The GRA, LGBT Survey, Action Plan and conversion therapy ban – what just happened?

On Tuesday, the UK Government (finally!) launched a long-awaited consultation on reforms to the Gender Recognition Act 2004 (GRA). This has been timed to coincide with several other events, including the publication of initial data from the Government Equality Office LGBT Survey, the launch of the Government’s new LGBT “Action Plan”, and the formal launch of the Memorandum of Understanding on Conversion Therapy.

While it makes sense – politically speaking – for all of these things to happen at once, it can be pretty confusing. The sheer amount of information to process alone is monumental. Part of my job is to engage with these events, and since yesterday morning my head has been spinning! So in this post I aim to briefly summarise what has happened, why it happened, and what this might mean for the future – especially with regards to trans rights.


GRA Consultation

Planned reforms to the GRA was announced in the wake of the 2017. The Government promised a consultation, which has taken a year to materialise.

Nevertheless, it’s now open and anyone can respond to it. The consultation outlines a number of issues that civil servants have identified with the GRA as it stands, and asks for your views on these.

You can read about and respond to the GRA consultation here.

There are a couple of issues with the GRA which trans rights advocates have highlighted as notably absent from the consulation, which you may wish to invite the Government to also address. These are:

  • The lack of provision for gender recognition for trans people under the age of 18.
  • No mention of the Gender Recognition Register, which currently lists all people who have successfully applied for gender recognition. This may prove a danger to trans people if a more authoritarian government were to come to power, as in the US.

In the past year there has been a moral panic in the UK media in response to proposals for GRA reform. You can find out more about this (and my thoughts on why the consultation is happening now) in my earlier post on the topic.


LGBT Survey

In 2017 the Government Equality Office launched the National LGBT Survey. This was the largest survey of LGBT (in)equalities ever conducted – not just in the UK, but the world. A total of 108,100 valid responses were recieved, of whom approximately 14,000 were trans (which also makes it the largest ever survey of trans people in the UK by an astonishing margin). Credit for this is due to the civil servants who quietly pushed through its implementation at a time of political turmoil and reshuffles in the wake of the general election, as well as the LGBTQIA+ organisations who promoted it extensively.

An initial research summary report was published on Tuesday. This provides a basic account of the research findings. The full research report was released late on Wednesday. This huge document provides a far deeper and more extensive look at the survey results. However, there is such an enormous amount of data available that researchers will probably be analysing the findings for years to come.

The timing of these publications is not a coincidence. The research included questions about gender recognition; the findings demonstrated a strong demand for reform from the trans population, with negligible opposition to proposals from cis respondents. The Government will therefore use this to back their attempt to reform the GRA.

You can read the reports of the LGBT Survey here (along with various data annexes).

You can read my initial reflections on the summary report in this Twitter thread.


LGBT Action Plan

In response to the findings of the LGBT Survey, the UK Government has produced a 75-point Action Plan. This describes the actions they propose to take to promote LGBT equality, which include drafting new laws, producing new policy and guidance, and ringfencing money from the Government Equality Office budget for carrying out equalities work.

It’s very easy to be cynical about “action plans” such as these, but they can actually have a real impact. For example, the Coalition Government’s 2011 Transgender Action Plan was widely regarded as useless by trans activists in following years, but (as I show in my research) its requirement for the implementation of new gender identity service protocols by April 2013 helped bring about important improvements in NHS England gender clinics. This included an end to the requirement for a local mental health assessment prior to a gender clinic referral, which reduced the number of waiting lists that transitioning patients have to endure.

The legislative centrepieces of the Action Plan are the proposed reform of the Gender Recognition Act, and a proposed ban on conversion therapy. Both potentially represent important steps forward for the law, but would also require relatively minimal action from the Government to tackle pressing issues highlighted elsewhere in the survey data (such as the enormous economic inequality experienced by LGBTQIA+ people). There are, of course, matters which weren’t asked about in the survey either, such as the UK’s treatment of LGBTQIA+ migrants and asylum seekers.

Therefore, in addition to holding the Government to account for implementing the LGBT Action Plan, we need to continue campaigning on matters such as austerity, immigration rights and the provision of public services.

You can read the LGBT Action Plan here.


Memorandum of Understanding on Conversion Therapy

On Wednesday afternoon I attended the formal launch of an effective ban on conversion or reparative therapy that has been agreed upon by the UK’s major professional bodies for therapists, counsellors, psychologists and psychiatrists. This is a really big deal because it represents an attempt to stamp out practices that aim to “cure” or “convert” a person’s gender identity or sexual orientation.

The Memorandum of Understanding was originally agreed upon in 2016. This document only addressed LGB conversion therapy. but (following a series of careful meetings and difficult negotiations) an updated version was published in 2017, which explicitly addressed conversion therapy targeting people on the grounds of gender identity. This was effectively a “soft launch”, ensuring that the document was made available to those who needed it.

Today “officially” launched the document in the House of Commons, with numerous MPs and representatives of religious and therapeutic organisations present. The idea was to promote the Memorandum of Understanding more actively, and draw attention to the issue of conversion therapy among all of these groups.

I was not very much involved in the drafting of the Memorandum of Understanding, but did attend one of the early meetings that discussed how it might be extended to ensure asexual and trans inclusion. At this meeting we struggled with the lack of formal evidence that trans people in particular were undergoing conversion therapy, although I supported others in arguing that the prevalence of deeply concerning anecdotal accounts alone necessitated action.

By coincidence(?) today’s formal launch event coincided with yesterday’s publication of the first ever statistics on LGBTQIA+ conversion therapy in the UK, as part of the LGBT Survey summary report. These figures are stark: 5% of respondents reported being offered conversion therapy, and 2% underwent it. That might sound like a small figure, but given the enormous response to the survey, what it means is that thousands of vulnerable LGBTQIA+ people have experienced these damaging practices in the UK. Worryingly, the survey also shows that young people continue to experience conversion therapy, and that the situation is more severe for trans people. Around 10% of trans respondents reported having been offered conversion therapy, and 4% stated that the had been subject to it.

Dr Igi/Lyndsey Moon from the Coalition Against Conversion Therapy, who played a key role in ensuring that the document was updated to include trans people, spoke passionately at the event. In addition to talking through some of the above figures, they also argued that simply attempting to “ban” conversion therapy may not result in the change we need to see. What needs to happen now is the long, hard work of cultural change – both within religious organisations, and within healthcare services.

You can read the Memorandum of Understanding on Conversion Therapy here.
Edit: I updated this post on the morning of Thursday 5th July to include a link to the full research report, which is now also available.

Ethical guidance on studying trans health, for researchers and ethics boards

I recently co-authored an article on research ethics for the journal Transgender Health. It’s based on an extensive review of literature on the topic, and written by an international team of scholars and health practitioners with extensive experience of conducting research in this field.

Transgender Health is an open access journal, so the article is freely available for anyone to read and share.

I’ve copied the abstract out below: please click on the title for full access.


Guidance and Ethical Considerations for Undertaking Transgender Health Research and Institutional Review Boards Adjudicating this Research

The purpose of this review is to create a set of provisional criteria for Institutional Review Boards (IRBs) to refer to when assessing the ethical orientation of transgender health research proposals. We began by searching for literature on this topic using databases and the reference lists of key articles, resulting in a preliminary set of criteria. We then collaborated to develop the following nine guidelines:

(1) Whenever possible, research should be grounded, from inception to dissemination, in a meaningful collaboration with community stakeholders;

(2) language and framing of transgender health research should be non-stigmatizing;

(3) research should be disseminated back to the community;

(4) the diversity of the transgender and gender diverse (TGGD) community should be accurately reflected and sensitively reflected;

(5) informed consent must be meaningful, without coercion or undue influence;

(6) the protection of participant confidentiality should be paramount;

(7) alternative consent procedures should be considered for TGGD minors;

(8) research should align with current professional standards that refute conversion, reorientation, or reparative therapy; and

(9) IRBs should guard against the temptation to avoid, limit, or delay research on this subject.

Of conduct and controversy: trans health activism at EPATH

Here in the UK, health is a key priority for many trans activists. While progress is sometimes painfully slow, numerous debates, protests and consultations have informed gradual change within a range of healthcare settings, and a growing number of health professionals are prepared to actively support trans peoples’ access to affirmative care. However, discussion of trans healthcare in the UK has remained focused largely on the specifics of the UK context, even as important events that influence gender identity services in particular are increasingly taking place on the world stage.

In this post, I look at recent activism at “PATH” (Professional Association for Transgender Health) conferences in Amsterdam and Los Angeles, as background to unfolding events at this week’s EPATH conference in Belgrade.


WPATH Symposium 2016

Last year I wrote briefly about international activism taking place at the World Professional Association for Transgender Health (WPATH) symposium in Amsterdam, the Netherlands. This included two unofficial fringe events: a Global Action for Trans* Equality (GATE) pre-conference, organised primarily by trans activists from the Global South, and the FreePATHH event, run by Dutch trans people living locally who couldn’t afford to attend the expensive WPATH event.

I myself experienced the WPATH symposium as exhausting, inspiring and frustrating. A myriad of positions on trans health care represented amongst the researchers, practitioners and activists present at the event, which is as it should be at any good conference. However, amongst the thought-provoking and challenging interventions, and numerous examples of progressive approaches and good practice, I also found myself overwhelmed by microaggressions from cis attendees, and thrown by the cognitive dissonance of experiences such as emerging from a session on trans-affirmative care only to find myself attempting to retain a professional demeanour whilst walking past individuas such as Kenneth Zucker. Zucker has been accused of subjecting gender questioning children to reparative therapy, and will also be known to UK readers for his participation in a recent BBC documentary (“Transgender Kids: Who Knows Best?”), to which Trans Media Watch responded with an extensively researched letter of complaint.

It was in this context that numerous interventions – both formal and informal – were organised by trans attendees at WPATH. GATE held sessions on depathologisation for trans and intersex people. FreePATHH created a range of notes with “free advice for better transgender care”, which were distributed in a social area for conference attendees to read. Someone gender-neutralised the (binary gendered) toilets with holographic signs. I also heard informally about South African trans women confronting a racist presenter on a panel.

ClTZLM9VEAASI-e.jpg large

In this way, the WPATH symposium felt like a sometimes discouraging, sometimes productive site for real debate and contestation, both professional and political. My impression was that the the interventions that took place there would probably have a gradual impact on how trans health is understand and practised in the years of come, particularly following the creation of TPATH, a group for trans people working in trans health.  What I didn’t realise was the extent to which events would accelerate in the coming months.


USPATH Conference 2017

In February the first USPATH (United States Professional Association for Transgender Health) conference took place in Los Angeles, USA. At this event, tensions over the place of pathologising forms of care in general – and Kenneth Zucker’s ideas and practices in particular – came to a head.

In a Twitter thread written during the event, health researcher Zoé Samudzi describes how a number of academics and health practitioners, led by trans women of colour, spoke out against the inclusion of Zucker on the conference programme. One session (the first of two at which Zucker was due to speak) was briefly interrupted by an impromptu speech and later quietly picketed, after which hotel security threatened to call the police on a number of attendees.

The next day, community representatives – again led by trans women of colour – met with USPATH and WPATH organisers to read a list of demands. In the wake of this intervention, Zucker’s second talk was cancelled, and a formal apology for the initial heavy-handed response to protesters was posted to the WPATH website. This post, which also promised action to better involve trans communities in general and trans people of colour in particular in the work of WPATH, was removed from the website just two weeks later.


EPATH Conference 2017

Today (6th April) the EPATH (European Professional Association for Transgender Health) conference will begin in Belgrade, Serbia. This event is likely to be a somewhat more conservative affair than the USPATH conference due to disciplinary differences between trans health practitioners in the US and Europe: however, like the WPATH symposium, the conference programme incorporates a wide range of perspectives.

There will once again be an associated FreePATHH event on Saturday 8th/Sunday 9th, which is being organised by Serbian trans activists in collaboration with some of the Dutch individuals behind last year’s FreePATHH. It will include free talks and panels on trans and intersex issues in the former Yugoslav region, as well as arts performances and a football match. At the EPATH conference itself, TPATH will have a presence, seeking to bring together trans people working in the field.

One point of potential contention at EPATH is a code of conduct which has been drawn up for the event. In many ways, this document reflects standard conference etiquette, through (for instance) condemning individual harassment of attendees. However, there are also a number of points that appear to have been written specifically in response to recent events.

We expect all conference participants to be respectful in person and online towards other delegates, speakers, organisers, staff and volunteers.

We are committed to providing a harassment-free conference and training experience for everyone, regardless of gender, gender identity and expression, sexual orientation, disability, physical appearance, body size, race, or religion.  Harassment of participants, speakers, staff or volunteers in any form will not be tolerated.

 Harassment includes offensive verbal comments, and other forms of using disrespectful and pathologising language inconsistent with human rights standards, deliberate intimidation, stalking, following, harassing, photography or recording without explicit consent, sustained disruption of talks or other events, inappropriate physical contact, and unwelcome sexual attention. Conference participants asked to stop any harassing behaviour are expected to comply immediately.

Upon reading the code of conduct, I was immediately reminded of accounts written by trans woman who have accused controversial practitioners of inappropriately photographing them at past events. This is particularly interesting given that he’s been confirmed to speak at the conference. The reference to “pathologising language” also appears to be a nod to some of the practices at previous conferences that have distressed trans attendees.

However, the question remains about what counts as “offensive verbal comments”, “sustained disruption of talks or events”, or “recording without consent”. If a similarly filmed disruptive event occurs at EPATH as took place at USPATH, it could conceivably be framed as “harassing behaviour” within the context of the of the code of conduct, leading to protesters being ejected from the event. This is concerning because the participation of controversial clinicians such as Zucker is typically defended on the grounds of enabling “free speech” within the context of the conference: however, on these grounds, we might expect that conference attendees wishing to peaceably protest or strongly critique bad science might also be afforded freedom of speech.

I won’t be attending EPATH myself this year; like the FreePATH attendees, I simply can’t afford the expensive conference fees. However, I will be following events with great interest, and encourage other non-attendees with a personal or professional interest in trans health and/or trans activism to do the same.

Some tips on opposing Kenneth Zucker’s new article on trans children

This morning it came to my attention that notorious child psychologist Kenneth Zucker has co-written a chapter on trans issues for the new (6th) edition of Rutter’s Child and Adolescent Psychiatry. The chapter, entitled “Gender dysphoria and paraphilic sexual disorders” effectively draws upon flawed and outdated research to promote reparative therapy for trans children. You can read most of it via Google Books here.

Cover of Rutter's Child and Adolescent Psychiatry

Abusing children – for science!

This is a big deal because Zucker draws upon harmful theories (including Ray Blanchard’s deeply reductive typology of transsexualism) to promote the idea that issues faced by gender variant children are due to a problem with the child, rather than societal gender norms. He therefore promotes a form of treatment that (to quote his new article) encourages parents to “set limits with regard to cross-gender behaviour, and encourage same-sex peer relations and gender-typical activities” in an attempt to cure them of difference. This is the kind of treatment that leads children to internalise the idea that non-normative gendered expression is shameful or wrong.

Rutter’s Child and Adolescent Psychiatry, meanwhile, is a widely-used textbook and can be found in university libraries and on reading lists in many countries.

I’m not sure what the best way is to stop this article from influencing practice. However, some ideas could include:

  • Write to professional organisations and ask them to explicitly oppose reparative therapy for trans youth
  • Write to University libraries and courses, asking them to consider sticking with the 5th edition of Rutter’s
  • Write to University departments and ask them to teach critical texts alongside the 6th edition of Rutter’s, and/or avoid putting the new edition on reading lists
  • Borrow the book from a local library if it becomes available, and write critical comments in the margins
  • Write to the book’s editors and/or publisher and question why Zucker has been given a platform for his outdated ideas
  • Comment on this post and/or join this new Facebook page to discuss possible ways forward.

The new edition isn’t yet widely available in libraries, so now is a good time to act.

If you’re writing letters or raising awareness of this as an issue, here is some useful information on opposing the article:

  • Zucker’s approach to treatment can seriously harm children
  • Zucker’s Gender Identity Service at the Toronto-based Centre for Addiction and Mental Health was recently suspended pending investigation in the wake of a large number of complaints – his approach to treatment is now also arguably illegal in the province of Ontario
  • Zucker’s new article represents poor academic practice. He cites himself 17 times, relies upon papers at least 20 years out-of-date to make many of his arguments, and also draws strong inferences from statistically insignificant quantitative findings
  • Zucker’s considerable academic position is based in part upon a small “invisible college” of academics who regularly peer-review and cite one another, thereby gaining many publications with a high profile whilst avoiding external criticism
  • There is a considerable evidence-based case to be made against Blanchard’s work. See for instance “The Case Against Autogynephilia“, a peer reviewed article by Julia Serano.

Thanks and respect to Peter Le C for raising awareness of this issue, and to oatc for suggested edits.

Psychiatrists plan transphobic conference

The Royal College of Psychiatrists’ Gay and Lesbian Special Interest Group (an organisation clearly well-qualified to meddle in trans affairs) are planning a delightful meeting in London next month.

Described as an “extremely stimulating meeting exploring the most recent academic, clinical and contemporary thinking on transgender issues, for all people interested in this field, Transgender: Time to Change will include contributions from a number of disturbingly transphobic speakers.

Let’s have a look at the programme for the day, shall we?

A meeting organised by the
Royal College of Psychiatrists’
Gay and Lesbian Special Interest Group
Friday 20th May, 2011
15 Belgrave Square, London SW1X 8PG

9.30am Registration

10.00am Morning session: Chair: Professor Michael King

10.10am Dr Domenico Di Ceglie: From Disorder to Diversity: Current views and controversies in the management of Gender Identity Disorder in Young People

10.45am Ms Julie Bindel There is no such a thing as a real woman (or a real man, for what matters). A feminist perspective on Gender Identity Disorder

11.20am Ms Christina Richards: Trans: What the empirical literature tells us

11.55am Discussion

12.30pm Lunch

13.15pm Afternoon session: Chair: Shawn Mitchell

13.20pm Dr James Barrett: Disorders of Gender Identity – what works

14.00pm Dr Az Hakeem: Deconstructing Gender and Parallel Processes: Features specific to a Specialist Transgender Psychotherapy Service

14.40pm Panel discussion – all speakers

15.15pm Finish

15.30 – 16.15pm GLBSIG AGM – all welcome

My, what a line-up. Where to begin?

The most obviously questionable speaker is Julie Bindel, a woman with a long history of transphobia. Bindel makes it her mission to subject trans people in general – and trans women in particular – to the very same treatment that she (rightly) decries as sexism when it is aimed at cis women. She has consistently argued against the provision of medical treatment for transsexed individuals. She has threatened to sue trans individuals and feminist organisations that dare condemn her damaging actions. What the hell gives her the right to comment on the psychiatric treatment of trans people?

However, Natacha Kennedy rightly points out that Dr Az Hakeem is considerably more dangerous. He runs a “specialist psychotherapy service for patients with transgender and other gender identity disorders” (source) at the Portman Clinic, meaning that he has a great deal of power over trans patients. Let’s have a look at what he has to say about us:

“The experience of many psychiatrists, psychoanalysts and psychotherapists working with transsexual patients is that they are individuals who, for complex reasons, need to escape from an intolerable psychological reality into a more comfortable fantasy. By attempting to live as a member of the opposite sex, they try to avoid internal conflict, which may otherwise prove to be too distressing.”

Regarding Hakeem’s approach to trans research, Kennedy points out:

There is so much wrong with Hakeem’s 2010 paper in which he claims to be able to ‘cure’ trans people it is hard to know where to begin. These kind of claims have been repeated throughout the chequered history of psychiatric engagement with trans people. His kind of treatment “talking therapies” as Julie Bindel calls them, “reparative therapy” being one of the many euphemisms employed by the “treatment has also been tried on gays and lesbians and been shown to fail, causing only feelings of trauma, guilt and suicidal tendencies.

His paper makes assertions for which he provides no evidence and his methods, selection of research participants and the nature of their participation in the study appear to be opaque in extreme. In addition there is no mention of research ethics which are particularly important when one is publishing research about individuals with whom one has a professional-client relationship.

Gosh. I’m sure glad this man is going to be sharing a platform with Bindel.

Who else do we have? Ah yes, Dr Domenico Di Ceglie. The conference blurb points out that he works for the Tavistock Clinic, a service that offers approximately sod all a very limited “service” for trans children and adolescents. Contacts of mine who have attended this clinic explain that therapists have patronised them, steered the conversation away from any real discussion of gender, and refused to offer treatment. Realistically, hormones are banned until you’re 18 for the vast majority of trans teens in the UK. Looks like you’re doing a sterling job, doctor!

James Barrett is a controversial fellow, to say the least. He’s deeply unpopular with some of his patients at Charing Cross, whilst others like him. He’s provided a great deal of help to many, but is a bit obsessed with the idea that people need to be in employment or education in order to earn treatment. He has been known to block treatment for individuals who have disabilities that prevent them from working.

Finally, we have Christina Richards, another Charing Cross psych. Shockingly, Christina brings the number of trans people speaking at this conference up to a grand total of one.

As a community, we shouldn’t simply let this pass. Most of these speakers aren’t just dodgy, they’re downright dangerous. We need to be asking the Royal College of Psychiatrists’ Gay and Lesbian Special Interest Group what the heck they think they’re doing, raising awareness of this travesty in the LGBT media, and if necessary picketing the meeting. If we let this go without a fuss then the vile propaganda of individuals such as Hakeem and Bindel will only spread unchecked.