Why gender medicine isn’t science, and isn’t medicine, Part 2

My keynote at the CASC conference in Adelaide, 18th October 2025

I was fortunate enough to be invited to give one of the keynote speeches at the inaugural conference of the Gender Healthcare Summit organised by the Coalition Advancing Scientific Care, an Australian organisation seeking to bring evidence-based considerations to gender medicine, especially for minors. My talk was an hour long, so I’m going to share my speaking notes in three separate posts. This is the second part. You can read the first part here.

With speakers and organisers for the CASC summit

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? It’s because what’s called gender medicine is part of a society-wide trend that sees any attempt to classify people objectively as coercive, and sees self-definition as the highest good. You could call this hyper-liberalism, or hyper-individualism, and it’s the idea that each person has a true self, and knows that true self, and self-knowledge about your true self by definition cannot be wrong.

Within this worldview notions of a shared human nature and the common good are meaningful only in something like the way Judith Butler thought gender was: they exist only because they have been performed repeatedly. To live a good life, to be an admirable person, to be a net positive for the world, to help rather than hurt others… the old-fashioned views on these things are the way they are for no reason, just empty tradition. And nowadays we are wiser; we understand that being good, or admirable, or a positive for the world is declaratory, not objective: for the individual to choose and not for others to judge. And the way you choose is to look within yourself to see what kind of person you are, and then express that person outwardly.

I say this is hyper-liberalism because it’s out on the far side past liberal of the conservative-liberal spectrum. For conservatives, there is such a thing as a shared human nature, and that’s why we’re able to have a concept of the common good. The point of society is to try to give life to shared ideals, and that will involve societal impositions and restraints on individuals. Liberals emphasise a different part of what it means to be a good, happy and flourishing individual — the bit that’s about freedom to make our own decisions and to choose for ourselves what it means to live the “good life”.

So you’ve got two different ideals: living according to shared values that spring from our shared humanity, and being “in tune with yourself”. A so-called liberal democracy is an attempt to combine and balance the two ideals, which both have a lot to offer. Our universal human rights must be based on some shared understanding of what it is to be human, and to flourish, but many of those human rights are rights to make our own choices and express ourselves as we wish, albeit constrained by other people’s rights, and more generally by the compromises required to share a society with others.

And what’s happening is that the liberal side of this balance has been pushed to an extreme, to the position that each person has a true self that they get to choose or discover by introspection. Inclusion, meaning the lack of external constraints based on objective definitions, is automatically good. And discrimination, in its original neutral meaning of noticing and when necessary acting on differences, is automatically bad.

From this point of view, communal ideas of “shared human nature” look coercive, and it’s coercive to label or categorise. Any time a person says they are something, and 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. The only thing you are an authority on is yourself, and you’re being coercive and bigoted telling other people anything about them.

By the by, this idea that official classification is state coercion because the category you’re classed in it may not match your own self-conception explains why the expressions “assigned at birth” or even “coercively assigned at birth” have been appropriated from an abusive, obsolete treatment protocol for babies with ambiguous or injured genitalia. And it’s why “self-ID” seems like such a no-brainer: linguistically, it taps into the highest ideal of this hyper-individualist way of thinking, namely self-definition.

The direction of travel in gender clinics is to abandon all pretence that they are still connected with any concern for healthy functioning. You see this in the recent trend for them to say that what they are offering is to help patients along their “gender journey” and enable them to pursue their “embodiment goals”. You work out your gender, you decide what physical form best expresses that gender — and there are no rules or norms, so it’s up to you — and then you go to people who can prescribe you drugs or offer you surgeries that will give you that physical form. (Or at least that they claim will give you that physical form; this is all divorced from physiological reality. It’s as if we’re Mr and Mrs Potato Heads, able to attach, detach, re-attach functioning body parts at will.)

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 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.

One of the many contradictions and inconsistencies of gender-identity ideology is that it has arisen within, and co-opts the language of, the liberal human-rights framework, even though that framework is includes objective tests for balancing rights, and for when other considerations, such as sound administration, are allowed to constrain someone’s rights. You sometimes hear people say “rights aren’t pie”, but that’s nonsense, rights often are pie. What you give to one person is often necessarily taken from another, and sometimes one person’s right to something hinders other people’s right to something else. That understanding is built into the framework.

Somehow the idea has arisen that to have your gender affirmed is a human right — and yet it’s impossible for it to be accommodated within this framework. We aren’t all protagonists surrounded by non-player characters; we’re each other’s fellow players and audiences. And certain performances — say, a man putting on the “I’m a woman” play by competing in a women’s sporting event — makes some other plays — in this case all the women who want to put on the “ fair competition and may the best woman win” play — impossible to perform.

More broadly, hyper-individualism makes any sort of balancing exercise based on objective considerations impossible.

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. 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 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, 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, the right not to suffer torture, inhuman or degrading treatment, which is an absolute right, not a qualified one. The European Court of Human Rights has ruled that being forced to undress in front of someone of the opposite sex violates this article.

Hyper-individualism is also hyper-subjectivity. If you can never take the measure of a man, you can’t set objective standards or criteria, and you can’t categorise. If you want to make generalisations, to collate, group and study people’s characteristics and experiences, these can only be under headings like: “People who think of themselves as belonging to a certain category, for which I can give no objective definition, say they experienced things they understood as instances of a certain sort of experience, for which I can also give no objective definition.”

You can’t say: male people commit most violent crimes, or most rape victims are female, or nearly everyone who works as a firefighter is male, or every human being who has ever got pregnant is female. You have no test of the “reasonable person”. All boundaries dissolve. That’s what queer theory is all about: making it impossible to say that anything is different or separate from anything else. You can’t say things are objectively good or bad — except that it’s definitely bad to disagree with someone’s self-categorisation. This makes it impossible to do sound scientific research.

This has already happened in fields where sex is a key explanatory variable. Professor Alice Sullivan, a sociologist and statistician at University College London, was commissioned by the previous Conservative government in the UK to carry out an independent review of data, statistics and research on sex and gender, and the final report came out this year. It’s a great piece of work, and what she and her team concluded was that the collection of accurate data on sex was (a) crucial for effective policymaking across a wide range of fields, from health and justice to education and the economy, and (b) had been seriously hampered by a widespread tendency to ask self-ID questions, at first just treating the two sexes as opt-in categories and then more recently by adding non-binary or “another gender”.

She recommended that data on sex should be gathered as the default in all government data-collection exercises, and that “sex” should mean sex — natal sex, or sex at birth, or whatever you want to call it. The current Labour government has welcomed the review, but so far shown little sign of actually taking the recommendations on board.

To look at our theme here today, of healthcare, hyper-subjectivity breaks everything there too. It’s not possible to do research or to offer 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 two states and how to distinguish between them. What causes pain, and 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 generally 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. But we absolutely do hear that it’s cisheteronormative to worry about destroying children’s future adult reproductive and sexual function. And it’s true that to say that this is wrong you 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, than not to do so

The protagonists of “gender affirming care” have lost sight of our shared human nature, they’ve forgotten that we are a particular type of animal. They think that we are entirely self-made, but we’re not. I’m sure some people in the audience think that we have a God-given nature; I don’t. I think we have an evolution-given nature. But anyway, the central point is: we are a particular type of creature.

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, then the future is here in gender clinics. If we don’t actively push back against this sort of radical subjectivity then I’m afraid the gender clinics will be not merely aberrations but outriders.

To come back to the present, 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, to think otherwise is bigotry and the job of clinicians is to validate the identities of gender consumers and enable them to pursue “embodiment goals”. What they mean by 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. What those outside the gender ritual 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 that they do understand are extremely damaging, those children will literally kill themselves.

Gender ideology sits within a vision of education as being about teaching children to understand their positionalities: where they sit in an identitarian framework made up of oppressed/oppressor pairs. The idea is that once a child has worked out “who they are” in this sense — it’s all about binary oppositions: white/ racialised; cis/ trans; hetero/ queer; neurotypical/ neurodivergent; coloniser/ colonised and so on — then the child will become liberated.

It’s a really simplistic theory: oppressor bad / oppressed good. And it’s static, nothing developmental about it at all. Your characteristics are fixed, so there’s no way to change who you are, you’re born either permanently oppressed or permanently an oppressor.

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 rigid, unchanging way is supposed to liberate you. It’s unclear how thinking about yourself in this way is meant to make you happy or well. And moreover, 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 work 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 good.

This whole belief system is pernicious, but the gender bit 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 that they are do so by comparing themselves to regressive gender stereotypes, but also, by the way, your 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 doing this about something trivial, we’re doing it about the biggest objective, systemic group difference among human beings. In evolutionary terms, the distinction between male and female is really meaningful. It has all sorts of consequences for the individual. Telling kids that it’s entirely subjective and up to them to work out which they are seems as unwise as telling them that breathing air or water is on a spectrum and that the only test is what they think and feel about how their respiratory system works. And that nobody else can tell them; there is no test, there are no criteria for where they are on the “breathe air to breathe water” spectrum: they will just know.

Replacing sex by gender identity within a complex system is the equivalent of introducing a false equation into the interlinked system that is mathematics. And when a lie is embedded in a system, over time it propagates throughout that system, and then everyone working within it has to try to protect the lie by staying well away from it. It’s worse than a loophole, which over time tends to get bigger. It’s a loophole you have to avert your eyes from and avoid mentioning.

I’ll give you a stark example. Sonia Appleby was the safeguarding lead at the GIDS clinic at the Tavistock Hospital in London. Various of her colleagues brought concerns to her about the high number of children being referred to the Tavistock, including their worries about the high number of children being referred to GIDS, and “a worry that some young children are being actively encouraged to be transgender without effective scrutiny of their circumstances”. She reported those concerns to her line manager.

At some point during the ensuing discussions she said how important it was that concerns were taken seriously and not shut down, and that if the clinic wasn’t careful, a “Jimmy Savile type situation” could arise. In case this man’s notoriety hasn’t made it this far, he was a TV presenter and charity fundraiser and absolutely prolific child abuser. After he died in 2011 it all started to come out, and you will probably not be surprised to hear that loads of people had known perfectly well what he was up to, or should have known, but ignored warning signs and penalised anyone who tried to whistle-blow.

One of Sonya’s jobs at the Tavistock was training staff in child safeguarding, and she routinely included a reference to Savile. In his charity work he was in and out of hospitals all the time, committing prolific sex offences against children under the noses of health-care staff. Her point was that it’s everyone’s responsibility to be vigilant and to speak up about any concerns, and that not just people but institutions can be groomed and be complicit. And she said that explicitly when she brought the safeguarding concerns within GIDS to managers’ attention — she straight away clarified that she didn’t mean there was child abuse, but rather an institution turning a blind eye to what was in front of them.

Even so one her colleagues took great offence at the idea that he might be considered as at risk of being complicit in child abuse, and he made a complaint. A letter was put on Sonia’s file for supposedly unprofessional and improper behaviour. This despite the fact that it’s literally the job of safeguarding leads to make this sort of point, and to train people to suppress this reflexive response of indignation at the idea that they might unwittingly be acting in a way that opens children to harm. After Savile died there were official inquiries and public apologies and the usual guff about “lessons must be learned”. Well, it turns out that the lesson of Jimmy Savile is: don’t mention Jimmy Savile.

There was this central lie: that children have gender identities, and that it’s a morally praiseworthy thing to mess with children’s healthy bodies to affirm those gender identities. And maintaining that lie means not looking directly at it, or at anything close to it. But everything in gender-affirming gender clinics is close to that lie. So to work within them you have to turn a blind eye to everything they are doing: to the fact that they are harming kids, not helping them. Their entire purpose endangers children, so of course child safeguarding of all sorts flies out the door.

I’ll publish the third part of this talk in another couple of days.