgender Justice. Bhimrao Ramji Ambedkar was a key figure in the Indian independence movement and a campaigner against the caste system. Sepuri outlined three key principles of the Ambedkarite theory of justice which are highly relevant to trans experience:
A grand vision of social justice, underpinned by commitments to liberty, equality, and freedom of expression.
Recasting social relations, emphasising the value of fellowship with all other human beings, in contrast to Brahmanic logics of caste distinction.
“Educate, agitate, organise”: a vision of political power in which education is central to liberation.
Sepuri observed that the recent rising power of ethnic democracy and Hindu nationalism in India has coincided with the increased “protection” of trans people in law. However, this has in practice involved increased regulation of trans people’s lives. Echoing Rajat, Sepuri argued that the NALSA judgement failed to recognise Brahmanical foundations of transmisogyny, instead helping to build Hindu nationalist rationales for governmentality. The text of the NALSA ruling invited trans people to “join the mainstream” within the implicit context of this Hindu nationalism.
These problems were compounded through the shift from a (flawed) rights-based approach in NALSA, to a welfare-based approach in the Transgender Act. In addition to the discriminatory provisions outlined by Rajat, Sepuri highlighted how the lack of specificity in the Transgender Act’s welfare provisions deny opportunities for trans people to gain social or administrative power, and provide no specific legal consequences for discrimination against trans people.
From an Ambedkarite perspective, therefore, trans people have been failed on multiple fronts. They are denied access to equality and freedom of expression outwith the limited context of Hindu nationalism, denied fellow feeling through the focus on welfare rather than meaningful access to work or power, and there is an absence of a coherent approach to education that recognises intersectional forms of oppression.
Final thoughts
Thursday was a long day. I received a lot of intense information, and also took part in many meaningful conversations which are not reproduced here. I found myself zoning out a bit during the sessions on parenthood and detransition, so took a break during the evening plenary. I had earlier advised a PhD student not to worry too much about constantly attending every possible session – I definitely needed to take this advice myself!
The messages greeted me as soon as I left the ancient, rattling commuter train from central Chicago, chalked onto the sidewalk all along Church Street on the walk to my hotel. They seemed oddly out of place in Evanston, a leafy college suburb with an extremely chill vibe; a strange contrast to the low-key cool of the bars and restaurants, and turquoise blue calm of the inconceivably vast Lake Michigan.
At first I misread the final word of every message as “repeat”, as in (for example): “Praise the Lord – repeat”. I thought someone was simply very enthusiastic about sharing their values. “Repent”, however, feels a lot more aggressive and also quite pessimistic, assuming the reader’s guilt and their urgent need to make amends.
I am here for the 2nd International Trans Studies Conference, held at Evanston’s Northwestern University, in the original homelands of the Council of Three Fires (the Ojibwe, Potawatomi, and Odawa peoples). In the opening plenary of the conference, the political scientist Paisley Currah argued that we are living in a crisis moment for trans politics: not because we are necessarily facing more discrimination than ever before, but because more people are paying attention to our existence. Many of these people hope we might repent our trans identities, our gender deviance, our very existence. And yet, here we are, gathering from around the world to discuss trans knowledge and trans ideas, and to imagine trans futures.
Over the course of the conference I am attending numerous talks and meetings across a dizzying array of topics and themes, taking in both theory and evidence from researchers based in the humanities, social studies, and physical sciences. I plan to blog regularly, sharing information I have learned as well as critical reflections on the event. There are literally hundreds of talks taking place over up to 11 simultaneous sessions at any one time, so please do not expect an exhaustive account! Still, I hope these posts will be of interest to people unable to attend the conference, as well as fellow attendees.
The opening plenary: ‘The State of the Post-Discipline’
The conference began on the evening of Wednesday 4th September, with a two-hour opening plenary titled ‘State of the Post-Discipline’, reflecting the official theme of the event. Across four talks, this session aimed to set the tone for the conference and introduce a series of key ideas for consideration in the coming days.
I felt the plenary very much reflected the ambition, the importance, and the limitations of this conference. Each of the speakers emphasised the importance of a materialist approach to trans studies, in which our research can speak helpfully to the reality of people’s lives. This necessarily involves grounding our work in practical examples of trans realities, and understanding our histories in order to better tackle the challenges of the present and future. The speakers were perfectly blunt about the enormous harms that trans people have faced across time and in many places, while maintaining an optimism for how we might productively learn together.
At the same time, it felt strange that together, these four opening commentaries reflected a very limited geographic perspective, with three of the speakers being based in the United States. Similarly, it was disappointing to see just one trans woman on the stage, the Mexican biologist and philosopher Siobhan Guerrero Mc Manus.
This unfortunately reflected the wider dynamics at play within trans studies. As conference organiser TJ Billard noted in their opening comments, trans studies has historically been dominated by US and (to a lesser extent) European voices. Moreover, all four of the field’s major journals are effectively based in the United States. The 2nd “International” Trans Studies Conference is inevitably dominated by US scholars and perspectives, even as there are an impressive range of people present from the rest of the world. I’ve also frequently observed the minoritisation of trans women with trans-oriented conferences and research projects, even given the enormous influence of key figures such as Susan Stryker (who will be speaking in a later plenary) and Sandy Stone.
Nevertheless, the conference couldn’t have found a better opening speaker than queer Indigenous historian and literary scholar Kai Pyle. I have long admired Kai’s written work, so it was exciting to finally see them speak.
North American conferences frequently open with a land acknowledgement, in which organisers and/or invited elders of local Indigenous communities recognise the role of Indigenous peoples as the original stewards of lands taken by settler colonists. However, land acknowledgements rarely offer deeper understanding, let alone any form of reparation for the enormous damage wrought by colonialism.
Pyle themself rightly noted that a single talk could not possible begin to account for the violences and erasures of the past and present, and they observed also relative absence of Indigenous academics from the conference space. They further comments that “although I’m speaking on a panel titled ‘The state of the post-discipline’, I’m barely concerned with the discipline at all”: instead Pyle is concerned with a future where indigenous trans people can live.
Nevetheless, it was powerful to begin the event with a talk specifically about the oppression and resistance of Indigenous peoples in the Great Lake region. Pyle also argued that this history is necessary for properly understanding the history of trans studies itself.
Pyle explained that the lands of the Illinois or Inoka people were first invaded by the French in the 17th Century. Subsequent European accounts and travelogues widely reported the presence of gender roles in Inoka society that did not align with European norms: examples included the leadership of women in agriculture, and genders that could not be easily categorised as female or male. The subsequent projection of European understandings and desires onto Indigenous North American peoples informed early pathological accounts of gender ‘deviance’ as physical and mental sickness, which in turn would inform inform diagnostic categories from the 19th century to the present day. Indigenous people themselves, meanwhile, were subject to immense colonial violence, including coercive conversion to Christianity, removal from their homelands through forced marches such as the Trail of Death, and cultural destruction through the Indian residential school system.
Turning to the early 20th century, Pyle told the story of Ralph Kerwineo, an individual of Potawatomi and Black heritage who successfully ‘passed’ as a man and married two women while living in his ancestral homelands. While Kerwineo might today be understood as a trans man, there is no evidence of any engagement with the traditional gender roles of his people. Pyle noted that this stands as evidence of both enormous alienation but also resistance: Kerwineo successfully lived a gender ‘deviant’ life in the Chicago are a hundred years of attempted elimination of his people.
Finally, Pyle reflected on the emergence of the two spirit movement in the early 1990s, in parallel with the emergence of the contemporary US trans movement, as well as trans studies.
The second talk was by Paisley Currah, who argued for theorising “trans rights without a theory of gender”. He posited that trans studies has been increasingly “stepping aside from just doing theory” over the last decade, as seen for example in the creation of the journal Bulletin of Applied Transgender Studies. In this context we can potentially separate questions of social justice from questions of what sex and gender might actually be.
Currah illustrated this argument with the example of campaigns around sex classification policies in New York City. Attempts to introduce a system of self-declaration in the 2000s and early 2010s were complicated the fact that some city bureaucrats supported the proposed changes, and others opposed them. This was summarised by a legal argument made by the city government: “the existence of difference approaches to similar problems does not render an agency’s rule irrational”.
In this context, Currah argued that sex/gender is in practice a “decision informed by law”, and by the needs and interests of lawmakers. For example, in many jurisdictions it is fairly easy to change a sex/gender marker on a driving license. This is because in practice driving licenses are used by the state primarily for tracking and surveillance, and it is therefore in the state’s interest for the license to reflect what people look like and how they live. By contrast, it has historically often been more difficult to change sex/gender for the purpose of marriage: that is because this would entail a disruption of the heteronormative biological logic for property transfer across generations.
Currah concluded by arguing that when we argue for changes to these policies, the existence and diversity of trans people “is enough”. We exist no matter what your theoretical position on sex or gender, and “a world without us cannot be willed into being”. The focus of policy advocacy should therefore be on what we need to flourish, rather than abstract theorisation.
I found Currah’s arguments extremely helpful and well-framed. However, I was surprised to his insights framed as novel, as the approaches he described feel well-established in the UK. Unlike in the US, materialist approaches have been central to trans studies since the 1980s, in the work of key scholars such as Dave King, Stephen Whittle, and Zowie Davy. Meanwhile, the focus on trans people’s practical needs is embodied in the work of organisations such as Trans Safety Network and Trans Kids Deserve Better, who very intentionally centre questions of harm rather than any theorisation around gender. My own PhD thesis (published in 2016!) and later book Understanding Trans Health deliberately set aside the question of sex/gender to focus on how trans healthcare services operate and are experiences in practice. The feminist philosopher Katharine Jenkins has done important work on how what is important about gender varies according to context, and the legal scholar Chris Dietz has extensively considered questions of governmentality in terms of how and why differing aspects of trans people’s lives are managed by different agencies of on the behalf of healthcare systems and the state.
I make this point not to try and undermine Currah or big up UK trans academia specifically. Rather, I want to note how this kind of awareness of what is already being done in different parts of the world highlights why a truly international approach to trans studies is so vital.
The next talk was by Siobhan Guerrero Mc Manus. Unfortunately I – and many other attendees – missed much of her talk due to an apparent failure by the translation company hired to support the conference. This was an enormous pity given what I did catch felt extremely important, and built on the critiques of Currah that were bubbling away in my brain during his talk.
Guerro Mc Manus emphasised the importance of organising across borders, with the example of taking successful trans liberation strategies from Mexico, adapting these in a Colombian context, and then again in Peru. Conversely, she described the example of how work on reforming the criminal code in Colombia informed trans activism in Mexico. In this kind of organising and exchange of ideas, reflections from the Global South might be combined with insights from the North, without simply reproducing Global North theory in a way that is not necessarily applicable to countries such as Mexico.
I wish I had heard more of these presentation! I feel the International Trans Conference’s investment in both live translators and translation through transcription software is an incredibly important move, and should set the tone for future events in the field (or “post-discipline”, if you prefer). At the same time, it is important to get this right lest non-Anglophone perspectives are further marginalised through technical error. While I just missed large parts of this one talk, attendees who were not fluent in English may have missed much more from the other speakers. I definitely felt for the organisers, speakers, and fellow attendees, and hope these problems will spur future work to further improve our communication across languages and borders.
The plenary closed with a short address from TJ Billard. Billard explained how the choice of conference theme was informed by the “first” International Trans Studies Conference, which took place in Arizona in 2016, “riding the high of the transgender tipping point” just months before the election of Donald Trump. An enormous amount has changed in the last eight years, and the time is ripe for a re-appraisal.
Billard’s use of the term “post-discipline” draws on the work of John David Brewer. Brewer describes post-discipline thinking as knowledge about a phenomena that is detached from disciplinary allegiances, instead emphasising theoretical and methodological pluralism, political investments, and ethical values.
The emphasis is therefore less on academic siloing, and more on real problems facing contemporary society. This couldn’t be more appropriate for trans studies, especially in the context of the insights shared by the other speakers.
Some final thoughts
The first “day” of the conference was really just an evening: the opening plenary, plus a reception where the in-person attendees got to spend time meeting and catching up with one another (some of the most important academic work!) I am finishing this monster post at the end of the second day of the conference, a true marathon which ran from 8:30am (when registration opened) to 9pm (when a reception and 10th anniversary celebration hosted by the journal Transgender Studies Quarterly theoretically wrapped up). It’s difficult to capture the sheer scope of this event: indeed, this series of posts can only possibly touch upon the vast amount of knowledge and information we are discussing at the conference.
For all that I (and others) have shared several critiques, I am hugely grateful this event is happening, and feel very privileged to attend in person. I couldn’t be happier to be a gender deviant, and hope to repeat the value-based work of resistance over and over.
Through 2018 and 2019, I travelled across the UK and Germany to speak with trans men and non-binary people about their experiences of pregnancy and childbirth.
These research interviews for the Trans Pregnancy Projecttook place in kitchens, living rooms, and cafes, next to canals and rivers. We covered topics ranging from conception to pregnancy loss, taking in questions of masculinity and the body, relationships with family, friends, workplaces and social groups, interactions with medical practitioners, and people’s journeys through perinatal services.
I remain deeply honoured to have been trusted by participants to share and analyse their stories. The questions planned by our project team touched on deeply intimate and sometimes traumatic experiences, as well as joyful accounts of kinship and bringing new life into the world. These were by design long, deep discussions, covering a great range of issues that have been rarely discussed in academic literature to date.
And sometimes, an unexpected conversation would happen.
We – the research team – did not plan to study domestic violence. Instead, this topic was introduced by research participants. I will never forget the first time this happened, silently putting aside my planned questions as the man in front of me quietly, carefully disclosed what had happened to him, and how it intimately shaped his experience of pregnancy.
As others shared their stories in turn, I began to realise just how important these narratives are, and the need for peer-reviewed work that explored them in detail. The resulting article is now available following a long gestation period (pun intentional). I hope it will useful to a range of practitioners – educators, crisis workers, midwives, obstetricians, doulas, family doctors – as well as to academics and, most importantly, community members.
I am also really pleased that we have published in the “platinum open access” journal Bulletin of Applied Transgender Studies. Launched in 2022 and hosted by Northwestern University Libraries, the journal is free to publish in and free to read, with articles shared under a creative commons license. We found this publication route offered an extremely rigorous double-anonymous peer review that really challenged us, and ultimately strengthened our arguments and use of evidence. Given the exploitation and profiteering that is rife in the academic publishing industry, supporting new journals such as the Bulletin feels like an important political move as well as the right scholarly decision.
Please do share this article in any context you feel it will be helpful to others. Remember, under the license anyone can distribute it as-is for non-commercial reasons: so download, print, and pass it around to your heart’s content.
Since I am getting a lot of interest on the topic of the Cass Review lately, I have created a dedicated new page for this website, accessible through the menu bar.
The page contains links to blog posts and media I have produced on the Cass Review, including my round up of evidence and and commentary from external sources. I will update it with any new writing or media as they happen. My aim is to ensure that all of this material is easy to find for people who land on my website, without having to scroll through the blog archives.
I don’t intend to keep the page up forever, as this site is primarily intended as a repository for my own work and interests. I am genuinely not very interested in the Cass Review, insofar as it is a collection of turgid documents with little to offer to the field of trans healthcare. However, I believe the disproportionate political interest in the Cass Review’s recommendations (actual and imaginary) warrants careful academic attention from those of us working in this area.
I am featured in the most recent episode of Red Medicine, a podcast about the politics of health, medicine, and the body.
The interview features a deep dive into the Cass Review, including the contexts of trans healthcare and the anti-trans moral panic, as well as the underlying assumptions and methodological shortcomings of Review’s final report on healthcare for trans and gender-questioning young people. We explore how the Review is constructed as credible in spite of its flaws, plus how and why that is dangerous both for young trans people and for good science.
You can listen to the report through the Simplecast link above, or alternatively through Apple Podcasts or Spotify.
I am very excited to see the publication of the most recent issue of the Community Development Journal (CDJ), which focuses on queer and trans lives and collectivity in India.
The issue, titled Queer and Trans Community Building in Post-NALSA and Post-377 India, is edited by Pushpesh Kumar, Sayantan Datta, and Neha Mishra. Across the editorial and seven articles, it explores pathways and barriers to community organising across a range of settings, including in families, religious contexts, community health programmes, universities, and the media.
A one of the editors-in-chief of CDJ, it was an honour to support the hard work of the special issue editors and authors, who have put together a truly groundbreaking collection. LGBTIQ+ organisations, and others with a broader remit who seek to work with LGBTIQ+ people, are increasingly taking community development approaches and (where they can afford to do so) employing community development workers. However, community development research has been slow to catch up, with very little literature examining queer or trans community development theory and practice. This special issue therefore represents an important act of leadership in the field, which I hope will pave the way for more expansive discussions of LGBTIQ+ issues within community development globally.
The issue also representives methodological innovation, bringing literary and media studies methods to consider opportunities and issues for community building in India, alongside the social sciences approaches more typical of research in the field of community development.
Wednesday 10 April 2024 saw the long-awaited publication of the final report of the Cass Review. This report was commissioned by NHS England, and provides a review of evidence plus recommendations regarding gender identity services for children and young people. It costed £3 millionto produce.
On publication, the Cass Review’s findings and recommendations were welcomed by the majority of UK media outlets, NHS England, the Editor-in-Chief of medical journal the BMJ, conversion therapy proponents such as SEGM, Sex Matters and Transgender Trend, plus spokespeople for the Conservative and Labour parties, who promised to ensure it will be “fully implemented”.
Conversely, the Review has been extensively criticised by trans community organisations, medical practitioners, and scholars working in fields including transgender medicine, epidemiology, neuroscience, psychology, women’s studies, feminist theory, and gender studies. They have highlighted problems with the Cass Review that include substandard and inconsistent use of evidence, non-evidenced claims, unethical recommendations, overt prejudice, pathologisation, and the intentional exclusion of service users and trans healthcare experts from the Review process.
This post provides a round-up of links to written commentary and evidence regarding problems with the Cass Review, plus quotes pulled from each. In light of these, I believe that current attempts to implement many of the Review’s recommendations are both misguided and harmful.
Readers who agree with me may wish to take actions including:
writing letters to MPs and other political representatives, NHS and professional bodies;
raising awareness within voluntary sector organisations and trade unions;
“The Cass Review’s internal contradictions are striking. It acknowledged that some trans young people benefit from puberty suppression, but its recommendations have made this currently inaccessible to all. It found no evidence that psychological treatments improve gender dysphoria, yet recommended expanding their provision. It found that NHS provision of GAMT [gender-affirming medical treatment] [..] was already very restricted, and that young people were distressed by lack of access to treatment, yet it recommended increased barriers to oestrogen and testosterone for any trans adolescents aged under 18 years. It dismissed the evidence of benefit from GAMT as ‘weak’, but emphasised speculative harms based on weaker evidence. The harms of withholding GAMT were not evaluated.”
“The administered ‘therapy’ included psychologically coercive and aversive practices with the goal of gender-typical, heterosexual outcomes. […] Although the 1987 article concluded that J’s case, among others, provided evidence that such therapy can ‘help’ similar children, J’s account indicates that all this treatment ultimately did was cause trauma and suppress her self-acceptance for 22 years. […] The 1987 publication should not be considered reputable evidence in any debate over transgender policies — either by direct or indirect citation. And yet, this article and publications of a similar age and theoretical background continue being referenced as if they were factual and reliable, by actors ranging from the Endocrine Society and the Cass Review to a parent support group[.]”
“Unfortunately, the Review repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculation. Many of its statements and the conduct of the York SRs [systematic reviews] reveal profound misunderstandings of the evidence base and the clinical issues at hand. The Review also subverts widely accepted processes for development of clinical recommendations and repeats spurious, debunked claims about transgender identity and gender dysphoria. These errors conflict with well-established norms of clinical research and evidence-based healthcare. Further, these errors raise serious concern about the scientific integrity of critical elements of the report’s process and recommendations.”
~
Professor Gordon Guyatt and colleagues [added 15/10/25] Systematic reviews related to gender-affirming care (statement led by the original pioneer of evidence-based medicine – while it does not explicitly name the Cass Review, it is highly relevant given the Cass team’s approach to conducting and interpreting systematic reviews, as noted in this analysis by Gideon Meyerowitz-Katz)
“Following fundamental principles of humane medical practice, clinicians have an obligation to care for those in need, often in the context of shared decision making. It is unconscionable to forbid clinicians from delivering gender-affirming care.”
“One of the overt criteria that the NHS followed in choosing Hilary Cass was her complete lack of experience in working with people with gender incongruence and dysphoria […] The common thread of many objections to the Cass report is the multifaceted downplaying of the importance of the voices of adolescents and their families, clinical practice, the scientific knowledge base, and national and global recommendations, while misleading the public that a complete lack of clinical experience in a given field is a guarantee of reliability. As a multidisciplinary team of experts and patients, we consider such a trend to be harmful and completely contrary to the interests of adolescents in need of help.”
“[I]t is very unusual in the history of medicine that a time-honoured treatment, with a good safety record, even if based on non-randomised trials and experts’ opinion, is simply banned, while waiting for better evidence.”
“Ultimately our responsibility is to offer compassionate, evidence-informed treatment to patients so that they get to decide what is best for them, given what is known and unknown about the risks and benefits of an intervention. To do otherwise would be failing in our scientific mission to ensure that gender affirming care is safe, effective, patient-centered, timely, efficient, and equitable[.]”
“Regardless of what Dr. Cass’ intentions may or may not have been, the Cass Review process itself intentionally and explicitly excluded any oversight from patients and their families and trans healthcare experts, and its content is not supported by a robust methodology. The Cass Review relies on selective and inconsistent use of evidence, and its recommendations often do not follow from the data presented in the systematic reviews. The Cass Review deprives young trans and gender diverse people of the high-quality care they deserve and causes immense distress and harm to both young patients and their families.”
“[…] while waiting for research results, not providing transgender adolescent care that may include puberty blockers and hormones to adolescents who experience gender incongruence is not a neutral act given that it may have immediate as well as lifelong harmful effects for the young transgender person. Also, asking transgender adolescents to participate in research as the only way to receive puberty blockers, as Cass recommends, is unethical.”
“Members of the BMA’s Council recently voted in favour of a motion which asked the Association to ‘publicly critique the Cass Review’, after doctors and academics in several countries, including the UK, voiced concern about weaknesses in the methodologies used in the Review and problems arising from the implementation of some of the recommendations. […] The BMA has been critical of proposals to ban the prescribing of puberty blockers to children and young people with gender dysphoria, calling instead for more research to help form a solid evidence base for children’s care – not just in gender dysphoria but more widely in paediatric treatments.”
“We are aware that this week’s release of the Cass review raises many questions and uncertainties for people accessing or wanting to access gender identity services, as well as for the staff working in those services. We also know that this is likely to be a source of significant distress and worry. On first glance, BAGIS Council are deeply troubled by some of the content of the Cass Review and the potential impact thereof. We will be considering this lengthy document carefully, and in detail, before offering a comprehensive response to its recommendations and before making any relevant observations regarding the process that has underpinned them.”
“The final Cass Review did not include trans or non-binary experts […] in its decision-making, conclusions, or findings. Instead, a number of people involved in the review and the advisory group previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming ‘gender exploratory therapy’, which is considered a conversion practice.”
“The Cass review recommendations are at odds with the current evidence base, expert consensus and the majority of clinical guidelines around the world.”
“[…] multiple relevant international organizations, including the Endocrine Society in the United States, have made statements to the effect that the issues pointed out by the Cass Review were already known, that puberty suppression treatment has been developed over many years, and that determinations on things such as the efficacy and safety of puberty suppression treatment should be made based on scientific findings […] WPATH 8th edition SOC in regards to the effectiveness, limits, and side-effects [of puberty suppression treatment] is written based on a greater number of systematic reviews than the Cass Review.” [p.17, translation by What The Trans, checked by myself with Google translate]
“Welche weiteren Personen außer der Autorin auf welche Art in der Erarbeitung des Reviews beteiligt wurden, ist nicht dokumentiert. […] Medizinische Fachgesellschaften wurden an der Erstellung des Berichts nicht erkennbar beteiligt. Es wurde eine sogenannte „Assurance Group“ berufen, welche jedoch ausdrücklich nicht an der Erarbeitung von Empfehlungen des Cass Reviews beteiligt war. Es liegen Berichte vor, dass außerdem ein „Advisory Board“ eingerichtet wurde. Die Zusammensetzung sowie der konkrete Beitrag dieses „Advisory Boards“ sind nicht dokumentiert[.] Es lässt sich insofern keine Einschätzung über die Expertise der Mitglieder abgeben.”
“It is not documented which other people, apart from the author, were involved in the preparation of the review and in what way. […] Medical societies were not identifiably involved in the preparation of the report. A so-called “Assurance Group” was appointed, but it was expressly not involved in the development of recommendations for the Cass Review. There are reports that an “Advisory Board” was also set up. The composition and specific contribution of this “Advisory Board” are not documented[.] It is therefore not possible to make any assessment of the expertise of the members.“
“TACTT is deeply concerned by the final report of the Cass Review, whose core underlying premise is effectively an eliminationist agenda, dressed up in the language of ‘reasonableness’ […] We urge clinicians to treat the Cass findings with extreme caution and not to assume that they represent best practice or that they have been arrived at after a full and impartial review of clinical data.”
~
Endocrine Society (USA and international) Statement from Endocrine Society[added 15/05/24] Note: statement prepared in response to an interview with Hilary Cass for the ‘On Point’ podcast.
“NHS England’s recent report, the Cass Review, does not contain any new research that would contradict the recommendations made in our Clinical Practice Guideline on gender-affirming care. […] Although the scientific landscape has not changed significantly, misinformation about gender-affirming care is being politicized.”
~
American Academy of Pediatrics (USA) Statement from American Academy of Pediatrics[added 15/05/24] Note: statement prepared in response to an interview with Hilary Cass for the ‘On Point’ podcast.
“The AAP’s gender-affirming care policy, like all our standing guidance, is grounded in evidence and science. […] What we’re seeing more and more is that the politically infused public discourse is getting this wrong and it’s impacting the way that doctors care for their patients. […] Politicians have inserted themselves into the exam room, and this is dangerous for both physicians and for families.”
~
Dr Max Davie and Dr Lorna Hobbs [added 08/08/24] (Consultant paediatrician and clinical psychologists – former education leads for London’s new child and adolescent gender services) Cass: the good, the bad, the critical
“The fact that any new prescriptions of puberty-pausing medication for someone under 18 is now a criminal offence in the UK may be shocking, but to those of us who were observing the Cass review it is not surprising. Dr Cass was known by colleagues to oppose medical transition when she was appointed to the review, after all.”
“[…] one experienced psychiatrist at a gender identity clinic in England – who did not wish to be identified – told the Sunday National that failure [to include those with lived or professional experience] had concerned many within the field. They said: “The terms of reference stated that the Cass Review ‘deliberately does not contain subject matter, experts or people with lived experience of gender services’ and Dr Cass herself was explicitly selected as a senior clinician ‘with no prior involvement … in this area’. ‘Essentially, ignorance of gender dysphoria medicine was framed as a virtue. I can think of no comparable medical review of a process where those with experience or expertise of that process were summarily dismissed’.”
“’There have been multiple expert academic treatises written on what was wrong with the Cass Review … they intentionally sidelined people who worked in the field,’ [Brisbane GP Dr Fiona Bisshop] told The Medical Republic. ‘Practitioners who worked with trans patients and trans people themselves were excluded from that whole review, and that didn’t happen [in Queensland]. They talked to the right people who were using the service and they also included some people in the review panel who were experts.’”
Responses and publications from expert researchers and educators
“Using the ROBIS tool, we identified a high risk of bias in each of the systematic reviews driven by unexplained protocol deviations, ambiguous eligibility criteria, inadequate study identification, and the failure to integrate consideration of these limitations into the conclusions derived from the evidence syntheses. We also identified methodological flaws and unsubstantiated claims in the primary research that suggest a double standard in the quality of evidence produced for the Cass report compared to quality appraisal in the systematic reviews.”
“The Cass Review relies on six systematic reviews of different aspects of healthcare for young people accessing gender identity services. Systematic reviews are a way of compiling information from multiple studies that have looked at the same topic and come to an overall understanding of the results. There are very specific guidelines for how systematic reviews should be done but the Cass Review’s systematic reviews deviated from best practice in systematic review methodology in several ways […]”
“While the Cass Review has been presented by the U.K. media, politicians and some prominent doctors as a triumph of objective inquiry, its most controversial recommendations are based on prejudice rather than evidence. Instead of helping young people, the review has caused enormous harm to children and their families, to democratic discourse and to wider principles of scientific endeavour.”
“Inductive and deductive reflexive thematic analysis was applied to a collection of Cass Review publications related to trans children’s healthcare published between January 2020 and May 2023 […] Four concerns are presented and explored: (1) prejudice; (2) cisnormative bias; (3) pathologization; and (4) inconsistent standards of evidence. Each of these concerns impacts the Cass Review’s approach to trans children’s healthcare, with negative repercussions for trans children’s healthcare rights and well-being.”
“Each of the recommendations summarised below is built on a foundation of prejudice, ignorance, cisnormativity and pathologisation of trans lives, running in direct opposition to the evidence base, and running in direct contravention of an NHS duty of care to children’s rights, children’s welfare, healthcare equality and healthcare ethics.”
“The Cass Review has shown zero evidence of harms of social transition or puberty blockers. The only harm is this hypothesis that they change the trajectory and outcome, locking children into a trans lifetime. This hypothesis is based on the worst quality evidence I’ve ever seen. This is why trans healthcare researchers are feeling stress and dismay at UK media and politicians cheering on Cass’ evidence-based policy.”
“In this commentary, this scientific evidence is reviewed, particularly focusing on the biological and psychosocial claims reported in the [Cass] Review. The scientific substantiation of assertions in the sections on understanding the patient cohort and clinical approaches is examined critically, resulting in the finding that the Review shows a number of issues that together point to a substandard level of scientific rigor in the Review. As such, it called in question whether the Review provides sufficient evidence to substantiate its recommendations to deviate from the international standard of care for trans children.”
“Zoals vele artikelen, waaronder mijn eigen recentelijke publicatie, hebben aangetoond, is het onderzoek van Cass echter zélf wetenschappelijk zwaar onder de maat. Het geeft bijvoorbeeld geen statistische onderbouwing van kwantitatieve claims. Ook gebruikt Cass eenzijdige bronnen voor haar aanbevelingen. Het rapport versimpelt verder veel lastige biologie, zoals het idee dat het brein pas volwassen is als je 25 bent.”
“However as many articles, including my own recent publication, have shown, Cass’s research itself is scientifically seriously substandard. For example, it provides no statistical substantiation of quantitative claims. Cass also uses one-sided sources for its recommendations. The report also simplifies a lot of difficult biology, such as the idea that the brain is not fully mature until you are 25.“
“It needs to be emphasized here that even The Cass Review found no empirical evidence of harm being caused to young trans people by puberty-blockers. This study, however, demonstrates that banning them causes very significant harm indeed. […] By far the most consistent prevailing theme to come out of the data was that of the overwhelming levels of distress these young people are experiencing[.]”
“Despite the concern-laden language about “helping” and “supporting” trans children, it is my opinion that what Cass is attempting to establish is an all-enveloping ambient conversion therapy approach to trans children, removing their autonomy, freedom of expression, mental health, helpful support and healthcare. […] If imposed it will, in my view, result in the deaths and deterioration in mental health of many trans children.”
“The Cass Review […] demonstrates that transphobic pop-cultural discourses have real material effects. Transphobic discourses became increasingly publicly popular, which led to increased criticism of current care models for trans youth. Heightened public scrutiny led to the Review’s commissioning and the subsequent banning of puberty blockers. There is a direct line between public discourse and restrictions on trans rights.”
“The Review does not make it clear that such a significant proportion of the experts it relies on do not believe in [the existence of] transgender children or that the root cause of distress in this population is gender. It may be unclear to policymakers and the public that people holding such views are shaping practice norms.”
“[…] above all else, the Cass teams disregarded evidence supporting trans care. They did so by starting their research from the position that trans care is a problem which must be solved in the first place. […] They started from the logic of a pandemic, expressed in the fear of a “social contagion” capable of upending cisgender supremacy, and in so doing, they created the conditions to make evidence that would assert a position of cis-supremacy.”
“I will argue that some of the recommendations contained in the Cass Review are not congruent with ethical norms concerning clinical research involving minors. There are sound reasons to perform clinical research in this area, and the investment in research is to be welcomed. However, a clinical trial is unlikely to enhance the evidence base.”
“Our concern here is that the Review transgresses medical law, policy, and practice, which puts it at odds with all mainstream U.S. expert guidelines. The report deviates from pharmaceutical regulatory standards in the United Kingdom. And if it had been published in the United States, where it has been invoked frequently, it would have violated federal law because the authors failed to adhere to legal requirements protecting the integrity of the scientific process. […] More generally, the Review’s circumscribed approach to drug approvals is out of step with pharmaceutical law and policy in both the United Kingdom and the United States. […] The [final] report’s application of a heightened evidentiary standard probably stems in part from its deviation from standard medical scientific process. Specifically, it lacked peer review, transparency of authorship, and equitable selection of nonauthor contributors.”
“Trust in research is not only fragile, but it is built on, over time. When this gets eroded or broken (as in the Cass Review), it creates a highly volatile environment for the medical and scientific community to try and shift.”
“In the USA, the 2025 HHS Gender Dysphoria Report […] it dismisses decades of clinical practice and undermines the legitimacy of care models that affirm youth gender identities. Like the Cass Review, it frames gender-affirming care as inherently suspect, requiring extraordinary proof to be considered safe. The resulting policies render timely care inaccessible, especially in politically hostile states. Neither report applies comparable scrutiny to irreversible paediatric interventions in other contexts, such as intersex care, nor do they address the harms of care denial or of imposition of questionable care.”
“Cass’ conclusions generally focus on limiting or minimizing medical GAC for youth and she also minimizes the robust data and the potential negative impact of increasing barriers for an already disenfranchised group.”
“The [Cass Report] is not a clinical guideline or a working manual. Unlike the systematic reviews from which it draws its conclusions, the report is not a scientific publication and was not submitted to a peer-reviewed journal. Furthermore, it does not produce new evidence or find any evidence of harm caused by social transition and the use of medical treatments such as puberty blockers and cross-sex hormones. […] [Critical reports] have compellingly exposed some of the report’s methodological flaws and the undue interpretation of the report by those who have used the document to advance their own anti-rights agendas.”
“Whilst the report cites adjacent NHS services using 0-25 models to justify a ‘continuity of care’ (224), designating trans persons as ‘vulnerable’ and confining them to child-oriented services indicates that more is at stake. These rhetorics contribute to the shoring up of state surveillance and intervention into the lives of legal adults who want to make choices the state disagrees with.”
“One of the main arguments that the Cass review has made is that there has been a dramatic and hard-to-explain increase in the number of children who identify as transgender and attend UK clinics with gender dysphoria seeking help. In a number of places, the review describes this increase as “exponential”, and notes that it appears to have been accelerating in recent years. […] The authors say that this increase is far too big to be caused by social acceptance of trans people, and therefore there must be some form of pernicious influence such as social media, mental health problems, or some other issue causing kids to become trans at increasing rates. […] But if you look at the actual data in the reports that the review is discussing, not only is the increase not exponential, it’s not actually that surprising.”
“I think it’s important to stick to the facts when critiquing a review such as the Cass report. […] I think the review made some serious mistakes in both science and interpretation, but they didn’t simply discard most of the evidence, or sneakily change their methodology to get rid of important research. The real story of the Cass review is much more complex than a single weakness that entirely discredits the work.”
“Some of the main arguments AGAINST using hormones and medications for transgender children are contradicted by the Cass review. Barely anyone has noticed, because the review mentions this fact once in a single paragraph, and most of the data is relegated to Appendix 8. […] This should be a key point. A chapter of the review. “Common arguments against giving transgender children medications are wrong”. Instead, it’s a footnote. That raises all sorts of red flags. Why were these key findings shunted to an appendix and largely ignored?”
“The [Cass Review] authors cite conversion clinics as evidence that transgender children rarely experience dysphoria as adults, use incredibly low-quality research to support the idea that detransition is more common than we might imagine, and almost entirely avoid the data which shows that most transgender people – including children – persist in their identities and do not regret their transition.”
“One of the strangest parts of the Cass review is the speculation on the potential negatives that medications may have […] For a review that spends a great deal of time bemoaning the state of the evidence supporting transgender care, this is an astonishing thing to do. The cited reference [on brain maturation being disrupted by puberty blockers] is a speculative theory about the importance of pubertal hormones on mice, with no follow-up data in humans.”
“There seems to be a very strong pattern in the Cass review which we are seeing repeated in almost every part of the publication. First, we have a review of the evidence for gender-affirming care in kids. Mostly, the evidence isn’t great. This is an unfortunate fact, and one that I’ve discussed at length. Then, the review will cite various unsubstantiated theories that vary from possible to unlikely to complete pseudoscience. These theories are given equal – or in some cases, greater – weight than the existing evidence in actual trans children.”
“For a document that spends literally thousands of words lamenting the quality of evidence for trans healthcare, it is startling to see that the only therapies that Cass recommends are the ones with by far the worst evidence around.”
“What we can say with some certainty is that the most impactful review of gender services for children was seriously, perhaps irredeemably, flawed. The document made numerous basic errors, cited conversion therapy in a positive way, and somehow concluded that the only intervention with no evidence whatsoever behind it was the best option for transgender children. […] The fact that so many have taken such an error-filled document at face value, using it to drive policy for vulnerable children, is very unfortunate.”
“[The Cass Review] is just a review. In my previous essay, I cited numerous scientific reviews carried out by experts in the field which all came to a different conclusion than the Cass review: that gender-affirming care is beneficial and gender-disaffirming approaches harmful for trans and gender-diverse youth. If those reviews aren’t “authoritative” enough for you, then how about the American Academy of Pediatrics review, or the Endocrine Society review, or the WPATH Standards of Care, or any of the other health professional organizations who have come to similar conclusions.”
“We suggest that the Cass Review contains unsound methodology, unacceptable bias, and unsupported conclusions. As academics and experts in the field, we regard The Cass Review as potentially harmful to trans children.”
“Some of [the] recommendations follow entirely spurious narratives and draw unfounded conclusions. The whole report is positioned in a way which considers continuation of current medication access as harmful, but removal of the current medication access as a neutral or beneficial act, despite no evidence to support this. We are particularly concerned about the content discussing neurodiversity; social transition; and access to medications for children and young people. The report positions the fact that clinicians are unable to predict the future of children and young people’s gender expression as a critical failing of current practice. No service can or should aim to predict the future of children or young people’s lives and the idea that a clinician will know a young person better than they know themselves is in direct contradiction to the United Nations Convention on the Rights of the Child. The aim for clinicians should be to provide a safe, accessible and supportive service which provides individualised care to all children and young people it encounters.”
“The signatories urged [UK education secretary] Phillipson to undertake three actions: – Restate commitment to, and pursue with haste, a legislative ban [on] all conversion practices. – Welcome the fair criticism of the Cass Review, reflecting the nuance of a complex field and recognising the substantial, widespread international critique. – Meet with us, with a shared commitment to keep inclusion at the heart of our practice, so that we can help build an education system and society where everyone can find a place to belong.”
“I am persuaded that the Cass Review, whilst by no means irrelevant, is deserving of little weight in determining where Ash’s best interests lie. (186) […] The wholly untested Cass Review does not help much, or even at all, since it could only (in this case) recommend that there is nothing that can be done to help Ash. Indeed I must confess the “do nothing” approach […] (albeit practically cloaked as “psychotherapy” – which Ash will not likely accept, even if it could be funded, which on the evidence it could not), troubles me because it seems to work on the assumption that doing nothing is better, which seems to be just kicking the can down the road until Ash is 18, in the hope that, given time, he will change his mind. (248)”
Important note: the conclusion to the judgement adds: “observers may also read this judgment as some kind of refutation of the Cass Review and the views of health professionals who adhere to similar views as expressed in that review, but again it is no such thing. Whilst the Cass Review appears to have some deficiencies, blind spots and limitations, ultimately that is a matter for the UK Government, not an Australian court, to determine” (276). I am sharing the judgement here as I feel it highlights important limitations in the Review even if it does not amount to a formal refutation.
Responses from trans community organisations
Coalition of 100+ LGBTQ+ community organisations and experts Letter to Wes Streeting[added 11/11/24]
“Trustworthy government reviews of the evidence base for a particularly controversial policy, especially in the medical field, do not look like the Cass Review. They have a clear mandate and problem to solve which are raised by those directly affected, not by newspaper columnists or ideologues. They do not exclude members of the patient cohort and those with long-term experience in the field from being part of their team or consider professional or lived experience “bias”. They ensure there is transparency and meritocracy in the appointment of key personnel. They consult openly and in an ongoing fashion with patients and organisations representing them. They do not assume that the treatments in question and anyone involved with them are part of an ideological conspiracy. They are clear and consistent about the evidentiary standards being used to judge any given concerns. They are careful not to give credence to unevidenced theories. They accurately represent the views of those they have engaged with. When problems arise or mistakes are made, they engage with the impacted communities. When strong critiques are made by other experts internationally, these are discussed and engaged with rather than ducked and declared unacceptable to mention.”
Disclosure: I contributed to and signed this letter.
“Decisions are being taken that affect our lives without any trans people in the room, let alone trans young people. Too often trans kids are portrayed as a monolith of confused, depressed teenagers. We are denied choice and robbed of our autonomy. But we should be trusted to make the same decisions about our healthcare that all people are.”
“[…] we believe there to be systemic biases in the ways that the review prioritises speculative and hearsay evidence to advance its own recommendations while using highly stringent evidence standards to exclude empirical and observational data on actual patients. This adds to the concerns we have previously had about Cass excluding trans people from the research oversight board – that Cass was set up from the start to impose a particular perspective without input from the patient cohort affected by the outcome.”
“In the absence of effective treatments for dysphoria outside of transition, ‘alternatives’ rely primarily on impossibilising transition […] any therapeutic paradigm for trans and gender-variant young people must explicitly centre the reality and accessibility of transition and affirm all potential genders/embodiments, and should provide information on what pseudo-therapeutic manifestations of anti-trans rhetoric look like, both in clinical and community settings. Models that do not include this risk endorsing the influence of transphobic hostility on identity formation, for instance, or affirming rhetoric that assigned sex is ‘reality’ when this coheres with a given young person’s identity.”
“Whether Hilary Cass wants conversion therapy to be institutionalised on the NHS again is immaterial: her recommendations have made space for it. Therapy is a caring profession, and despite the crueller parts of its history, good work happens under its banner – but so does violence. The NHS must set out a clear and actionable plan to keep conversion therapy out of its services, and investigate instances where it may have been allowed to take place. Anything else is complicity.”
“In June of 2023 it was disclosed to us by members of the Cass Review team that anti-trans author and commentator Dr Az Hakeem was part of “NHS England’s policy working group which commissioned the NICE evidence reviews undertaken in 2020”. Dr Az Hakeem has long been a partisan opponent of gender affirming medical treatments. While Hakeem disavows conversion therapy or trying to dissuade trans people from medical interventions, on his personal website he directs readers looking for specialist support for gender dysphoria to conversion therapy activist groups, such as Bayswater Support Group, and the anti-trans pseudoscientific lobby group SEGM. Hakeem is also a member of CAN-SG who have from their earliest webinars (link) promoted the idea that trans people should be dissuaded from transition and instead either change their minds, or undergo therapy to live with the discomfort of gender dysphoria without accepting their trans identity — in other words, that trans people should undergo conversion therapy.”
“The report […] strays far beyond its scope and competence in recommending a review of adult services and in suggesting that young people ought to stay under the care of children and young people’s services until the age of 25. The latter is based on highly questionable understandings of brain development which have been repeatedly debunked as an oversimplification of the constant changes in human neurology over the course of our lives. […] Underpinning this report is the idea that being trans is an undesirable outcome rather than a natural facet of human diversity. This is clear not only from the recommendations but also from the exclusion of trans researchers from the design of the review process and the links individual members of the research team have to anti-trans groups, which the Cass team were warned about.”
“The Report dismisses almost all evidence around existing protocols for treating trans young people, including lived experience, on the spurious grounds it does not meet unobtainable levels of proof. The team do not apply the same rigorous evidential tests to their own proposals. Indeed, if such evidential requirements were imposed consistently and equally across the NHS, it would mean that many routine treatments, including treatments for menopause, palliative care and mental health, would also have to cease.”
“Of note, many other paediatric medications that are routinely used in paediatric care, do not and cannot have the level of evidence that Cass and NHS England demand: medicines for ADHD, for example, anti-psychotic medications, and many others have comparable if not lower levels of evidence.”
“I was invited to consult with the Cass review. After three discussions it was obvious that the review had been written before we started. She totally discounted evidence from trans people from the basis of knowledge or lived experience.”
“Young people we have spoken to are concerned about what they have read, including the desire to understand “why” young people are trans, and to place what feel like “limits” on gender expression, further pathologising and medicalising their identities. We share these concerns. We are deeply frustrated with the lack of clarity throughout the report, which has enabled wilful misinterpretation and the spread of harmful misinformation. Clear and accessible language is vital, especially when services are operating in a context where there is significant hostility to and misconceptions about trans people, particularly in the media. “
“In the world the Cass Review imagines a trans child will be seen quickly but not given the care they need. They will still wait for years if they want to access gender affirming healthcare. While they wait they will be expected to engage with therapy that risks becoming conversion practice. While they wait, they will go through a puberty they may find profoundly distressing. They will be treated for every other condition they have. They will be treated for conditions they develop as a consequence of denial of trans healthcare and living in a transphobic world. But they won’t get the care they need to feel comfortable in their own skin. This is a model of care that works for cis people who are upset by the idea of a trans child existing.”
“The NHS has always been a violent, white supremacist, saneist, transphobic system; the Cass Report was never going to change that system, indeed it was designed to expand it. The NHS does not provide trans healthcare: it disciplines and punishes trans people, so we will transition in any way we can – with community-led care, private care, and overseas care. We will smuggle, borrow, share, and steal the medicine we need. We will take direct action to protect each other. We survive. We rebel. Fuck the NHS.”
“Politicians will continue to create moral panics to distract and divide us from their own failings. The Cass Review, instead of focusing on a lack of funding, long waiting lists and overstretched staff is ultimately calling to restrict trans healthcare. Enough is enough. Trans youth don’t need to be studied, managed or saved. They need the same opportunities and quality of care that their cis friends and family receive.”
Responses from trade unionists and human rights groups
“[T]rade unions’ rejection of what has been framed by the media and political establishment as a ‘moderate’ and ‘reasonable’ line on trans rights should be seen as a cause for hope. […] Regardless of what comes next, though, we must be guided in everything we do by what trans communities and trans-led organisations are asking for. As members of organisations founded on worker self-representation, “nothing about us, without us” must be at the front of our minds and hearts.”
“This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people. It’s concerning that sections of the media and many politicians continue to spread moral panic with no regard for the possible consequences for trans people and their families. The negative rhetoric by the Government about the dangers of so-called gender ideology, healthcare for young trans people, as well as the push against LGBT-inclusive sex and relationship education is harmful and extremely damaging.”
“As much as Cass’s report insists that all lives — trans lives, cis lives, nonbinary lives — have equal value, taken in full it seems to have a clear, paramount goal: making living life in the sex you are assigned at birth as attractive and likely as possible. Whether Cass wants to acknowledge it or not, that is a value judgment: It is better to learn to live with your assigned sex than try to change it. If this is what Cass personally believes is right, fair enough. It can charitably be called a cultural, political or religious belief. But it is not a medical or scientific judgment.”
“Though there is much more evidence now to support gender-affirming care than in 2008, there is also a much stronger anti-trans movement seeking to discredit and ban such care. British media coverage has given that movement a big boost in recent years, turning the spotlight away from the realities that trans kids and their families are facing, and pumping out stories nitpicking at the strength of the expanding evidence base for gender-affirming care. Its coverage of the Cass Review followed suit.”
“International medical organizations and transgender activists are roundly condemning a new U.K. report on gender-affirming care for minors, saying the report ignores years of research to propagate “harmful” misinformation.”
“The Report included many recommendations for treatment of youth presenting at gender clinics in England. Some of these were fairly technical, describing proposed relationships between NHS entities such as regional centers, centralized authorities, and local/tertiary providers. Other recommendations were broader […] The recommendations synthesize a view of medical transition as a bad outcome to be avoided, and a belief that gender dysphoria can be successfully treated non-medically, despite no non-medical interventions being evaluated in any of the series of systematic reviews[.]”
“The French Society of Pediatric Endocrinology and Diabetology (SFEDP) recently commissioned its own version of the Cass Review, and this study reached almost the exact opposite conclusions of Cass […] Upon reading both the Cass Review and the SFEDP Review, what immediately jumps out is the very different tone of each—Cass takes a tone that feels skeptical to the point of excess, offering mysteriously curt phrasing, statements rife with implications of harm or conspiracy by mainstream providers, and an overall sense of invalidation. By contrast, the SFEDP Review reads like a scientific paper—its language is straightforward and sterile, and there is none of the innuendo of Cass.”
“This week, when the Cass Review was released, news outlets rushed to cover the story, highlighting the report’s conclusions without taking time to consider whether the report could be flawed. In doing so, it amplified and solidified to the wider public the report’s key conclusions without balancing it against the evidence it excluded to reach them. […] Crucially, despite a four-year process, it still failed to find any smoking gun of widespread regret among trans folks who transition. It instead had to rely on a methodology that allowed it to exclude any data about how gender-affirming care helps trans people.”
“We contend that the Cass Review is not fit for purpose. We suggest that it was not merely knocked off course by a flawed methodology. We believe the Cass Report is a deliberate part of a political project aiming to reduce the availability of trans healthcare, possibly eventually in its entirety. It is imperative that we understand this and act on it.”
“The trans and questioning children who are at the centre of this conversation are in community with one another, and they understand exactly what is happening to them. While we are focussed on the bigger picture, I was taken by their confidence and eloquence when speaking of their experiences. [A speaker shared] a story about speaking to a trans kid they knew through their work, who, speaking of their many friends who had died of suicide: “Yeah, you know how it is.” And we do. We are used to just how extreme what is currently happening to us in the UK is, and the real effects it has on us. We have been sounding the alarm for years, but we are now feeling the UK’s uniquely slow and bureaucratic oppression start to bite[.]”
“Children’s wellbeing is indeed at stake here, but that includes the wellbeing of children who are actually trans. Far from taking the matter out of politics, the review – and Rishi Sunak’s subsequent praise of it – has put it centre-stage. Some readers will remember the climate of homophobia that suffused the run-up to the 1997 general election, when the Conservative Party, desperate as it is now, brought out the “They’re coming for your children” rhetoric in a last-ditch effort to panic people into voting for it. This review – whose final report has been awaited for some time – feels like an attempt at the same thing.”
“It is important to note that the Cass Review contains very little new data and evidence. Any statements it makes are based on the same level of evidence that every major medical organization in the United States, along with some of the largest mental health societies in the world and professional associations of transgender health, have determined to support transgender care. If its claims differ from those institutions, it’s because reviewers made choices to view the evidence around transgender care negatively.”
“The Cass Review seems to have emulated the Florida Review, which employed a similar method to justify bans on trans care in the state—a process criticized as politically motivated by the Human Rights Campaign. Notably, Hilary Cass met with Patrick Hunter, a member of the anti-trans Catholic Medical Association who played a significant role in the development of the Florida Review and Standards of Care under Republican Governor Ron DeSantis. Patrick Hunter was chosen specifically by the governor, who has exhibited fierce opposition towards LGBTQ+ and especially transgender people, and then immediately got to work on targeting transgender care. The Florida review was purportedly designed and manipulated with the intention of having “care effectively banned” from the outset, as revealed by court documents. The Florida Review was slammed by Yale Researchers as “not a serious scientific analysis, but rather, a document crafted to serve a political agenda,” and much of their full critique is applicable to the Cass Review as well.”
“[A] focus on “distress” was used to obfuscate the core purposes of treatments in transgender care. By keeping the reader’s attention on a subset of a treatment’s (often hypothesized) effects, Cass elides ancillary outcomes with the reasons why those treatments are used […] It is urgent to understand that implementing Cass will entrench deeply transphobic ideas and practices within the NHS. The result will be a systematic and dangerous failure to serve the needs of a patient group that is marginalized, maligned, and misunderstood at every turn.”
“The 32 recommendations, informed by the highly conservative evidence base, look to impose further restrictions and control on trans lives — and not just the lives of trans youth with the scope of these recommendations including 25 year olds. Given that we know The Cass Review has been majorly influenced by anti-trans activists with ties to conversion therapy efforts, it’s probably worth looking at some of the recommendations and how they relate back to what transphobes are doing to organise against trans liberation.”
“The overall recommendation is to force patients to wait through psychological busywork and relevant-sounding delays, implementing a largely-arbitrary set of hoops to jump through with the hopes the patient just gives up. Focus on the patient’s anxiety, focus on their autism, focus on any other issue except their gender and their desire for a sex change[.]”
“Earlier this month, WIRED noted that generative AI has a track record of representing queer and trans people as a collage of stereotypes. It is not clear why the Cass team used AI-generated images in this report, which, again, has been used as evidence by the NHS to stop providing gender-affirming care to trans kids.”
“Questions have been raised about the neutrality & evidence basis for the controversial #CassReview. The report’s author Hilary Cass has been asked to provide answers why she is meeting with Women’s Declaration in the House of Lords this week.”
“§6.18 presents us with the idea that toy choice is influenced by hormones. To accept this report is to accept that estrogen, for example, has a biological effect that causes a preference for play with toy cooking pans over toy trucks. In §6.23 we are directed to the work of Melissa Hines in support of this hypothesis. Hines was one of the two authors of the “vervet monkey” study that claimed to show such toy preferences in monkeys. A study that implies something about estrogen makes monkeys want to play with cooking pans.”
“Here is Cass citing “Thoughts On Things And Stuff”. This is a YouTuber whose channel includes a host of anti-trans video material, including material from notorious anti-trans figures, including ‘”‘Gays Against Groomers’.”
“It has been drawn to my attention that [a booklet produced based on research cited by the Cass Review] was funded by SEGM’s William Malone & anti Trans lobby group Transgender Trend.”
“In 2021, Trilby “Tilly” Langton, the sole gender affirming care “expert” involved in the Cass systematic reviews, went to lobby Kemi Badenoch about the conversion therapy ban. With a featured speaker at the 2024 CAN-SG conversion therapy conference.”
“The review found 5 studies of moderate certainty relevant to psychological health. All 5 supported the conclusion that treatment of trans teens with CSH [cross-sex hormones] improved psychological health. There were no findings of worsening psychological health. What conclusions would you draw from this? Our intrepid authors draw no conclusions from this whatsoever, instead declaring the evidence for every outcome for which there was no high certainty study “inconclusive.” Similar is true for other outcomes and for puberty blockers. This is the sense in which the Cass Review absolutely did ignore almost all evidence on the efficacy & safety of PBs [puberty blockers] and CSH. The majority of moderate certainty studies were included in the results section but then arbitrarily ignored in the conclusion entirely.”
“The Cass Review Report does not conclude that puberty suppressing hormones are an unsafe treatment. The report supports a research study being implemented to allow pre-pubertal children to have a pathway to accessing this treatment in a timely way and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria. In the data the Cass Review examined, the most common age that trans young people were being initially prescribed puberty suppressing hormones was 15. Dr. Cass’s view is that this is too late to have the intended benefits of supressing [sic] the effects of puberty and was caused by the previous NHS policy of requiring a trans young person to be on puberty suppressing hormones for a year before accessing gender affirming hormones. The Cass Review Report recommends that a different approach is needed, with puberty suppressing hormones and gender affirming hormones being available to young people at different ages and developmental stages alongside a wider range of gender affirming healthcare based on individual need.”
Some final thoughts: recommendations such as this from the Q&A are not clearly reflected in the content of the reportor thelater Q&A published on the Cass Review website. In a blog post accompanying that Q&A, Dr Cass complains about “some of the assertions being made on social media, and occasionally on mainstream broadcast media, which misrepresent the report and its findings, whether wilfully or otherwise“.
In my expert opinion, the critiques linked to in this blog post have yet to be properly addressed by the Cass Review team, let alone any of the politicians or healthcare service directors promising the implementation of the Review’s findings.
Regardless of whatever Dr Cass’ intention may or may not have been, the Review process itself intentionally and explicitly excluded any oversight from service users and trans healthcare experts, and involved collaboration with proponents of conversion practices. The final report relies on poor and inconsistent use of evidence, and makes recommendations that put young trans people in danger.
I will be speaking about my research at an event hosted by the Strathclyde University Feminist Research Network at 3pm on Wednesday.
The talk is titled “Reproductive Justice for Trans People”. It will focus on findings from the Trans Pregnancy and Improving Trans Experiences of Maternity Services projects, but will also touch on wider questions of social reproduction for trans people of all ages and genders.
There are also a lot of other great talks on feminist topics hosted by the Feminist Research Network as part of their seminar series, so definitely check them out!
Dr Ruth Pearce 