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?

(or why I won’t be responding to another government consultation on trans healthcare).

Just weeks after having submitted an invited response (invited as an academic expert) to a government consultation on making a legal ban on puberty blockers permanent, ANOTHER government consultation on trans healthcare has today been launched.

This one is on adult trans healthcare services. There are many reasons to approach this consultation with concern. The consultation itself provides a link to the incredibly biased and prejudice-ladden letter from Dr Cass which is a driver of this current review.

I cannot even remember how many government consultations related to trans rights or trans healthcare I have completed over the past 8 years. It is far far far beyond a joke.

And each public consultation takes the same form. The new NHS adults services consultation even provides a link to an analysis and summary of responses to the 2017 consultation. Reading the executive summary of that analysis is very telling and illustrative of the problem. In the 2017 consultation, responses were divided into three groupings:

• Current, former or prospective user of gender identity services (30.15% of respondents)
• Individual member of the public (26.8% of respondents)
• Clinician (16.75% of respondents)

The 2017 consultation responses summarises very succinctly the differences between these responses (worth reading on pages 2-6). In short, the current and former users of gender identity services provided detailed and meaningful suggestions on how services could be reformed and improved. Clinician respondents, who were, mostly GPs, broadly didn’t know what to do with trans people and didn’t want to have responsibility. Members of the public felt being trans was a mental disorder and wanted services to be made significantly worse for trans people. The consultation presented all of these contrasting views, with the views of actual trans people in one grouping (glossing over nuances in actual recommendations re different ways of improving trans health), while views that were ambivalent or fundamentally opposed to trans well-being and healthcare rights were given equal weighting to those of actual service users.

This pattern has then repeated time and time again since 2017.

This pattern will be repeated in this new NHS consultation. Although now the anti-trans lobby is much more organised and assertive, so I expect even more volume of anti-trans submission, including from transphobic clinicians and medical professionals, and including from those purporting to be prospective service users (or concerned family members of service users).

This pattern of public consultation for minoritized healthcare is extremely abusive.

Every consultation response is a huge amount of effort to do well. It is a significant extraction of labour from already exhausted trans people, including from those of us who are called to respond as trans-supportive researchers or on behalf of civil society.

It is abusive to ask us for consultation after consultation after consultation. Every single one we respond defensively, knowing that the purpose of the consultation is not to improve services and respect rights, but to justify an ever further roll back of those rights, and ever more severe degredation of those services.

It is abusive to ask trans folks to engage in yet another consultation where the views of those fundamentally bigoted about trans existence are given equal weight.

It is abusive full stop.

This particular consultation is where I personally draw a line. It is not acceptable.

I expect adults trans healthcare will be made worse in the coming years, building upon Cass. I expect this public consultation, including the thousands of responses from profoundly anti-trans individuals and lobby groups, will be used to justify that degregation of essential healthcare. To justify the inclusion of ever greater rights violations in our healthcare. To justify ever greater encroach into the reasons to deny care to those of us who are the wrong kind of trans.

Esteemed trans healthcare scholar Dr Ruth Pearce wrote all the way back in 2018 (about another consultation on trans health conducted about us yet without us), that “we respond not with hope or optimism, but in fear. This is the power you wield over us”.

Over the past years I have responded to more government consultations on trans topics than I can count. Every single submission I have written, not out of hope, but out of fear. Out of a feeling of responsibility to use my relative privilege to at least try and change the outcomes, to raise my voice to highlight the current injustices and the harms of abusive practice.

But we are clearly not being listened to. Time and time again we are not being listened to.

How long do we keep collaborating in the same pattern. How long do we keep gas-lighting ourselves?

Today I’m saying no.

I refuse to remain in any part of this extremely abusive relationship.

I refuse out of principle to engage in any way with a consultation that is equally interested in the views of non-service users, that does not have really basic ethical commitments to trans depathologisation, dignity and healthcare rights, that does not have trans leadership and trans power at its centre.

I refuse to respond defensively while having zero hope that my words and my time are going to change the outcome. In this case, as before, I fundamentally don’t believe my inputs will in any way change the outcome. Quite the opposite – I believe my words and my submission, alongside those of others submitted and hard-worked-on out of a feeling of responsibility to our communities, will provide the government/NHS with a veneer of respectability, that they asked and listened to all views.

Listening to all views is not good enough. I literally cannot stomach another consultation that will be written up as “here’s what trans people want, however here’s what doctors and members of the public want, so we are therefore going to make trans healthcare worse”. It is not good enough. I am out.

I’m not saying that stepping out of this consultation will be enough to change the outcome. I’m not saying there is a clear path to trans justice.

But I’m at least not going to waste my time on another heartless and fundamentally flawed process.

Today I will choose to do something better with my time.

I hope we can at some point be more coordinated and demanding, standing together in solidarity and power, saying we will not engage with processes that are fundamentally dehumanising and abusive. Most folks I know right now are too worn down by all the loses, by all the pain, by all the energy expended on heartless consultations, to have the energy and reserves to try and take back any power.

Maybe that is one of the ways forward. For now we take time, we rest, we refuse to respond defensively, we let go of the fleeting hope that our submission will be enough to change power structures that continue to inflict harm after harm.

We focus our time and energy on ways to keep ourselves and those who are suffering afloat through these tough times.

We state clearly and in unison that when the government and the NHS decide they believe in our humanity, when they have an ounce of care for justice and equality, when they recognise that anti-trans views are not welcome in consultations on our healthcare, then we have plenty of ideas to share on the meaningful reform of trans healthcare. But until that approach is made in good faith, and with trans people in positions of authority – we have better things to focus on. We focus on surviving the anti-trans hate that continues to grow in the UK, including in senior leadership in the government and NHS.

.

At the end of 4 days of trans health presentations from researchers, clinicians and community advocates from across (parts of) the world, I wanted to capture some of my key learnings and reflections. The conference took place the last week of September, in Lisbon, Portugal. This is my first WPATH (a conference of the World Professional Association for Transgender Health). A majority of trans communities have no access to WPATH information, yet WPATH learning is important to many trans people and families. I’ve always appreciated those (especially Ruth Pearce) who try to make conference information available to those unable to attend. I note the significant barriers to attendance for those without an employer or institution to fund expensive attendance fees and travel, to those with disabilities or caring responsibilities unable to travel, for those without a visa to come to Europe, to those facing other barriers to attendance.

Overall vibe

The overall vibe was better than I had expected, although my expectations were drawn from hearing really poor experiences at past WPATH conferences. I found overall the tone of trans positivity, depathologisation, treating trans people as equals, centring research and healthcare ethics, was better than I had expected. However, there were still a portion of content and conversations where biases were clearly on display. I particularly noticed these biases in the very frequent exclusion of non-binary existence, on the continued pathologisation, mistreatment and exoticisation of trans children, and on a very significant domination of a US and white perspective, with notably limited representation from global majority populations. I gather only 3 attendees were from Africa (out of 1,445 registered in-person attendees). I also am scratching my head to think if there was even a solitary reference to the experiences of trans children in care in the presentations I attended – I don’t think there was.

The event had a trans chill out room where trans attendees could step away from the main event to decompress and reflect. It was noticeable that few trans attendees spent time there in the first days of the conference, with the fullness of the room growing over time, as trans researchers, clinicians and advocates encountered more challenging content and interactions. On the third day I heard one person reflect that despite WPATH improvements, it is noticeable just how many trans people are sat in the trans space burnt out by negative engagements by day three of four. I myself had a number of negative and hostile encounters, and a number of presentations that I could not sit through, finding some content taxing or upsetting, particularly where content demonstrated abusive clinical or research practices towards trans children. There were a number of other challenges at the conference, with no encouragement of sharing pronouns (apparently pronoun ribbons were lost in shipping), not being able to find gender neutral toilets on the first evening, and apparently some staff policing of toilet usage which was rather surprising in a trans health conference.

There were also a large number of encounters and presentations that were an absolute delight. I met a huge number of people from across different countries and disciplines who deeply care for improving equality and justice for trans people of all ages and situations. I heard some research that shows where we should be in terms of ensuring research and healthcare is centring the rights and needs of trans communities. One clear highlight was an opportunity to connect with TPATH, the trans professional association for transgender health, including an opportunity to connect with some Portuguese trans folks who were not able to attend the conference.

 Session structure

 The session included plenary speeches, symposia, oral abstracts and posters. I will write about each in turn.

Plenary sessions.

On each day there were two plenary sessions, that were hour long speeches to the full audience, from one or two speakers, with a moderator. The plenary speakers were appointed by the WPATH president. Three were related to surgery, which I won’t engage with here as its not an area I focus on or know a lot about. A broader reflection was that at times the plenaries overall were a source of pathologisation, erasure of non-binary people, dehumanisation, exoticisation, and demonstration of clinical control over trans communities. There were several sessions where, if one had a bingo card of common areas of biases and indicators of cis-supremacy, one might have ticked off many exemplars. The speakers also privileged a white, cis, US/European, abled, and clinical position. Of the plenary sessions, the one I enjoyed the most was the opening plenary, delivered capably by an American, the US state representative for Montana, Zooey Zephyr. It was a powerful and moving speech, capturing the challenges that we currently face. I particularly resonated by the words (that I am paraphrasing), that when anti-trans laws are passed, when communities face state persecution, the harm comes severe and fast, whilst processes to overturn such harms are drawn-out and slow. Those words certainly resonated with my experience in the UK, where the harms of recent criminalisation of adolescent healthcare has indeed been severe and fast. The speech and presentation was excellent, but very US centred for an opening plenary. I wouldn’t expect anything less than US centred content from a US state representative, so this US centring is more a question for WPATH leadership than for the presenter. Why would a WPATH opening plenary would be so US centred. The tendency for WPATH (the World association) to act as US-path on holiday does appear to continue to be on display. However, this opening plenary was at least very strongly trans-positive, centring trans rights, calling attention to the abuse, control and persecution of trans communities, including trans children. The other plenaries alas did not all maintain this important commitment on trans-positivity, rights and justice. Several centred a clinical perspective grounded in assumptions of clinician control over trans lives. The plenary on trans children was particularly problematic and disappointing, presenting to a wide audience some older concepts and research that are problematic and outdated, centring and justifying clinical control over trans children. There were times across the plenaries where trans community and service user voice and perspectives were absent, with speakers prioritising a cis, adult, white, global North, clinician perspective. 

I was disappointed to have the plenary on puberty blockers delivered by stakeholder from the Dutch clinics, whose model does not centre trans child and adolescent rights. The presentation itself summarised older research (some of which is problematic) and failed to update the audience on newer research findings from other countries. It was a really lost opportunity to update general attendees on the most up-to-date research on puberty blockers. I also wish we could hear more from Dutch trans communities and service users, particularly child service users, on the Dutch approach. My own research has centred the experiences of service users in the English Children’s Gender Service, which aimed to replicate the Dutch model. My own experience and my research with that service has demonstrated widespread clinical abuse and harms to trans children in that service. (My research, including on experiences in gender clinics, experiences of childhood social transition, experiences with puberty blockers, and on pathologisation and cis-supremacy in healthcare can all be found here).

I hope the next WPATH can better centre child rights, trans rights, an ethics of depathologisation and equality in future plenary sessions, ensuring that any presentations from clinicians centre some fairly basic ethical commitments.

Parallel sessions

Across the conference there were 14 different sessions (hour long time slots), during which attendees had to choose between 5 parallel options, 3 of which were usually symposia and 2 of which were oral abstract sessions. That meant there were a total of 70 hour long sessions, that we could attend only 14 of. The sessions we could attend are recorded and available to watch on catch-up, and I’ll certainly check in on some of the ones I missed in coming weeks. Here I’ll comment on some of the symposia of oral abstract sessions that I attended.

Symposia

On being a target

There was an excellent session on trans researchers being a target of hate and harassment. Unsurprisingly it featured two UK researchers, talking about the amount of targeted hate that comes with being a trans researcher in the UK. We need to find better ways of supporting trans researchers. And we need our institutions to step up, both to protect trans researchers from external abuse, and to ensure research spaces and universities are actually safe from organised transphobia.

Trauma-informed approaches to care

This session talked about trauma informed approaches. I’ve not heard much discussion of this before, and certainly not on how to ensure child and adolescent care is trauma informed. I noted particularly the discussion on how certain mindfulness techniques are inappropriate and triggering rather than relaxing for those living with trauma. I recognised this in myself (I find mindfulness unbearable), but wasn’t aware this was a more general phenomenon. There has been a big recent focus on mindfulness in schools in the UK, and I wonder how this is being experienced by children living with trauma, which will include a lot of trans children.

Evolution of gender expression care

This session focused on the support that trans people, and especially younger trans children, may benefit from in areas of their life not related to medical care. The presenters are including the term ‘gender expression’ care to capture support with social transition, gender expression and finding gender joy, as distinct from and running parallel to medical transition support.

New long-term research on adolescent gender-affirming medical care

This session was excellent, with three important presentations from the US, from Diane Chen, Laura Kuper and Kristina Olson. I will write up some more detail on these three presentations soon as they are very timely and relevant. This is now written up as a separate blog post here.

Preserving evidence-based trans healthcare for adolescents in Europe and North America

This included presentations on how clinicians are navigating care restrictions and challenges to care. It included a focus on the UK, USA, Croatia, as well as discussion on upcoming guidelines from Switzerland, Germany and Austria. It included discussions of clinical care on the defensive, and how to ensure services that are under attack are shifted to the most defensible positions. I would have liked a more significant focus on how to ensure ethical principles and child rights within services that are under attack. I would have liked more explicit discussion of the impacts on trans children of a shift into defensive practice, which often includes bringing in or maintaining approaches that are not in a child’s best interest. I would have liked more consideration of how to ensure child rights and prioritised while operating under defensive practice, and more explicit acknowledgement of the harms, and more proactive work to ameliorate such harms. I’d also like more discussion of how a shift to defensive practice can provide a cover for coercive and harmful practices beyond what might be 100% essential. And how those shifting to defensive practice need to be more rather than less accountable to criticism of their practices. We also need to consider whether shifting to the most defensible positions actually appeases or reduces criticism from trans-hostile actors – in the UK this was certainly not the case, every shift to the defensive led to more attacks on care. I think a ethical and rights based defense of care is stronger than any effort at appeasement. (This session clashed with another session on “Research-based, ethical, lifesaving: findings from a long-term satisfaction study on pediatric gender affirming care” that I hope to catch up on later.

Centring Gender Diverse Young Children’s Voices and Experiences in Clinical Care and Research

A tool developed by Zucker (1977) was presented, with discussion of its cisnormative flaws and failings. The presentation then talked about experience of modern research using this tool. I don’t understand using an outdated and inappropriate tool developed by Zucker with modern trans children. I didn’t stay for the full presentation so perhaps I misunderstood something. I worry about research practices that do not centre trans children’s well-being and do not protect from research related harms. In my experience every question asked to a trans child by a professional, of any type, is an example of that child being treated differently. Children notice when their identity is treated differently. They notice when they are being studied. All research needs to consider the potential for children feeling shame. I returned to the session later for a discussion on the use of dolls to help children display their gender. I was probably not in the best head space for the doll discussion. Again, I was prompted to ask myself how many cis children are asked to dress a doll in a meaningful outfit under adult stranger/professional scrutiny. How do those trans children feel. I’m sure this can be done in a really positive way, and I don’t doubt the researchers presenting who seemed lovely do this in a positive way. But there was also suggestion of sharing this approach and these dolls much more widely. I didn’t stay for the whole session. I hope there was also significant discussion on the many trans children who do not want to dress dolls while under adult scrutiny, on the children who don’t want to be treated differently just because they are trans. I hope there was discussion on the ways in which a doll dressing exercise can be done really badly by the wrong facilitator, how it could be experienced by a child as being a subject of adult curiousity of how different and weird they are compared to their siblings and peers who are not asked to do this task. I worry about any initiative that en masse treats trans children in a different way to cis children, and anything that is not individually determined and centred. The younger children who I have known most closely would have hated being asked to dress a doll to present themselves, especially at a point in time early in transition where their clothing and expression is being most extremely scrutinised and judged and commented on by those around them. For all of these tools, I guess the context and the intent is really important. In a really safe environment, where children are not already feeling hostility and judgement and shame, perhaps a doll dressing challenge could be a source of gender joy for some children. How do we know which environments are safe for this? How do we know which children will enjoy it? How do we offer this as one of very many, many, fun activities, and ensure children do not feel compelled to engage as part of defending their existence to the adults around them. Given the choice of a coordinated doll dressing activity and a game of tag or watching a movie, a majority of the trans kids I know best would choose tag or watching a movie. In my experience, younger trans children, especially those early in transition, are very very tuned in to any areas of their life where they are treated differently or scrutinised. How do we ensure that activities that treat them differently do not make them feel like there are being judged or assessed, or make them feel they need to perform to meet adult expectation or approval.

Oral abstracts

Engaging Family

There were several presentations on engaging with families. It is interesting to see the work that is being done with families who help them to better understand and support their trans children. One reflection that I had, was on how can support services better recognise a diversity of support needs amongst parents.

From my own experience I wonder about the targeting. In my experience the parents and carers who show up, who are reachable with interventions, are less likely to benefit from basic trans 101 education and support with things like ‘ambiguous loss’. As a trans person and a parent in such spaces, I have found some ‘support’ to be really upsetting, and I know plenty of cis parents who have felt the same – who have needed support in managing state oppression and the minority stress of being a family facing overt anti trans abuse and hate, who have found sessions focused on ambiguous loss or trans 101 a world away from the support that they actually need.

On the topic of ambiguous loss I also wonder how we can better recognise the way in which rhetorics of ambiguous loss provide some parents with a cushion that enables them to gain emotional support from trans-ignorant cis communities – for that parent, moving away from a rhetoric of ambiguous loss also means moving away from their available emotional support network. That support network needs to be replaced by a trans-positive support network, and I’d really be interested in seeing how support for parents can focus less on trans 101 or on dealing with ambiguous loss, and more on building trans positive emotional support networks, reducing the isolation of supportive parents/carers, and on providing meaningful support to help families facing state persecution, helping parent/carers emotionally stay afloat whilst engaging in constant advocacy for child rights and whilst facing harassment, isolation and abuse.

Especially in context where oppression is high and rising, I would love to see more focus on how to ensure supportive parents and carers can not fall apart under the strain. Of course, the trans-hostile and trans ignorant parents are also very important – I would just not assume that they are the parents who will voluntarily walk through the door. Unless you have other means of reaching such parents (eg direct referral from the GP, or targeted outreach with a less supportive parent building on a connection with a more supportive parent), I wouldn’t assume you are ever meeting those parents.     

I would also like to see more consideration within those facilitating and organising parent/carer support groups of how to ensure the spaces do not expose parents/carers to an excessive amount of anti-trans opinion. In my experience those spaces work best when they are a good mix of parents who have become strongly supportive and educated, who are actively fighting for trans children’s rights and those parents who are new and managing their own learning curve. I have noted a tendency for the facilitation of these spaces to have shifted towards younger, non-parent and trans facilitators. I have also noted a growth in space for parents to discuss at length their own transphobic assumptions, where facilitators perhaps want every parent to have their say and don’t feel able to police any minimum standards of respect. The last ‘support’ group I attended I was directly called a ‘traitor to feminism’ for being a non-binary person in a facilitated group discussion without any backup.

(as well as being a toxic work environment for a younger trans facilitator) this ‘let everyone speak their mind’ approach is also driving away those parents who are more supportive. The cis parents who are attending in search of a safe space away from a trans-hostile world are encountering yet more trans hostility in those facilitated support spaces, and many are stopping attending. I myself more often than not find such spaces traumatising rather than reinvigorating, and I know many cis parents who feel the same. If the more supportive parents, who are looking for support on trans advocacy and dealing with transphobia get deterred from support groups, then that is a huge loss to those new parents who usually learn a lot of trans positivity and how to better support their children from parents who have walked the same path. I would be interested to hear more research that recognises the diversity of positionality within parents groups (including the existence of trans parents in those spaces), how to ensure those spaces are overall safe spaces for all parents (whilst providing some space for parents sharing their worries), and a mechanisms for more targeted approaches where a trans 101 isn’t the starting point for all families, with an emphasis on the support required beyond trans 101.

I always find the topic of ‘ambiguous loss’ a bit triggering. Clearly some parents do experience it, and need some therapeutic support with it. I wish there was more recognition of the diversity of ambiguous loss. In my experience a majority of parents experience ambiguous loss, which when you dig deeper is about a loss of safety. Especially for white families in countries and areas not particularly affected by violence or conflict, parents have an expectation of safety for their child. When they realise their child is trans, parents can have a reaction of fear, that their child is not going to be safe, in the present or in the future. This loss of expected safety is something that parents can find emotionally upsetting. In a world where there isn’t much language, parents can fall to a language of ‘grief’ to explain this loss. For some parents who I know, the language of grief is a mis-application, describing something that is different to grief. I’d like to see more focus on loss of safety as a concept, including helping parents to re-examine and re-conceptualise what they are feeling, especially where their feelings are not really about grief.

Clearly some parents also feel something like grief. One presenter mentioned an initiative on creative writing to help parents process their emotions. They included a description of a parent writing a eulogy. I am not a counsellor and don’t know how best to help parents who feel that way. I do worry about how much acceptance or space we should give for a grief narrative in more general or plenary spaces. It is clearly offensive. I also worry about the impact of giving space to a grief narrative on those parents and carers who have actually lost a child. Parent support spaces should be a safe space for those parents too, and I think more care should be taken over how ‘ambiguous loss’ is dealt with, including ensuring there are spaces for parents who want to talk about a loss of safety without having to hear other parents talk about ‘grief’ for a still alive child.

Law, Policy and Ethics

This included a presentation on the reasons why a proposed NHS research trial on puberty blockers is unethical, as well as evidence on the negative impacts of US healthcare bans.

Community engagement

This was a fantastic session, centring trans led research including from India, centring trans-led community designed research, the roles of community initiatives in steering research or clinical practice, and the importance of gaining service user trust.

Other conversations

I had many other interesting conversations. In many countries it was shocking to me to hear just how very far ahead of the UK in terms of treatment and support for trans children and adolescents they are. Folks from many countries expressed concern and solidarity on just how bad the UK is right now, seeing it as so very far behind acceptable levels of care, law and policy. I heard about interesting upcoming work, about current practice in the US, Canada, Australia, New Zealand, about support for trans youth in countries like South Africa and Vietnam, about upcoming research on disassociation, about initiatives to support folks under state violence. I met many awesome people who I hope to stay in touch with.