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Upholding trans children’s rights

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Trans children have rights under international and domestic law, and we can be more assertive both in calling attention to rights violations, and in demanding institutions uphold these rights in policy and practice.

This accountability should be more robust in Scotland, who in 2024 brought the UN Convention on the Rights of the Child (UNCRC) properly into domestic law.

When the Scottish Government embedded the UNCRC into Scottish law, it made a commitment to children across Scotland: that child rights matter; that decision-makers will be held accountable for upholding the rights of all children.

When it comes to trans children, that promise has fallen short – trans children are seeing their rights eroded and ignored, in healthcare, education and wider society.

Scottish school are institutions with a legal duty to uphold trans children’s UNCRC rights, yet we are now seeing Government policy advising schools to segregate, humiliate and harm trans pupils. This approach is incompatible with Scottish UNCRC commitments, severely threatening trans children’s safety, well-being and access to education, and placing schools and educational policy makers in violation of their legal responsibilities.

In healthcare we are seeing trans children’s right to safe and equal access to health eroded by policy across Scotland. Scottish children’s trans healthcare policy is not meeting its legal obligations under the UNCRC.

I call on Scottish MPs and MSPs, the Scottish Children’s Commissioner, and all who care about child welfare, to uphold their UNCRC responsibilities, speaking out on current injustices, protecting and upholding trans children’s rights under international and domestic law.

I call on everyone engaging in working with or shaping policy towards trans children to explicitly recognise their legal obligation to trans children. Under UNCRC there is a legal responsibility to listen to trans children, explicitly and directly, in a meaningful way, where trans children’s voices, experiences and priorities meaningfully shape Scottish policy.

The incorporation of the UNCRC into Scottish law is having consequences across Scotland, shaping the way in which institutional policy is defined and evaluated. Trans children need to be part of this process.

We need to hear two statements significantly more often across Scotland: “what does this mean for trans children in Scotland?” and “is this compliant with our obligations to trans children under the UNCRC?”. The first question explicitly recognises the existence of trans children; the second explicitly recognises their rights under the crc. Both questions can only be responded to through close and trustworthy collaboration with trans children, centring their voices and perspectives, and ensuring such voices and perspectives meaningfully shape policy and practice.

For more on trans children’s rights under the UNCRC, see this peer reviewed article, in the leading International Journal of Child Rights, jointly authored with Dr Ruth Pearce from the University of Glasgow.

These UNCRC rights and obligations are relevant in all countries across the world, apart from in the USA (the only country not to have signed up to the UNCRC).

Across the whole world we need to see Governments, policy makers, and individual institutions, from schools to councils to healthcare bodies, recognise trans children’s rights, uphold trans children’s rights, and be accountable where these rights are violated.

Harming trans kids – Using art to capture the impacts of the Sussex ICB investigation

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When puberty blockers were banned in June 2024, the legislation included a clause stating that those currently on blockers would not be medically detransitioned, and could continue care if adopted by an NHS GP.

Only one NHS GP practice, WellBN in Brighton, agreed to take over this care, with trans adolescents and families from across Great Britain moving to their care. Patients have reported extremely high rates of satisfaction with this care.

In May 2025 ICB Sussex (ICB = Integrated Care Board, the level of bureaucracy above a GP practice and below NHS England) and NHS England launched an investigation into this care. The investigation has already caused a high level of harm to trans adolescents and families. Essential care is under threat of being taken away, with a threat of forced medical detransition. One person (I can’t share their identity) put this situation into a series of illustrations, capturing powerfully the current situation. This has been shared on instagram, but for those who don’t use it, they gave me permission to share here. I’ve added a bit of extra context.

Image one captures the ICB’s allegation of trans adolescents having been exposed to ‘potential harm’. What we instead have seen, is young people thriving and excelling through access to respectful affirmative healthcare.

[Description of image 1 “Potential Harm”: One trans young person is winning at sports; One is dreaming of a happy future relationship and marriage; one is hanging out with friends; one is doing their school work; one is playing the piano while proud parents watch; one is going shopping with a parent – while professionals write up reports of potential harm]

Image two captures the NHS’s approach to data collection. GP practice patients refused consent for the ICB taking their private patient data. GP practice patients, adolescents and parents, added notes to their files formally refusing permission to share their data. The GP practice did not want to share this data, and refused for several months. The GP offered anonymised data – the ICB was not interested in anonymised data. The ICB and NHS England stated that consent was not necessary due to ‘patient safety concerns’ despite no evidence of harm. The ICB finally threatened to cancel WellBN’s whole NHS contract, closing down a GP surgery with 25,000 patients, if they didn’t hand over patient data. WellBN at this point folded and handed over all trans children’s data. Information commissioner office complaints have been submitted.

[Description of image 2 “Data Pulling”: A house is being trashed with objects broken. Men in black suits (with the words Multi-disciplinary team on their top) are forcibly removing boxes of data, while adolescents and families try to keep hold of them. The boxes are labelled ‘private data’, ‘gender history’, ‘medical history’, ‘childhood history’.]

The third image covers the evaluation of patient harm. A patient harm investigation is being conducted without speaking to a single trans adolescent or family. It is being conducted purely based on clinical notes. The conclusion has been pre-determined with the investigation clearly considering affirmative care inherently a form of harm. Trans adolescents and families have prepared testimony on the reality that not only has there been no harm, their care has been excellent. Trans adolescent and family voices are not being heard.

[Description of image 3 “Desktop Review”: Adolescents and families are shut outside, using loud speakers to say ‘Please hear us, we were not harmed’; ‘children not harmed’, ‘no harm only care’. Inside, behind thick walls sits the head of the investigation team doing a ‘desktop review’ writing ‘harm is evident’.]

The fourth image focuses on the ICB’s plan to close all WellBN Care and refer patients elsewhere. Trans youth who are under 17 are to be forced to into gender clinics that offer conversive talk therapies focusing on investigating trans identities. 17 year olds will join waiting lists for adult care that stretch into years and years long.

[Description of image 4 “Expedited Referral”: A scared young person is being pushed into a room. The room was labelled ‘conversion therapy’. The word conversion has been crossed out, and in its place the words ‘gender exploratory’ therapy are now scrawled. In another scene a slightly older adolescent sits at a computer where the screen states ‘Gender Identity Clinic waiting times: 75 years].

Image 5 covers the preferred NHS approach for trans youth, gender clinics that focus on invasive, traumatic and inappropriate questioning of trans youth.

[Description of image 5 “Holistic Assessment”: Worried looking parents embrace a worried looking adolescent on one side. Ahead of them is a barrier labelled ‘caution no treatment ahead’. Behind the barriers are six faces with word bubbles ‘how do you feel about your penis?’; ‘do you get erections?’; ‘how often do you masturbate?’; ‘Are you sure you’re trans’?’; ‘Do you like girls’ underwear?’; ‘are you gay?’].

Image 6 focuses on the ICB’s intention for ‘assisted withdrawal’ of affirmative healthcare. This is forced medical detransition. It is abusive and harmful.

[Description of image 6 “Assisted Withdrawal”: A trans girl is having her long hair cut and facial hair painted onto her face; a trans boy is having breasts added; a young girl musician is crying while a professional says ‘don’t worry you’ll be singing with the boys in no time’]

The ICB have stated that they expect the outcomes to be ‘stark’ for impacted trans youth ‘especially the younger ones’. This image powerfully captures the type of stark outcomes that the ICB is well aware of as possibilities, having included these risks in their own risk assessment.

[Description of image 7 “Stark Consequences”: The image shows various depictions of children and adolescents having serious mental health consequences, including school drop out, stopping eating, mental health crisis and death]

The eighth image captures the ICB and NHS England’s intended ‘robust tracking approach’. Now that they have full patient data on adolescent and supportive families, they intend to ‘robustly’ track these children and families, keeping their data for 20 years, and tracking what adolescents and families do next. They have stated that if they think families and adolescent will continue to access medication through private means, they will be reported by the ICB to social services. Families and adolescents feel extremely threatened, extremely unsafe. Many are trying to find ways to flee the country.

[Description of image 8 “Robust Tracking Approach”: A scary large figure with a magnifying glass stares down at a scared looking child, while parents try to pull the child away to somewhere safer]

The final image shows scared young people being pushed into a black hole.

[Description of image 9 “Improving Lives Together”: Scared young people, some of whom are crying are being pushed into a black hole. The adults pushing them in are saying statements like “just one of those stark outcomes”; “have to follow the guidelines”; “It’s not commissioned”; “the guidelines have shifted”; “there are trans kids?”; “the terms of reference sets this out quite clearly”.

Across all of the above images the artist has included ICB Sussex’s tagline ‘Improving Lives Together’.

Why I won’t be engaging with the UK’s puberty blocker study

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Funding for the long awaited study on puberty blockers was announced this week, with £10 million pounds designated for a study running until 2031.

The study team at a glance appears to be fully cis, with no trans leadership. At least one senior leader attended a conference of a known anti-trans hate group. None of the leaders of this study bothered to attend with the WPATH global conference on trans healthcare that happened at a similar time.

The study aligns with and is embedded in new children’s gender services, designed in response to the Cass Review. Those services are deeply unethical and harmful, using staff selected for having no background in trans healthcare, trained according training materials steeped in pathologisation and misinformation.

Those service are deeply unethical and harmful with us already hearing regular negative reports of intimidating approaches to care, children being assessed by 5 or six professionals.

The research is by design unethical and coercive, with participation expected to be mandatory for all seeking to access healthcare.

The trial is by design unethical and coercive, putting youth at random into wings of puberty blocker or denial of puberty blocker, when forcing a youth who is distressed about puberty through an unwanted puberty for the sake of an unneeded trial is deeply unethical and cruel.

I expect more horrors will be revealed whenever we find out the inclusion criteria for the study. I expect the exclusion criteria will be used to exclude certain groups of trans youth. The fact it is being kept ultra secret is another red flag.  

The trial is by design likely to fail, with a strong impulse for those in the non-healthcare wing of the study to drop out, either to access healthcare outside of the study, or because there is no benefit and significant ongoing harm to being a such a study without accessing healthcare.

The study is certain to provide rubbish data – as per the Cass Review cis professionals with no experience and no inclination to listen to trans people or learn from existing research tend to focus on and measure the wrong things – measuring what is of concern to transphobic cis people rather than what is of use in improving outcomes for trans youth.

The study is deeply unethical for having no trans leadership – cis professionals particularly in the NHS continue to fail trans communities.

The study shows significant signs of having a semblance of youth engagement, with zero youth power. That is unacceptable.

The whole thing is deeply harmful and unethical, drawing its basis from the Cass Review, already one of the most critiqued healthcare reports, which will one day be viewed as a flagship example of bigotry driving healthcare policy.

Several people have asked if I will be volunteering to be on any lived experience panels or similar linked to this study. I have not been asked (and do not expect to be).

My answer would be very clear.

No.

No I will not in any way collaborate with a deeply harmful and unethical process.

No I have no faith at all that voices speaking up for trans youth healthcare rights will be listened to.

No I will not be complicit in providing any veneer of ‘inclusion’ to a process that is deeply cis-supremacist, unethical and harmful.

Others have asked me if trans youth or families should engage in the research governance, consultation and ‘accountability’ structures.

My advice would be – No.

Time and again I’ve seen people give the benefit of the doubt to processes like this, and be deeply burned. I’ve seen trans kids try their best to influence and be ignored and side-lined. Consultation without influence or power is not a genuine consultation.

Folks want to hope for the best. They hope that they can make a difference. They think it is better to be in the room than out of it. I strongly disagree.

Do not allow your hope, your faith in people being willing to learn, to persuade you to engage with a service and system set up intentionally to cause harm. Do not allow yourself to be a tool for their system.

I have not been asked by trans and LGBT civil society whether they should engage.

I was extremely disappointed throughout the Cass Review process to be continually reassured by figures in trans and LGBT civil society that engagement with the Cass Review was worthwhile, that they were having influence, that they were adding value.

As many of us outside of positions of (relative) power said would happen from the start, trans engagement in the Cass Review process was callously utilised to provide a veneer of inclusion and consultation to a process that was by design cis-supremacist and toxic.

The Cass Review has even been described as a process with ‘extensive’ youth and family and lived experience consultation. But consultation, as we saw with the Cass Review, as we saw with every NHS review related to trans healthcare I’ve engaged with for years, does not mean influence.

I will have no patience for any folks who in 2025 naively stumble into roles that provide a veneer of trans engagement to this harmful NHS trial. At the start of the Cass Review a position of ‘giving the benefit of the doubt’ to a review designed to intentionally exclude trans people was barely tenable. Those giving reassurances and the benefit of the doubt in the latter years of the Cass Review were something other than naïve.

There is no space for trans and LGBT civil society pretending to be naïve about the harm and unethical nature of this current study.

I hope for at least some solidarity with trans kids.

I hope that the least we can do is not engage with and lend any form of trans community support through participation in abusive practices.

I hope we can focus efforts on resistance from the outside. On supporting trans adolescents to continue to resist the harms that are foisted upon them, including resisting the harms of this trial and the associated study.

That will be my focus. Damage limitation from the outside.

Whilst continuing to speak up about the harms inherent in any process that is designed in this manner. Setting a clear expectation that crumbs and consultation from the outside is by definition not good enough.

We need trans leadership in trans children’s healthcare, in all trans healthcare. Nothing about us without us, and that means with genuine influence and power across healthcare design and management structures, not relegation to ‘lived experience’ panels that have no power to change and hold to account the fundamental and intentional failings of the whole approach.

We need depathologisation as a core principle. We need affirmative healthcare.  

Research should uphold children’s rights. Research should not cause harm.

Healthcare ethics Professor Simona Giordano testified recently to the Women’s and Equality Committee on the harms of this proposed study, noting that in this study “there is a risk that NHS England will violate fundamental principles contained in virtually all declarations and conventions on human rights as they apply to participation in research”.

The Welsh Children’s commissioner recently flagged similar concerns.

Not wanting to participate in research that breaks basic principles of healthcare and research ethics should not be a radical position. It should be the basic starting position for anyone who has any care for trans children.