Conversion therapy is harmful and shouldn’t inform NHS practice. This shouldn’t be controversial, but sadly in the UK conversive approaches are now mainstream.
A new article just published today shines an important lived-experience perspective on some old clinical literature.
by Jayne McFadyen, Timothy W Jones, Rowena Koek, Fintan Harte, Brendan Jansen, Megan Galbally, Warren Kealy‐Bateman, Catherine Wall, Quinnehtukqut McLamore and Anja Ravine
In this short blog I will briefly discuss this new article, and its place in modern healthcare policy in the UK. First a bit of background.
Kosky (1987)
The new article published today presents a lived experience critique of an old 1987 article:
Kosky (1987) Gender disordered children: Does inpatient treatment help?
The abstract to that 1987 article states:
“Treatment guide-lines for gender-disturbed children currently are unclear. This clinical report describes eight children with cross-gender behaviour who were treated in an inpatient unit for children. The short-term outcome and long-term clinical observations are provided, which indicate a generally good outcome. The findings may have both practical and theoretical significance because they suggest that some gender disorders may be determined by intrafamilial interactions which are correctable“.
You might not be familiar with that article. But if you have been paying attention to discourse on trans youth healthcare you will be familiar with a 2016 literature review that included the Kosky article.
Ristori and Steensma (2016) Gender dysphoria in childhood
This literature review is an absolute favourite of transphobes, and has been the key citation to justify terrible healthcare policy that has harmed trans children for the past decade. It is the key citation used to legitimse the idea of ‘desistance’ or the concept that trans children will grow out of being trans, as long as they are rejected rather than affirmed or allowed to socially transition, as long as they are forced through an unwanted puberty rather than receiving affirmative healthcare. It is a key citation supporting policy recommendations against social transition. It is a key citation supporting the rejection of trans children’s identities at school. It is a key citation given to parents of trans children to encourage them to reject their children. It is a key citation underpinning the claim that puberty blockers are dangerous and should be banned due to their impact on changing the trajectory of sexual and gender identity development. It is a mainstay of anti-trans policy making, and a key citation of the Cass Review.
The Cass Review utilises a 2016 literature review as a key citation, to avoid citing the underpinning literature, the titles of which would raise concerns. The Commission on Human Medicine adopts the same tactic, citing an even more modern literature review by Michael Biggs, that does the exact same thing, using a modern ‘literature review’ to rebrand and present as modern a literature review of some really old and problematic studies.
If we look at the studies upon which the 2016 Ristori and Steensma literature review is based, we see just how old those studies actually are:
Bakwin (1968) Lebovitz (1972) Money & Russo (1979) Zuger (1984) Davenport (1986) Green (1987) and Kosky (1987)
These studies are HUGELY unethical trash, that should have been in the bin decades ago, as I’ve written about before here, here and here. Even looking at their titles shows a pathologising view of difference.
The new study that has been published today focuses on the last of these, Kosky (1987) “Gender-disordered children: Does inpatient treatment help”.
Kosky (1987)
The study Kosky 1987 provides a clinical perspective on the treatment of gender non-conforming children in and around the year 1975.
In 1975, Jayne McFadyen (a key author of the new article published today) was ten years old. She had known she was a girl since the age of 8, but lived in a time and a place where affirmation or being supported to be a trans girl was not considered an option by the professionals around her. Clinicians blamed her parents for causing her gender non-conformity, and took her away from them, putting her into an institution where she would be treated to convert her into a gender confirming boy.
Within the 1987 article, the clinicians in charge of ‘conversion therapy’ outline the success of their approach.
Many decades later, Jayne recognised her experience, the location and dates of her own experience as lining up with the 1987 article. But she did not recognise the article’s central claim that the therapy had been beneficial and successful. She felt very strongly the opposite.
Now in her 60s, Jayne shared with a team of researchers her own perspective on her conversion therapy treatment at the age of 10, as well as sharing her own clinical file and notes that she was able to access. She recalls being shamed, abused and traumatised in attempts to wipe out her gender non-conformity.
According to the Kosky study, the institutionalisation, separation from parents, and abusive treatment was a success, removing gender non-conformity. The Kosky study has been used for decades, and continues to be cited today, to justify several claims:
- It is used to evidence a claim that a majority of gender non-conforming children, if unsupported/rejected, will not be gender non-conforming or trans as adults.
- It is used to evidence a claim that parental influence can cause a child to be gender non-conforming, and that separation from parental influence can remove gender non-conformity or transness.
- It is used to evidence a claim that that therapy can remove a child’s transness, gender non-conformity or gender confusion.
The new article examines this woman’s memories and her clinical records, comparing these with the claims within the published study. Important differences are noted. Substantial ethical failings are noted, both in terms of clinical practice and in terms of research. The woman shares her life experience – the impact of the ‘treatment’ in creating and reinforcing shame and self-hate. The ‘treatment’ forced her, through fear, into repression and hiding. She reflects on how it took her decades to process the impact of the childhood abuse that she received at the age of ten – abuse that is claimed as a success in the Kosky study. She shares how in mid adulthood she finally transitioned. Now in her 60s, half a century on from her institutionalisation at the age of 10 in 1975, she reflects on the harms done to her as a child. She shares her perspective, how her identity as a girl and woman has not wavered since she recalled feeling that way at the age of 8.
The new article argues that this 1987 publication “should not be considered reputable evidence in any debate over transgender policies — either by direct or indirect citation”.
It notes, however, that this article is indeed being used as evidence upon which healthcare policy is based in 2025. It notes it being used indirectly, via the 2016 literature review, by the Cass Review. It notes it being used by anti-trans parent organisations like Bayswater, by those advocating for conversion practices, and by those who accuse parents of ‘transing’ their children.
This article continues to be used, directly or indirectly, by actors including the NHS to justify plainly bad policy positions including:
- To justify restrictions on, or criminalisation of puberty blockers, on the basis that gender non-conforming kids naturally grew out of their gender non-conformity, before puberty blockers changed the outcome, unnaturally keeping kids on a trans pathway.
- To justify restrictions on social transition, including in schools, on the basis that unsupported children grew out of gender non-conformity
- To justify advising parents against supporting a trans child, on the basis that unsupported children grew out of gender non-conformity
- To justify safeguarding investigations into supportive parents of trans kids, on the assumption that parental action can cause a child to be mistakenly trans
- To justify in-depth questioning of trans kids without their parent present, on the assumption that parental action can cause a child to be mistakenly trans
- To justify denying the existence of trans children, replacing that group as a whole with the term ‘gender questioning children’, on the assumption that childhood gender variance is temporary, unstable and will be grown out of as long as it is not affirmed.
- To justify prolonged non-affirmation or rejection of a trans child’s identity, on the assumption that affirmation puts children on a lifelong medicalised pathway who would otherwise grow out of it.
The seven bullet points listed above are having a huge impact on trans children across the UK in 2025. Each one of them is so absurd to almost be laughable. Each one of them is having a cruel and abusive negative impact on trans children’s lives.
This abusive 1987 study was considered a terrible study on which to base modern healthcare policy even before this new lived-experience critique. This lived-experience critique adds further weight to a long-stated argument that these old abusive studies should have no influence over healthcare policy in 2025. Studies like the 2024 Cass Review, like the 2024 Commission on Human Medicine report that enabled the continued criminalisation of puberty blockers, continue to rely on literature reviews of very old and abusive research to justify harmful trans-hostile policy positions, while ignoring modern research that overwhelmingly supports affirmative care. This decision to ignore modern literature and rely on trans hostile literature summaries of old and abusive literature is entirely political and ideological.
The new article summarises its key finding thus:
“Contrary to ongoing representations of efficacy, “therapy” that aimed to change or suppress a gender diverse child served to delay self-acceptance for two decades and caused long term harm”.
The NHS already know this.
Those opposed to or ideologically in denial of trans children’s existence will continue to apply conversive approaches to trans children regardless.
The Cass Review, and UK NHS policy remains rigidly committed to doing everything it can to harm trans children. For more on this, I strongly recommend reading another article, also out today.
Growing Up Transgender 