International Trans Studies Conference, Day 3: getting emotional with political economy

This is the third in a series of blog posts about the 2nd International Trans Studies Conference in Evanston (4-7 September 2024).


Read Part 1 here.
Read Part 2 here.

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 with trans flag and text that says: read and submit your favourite texts for free. Visit www.transreads.org.
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!

Returning home for Bath Pride

This year saw the city of Bath’s first ever Pride march. It felt long overdue, but also an unthinkable impossibility come to life.

Photo of Bath Pride march


I was born and grew up in Bath, before moving to Coventry for university. While some of my friends were eager to leave Bath for more exciting places, I loved the city deeply – and still do.

I was very ambivalent about moving. Growing up on the outskirts, I felt deeply connected to the landscape: the hills, the woods, the little hidden valleys and streams. Meanwhile, Bath’s deep human history felt ever-present as I dodged tourists in the Georgian streets, sauntered past the Roman Baths, and climbed past Iron Age fortifications on Solsbury Hill. As a teenager, I went to grunge gigs in listed buildings, and wandered down country lanes to parties in distant farm fields.

I have written a few times recently about some of my experiences as a young queer person in Bath. These were the last days of Section 28. My school was a hotbed of homophobia, and I lived in a void of information. In many ways, I felt so incredibly, utterly isolated. At the same time, I received invaluable support at a very vulnerable time in my life: from friends who had my back unconditionally as I came out as trans and bisexual, from teachers who found quiet ways to support me, and from Off The Record‘s free counselling service for young people,. Bath is home to small-town conservative values but also has a strong liberal streak, and this complexity really was reflected in my experiences.

I didn’t really know what Pride was, what Pride was for until years after I left my childhood home. It wasn’t until I was a young adult that I really gained an understanding of queer community, of the healing power of both protest and celebration, and of the sheer joy of mass togetherness. That wasn’t ever something that felt conceivable for me in Bath, let alone possible.

But of course, as I grew older and changed, so did Bath.

Photo of Ruth posing with a street sign for Gay's Hill, and a placard reading Ban Wes Streeting.


Just like every other part of the UK, more and more young people in Bath came out as lesbian, gay, bi, trans, queer, and/or asexual. Off The Record started up a dedicated LGBTQ+ youth group. In the mid-2010s, Bath had first a gay mayor and later a gay MP. From 2015, students at Bath Spa University organised their own Pride events, and in 2016, Bath Amnesty marked Pride month with a stall. In 2017, a Pride procession block joined the Bath Carnival.

I was nevertheless pretty surprised to see the first major, dedicated Bath Pride celebrations planned for this summer, on Sunday 18 August. For this to happen, you needed a critical mass of dedicated organisers, volunteers, and community members prepared to come together and make it happen. You needed enough people prepared to assemble and loudly celebrate and protest at a time of rising hatred and violence towards us. You needed to take all of this and put it on the streets of city known for its architecture, parks, and landscape, rather than any kind of political organising or protest culture.

So I returned home, to be a part of it.

Photo of four happy people at Pride.


Bath Pride was gentle, Bath Pride was beautiful, and Bath Pride was powerful. Bath Pride was a family picnic in the grounds of the Holburne Museum, a club night at Komedia, and a thousand people marching through the streets to demand our liberation.

Bath Pride was about community. I have so much respect for how much the organisers centred this in everything they did. There were no corporate floats, no major brands, no prioritising of some queer people over others. Most of the people in the march were just ordinary individuals, out solo or with their partners or friends. There was also a significant presence from groups including a local church, the city’s roller derby league, and the LGBTQ+ staff group from the Royal United Hospital. My mum volunteered as a steward.

Bath Pride was radical. It had never been done like this before, and it was done so well. While the overwhelming vibe was one of joy and celebration, this was very much a protest. Home-made placards abounded. NHS staff pointedly wore pro-trans t-shirts. A tall person with a stylish mustache wearing a cowboy hat, open pink cropped jacket and pink shorts waved a Palestinian flag in solidarity with the people of Gaza. This Pride was very Bath, but it was also about moving beyond tolerance, arguing for real liberation in a way that challenged the city’s cosy liberal consensus.

On some streets, people stood and waved or even joined in, with the march swelling as it went. On others, especially in busy shopping areas, I was reminded of the tension and threat inherent in Trans Pride, with confused or hostile looks directed our way. We were challenging people: with loud disco music, with political slogans, with our insistent presence. In the context of Bath’s politely commercial street culture, even thoroughly overbaked chants such as “trans rights are human rights” took on a new resonance. At a time when the NHS, schools, and new Labour government are actively attacking young trans people’s basic access to healthcare, education, and any level of personal autonomy, this kind of visibility couldn’t be more important.


After the march, my partner and I wandered the Holburne grounds. We admired stalls for local queer crafts, as well as community groups such as Bath Welcomes Refugees, The Diversity Trust, B&NES Fostering, and… Off The Record. I took the time to thank the people on this stall for the support I received from their organisation 20 years ago, and learned about what they are doing to support young people today.

And then we left the city centre – walking up Gay’s Hill, before taking time for a drink and apple pie at the Fairfield Arms. The pub, which has been run by a gay couple for many years now, was full of local people enjoying a Sunday roast or just hanging out in the pub garden. We had a chat with one of the landlords, who said he was a bit sad to miss the Pride event, but the weekend was always a busy time for them.

Queer lives are weaved through the very fabric of the city of Bath. We are always and have always been everywhere, quietly getting on with our day to day. But we also deserve love, recognition, community, and visibility on our own terms. That’s why Pride is so important.


Information on supporting or donating to Bath Pride, to ensure independent, and community-centred future events, can be found here.

Amplify trans youth

This morning I logged into instagram and watched, transfixed in amazement and worry, as a young person scaled the walls of the Department for Education.

The aspiring spiderman is part of the activist group Trans Kids Deserve Better. At the time of writing they are staging a multi-day protest at the Department for Education building in London, for the right to a safe and inclusive education.

Watching the video, I fear for Squirrel, the anonymous activist who is genuinely risking their life to stop government employees from taking the group’s banner. It’s very apparent that Squirrel is a skilled climber who knows what they are doing – equally, one wrong move could result in a deadly drop to the concrete pavement. This is not safe.

But of course, the entire reason this protest is happening is because young trans people are not safe.

Trans Kids Deserve Better launched their campaign for youth autonomy, safety, respect, and inclusion in July, from a dramatically high ledge of an NHS England building. In an interview with Jess O’Thompson for Trans Writes, the emergency doctor and children’s TV presenter Dr Ronx Ikharia argued that “our young people deserve better than suffering, and shouldn’t be scaling walls”. But they added that for this to happen, trans kids must be “believed, supported, affirmed, and loved”.

And this is the crux of the issue. Under the Conservative and Labour governments, we have seen a policy environment in which teachers, doctors, therapists and parents are actively discouraged or prevented from believing, supporting, affirming, or loving young trans people. Instead, families face prison sentences for supporting young people’s continued access to medication, NHS England is expanding the provision of state-funded conversion clinics, and a growing number of schools are refusing to allow even the discussion of trans experiences.

Trans kids are not safe because they have been entirely failed by the adult world. They have been failed by politicians, failed by civil servants, failed by the NHS, failed by the voluntary sector, failed by researchers, and in many cases also failed by their doctors, teachers, and parents or carers. This is why the activists from Trans Kids Deserve Better are literally scaling walls in their fight for an actual future.

Looking at the challenges facing young trans people, it can be easy to lose hope. But the actions of Trans Kids Deserve Better show that there is a better way. Doomerism helps nobody. The successes of successive liberation struggles have come about because people have continually dared to believe that a better world is possible, and fight for it. The young people currently sat outside the Department of Education are not bemoaning what they have lost: they are insistently demanding change.

Image from Trans Kids Deserve Better

What can we do? In their conversation with O’Thompson, activists from Trans Kids Deserve Better explained that while trans adults often want to “protect” trans youth, they would rather we “amplify” them: “we don’t need sympathy, we need support”. This is a call to action, with a focus on solidarity, rather than trying to speak for young people or bemoan their situation.

Many adult trans people and allies have complained about the lack of mainstream media coverage for the actions of Trans Kids Deserve Better. But we should not simply wait for the papers or news programmes to start caring. It’s up to us to talk about what’s happening. Today’s queer and trans communities only exist at scale because we made our own media, told our own stories, and forced the mainstream to catch up.

So I encourage everyone who reads this to share the story of what is happening. Share it on social media, share it with friends and family, share it in conversations at work and in bars and in cafes and in parks and at gigs and festivals. A few days ago I was at a pub in Bath, fresh from Pride, still holding a placard that read “Ban Wes Streeting” (copied shamelessly from someone else in Glasgow a couple of weeks prior). Someone asked what Wes Streeting had done, so I told her. She was appalled, but grateful to have learned what is happening, and better informed to act. Information spreads when we spread information.

Trans Kids Deserve Better are also hoping that more people will contribute to their actions. You can sign up as a supporter, stay updated from their Instagram account, or contribute to their fundraiser.

If you, like me, would rather not see young people risking life and limb by climbing public buildings, it is time to fight with them, not “for” them. Together we can build a safer world.

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

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

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

Screenshot of Scientific American website.

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

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

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

New article: Trans Birth Parents’ Experiences of Domestic Violence

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 Project took 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.

Read now for free:
Trans Birth Parents’ Experiences of Domestic Violence
Conditional Affirmation, Cisgenderist Coercion, and the Transformative Potential of Perinatal Care

by Ruth Pearce, Carla Pfeffer, Damien W Riggs, Francis Ray White, and Sally Hines


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.

Journal logo

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.

Trans Kids Deserve Better – protest at NHS HQ

Young trans people have been leading an incredible protest at Wellington House, the London headquarters of NHS England. They have been holding space on a ledge of the front facade since London Pride on Saturday 29 June.

The protesters will be coming down today (Tuesday 2 July) and have called for supporters in London to join them at a rally from 4pm.

Photo of a group of people sitting on a ledge of a building, with towering pillars and glass windows behind them. They are holding a large banner which reads "We are not pawns for your politics". They have decorated with the windows of the building with trans flags, placards, and the words "trans kids deserve better".


The action powerfully highlights the repeated failure of UK politicians, the mainstream media, and NHS bodies to truly listen to young trans people about their experiences and needs. This is perhaps most powerfully seen in the Cass Review, which has systematically excluded expertise and evidence from trans people in formulating its recommendations, and in trans healthcare bans implemented for under-18s in England in Scotland. Meanwhile, the Labour party are promising to uphold these bans and implement a range of deeply transphobic policies should they win the election on 4 July.

These concerns are powerfully highlights by the protesters themselves. In Diva, a 17 year old activist explains:

“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. 

In every other way I am trusted when I tell people what I want to do with my life. But not now. There is so much real anger out there and we hope our actions will encourage others to fight for a voice, and the healthcare and dignity that we are currently denied.”

Another protester explained to Pink News:

“We are staging this protest to remind politicians and voters that we’re real kids, not just political talking points. We may not have a vote, but it is our lives that are at stake. Gender-affirming healthcare is a matter of life and death for us and we hope our actions will bring awareness to this fact and encourage others to fight for the healthcare and dignity we are so shamefully denied.”

As a former youth activist working in this field for almost two years now, I am hugely heartened and inspired by this powerful protest. In the face of institutionalised violence and silencing, young trans people are seizing the narrative. It is up to us adults to listen, learn, and fight alongside them.

New article: “Child rights in trans healthcare”

Image of the cover for the International Journal of Transgender Health

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

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

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

The article can be read for free here.

CDJ publishes historic issue on Queer and Trans Community Building in India

Cross-posted from the CDJ Plus blog.

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.

Cover of the Community Development Journal


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.

The editorial for the issue is free for anyone to read, as is Anannya Dasgupta’s article Queerious communities: building writing centres in Indian universities. The remainder of the issue is available to all individuals and institutions who subscribe to CDJ.

My speech on the Cass Review and Scotland’s trans healthcare ban (with footnotes!)

This post shares a video and transcript of my speech at the emergency demonstration in George Square, Glasgow, on 18 April 2024, against the decision from NHS Greater Glasgow and Clyde to ban endocrine treatments for trans people aged under 18. The speech was unplanned and made without notes, so I have made some small corrections in the transcript, plus minor amendments for clarity. I have also added references for some key points. Thank you to @transprotestglasgow for the video.

Readers seeking more detailed evidence and academic critiques may find my previous blog post helpful: What’s wrong with the Cass Review?

TRANSCRIPT

Hi, I’m Ruth Pearce.

I’m a Lecturer in Community Development at the University of Glasgow, and I’m a researcher on trans healthcare.

And I was a trans child.

I want to talk about that for a moment. Because I came out to myself circa 2001, when I was 15, when not many people did that. And it was hard for us. And there was trans community, and there was information, but it was very difficult because we felt very, very alone. I was mostly only able to connect with other trans people my age through the internet, through blogs, and they were mostly Americans. The Brits were there; a lot of us connected later as we grew older. But we were so isolated.

A really important thing to remember, in a moment like this where we are seeing a return to the kind of medical policies that were in place when I was a kid: there are so many more of us, and we are so much more powerful than we have ever been.1 Never forget that strength we have together.

One of the things Hilary Cass says in her report is that the meaning of the word “trans” has changed since 2020.2 She says, and there is no evidence for this, that “trans” in 2020 meant something quite rigid and specific, and only now in 2024 it’s become an umbrella term for lots of identities. Tell that to me coming out as a trans teenager in 2001!

So here’s the thing. We’ve always been here, and we are more powerful now, but we are seeing this backlash. That’s been a long time coming and transphobia changes its face over time. One of the things I wanted to do to deal with my loneliness and the experiences I had was that I wanted to become an activist. And when I started doing activism, when I got into meetings with people in government, and with the Equality and Human Rights Commission, they said “there’s no evidence” for the discrimination we faced. So I was like, “fine: let’s see what evidence I can find”.

So I did a PhD in trans healthcare.3 And I found what you often find when you do research; you often find things you don’t expect. So I did find some things I expected to find. About waiting lists and how hard they are. About how hard appointments can be when you’re meeting with sexist and transphobic clinicians who are asking you, as a young person, how you masturbate and who you’re attracted to. But what I didn’t expect was the sheer level of pain from the waiting. And I talk about that in my work. And the anticipation, where we are anticipating all the time. When is it going to happen? When are we going to get to live our lives? And that happens on every level of our lives.

I was also shocked by the level, and detail, and complexity of the ignorance of healthcare practitioners. It ranges: it’s not just that they all hate us, right? It’s that some people are trying to control us, some people want to help but don’t understand how, and some people don’t want to know. There’s different kinds of ignorance.4

So I published my work, and other people have followed. Other people were there before me of course, because “trans” was not new, and trans research wasn’t new either. There is now a lot of published research on what it is like to go through a gender clinic, and what it is like for a young person to go through a gender clinic. There’s people like Cal Horton5 and Natacha Kennedy6 who are writing on this, and Harvey Humphrey7 who works here in Glasgow. There’s a lot of people doing work on this.

We are saying, time and time again, “we need services that meet our needs”. For some people, that is access to puberty blockers, and that is access to hormones. For other people, that is access to counselling, and therapy, and community support. What we call “trans-affirmative” or “gender-affirmative” care is flexibility, meeting a person where they are at, and based on what they want to do with their lives.8 You don’t have to change your body – but you can.

It’s our body, it’s our right: we can do what we want with our own bodies.

This is what is disgusting about the decision by NHS Greater Glasgow and Clyde. They have not addressed the years and years of mistreatment and abuse in their child and adolescent clinic at Sandyford. It is not a great place that we are trying to save. It is a clinic that has repeatedly refused to treat young people, and made people hold on for care. It has helped a handful of people. Dozens of people – only dozens – have accessed treatment in the last few years.9 Now they are proposing to stop doing the very little they are doing to support young trans people.

People who get a referral to a child and adolescent gender clinic are not necessarily seeking access to counselling and therapy, because you can get that elsewhere.10 They are not seeking access to community, because you will find no community at Sandyford. They are most likely seeking access to endocrine treatments: puberty blockers and hormone therapy. And that’s what they are going to stop doing.

Sandyford say they are still accepting new referrals. But what is the point of a gender clinic that does not offer people medical treatment?

NHS Greater Glasgow and Clyde have based their decision on the final report of the Cass Review. Let’s talk a bit about the Cass Review.

I’m an academic researcher. If the Cass Review was submitted by an undergraduate student, the first thing I would say is: “That’s nearly 400 pages long! No-one’s going to have time to mark that”.11 And you’ll notice that all the people in the media, all the Labour politicians, all the Tory politicians, all the people saying we should immediately implement the findings of the report: none of them read nearly 400 pages in one day. Neither did the journalists at the BBC, the Telegraph, the Times, the Daily Mail, the Observer, the Independent. We expect better! And now the Scottish media: it’s all over the Scotsman, the National, the Herald. None of them have bothered to read the report, or think about it critically.

So here’s a bit of information about the Cass Review. The Cass Review was undertaken by a group of people who, from the very start, excluded trans people from oversight of the project. That was in their terms of reference.12 They didn’t want people who had experienced services having a formal part in the report. They excluded healthcare experts. If you were someone who had worked in a gender clinic you were excluded from being part of that.13 You know, I have lots of disagreements with many people who work in gender clinics, but you would have thought they might get a say.

You can see that ignorance, that intentional ignorance, playing out in the final report of the Cass Review. You can see, if you read the Cass report, that they looked at over 100 studies, most of which show that puberty blockers and hormone therapy can help young trans people. And they just ignored them.14 Intentionally. They say that the majority were not “high quality evidence”.15

What else is not high-quality evidence in healthcare? Paracetamol for back pain.16 There is no high quality evidence for that, in the terms of the Cass Review. Anti-psychotics.17 ADHD medication.18 All these medications that are in regular use. You know what else? Puberty blockers for young people with precocious puberty – if they’re cis.19 That is direct discrimination. 20

The thing is, that’s the Cass Review being serious. Let’s think about when it gets weird.

There’s a graph in there, where they show referrals to a gender clinic (the Gender Identity and Development Service in England) rising year on year, with “an exponential rise in 2014”. But they cut the graph off at 2017. But if you look at 2017-2020 the referral rate flattens off. It’s deliberate removal of evidence.21

We know why this is happening. Experts – medical experts, and experts by experience have been cut out of the Cass Review process. If you are trans, that’s you. You are an expert by experience. You know what it’s like. We have been cut out the process!

And the NHS have done that here in Scotland. There was no consultation on the ban that’s come in.

Who did they consult? We know there are people who are proponents of conversion therapy who were on the Cass Review team.22 That is what they are proposing.

They are proposing conversion therapy. Not just for trans kids, because they want to deal with all gender-questioning and non-conforming kids. This is going to be conversion therapy for queer kids. Little boys who want to wear a dress, they might not be trans, but they deserve to have the space to explore. That is not going to be what happens in clinics where people are referred which are being informed by conversion therapists.23

So consequently you have other weird stuff in the Cass Review. They’re dismissing all the evidence about why puberty blockers and hormones can benefit people within particular contexts, but they’re relying on other evidence for their recommendations. Let me give you one citation. “Thoughts on Things and Stuff, 2023”. That is a citation from the Cass Review: Thoughts on Things and Stuff.24

What is “Thoughts on Things and Stuff”? It’s a right-wing Youtube channel run by anti-trans bigots,25 featuring contributors such as “Gays Against Groomers”.26 This is the level of evidence that is informing NHS Greater Glasgow and Clyde.

And I’ll tell you what else is in the Cass report. They say that little girls are likely biologically inclined to play with dolls. It’s right in there, in the Cass report.27 And little boys are probably biologically inclined to play with trucks. Why is this? It’s not just an anti-trans agenda. It’s an anti-feminist agenda. Its an anti-woman agenda.

Why is this happening? It’s happening because trans people are an easy target.

If you want to stop young people accessing contraception as teenagers, you remove trans people’s right to consent to care as young people. If you want to prevent young people – teenage girls – from having abortions, and you’re failing time and time again in the courts, you instead target puberty blockers, because that way you can set a precedent for preventing people from being able to make decisions as young people. You are undermining the idea that young people might have the capacity to consent to care and make an informed decision about their own bodies.28

So I will end on this. I’m a woman, I’m a trans person, and I think it’s really important we think about allies. I had the parent of a trans child contact me and say, “thank you for being an ally”. I want to think her for being an ally. The thing about allies is, we talk a lot about an “ally” being someone who supports somebody else. But no: allies are people who stand by each other and work together.

That’s why we need a trans feminist movement. A trans feminist movements gives people autonomy over their own bodies, space to make their own decisions, and enables people to stand together when we are all at risk.

So I’ll leave you with a chant I want to hear more of at protests:

“Trans rights, women’s rights: one struggle, one fight”.

FOOTNOTES

  1. My statement here is intended to highlight that more people are out as trans than ever before. Contrary to narratives of “social contagion”, there have always been people with gender diverse or sex nonconforming experiences. What has changed is that there is greater access to information and community, which makes it easier for people to come out. ↩︎
  2. “During the lifetime of the Review, the term trans has moved from being a quite narrow definition to being applied as an umbrella term to a broader spectrum of gender diversity. This clearly has implications for conceptualisations of detransition” (Cass et al., 2024, p.187). This claim is demonstrably false, as “trans” (and before that, “transgender”) has been used as an umbrella term for decades. This is shown in my own previous work as well as writing dating back to at least the 1980s by individuals such as Leslie Feinberg. ↩︎
  3. https://wrap.warwick.ac.uk/88285/ ↩︎
  4. For an excellent, more recent and more detailed analysis on this topic in the context of trans youth healthcare, see Magdalena Mikulak’s (2021) article “For whom is ignorance bliss? Ignorance, its functions and transformative potential in trans health“. ↩︎
  5. https://growinguptransgender.com/evidence/ ↩︎
  6. https://www.gold.ac.uk/educational-studies/staff/kennedy-natasha/ ↩︎
  7. https://www.gla.ac.uk/schools/socialpolitical/staff/harveyhumphrey/ ↩︎
  8. “Our stance, as gender-affirming practitioners, is that children should be helped to live as they are most comfortable. For a gender-nonconforming child, determining what is most comfortable is often a fluid process, and can modify over time. Therefore, in a gender affirmative model, gender identity and expression are enabled to unfold over time, as a child matures, acknowledging and allowing for fluidity and change” (Hidalgo et al., 2013). ↩︎
  9. “Since 2018, around 1.77% of young people who are referred to the gender care services at Sandyford have gone on to be prescribed puberty blockers”: https://www.thenational.scot/news/24262271.many-young-people-scotland-given-puberty-blockers/. ↩︎
  10. Although in practice, trans people are often also turned away from mental health services due to “trans broken arm syndrome“. ↩︎
  11. In my original speech, I inaccurately stated that the report was “500 pages long”. However, my point about requiring time to carefully consider its contents remains. ↩︎
  12. “The original published Terms of Reference (ToR) for the Cass Review’s assurance group explicitly excluded trans expertise, stating that it “deliberately does not contain subject matter experts or people with lived experience of gender services” [Report 1, version 1]. The current (updated) assurance group ToR is worded less clearly, yet still conveys exclusion of those with expertise or lived experience, as such individuals would naturally be expected to have an interest in the outcome of the review” (Horton, 2024: p.7) ↩︎
  13. One former gender clinician was involved in the research process: Tilly Langton, formely of England’s Gender Identity Development Service (GIDS). Langton’s recent activities include promoting conversion therapy materials in training for NHS psychiatrists and lobbying Kemi Badenoch about the UK government’s conversion therapy ban, alongside proponents of conversion practices. ↩︎
  14. Hilary Cass has contested this claim in reporting for the BBC. Her argument is that of the 103 studies analysed for the review, 60% were included in the synthesis of evidence. However, my argument here is specifically that the findings of these papers were broadly ignored in the writing of the report’s recommendations, while less robust material was instead prioritised. As Simon Whitten argues, “The majority of moderate certainty studies were included in the results section but then arbitrarily ignored in the conclusion entirely”. ↩︎
  15. I have removed a statement I made about randomised control trials from the transcript here as my point was unclear and therefore potentially misleading (as can happen when you do an unplanned speech on a complex topic!) Unlike the Cass Review team, I am keen to correct my errors. See the links in the above footnotes above for more detailed information on inclusion/exclusion criteria for the Cass Review. ↩︎
  16. See e.g. https://www.nps.org.au/news/is-paracetamol-effective-for-low-back-pain. ↩︎
  17. The landscape of evidence anti-psychotics is a complex one. There is “high-quality” evidence that anti-psychotic drugs work better than placebos in addressing various conditions, but the evidence for use of multiple drugs, reducing or increasing doses at particular junctures in treatment, or taking one drug rather than another in treating specific conditions is often of a similar (or lower) quality than the evidence for benefits of endocrine interventions assessed by the Cass Review (see e.g. https://www.sciencedirect.com/science/article/pii/S0890856716319992). ↩︎
  18. Specifically in the long-term, see e.g.: https://www.nationalelfservice.net/mental-health/adhd/adhd-medications-effective-safe/. ↩︎
  19. https://onlinelibrary.wiley.com/doi/10.1111/cen.14410 ↩︎
  20. At this point, somebody stuck their hand up in the audience. I responded: “Someone stuck their hand up and might give me a footnote on that! I totally approve of that. I might invite you up later because I like evidence and I’m obsessed with it. [person indicates they were just waving to their friend, crowd laughs] Oh that’s grand! There we go, we haven’t even had a footnote.” Well, here is the footnote. ↩︎
  21. p.24 of the Cass Review final report. The rationale for this within the report is that the figure is adapted from a 2018 paper published in Archives of Sexual Behaviour. However, as Trans Actual observe: “The number of referrals to GIDS is known until 2020/21 […] the last 3 years for which data is available, shows that the number of referrals has recently plateaued. Such data is inconvenient for a narrative that relies on an inexplicable explosion in need[.]” ↩︎
  22. https://transsafety.network/posts/gender-exploratory-nhs-training/ ↩︎
  23. A historical example of treatment that “tries to make the child comfortable with the sex he or she was born with” within a gender clinic context can be found here: https://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences. ↩︎
  24. p.70, used to evidence the activities of GIDS’ research team at a WPATH conference. They could have instead cited the conference website. ↩︎
  25. A good summary of the channel can be found in this piece by What The Trans: “When citing a recording from the WPATH 2016 conference, Cass uses a YouTube channel called Thoughts on Things and Stuff. This appears to be the associated channel of a now-defunct blog largely focussed on criticising the Mormon Church. Why this was relevant to Cass is unclear, although titles of recent uploads at the time of the WPATH video include “Dr. Stephen Levine: 13 Untruths Behind Gender Affirmative Therapies for Kids” (Levine is an advisor to Genspect) and “Gays Against Groomers: stop the indoctrination and medicalization of children. 2023 Florida testimony.”, which perhaps provides a clue to how Hilary Cass ended up citing a channel with only 22.4K subscribers. It thus seems that, in addition to being advised by and networked with a variety of prominent anti-trans figures and organisations, Hilary Cass appears to be getting her professional news from homophobic and transphobic YouTube channels.”  ↩︎
  26. Anti-gay campaigners have long attempted to position LGBTIQ+ people as a danger to children. In recent years this tactic has seen a resurgence, through positioning trans and queer campaigners as “groomers”. GLAAD have described Gays Against Groomers as a group who intentionally use “ambiguous messaging about characterizing LGBTQ+ people as pedophiles falsely and maliciously with the absolutely clear intent of driving fear.” ↩︎
  27. pp.100-101 ↩︎
  28. https://transsafety.network/posts/bell-v-tavistock/ ↩︎

Merton Equality Conversation: 3 May 2024

This Friday I will be speaking in the TS Eliot Lecture Theatre at the University of Oxford for the annual Merton Equality Conversation.

Hosted by Merton College, the event is titled “The future of disability and gender: trans and disabled perspectives on healthcare and liberation“.

I’m very much looking forward to being in conversation with Jamie Hale, whose work I have admired from afar for some time!

You can book your place here.