transgender

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Conference report: International Trans Studies Conference, Day 1

REPENT.

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.

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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.

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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.

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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.

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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.

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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.

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Podcast: Reviewing the Cass Review

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.

More information on the topic is available in my post What’s wrong with the Cass Review?

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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.

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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.

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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/ ↩︎