Imagine that we were here to talk about some area of medicine other than gender medicine. Everyone present would share a broad understanding of the following:

• What it means for the relevant body part or system to function properly – what it is to have a healthy immune system, circulatory system, hip joint or whatever.
• What sorts of things can go wrong with that body part or system – over- or underactive immune system; irregular heartbeat; pain and stiffness on using the joint, that kind of thing – and what would be the symptoms.
• How to carry out a differential diagnosis to decide what has gone wrong – we don’t talk about “fever” or “chest pain” as specialties, because those can be caused by lots of different conditions, and care is needed to work out what is causing any particular patient’s symptoms.
• Why things go wrong – post-viral syndrome; narrowing of the arteries; deterioration of the cushioning within the hip joint and so on.
• What can be done to return the body part or system to healthy functioning, entirely or partly.
• If that isn’t possible, what can be done to ameliorate the symptoms – that is, to mitigate or control the harms done – and note that that means having an idea of what it means to feel better or worse; there are value judgments here.
• The likelihood of successful intervention, and how successful.
• The negative effects of the treatment, if any – and there usually are negative effects.

There is, of course, less agreement on psychological diagnoses than on physical diagnoses, and on what causes mental illnesses than physical ones. But there isn’t a total lack of information, and there’s a pretty solid understanding of what it is like to be functioning well psychologically.

The first parts of this framework would not be part of the conference schedule, because there would be no need. They’re fundamental to the meaning of health and health care, and to the best understanding in the particular field. The programme would exclusively concern the later parts: changing treatment protocols; new operation techniques and drug regimens; evidence about outcomes, downsides and so on. All the things that come from operating the machinery of evidence-based medicine: case studies, prospective and longitudinal studies, double-blinded randomised controlled trials and systematic evidence reviews.

It’s easy to forget that this machinery can only crank into operation because we start with a shared understanding of what it is to be healthy. Without that you can’t think about what can go wrong because you don’t know what “wrong” is. And you can’t come up with hypotheses for why and how it went wrong. And you’ve no hope of generating plausible ideas about treatment.

Once you see that, it’s obvious that gender medicine isn’t medicine, because the foundations are missing: nobody knows what it is to have a healthily functioning “gender identity”. I suppose someone working in the field would say that it’s “not suffering from gender dysphoria”, but that’s just a fancy way of saying “not suffering distress about something undefined”. And note too that gender clinicians insist that there is nothing wrong with being trans, it’s just a natural variant – which is odd when the way they think people end up deciding they are trans is generally that those people are suffering distress about this undefined thing called gender identity. And without knowing what it means to have a healthy gender identity, it’s not possible to say what it means to have a malfunctioning one, what might have caused that and how it can be treated.

Saying someone has gender dysphoria is like saying their humours are out of balance. That was the ancient Greek theory for what made people unwell, which lasted until the Middle Ages. The four humours were blood, phlegm, yellow bile and black bile, and the treatments were things like bloodletting and purging: they were junk because the theory was junk. 

It’s the same with gender medicine. The treatments offered – puberty blockers, cross-sex hormones, chest and genital surgeries and so on – are like bloodletting and purging. There isn’t any reason to think they would work.

You could do scientific research on the four humours, if you wanted. You could propose hypotheses and set up trials. And you’d generate data and hypotheses for future research. But this would be falling into the trap that Harriet Hall, a doctor who died in 2023 who was a proponent of rationalist medicine and opponent of quackery, called Tooth Fairy Science. It’s as if you decided that there was a Tooth Fairy, and it would be good to work out how to maximise the amount of money she left.

Hall wrote:

“You can study whether leaving the tooth in a baggie generates more Tooth Fairy money than leaving it wrapped in Kleenex. You can study the average money left for the first tooth versus the last tooth. You can correlate Tooth Fairy proceeds with parental income. You can get reliable data that are reproducible, consistent, and statistically significant. You think you have learned something about the Tooth Fairy. But you haven’t. Your data has another explanation, parental behavior, that you haven’t even considered. You have deceived yourself by trying to do research on something that doesn’t exist.”

All this is to say that the usual criticisms of gender medicine start too far downstream. It’s true what the critics say: there are no good studies showing positive outcomes for any of the interventions, and there is no evidence that puberty blockers or cross-sex hormones “save lives”. But there’s a more profound criticism upstream of that, which is that there is no reason to think the sorts of things done in gender clinics even might work. The whole thing is based on an invented premise, just as humours were.

When we start our criticisms downstream – that is, with the paucity of evidence – we give the gender doctors too much credit. The burden of proof lies with them, not us. They should have to start by saying what is wrong with someone who is experiencing distress to do with their “gender identity”, and why the sorts of treatments they offer might work.

Even if every finding of the critics is negative – and it really does tend to be – by taking it all seriously we’re paying it a compliment it doesn’t deserve. Because we’re implicitly accepting that the sorts of things its proponents are doing might work, and as with the Tooth Fairy, there are endless things they might try: different hormone treatments; different genital surgeries; different timings; voice training; facial-feminisation surgery and so on. They won’t run out of hypotheses to test, but there’s no reason to do any of it in the first place.

Gender medicine is Tooth Fairy Medicine

One of the reasons we don’t see that gender medicine is based on a false premise is that it’s such a big claim. Medical scandals aren’t generally like this. They’re like the pelvic mesh scandal, in which a lot of women were severely injured by having a synthetic mesh implanted to treat pelvic organ prolapse. You can see why someone might have thought this treatment would work. The scandal isn’t that it was hypothesised or tested; it’s that it wasn’t properly tested and women whose condition was made worse were ignored so the practice went on too long.

Most people naturally presume that gender doctors know what they’re doing because why wouldn’t most people think that? Gender doctors are credentialled. They have their own research journals and clinics and learned societies. So most people, even if they give credence to some criticisms of gender medicine, simply think the field has “gone too far” in a way that we’re pretty familiar with from other fields of medicine. That gender clinicians have been nothing worse than incautious. It’s hard to accept that an entire field of medicine simply shouldn’t exist. 

Another reason we don’t see the emptiness of gender medicine is that gender clinics are doing a damn good imitation of medicine. Judith Butler famously said gender was an “imitation for which there is no original” – that it’s meaningful only because we do it over and over again. Well, the gender clinicians are performing the rituals of medicine: making appointments, doing consultations, coming up with diagnoses, writing prescriptions, doing blood tests, referring patients to other specialists like surgeons and endocrinologists, and making claims about outcomes and efficacy. When they interact with funding bodies, insurers and governments they talk as if what they are doing is medicine.

But the rituals are empty, just as Butler claimed gender rituals are empty. The expression “gender dysphoria” functions as nothing more than a placeholder to make it possible to form sentences that look similar to the kinds of sentences you might utter about angina, say, or multiple sclerosis, or schizophrenia. But because the expression “gender dysphoria” is meaningless, the sentences are meaningless.

In fact gender medicine is purely performative – which should delight queer theorists, since they love performativity. The theme of the performance is the claim that each person has a true self and knows that true self, and when they give expression to that true self they by definition cannot be wrong because the true self is the declaration. The purpose of gender medicine is to give an appearance of solidity to a specific sort of declaration of one’s true self – to your gender identity. What gender clinics are selling is identity validation.

If you think that this is the sort of thing a gender identity is – a thing that a person can utter into being – then it’s not just gender clinics that have this purpose. It’s everything that gender-identity believers would call “gendered” and the rest of us would call single-sex. To them, the reason for having women-only or men-only spaces, services or sports is so feminine people and masculine people can perform their femininity and masculinity respectively.

Actually that’s not quite right, because in their belief system there isn’t any requirement to perform your gender, just to state it. Nothing further than the statement is required of the person making it: it’s other people who have to do the work by believing that statement – that is, by “affirming” the gender. The expression “gender self-identification” is a misnomer – it’s not something the possessor of the gender identity has to do, beyond proclamation. It’s a demand that other people affirm you as being the gender you state yourself to be. 

This leaves no place for other people’s judgment, indeed no role for other people except as supporting actors or appreciative audience. No room for the rest of us to say we don’t fancy joining in the performance, or to be a critic and say it’s not a very good performance. We’re not allowed to say: “OK, you say you’re a woman, that you’re living as a woman or have a female gender identity, but you don’t seem very female to me.”

A woman can do the most obviously unmasculine thing possible, namely get pregnant, and still be “living as a man” as long as she says she’s a man. A man can do the most obviously unfeminine things, namely impregnate or rape a woman with his penis, and still be “living as a woman” as long as he says he’s a woman. Because “men can get pregnant” and “women can rape too”.

It’s a bait and switch. The physical reality of binary sex is replaced with something called gender or gender identity. People who aren’t au fait with what’s going on think this is something defined. Generally they think it’s something very sexist, like “women are the kinds of people who do feminine things.” But at least that’s a little bit objective. Instead it’s just a man saying “I’m a woman.” There’s nothing objective about it, not even stereotypes. All that remains is the declaration.

People who haven’t been educated – indoctrinated if you like – in gender beliefs tend to think that what is being talked about is either an observable personal characteristic, probably innate, or a serious physical or mental health condition. Something inherent and diagnosable. They think that to fail to acknowledge it in someone, and treat it if they are unhappy, would be unethical.

I think people inside the gender ritual know perfectly well that most people outside it totally misunderstand what they are saying. They know that the judges who side with the parent who wants to block puberty, and the social workers who say a 13-year-old should get cross-sex hormones, and the teachers who affirm a child’s gender, and the parents who go along with the gender therapist’s advice to use preferred pronouns, all think that there is a special sort of person who is “trans”. But those inside the system know that all it takes to be this special sort of person is to say that you are this special sort of person.

When you finally see the gulf between what people outside the gender ritual think people inside the gender ritual mean, and what they actually mean, it makes the physical interventions even more monstrous. If what the clinics are selling is identity validation, why do they give people drugs and surgeries? Why can’t they just say to their patients what they claim to believe: that women can have penises, men can get pregnant, trans women are women, trans men are men and non-binary identities are valid, and it’s transphobic to think you need to do anything to your body to validate your identity? Why do they stop the “wrong puberty” and cut off the penises and breasts? What even could “gender-affirming care” mean, when all that having a gender identity means is saying you have it?

They are trying to ride two horses: simultaneously claiming that this is medicine, which means you have to do medicine-like things – diagnose something that is out of alignment and offer treatment that will supposedly bring it back into alignment – but also claiming that people are what they say they are and trans people don’t “transition” because they always were whatever they say they are.

Why are they riding two horses? Well, the answer depends on how cynical you are. I have no doubt that a lot of the people inside the gender ritual have got lost in the contradictions, and genuinely think they are doing the right thing. But I will make three observations.

First, even compared with other fields of medicine, gender medicine gives people a lot of power and a lot of self-validation as “good” and “progressive”. They get to rescue suffering children and help those children to be reborn as the selves they were always meant to be. They get to remodel human flesh. And they get to lecture the world about morality while they’re at it.

Second, there’s something powerfully pagan about it all: the greater the physical sacrifice the more real the belief. If you cut off parts of your body and sacrifice your reproductive system to your gender identity, that functions as a sort of proof that your gender identity must be real. For all that devotees profess to take everyone’s claims about their gender identities at face value, it’s a bit unsatisfying to leave it at that. Taking irreversible measures in the service of your gender identity is a way of signalling commitment: you’re showing that it’s really real, and you really mean it.

And third, it’s a lucrative business. As the American journalist Upton Sinclair famously said: “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”

The rise of hyper-liberalism

Why do gender clinicians feel like they’re good people and that what they are doing is right, even though when you look at it objectively all they’re doing is harm? A big part of the reason is that gender medicine is part of a broader trend towards seeing any attempt to classify people objectively as coercive, and self-definition as the highest good. Gender-identity beliefs are part of an emergent new belief system – let’s call it hyper-individualism – within which each person has a true self, and knows that true self, and self-knowledge about your true self by definition cannot be wrong. 

Think about the conservative-liberal spectrum as conventionally understood. For conservatives, there is a shared human nature, and the point of society is to try to give life to shared ideals, which will inevitably involve societal impositions and restraints on individuals. For liberals, being a good, happy and flourishing individual is primarily about the freedom to make our own decisions and to choose for ourselves what it means to live the “good life”. 

A so-called liberal democracy is an attempt to combine and balance the two ideals, which both have a lot to offer. The human-rights framework created after the second world war is based on a shared understanding of what it is to be human, and of human flourishing, but many of those rights are to make our own choices and express ourselves as we wish, within limits. It’s built into the system that rights sometimes collide, and are often constrained by the compromises required to share a society with others. It’s a framework within which, to quote the American jurist Oliver Wendell Holmes: “Your right to swing your fist ends where my nose begins.”

But what’s happening now is that we’ve pushed out past the liberal side of this balance to a new extreme: to the position that each person has a true self that they get to choose or discover by introspection. This new belief system means abandoning the healthy individualism of classical liberalism, which involves respect for differences of opinion and emphasis on “freedom rights”. Within it, notions of a shared human nature and the common good are no more meaningful than Judith Butler’s concept of performative gender, no longer regarded as normative or aspirational but instead as coercive. 

Indeed, any attempt to label or categorise people ends up being seen as coercive and bigoted. Inclusion, meaning the lack of external constraints based on objective definitions, then becomes automatically good. And discrimination, in its original neutral meaning of noticing and when necessary acting on differences, becomes automatically bad. Being good, or admirable, or a positive for the world becomes declaratory, not objective: for the individual to choose and not for others to judge. Each person is now supposed to look inwards to see what kind of person they are, and then express that person outwardly. If other people or the authorities don’t agree, those other people and the authorities are not only wrong but evil, in that they are harming individuals and forcing them to live inauthentically. 

This line of thinking inexorably arrives at the idea that expressing your gender identity – and having it affirmed by other people and the authorities – is a human right. Yet it’s impossible for it to be accommodated within the classical human-rights framework, with that framework’s recognition that rights sometimes collide and are constrained by other desired policy outcomes and other laws. 

We aren’t all protagonists surrounded by non-player characters; we’re each other’s fellow players and audiences. And certain performances make other performances impossible. 

Take, for example, a man putting on the “I’m a woman” play by competing in a women’s sporting event. That automatically makes it impossible for women to put on the “fair competition and may the best woman win” performance.

Or take privacy and free speech. Both are qualified rights within the human-rights framework: we may override one person’s privacy if it unreasonably constrains another person’s free speech, and vice versa. But when a person’s privacy is to do with what they conceive of as their identity, the only acceptable position within this new way of thinking is to affirm that identity. And if ensuring that people do that means draconian limitations on their free speech, that’s too bad. 

As for one person’s identity imposing on other people’s privacy, that is understood to be an impossibility, because “people are who they say they are”. The transwoman stripping off in the women’s changing-room is a woman, and no more an imposition on the other occupants’ privacy than any other woman stripping off would be. And if that’s not how it looks to some women, well, they are siding with the state that coercively assigned that poor transwoman male at birth, and are therefore evil and don’t deserve any rights.

This shift doesn’t merely destroy human rights, it harnesses the machinery of human-rights law to work against human rights. Silencing other people on a perfectly obvious fact that everyone can see – that someone is a man or a woman – now has the force of a human right behind it, namely privacy, when in fact it’s a rights violation – a serious infringement of other people’s freedom of speech.

Similarly, gender self-ID means that a man stripping off in front of naked women in a supposedly women-only space, and watching them strip off in front of him in that space, is doing something right and proper if he identifies as a woman. Those women are validating his identity, and he has the right to have his identity validated and they don’t have the right to withhold that validation.

Again, this is not just a destruction of human rights, it’s a full reversal. And it’s not just any old human-rights violation, it’s state-sanctioned sex crime – voyeurism and indecent exposure – and a violation of Article 5 of the UN Declaration on Human Rights (Article 3 of the European Convention on Human Rights), the right not to suffer torture, inhuman or degrading treatment. The European Court of Human Rights has ruled that being forced to undress in front of someone of the opposite sex violates this right, which is absolute, not qualified.

This emerging hyper-individualist belief system has profound implications for education. Within it, the purpose of school is to teach children to understand their positionalities: where they stand in an identitarian framework made up of oppressed/oppressor pairs: white/ racialised; cis/ trans; hetero/ queer; neurotypical/ neurodivergent; coloniser/ colonised and so on. The idea is that once a child has worked out “who they are” in this sense, the child will become liberated. 

It’s a really simplistic vision: oppressor bad/ oppressed good. And it’s static rather than developmental. Everyone’s characteristics are fixed: you’re born oppressed or an oppressor, and there’s no way to change.

This vision is inimical to everything we understand about how to help children to grow up to be happy, admirable citizens. There’s no explanation of how understanding the world and yourself in this way is supposed to liberate you, or make you happy or well. Everyone has to be a permanent activist – “doing the work”. No time for the things we know actually make people happy, such as being good parents, children, siblings, neighbours, employers, employees and so on, and doing good in the world.

I said that within this ideology your characteristics are fixed – well, one of them isn’t really, because it’s invented, namely your gender identity. Having a special gender identity – which is just a matter of declaration, remember – makes you a victim, oppressed by “cis” people, and if people refuse to validate you they are hurting you. And since oppressors are bad and oppressed people are good, it’s hardly surprising that so many young people are professing special gender identities. It’s more than just wanting to be special or different, it’s wanting to be praiseworthy, to be virtuous.

This whole belief system is pernicious, but the gender part of it is the worst, because it’s so destabilising. I don’t approve of telling people that their race or some other personal characteristic makes them good or bad, but at least those characteristics do actually exist in an objective sense, which gender identity doesn’t.

It’s hard to imagine anything more confusing to tell children than that they have to look inwards to work out something as fundamental as whether they are boys or girls, and to do so by comparing themselves to regressive gender stereotypes – but also, by the way, gender identity absolutely isn’t about performing those regressive stereotypes, it’s an inner feeling, there’s no right or wrong way to be a boy or girl but it’s vital that you work out which you are.

And we’re not destabilising something trivial, we’re destabilising the biggest objective, systemic group difference between human beings. In evolutionary terms, the distinction between male and female is as meaningful as it gets. It has all sorts of consequences for the individual. It’s fundamental to being human.

Hyper-individualism in healthcare

The  rejection of objectivity makes it impossible to define and measure good and bad treatment outcomes. It’s not possible to offer genuine, as opposed to performative, medical treatment if you don’t have an idea of what is a better state to be in, and what is a worse state to be in, what causes those differing states and how to distinguish between them. 

What causes pain, and the recognition that it’s better not to be in pain. What it looks like for wounds to heal well or badly, and that it’s better for them to heal well. That it’s better to be mobile and continent than immobile and incontinent. That it’s better to have your limbs and organs and physiological systems functioning properly than not.

We don’t tend to hear: what is pain but a social construct? Or: it’s stigmatising to incontinent persons to suggest that it would be better not to have stress incontinence as a result of giving birth. These may seem like jokes, but they are no more ridiculous than something we absolutely do hear: that it’s “cisheteronormative” to worry about hormonal and surgical treatments that destroy children’s future adult reproductive and sexual function. Because to express such worries you do indeed have to take a normative position – that it is better, all else equal, to preserve a child’s capacity to have a fully satisfying sex life when they grow up, and to be able to have children. But within gender medicine all such normative positions are rejected, with the only measure of what is right or wrong being each individual’s subjective gender claims.

And here we have another of those catastrophic and in my opinion tactically deliberate misunderstandings between people inside the gender ritual and people outside it. Inside it, the shared understanding is that no physical state is inherently any better than any other, that to think otherwise is bigotry and that the job of clinicians is to validate the identities of gender consumers. What they mean by “gender care is lifesaving care” is that life isn’t worth living unless you get to choose who you are, and to force everyone else to play along – or maybe that by refusing to affirm you people are killing the real you, the claimed identity, which only exists if people affirm it. 

Meanwhile those outside the gender ritual think there is such a thing as a “trans kid”, gender clinicians perform differential diagnoses to work out which ones they are and perform interventions that make their lives genuinely better. What they understand when they hear “gender care is lifesaving care” is that “trans kids” are suffering so greatly that if you don’t perform physical interventions to alter the appearance of their primary and secondary sex characteristics, those children will literally kill themselves.

Clinicians who fully embrace the “gender-affirming” approach have abandoned even the pretence of concern for objectivity, in particular for healthy functioning. You see this in the recent trend for them to say openly that what they are offering is to help patients along their “gender journey” and enable them to pursue their “embodiment goals”. The patient – now a client or even a customer – works out their gender, decides what physical form best expresses that gender – and there are no rules or norms, it’s up to the individual – and then goes to people who can prescribe them drugs or offer them surgeries that will give them (an approximation of) that physical form.

Because self-definition is the highest, indeed only, good, doing this to yourself is extremely moral, and helping other people to do it to themselves is moral too. And regret is a moot point – it’s what you want in the moment that matters; if you change your mind in future that’s all good, you are just at a different point in your gender journey. You can’t go back to the person who facilitated you in cutting off healthy body parts and blame them: it was your call, they were just affirming you. This isn’t even “buyer beware”. It’s a total abdication of not just responsibility but of even the bare acknowledgement that it’s possible to be harmed by pursuing goals you chose for yourself. 

At this point, the protagonists of “gender affirming care” have lost even the most minimal concept of a shared human nature. Some people think that we have a God-given nature. I don’t; I think we have an evolution-given nature. But where I agree with religious people is that we are a particular type of living creature. I have a lot more in common with them than with someone who thinks human beings are entirely self-made.

There’s a quote I often think of from the science-fiction writer William Gibson: “The future is here, it is just unevenly distributed.” Well, if the future is one in which the patient is the sole authority and there is no shared understanding of what healthy function means, and no measure of whether a treatment is effective than whether the patient said they wanted it, then the future is already here in gender clinics. If we don’t actively push back against this radical subjectivity then I’m afraid gender clinics will be not merely aberrations but outriders.

Return to reality

Hyper-individualism is making a lot of headway, but it’s by no means hegemonic, and everywhere it arises, some pre-existing norms and rules and structures survive. To the extent that we can use and ideally strengthen those pre-existing norms and rules and structures, we can contain the harms and then hopefully squeeze the space left for them more and more until the new ideology returns to being marginal. 

I think this helps us think through how the UK has made so much headway against gender-identity ideology in the past few years. It’s tempting to think that the right approach is to dive in at the most obvious places – those where “the future is already here”, in particular, the messed-up definitions of sex in law. But that’s not the approach we’ve taken at Sex Matters, for two reasons. The first is that it took the other side years to get where we are now step by step, and we need to undo it by retracing those steps. The second is that facts on the ground have gone way beyond the law, so fixing the law won’t necessarily have any impact. We have never had legal gender self-ID in the UK yet it’s become the de facto norm.

So what’s the “TERF Island” playbook? It starts with shoring up laws protecting freedom of speech and belief, in particular in the workplace. If people can’t say that there are two sexes and that sex can’t change while holding down a job, then they won’t say it. The most powerful silencing force is the fear of being indigent. Hardly anyone will speak up if they risk not being able to pay their mortgage or put food on the table.

I’m not sure that my colleague Maya Forstater, the CEO of Sex Matters, understood her employment-tribunal case against her employer, the Center for Global Development, in this light at the time, but with hindsight it was the first stage in this playbook. Maya lost her job because in 2018 she said publicly that she opposed the UK government’s plans to introduce legal gender self-ID – to make it cheap and easy to change your recorded sex on demand. It took her four years, and a harrowing loss at first instance, before she won on appeal; established the precedent that so-called “gender-critical belief” was sufficiently respectable that being fired for holding and expressing it was a breach of UK employment law; and received compensation for her employer’s unlawful discrimination against her.

So what was Maya’s dangerous belief? It had three parts: (1) that sex is real, binary and immutable; (2) that being able to say so is important; and (3) that this is especially so for women’s rights. It’s extraordinary to think that almost exactly five years ago, a UK judge ruled that this mainstream position was so beyond the pale that someone who stated it could be cast out of polite society, stripped of the protection of the law and left unable to make a living.

Since then a series of legal victories citing that precedent have firmly established that, in the UK, it is possible to speak the truth about the two sexes and keep your job. Of course, not all employers have yet got the message, but it is spreading. 

Now the next step is under way: using this freedom not merely to state abstract truths about the two sexes, but to advocate for sex-based rights in the workplace and elsewhere. Because free speech isn’t “just” speech – it’s advocacy. Women don’t merely want to be able to accurately refer to people’s sex, and to say that sex matters, we need to speak honestly about sex because our rights depend on doing so. In this sense, gender-critical speech is advocacy for sex-based rights. A series of cases this year, including one taken by Nurse Sandie Peggie against the hospital where she works in Scotland and another by a group of nurses working in Darlington, have involved female employees who don’t merely want to say they think men can’t be women in general, but to say that a specific man isn’t a woman, and that therefore he should get out of their changing rooms. 

These cases were already under way when, in April this year, the UK Supreme Court ruled in the case of For Women Scotland (FWS) that the protected characteristic of sex in the Equality Act really means sex – male and female – not “sex as modified by a gender-recognition certificate” and certainly not self-identified gender. The Equality Act is a consolidation act that replaced most pre-existing equality and anti-discrimination law as well as adding some new elements. The judgment used the principles of statutory interpretation and an examination of the purpose of the Equality Act – namely to tackle longstanding, entrenched discrimination based on objective characteristics – and came to the conclusion that the law simply couldn’t function any other way.

The judgment didn’t expressly say this, but what it was doing was reasserting the importance in law and everyday life of the material reality of sex. It was based on recognising that women experience sex discrimination because of their sex, not because of how they identify. The brute fact of being female – of belonging to the sex capable of getting pregnant, even if you as a particular woman don’t ever get pregnant, or indeed can’t personally get pregnant – is why women have been exploited and oppressed throughout recorded history. If a trans-identifying man experiences sex discrimination as a woman it’s what’s legally called “discrimination by perception” – someone has wrongly understood this male person to be female and treated him badly because they treat women badly. It’s not because he has a female gender identity.

What the FWS ruling did is put the notion of gender identity, of transition, back in its box. People can think of themselves as trans and “identify” as the opposite sex if they want – that’s freedom of belief and speech – but doing so is not going to change the category they are in for the purposes of anti-discrimination law. And since the legal underpinning for female-only and male-only spaces, services and sports is precisely that anti-discrimination law, the ruling means that identifying as trans makes no difference to the category an individual belongs in for such purposes.

Broadly speaking, the Equality Act says: “Don’t discriminate on the basis of a protected characteristic except in specified circumstances where that is the right thing to do.” When you put up a sign that says women-only or men-only in the UK, you are using the so-called “single-sex exceptions” in the Equality Act – exceptions to the prohibition on sex discrimination – even if you don’t know you are. These exceptions require you to satisfy gateway conditions (roughly, that the service would be inefficient, less effective or impossible to provide on a mixed-sex basis, or because a person of one sex would reasonably object to the presence of someone of the other sex, or because only persons of one sex need it). And you can’t satisfy those gateway conditions if you’re willing to let in people of the opposite sex with trans identities because letting them in shows that there wasn’t a lawful basis for being single-sex at all.

The reasoning of the judgment is clearly applicable in any other law where sex is relevant and other people’s rights are in play – for example, the rules governing police strip-searching of detainees. There is still mopping up to do by taking more legal cases to prove that, but there’s good reason to think that such cases will eventually succeed, even if there are reversals along the way. And then UK law will have reverted, in very large part, to being based on the reality of sex, not the fiction of gender identity.

Living “as a woman”

There’s an incredibly irritating expression that men with trans identities often use: they say that they are “living as a woman”. Whenever I hear it I always wonder to myself: “Am I ‘living as a woman’ right now?” Is it living as a woman to have a PhD in maths? To like knitting and embroidery? To have given birth twice? To grow my hair or to crop it? To wear makeup or not bother? To care for infirm family members? To be the family breadwinner? Because I have done all these things, and I think that all that takes for me to “live as a woman” is that I am a woman, and I live. Nothing I can do or say can cast me out of my sex, and nothing a man can do or say can cast him out of his.

But when men first started persuading doctors that they were really women inside, about a century ago, there was actually something it meant to “live as a woman”. If you watch the 2015 film The Danish Girl, starring Eddie Redmayne, you’ll see what I mean. It’s based on a highly fictionalised autobiography – a very sad one, that of a man who became convinced in the 1920s by quack doctors that they could give him his dearest wish, namely to turn him into a woman. They thought they would do it by implanting ovaries into his abdomen that they had taken from an unknown young woman. But this was before doctors understood blood types or organ rejection, and before the discovery of antibiotics, so he only lived a little more than a year after the operation before dying in great pain.

What the Danish Girl, who took the name Lili Elbe, wanted could fairly be described as “to live as a woman”. He wanted to wear women’s clothes and makeup, work as a shop girl, kiss men at dances and marry a man – all things that men have always been physically capable of doing, and which cause no harm to others, but at the time were not permitted to do. 

But nowadays we have hit bedrock when it comes to distinctions between the sexes. There are the brute facts of biology, such as men being unable to get pregnant but being on average much physically stronger than women. There are situations where one sex or the other is excluded for good reason, as expressly allowed for in anti-discrimination law. And then there are linguistic distinctions – words like she and he, mother and father. 

Since all but the most superficial aspects of human biology are fixed, what “living as a woman” therefore necessarily means nowadays is the second and third of these. In other words, it means inserting yourself into situations that are restricted to the other sex for good reason, thereby harming other people’s rights, and demanding other people refer to you with words that disguise or misrepresent your sex – that is, seeking to compel other people’s speech. 

What the Supreme Court did is take the use of opposite-sex spaces off the table. If you’re male, it doesn’t matter whether you regard yourself as having a female gender identity, you still can’t “live as a woman” by walking through the door marked F. On the compelled speech, the law is not yet so clear. 

In general there is no obligation to use preferred pronouns – although the police seem not to have got the memo, as evidenced by the recording of non-crime hate incidents and even arrests for “misgendering”. In work, however, employers may lawfully restrict speech for all sorts of reasons. They can insist you use certain forms of words – have a nice day, the food is excellent, it’s been a pleasure to serve you. 

But employees do have protection against discrimination on grounds of belief, and for many “gender-critical” people, using sex-based pronouns is central to their belief system and using preferred pronouns is compelled speech. The right framework for thinking about this is the law about freedom of belief and speech. People are free to believe they are members of the opposite sex, or have no sex at all, and to say so; other people are free to believe they are not, and to say so too. I predict that cases establishing where the boundary lies between employers’ right to police employees’ speech, and employees’ right not to pay lip service to a belief they do not hold, will feature heavily in the employment tribunal in coming years.

Gender medicine in a sane world

It’s not easy to defeat a new idea, especially one that is simple, appealing and wrong, like “people are who they say they are.” Once a new paradigm is loose in the world, you’re unlikely to be able to completely eradicate it. But what we can do is limit and constrain the consequences of believing that people are men and women according to what they say they are, both for the believer and for everyone else. That won’t just limit the harm, it limits the appeal of believing it or acting on it in the first place.

To return to what I said at the beginning: gender clinics are locations for the validation of gender identities. The consumers get to say who they are, the clinicians agree and promise that everyone else will too, oh and by the way here are some major medical interventions to choose from, what you do with your body is up to you. That’s what they have been selling for decades: out there in the big wide world everyone else will play along, latterly with the addition of “if they don’t you can get them cancelled – kicked off social media, fired, made unemployable and friendless.”

The clinicians never should have made this promise, of course. Quite apart from the ethics of what they were doing to the people in front of them, they were selling something that wasn’t theirs to sell, namely the promise that everyone else would give up their freedom of belief, freedom of speech, and all the human rights that require honesty about sex, including privacy. Nevertheless that is what they did, and for a few decades they got away with it. 

If they can’t tell their patients any of this, it’s not clear what they can sell. There might still be people who want extreme body modifications that they think of as “gender affirming”, but if they can’t expect other people to agree with that – to give them access to spaces and services reserved for the other sex and to use the language they demand – I wonder just how many there will be.

I think we are nearly at that point in the UK, although the gender peddlers haven’t noticed yet. For decades everyone has been in agreement that “living as the opposite sex” means using opposite-sex spaces. But now the highest court in the land has ruled that you simply don’t have the right to do that, not now, not ever. Not if you take hormones. Not if you have surgery. Not if you get a gender-recognition certificate. At the same time we have been taking and winning cases on freedom of speech and belief. We still need a really good pronouns case, but the direction of travel is clear. It’s not quite all over bar the crying, but that moment is getting closer.

So what would a gender clinic be able to offer once the crying is over too?

For adults, I think they could offer cross-sex hormones and extreme cosmetic surgery as a consumer product – that is, without any claims of alleviating medical symptoms, with full disclosure that nothing being offered will change a person’s legal or social status or give them any new rights or oblige anyone else to do anything, and with an honest description of the costs and risks. Occasionally you read things about people who have undergone major remodelling – getting ears cut off, tongues forked, faces and eyeballs tattooed in service of identifying as a snake, that kind of thing. Well, gender surgery could be like that.

Needless to say, none of this would be paid for by taxpayers or insurers, and any doctor who offered would have sky-high malpractice insurance premiums. They would operate at extreme risk of being sued by patients who later regretted the destruction of healthy body parts and said they had been mentally ill and taken advantage of. But laws can’t fix everything and this is not a perfect world. 

And what about children? As far as I’m aware there is nowhere in the world where extreme cosmetic surgeries are provided to minors. But even before we get to a more general understanding that this is what the gender clinics are in truth offering, I think that taking the use of opposite-sex spaces, now or in the future, off the table deals a fatal blow to gender-affirming care for minors.

Think about it: what precisely is the offer of gender clinics to children, as distinct to adults? It’s that you can be redirected to the other sex’s puberty and that if you start early you will pass better. The promise of the pathway that starts with childhood social transition and proceeds to puberty blockers and then cross-sex hormones is that you’ll end up living in true stealth: indistinguishable from people of the sex you wish you were.

But the For Women Scotland judgment means that you won’t be able to use the spaces for that sex, at least not lawfully. Sure, there’s no such thing as toilet police and if you really do pass nobody will know. But crucially, if you’re never going to be entitled to be treated in everyday life as a member of the opposite sex, that’s simply not something clinicians can sell you. They can’t offer kids a treatment that is predicated on that child doing something the highest court in the land has said they have no right to do because if they did, that would infringe on other people’s rights. 

Even if shady private clinicians skate this line, I don’t think a public health-care system could. How can it possibly be ethical to offer children a treatment pathway that will make it permanently impossible for them to fit in in the only single-sex spaces they are legally entitled to be in? Are representatives of the state seriously going to say to the children that they will be able to break the rules and get away with it? It’s bad enough for an adult to decide to complicate their life in such a manner. But a child simply cannot be offered this.

And then there is the fact that children spend their time in schools. Clinics – and “gender-affirming” parents – have got away with transitioning kids on the assumption that schools will play along on “doctor’s orders” – if not the orders of a particular doctor for this particular child, a broader understanding that doctors say this is the right approach. Of course doctors should never have said this, since they never had the right to destroy other children’s rights and break safeguarding systems, but they did. Now they have to stop.

I don’t think gender clinicians in the UK understand this yet. They still think it’s not their job to think about what the puberty-blocked child will do in school, and what they will do as adults in the future. But the whole thing hangs together: clinics can’t sell affirmation if that isn’t going to be on offer out in the big wide world. 

To get this message across, and more generally to reassert the objective reality of binary sex, requires a hell of a lot of “misgendering”. It’s hard to do this, since it’s been made taboo, and it’s widely regarded as unnecessarily rude, even cruel. If you do it you’ll hear, even from people who are very sympathetic to your arguments on childhood transition, women’s single-sex spaces and so on, that using people’s preferred pronouns is “simple politeness” and that it “costs you nothing”.

Well, if it’s that minor, why can’t I use my words the way I want? Preferred pronouns can’t simultaneously be a tiny thing and absolutely vital. Remember, we’re talking about an ideology that doesn’t just insist that “I am who I say I am”, it also says “and you must agree”. That becomes apparent when you refuse to agree. And anyway, who’s really being rude here: the person who tries to force the entire world to join in their fantasy, or the person who declines?

The central thing we all have to keep remembering is that this is an ideology that doesn’t just say “I am who I say I am”, it also says “and you must agree”. Well, people can say they are whoever or whatever they want – but the only way to protect women’s rights and children’s health and wellbeing is for those of us who don’t agree to say so.

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For those who value truth, reason and material reality and recognise that the very foundation of how we make sense of the world, the scientific method, is being undermined. We cannot allow a neo-religious belief to continue to destroy reason and rationality.

Twitter: @SeenStem

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Date: 25th October 2023

Author and Sex Matters director of advocacy Helen Joyce has been shortlisted for the prestigious John Maddox Prize for courageously advancing public discourse with sound science.

Run by Sense about Science, an independent charity that promotes public interest in sound science and evidence, in partnership with Nature magazine, the international prize recognises individuals who stand up for science and evidence, advancing public discussion around difficult topics despite challenges and hostility.

Helen, a journalist who previously held senior roles at The Economist, was shortlisted for “her courage in highlighting the need for further research and evidence to be brought into discourse and policy discussion related to gender identity, and raising the importance of acknowledging biological sex differences”. She was among six shortlisted for the prize, which was won by Nancy Olivieri, a haematologist at Toronto General Hospital.

Judges for the prize said:

“Helen Joyce has been shortlisted for her courage in raising the importance of considering biological sex differences in health and social research, and the need for medical interventions to be evidence-based and transparently researched.

“Against a background of polarised and at times hostile reaction she has advocated for all researchers to be able to share findings openly and safely, whilst raising awareness of the harms resulting from a lack of research and absence of evidence underpinning medical interventions.”

Helen’s book Trans: When Ideology Meets Reality was an Amazon top ten bestseller and a Times and Spectator book of the year. Earlier this year, journalists uncovered that Helen’s book was among several by gender-critical authors that had been removed from the shelves by staff at Calderdale Council libraries in Yorkshire.

The announcement comes after a string of interviews given by Helen in recent months on podcasts hosted by high-profile figures such as Richard Dawkins, Peter Boghossian and Jordan Peterson, and speeches at groundbreaking international conferences, including the keynote address in Killarney, Ireland for the inaugural conference in April of Genspect, an international interdisciplinary coalition seeking an evidence-based approach to gender-identity issues, and at the ICONS International Women’s Sport Summit in Denver in July.

Maya Forstater, executive director at Sex Matters, said:

“Sex Matters would like to congratulate Helen on this significant and well-deserved achievement.

“Helen is a brilliant communicator whose intellect, courage and compassion are unparalleled, and we are so proud to have her on the team.

“Many in the UK may not be aware of the extent to which Helen is making a mark internationally, but we hope that this will be the first of many accolades for her important work on sex and gender.”

Notes for editors

Link to Maddox Prize 2023:

• https://senseaboutscience.org/activities/maddox-prize-2023/

About Sex Matters

Sex Matters is a human-rights organisation co-founded in 2021 by Maya Forstater, who is its director, to campaign for sex-based rights. It lobbies for clarity on sex in law and institutions; publishes research, guidance and analysis; supports and mobilises people to speak up; and holds organisations accountable.

About Helen Joyce

Helen Joyce is a journalist and author of Trans: When Ideology Meets Reality, an Amazon top-ten bestseller, and a Times and Spectator book of the year (recently reissued as Trans: Gender Identity and the New Battle for Women’s Rights). She was a staff journalist at The Economist between 2005 and 2022, holding several senior positions, including International editor, Finance editor and Britain editor. She is director of advocacy for Sex Matters. Her newsletter can be found at thehelenjoyce.com.

About Maya Forstater

Maya Forstater is co-founder and executive director of Sex Matters. In 2019 she lost her job as a researcher with the European arm of American think-tank Center for Global Development, after tweeting and writing about sex and gender. She was the claimant in the landmark test case which established that the protected characteristic of belief in the Equality Act covers gender-critical beliefs. Her website is ​forstater.com and she tweets @MForstater.

Sex Matters is a human-rights organisation campaigning for clarity about sex in law, policy and language | sex-matters.org

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Three further chapters are contributed by members of the Sex Matters advisory group. Alice Sullivan and Lucy Hunter Blackburn (with their co-author Kath Murray) ask “Why do we need data on sex?”; Cathy Devine examines sex, gender identity and sport; and Jo Phoenix considers sex, gender, identity and criminology’. In fact, all of the book’s 15 chapters will be of interest to supporters of Sex Matters.

The technology of puberty suppression

Michael Biggs’s chapter examines the technology of puberty suppression. “Puberty blockers” (gonadotropin-releasing hormone agonists, GnRHa)) have been commonly prescribed to suppress puberty from the age of 12 or younger as a treatment for gender dysphoria.  

This chapter investigates the technology of puberty suppression, comprising not just a specific drug but also a discourse that justifies its usage through the promise of a more complete transformation of sexual characteristics. 

The chapter examines the origin of puberty blockers in the Netherlands in the 1990s, scrutinising the rationale for this intervention. It then traces the subsequent adoption of this Dutch protocol in the United States and Britain down to the 2010s. It concludes by evaluating recent evidence for the outcomes of puberty suppression.

The phenomenon that is sex

Hilton’s chapter (co-authored with Colin Wright) reviews the biological understandings of the phenomenon that is sex, examining fundamental questions like “What is sex?” and “Why does sex exist?” The chapter begins with a brief tour of the evolution of the binary gamete system on which “female” and “male” are founded and explores some of the diversity of sexed bodies – including pregnant male seahorses and sex-changing clownfish – in the natural world. The chapter reviews current developmental biology knowledge and how sex manifests in humans: “How do we make babies?” and “How do female and male bodies grow?”.

Finally, the chapter critiques emerging ideological misinformation about sex, addressing arguments that unscientifically focus on those people with atypical sex development in order to assert that sex is a fuzzy spectrum or even a mere social construct. Hilton and Wright conclude that such arguments are purely ideological, lacking explanatory power, and ultimately spurious, constructed – to the detriment of scientific trust and integrity – in pursuit of political aims.

For an academic book of almost 300 pages, the paperback is reasonably priced at £35.99 – if you use the 20% discount code EFL03 on the publisher’s website you can get it for £28.79. Or ask your local library to order a copy! 

At the moment a few of the chapters can be read for free on Google Books.

The post Sex and gender: a contemporary reader appeared first on Sex Matters.

For the full official transcription of the debate, see Hansard.

In the chair, Judith Cummins began by reminding everyone that the petitions being debated indirectly related to two ongoing legal cases in the Scottish courts, but that reference to those would be allowed.

Tonia Antoniazzi (Gower) (Labour) introduced the motion for debate: that this House has considered e-petitions 623243 and 627984, relating to the definition of sex in the Equality Act 2010. She emphasised that despite the difficulties of speaking up on these issues, it was the responsibility of MPs to do so. She also summarised the discussions she had had with people and organisations on both sides of the debate about why it was necessary.

“As well as supporters of both petitions, I spoke to the EHRC, whose job it is to protect everyone’s rights and to explain the Equality Act. The EHRC said that the law can be hard to implement – and don’t we know it?”

Ranil Jayawardena (North East Hampshire) (Conservative) spoke as a father of two young daughters, emphasising that it is parliament’s job to make sure that laws are clear and fair, and pointing out that the legal definition of sex matters across many areas: schools, sports, health, crime and prisons. He talked about making the Equality Act align with reality and said that that this did not affect anyone’s rights.

“In 1597, Edward Coke, the Attorney General, told Parliament that the law cannot do the impossible. The example he used was the law cannot make a man into a woman. I believe that he was right then and that he is right now.”

Joanna Cherry (Edinburgh South West) (Scottish National Party) spoke about the rights of gay men and women to be right of lesbians and gay men to be same-sex attracted and not same-gender identity attracted, and so the right of lesbians to exclude men from their dating pool.

“The protected characteristic of sexual orientation is contingent on the definition of sex as meaning biological sex. […] Gender identity is not relevant to sexual attraction.”

Miriam Cates (Penistone and Stocksbridge) (Conservative) highlighted the confusion that arises when people think that anyone has a legal right to be treated as if they have changed sex, illustrating the practical and safeguarding implications with a recent legal case.

“There is nothing more destabilising to society than to dismantle the legal, social and cultural guardrails that protect women and children by pretending that males become females and vice versa, and allowing that to creep into our law.”

Dame Angela Eagle (Wallasey) (Labour) said that she was a lesbian and that there were no laws about who people could fancy and who they could date. She spoke in favour of the petition against clarifying the Equality Act, and characterised the other petition as an attack on trans people’s rights to exist and to live with respect and dignity in an accepting society.

“A change to the Equality Act’s definition of sex to biological sex would have a huge effect on all trans people by effectively mandating their exclusion from public spaces unless they use facilities in their so-called birth gender, which would be humiliating and damaging to them.”

Angela Richardson (Guildford) (Conservative) explained how the law needs to protect everyone’s rights and said that the protected characteristic of gender reassignment – which covers trans people whether they have a gender-recognition certificate or not – does not give someone the right to use opposite-sex facilities or services. She highlighted the need for legislation that can be explained clearly and easily, in practical terms.

“[Employers and service providers] need to be able to explain their rules on their signs and websites, on the phone and to staff. That means being clear about where there are sex-based rules and where a service is provided for both sexes together.”

Jess Phillips (Birmingham Yardley) (Labour) emphasised that sex and gender are different and that biology matters. She drew on her experience of running single-sex services to argue strongly that generic services that are expected to cover men and women simply do not work – sometimes resulting in victims and perpetrators of violence women using the same service.

“The majority of victims of domestic violence are women, and they are much more likely to be seriously hurt or killed. We must be really careful to protect our intricate and finely balanced services for women.”

Sir Peter Bottomley (Worthing West) (Conservative) referenced Helen Joyce’s book Trans: When Ideology Meets Reality and Kathleen Stock’s book Material Girls and talked about how Stock has been bullied. He referenced the anomalies caused by a badly worded question about gender identity in the 2021 census. He also mentioned sport, and asked:

“Why should a cyclist who is the 500th fastest in his age group or category be allowed to declare themselves a woman, and win a women’s cycling race? There is no justification for that. There never was, and there never will be.”

Rosie Duffield (Canterbury) (Labour) mentioned the abuse that she and other women face every day for speaking about this issue. She explained that one in four women will experience domestic abuse in her lifetime; two women a week are killed by a current or former partner; 41% of women care for a child or other relative compared with 25% of men; around 90% of single parents are women. 

“Because of those and other differences in men’s and women’s lives, we need to be able to monitor sex discrimination and provide for the needs of women and girls, particularly when they are most vulnerable. The Equality Act is the law that allows for that.”

From this point on, Sir George Howarth was the Chair.

Nick Fletcher (Don Valley) (Conservative) started by flagging that many members would be thinking about adult men who identify as trans entering adult women’s spaces, but his real concern was what happens when a six-year-old girl is in that changing room. Having worked in construction for most of his life, he made the analogy with health and safety rules – a near miss is reported to stop tragedy happening. He then talked about the need to prevent unfairness in sport, and the danger of telling children that they can change sex.

“I feel that I have to stand up for the six-year-old girl in the changing room confronted with a 50-year-old male who is going through a tough time. I am standing up for the nine-year-old who wants to stand in first place at the Olympics but thinks, “What’s the point?” when a biological man will be there in her place.”

Dame Nia Griiffith (Llanelli) (Labour) said that existing services could choose either to be single-sex or could be women-only services that are trans-inclusive and that the proposed clarification of the act would create a blanket ban on trans people from services that they had previously enjoyed without concern or complaint. She said that there had been a conflation of transwomen with criminals.

“Why the idea that someone can dress up as a woman and therefore carry out whatever criminal act they intend to should determine how we decide to treat trans women is absolutely indecipherable to me.”

Hannah Bardell MP asked Griffith whether she agreed, as a fellow lesbian, that trans people did not threaten them but in fact enhanced their existence. Griffith agreed.

Andrew Lewer (Northampton South) (Conservative) made the point that people can identify however they like, so long as claims about their identity do not injure other people. But laws had drifted away from reality and got muddled, he said, and other people were now being injured. He described some intimate procedures and reasons why a woman might want them carried out only by another woman. He referred to the recent NHS Confederation guidance and said that its claim that a man who identifies as a woman would be a satisfactory person to provide that care was not only heartless, but illegal.

“If a man provides such care to a woman who says that she is only willing to receive it from another woman, it is a sexual assault.

Have we reached the point where medical associations are instructing care providers to sexually assault women in the name of inclusion? That is why it is essential that the meaning of sex in the Equality Act is made much clearer, in order to end this and save lives.”

Luke Pollard (Plymouth, Sutton and Devonport) (Labour/Co-op) said that he wanted to spend as much time talking about trans people’s access to healthcare. He said that trans people are legally allowed to access opposite-sex toilets and changing rooms and it was wrong to characterise them as predators. He thought that changing the Equality Act was unnecessary, unworkable and unfair, and was worried that it might lead to a roll-back of rights for the LGBT+ community.

“When we talk about biological sex, we are talking about the sex assigned at birth. That means that there is a real complication and a potential assault on people with intrusive medical tests to look at their biological sex at birth rather than where they are today.”

Tim Loughton (East Worthing and Shoreham) (Conservative), like Antoniazzi, emphasised that parliament was the place for issues of sex and gender to be resolved and highlighted that the debate was about about clarification, not change.

His focus was on sport: since the London Olympics ten years ago, around 60 governing bodies have opened up the female category to male athletes, when the entire purpose of competitive women’s sport is to recognise and reward female excellence by allowing girls and women to compete fairly, like against like, he said. He flagged that even when sporting regulators have the law behind them, they worry about the risk of vexatious, costly legal actions and online abuse.

“Parents worry that their daughters will get injured on the field playing with bigger, stronger, heavier boys who identify as girls. Faced with such unfairness and risk, women and girls vote with their feet. A measure that is described as ‘inclusive’ actually means that girls and women are excluded from their own competition.”

Lloyd Russell-Moyle (Brighton, Kemptown) (Labour/Co-op) mentioned abuse directed at politicians on all sides of the debate. He said that MPs were hearing cherry-picked case studies and that cases, people and sex were complex and not binary. If there was a rule that discrimination could only happen according to biological sex, he said, organisations would not be allowed to be trans-inclusive. He wanted local flexibility; he said the law was clear but services were under-funded.

“People are complex. That is why flexibility in the current law is important. By defining things too much, what we suddenly do is assume that everyone lives in these easy, binary boxes.”

Jonathan Gullis (Stoke-on-Trent North) (Conservative) said that he was speaking passionately about this issue because a woman in his life had fled domestic violence and would have been terrified to be near anyone male, whether or not they were a transwoman, because of the abuse, rape and torture that she and her daughter had suffered.

He said his constituents were “befuddled” by the debate since to them it was obvious that in the Equality Act “sex” was biological sex. Women were being persecuted and abused for speaking out, just as much as anyone in the trans community, and he wanted his daughter to grow up looking to heroines such as Rosie Duffield, Joanna Cherry and JK Rowling.

“Their rights should not be eroded because of an extremist minority shouting very loudly on social media and pursuing a very hard-line agenda that is not in keeping with the majority opinion, as we have seen during the national debate.”

In response to a question from Dame Nia Grifith about his understanding of the Equality Act, he added:

“I want to make it perfectly clear: sex is not assigned at birth. You are born a man or you are born a woman. Those are indisputable facts. You have XY chromosomes or XX chromosomes. Again, that is not up for debate or discussion.” 

Neale Hanvey (Kirkcaldy and Cowdenbeath) (Alba) spoke as someone who has worked in clinical practice for 25 years and as a same-sex-attracted man – his sex and sexual orientation being strong parts of his identity. He made the point that if sex were to mean anything other than the biological category of natal male, gay men would not be able to describe themselves and the law would not be able to protect them.

He said he felt that the statement “transwomen are women” both implied the need to subvert and subsume the meaning of “woman” as it is commonly understood and suggested that there was something less, something other, about a trans identity, and he did not agree with that. He was clear that telling children there was something intrinsically wrong with them was absolutely unforgivable.

“I see absolutely nothing controversial in calling a transwoman a transwoman, and a transman a transman. These are necessary biological categories for society and the Equality Act to accommodate, value and protect. Without a stable, codified language, the whole meaning of protected characteristics, hitherto based on sex, comes tumbling down.”

Peter Gibson (Darlington) (Conservative) spoke in favour of the status quo petition, and noted Baroness Falkner’s remark that changing the definition of sex that “could bring clarity in a number of areas” but also “ambiguity in others.” He said that his fear was that the change ran the risk of excluding trans people from effective protection by the Equality Act, and that changing the act would alter its original intention and could throw into question over 10 years of case law.

“By restricting the definition of sex to sex assigned at birth, we could have a situation whereby protection from discrimination created a two-tier system. Trans people who are perceived to be cisgender would have more protection under the law than trans people who are not perceived to be cisgender.”

Kirsty Blackman (Aberdeen North) (Scottish National Party) said she rejected the idea that trans people were potential predators, as this was demonising a protected group, and that the term “ordinary people” was an exclusionary phrase if it was used to mean “non-trans people”. She disliked being called “straight” on social media.

She said that nobody had been able to explain what biological sex was, but had talked about XX and XY chromosomes; she had no clue about her own, she said, but assumed they were probably XY. She felt that both women and trans people were treated as lesser in society. She talked about “gatekeeping” in relation to toilets and said that a friend of hers had been told that her two teenage daughters could not use a toilet because they had short hair and wore trousers. She suggested that what we should want is for everybody to be able to to the loo when they were shopping.

“I have a fair idea of what my genitals look like and how they compare with how other people’s look, but if we are talking about biological sex there needs to be a definition that everybody in this room can agree with.”

Caroline Ansell (Eastbourne) (Conservative) rose to say that her argument had been won before the debate started, when the chair had mentioned two live court cases – her point being that individuals were operating in a legal grey space, rather than being directed by Parliament. She mentioned that the lead petitioner, Maya Forstater, had spent nearly two years and £100,000 just to determine that her beliefs were covered by the Equality Act, but this judgment meant that a GRC could not force other people to change their perception of a person’s sex. 

She talked about the woman driven out of Oxfam; Professor Kathleen Stock hounded from her post at Sussex University simply for saying that male people and female people are two different groups; and “Sarah Surviving” who is suing Brighton’s rape-crisis centre for refusing to provide women-only support.

“Those individuals and organisations are forced to run the legal gauntlet case by case, isolated and alone, and sometimes at very great cost to their reputation, to their career and to their health.”

Anna Firth (Southend West) (Conservative) focused on single-sex spaces and services. She wanted the Equality Act to be clear that having a gender-recognition certificate does not give male people the right to compete in women’s sports, undress or shower with women and girls, or be employed in a job that involves intimate contact with women. She described this as a very simple clarification, and emphasised that “case by case” simply does not work, since it leaves service providers to make difficult decisions. She gave the NHS’s Annex B policy as an example of the confusion caused.  

“Families, women and children in Southend West want to know that when the sign on the door says or indicates female, that is not up for negotiation. The only people who should be in that space are biological women. Biological males or trans women or non-binary people should simply not be in those spaces.”

Kirsten Oswald (East Renfrewshire) (Scottish National Party) started by complaining that the language used in the debate had not been “measured”. She said that the suggested change would be likely to increase confusion, to the detriment of both trans people and women – and that it was a change, not a clarification. She said that she wanted to hear more about women’s rights, that women’s rights were not diminished by someone else having their rights upheld, and that what endangers women is predatory and violent men.

She stated that people have been going to the loo without any issue for many years but this was now a thorny issue. She talked about “intersex people” and commented that large proportion of adult women do not ovulate.

“There is no legal precedent for the definition of biological sex […]. That means that there is not a way of looking at how we support women’s rights to privacy, for instance. That kind of change could have regressive consequences: it could actually entrench gender stereotypes and biological determinism for women.” 

Anneliese Dodds (Oxford East) (Labour/Co-op) began by describing her party as “the party of the Equality Act” and remarked that it was 13 years since Harriet Harman MP had piloted the landmark legislation through Parliament.

Stephen Doughty (Cardiff South and Penarth) (Labour/Co-op) interrupted to ask if she agreed that the Conservative Party had a wider agenda is to remove all its protections.

Dodds agreed, saying that we could not understand the Government’s intentions when the Prime Minister attacked the Equality Act one day, only to cast himself as its defender the next. She stated that Labour remains committed to protecting and upholding the Equality Act, including the public-sector equality duty, its protected characteristics and its provision for single-sex exemptions, and called on Kemi Badenoch to make it clear that she also supports the act. She confirmed that Labour also supports the protection of certain spaces that are for biological women, such as refuges for vulnerable women. 

She said that her party believed in a common-sense approach that provided clarity for service providers both in circumstances where trans people are included, and where excluding trans people is a proportionate means to a legitimate end. But she pointed out that the Government had given no indication of how it would provide that clarity, and its written response to the petitions did not support it. She asked Badenoch to set the record straight, and to confirm that detailed policy and legal analysis is being carried out and will be published. When the Government comes forward with any proposals out of all the rumours heard in the press, Labour will respond, she said.

“It is thanks to Labour’s Equality Act that it is possible today for service providers to create and maintain single-sex services where that is a proportionate means of achieving a legitimate aim.”

The Minister for Women, Maria Caulfield, noted Parliament’s responsibility to constantly review legislation. She said that reference to sex had generally been considered to refer to whether a person is a man or woman in law, rather than to their biological sex or sex at birth.

Joanna Cherry MP stood up to point out that supporter of the first petition were not seeking to define sex in law for the first time, and that it has long been recognised in the common law, referring to Bellinger v Bellinger.

Caulfield resumed and said that the Equality Act’s protection applies on the basis of perceived characteristics as well as actual characteristics, so a transwoman who passes as a woman can claim protection from discrimination on that basis. She mentioned Badenoch’s concern that the Equality Act may not be sufficiently clear in the balance it strikes between the interests of people with different protected characteristics, and stated that the Government has taken advice on the potential implications of the change and is considering the next steps at the moment. The opposing views of two United Nations representatives were also discussed.

Caulfield stated that the Government was committed to maintaining the safeguards that allow organisations to provide single-sex services; recognised that being able to operate spaces reserved for women and girls is an important principle, and should be maintained; and understood that creating environments where women and girls are protected from further trauma was a crucial part of enabling them to heal. She encouraged MPs to refer to the Equality and Human Rights Commission’s guidance.

“Where it is a proportionate means of achieving a legitimate aim, the Equality Act is also clear that service providers can exclude, modify or limit access for transgender people even when they have a gender-recognition certificate.”

Tonia Antoniazzi (Gower) (Labour) took the floor again to sum up. She noted that those present had ignored calls for no debate – because this was Parliament’s work, and this was a democracy. She added that the medical conditions referred to as “intersex”. were irrelevant to the discussion: there is no third sex or intermediary sex, and people with those variations on the sex development pathway are either male or female.

“Speakers have made it clear that it is not about suggesting that all male people or all trans people are predators; it is just that single-sex spaces are an important risk management tool, given the overwhelming statistics in the patterns of male violence.”

The Chair, Sir George Howarth, thanked MPs for discussing this sensitive issue in a respectful manner. The House resolved that it had considered e-petitions 623243 and 627984, relating to the definition of sex in the Equality Act 2010.

For the full official transcription of the debate, see Hansard.

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The aim is to provide clear starting points for debate and discussion, for anyone trying to understand the competing claims around these issues.

The idea that people might have a concept of themselves that differs from the material reality of their sexed bodies took hold in the 1960s as doctors sought to explain patients who insisted they were “really” women, despite being male. Over time this self-concept became known as “gender identity” and spread from American university campuses to academics, clinicians and officials across North America – and then beyond – who adopted the idea that everyone has a gender identity, and that “transness” is the experience of having a gender identity that differs from your sex.

This is a belief system. In reality sex remains binary and immutable. It is not “assigned at birth” but observed. Although in many circumstances (like deciding who is the best person for a job), a person’s sex doesn’t matter, in others (like deciding who to remind to get tested for prostate cancer) it matters a lot. 

We argue that people’s feelings about gender should not be permitted to override the material reality of sex in places where sex matters, such as single-sex spaces, services and sports, and healthcare.

Reality-based language is also crucial to support an evidence-based approach by medical professionals to treating people who feel distress about their sex. It is a fundamental change in the nature of medical treatment to treat bodies as less important than identities and to use hormones and surgery to try to make people’s bodies conform to an inner sense of how they should be.

In discussions of these issues, the same questions are asked again and again, and the same wrong answers are given. One of the worst examples is the use of “differences of sexual development” (DSDs) as talking points to confuse people into thinking that sex is a spectrum not a binary. 

In writing these FAQs we have drawn on material produced by CAN-SG, the Clinical Advisory Network on Sex and Gender, which has kindly allowed us to rewrite and simplify its source material. 

We will be producing legal FAQs later this year. 

The post Answers to questions on sex, gender, biology and identity appeared first on Sex Matters.