In late November I attended the AUSPATH (Australian Association of Transgender Health) conference in Tasmania, Australia. I had been invited as the key-note speaker on the first full day of the conference, given a 50 minute slot (followed by 40 min panel discussion with head of WPATH and head of PATHA (New Zealand Association of Trans Health). The audience was 555 people invested in trans healthcare, mostly trans healthcare professionals and advocates from across Australia, with a 50+ contingent from New Zealand. For transparency, as an invited key-note speaker I had my travel and accommodation paid by Auspath – I did not receive any other payments. A few people have asked if I can share my presentation – it was not recorded but I have captured a lot of the presentation content here, a mixture of my notes and memories combined with some of my slides.

Hi everyone, I’m absolutely delighted and honoured to be here today. I’ve already learned a lot about Australia in just a few days – I’ve learnt what a drop bear is. I’ve understood that my taste in Australian beer (VBs) is apparently bogan.

My name is Dr Cal Horton, I’m a trans and non-binary researcher from the UK. I’m also a parent of a trans kid. Being an advocate for and parent of a trans kid is not a particularly great position at the moment in the UK, so I will ask for no photos today please. I am currently based at both Oxford Brookes University and University College London. I am actively looking for routes out of the UK for my family, so if anyone is looking to hire a researcher, get in touch. I have no declared conflicts of interest – big pharma hasn’t come knocking yet – any day now, I’m sure.

Before I begin my presentation, I want to start with a reflection on the time and place at which I’m talking. In terms of place, I want to acknowledge the Muwinina and Palawa people as the traditional owners of this Land. I recognise histories of violent colonialism and brutal dispossession, and pay my respect to Aboriginal Elders past and present across Lutruwita. Sovereignty was never ceded, this was and is Aboriginal land. In terms of time, I recognise that we are speaking following two years of live streamed genocide in Palestine. In the UK we have a long and brutal history of colonialism and violence against marginalised groups. I note that this year the Lemkin Institute for Genocide Prevention raised a red flag warning for risk of genocide for trans and intersex communities in the UK.

Today my presentation is going to focus on how we move from pathologisation and violence to autonomy and rights in trans healthcare, with a focus on trans children. I’m using the term trans child to refer to everyone under the age of 18, though will sometimes reference more specific terms like trans adolescents where relevant.

When I talk about why the UK is so bad for trans people, why it is so bad for trans children, and for trans children’s healthcare, it is important to talk about the three Ps. Firstly Prejudice. We have a situation where individuals holding acute prejudice about trans people are in positions of influence or leadership over trans children’s healthcare. We have individuals in charge of the new children’s gender service who have never even attended WPATH, yet who have found the time to attend events organised by misinformation groups recognised as anti-trans hate groups.

The second important P is Pathologisation. In the UK you never even here the term ‘trans child’ in our NHS. It is all ‘gender questioning children’ or ‘children distressed by their gender’, ignoring the reality that the major reason that trans children are stressed and distressed is because of the violent persecution they are facing, including from the NHS. The language in the UK always focuses on describing trans children in pathologising terms, describing them as a group that are “complex” with extensive “co-morbidities”.

The third P, that impacts on trans children’s oppression in the UK, is Power. The current situation for trans children in the UK, the current situation for trans people in the UK, is impacted by the systemic exclusion of trans people from positions of establishment power, across and beyond the NHS. In my work, understanding why everything is stacked against trans children, I’ve started to increasingly focus on the concept of cis-supremacy.

When I talk about why the UK is so bad for trans people, why it is so bad for trans children, and for trans children’s healthcare, it is important to talk about the three Ps. Firstly Prejudice. We have a situation where individuals holding acute prejudice about trans people are in positions of influence or leadership over trans children’s healthcare. We have individuals in charge of the new children’s gender service who have never even attended WPATH, yet who have found the time to attend events organised by misinformation groups recognised as anti-trans hate groups.

The second important P is Pathologisation. In the UK you never even here the term ‘trans child’ in our NHS. It is all ‘gender questioning children’ or ‘children distressed by their gender’, ignoring the reality that the major reason that trans children are stressed and distressed is because of the violent persecution they are facing, including from the NHS. The language in the UK always focuses on describing trans children in pathologising terms, describing them as a group that are “complex” with extensive “co-morbidities”.

The third P, that impacts on trans children’s oppression in the UK, is Power. The current situation for trans children in the UK, the current situation for trans people in the UK, is impacted by the systemic exclusion of trans people from positions of establishment power, across and beyond the NHS. In my work, understanding why everything is stacked against trans children, I’ve started to increasingly focus on the concept of cis-supremacy.

Thank you for listening.

My wider reflections on AUSPATH are available here:

Last week I had the huge privilege of being invited to give a keynote speech at this year’s Auspath (Australian association of transgender health) conference, held in Tasmania. I loved being at Auspath, met many awesome people, and enjoyed learning about Australian approaches and best practices, many of which I wish the UK would learn from. There were also a couple of things at Auspath that gave me pause. In this blog I’m going to briefly run through some of the things I liked best at Auspath, before a deeper dive into two areas of that left me thinking. I don’t claim to have all the answers, but am sharing my current thinking – I would love to hear other people’s takes, on their experience at Auspath, on their priorities for improving trans youth healthcare in Australia and beyond, and on their experience and perspectives on the two issues covered at the end of this blog.

Highlights

It was a rare joy to be around so many incredible people fighting hard for a positive future for trans kids. I really valued:

• Hearing so many clinicians speaking with genuine compassion and respect about trans lives. Even where I took issue with a minority of clinical approaches, the professionals I heard at Auspath clearly cared for trans youth, clearly had a base level of respect for trans lives, clearly wanted the best. It is a very different world from the UK where I can count on one hand the number of NHS professionals I’ve met who I’ve heard speak respectfully about trans kids. I’ve focused the latter sections of this blog on critique rather than praise, because pretty good shouldn’t be the bar – Australia has the potential to be world leading in trans youth healthcare.
• Hearing so many professionals, advocates, community members, parents, allies, speaking with determination about protecting trans kids and trans healthcare from the abuses spreading across the world.
• Hearing an impressive and eloquent young person speak about their experiences, including obstacles and barriers to equal access to healthcare.
• Hearing an impressive and eloquent parent share their experience on the difficult path advocating for a trans child in Australia.
• Learning about Country and first people’s knowledge and experience. It would have been good to hear more on the topic of first people’s experiences and priorities.
• Listening to a panel talk about the fight for trans kids in Queensland (I was crying through most of that panel).
• Feeling really welcomed at the conference, some many people came up to me with kind and friendly words, and I also felt very welcomed as a non-binary person in that space.
• Hearing a panel of young adults speak on their experience advising on trans health research projects, on the need to include young people who were unable to access paediatric services, the need to include rural youth, the need for fair pay, for both career development opportunities for those who are research inclined as well as keeping space for input from young people with no interest in working in research. The importance of disability justice informed approaches.
• Meeting young adults who are willing to challenge establishment status quo approaches. I think this is really valuable. So much cis-supremacy and cisnormativity operates through the maintenance of outdated systems and approach that we don’t even question. Having young people speak up and ask these questions is super important. One such question was ‘do we ever need to collect and report on data on assigned sex/gender?’. It’s a really good question. My current answer is ‘I don’t know, but certainly very significantly less than we do at present. This is definitely a question I will carry with me. I’m doing a new piece of research at the moment on non-binary adults and in that survey we are including a specific question ‘do you want to see results from this research broken down by assigned sex/gender?’, along with open text boxes for people to share their reason for or against. These answers should likely be context specific and driven by the information needs of the people whose data it is. Certainly we should have already moved away from the approach I still saw some places in Auspath where a person was introduced as ‘patient A – AFAB – identifies as a boy’.
• Meeting lots of awesome people from New Zealand, commiserating and strategizing on how to fight and support young people through state enforced discrimination.
• Meeting lots of healthcare providers working outside of specialist gender clinics, who are working to develop alternative routes to respectful and informed consent care. Many of these are currently supporting adults – with confidence and advice the same care can be extended to under 18s.   

There were two points in Auspath where I heard completely different messages from different people, and that relates to the two topics that I’d like to do a deeper dive into in this blog: MDT assessment and comprehensive bio-psychosocial assessment. Some people came up to me and expressed concern that such things were happening in the UK, and that we should fight them being introduced in Australia. Other people came up to me to share their knowledge of these practices being experienced by trans children in Australia.

In my presentation I spoke about the harms of excessive questioning of trans kids. In the UK this 100% comes from a position of bad faith. Clinicians are encouraged to ask hundreds of questions, with an intention of probing, prodding and undermining trans identities. At Auspath I did not hear any explicitly and intentionally bad faith or actively transphobic intent. I did however, from some clinicians, hear approaches that, whilst coming from a better place, constitute the same excessive questioning. In Australia this excessive questioning was sometimes marketed and justified as ‘adding value’. Even from some brief conversations with service users I heard people share stories of having experienced this ‘added value’ as harmful. I would really like to call attention to the over questioning of trans kids even in nominally affirmative services. Being trans is normal, and trans kids shouldn’t be faced with extensive additional healthcare questioning compared to their cis peers. Any systems that normalise asking additional bio-psycho-social questions of trans kids compared to what is standard for cis kids is a problem. And here, our base comparator should not be the among of questioning that is standard for cis kids who need psychiatrist or psychologist support – our comparator should be an average cis kid who is not under psychologist or psychiatrist led care. Simply being trans, or accessing trans healthcare, does not justify invasive and excessive psychology centred questioning – this approach is a legacy of pathologisation. Two phrases were heard at Auspath more than I would like: Multi-Disciplinary Team Assessment, and Comprehensive Bio-Psycho-Social Assessment.

Multi-Disciplinary Team Assessment

In the UK it is presumed that a trans child needs to be assessed by multiple different professionals, often including a psychologist, psychiatrist, paediatrician, social worker, and that is before assessments with an endocrinologist or fertility specialist. These multiple levels of assessment are abusive and excessive. At Auspath clinicians listed a dizzying array of different professionals being involved in MDT assessment of trans kids. In Spain, in the highly respected Transit service in Catalonia, trans kids see one medical professional, usually a GP. The GPs role is to support informed decision making by a trans young person (and their family depending on age), their role is not to assess and decide upon access to healthcare. In this Spanish service that one medical professional, that one GP, can provide healthcare, including endocrine care for trans adolescents, without input from additional professionals. They do still operate in what they describe as a multidisciplinary team, having different colleagues within their service. This multidisciplinary team allows the GP to offer access to different additional services, optionally, in an opt-in approach. Young people can ask to additionally see a psychologist. They can ask to see a social worker or family worker, to support with school for example. But these additional professionals are additional optional services, a trans young person does not have to see, and certainly does not have to be assessed by, a whole multidisciplinary team of different professionals.

At times in Australia it was unclear to me what different clinicians mean when they refer to multi-disciplinary team working. I hope Australian colleagues can consider and articulate where they are working within an MDT that offers optional opt-in access to a range of different professionals, without mandating that a trans child see an overwhelming range of different professionals. I hope clinicians can be clearer in whether their approach forces trans young people into running a gauntlet of different stages of assessment by a series of different professionals. I hope more attention can be drawn to the harms of forcing trans children through multi-professional assessments where additional professionals are not desired or needed. WPATH SOC 8 recommends an MDT assessment for trans adolescents – I hope Australia can be part of building an evidence base for a better approach in time for SOC9.

Comprehensive Bio-Psycho-Social Assessment.

This is a term that I find really triggering. In the UK this term is used to define practices that are pathologising, intrusive, uncomfortable, and harmful for a trans child. When I first heard this term from clinicians in Australia I assumed it meant something else here. I initially hoped that it was being used as a defensive practice, by clinicians under anti-trans pressure, who are keen to emphasise the thoroughness of their care, using this term as a fancy descriptor for actions that I, as a non-clinician, would describe as ‘having a chat’, or ‘getting to know your patient’. A good GP can ‘have a chat’ with a patient, and quickly find out some useful information about them to better help them understand, build rapport with, and support their patient. This can include some brief questions to understand their life circumstance, their family support, their strengths, supports, stresses or concerns. This can be done rapidly in a first appointment as a non-intrusive, flexible, patient-centred and low stakes chat. This should not be defined as a ‘comprehensive bio-psycho-social assessment’.

I was chatting to one clinician, who described taking notes during such a ‘getting to know you’ chat, with those notes not affecting care pathways but being taken primarily to enable quicker rapport building at the next appointment. I commented that I find it really uncomfortable to have clinicians take notes when I am asked questions about my life and circumstance. This is clearly linked to my own institutional trauma in unsafe healthcare settings where answers to these questions are definitely being judged by clinicians, where answers might end up in a non-consensual case study report, and where these notes do impact on your (or your child’s) access to care. It is important for good healthcare professionals to note how much institutional trauma and distrust many trans people, including trans kids, carry into the clinic. Even young people I met in Australia spoke at length of trauma experienced in encounters with various healthcare professionals who were there to judge and control.

I had initially hoped that references to ‘comprehensive bio-psycho-social assessment’ were just a sign of defensive practice. I was dismayed and at one point upset to hear that actual comprehensive bio-psycho-social assessments are still a core part of care in locations across Australia, particularly in trans children’s healthcare, particularly in services delivered by mental health professionals. I was disappointed to see reference to incredibly detailed family tree mapping, filled with details entirely unrelated to a child’s access to trans healthcare services. I was disappointed to see wide-ranging body mapping exercises, children asked to draw themselves, notes taken on left or right handedness, even assessments of pen grip. Many of these unnecessary and pathologising over-assessments were marketed and justified by professionals as ‘adding value’. If we are seeing a trans kids, we ‘might as well’ assess whether they are having trouble holding a pen. We might as well investigate their full family system for areas of family disfunction. We might as well screen for ADHD, autism, anxiety, anger issues, dyslexia, poor family functioning, disordered eating, sexual health support needs, bullying support needs etc etc.

The list of things we ‘might as well offer’ as ‘added value’ while we are here grows ever longer, especially in trans children’s healthcare. Some of this emphasis on ‘added value’ is perhaps a symptom of some professionals realising that the original reason for their role is outdated, pathologising and unneeded. But why are ‘added value’ assessments brought into trans children’s healthcare? Why are trans children’s healthcare assessments so broad, ill-defined, all encompassing? The answer lies in services that are struggling to adapt from a pathologising model of care.

In terms of unnecessary questioning added on to trans healthcare, I am perhaps least worried about short screening questions that are designed to triage young people to additional support services that might well be beneficial. Some trans kids might also want an ADHD assessment. Some might want support for anxiety. But even then I’d rather this was done transparently, optionally, and with patient consent ‘would you like to do a few additional questions to help us see whether you might benefit from our optional mental health or neurodivergence services including related to anxiety, ADHD, eating disorders etc. For triaging child developmental concern, this can be similar ‘while you are here, would you like us to check your/your child’s pen grip, for dyslexia etc’. This transparency is important as it helps service users understand and have trust in the process, while also letting them tell clinicians when ‘added value’ services are not need, are already being managed by other professionals or are not wanted at this specific time. Crowding all types of assessment into a trans health assessment makes these extra long and stressful.

Then there are areas of a comprehensive bio-psycho social assessment that are clear remnants of past pathologising models. Questions on childhood toys, friendships, family gender roles, sexuality of parent or child, and many other unnecessary questions are inappropriate. At the conference there was one exchange that was particularly noteworthy. A clinician commented that they always ask trans young people about their romantic relationships. They noted that young people commonly respond by querying ‘why are you asking this?’. They said that they then tend to respond ‘Because it helps remind me that you are a full human, more than just your gender/transness’ (I didn’t take live notes and won’t be getting the statement 100% accurate).

I had three reflections on this answer. Firstly, it is important to recognise power dynamics in a clinical encounter. It is hard for any service user to question the approach of their clinician. It is particularly hard in a trans healthcare appointment, and especially so for a child. If young people are questioning our approaches, we would do well to take this as a significant potential indicator of discomfort. It is really hard for a child to question an authority figure, especially one whose approval they need. If we are asking questions that young people indicate some level of discomfort with, if there is not a very strong clinical need, surely we should not be asking those questions.

Secondly, I note that the young person’s question ‘why are you asking this’ was not provided a satisfactory answer. Clincians should not need private information on trans people’s lives in order to remember that we are more than being trans. I don’t think the speaker realised the impact of their words on some trans people in that room. I left the room at that point. There is a long history of trans people, especially trans kids, being asked invasive questions for no reason other than to satisfy clinician curiosity. Curiosity driven questions are entirely inappropriate – we shouldn’t have to humanise ourselves in order to access healthcare.

Thirdly, sexual orientation and relationships questions are often asked without clear purpose. In the UK these questions are deemed necessary based on anti-trans fake theories of childhood transness being a reaction to homophobia or sexual abuse. In the UK’s puberty blocker trial these are also justified through inclusion of a criteria excluding youth with any judged potential for having unprotected sex from eligibility to access the trial.

In less transphobic services these questions are sometimes justified by reference to a need to screen for unmet sexual and reproductive health information and support needs. I would tend to agree that trans youth may have unmet sexual and reproductive health information and support needs. Schools, regular resources and parents may all be ill-equipped to provide trans-inclusive education. But screening for unmet sexual and reproductive health needs can be done transparently, intentionally, none creepily and with consent. It does not need to be untransparently sneaked into a wider trans healthcare assessment, where historically youth have been forced to answer unwanted and intrusive sexual questions driven by clinician curiosity or clinician ignorance, unrelated to screening for sexual and reproductive health services. I would suggest that asking a young trans adolescents about their sexual and romantic relationships or desires is rarely an effective strategy in building rapport. When asking potentially irrelevant questions that are likely to make a young person uncomfortable it is not sufficient to give them an option not to answer. Some questions should not be asked. I’ve accessed specific sexual and reproductive health services as an adult without being asked any of the type of personal questions that psychologists and psychiatrists sometimes feel entitled to ask of trans children.

I would strongly question the appropriateness of insisting on a comprehensive biopsychosocial assessment in trans youth healthcare. I would ask clinicians to document much more clearly the questions they are asking and the purpose or clinical need for each question. I would suggest tat rapport building questions should be short, comfortable, flexible and non-intrusive. I would suggest that ‘added-value’ screening questions to triage to additional support services should be transparent, opt-in areas of questioning, strongly delineated from what is being assessed.

I hope we can quickly evolve away from assessment-based models of care for trans children and young people. And while assessment remains, we all have a shared duty of care to reduce the exceptionally excessive breadth and depth of questions that have become wrapped up in a comprehensive biopsychosocial assessment. Professionals who are able to deliver effective rights-respecting healthcare to trans children and young people in Australia without invasive psychological and psychiatric assessment as standard, please can you more clearly communicate what questions are actually clinically necessary, whilst also documenting the questions that you consider not clinically valid. (I’m happy to anonymously share examples on my blog).

Trans healthcare is not a psychological or psychiatric treatment, and we need to move trans children significantly further from being in positions of psychology/psychiatry-centred questioning and assessment. I’m not against jobs for psychologists and psychiatrists – we can channel those existing resources into helping trans kids with anxiety and stress related to living in a trans-hostile world, and into treating the adults around them who fall into anti-trans radicalisation. Trans kids in rights-respecting healthcare services across different parts of the world receive trans healthcare without a comprehensive biopsychosocial assessment, and we can aspire to this across Australia.

Flight home

After Auspath I tagged on a few holiday days in Tasmania, seeing some beautiful landscapes and wildlife, an incredible experience. I’m writing this blog whilst rather sleep deprived and time-zone confused on a long flight back to the UK. In the two weeks I was away, the UK has completely removed protection for non-binary people (in a legal case that made absolutely no sense); the UK has banned trans girls (and trans women as leaders) from girl guides; and banned trans women from the Women’s Institute. These are all severe blows. Girl Guides has long been one of the best allies for trans girls – an organisation whose inclusive policy we have long pointed to when asking for schools or other organisations to choose equality and inclusion. Having them bow to transphobic pressure is a blow not only for the impact on Girl Guides, but for what this means for the whole state of inclusion of trans girls in UK society.

I have felt so much lighter and safer being in Australia and fly ‘home’ with significant trepidation and fear for the future. At least I am re-energised from feeling safe and hopeful through my days in Australia and at Auspath. But the fight goes on.

Thanks to anyone who got to the end of a very long blog!

In cross-national solidarity,

Cal

I keep coming across research, written by authors who are not non-binary, that includes the confident statement that a majority of non-binary people are not transgender, or that a majority of non-binary people are cisgender.

I will start by saying that identity is complex and personal and every individual can identify how they please. Naturally. Personally, I am trans and non-binary. I both identify as trans, and I also consider ‘trans’ as an umbrella term that has space underneath it to capture non-binary identities in general [whilst recognising that some non-binary people, just like some binary-oriented people of trans experience/history, don’t like to be called or recognise themselves as trans].

I personally feel stressed out and othered by language that defaults to ‘trans and non-binary people’ as though they are two distinct categories (I’m personally happier with a default assumption that the term trans will always include non-binary people, and where folks want to emphatically include non-binary people who reject trans as an umbrella I’m be ok with the cumbersome ‘trans and/or non-binary’. Of course humans are messy and no language will be perfect.

A conclusive and confident statement about a majority of non-binary people being cisgender always pushes me to ask the question – where is the data coming from?

In my personal experience, I’ve known many people who start out identifying as non-binary and ‘not trans’, who over time, embrace the umbrella label of trans [I’m not sure I’ve ever met anyone who has gone the other route]. I’ve known many non-binary people who initially feel that they cannot or must not take the label trans, that using such a label would be ‘appropriation’, if they have not medically transitioned enough, if they have not socially transitioned enough, if they have not suffered enough. With connections to trans communities I’ve known many such people come to adopt the label of trans. Whether an individual non-binary person finds meaning under the umbrella label trans is not a static binary and can change over time.

There is also a curious double standard in some surveys wherein non-binary people can be labelled as cis if they do not actively identify with the word trans, whereas trans is considered a default marker for binary-oriented trans people even if they do not personally identify with the term.

Lets look at the original report that is the root of the claim that a majority of non-binary people are cisgender and see whether there are any potential problems with that report.

It is a 2021 report titled “Nonbinary LGBTQ Adults in the United States“

It tells us confidently that “A greater percentage of nonbinary LGBTQ adults are cisgender rather than transgender”. I’ve seen this claim, that a majority of non-binary people are cisgender replicated in many publications.

There are several points to give us pause about the reliability of this claim.

Firstly the data comes from surveys conducted in the US in 2016-2018, that were designed in 2014. Identity language and knowledge amongst non-binary communities has been on a huge journey over the past decade. There are way more resources, groups and connections for non-binary people in 2025 than in 2016. Presuming that identity labels for non-binary people in the US in 2016 align with non-binary identity labels (worldwide!) in 2025 is a big assumption.

Secondly, the surveys from which this claim are drawn were not designed to find out whether non-binary people identify as trans, and were not designed, as far as I’m aware, in collaboration with non-binary authors. The summary report is from the Williams Institute, a research institute that has a history of being critiqued for some failings in the way it considers trans people’s data.

Take a look at this figure from the 2021 summary report and tell me if it might demonstrate some structural areas of ignorance or bias. As a non-binary reader this figure makes me dizzy. At best it begs some serious questions.

I tried to find out what was the underpinning data, what exact questions were people being asked in 2016 that led to the above diagram and it is rather complex and confusing.

The original sample comprised 1,369 LGB(T) people in 2016-2017 (people were asked if they were ‘lesbian, gay, bisexual, queer, or samegender loving’ and respondents needed to answer yes to be included).

This sample was filtered into two different surveys based responses to these two questions, designed in 2014:

1. On your original birth certificate was your sex assigned as male or female
2. Do you currently describe yourself as i) man, ii) woman or iii) transgender.

[In some versions of the survey a fourth option for part 2 was included “(iv) do not identify as female, male, or transgender”.]

Respondents who did not pick the option ‘transgender’ above were filtered into an LGB survey called the Generations study. It was presumed to be a study of cisgender people (though respondents were never asked if they identify as cisgender). (27 respondents who clicked man or woman rather than transgender in a way that did not match with their assigned sex were excluded from the Generations survey).

It is important to note that people only gain access to the Generations study if they click that their identity is ‘man’ or ‘woman’ in the initial filter question (making it harder to access, for say, non-binary people…).

The presumed cisgender participants of the Generations study are then asked about their gender identity:

“If you had to choose only one of the following terms, which best describes your current gender identity?” a) woman (744 answered this) b) man (665 answered this) c) non-binary/genderqueer (94 answered this). 15 did not respond.

Note none of these participants have been asked if they identify as cisgender, they are simply LGBT identifying participants who did not click on ‘transgender’ in the initial screening. These 94 people in the US are deemed to be ‘cisgender non-binary people’. This group of ‘non-binary/gender queer’ individuals are further sub-divided into those who are deemed ‘cisgender LB women’ and those who are deemed ‘cisgender GB men’ based on whether they had ticked man or woman in the very first question. All non-binary people must be a man or a woman.

People who clicked ‘transgender’ at the first question are steered to a separate survey called ‘transpop‘. Everyone in the second survey is classified as transgender, as they needed to specifically click the option ‘transgender’ for question one.

People in the transpop survey were asked about their ‘gender identity’.

They were asked two questions:

1. Which of the following terms best describes your gender identity? a) man, b) woman or c) genderqueer/non-binary.
2. Do you currently consider yourself a) man b) woman c) transgender.

If it seems that the questions options are confusing and non-logical, it is because they are confusing and non-logical.

Comparing the two surveys

1518 individuals completed phase one of the Generations survey, of whom 94 identified as non-binary. Only 274 people completed the transpop survey across all waves of that survey, of whom 76 identified as non-binary. The total number of those deemed cisgender non-binary men and cisgender non-binary women in the Generations survey (=96) was greater than the number of non-binary people in the transpop survey (=74). This leads to the confident conclusion that ‘a majority of non-binary people are cisgender. Despite not one non-binary person having been asked ‘are you cisgender’? Despite no questions that specifically recognise a non-binary person’s identity before asking whether the word transgender or trans as an identity term or an umbrella term is meaningful to them.

I do not find the above reliable or (globally) meaningful for providing insight into non-binary populations in 2025.

Overall

This survey from 2016-2017, designed in 2014, makes a range of questionable choices. I don’t think anyone would argue that these choices stand up in 2025 as a useful way of collecting information about trans and non-binary populations.

Most importantly, it never specifically asks non-binary people ‘do you identify as transgender yes or no’. ‘do you identify as cisgender yes or no’, or the question ‘do you feel comfortable defining your non-binary identity under a broader umbrella as trans’.

There are plenty of non-binary people who may not specifically identify with the word trans as a key self-descriptor, who nevertheless are happy under a broad ‘trans umbrella’.

It is a double standard to define all binary trans people as ‘trans’ based on e.g. identification as a man while having assigned gender female even if that individual does not personally ‘identify as’ trans, but limiting non-binary transness to only those who ‘identify as’ trans.

Overall I think identity and labels are messy, binaries are often false.

I do not think any of the above is a robust basis on which to make confident claims that ‘a majority of non-binary people are cisgender’.

Could we, maybe, actually ask non-binary people what we actually think?

Could we stop relying on surveys such as this deeply flawed 2021 Williams Institute survey for understanding non-binary lives?

Are we sure?

Today EHRC released its consultation on the segregation of trans people.

There seems to be general trans community momentum behind an assumption that we want to get as many people as possible to respond to this consultation.

I just want to ask…. Are we sure?

1. Clarity of segregation

The consultation is not a consultation on whether trans people should be segregated. It is a consultation on whether the recommendations are clear enough.

Imagine the recommendation was “police should shoot trans people in the head”.

A consultation on ‘clarity’ would quibble with what do we mean by shoot, does a cross bow count. What do we mean by head – is a grazing wound sufficient or is a kill shot needed.

A consultation on clarity of discrimination gives no space to consider whether the recommendations are i) legal ii) fair and just and in keeping with equality and decency and what we expect from a modern society.

• 2. EHRC is in charge

The EHRC will write up the findings (or they will be written up by a consultant following the terms set by EHRC).

There is no way of winning this.

There is no way of submitting in a format that will lead to the EHRC saying that the consultation declared segregation a bad idea.

At best it will lead to tweaks in the wording to make it clearer how and when we are to be segregated.

We can add all the protests, all the pleas for human decency, all the testimony of real world harms we are already experiencing to the submissions. It will count for nothing.

The consultation results will be written up in the way that suits EHRC.

It will either say that the guidance is clear, or it will provide suggestions on how to clarify it further.

All other content that does not relate to clarity will simply be discarded.

It will never result in a report saying that the guidance is out of keeping with human rights and unpopular with public opinion

• 3. Popularity contests are a losing battle

Even if the EHRC were willing to capture the number of positive endorsements of their guidance versus the number of criticisms, it will never present this as public support for or against the guidance.

The EHRC are in charge of the process.

If there are a majority of positive endorsements of segregation, then this might make it into the EHRC summary.

If there are a majority of criticisms of segregation, this will never make it into the EHRC summary. They will focus purely on the questions asked, the percentage of respondents who felt the guidance was a) clear b) not clear.

We cannot win by playing this game

• 4. The stakes are high

Trans people (myself included) are bloody worn out. Panic attacks are common. People are afraid.

People want to do something, whilst working with very little spare energy

I looked at the consultation briefly today.

It felt like an actual kick in the stomach to read it.
It is very long and confusing – it would take me days to properly process it and formulate a response, and I’m an academic used to analysising such stuff

But more importantly – it felt like an actual kick in the gut to read it.

It has already caused me harm.

Do we really want to ask all of our trans friends to do this?

Knowing what it costs us? Even to read the detailed EHRC documents is a tick in the teeth – reading how the powerful plan to discriminate against us is not a neutral pastime.

I think very carefully before sharing anything written by hate groups – let alone asking people to read hate group material.

This material will traumatise some readers. It has left me in tears this afternoon.

I don’t know why we’d ask our community to go and read that – to feel compelled and threatened into going to read that to protect their safety – when the consultation is not going to be the thing that leads to a life of safety.

The potential benefits of community-wide filling in of this consultation are infinitesimally tiny.

Do we also really want to ask our allies to do this?   

Knowing that most allies will do very little, and if they do this then they will tick off their trans activism badge for the year – is this the single best use of ally time?

Of course we can stream line the process – providing simple guidance etc. But even engaging with the consultation questionnaire is overwhelming and stressful and made me feel afraid and disempowered.

Do we want everyone feeling further afraid and disempowered?

Can we guarentee that the costs are worth the benefits?

• 5. Charity momentum

In the UK the ‘trans community’ is very disjointed. There are not any clear mechanisms for actually inputting into decisions on how ‘we’ should proceed.

Instead we tend to have ‘leadership’ from trans charities.

If trans charities say we should participate in a consultation, folks tend to follow on,

If trans charities produce guidance, folks tend to think they should participate.

But

I’ve worked in a lot of charities.

I know how they function.

Responding to a government consultation is a very core part of being a charity

It feels like an achievement.

A box gets ticked. It goes on an annual report to supporters and trustees

Leadership may ask junior staff to do the consultation response, on an assumption that of course a major trans charity will respond to a government consultation with relevance for their members.

A charity might well get criticised if they do not respond.

And once a charity decides to respond, well, it’s only kind to provide clear guidance for other community members to be able to respond.

And thus charities push the trans community into participation in yet another consultation in which there is no trans power, no trans accountability.

They push us into a game we literally cannot win.

A lot of UK trans charities collaborated for many years with the Cass Review process.

They were used by Cass.

Their collaboration was used to justify the legitimacy of the process – a process that it was clear from the very start was illegitimate.

I have not seen one of them publicly reflect upon that collaboration, publicly learn lessons about how trans participation in government ‘consultation’, time after time, is used to legitimise things that should hold no legitimacy.

• 7. Boycott is an option

I never hear proper discussion of an organised boycott of such things.

Why not?

If we cannot win. If we are guaranteed to lose – why play their game at all?

Especially when playing is deeply harmful to our well-being.

Why not stand back and clearly say as a community:

Trans segregation is wrong.

We are not interested in unpicking the clarity of the terms under which we are segregated.

We refuse to be segregated.

We refuse to engage with processes led by those who hate us.

We refuse hate and fascism.

We refuse.

• 8. Better uses of our time

Amongst trans communities spirits are low and there are a lot of very significant challenges we face.

Why is this consultation a good use of any of our time?

I would love to say to the trans people in my life – do yourself a favour – skip this consultation.

I particularly don’t want the young trans people who I know to pour their heart out in submissions on the impact of this guidance on their life – in a consultation where that type of testimony will be ignored.

I would argue we are much better off focusing on legal challenges – arguments that the guidance and the Supreme Court is breaking international and national law.

I would argue we are much better off focusing on justice and equality and basic decency related arguments, writing public blogs and articles on how the guidance harms us, spending our limited time talking to our MPs, campaigning for actual justice, talking to our communities on the harms of segregation, supporting our trans children to get through the next months, finding the optimism that we and they need, advocating for their rights at school.

Keeping the focus of our efforts not on telling EHRC on the clarity through which we are segregated, but on maintaining our own wellbeing and self-esteem, refusing to play their game.

I also think refusal at this point, and refusal in solidarity would be a powerful message and example to underpin the wider refusals that need to continue.

Through refusal we underpin that we do not accept the terms by which they want to rule our world. We show and practice defiance that we are not going to disappear.

I’ve lost energy to finish this blog coherently.

Everything in life takes energy.

There is so much to be done.

Above all we need to look after ourselves and our community

Asking for the community to spend time on this consultation seems like voluntarily smashing ourselves in the face with a brick. It will harm us. It will not harm those who are trying to harm us.

I don’t know everything.

I only know I have now done 20 such consultations and every single one led to either no change or to a roll back in rights.

And this consultation seems more hopeless than every one of those.

I will go with the collective wisdom, including from those who are wiser than me. But before we all agree to collectively participate in – and to ask our friends and allies to at scale participate in – the consultation – can we at least ask:   

Are we sure?