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The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.

Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

“In their study, they found that some of these gene variants were significantly more associated with being trans women, and not just being male. That doesn’t establish causality, and it is just an association. And in fact, its a weak association,”

genetic markers are not assumed to be the only factor in what shapes something like gender.

When publishing material that supports the idea that there is a biological element to gender identity, scientists, policy makers and the general public are less inclined to listen to trans activists.

Trans activists seek to educate people on their fundamental human right to experiment with dress, movement, identity and presentation.

“The way that science, technology and science is progressing can be incredibly dangerous in regards to things like eugenics.”

Until 2013, trans people in Sweden were required to undergo sterilization before they could access gender-affirming treatment.

Given the rising accessibility of gene testing, this sort of research can easily be weaponised as justification for sterilisation, persecution or the abortion of fetuses with these genes.

It also further troubles the tenuous relationship that the scientific and medical community have with the trans community.

Fostering the notion of a genetic factor to gender dysphoria threatens to further complicate trans people’s access to appropriate care.

it takes away their right to self determination and the right to bodily autonomy in regards to gender expression and creativity.”

raises questions about the repeated and unchecked power discrepancies between science, medicine and the trans and gender diverse community.

Months later, I compounded my accidental ‘like’ crime by following Magdalen Berns on Twitter. Magdalen was an immensely brave young feminist and lesbian who was dying of an aggressive brain tumour

Magdalen was a great believer in the importance of biological sex, and didn’t believe lesbians should be called bigots for not dating trans women with penises, dots were joined in the heads of twitter trans activists, and the level of social media abuse increased.

‘TERF’ is an acronym coined by trans activists, which stands for Trans-Exclusionary Radical Feminist. In practice, a huge and diverse cross-section of women are currently being called TERFs and the vast majority have never been radical feminists

why am I doing this? Why speak up? Why not quietly do my research and keep my head down?

I’ve got five reasons for being worried about the new trans activism, and deciding I need to speak up.

Firstly, I have a charitable trust that focuses on alleviating social deprivation in Scotland, with a particular emphasis on women and children. Among other things, my trust supports projects for female prisoners and for survivors of domestic and sexual abuse. I also fund medical research into MS, a disease that behaves very differently in men and women

I’ve wondered whether, if I’d been born 30 years later, I too might have tried to transition. The allure of escaping womanhood would have been huge.

The second reason is that I’m an ex-teacher and the founder of a children’s charity, which gives me an interest in both education and safeguarding

The third is that, as a much-banned author, I’m interested in freedom of speech and have publicly defended i

The fourth is where things start to get truly personal. I’m concerned about the huge explosion in young women wishing to transition and also about the increasing numbers who seem to be detransitioning (returning to their original sex), because they regret taking steps that have, in some cases, altered their bodies irrevocably, and taken away their fertility

ten years ago, the majority of people wanting to transition to the opposite sex were male. That ratio has now reversed. The UK has experienced a 4400% increase in girls being referred for transitioning treatment. Autistic girls are hugely overrepresented in their numbers.

American physician and researcher Lisa Littman set out to explore it. In an interview, she said: ‘Parents online were describing a very unusual pattern of transgender-identification where multiple friends and even entire friend groups became transgender-identified at the same time. I would have been remiss had I not considered social contagion and peer influences as potential factors.’

her career took a similar hit to that suffered by Maya Forstater. Lisa Littman had dared challenge one of the central tenets of trans activism, which is that a person’s gender identity is innate, like sexual orientation. Nobody, the activists insisted, could ever be persuaded into being trans.

The argument of many current trans activists is that if you don’t let a gender dysphoric teenager transition, they will kill themselves.

the new trans activism is having (or is likely to have, if all its demands are met) a significant impact on many of the causes I support, because it’s pushing to erode the legal definition of sex and replace it with gender.

As I didn’t have a realistic possibility of becoming a man back in the 1980s, it had to be books and music that got me through both my mental health issues and the sexualised scrutiny and judgement that sets so many girls to war against their bodies in their teens

I want to be very clear here: I know transition will be a solution for some gender dysphoric people, although I’m also aware through extensive research that studies have consistently shown that between 60-90% of gender dysphoric teens will grow out of their dysphoria

The current explosion of trans activism is urging a removal of almost all the robust systems through which candidates for sex reassignment were once required to pass. A man who intends to have no surgery and take no hormones may now secure himself a Gender Recognition Certificate and be a woman in the sight of the law.

We’re living through the most misogynistic period I’ve experienced. Back in the 80s, I imagined that my future daughters, should I have any, would have it far better than I ever did, but between the backlash against feminism and a porn-saturated online culture, I believe things have got significantly worse for girls.

From the leader of the free world’s long history of sexual assault accusations and his proud boast of ‘grabbing them by the pussy’, to the incel (‘involuntarily celibate’) movement that rages against women who won’t give them sex, to the trans activists who declare that TERFs need punching and re-educating, men across the political spectrum seem to agree: women are asking for trouble.

I’ve read all the arguments about femaleness not residing in the sexed body, and the assertions that biological women don’t have common experiences, and I find them, too, deeply misogynistic and regressive

It’s also clear that one of the objectives of denying the importance of sex is to erode what some seem to see as the cruelly segregationist idea of women having their own biological realities or – just as threatening – unifying realities that make them a cohesive political class.

It isn’t enough for women to be trans allies. Women must accept and admit that there is no material difference between trans women and themselves.

‘woman’ is not a costume. ‘Woman’ is not an idea in a man’s head. ‘Woman’ is not a pink brain, a liking for Jimmy Choos or any of the other sexist ideas now somehow touted as progressive. Moreover, the ‘inclusive’ language that calls female people ‘menstruators’ and ‘people with vulvas’ strikes many women as dehumanising and demeaning.

I’ve been in the public eye now for over twenty years and have never talked publicly about being a domestic abuse and sexual assault survivor. This isn’t because I’m ashamed those things happened to me, but because they’re traumatic to revisit and remember.

the scars left by violence and sexual assault don’t disappear, no matter how loved you are, and no matter how much money you’ve made. My perennial jumpiness is a family joke – and even I know it’s funny – but I pray my daughters never have the same reasons I do for hating sudden loud noises, or finding people behind me when I haven’t heard them approaching.

I believe the majority of trans-identified people not only pose zero threat to others, but are vulnerable for all the reasons I’ve outlined. Trans people need and deserve protection

So I want trans women to be safe. At the same time, I do not want to make natal girls and women less safe. When you throw open the doors of bathrooms and changing rooms to any man who believes or feels he’s a woman – and, as I’ve said, gender confirmation certificates may now be granted without any need for surgery or hormones – then you open the door to any and all men who wish to come inside. That is the simple truth.

On Saturday morning, I read that the Scottish government is proceeding with its controversial gender recognition plans, which will in effect mean that all a man needs to ‘become a woman’ is to say he’s one. To use a very contemporary word, I was ‘triggered’

I forgot the first rule of Twitter – never, ever expect a nuanced conversation – and reacted to what I felt was degrading language about women. I spoke up about the importance of sex and have been paying the price ever since. I was transphobic, I was a cunt, a bitch, a TERF, I deserved cancelling, punching and death. You are Voldemort said one person, clearly feeling this was the only language I’d understand.

Huge numbers of women are justifiably terrified by the trans activists; I know this because so many have got in touch with me to tell their stories. They’re afraid of doxxing, of losing their jobs or their livelihoods, and of violence.

But endlessly unpleasant as its constant targeting of me has been, I refuse to bow down to a movement that I believe is doing demonstrable harm in seeking to erode ‘woman’ as a political and biological class and offering cover to predators like few before it

I stand alongside the brave women and men, gay, straight and trans, who’re standing up for freedom of speech and thought, and for the rights and safety of some of the most vulnerable in our society: young gay kids, fragile teenagers, and women who’re reliant on and wish to retain their single sex spaces

The supreme irony is that the attempt to silence women with the word ‘TERF’ may have pushed more young women towards radical feminism than the movement’s seen in decades.

All I’m asking – all I want – is for similar empathy, similar understanding, to be extended to the many millions of women whose sole crime is wanting their concerns to be heard without receiving threats and abuse.

a 2022 Reuters investigation found that some American clinics were quite aggressive with treatment: None of the 18 U.S. clinics that Reuters looked at performed long assessments on their patients, and some prescribed puberty blockers on the first visit.

As Cass writes in her report, “The toxicity of the debate is exceptional.” She continues, “There are few other areas of health care where professionals are so afraid to openly discuss their views, where people are vilified on social media and where name-calling echoes the worst bullying behavior.”

The report’s greatest strength is its epistemic humility. Cass is continually asking, “What do we really know?” She is carefully examining the various studies — which are high quality, which are not. She is down in the academic weeds.

he notes that the quality of the research in this field is poor. The current treatments are “built on shaky foundations,” she writes in The BMJ. Practitioners have raced ahead with therapies when we don’t know what the effects will be. As Cass tells The BMJ, “I can’t think of another area of pediatric care where we give young people a potentially irreversible treatment and have no idea what happens to them in adulthood.”

She writes in her report, “The option to provide masculinizing/feminizing hormones from age 16 is available, but the review would recommend extreme caution.

her core conclusion is this: “For most young people, a medical pathway will not be the best way to manage their gender-related distress.” She realizes that this conclusion will not please many of the young people she has come to know, but this is where the evidence has taken her.

In 1877 a British philosopher and mathematician named William Kingdon Clifford published an essay called “The Ethics of Belief.” In it he argued that if a shipowner ignored evidence that his craft had problems and sent the ship to sea having convinced himself it was safe, then of course we would blame him if the ship went down and all aboard were lost. To have a belief is to bear responsibility, and one thus has a moral responsibility to dig arduously into the evidence, avoid ideological thinking and take into account self-serving biases.

“It is wrong always, everywhere, and for anyone, to believe anything upon insufficient evidence,” Clifford wrote

A belief, he continued, is a public possession. If too many people believe things without evidence, “the danger to society is not merely that it should believe wrong things, though that is great enough; but that it should become credulous, and lose the habit of testing things and inquiring into them; for then it must sink back into savagery.”

Since the Trump years, this habit of not consulting the evidence has become the underlying crisis in so many realms. People segregate into intellectually cohesive teams, which are always dumber than intellectually diverse teams. Issues are settled by intimidation, not evidence

Our natural human tendency is to be too confident in our knowledge, too quick to ignore contrary evidence. But these days it has become acceptable to luxuriate in those epistemic shortcomings, not to struggle against them. See, for example, the modern Republican Party.