Content note:
This piece directly engages with gender-critical rhetoric and quotes from anti-trans advocacy. If you’re not in a place to read a detailed analysis of these arguments right now, the core message is this: clarity about power and standing is one of the strongest tools we have to push back. As always, it is written with care, but do take care of yourself first.
Foreword:
Let me begin by admitting something I’ve learned living through over a decade of anti-trans activism: its claim to being invested in “safeguarding”, of being “rational,” “evidence-based,” or “neutral” is untrue. These words, so often used to dress up ideology, are rarely about precision. They are usually about control, cloaked in the language of objectivity. This is especially true when it comes to what’s now called gender-critical discourse: a framework that positions itself as cautious and grounded in scientific truth while quietly weaponising assumptions so deeply entrenched they become invisible even to its proponents. This is not a defence of poor practice, nor a rejection of evidence or audit. It is an examination of how ideology distorts what evidence is allowed to mean, and who pays the price for that distortion.
I say this as someone who has also spent years in survivor spaces, peer support groups, and in clinical settings where bodies are discussed with both reverence and terror. I’ve seen how, when discussions are about transitioned people, or those who want to transition, conversations about care can dissolve into debates about the legitimacy of people’s experiences, how a simple question like “Does hormone therapy help?” can become a minefield of loaded terms: transition, authenticity, gender ideology, risk. And yet, beneath the jargon and performative defensiveness lies something far more fragile and human: a struggle to understand where we draw lines between care and control. I still remember a sixteen-year-old trans boy telling me that access to tier-4 mental health care was predicated on withdrawing his HRT. He told me with a grace that still hurts to remember, because less than six months earlier, we’d celebrated that milestone together, knowing what it meant to him. I still have the card he gave me: thank you for giving me hope.
If you’re reading this as someone directly affected by these policies, if you’re waiting months or years for care, if you’ve been told your own understanding of yourself is suspect, if you’re watching your mental health deteriorate while people debate your legitimacy, I want to say this clearly: this is not a fair fight. The burden of proof has been weaponised against you. You are asked to justify your existence, your needs, and your capacity for self-knowledge in ways no other patient population is required to. That imbalance is not an accident, and it is not a failure on your part.
This essay is not about refuting arguments with counterarguments. It’s about tracing a pattern, a logic that emerges when certain people are deemed “too vulnerable” to make their own decisions, even as those same people endure suffering in the name of preserving the status quo. To do this, we need to step into the uncomfortable space between what is said and what remains unspoken. Let me guide you there.
Let’s start with a confession: Gender-critical ideology (GCi) has never been about accurate data or wellbeing
It has never been about improving outcomes, welfare, safeguarding or addressing systemic failures in healthcare delivery. At its core, it operates on three interlocking beliefs that, when examined closely, reveal themselves as less scientific and more… theatrical. They are a drama of control masquerading as reason.
First: The insistence that sex is a fixed, binary biological fact, despite broad medical understanding acknowledging sex as a complex interplay of chromosomes, hormones, anatomy, and physiology. GCi both entirely ignores that many transitioned women are phenotypically female, and ignores intersectionality: that trans women of colour, for example, may have spent decades navigating a world that polices their gender *and* race, only to be told their bodies “don’t count” because they don’t fit a binary fantasy. This isn’t just denialism; it’s a refusal to confront the messy reality of human bodies, and it’s a refusal to invite discussions about power. What it favours is a narrow but comforting schema: male/female, man/woman, are supposedly clear lines drawn with surgical precision where none exist.
Second: The belief that transition outcomes are inherently undesirable, regardless of patient-reported benefits or clinical evidence. This is not a neutral position; it’s a value judgment dressed as analysis. It treats trans people as subjects to be studied rather than individuals whose lives matter, ignoring the lived diversity of trans lives – including older trans people, who often describe transition as the only thing that allowed them to leave abusive homes or build stable lives. It reduces the question of whether someone should receive care to a moral calculus about who gets to exist as themselves. That isn’t clinical caution; it’s a prior commitment to a preferred outcome.
Third: The assumption that restricting access to healthcare, rights, safety, or public participation is justified if doing so reduces the number of people who transition. Here’s where ideology becomes most explicit in its harm: it treats suffering, delayed care, worsened mental health, and increased self-harm as an acceptable cost in pursuit of a goal that is not medical but existential (fewer trans people). Indeed, the GCi doctrine, that physical transition is harmful, both morally and socially, is more accurately conceptualised within a different frame; more accurately understood as an eliminationist project: not reproductive eugenics, but a social programme that aims to reduce the number of trans people by making transition harder to access, harder to survive, and harder to live with dignity. This harm falls hardest on trans people with the least privilege: low-income trans individuals who can’t afford private care when NHS waitlists stretch for years, disabled and neurodiverse trans people whose needs are dismissed as “complications” rather than addressed with adaptive support, and those who fail to meet the embodied gendered expectations of “man” or “woman”.
These beliefs do not emerge from empirical analysis. They are born from schemas so deeply internalised they feel like truth. GCi advocates do not ask “What if we’re wrong?” about these assumptions because the idea of being wrong threatens the entire structure of their worldview. And that is where the fog begins: a moral fog designed to obscure how paternalistic control masquerades as care, how exclusion becomes a form of “protection”, and how ideology can so thoroughly govern other people’s bodies without ever acknowledging it outright.
The Case Study: When Critique Becomes Condemnation
Let’s take a specific example to make this pattern visible in the real world. The UK’s Levy Review of NHS adult gender dysphoria services was released recently, and it has since become a battleground for GCi advocacy groups like Sex Matters. At first glance, their critiques might seem reasonable – after all, no one is arguing that the current system is perfect. Long waits for appointments, inconsistent data collection, understaffed clinics: these are real problems. But what happens when these critiques are filtered through the lens of GC ideology?
Consider this passage from Sex Matters’ response to the review:
“The Levy Review catalogues the many gross failings of adult gender clinics, including the lack of any data on outcomes. Benefits, harms, regret and detransition are not systematically tracked. Yet inexplicably Levy goes on to recommend that the process of assessment and treatment be standardised and accelerated.”
This is a textbook example of GCi logic in action. The first sentence highlights a legitimate issue: poor outcome tracking. But note how quickly this shifts into moral judgment (“gross failings”) and ends with an accusation that ignoring data while accelerating care is “inexplicable.” This framing assumes that improving access to substandard services must be unethical – a stance that ignores the fact that many areas of medicine, including oncology, operate without perfect data but still prioritise patient well-being. It also ignores that vulnerable and marginalised trans people, people of colour, those on low income, and disabled trans people can’t wait for “perfect data”; they need care now to survive.
GCi advocates then compound this by conflating operational critique with moral endorsement:
“What they are doing, in other words, cannot reasonably be described as medicine at all.”
This is not a critique of how care is delivered; it’s an erasure of the entire purpose of that care. By dismissing trans healthcare as non-medicine until it meets arbitrary standards (which GCi advocates themselves define), they treat trans patients’ suffering as acceptable collateral damage in their ideological quest to reduce transitions.
The final passage from Sex Matters illustrates this most clearly:
“Given that historically 80–90% of this patient group was same-sex attracted, some will see this as simply speeding up the pipeline of state-sponsored conversion therapy.”
Here’s where GC ideology becomes explicit in its harm. First, it reduces trans care to a “pipeline,” implying patients are being funnelled toward an outcome that is not their own – negating both their agency and the care and understanding of those supporting trans people. Second, it frames hormone therapy and surgery as forms of conversion therapy, despite no evidence that these procedures aim to erase sexual orientation (a claim with historical roots in anti-LGBTQ+ prejudice). Finally, the phrase “state-sponsored conversion therapy” weaponises the term to imply state complicity in violence, even though what’s actually happening is regulated healthcare delivered by clinicians within a public system, not an ideological programme designed to change anyone’s sexuality. It is a rhetorical move that bypasses actual harm (e.g., waiting lists) to focus on abstract moral condemnation. For trans youth who’ve already endured bullying, homelessness, or family rejection because of their gender, these aren’t just words – they are a threat that the state itself will abandon them to more pain.
The pattern is that of exclusion and harm dressed as concern for vulnerable people, has real-world consequences: trans youth facing longer waits, clinicians deterred from offering care due to fear of backlash, and systemic failures left unaddressed in the name of ideological purity.
How GCi Thinking Differs From Ethical Advocacy
Human rights advocacy, when done well, is rooted in proportionality, evidence, and a commitment to minimising harm for all involved parties. It does not treat entire groups as threats, nor does it weaponise uncertainty to justify exclusion.
One of the quiet tricks of gender-critical rhetoric is to imply that the only alternative to restriction is recklessness. That isn’t true, and trans people have been articulating better models for years. Care that respects complexity does not mean rushing or abandoning thoughtfulness. It means recognising that autonomy and support are not opposites.
In practice, this can look like:
• Informed consent models that ensure patients understand risks and benefits, while respecting that adults are capable of making decisions about their own bodies, including trans elders who’ve waited decades for care and may have different desires for surgical outcomes, or low-income trans people who can’t afford to “experiment” with delay.
• Trauma-informed care, where histories of abuse are treated as reasons for more support, not grounds for disbelief, especially for trans BIPOC, whose trauma may include both racism and transphobia.
• Neurodivergent-affirming services that adapt communication styles and decision-making processes, rather than treating difference as impairment, like clinics that use visual schedules for autistic trans youth or allow non-verbal consent for disabled patients.
• Integrated mental health support that is available alongside gender-affirming care, not as a gatekeeping obstacle, but as a resource, such as pairing hormone therapy with counselling for trans people who’ve experienced homelessness or violence.
None of this is hypothetical. Variations of these approaches already exist, both within and outside the NHS.
How GCi enables harm, and what good care looks like:
Operational Critique ≠ Ethical Erasure
GCi advocates argue that poor data tracking invalidates trans healthcare itself, but ethical advocacy would ask: How can we improve data collection without denying care to people who can’t wait? For example, longitudinal studies of transition outcomes are possible while still respecting patient autonomy (e.g., voluntary participation in research) and could even be designed to centre marginalised voices, like trans women of colour or disabled trans men, whose experiences are often excluded from “mainstream” studies.
When delay is discussed abstractly, it can sound neutral, even prudent. In reality, delay can be actively harmful. Prolonged waiting lists are associated with worsening dysphoria, increased anxiety and depression, social withdrawal, and elevated risk of self and societal harm – disproportionately so for trans people of colour, who face compounded barriers like racism in healthcare, or low-income trans individuals who can’t access private care to fill gaps. “Existing as yourself” is not an abstract ideal; it’s the difference between being able to function at work, maintain relationships, or get through an ordinary day without constant psychic strain.
For many trans people, the harm is compounded by being studied rather than supported: being asked to wait patiently while their distress is treated as data, and their survival framed as a methodological inconvenience.
GCi’s refusal to acknowledge this distinction reveals a fundamental difference in approach: they are not seeking solutions; they are attempting to prime the system to fail.
The “Vulnerable Young People” Narrative
Sex Matters highlights that many trans patients are young, neurodivergent, or have histories of trauma, framing this as proof that transition is inherently suspect:
“The Levy Review documents the rapidly rising number of young people coming into clinics, including a significant proportion with autism… and other mental health conditions as well as histories of trauma.”
This rhetoric mirrors historical pathologising of marginalised groups. Neurodivergent and traumatised individuals are not “defective” candidates for healthcare; they are people whose lived experiences demand compassionate care, not paternalistic restrictions. This is especially true for trans youth of colour, who may already navigate racism and transphobia in clinics, or disabled trans kids whose needs are dismissed as “overdiagnosis” rather than addressed with adaptive support. In contrast, ethical advocacy would ask: How can we support these patients’ autonomy without dismissing their distress as invalid? For instance, trauma-informed clinics or neurodivergent-friendly care models could address needs without assuming “trans identity” is a symptom to be corrected. We also know that trans people, as a result of societal punishment for gender diversity, are more likely to suffer significant harm, including physical, sexual, and emotional abuse, as a direct response to having a different gender identity than their bodies present. Evidence of such violence, therefore, is not an excuse not to treat, or to delay treatment until resolution; it is evidence of the societal punishment for gender diversity, and therefore treatment, if it is to be genuinely appropriate, would be to address both issues concomitantly with that understanding in mind.
Charity Status and Ethical Accountability
As a registered UK charity, Sex Matters operates under the condition that it must promote “public benefit” in line with charitable aims (e.g., relief of poverty, advancement of health/education). Their “advocacy” – rooted in restricting access to healthcare for trans people under the guise of “protection” raises serious questions about alignment with public-benefit principles. This is especially egregious when considering that charity funds could instead support community-led trans centers that serve low-income or BIPOC trans people, who often lack access to mainstream clinics. Charitable status is not a shield from ethical scrutiny; if an organisation’s primary aim is to deny rights or services based on unproven assumptions, it raises questions about how well current charity law is equipped to address this kind of advocacy. This contradiction, being both a “charity” and an agent of exclusion, is not accidental; it reflects how GC ideology leverages legal frameworks to legitimise harm.
Why GCi logic fails, even on its own terms
Let’s dismantle some of these logical moves one by one, not to win an argument (though they do fail spectacularly) but to expose how easily ideology can masquerade as reason when it lacks accountability. None of this is an argument against good data, careful practice, or reflective medicine. Outcome tracking matters. Audit matters. Research matters. There may be contexts where slower implementation, better resourcing, or additional support genuinely benefits patients. The distinction is this: caution in service of care looks nothing like obstruction in service of ideology. One asks, “How do we do this better?” The other asks, “How do we stop this from happening at all?”
1. The False Binary: Efficiency vs. Efficacy
GCi advocates argue that the NHS should halt trans care until “evidence” of efficacy is proven, yet they ignore that no medical field has perfect data. Cancer treatments evolve based on patient outcomes and clinical trials, not because every possible long-term effect is known. By demanding perfection before allowing care for a vulnerable population (trans youth), GCi logic bypasses both the ethical imperative to act in good faith while gathering evidence, *and* the reality that suicidality and self-harm risk are markedly higher among trans young people, and compounding marginalisation increases that risk further.
2. The Weaponisation of “Inexplicability”
“Levy goes on to recommend that the process… be standardised and accelerated.”
This is described as inexplicable because it prioritises patient access over ideological purity. But this recommendation is both reasonable and humane. Speeding up care for a population experiencing high rates of mental health crises and self-harm is not “inexplicable”; it’s morally urgent. GCi calls this urgency “irrational,” but their own logic rejects healthcare unless it aligns with an irrational schema.
3. The Ghost of Conversion Therapy
By equating trans care with state-sponsored conversion therapy, GCi advocates ignore two facts:
– Conversion therapy explicitly targets sexual orientation (e.g., forcing LGBTQ+ people to conform to heterosexuality), while hormone therapy and surgery are about aligning one’s body with their gender identity. These are not equivalent practices.
– The phrase “conversion therapy” is itself a loaded term often used to erase trans and non-binary people in favour of cisgender norms. GCi’s use of this rhetoric clearly reveals little concern for patients. Its doctrine favours weaponising moral panic against transition as a “cultural threat”. It demands conformity to the idea that gender must align with a myopic, incomplete, binary vision of “biology.”
Clarity, care, and compassion.
If GC ideology relies on moral fog, clarity is its antidote. One of the cruellest features of gender-critical rhetoric is how it positions trans people as unreliable narrators of their own lives. When someone suggests that your judgment is impaired by identity, by trauma, or by neurodivergence, they are not raising a neutral clinical concern. They are denying you epistemic authority: the right to know and speak truthfully about your own experience. This is not medicine. It is a power move.
Here are practical tools for dismantling it, not with hostility but with precision:
Name the Hidden Premise
Ask: “Is your concern about improving care, or the fact that people transition at all?” If the latter, no amount of data will satisfy them. Their opposition is existential, not technical. For example, when a GCi advocate dismisses patient-reported benefits of hormone therapy, ask: “Have you spoken to trans people who’ve had their suicidal ideation reduced by hormones? Because I have – and their lives matter more than your scepticism.”*
Separate Process from Principle
Acknowledge service gaps (e.g., long waits) without conceding trans healthcare’s legitimacy. Operational reform does not imply moral endorsement, and delay is itself a harm. For example, if a colleague says, “We need more data before expanding care,” respond: “I agree we need better data -but why should trans people wait while we collect it? Should oncology patients wait too?”*
Expose Asymmetry in Scepticism
Ask why uncertainty is only weaponised here: “Why do we accept risk in other medical fields but treat it as disqualifying here?” For instance, GC may cite inflated concerns over detransition rates as proof of transition’s irreversibility, while ignoring the diversity of individualised treatments, the reversibility of most, *and* the fact that trans people have a lower regret rate than 90% of cosmetic surgery patients -yet no one demands “more data” before letting someone get a nose job.
Centre Standing, Not Identity
Avoid defensiveness about being “cis” or “trans.” Instead, say: “You’re asserting authority over a healthcare pathway you don’t bear the risks of”. That’s not a neutral stance. It’s rather entitled governance by people who won’t be held accountable for harm, nor suffer the consequences of their actions. This shifts focus from identity to power dynamics, which is where GC truly operates. For example, if a parent says, “I’m worried about my trans child,” respond: “What would you want if *you* were their doctor? Would you deny them care because of uncertainty?”
Refuse the False Dilemma
Push back against the narrative that prioritising care for trans people undermines “safeguards” (which are often abstract, not concrete). Real safety comes from listening to patients’ experiences, not erasing them in pursuit of a hypothetical ideal. For example, when GC argues “we need to protect young people,” counter: “Protecting them means giving them timely care, not making them wait years while their mental health collapses.”
For allies, this matters too. Support doesn’t only happen in “debates”. It looks like:
• Believing trans people in your life when they describe harm, even when it makes others uncomfortable. For example, if a friend says, “My doctor refused my hormones because of GC rhetoric,” validate their fear instead of asking, “Are you sure?”
• Pushing back on “just asking questions” rhetoric that treats delay as neutral. If a coworker shares a GC article, say: “I’ve read that trans people’s wait times are harming them. I think we need to be asking the right questions”.
• Using your credibility to challenge exclusionary policies in workplaces, unions, and professional bodies, e.g., signing petitions for better trans healthcare funding, or speaking up when a colleague makes a GC joke. Being an “active bystander” is already a model used in the NHS to address harmful dialogue. If you’re offered the training – take it.
• Knowing when to step back, and when silence would function as consent. e.g., if a trans person says “I don’t want to talk about this,” listen instead of pressing for details.
• Writing your own blogs underlining the harms of oppressive ideologies: trans people’s experiences are comparable to the oppression of many vulnerable minorities. e.g., drawing parallels between GC ideology and the history of oppression against LGBT people in the 1980s.
Clarity as Resistance
Gender-critical ideology thrives in moral fog, on collapsing complexity into slogans, on framing restriction as care, and on treating trans existence as a problem to be managed. When you strip that fog away, very little remains. What’s left is an attempt to govern other people’s bodies without accountability or proportionality, justified by an ideology that cannot tolerate certain outcomes (i.e., trans people living with dignity).
Clarity collapses this logic. And clarity is something trans people and thoughtful allies are more than capable of providing, as we are beginning to see today. Not through rage, but through a quiet insistence on naming what we see: the harm in exclusion, the courage in seeking care, and the humanity that exists even when schemas demand otherwise.
In survivor spaces, in peer support groups, in clinical settings, the question is never abstract. The framing is careful, compassionate and considered. Will this person get the care that enables them to live a better life? Will they be forced to choose between authenticity and access? Will their suffering be treated as evidence against them, or as a reason to act?
The answer to “who gets to decide whose bodies matter” is already being written: in waiting rooms, in delayed referrals, in the long gap between seeking care and receiving it.
We know what ideology looks like when it governs bodies. The remaining question is whether we can name it clearly, whether we can make accurate comparisons to other forms of healthcare, and whether we can clearly define the impending human tragedy that gender critical ideology seeks to impose.
