David Pilgrim
Introduction
I argue below that the concerted pressure from transgender activists within the British Psychological Society (BPS) has a particular social and historical context. Their claims emerged from a complex mixture of factors at the turn of the 20th century. That picture included philosophical idealism from Nietzsche via Foucault, New Social Movements in the wake of black civil rights protests in the USA, changes in biomedical ambitions for a technological fix for human distress, the abandonment of redistributive forms of politics to create social justice in favour of the politics of recognition, the shift from second wave to third wave feminism with its celebration of Queer Theory, as well as the direct and indirect financing of the transgender movement. On the latter count, the gender clinic industry is a source of drug company profits (from the use of puberty blockers and cross-sex hormones). In addition, there key billionaire contributions to support transgender activism via charitable foundations (https://4thwavenow.com/2018/05/25/the-open-society-foundations-the-transgender-movement/).
I will return to these synergistic ideological and economic mechanisms below but will start with their practical outcome in recent times in the BPS. By going to and fro between these local and recent events on the one hand, and their social and historical context on the other, I hope to understand why this particular ‘culture war’ about gender has often generated more heat than light. That trend can be seen in purported scholarly organisations like the BPS and in the NHS, where advocates of ‘gender medicine’ have become impaired in their reasoning and their honesty about both evidence and ethics.
The BPS has painted itself into a corner on gender
Since the final Cass Review was published, there has been a stubborn resistance from transgender activists in the UK. Those we listed in our letter to Professor Tony Lavender, Chair of the BPS Practice Board [on this blog August 15th] reflect that push back inside the BPS, from those capturing its policy stance on the contested notion of ‘gender’. We might add others, such as Dr Rob Agnew (Chair of the BPS Psychology of Sexualities Section – see below) and Dr Adam Jowett (Chair of the BPS EDI Board and BPS Trustee). The first, a clinical psychologist, on X described the release of the Cass Review as a ‘…bad day for trans youth…’.
The second, an academic psychologist, provided research to the previous government, which despite its foreboding rhetoric and poor methodology, failed to offer a shred of evidence that conversion therapy for gay or transgender people existed in Britain within mainstream mental healthcare.
The misleading elision of aversion therapy for gay men in the past and exploratory conversations with children today, is absurd (Pilgrim, 2023a). Despite this, that line of reasoning has continued in the BPS since 2018 with Igi Moon at the helm, spearheading the ‘Coalition Against Conversion Therapy’, using the Society’s resources and its administrative base to lobby government. Take this boast from the Coalition:
“Dr Igi/Lyndsey Moon, who is chair of the Coalition and British Psychological Society lead said:
‘This is a clear sign that the Government has at long last listened to LGBT individuals and national organisations who have tirelessly campaigned for change. We, along with our Coalition partners, have repeatedly called for an end to the practice of Conversion Therapy and will work with the Government to ensure it delivers on its promise. The Coalition will fully engage with the forthcoming consultation on the best way to implement an end to this practice.’” (https://www.cosrt.org.uk/tag/coalition-against-conversion-therapy/).
Today, trans capture is not unique to the BPS, but the difference is that most other relevant organisations are now adapting to the realpolitik of a post-Cass world and are managing to contain the excesses of their activist members. Within medicine, controversially, the BMA is out of sync with that trend and so it has become newsworthy for the storm that this has created in its own membership (Feinmann, 2024). Hundreds of BMA members are now resigning in protest at trans capture in their trade union and professional body (see https://archive.ph/uRNLH and https://archive.ph/VINHO).
Agnew and Jowett, along with the activist authors of the Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity (https://explore.bps.org.uk/content/report-guideline/bpsrep.2024.rep129b). (first issued in 2019 and modified in 2024), as well as the collusive support of the editor of The Psychologist, have now painted the BPS into a corner. Because the matter of gender has not been explored fully and properly within the whole membership containing, like civil society more widely, distinctly differing viewpoints, one, and only one, policy, theoretical and ideological position on sex and gender has been left standing. For now, the white, pink and blue flag flutters imperiously above the Leicester HQ.
This poses a problem for the BPS and is an irritating embarrassment to any ordinary member holding a view non-compliant with transgender activist dictates. If that conclusion is in doubt about policy capture, at the time of writing the BPS has just offered the world an ‘unconference’ [sic] to explore ‘perinatal psychology’ ( https://www.bps.org.uk/event/reflections-equality-diversity-and-inclusion-perinatal-psychology-systemic-vitality-or). Although factually only women can have babies and breastfeed naturally, the BPS now endorses the neologisms of ‘birthing parents’ and ‘chest-feeders’.
I now turn back to the wider context to understand how we have arrived at this strange scenario, whereby a putative scholarly organisation has been reduced to a platform for partisan rhetoric.
The wider context: hegemony and mission creep
The word ‘hegemony’ connotes the dominant role of one viewpoint in a specific cultural setting. It has a dynamic implication, because nothing lasts in human affairs. There is a power struggle and there are winners and losers over time and place. In Western democracies we are living in a time when the dominance of gender ideology has been embedded since the 1990s. However, it is now fracturing. The word ‘gender’ appeared as an alternative to both ‘women’ (‘women’s studies’ became ‘gender studies’ in the academy) and sex, as in the highly risky use of ‘gender’, not ‘sex’, in medical records (Dahlen,2021). This was reflected in the ascendency of Queer Theory, third wave feminism and the politics of recognition, at the height of postmodernism in the 1990s (Butler, 1995; Rubin, 1992; Califia, 1995; Taylor, 1994).
In the clinical domain, what started in the 1960s as a compassionate acceptance of adult transsexuals, who at that time were mainly men wanting to be women in physical appearance and social presentation (Benjamin, 1966), soon moved into areas of practice that provoked critical opposition for a range of reasons. Those critics, for daring to speak out, were to be dubbed ‘transphobic’ or ‘anti-trans’. This article will probably meet the same dismissal.
Thus, the right to disagree, in the academy, the clinic or wider civil society was to be quashed at every opportunity by transgender activists. This casts doubt upon the confident cultural dominance of transgenderism. For hegemony to be true to form it needs to acquire a stable matter-of-fact consensus view without coercion; it is a form of soft, not hard, power. That is a defining feature of hegemony: it relies on credible language not on brute force. Thus, transgender activists have not enjoyed that taken-for-granted consensus, as they have had to face opposition from unimpressed and unpersuaded critics. In response, these critics have been personally disparaged, threatened and harassed.
Mission creep in the clinic and the invention of cis bigotry
Under the transgender umbrella it soon became evident that the male to female (MtF) transsexual group contained at times a version of extended fetishism or autogynephilia (Blanchard, 2005). These male cross-dressers were sexually aroused by acting like women and surrounding themselves intimately with natal women. The latter were to be dubbed, patronisingly by transgender activists, as ‘cis women’ raising a logical conundrum. If a transwoman was now declared with total certainty to be a woman, then why was a natal women called something else (i.e., a ‘cis woman’ and not just plainly a ‘woman’)? One answer, which the anti-realist postmodernists found unacceptable, was that women have XX chromosomes and men have XY chromosomes. Postmodern framings ignored facts and instead preferred unending fictions. Another answer was the hierarchy of victimhood created by the logic of identity politics (transwomen were deemed to be more oppressed than cis women).
To say that a woman is an adult human female (a dictionary definition) was then rendered as a form of hate speech by the guardians of identity politics and, at times, this even triggered police involvement. However, a man has never had a baby and never will. The ‘unconference’ noted above will not change that reality. A woman will never die of prostate cancer. A man in a dress demanding to be called ‘she’ is still a man (Greer, 1999). Indeed, for gender re-assignment to mean anything plausibly, it must manipulate a healthy male body to look like a female one or vice versa. This generated another conundrum but this time about social norms. Despite norm-busting claims of celebrating gender diversity, what used to be called a ‘sex change’ has, by and large, hormonally and surgically generated very conservative and caricatured stereotypes of appearance.
A legacy of these linguistic gymnastics has been the emergence of a ‘woman with a penis’ and even a ‘trans lesbian’, defying the logical and historical agreement that lesbians are females sexually attracted to other females. Old-fashioned common-sense realists (i.e. most ordinary citizens remembering their school biology lessons) were thrown into confusion with all of this postmodernist word play. Wrong footed, unenlightened ‘cis’ social actors were to become bigots for ‘misgendering’ a man in a dress or ‘dead naming’ a person they had known for years as male or female, who has now opted to self-identify as a member of the opposite sex. Just as the victimhood of being transgender was guaranteed, then so too were the inevitable moral failings of untutored ‘cis’ people, with oppressive ‘cis women’ being especially suspect. ‘Black face’ causes understandable offence but ‘woman face’ is supposedly now a symbol of human progress and tolerance (cf. Tuvel, 2017).
Depicting or speaking about something as real is not necessarily the same thing as it being real (technically this is called an ‘epistemic fallacy’). We can recognise a drawing of a unicorn, but unicorns do not exist. People may lie about themselves or be deluded. The recognition of self-statements by others is a negotiation not an enforced outcome on tramlines, a point those defending the ethics of recognition note (Honneth, 1995). But according to gender ideology, insinuated now in the official BPS policy position, if a boy says he is a girl, then he is a girl. Accordingly, ontological realism with its principle of limits was discounted by Queer Theory underpinning BPS policy. Instead, it favoured unendingly elastic epistemological relativism (cf. Henry, 1950). A philosophical realist insists that an adult person with XY chromosomes is a man. By contrast, a philosophical idealist claims that they can be a woman if they say they are. One of them is wrong.
The principle of limits first discussed by the philosopher and psychologist C.D. Broad in the early 20th century was defended later by second wave feminists (Broad, 1949). For example, Oakley (1972) accepted that gender expression was socially negotiated over time and place, but she held on firmly to biological reality and the immutability of sex. However, within twenty years, the third wave went much further, rendering the material reality of the natural world irrelevant. Talk, and talk about talk, now became all important, in the hurry towards the promised land of radical social constructivism. Sex as a biological fact was old hat and a likely source of hate speech.
This switching of priorities in social science, bizarrely later to be adopted by some who should have known better in the natural sciences, with their authority predicated on versions of philosophical realism, conflated ontology and epistemology. Now ‘everything was socially constructed’, a view reinforced by the growth of postmodern psychology in the academy. In the clinic, it led to GIDS, with its preference for children being ‘assigned’ a sex at birth, as if it were an arbitrary opinion.
That scorned decision-making from people offering their commonsense observations about a baby boy or girl, must now be trumped by the absolute life-long certainty of self-identification. This must not be gainsaid by anyone, including psychologists. ‘Trans children’, even before they went to school, would signal with certainty that they had been ‘born in the wrong body’, and adults must accept that judgment credulously.
However, a ‘non-binary’ claim within the transgender panoply created another conundrum and contradiction: if we are all born with a life-long fixed ‘gender identity’, then how can it change from day to day or hour to hour in some, but not all, of us? If our gender identity is like a permanent inborn soul, then how come that for some of us it keeps slipping and sliding away? The mystique of ‘having’ a gender is mysterious indeed and these are serious theological and psychological questions about souls or selves. Ultimately how do we understand personhood? (See Smith (2010) for a critical realist take on that big question.)
The impact of gender ideology in the BPS
The Guidelines issued by the BPS on gender in 2019 and revised this year reflect this wider context of an ideology which has been imposed on children by adults. Children did not invent gender ideology. However, their views have been shaped by it en masse, encouraged by virtue signalling policy makers in health and education and online social contagion. In truth, ‘trans children’ do not reflect a suddenly recognised aspect of ontology. After all, where were they all 30 years ago? Instead, in the wake of Queer Theory they were invented by some adults on an ideological mission and nameable activists in the BPS and other organisations reflect that scheming and earnest missionary activity (Moore and Brunskell-Evans, 2019).
Diagnostic overshadowing, revealed in the Cass Review, became evident and was reflected in Agnew’s simplistic view that there is a single reductive category of ‘trans youth’. According to him and the discredited GIDS leadership, we need look no further than self-identification and a moral obligation to affirm the self-statements of gender questioning children. What this insistence closed off was the evidence that the GIDS waiting list contained distressed children who were depressed, anxious, survivors of abuse, might have marked autistic features or had come from a family context of parental homophobia (Barnes, 2023). Psychologists led that now discredited biomedical project and the BPS backed it to the hilt; recent events suggest that it does not intend to abandon that position.
Whilst affirmation superficially signals patient-centredness, it is the very opposite. Diagnostic overshadowing and the reification of ‘trans children’ diverts clinicians from a standard obligation to offer biographically unique formulations. Why were these young people being treated in a different way to any other clinical presentation? Also why were psychologists leading the charge for biomedical interventionism, when that reactionary and bio-reductionist role had been left previously to biological psychiatrists, with their ‘great and desperate cures’ which always focused on the body, rather than biographical uniqueness?
The answer to these questions lay in mission creep from the Benjamin regime, with its focus on adult transsexuals in the 1960s, to children in the 1990s. Once activists made that daring shift it would inevitably be provocative and so it was the case. The psychology leadership at GIDS adopted uncritically that mission creep, modelled in the Netherlands on a small and highly selected sample of children and ‘rolled it out’ in the NHS, as a full-blown service philosophy (Biggs, 2023). Worse than that, a study looking at outcomes failed to demonstrate the clinical effectiveness of an affirmation model in the UK – that bad news for transgender ideologues was actively suppressed for many years (Butler et al, 2022). This obfuscation only came to light because of a freedom of information request (Biggs, 2019). That evasion of the truth from those committed to expanding ‘gender medicine’ in the NHS was confirmed by the unwillingness of managers of adult gender clinics to release follow up data about the outcomes for transgender patients during the Cass Review (https://www.theguardian.com/society/2024/apr/10/adult-transgender-clinics-in-england-face-inquiry-into-patient-care.)
If affirmation is so worthy and the outcomes are so good, then why is evidence about them being cynically suppressed by those promoting and managing ‘gender medicine’? The answer is that ideology has been more important than evidence for those defending its expansion. A summary of this challenge for transactivists about evidence is offered here in Feinmann (op.cit.):
At the heart of the dispute is a series of systematic reviews that rigorously examined the robustness of practice and guidelines underpinning the care of young people with gender dysphoria, in particular influential guidelines by the World Professional Association for Transgender Health (WPATH). A total of seven papers by the York University systematic review group were published in the Archives of Disease in Childhood in April. The papers found that the evidence on the use of puberty blockers and hormones in young people with gender related distress was “wholly inadequate, making it impossible to gauge their effectiveness or their effects on mental and physical health.” Nick Brown, editor of the Archives of Diseases in Childhood, told The BMJ, “A common thread in the review findings was the breathtaking dearth of quality evidence to guide care in this vulnerable group of young people.”.
This need to suppress or evade inconvenient truths, along with the iatrogenic risk that all ‘trans youth’ are exposed to by an affirmation model (Jorgensen, 2023), has culminated in a crisis for transgender hegemony in clinical contexts. It is now breaking down, as the Royal College of Psychiatrists, the Royal College of General Practitioners, the Academy of Medical Colleges, the Association of Clinical Psychologists and the Pharmaceutical Society have now all backed the Cass Review and pulled back from previous degrees of trans capture. This is true also of the incoming Secretary of State for Health who has continued the ban on puberty blockers. That new emerging consensus is clearly leaving the BPS out in the cold in policy making.
The paradox of identity politics writ large in the BPS
The weak governance at the top of the BPS, alongside its largely passive and acquiescent membership have, in recent years, created an open goal for transgender activists. Igi Moon coopting the BPS administration for the wild goose chase of purging the land of conversion therapy (i.e. having routine therapeutic explorations) has been par for the course. So too with Christina Richards, a co-author of the WPATH ‘standards of care’, who had free reign to dominate the BPS Guidelines group. This counselling psychologist left being non-directive at the consulting room door and told us that there was to be no debate and that all identities have equal value. However, on pragmatic grounds Richards modified the ‘Kink’ and ‘Slut’ strictures from the 2019, when the document was revised in 2024.
The Sexualities Section of the BPS has now become obsessed by transgender rights, mirroring the reason, in wider British society, why the LGB Alliance found it necessary to split away from Stonewall. Those leaving in protest emphasised that in their own histories they might have been shepherded by adults into a biomedical pathway. The BPS Lesbian and Gay Section formed in 1998 initially made only a passing mention of transgenderism (https://www.bps.org.uk/member-networks/psychology-sexualities-section). Today it is called the “Psychology of Sexualities Section”. But, as a sign of how times have changed in the shifting self-righteous world of identity politics it includes the following commitments:
“...developing non-heterosexist and gender-inclusive forms of research, theory and clinical practice in British psychology...”
and
“…taking a broadly affirmative approach towards sexualities, including transgressive sexualities, while also strongly condemning those which are coercive…“
This legitimises the title of the controversial Guidelines, which we have critiqued and complained about on this blog.
Maybe the gains of homosexual rights, now largely won in formal legal terms in Western liberal democracies, have created the space for a new raison d’etre for both Stonewall and trans captured organisations like the BPS. This focuses on reifying trans identities and appealing to a sense of injustice about a new form of victimhood. The latter seemingly entails the ‘human right’ of existentially confused children to have access to an iatrogenic pathway of hormones and surgical mutilation on demand, being cruelly denied to them by Cass and her supporters. Accordingly, Rob Agnew the Chair of the newly named Section in a forlorn response on X to the release of the Cass Review said this:
Bad news for our trans youth this morning, but let’s be honest, we knew it was coming. In 2021/22 I reviewed the WPATH guidelines for the General Medical Council for a fitness to practice lawsuit in trans youth healthcare provision. The conclusions and the consequences of Cass are out of step with better quality, more comprehensive reviews, and out of step with approaches in other countries. So over the coming days I, and many other clinicians, will be having a look at the final Cass Review in detail and trying to answer the question ‘Why was Cass unable to find the research needed to provide trans youth with vital medical approaches that other countries found?‘.
Maybe Cass was trying to go beyond the selective approach to evidence preferred by the activist-driven WPATH (see later). Maybe Agnew might indeed ‘look’, but he would find nothing of value to him in the evidence available, unless it is to be approached with a highly biased selective attention.
All this indignant rhetoric from Agnew reflects a paradox of identity politics as both a libertarian and authoritarian form of adventurism. On the one hand, the politics of recognition seem to invite tolerance and an unending plurality of perspectives. On the other hand, those same politics enforce very strict rules of expression. Its leaders and guardians, in no uncertain terms, tell us what must be spoken and proscribe what must not.
Second wave feminists, scientific realists and some religious groups have chosen to speak out against this dogma and denial of debate from their particular gender critical perspective, Consequently, they have been vilified and hounded by the gender thought police. Some have lost their jobs. Some had death and rape threats. Some were cancelled on university campuses. All were cast as bigots; the term ‘TERF’, and the recurrent online invitation to kill one, was largely limited to women. A recurrent problem for the logic of identity politics is that special pleading for one social group often might necessitate hostility to another. For example, in the case of transgenderism there is recurring misogyny and a contempt for lesbians (the real ones not the fictional ones).
The ‘no debate’ campaign was clear to see, as freedom of expression in general, and academic freedom in particular, were restricted in ways previously seen only in Nazi Germany and Stalinist Russia. Whether authoritarian control is imposed by the Party or by identity politics from the cyber-mob, the right to speak out freely and disagree with one another is suppressed (cf. Nossel, 2020). But without disagreement there can be no progress about either knowledge production or deliberative democracy (Mercier and Sperber, 2021; von Heiseler, 2020).
This wider process of suppressed debate has infected the BPS, with consequences for a discipline already theoretically and methodologically contested. Psychology is at the cusp of social and natural science, and unsure whether to celebrate or reject its older pretensions to be an experimental science guided by statistical precision. It starts in artificially controlled closed systems, like the psychology experiment, or conclusions from spreadsheets of correlations, but then claims authority in the fluxing situated complexity of everyday life (all human systems are open systems). It gets methodologically confused (or sometimes pre-emptively arrogant) about that challenge. Epistemological pluralism and contestation have thus been inevitable. Understandably we are now used to the collective noun for psychologists being a ‘disagreement’.
Transgender capture has now entered that contested space with its favoured radical social constructivism. It is part of the ‘broad church’ depiction from the Society’s apparatchiks. In relation to gender, that broad church now seems to have been taken over by a cult, or at least a group of socially connected activists, using the manipulative tactics of entryism. In our letter to Tony Lavender, we pointedly named these people. They were joined for a while by others working in gender clinics attempting to extend prescribing rights to psychologists. This had puberty blockers and hormones in their fixed sights. That particular putsch from the trans activists in 2019 failed but it was a close call.
Strictly this network has been ‘cultish’ rather than a cult, as it lacks a defined charismatic leader. Also, the underpinning history of transgender activism has been complex as I noted in the introduction and so the singular ‘cult thesis’ is reductive. Nonetheless, it makes sense that some gender critics use the term ‘cult’, given the mixture of dogmatism and messianic fervour that characterises the transgender movement for now. The parents of gender questioning children understandably do at times report that they have lost them to a cult.
Dogmatism and rigidity of thought are well explored by cognitive psychologists. We can reason in quickly needed binaries to ward off risk or spot a friend or foe. As we mature, we also learn cautious reflection to generate situated wisdom (phronesis) and tentative understandings about our inner and outer worlds (Dutton, 2020; Kahneman, 2011). What identity politics have done, reinforced by rapid online digital decisions, is to encourage a fixation in a simplistic toddler mode of thinking, or what previously psychoanalysts called ‘splitting’. Black and white, goodies and baddies, you are either for or against us, ingroup good, outgroup bad, ‘like’/’dislike’ etc. Mature grown-ups show epistemic humility, nuanced reflection and context specific moral reasoning, toddlers do not (Neiman, 2021). The activists capturing the BPS (and the BMA-see below) are like very clever toddlers getting their own way, when they can.
The point here is that such antics are ripe for psychological understanding, rather than passive and unthinking compliance. It was that compliance, which the transgender activists, who were writing the ‘Guidelines’, were expecting from a dutiful membership. Collusively, the Professional Affairs Board and the Society’s ‘Director of Knowledge and Insight’ [sic] signed them off with unreflective enthusiasm in the same year that the final Cass Review was published. This may be a decision that they are already regretting.
The unlikely bedfellows of the BPS and the BMA
Post-Cass, the transgender activists are not going down without a fight in Britain. Ex-GIDS staff are forming alliances with cooperative medical prescribers to set up new services and keep the old spirit alive in the private sector. The ban on puberty blockers has now made their enthusiasm for the old regime precarious in practice, though workarounds will be tested out and promiscuous prescribers may try their luck again in the court of the GMC.
Within organisations they are also offering a rearguard action to discredit Cass. Two stand-out examples are the BMA and the BPS, which are bucking the trend of consensus building about implementing her Review (Abassi, 2024; McCartney, 2024). Apart from their tactics of entryism to achieve short term goals, transgender activists are now playing catch up about evidence and accordingly they are in a bind. The reason for the catch up is that evidence has never really been their strong suit. Who needs evidence when the truth about gender identity is taken as a given? The BMA, at risk of losing much of their membership, have announced that they will review the Cass Review in the next few months, a decision flowing from the capture of the BMA council by a handful of transgender activists. Watch that space, when selected papers are cobbled together.
A shared rhetoric of justification of both psychology and medicine is that they are evidence based. However, this poses a problem for transgender activists. Privately they know that there is still no strong evidence that biomedical affirmative care is either effective or safe. In the case of paediatric transition, this immediately becomes a child protection issue. We have regularly made this point to BPS leaders, and they have regularly ignored us. The Guidelines they have endorsed totally fail to properly consider either empirical evidence in the round, or sound ethical cautions about child protection.
The metaphysical chasm revealed by trans capture
Notwithstanding the antics of activists in the BMA or the BPS when capturing the policy machinery, there is an irrefutable deep metaphysical chasm between gender ideology and its critics. It is not only that the former conflates ontology and epistemology whereas the latter separate them. It is also about a fundamental difference of viewpoint about ethics flowing from that gap. Transgender entryism in the two organizations genuinely brings with it the belief that there is one, and only one, valid ethical framework, which I deal with below. They are so certain on a priori grounds that the unending recognition of the self-statements of any individual, adult or child, must be respected that the consequences of that policy are ignored.
In line with that moral certainty, which is foundational to identity politics, they take their eye off the ball about evidence. Alternatively, they suppress inconvenient findings as I noted above and only deal with it as a post hoc rearguard action. In the latter, two features are evident. First, menacingly they attack their opponents, ad hominem style. Second, they assert that their own selective version of evidence is superior by dent of professional expertise or being experts by experience.
On the first count, Hilary Cass was disparaged for being ‘cis and het’. The degree of vilification she experienced warranted advice from the police that she should not travel on public transport. An immediate response in the journal, which is the quasi-academic outlet for WPATH, has a self-evident title making this point (Horton, 2024).
On the second count, WPATH now has a major credibility problem when it tries to defend its empiricist credibility, given that it is activist driven. The argument that being expert in a field offers an immediate authoritative position is as flawed in ‘gender medicine’, as in any other branch. However, the activist-with-an-agenda component amplifies that tendency. Those with a vested interest in the field, whether as practitioners or ideologues, raise immediate and unique doubts about their plausibility (Choudry et al 2002).
Insider lobbyists use their expertise as a claim to legitimacy, but sceptical outsiders argue the very reverse. In the case of WPATH the creation of their own dedicated journal outlet (the International Journal of Transgender Health) guarantees a reliable noticeboard for its aims, while pretending to offer academic impartiality. This has been mirrored in the use of The Psychologist by activists in the BPS. The problem for both WPATH and the BPS is twofold. Evidence rarely supports their cause, despite their claim to the contrary, and the ethics of recognition are not the only game town, a cue for the next and final section. If the BPS leadership insists on blindly taking its policy lead from WPATH, then it is now entering a particularly sinister phase of collusion.
WPATH, castration and the ethics of recognition
WPATH is the international (though US-dominated) home for transgender activists and those clinicians who have built their careers within ‘gender medicine’. To say the least, this is rather grandiose posturing, given that there is no genuine international consensus on gender medicine. Its worth in principle is doubted by many and those supporting it have no confident agreement on evidence-based and safe practice.
Unsurprisingly, a core aim of WPATH is to encourage policy makers to expand the availability of ‘gender medicine’, emphasising grounds of equitable access to all transgender people (a capacious group now). In our letter to the BPS leaders, pointing up this enmeshment and expansionist aspiration, we noted that a key figure has been Christina Richards who wrote a section for the eighth edition of the ‘Standards of Care’ issued by WPATH (Coleman et al 2022; WPATH, 2024). Thus, Richards is both a dominant activist within the BPS and a key UK representative on the international scene. Note that two other members of the writing group producing the ‘Guidelines’ in 2024 (Igi Moon and Alex Penny Lenihan) were also WPATH members. This was a triple guarantee that the BPS Guidelines would be WPATH compliant.
The expansionist aim of WPATH is predicated on a plausible ethical claim, aligned with the politics of recognition. The latter emerged in the wake of the American civil rights movement about equal citizenship. It shifted the matter of social justice away from redistribution (a structural focus) to that of personal recognition alone (a post-structural focus) (Fraser, 1999). A consequence of this shift has been that those traditional concerns about inequalities, created by the real material forces of biology and economics, have been replaced in importance by policies of obligated recognition. This is why the ethics of recognition now can only be understood by making sense of the strengths and weaknesses of the politics of recognition or identity politics (Pilgrim, 2023b).
Transgender activism is one variant of New Social Movements in civil society, expanding since the 1970s and commonplace in the EDI policies of organisations. In truth the ‘E’ has virtually disappeared because it came from an old, and now largely ignored, social movement rooted in the conflict between labour and capital in the workplace (Ben-Michaels, 2006). Recent events suggest that the transgender movement is now faltering because it is dogmatic about fictions but casual about facts, as well as being menacingly authoritarian. Accordingly, it is at odds with the rights of women to be left to their privacy and dignity and of children to grow up naturally without interference.
Whilst the ethics of recognition are important, and any fair-minded person can reflect on their merits, they are not the only game in town (Häyry, 2009). The Cass Review reflected a different, and equally legitimate, ethical stance based on consequentialist and deontological arguments about the priority of a duty of care to do no harm (the principle of non-maleficence). If gender medicine is not provenly safe, then we need to hit the pause button. This is basically the case from Cass. Thus, the strength of her analysis was its focus on patient protection in general and of child patients in particular, whereas the strength of the transgender position was in its prioritisation of respect and recognition. However, the WPATH guidelines have now entered a low point of credibility in their hegemonic struggle against those like Cass and her legions of supporters.
The WPATH position has been generated only by activists and gender clinic career professionals. The have no good faith interest in a fully balanced, evidence-based, justification for the very existence of gender medicine. Quite the opposite: it would be like turkeys voting for Christmas. According to WPATH, gender medicine should be expanded simply because it is inherently a ‘good thing’. And why is it a good thing? Because WPATH and their local missionaries capturing the policy process say so.
However, their own internal discussions in revelations about the ‘WPATH files’ have demonstrated that its leaders have known for a while that the findings of Cass were substantially correct (https://sex-matters.org/posts/updates/wpath-the-truth-about-gender-affirming-healthcare/). This leaked internal discussion from the WPATH leaders shows that they know full well that major biomedical interventions can be iatrogenic (what a surprise) and that it is impossible for children to give informed consent. The consent is not informed by evidence of efficacy and safety and the capacity to consent is impaired by dint of cognitive immaturity. Despite this indisputable scenario, the most recent version of the WPATH ‘Standards of Care’ now recommends no lower age limits on biomedical transition (except for genital surgery on girls).
Moreover, apart from hiding that damning discussion from public scrutiny (as with the evasions about evidence in the UK I noted earlier) the other step taken in the new ‘Standards of Care’ issued by WPATH has included for the first time ‘eunuch identities’ (WPATH, 2024). This is what the relevant paragraph says:
Eunuchs and eunuch-identified people have existed for millennia. Some eunuchs or eunuch-identified people experience dysphoria about their genitalia and desire that their reproductive organs be surgically removed or rendered non-functional. Due to social stigma and perhaps a lack of previous medical access and information, some eunuchs or eunuch-identified people may attempt to do this by themselves or with people who are not sufficiently trained, often leading to unfortunate outcomes. One of the consistent priorities throughout the SOC-8 is to encourage and highlight the importance of individualized care for transgender and gender diverse people in lieu of one-size-fits-all health care models. This is as true for eunuchs or eunuch-identified people as for other people who identify as transgender or gender diverse. (https://www.wpath.org/media/cms/Documents/SOC%20v8/SOC-8%20FAQs%20-%20WEBSITE2.pdf)
This position from WPATH was fed by those in the Eunuch Archives (https://reduxx.info/top-trans-medical-association-collaborated-with-castration-child-abuse-fetishists/). The Archives have been generated by men with castration fantasies, many of which include ones about castrating young boys. The link between WPATH and the Eunuch Archives has had a direct impact on the NHS. In Scotland advice from that link was uploaded to official guidance (now removed) (https://archive.ph/rEqzo).
This permeable discursive boundary between pornified child abuse and the WPATH guidelines for ‘gender medicine’ may be shocking to any newcomer to the strange world of gender politics. However, the eunuch question is being dealt with consistently by WPATH, within the broad rationale of both the politics and ethics of recognition. That ‘all identities are of equal value approach’ is germane to the BPS guidelines and is traceable to the politics of recognition and to the sexual libertarianism of Queer Theorists like Rubin and Califia (ibid).
Contra to the realist’s principle of limits, the collective imagination of gender ideologues has no limits. If an identity (any identity) can be stated, then it must be respected, no question. The problem for the ethics of recognition is that some self-identified groups are offensive to others and for good reason. Paedophiles, incels and necrophiliacs can and do claim a worthy personal and group identity. Will they be next on the WPATH ‘good to go’ list? If they are not, then the WPATH leaders will need to reflect on and articulate ethical criteria other than recognition per se; the ethics of recognition are a one trick pony.
Whilst any psychologist can read and reflect on the merits of Queer Theory or the ethics of recognition, they may then be found lacking for legitimate reasons. Criticisms should then be listened to respectfully and not shouted down. Why should the BPS membership slavishly adhere to the directives of a manipulative group of transgender activists? Their ‘Guidelines’, are little more than ‘thou shalt’ type propaganda. Why should those of us pointing out that high handed bossiness be silenced? How is that process of silencing consistent with the BPS claiming to be a scholarly society and a ‘membership organisation’? The Society seems to have now sacrificed the principle of academic freedom at the altar of identity politics and it is dancing to the tune of WPATH.
A problem now for WPATH is that elective castration is deemed to be a matter of serious criminality, when sought and found in non-clinical settings. However, we are then expected, quite seriously, to accept that the same procedures are positively ethical and wholesome, when carried out in clinical settings. Compare the self-righteous defence of elective castration from WPATH above, with how the British courts dealt, in April 2024, with Marius Gustavson (https://www.bbc.co.uk/news/uk-england-london-68977469). He was given a 22-year prison sentence for heading up a ‘lucrative business’ in human castration and variants of BDSM, including electrocution. The sentencing judge described the perpetrator’s conduct as “gruesome and grisly” and “extremely dangerous”. He deduced a combined motivation for the crimes of financial gain and sexual gratification. Defence lawyers suggested that Gustavson was offering a service to ‘put a smile on people’s faces’ of those suffering, like him, from ‘body integrity dysphoria’. That claim for recognition-based beneficence, from this non-clinical ‘eunuch maker’, is broadly the same as the ethical rationale from WPATH of reducing dysphoria. Any fair-minded reader would struggle to spot the difference between them.
The claim from WPATH is that adverse outcomes would be minimised (but note not disappear) in clinical settings, but why castrate anyone in principle, ever? How exactly is mutilating a healthy body a life affirming activity? Going back to Kant, this has been a serious challenge for medical ethicists. Where is the longitudinal evidence that elective castration leads to long term mental health gain, rather than it being an extreme masochistic act, surrounded by short term sexual excitement at a no-turning-back existential moment? Why were WPATH content and enthusiastic to rely on the advice of the sinister paraphiliacs in the Eunuch Archives? The answer to these questions is that the ethics of recognition have now been offered as a credible alternative to both the deontological and consequentialist traditions.
WPATH is now clearly pitched against Cass and a wide range of her supportive gender critics. We all can decide which side we are on or if we are ambivalent. We can reflect carefully on a serious healthcare and education policy matter. WPATH and the BPS want that reflection to cease as they already know the answer: gender medicine must expand and expand, as an exercise in ensured human betterment. Richards told us confidently, the ‘debate is shut’; but some of us disagree and for good evidential and ethical reasons.
Squaring the circle about the ethics of castration (sordid and criminal or wholesome and beneficent?) may reveal yet another crack in the credibility of the advice of WPATH. In case the obvious needs stating, it is not only those seeking elective castration, discussed with relish in the Eunuch Archives and now in WPATH, who point up this ethical minefield. It is also within the now routinised world of MtF transitioning, or what used to be called a ‘sex change’. The latter is euphemised as ‘bottom’ surgery, which is the removal of the penis and testicles and the construction of a neovagina, with the serious iatrogenic risks this creates (Negenborn, et al., 2017). In the interests of personal recognition, non-medical ‘cutters’ and ‘eunuch makers’, often criminalised, operate just like the prestigious surgeons working in gender clinics. Both destroy healthy genitals, and both put physical health at risk, with no guarantee of mental health gain, case by case.
A complement of this grisly scenario is that healthy young females (usually destined if left alone to become lesbians) are having double mastectomies at the hands of qualified surgeons in pursuit of authentic selfhood. They do not send tissue for histopathological analysis (as would happen in routinely in cancer surgery) because they know full well that the breasts removed are perfectly healthy (cf. Hostiuc et al.,2022). It is little surprising then that the American Society of Plastic Surgeons has just announced that such surgery is unethical, though the litigious culture of the USA may have prompted that judgment (https://www.city-journal.org/article/a-consensus-no-longer).
This is yet another sign that the hegemony of transgender activism, embodied in the work of WPATH is now breaking down. A further sign is that NHS England no longer uses the WPATH guidelines as its benchmark of good practice. Any resistance to Cass from the BPS or the BMA will put evidence firmly in the spotlight, which has not been the strongest card that transgender activists have played to date. The hegemonic power balance is shifting away from transgender activism at the very point that the BPS has opted to offer its full and unguarded support.
Conclusion
I have placed the trans captured position of the BPS in its social and historical context. The Society has been one international outlet for WPATH triumphalism. At times our local leaders have reciprocated by being international contributors. Activists like Richards have embodied that linkage and other members of the team imposing the Guidelines on the BPS membership were WPATH members. Its database of members is online for all to see and the few cases of UK representatives stand out for their activism in the BPS and their careers in NHS gender clinics and increasingly privatised care post-Cass.
The BPS now finds itself in an isolated position by defending a pre-Cass position in a post-Cass world. The ACP-UK has a key seat at the table in the latter context of policy development, whereas the BPS has now lost that status. It remains captured by gender ideologues, who have recently enjoyed their salad days in the BPS and other organisations. However, those activists are now losing their grip on cultural dominance. Their lonely isolation may be reduced by the live links they have retained with WPATH and the energising struggle to win their battle over ‘conversion therapy’. In their turn, gender critics will point out that the real conversion therapy is to take a healthy young body and render it sterile and mutilated, with the goal of creating a semblance of the opposite sex, but with no guarantee of mental health gain from case to case.
The exposure of doubts from lead activists in the leaked ‘WPATH files’, and the Association’s new-found cooperation with the sinister Eunuch Archives have exposed it for what it is, i.e., obsessed by personal recognition at all costs. It seems to be unconcerned with public safety or child protection. The UKCP have now pulled out of the campaign against conversion therapy, while BPS activists remain at its centre. That twin goal from activists, of turning conversations into conversion and defending the discredited GIDS regime, undermines the case from the BPS to be taken seriously today.
On this blog, the more we shine a light on the policy antics of the Society the more it is obvious that it remains a dysfunctional organisation, with little or no claim to public confidence because it has no credible governance. Its penchant for policy developments which are unrepresentative of its broad membership and a threat to public safety is particularly noteworthy and reckless. Allowing the cultish antics of transgender activists to have so much sway is typical of an organisation that has seriously lost its way.
References
Abassi, K. (2024) The Cass review: an opportunity to unite behind evidence informed care in gender medicine. BMJ385:q837
Barnes, H. (2023) Time to think: The inside story of the collapse of the Tavistock’s Gender Service for Children Swift Press
Benjamin, H. (1966) The transsexual phenomenon New York: Julian Press.
Benn Michaels, W. (2006). The trouble with diversity: How we learned to love Identity and ignore inequality New York: Holt.
Biggs, M. (2023) The Dutch protocol for juvenile transsexuals: Origins and evidence, Journal of Sex & Marital Therapy,49: 4, 348-368.
Biggs, M. (2019) Britain’s experiment with puberty blockers’, Inventing transgender children and young people, (pp4-55) (eds. M. Moore & H. Brunskell-Evans) Cambridge Scholars Publishing,
Blanchard, R. (2005). Early history of the concept of autogynephilia. Archives of Sexual Behavior. 34, 4:439–446.
Broad, C. D. (1949). The relevance of psychical research to philosophy”. Philosophy. 24, 91, 291-309.
Butler, J. (1999) Gender trouble: Feminism and the subversion of identity. New York: Routledge
Butler, G., Adu-Gyamfi, K., Clarkson, K., El Khairi. R, Kleczewski, S., Roberts, A., Sega,l T.Y., Yogamanoharan, K., Alvi, S., Amin, N., Carruthers, P., Dover, S., Eastman, J., Mushtaq, T., Masic, U. and Carmichael, P. (2022). Discharge outcome analysis of 1089 transgender young people referred to paediatric endocrine clinics in England 2008–2021. Archives of Disease in Childhood. doi:10.1136/archdischild-2022-324302.
Califia, P. (1995) Public sex: The culture of radical sex. New York: Clies
Choudry, N.K., Stelfox, H.T. and Detsky, A.S. (2002) Relationships between authors of clinical practice guidelines and the pharmaceutical industry. Journal of the American Medical Association 287:612–7.
Coleman, E., Radix A.E., Bouman, W.P., Brown, G.R., de Vries, A., Deutsch, M.B., et al. (2022) Standards of Care for the health of transgender and gender diverse people, Version 8. International Journal of Transgender Health. 23:sup1, S1-S259
Dahlen, S. (2021) Dual uncertainties: On equipoise, sex differences and chirality in clinical research The New Bioethics. 27, 3, 219-229.
Dutton, K. (2020) Black and white thinking: The burden of a binary brain in a complex world. London: Bantam.
Fraser, N. (1999). Social justice in an age of identity politics: Redistribution, recognition and participation. In Ray, L. & Sayer, A. (eds) Culture and economy after the cultural turn (pp25-52) New York: Sage.
Feinmann, J, (2024) Puberty blockers: BMA calls for lifting of ban on prescribing to children. BMJ386:q1722
Greer, G. (1999) The whole woman London: Penguin.
Häyry, M. (2009) Presidential address: The ethics of recognition, responsibility, and respect. Bioethics.23(9):483-5.
Henry, J. (1950) The principle of limits with special reference to the social sciences. Philosophy of Science 17, 3, 247-253.
Honneth, A. (1995) The struggle for recognition: The moral grammar of social conflicts Bristol: Polity Press.
Horton, C. (2024) The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children. International Journal of Transgender Health (online March)
Hostiuc S., Isailă, O.M., Rusu, M.C. & Negoi, I. (2022) Ethical challenges regarding cosmetic surgery in patients with body dysmorphic disorder. Healthcare (Basel). 10(7):1345.
Jorgensen, S. C. J. (2023). Iatrogenic harm in gender medicine. Journal of Sex & Marital Therapy, 49(8), 939–944.
Kahneman, D, (2011) Thinking fast and slow New York: Macmillan.
Moore, M. and Brunskell-Evans, H.(eds) (2019) Inventing transgender children and young people, Cambridge: Scholars Publishing.
Mercier, H. and Sperber, D. (2011) Why do humans reason? Arguments for an argumentative theory. Behavioral and Brain Sciences, 34, 2, 57-74.
Negenborn, V. L., van der Sluis, W. B., Meijerink, W. J. H. J., and Bouman, M-B. (2017). Lethal necrotizing cellulitis caused by ESBL-producing E. coli after laparoscopic intestinal vaginoplasty. Journal of Pediatric and Adolescent Gynecology, 30, e19–e21.
Neiman, S. (2011) Moral clarity: A guide for grown-up idealists London: Vintage
Nossel, S. (2020) Dare to speak: Defending free speech for all New York: HarperCollins.
Oakley, A. (1972) Sex, gender and society Aldershot: Arena
Pilgrim, D. (2023a). British mental healthcare responses to adult homosexuality and gender non-conforming children at the turn of the twenty-first century. History of Psychiatry, 34(4):434-450.
Pilgrim, D. (2023b) Identity politics: Where did it all go wrong? Oxford: Phoenix.
Rubin, G. (1992) Thinking sex: Notes for a radical theory of the politics of sexuality. In C.S. Vance (ed) Pleasure and danger: Exploring female sexuality (pp, 267-319). London: Pandora.
Smith, C. (2010) What is a person? Chicago: Chicago University Press.
Taylor, C. (1994) The politics of recognition. In A. Gutmann (Ed.), Multiculturalism (pp. 25–74). Princeton: Princeton University Press.Tuvel, R. (2017). In defense of transracialism Hypatia: A Journal of Feminist Philosophy. 32 (2): 263–278von Heiseler T.N. (2020) The social origin of the concept of truth – how statements are built on disagreements. Frontiers in Psychology Apr 28;11:733
WPATH (2024) Standards of Care (version 8) https://www.wpath.org/soc8
psychology UNREDACTED 