This is a German Book published in 2022
Title in English
My chapter in English
There are two conflicting ethical paradigms concerning how children and young people who identify as transgender should be cared for and protected. The first ethical paradigm posits that social justice requires an affirmation of the child or young person’s inner gender identity and their right to have their body match their authentic self. Those who object to medical transition are described as social conservatives whose undisclosed motivation is to uphold traditional gender norms (see The Lancet Child and Adolescent Health, 2021). Medical intervention is a minority rights issue, not only for ‘trans’ children but for the LGBTQ+ community as a whole. In the past 30 years in the United Kingdom (UK), Western Europe, Australia, New Zealand, and North America this ethical paradigm has become hegemonic and is now the standard approach in gender identity development services and clinics internationally.
The second ethical paradigm counters the normalisation of medicalising children, charging it with a derogation of safeguarding responsibilities. It posits that the gender affirmative model of healthcare commits young people to lifelong medical treatment with minimal attention to the causes of their belief they have been ‘born in the wrong sexed body’. Puberty blockers are an uncontrolled experiment on children which invariably leads to cross-sex hormones and later to surgery. In this mode of thought, children and young people are developmentally immature and cannot consent to treatments that have life-long, harmful consequences. Those who promote medicalisation are described as conforming to an ideology that has no rational or objective foundation (see The Society for Evidence-Based Gender Medicine, 2021).
In this chapter, I argue that detransitioner voices are central in helping critically appraise the gender identity affirmative services that advocate for medical intervention as a benign utopianism where social justice for the gender diverse can finally be realised. The multiple voices of detransitioners tell a story that undermines and falsifies this utopian narrative, describing medicalisation as mutilation, even castration of their bodies. In the UK the two mutually exclusive paradigms are currently pitted against one another in the law courts. Keira Bell, a 23-year-old woman who began medical transition aged 15, and who now deeply regrets it has been instrumental in legally challenging the medicalisation of children and bringing attention to a global audience of the competing ethical stances.
- The Tavistock: The Postmodern ‘Turn’ in Medical Ethics
In the UK, specialized gender affirmative medicine is provided by the Tavistock and Portman NHS Foundation Trust and commissioned by the National Health Service (NHS) England. There are two services: (1) The Gender Identity Development Service (GIDS) for children, adolescents, and young people under 18 which, until December 2020 and a Judicial Review ruling, has referred children as young as 10 to endocrinologists for puberty blockers and later cross-sex hormones since 2011; (2) The Gender Identity Clinic (GIC) for adults where people over 18 years can be prescribed cross-sex and be referred for surgery.
When it opened in 1989 the Tavistock GIDS was one of the first gender identity affirmative services for children internationally, working therapeutically with only a handful of young patients (Di Ceglie, 2018). It innovated an approach that locates children’s rejection of their sexed body as belonging to the area of gender identity development rather than a psychological disturbance, or what we now classify as ‘gender dysphoria’. This approach is known as the ‘affirmative model’ because its first principle is that a child’s gender identity must be affirmed and not pathologised (Di Ceglie, 2018). The Tavistock is proud to inform that it still abides by the set of principles that were initially laid down: “the unconditional acceptance and respect for young people’s gender identity” (Tavistock and Portman Foundation Trust, 2018).
I have written elsewhere about the history of the Tavistock GIDS and its evolution through various interweaving stages of influence by lobby groups, transactivists and, from 2010 onwards, postmodern queer theory (Brunskell-Evans, 2018, 2019, 2020).
Dr Bernadette Wren, the Lead Consultant Psychologist at the GIDS until 2020, welcomes the “postmodern ‘turn’” in psychology as part of facilitating the affirmative model. She argues that postmodern ideas, and one of its branches queer theory, although first developed in the 1990s in the philosophy and humanities departments of the university, have resulted in exposing “important social, political and ethical issues in psychotherapy” (Wren 2014, p. 272). Orthodox psychology exercises “regulatory” hetero-normative power over children, reproducing the “male/female and hetero/homosexual binaries” as “foundational meta-narratives” (Wren 2014, p. 273). It “gives the power of definition and judgment too readily into the hands of the medical establishment keen to define and regulate gender” (Wren 2014, p. 280). It aspires to be classified as a science, and in proclaiming itself objective, is deployed by clinicians “… to bolster the usual binaries in mental health: normal/abnormal, straight/perverse, healthy/sick” (Wren 2014, p. 282).
Wren argues that to suggest to a teenager who was “assigned female” at birth that her masculine gender identity has underlying causes would be to pathologize her or to suggest that in some sense she is misguided or delusional. The postmodern psychotherapist in contrast aims to “restore dignity to those whose transgender identification feels to them viable, respectable, and worthy of value” (Wren 2014, p. 282). She insists that identifying as a boy might be “a good enough compromise” of “her needs, historical conditions, and life circumstances” (Wren 2014, p. 282).
What are sex and gender?
By 2015, the NHS mandated the Tavistock GIDS to “provide specialist assessment, consultation, and care, including psychological support and physical treatments, to children and young people to help reduce the distressing feelings of a mismatch between their natal (assigned) sex and their gender identity” (NHS England, 2015).
Given that the terms “gender identity” and “assigned sex” are central to the UK’s health policy I argue it is important they are defined since it is on the basis of their meaning that medical treatment is authorised. The Tavistock does not attempt to explain why dimorphic biological sex, empirically observed in all mammals, is culturally “assigned” but describes gender identity as an inner feeling which overrides biological sex regarding whether one is female or male (Tavistock and Portman NHS Hospital Trust, 2021):
Some children who were assigned male (i.e., registered as male) when they were born, may not feel like a boy when they are older, or may prefer to dress in clothes or play with toys that other people say are “for girls”. They may feel or say that they are a girl. In the same way, some children or young people who were assigned ‘female’ at birth might feel or say that they are a boy.
The Tavistock defers to children and young people’s understanding of gender which it then affirms in the consulting room. The young people who arrive at the GIDS understand gender “in an increasingly diverse way … and have often familiarised themselves with a large range of different identity labels in discussions online or with their peers”, exemplified by a glossary of LGBTQ+ terms which children and young people use. (Tavistock and Portman NHS Foundation Trust, 2021a). The Tavistock informs that “ideas around gender” are complex, and that “there is a huge range of human diversity in how people feel about and express their gender” (Tavistock and Portman NHS Foundation Trust, 2021a).
The Tavistock describes its stance as “neutral” concerning definitions of gender identity, and in that alleged neutrality, it understands its practices as “empowering”, “affirmative towards however a young person has come to understand themselves … without seeking to confirm, reject, or impose upon them any of the options which are available” (Tavistock and Portman NHS Hospital Trust, 2021a).
It is important to examine the Tavistock’s claims to neutrality. Firstly, in completely failing to define sex or gender it falls back on explanations that are based on social stereotypes or are tautologous, referring back to themselves in a circular fashion. Secondly, there is nothing neutral about the affirmation of children’s LGBTQ+ identities but rather affirmation signifies that the service is politically and theoretically positioned. Thirdly, it ignores the voices of detransitioners in the UK (and internationally) who declare that affirmation has not only disempowered them but actively harmed them.
- Keira Bell, Detransitioner
Judicial Reviews allow petitioners in Britain to bring action against a public body they deem to have violated its legal duties. In 2020, Keira Bell became a claimant against the Tavistock in a Judicial Review held at London’s High Court. She alleges that the GIDS allowed her to pursue the unrealizable fantasy – the delusion – that she could change sex, left her psychological issues unaddressed and referred her for puberty blockers after only a small number of superficial appointments (Bell, 2021). She describes herself as having been an extremely vulnerable adolescent when she was referred to the GIDS aged 15, deeply distressed about her sexed body, sexually attracted to girls but having no positive association with the term lesbian, and suffering a range of underlying familial, emotional, and psychological problems (Bell, 2021). She describes how her identification as male gradually built up as she found out about transitioning online and that she arrived at the GIDS fully versed in the LGBTQ+ language and concepts which her therapists did not question (Bell, 2021). By the time she was 16, she was prescribed puberty blockers, at 17 she was prescribed testosterone and at 20 she had a double mastectomy.
Bell does not feel that dignity had been afforded her by the GIDS ‘postmodern turn’ or that medical transition was the best way forward to accommodate her personal circumstances (Bell, 2021). She describes how the further she went down the route of transition, the more she began to realize that “I wasn’t a man, and never would be”. Her belief that being male would represent her “real” or “true” self, dissipated as she matured, and she began to recognize that “gender dysphoria was a symptom of my overall misery, not its cause”. Five years after beginning her medical transition, she began the process of detransitioning. The consequences of what happened to her are “profound”:
… possible infertility, loss of my breasts and inability to breastfeed atrophied genitals, a permanently changed voice, facial hair. But it was the job of the professionals to consider all my co-morbidities, not just to affirm my naïve hope that everything could be solved with hormones and surgery (Bell, 2021).
Bell’s lawyers argued that Tavistock failed to protect her and fails to protect all young people who seek its services and that instead of careful, individualised treatment the service has been conducting what has amounted to uncontrolled experiments on young people (Bell, 2021). Expert witnesses provided evidence to the Court that hormone blockers are a crucial steppingstone to cross-sex hormones and eventually surgical interventions. The medical pathway is experimental and brings severe, life-long consequences including bone/skeletal impairment, cardiovascular and surgical complications, reduced sexual functioning, and infertility (Bell v Tavistock, 2020). Without medicalisation, however, identifying as the opposite sex has a high rate of natural resolution, and after adolescence, the majority of young people are reconciled with the biological fact that they are male or female (Bell v Tavistock, 2020). The Review concluded that children 16 and under have reduced capacity to consent to puberty blockers since they cannot weigh up the consequences of their life-long effects in adulthood (Bell v Tavistock, 2020). It ruled that the GIDS cannot administer puberty blockers (in most cases) to young people without application to the court (Bell v Tavistock, 2020).
Postmodern Social Justice
The Tavistock’s conviction that children, even those as young as 10 years do have the capacity to consent to puberty blockers if they are cognitively competent, and that advancing a medical pathway promotes an ethical and accountable pathway, has not been dimmed by the High Court’s ruling. The Tavistock, as well as the hospitals which facilitate the hormone treatment (University College London Hospital NHS Foundation Trust and Leeds Teaching Hospital NHS Trust), were granted legal permission to challenge the High Court ruling in June 2021, the results of which are not, at the time of writing, been published (Tavistock and Portman NHS Foundation Trust, 2021b) (see Brunskell-Evans, 2021).
In recognising that different orders of social justice are pre-figured by those who object to puberty blockers, and those who are gender affirmative and endorse them, Bernadette Wren insists the predominant issue for the GIDS is “social justice” for the “gender diverse” (Wren, 2020 p.42). The GIDS practice of prescribing puberty blockers doesn’t arise from “narrow ‘clinical’ judgment” but rather from “broader social acceptance of the challenges brought by new medical technologies, new ideologies of self-determination and new models of parental responsiveness and love” (Wren 2020, p. 41).
Wren argues that we now live in a “permissive culture” where we believe that children and adolescents can achieve “a measure of authentic self-knowledge” and that “young people—including those who are gender diverse—may be allowed considerable freedom to make their own mistakes” (Wren 2020, p. 41). Objecting to medical intervention could be seen as “socially just”—or it could be understood, as she does, as “a backlash against the expansion of gender norms and possibilities and the re-pathologisation of young people’s feelings and desires” (Wren 2020, p. 42).
The Lancet, Britain’s flagship medical journal, concurs that focusing on the potential harms of puberty blockers and cross-sex hormones ignores the fact that the young person’s wellbeing is broader than physical health alone. The issue of medicalisation cannot be separated ethically from issues of social tolerance, equality, and the full rights of citizenship for the “gender diverse”. It asserts that “those pushing the legislation” against medicalisation do so based on a “claim to protect children” (The Lancet Child and Adolescent Health, 2021). “Social conservatives” frame “gender-affirming care as child abuse and medical experimentation” ignoring “decades of use of and research about puberty blockers and hormone therapy: a collective enterprise of “evidence-based medicine” (The Lancet Child and Adolescent Health, 2021).
The Lancet asserts that puberty blockers are falsely claimed to cause infertility and to be irreversible” (The Lancet Child and Adolescent Health, 2021). The dominance of the infertility narrative, “perhaps reveals more about conservatives’ commitment to women’s role as child-bearers”. Those who object to medicalisation are not protecting vulnerable children but “traditional gender norms”, carrying out “a reactionary campaign similar to earlier anti-abortion and anti-same-sex marriage campaigns” (The Lancet Child and Adolescent Health, 2021).
The Lancet posits that what drives this “disproportionate emphasis” on young people’s “inability to provide medical consent” is the anxiety evoked by focusing on the minority who regret medical transition (The Lancet Child and Adolescent Health, 2021). It cites a research study by plastic and reconstructive surgeons who, having conducted a systematic review of several databases, estimate 1% of adults regret gender-affirming surgery (Bustos et al, 2021). It alleges that the arguments against medicalisation “lack the voices of trans youth and their health providers” (The Lancet Child and Adolescent Health, 2021). “Trans youth seek gender-affirming care because they are trans, and they have the same right to health and wellbeing as all humans” (The Lancet Child and Adolescent Health, 2021).
The UK group Thoughtful Therapists have responded critically to the lack of evidence base for the Lancet’s assertions, including its statistics about detransitioners (O’Malley et al, 2021). The 1% of people who regret transition refers primarily to studies of adults who transitioned in an era when medical transition was only taken under strict protocol. Using the outdated statistic is “highly irresponsible and lacks the rigour for which the Lancet group of journals is known” (O’Malley el, 2021). The population transitioning in the past 10 years is qualitatively different from predecessor cohorts. We now find ourselves in a markedly different era, characterised by a 1727% rise in the numbers of children seeking to transition at the Tavistock GIDS since 2015 and a gender-affirmative approach, which has been adopted almost universally, making the proffered statistic anachronistic” (O’Malley et al, 2021).
- Detransitioners as Knowledge Makers
Is Bell an anomaly, a young person who is atypical of this novel cohort who, unlike her, are truly trans? For reasons of space, I have selected a small number of voices of other detransitioners although multiple detransitioners are prominent on social media sites, not only in the UK but in other countries such as Germany, Norway, Sweden, France, and North America whose life stories are remarkably similar to that of Bell.
In the late autumn of 2019, a Detransition Advocacy Network was inaugurated in the UK to amplify the voices of detransitioners. Olivia a 25-year-old German woman spoke at that event and talked about the difficulty of living as a young lesbian without cultural role models or social networks. Meeting other detransitioners was a revelation, she says. “Where have these women been all my life? . . . It was just so normal to be a lesbian and a masculine woman, and I’ve never felt that ever” (Detransition Advocacy Network, 2019). She says, “There’s a very strong narrative that if you don’t transition you are going to kill yourself … I genuinely thought it was the only option.” (Detransition Advocacy Network, 2019). Olivia started breast-binding at 18, saw a gender therapist at 19, took testosterone a month after her 20th birthday, and had a mastectomy, hysterectomy, and oophorectomy (removal of ovaries) by the time she was 23. Mourning the loss of her breasts and her fertility Olivia asks: “What are the surgeons doing calling this … gender-affirming health care”? “These surgeons … should be in prison for doing this.” Medical intervention “does not make you less female … It’s not a sex change, its castration” (Detransition Advocacy Network, 2019).
Sinead Watson is a British woman who took testosterone in 2015 aged 20 and continued for four to five years resulting in male-patterned baldness, a thickened larynx, and a male voice. She had a double mastectomy aged 26 when she was “severely mentally ill” and which she regretted months later (Watson, 2021). She describes how unwanted sexual experiences in her mid-teens from trusted “people” shattered her feelings of safety and security. From that experience she got the feeling “I hate being a woman” and from that, and her exposure to trans material online, she got the idea “I need to be a man” (Watson, 2021). Watson was prescribed testosterone after 3 months of attending the Tavistock GIC, but she alleges some young people in her social networks were prescribed it almost immediately. She says that none of the psychological and emotional reasons that might have led to her conviction that she is male were explored. She says, with a mixture of anger and disbelief, she can’t believe she was “allowed to do this” (Watson, 2021).
Watson has spoken to countless female detransitioners, some have already had hysterectomies and their ovaries removed so they have gone through menopause. She expresses dismay that the majority of people are unaware of how serious medicalisation is: There are abused children, traumatised children confused children, whose issues are not being addressed but ignored. They are being affirmed, they are not given exploratory talk therapy, and are put on drugs that are irreversible, and which leads them onto the path she has taken. She pleads “leave children alone!” She has seen how the specialists are “bought and caught up”, “petrified of anything other than affirmation only”. If children are taken by parents to gender clinics, the psychologist will only focus on gender, leaving all other issues out. “Basically, what is happening is conversion therapy: Gay kids are being transed” (Watson, 2021).
Two Anonymous Detransitioners from Nordic countries say that in their experience the existence of detransitioners poses a threat to the queer narrative of “transgender as a permanent reality”. To detransition is to make a “controversial statement … so the number of people who detransition is shrouded in secrecy and currently unknown” (Anonymous Detransitioners, 2020, p. 168). It is hard to put a number on the amount of detransitioners because there is “a lack of meaningful research on us” (Anonymous Detransitioners, 2020, p. 168).
Through their involvement with a community of female detransitioners, Anonymous Detransitioners realised there is a pattern of “situational similarities which intertwine … and underpin our shared experience” (Anonymous Detransitioners, 2020, p. 168). Many girls and young women in their network, including themselves, hadn’t fitted as children into the rigid system of gender roles socially ascribe to them. Many describe how they were sexually assaulted and abused and felt unsafe in their bodies as women. Being lesbian in addition hands a girl and young women “an easy way into the queer community” (Anonymous Detransitioners, 2020, p. 168). From there on, they say, “the pathway to transition is quite short” (Anonymous Detransitioners, 2020, p. 168). What is common across all these factors is that they are all connected to the mistreatment of young girls in “a patriarchal society” and that for many it is hard to live up to “the expectations of prescribed gender” (Anonymous Detransitioners, 2020, pp. 168, 169).
Carey Callahan is an American detransitioned woman and psychotherapist who took testosterone for two years and while saving up for a double mastectomy chose, in 2014 aged 32, to go through the process of detransitioning (Callahan, 2018). She insists that when in 2014 she resolved to detransition she was, without immediately knowing it, part of “the emergence of a new kind of womanhood” (Callahan, 2018 p.166). She wanted to feel that her body was real and correct. “Very quickly, almost all at once, it was the same kind of thought in people’s heads” (Callahan, 2018 p.166). In the USA groups began to form where many women wrote their stories and read each other’s writing, created online forums, designed surveys, planned meetings, strategized on how to give support to “the wave of women joining us” (Callahan, 2018 p.167). They talked about all the ways they had hurt themselves, of which transition was only one of many. There were drugs, starving oneself, abusive relationships disguised as kinky ones where in radical queer scenes to prove credentials as LGBTQI+ friendly you had to date or at least have sex with “every gender in every kind of body” (Callahan, 2018, p.166).
Patrick (undisclosed age) is a French man who had hormones and surgical intervention as an adult) (Patrick, 2020). Patrick tells of the influence of traumatic events before transition but that he was diagnosed as transgender by a trans-identified clinician at his first appointment at a clinic in France: “Gender affirming therapy had poured fuel on the fire of my disorder” (Patrick, 2020, p. 176). Although he reports starting on hormones initially brought an increase in confidence and well-being, these drugs eventually intensified depression and suicidality. The changes that oestrogen and surgery wrought on his body meant he had no sense of self that bore any “connection with my physical reality” (Patrick, 2020, p. 175). Having embarked on medical transition it was utterly distressing to notice “that one isn’t becoming the other sex, but some kind of patchwork, with scars and implants, in a life-long medicalisation process with synthetic hormones” (Patrick, 2020, p. 176). Being a woman by virtue of the social performance of womanhood was not only untying him from “a physical determinant” but placing him at odds with “the functioning of humanity” (Patrick, 2020, p. 177). It wasn’t bigotry or transphobia which was responsible for his sense of social isolation, but the transitioning itself which had rendered him “dysfunctional” (Patrick, 2020, p. 177).
- Sexism at the Tavistock
In 2015, the year Keira Bell was convinced she was male and sought the services of the GIDS, there had been an exponential rise in referrals of young people, particularly girls who outnumbered boys two to one (Tavistock and Portman Foundation Trust, 2021c). Between 2009-10 and 2014-15, demand for services had increased 50% per year from 97 in 2009-10 to 697 in 2014-15. In 2009-10, the number of males was 56 with 40 referrals of females (and one child with no apparent attempt to identify sex); in 2011, girls equalled boys in number; in 2015-16 referrals rose at their fastest rate yet, more than doubling from the previous year to 1,419 (Tavistock and Portman Foundation Trust GIDS, 2021c). In 2020-21 there were approximately two and a half thousand referrals of young people, two-thirds of whom are female (Tavistock and Portman Foundation Trust, 2021c). Over 4,600 young people are now on the waiting list (Barnes, 2021).
Dr Lisa Littman, a Brown University School of Public Health assistant professor in the US, describes girls who had no previous history of childhood body dysmorphia before puberty as having a condition she calls Rapid Onset Gender Dysphoria (ROGD) (Littman, 2018). Despite overwhelming evidence from its own data that girls who present at the GIDS became trans-identified during adolescence the Tavistock repudiates that ROGD exists. It describes ROGD “as a descriptive term and not a recognized diagnosis” (The Tavistock and Portman NHS Foundation Trust, 2021d). It claims that it is “both premature and inappropriate to employ official-sounding labels that lead clinicians … to form absolute conclusions about adolescent gender identity development”: “Alarmist descriptions of social ‘contagion’ can contribute to the stigma and isolation around gender-diverse young people” (Tavistock and Portman NHS Foundation Trust, 2021d).
Some GIDS psychologists have written anonymously about their deep concern about the exponential rise in children presenting at the GIDS, and the automatic affirmation of the ‘trans’ identity of these children, largely girls, who suffer profound problems. In the consulting room they are left with little option but to affirm a child who tells them that they are the opposite sex, thereby foreclosing exploration of feelings and meanings, or of underlying issues or mental health problems that may have led to a cross-sex identity (Anonymous Psychologists, 2019). Anonymous psychologists confessed what they are thinking in the consulting room but can’t say to parents or young people:
… [you] are caught in a terrible moment of social contagion, ensnared in a toxic storm of psychological and emotional distress meeting homophobia, sexism, misogyny against the backdrop of the most appalling ‘bad science’. There is no such thing as a male or female brain, and you cannot be ‘born into the wrong body’ (Anonymous Psychologists, 2019).
Drs Anna Hutchinson and Melissa Midgen, gender-critical psychologists with many years of experience working at the GIDS, argue that the teenage girls they see suffer a constellation of psychological, familial, and social problems. At the time they became trans-identified, many have complex social and mental health issues for which transitioning seems the solution: eating disorders, grief, struggling with sexuality and shame, being bullied, lonely, autistic, or struggling with depression and anxiety (Hutchinson and Midgen, 2020). Their mental health issues are far less the result of the stigma and unique prejudice at their gender nonconformity than the somatization of their multiple problems. In attempting a physical solution to what is a psychological and sociological problem the GIDS participates in young girls’ pathologisation of their sexed bodies. These clinicians conclude that the GIDS’ lack of interest in the causes of the exponential rise of girls wishing to be boys is negligent and tantamount to further sexist abuse on top of that which the girls have already suffered (Hutchinson and Midgen, 2020).
- The Tavistock: Inventing Transgenderism
The trans-identifying political activist Christine Burns describes the strategic transactivist “push” in 2010 in the UK (and the USA) to bring “trans” from “out of the shadows” culminating finally in 2015, the year of “trans visibility” (Burns, 2018 p. 1). The rise in 2010 of children at the GIDS identifying as ‘trans’ and the subsequent exponential rise since 2015 corresponds with this period. Burns encapsulates what has become the orthodox activist view that before paediatric gender affirming medicine, “trans” adults had to suffer the trauma of “irreversible bodily changes … as a result of going through the wrong puberty” (my emphasis) (Burns, 2018, book dedication page). The Tavistock concurs and sees itself as facilitating social justice for an oppressed minority that has always existed: “…transgender people have been documented across many different societies and across historical time” (Butler, Wren, and Carmichael, 2019).
Dr Susan Matthews, literary historian, reminds that “the story of ‘transgender’ is a recent invention” and that the idea of “the ‘authentic self’ realized through ‘gender affirmation’ is as historically new as the technologies that make it possible” (Matthews 2018, p. 123). She points out that by reading fiction, stories, and medical discourses for changing conceptualisations of sex and gender in the past two hundred years we can trace the recent birth and creation of discourses about transgenderism and identify both what is new in postmodern definitions of sex and gender and “the fears that the transgender narrative seeks to conceal” (Matthews, 2018 p. 123). Children and young people do not speak with their authentic voices but “ventriloquise the culture that produces them … [and] it is for this reason that they are uniquely in need of protection lest they be co-opted as unwitting actors in adult narratives” (Matthews, 2018 p. 133). Contemporary transgender ideology is a product of our moment in history and has invented a new set of beliefs that are “without historical precedent” (Matthews, 2018 p. 135).
What the voices of detransitioners pinpoint is the moral danger of a culture that has responded to the transactivist “push” and has taken on board the fundamental illogicality of its ‘truths’: (a) that biological sex is a social construct, not a fact that is empirically observed; and (b) that gender is inherent and not a product of culture. Patrick says: “A trans individual does not index his or her identity on biology, but on a social gender role and might in the process, feel the urge to adapt his or her body” (Patrick, 2020 p.176). “Contrary to the transgender doxa that is permeating our culture … sex isn’t an assignment” (Patrick, 2020 p. 177). “Boys and girls are certainly faced with the cultural pressure to develop, nurture and defend an identity, but identity doesn’t come first, sex does” (Patrick, 2020, p. 177).
Carey Callahan argues that the personal stories of individual detransitioners have branched out and can be mapped onto the “ideological narratives” of our culture (Callahan, 2018 p.166). The consciousness has arisen amongst the expanding network of detransitioner networks to which she belongs that as women they have been collectively facilitated to divorce themselves from their female bodies. In their shared “social reality shift” the ideologies that had operated invisibly were now rendered “stark and unavoidable in their visibility” (Callahan, 2018, p.166). What, she asks, do the voices of detransitioned women say”? “We say the blame rests on lesbophobia and a queer theory which glamorizes disembodiment … on mental illness … [and] a crime that was done to us” (Callahan, 2018, p.176). The voices of detransitioned women matter not only as an indictment of the medical industry or queer politics but as a warning that in our sexualised culture ‘femininity’ bears such symbolic meaning. She asks that we relate to detransitioners who have re-identified as women “as the researchers, writers, healers, leaders we are”. “We are no longer speaking in whispers, but at full volume” (Callahan, 2018, p. 179).
The Tavistock is taking part in an entirely new way of thinking about what it means to be human rooted in postmodern queer theory and transactivist politics. The Tavistock is driven by a single theoretical construct namely the issue of ‘identity’ defined by postmodern queer theory and in doing so it subsumes the multifactorial physical, psychological, sociological, and familial context within which a child identifies as transgender.
Whenever an ideology grips society it can be recognised by the authoritarian suppression of alternate views. The Tavistock has turned its back on any analysis that challenges affirmation, mirroring almost exactly the ‘no debate’ of transactivist ‘cancel culture’ which prohibits critical discussion in the academy. Because of its blindness to any other model of understanding heteronormative power than postmodern queer theory, it has fallen straight into the trap of exercising it, deploying the very rigid concepts of what it is to be male and female from which postmodern queer theory allegedly frees us. In allegedly affording young people freedom from normative gender, the terrible irony is that the GIDS exposes girls (and boys) to the same sexist stereotypes of what it means to be a boy or girl that have caused them to seek help in the first place.
Detransitioner testimonies are powerful, not only because of the heart-rending empathy they inspire but at the epistemological and ontological levels. Detransitioners are similar to anthropologists working in the field, bringing ethnographic snapshots back to a society that has been persuaded that any ethical concern about the irreversible changes wrought on children and young people’s bodies is socially conservative and heteronormative. An examination of postmodern health care and medical ethics at the Tavistock reveals they are rarely expert, evidence-based or objective but on the contrary, are highly politicized and controversial. It is imperative we listen to detransitioners if we want to challenge the harm perpetrated on the bodies of children and young people by the deployment of unsubstantiated theories wielded in the name of social justice.
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