Gender identity ideology and how it damages UK healthcare

Peter Jenkins

This article is a revised version of a talk given to an NHS staff group

Gender identity ideology

So, where to start?  The topic in hand is a very broad one, namely ‘Gender ideology and its impact on healthcare in the UK’.  Even the title is provocative, I guess.   The very notion of ‘gender ideology’ is not accepted by some as being an accurate term, and it might be considered to be dismissive, or even offensive, by others.  Therein lies the problem.  I’m proposing that an ideology is a relatively consistent set of ideas, linked to achieving certain specific political goals. Outside of normal day-to-day politics, people following any set of ideas probably see their own approach as the ‘truth’ and therefore decidedly not up for debate.  It’s very difficult to accept that one’s own ideas are actually part of a wider ideology, without having the willingness, or the ability, to step outside your own  particular worldview and to be open to discussing ideas on their actual merits, rather than as a set of beliefs which are just not open to question.

So what I want to discuss is a basic model of gender ideology, which, to my mind, consists of three key concepts, and three key processes.  Actually, I would really prefer to say it is about gender identity ideology, rather than gender ideology, which is still far too vague to my mind.  So gender identity is the foundation stone, the key building block of the whole structure, linked to other concepts or ideas, such as affirmation and entitlement, which I’ll come on to later. 

So, what is gender identity? Gender identity is the idea that, quite separate from our biological sex, or from socialised notions of gender (which is what society expects of the roles of being male or female), that there is an internal sense of identity, which is not directly linked either to biological sex, or to social gender roles.  It is suggested that this sense of gender identity is innate, quite possibly biological in origin, and that for some, this gender identity is at odds with their biological sex, hence the notion of ‘being born in the wrong body’. 

You may already know that the concept was originally defined by John Money, a US psychologist, in working with a family where a young male child had his penis accidentally destroyed in a botched circumcision.  Money’s advice to the distraught parents was to raise the boy as a girl.  This was an unethical experiment which had a tragic outcome, with the later death by suicide of the boy at the very centre of this grotesque experiment.  Here, the notion of gender identity was imposed from the outside on the boy, without informed consent, either by the child, or by his parents.  The more recent version of gender identity, in contrast, is presented as being a self-concept which grows organically from the inside.  However, it soon runs up against societal disapproval and bigotry, and so requires kindness and approval by supportive others. 

The immediate problem here, to my mind, is that we have no tangible evidence at all for the existence of gender identity.  It is simply an idea, a concept, with very powerful effects upon those who support it in themselves, their friends, or family members, or in society at large.  However, there are absolutely no criteria for determining the existence of a gender identity.  The World Professional Association for Transgender Health (WPATH) simply announced the discovery of a new gender identity back in late 2022, namely that of ‘eunuch’, without any public discussion.  It’s rather like the Scottish National Party suddenly announcing the discovery of 24 genders, completely out of the blue.  It is all just part of a belief system, that is, of a revealed truth – which either you accept unquestioningly, or you may prefer to doubt it, preferably very quietly, particularly when you are at work. 

Affirmation

Now, the second key concept in this belief system is that of affirmation.  Unlike most belief systems, such as a religion or a political orientation, someone’s internal sense of gender identity requires continuous validation from others.  Initially, this might take the form of immersion in the supportive world of social media, or what we might term ‘TikTok medicine’, which offers an array of successful coaches, role models and a peer support system.  For teenagers, research suggests this underground process of initiation provides a crucial point of entry into the social world of becoming trans.  It is usually completely unknown to parents or to other adults, right up to the dramatic point of coming out as trans, by which time it is almost irrevocable. 

While this belief in a gender identity, and perhaps a sense of being born in the wrong body, may make sense of the young person’s experience of social awkwardness, and their anxiety about unwanted physiological changes that are a normal part of adolescent puberty, it actually conflicts with many aspects of their usual, day-to-day social experience.  So it needs constant, sympathetic social affirmation from peers, family and gatekeepers to supportive services.  New recruits thus live in fear of misgendering, deadnaming, or other non-acceptance of their new internal beliefs. 

This helps to make some sense of what is otherwise an unexplained mystery, namely the intense political focus on banning something, for which there is vanishingly little evidence, that is alleged conversion therapy.  This campaign piggy-backs on the horrendous experience of some gays and lesbians in the period up to about 1975 of medicalised and psychiatric attempts to use aversive techniques to dissuade them from same-sex attraction.  However, it is a key article of faith that attempts to convert trans clients or patients from their beliefs are actually widespread in the UK. 

However, research simply does not support this.  My own counselling organisation, the British Association for Counselling and Psychotherapy, records no successful complaints at all featuring conversion therapy during the period 2015-22, for example.  The research, if anything points towards some forms of ill-treatment occurring mainly within faith settings, which are, obviously, already covered by the criminal law.  The campaign to ban conversion therapy is essential, however, to paint a compelling narrative of systematic persecution and suffering on the part of trans people.  This is necessary in order to build up wider public support for its wider political cause.  Some astonishingly weak research is pressed into service in order to achieve this.  For example, the draconian ban on so-called conversion practices in Victoria State, Australia, rested on a carefully selected sample of just 15 adults, most of whom were gay or lesbian and not trans at all. 

If we look in detail at alleged examples of conversion therapy, what we find is not so much an attempt to convert a trans client to drop their beliefs, but a failure on the part of the therapist to enthusiastically endorse these beliefs, via the use of affirmation, use of pronouns, or via a prominent display of posters, slogans and so on.  And, for any therapists who make a point of not providing an unthinkingly affirmative response, there is always the potent threat of a professional complaint, or a possible legal case, to bring them sharply back into line.

Entitlement

So far, we have looked at the central concept of gender identity, and then at the social affirmation this needs to reinforce it and keep it alive.  The third concept is usually enticingly packaged in the format of human rights, such as ‘trans rights are human rights’.  Yet, this is a somewhat circular argument, if you think about it – what other kind of rights would they be? Presenting the trans agenda in the format of human rights is a very effective strategy, however, as it makes it very difficult to question or challenge.  Who, in their right mind, would want to be seen as opposing human rights? Only a fool or a bigot, it would seem…

However, the seductive language of human rights conceals and actually misrepresents a much wider framing of the issues at stake here.  Trans ideologues and their allies will claim that extending the legitimate rights of trans people is simply recognising the reality of a newly identified oppressed group.  This is nothing more than a kind of tidying up of the legal landscape, if you like.  However, trans rights are actually very limited in scope, if we really drill down into the actual provisions of the Equality Act 2010 and the Gender Reassignment Act 2004.  What we do tend to find is that trans rights are absolute in nature, non-negotiable and non-reciprocal.  So, we have the absurd spectacle of an able-bodied man running a rape crisis centre in Edinburgh, and refusing to inform vulnerable female clients that not all counsellors there would necessarily be female.   We discover that access by men identifying as trans to protected spaces designed for biological women does not entail the right in return of women to access trans spaces.  We find that access to women’s sports by full-bodied males, such as the swimmer Lia Thomas in the US, makes a complete mockery of the basic division of competitive sport into male and female categories.

If we look at how trans rights operate in practice in the crucial field of medical healthcare, then we can quite quickly see that this is a model which prioritises client preference, and patient autonomy, in the form of open access to medical transition, without proper regard for gatekeeping.  The patient seeks out healthcare services, such as puberty blockers, cross-sex hormones, or surgery.  These treatments are then deemed to be medically necessary by the healthcare provider, and are then provided by health insurance in the US, or in a more rationed form, via the NHS in the UK.  I would argue that this is actually much more about entitlement, i.e.  entitlement to healthcare on demand, rather than representing a new addition to an already fairly crowded set of human rights, i.e.  for people generally, or for people with disability, or for women, gays, lesbians and children. 

Facilitating transition

For me, these are the important building blocks of gender ideology as a new political movement, namely gender identity, affirmation and entitlement.  These concepts in turn relate to three processes, the first of which is the crucial one of facilitating transition.  There are two sides to this.  The first is the claim that it is actually possible to transition from one biological category to another, that is from male to female, or vice versa.  Various examples from the natural world are rather awkwardly pressed into service at this point, ranging from clown fish to penguins, or from turtles to sea horses.  We know that it is possible to change the body’s sexual characteristics via mastectomy, breast augmentation, phalloplasty, etc, but none of this changes the basic reality of the binary nature of chromosomes.  Biological sex is binary, not socially determined.  It is for this reason alone that we should avoid using the confusing term gender at all costs. 

The second part of this is to unpack the so-called different levels of transition, in other words to distinguish between social, medical and legal transition.  This is the approach recommended by WPATH, for example, as if this is a seamless, but also open-ended process, which individuals can step on to and then step off again, and move away from, or resume, at any point, rather like stepping onto an effortlessly forward-moving airport walkway.  The rather dubious destination, however, once begun, is all one way and is never in any real doubt at any stage.  WPATH’s Standards of Care spell out their overall purpose very carefully: “to better align their body with their gender identity”. And, just to go back to the very, very small print, if you do decide at any point that this is probably not the right destination for you, and that you want to return home (or detransition, in current parlance), then you’re definitely completely on your own from that point onwards, and you really should expect no further help at all in this rather difficult process.  All this is clearly a far cry from the tenets of conventional medicine, which are simply to heal the sick.

So transition appears to come in neat stages, starting with social transition, often in adolescence, and increasingly before that, in primary schools.  Social transition involves changes in dress, preferred name and pronouns, access to other sex’s facilities, such as toilets, sports, changing rooms, etc.  Medical transition is held out as furthering this process by holding off (or more accurately, completely destroying) an unwanted puberty, with cross -sex hormones and surgery to remove and refashion unwanted body parts.  Legal transition completes the process, by formally changing sex on official documents, such as driving license, passport, etc.  The Supreme Court are putting the finishing touches to this legal fiction even as we speak.

In reality, these neat divisions just do not apply in practice.  Even social transition involves medicalised interventions, such as breast binders, or in the US, double mastectomy for adolescent girls, to reduce the risk of misgendering.  This is justified by recourse to an untested harm reduction model, where perceived psychological benefits to the patient are consistently traded against the risk of known medical detriments along this path, in order to further the overall transition process.  Legal transition deliberately, to my mind, generates confusion rather than clarity here, so we have the spectacle of an able-bodied male boxer taking on female opponents in the Olympic Games, simply on the basis of holding a passport descriptor as being female. 

Promoting lived experience

The second process, which is another really important part of the overall political ideology, is that of promoting lived experience.  Clearly, the subjective experience of patients and service users in relation to healthcare is a useful resource, which has been overlooked too often in the past.  But even the badging of the concept is itself persuasive and misleading, given the power of language to frame the debate.  However, if you think about it, all experience is lived experience – by definition, there can be no such thing as unlived experience (unless we choose to include fantasy in this category?) So we are simply just talking about experience here, which ultimately boils down to anecdote and personal opinion. 

In health research terms, this kind of data rightly belongs at the very bottom of the hierarchy of research validity.  I think it ties in with the recent move in universities away from quantitative research, such as outcome studies, randomised controlled trials, and so on, and towards cohort studies, focused on patient satisfaction levels, or small-scale qualitative research focused on perception – yes, you’ve got it, on lived experience.  More widely, the process within organisations has been to prioritise the claimed primacy of the lived experience held by certain specific groups, via the appointment of self-selected reference committees, policy review groups, etc.  Thus, we find that after concluding a total of just 18 interviews with trans people, the Office for National Statistics included a question about whether ‘the gender you identify with’ is the same as ‘your sex registered at birth’ in the 2021 census, producing predictably uncertain and worthless data as a consequence. 

However, the real crux here is that not all lived experience is judged to be of equal value.  As we have seen, the lived experience and political views of a male-bodied counsellor in a female rape crisis centre clearly outweighs the lived experience and preferences of female-bodied counsellors and their female-bodied clients.  We also see this process at work in the response of the UCU trade union at Sussex University, where a gender critical professor, Kathleen Stock, was driven out of her job.  The union’s rather bizarre response to this was to campaign in favour of a survey of the lived experience of trans staff and students, rather than stand up in any way for her legal rights to free speech, or her right to work freely and without fear of harassment from students, or from other staff.   

Achieving compliance

Well, moving towards a conclusion here – our final process is that of putting it all together and making it work, in other words, of achieving compliance from others.  The purpose of any political ideology or movement is to gain power, wherever this can be done.  So this process works at lots of different, interlocking levels.  I think it really has to be acknowledged that gender identity ideology has been remarkably successful in fundamentally changing the nature of society in the industrial West, at least, within the last decade.  Positive representations of trans people are now mainstream within the mass media, social media, youth culture, within schools, universities, the police, the National Health Service (NHS), advertising, corporate policy, professional associations, and so on. 

How has this been achieved? Partly through a stealthy process of policy capture, via the soft underbelly of the public sector, such as education, healthcare and public services.  At an interpersonal level, this very much plays on the notion of the desirability of social acceptance, the need to ‘just be kind’ towards others.  This has been allied to the conscious piggybacking of trans ideology onto the earlier successful gay and lesbian liberation movements.  This is demonstrated by the rapid pivot of Stonewall towards trans issues after 2015.  We can also see this within healthcare, for example, in terms of subtle pressures to comply via the NHS Rainbow Badge scheme, and the not-so-subtle nudges arising from application of the US-based EPIC data management system.  This controversial and quite bizarre data system seeks to get medical staff to record the gender identity of all newly-born babies, and to carry out ‘organ inventories’ of the reproductive features of all patients. 

At yet another level, compliance has also been achieved by the trans movement’s absolute refusal to debate issues, particularly about its adverse impact on women’s rights, with any seriousness.  It also refuses to acknowledge the legitimacy of safeguarding concerns which follow on from promoting social transition in schools, for example.  For those who actively oppose gender identity ideology, there are attempts to bring professional complaints, and systematic efforts to deny us access to the mainstream media, unfortunately aided and abetted by institutions such as the BBC and ITN, and papers like the Guardian. 

Conclusion

And yet… and yet… overall, compliance in the UK with trans ideology is definitely weakening.  The general public’s stated acceptance of the reality of trans presence peaked several years ago, according to YouGov surveys, and is now steadily falling away.  The courts have repeatedly defended the rights of people like myself to hold and express gender critical views at meetings like this.  And, finally, we have the Cass Review, which follows a standard public health approach to these knotty issues of whether we really should be providing puberty blockers to teenagers, without very good evidence of their safety, or of their effectiveness. 

So, the tide is now definitely turning away from peak trans and towards much more open debate about these crucial issues.

December 2024