A group of activists at a protest situation, holding brightly-coloured placards. One reads “I am not trapped in my own body. You’re trapped in your outdated views of gender.” Another reads “My gender is not a disorder.”

I don’t actually want to talk about J, the possibly transgender child at the centre of an abuse and custody dispute which has reached the courts and thus the papers. I think that great harm has potentially been done to J by the conflict, the state interventions and the media coverage. The last thing any child needs, transgender or not, is for their gender identity to become a subject of parental debate, legal debate and media debate — that is not an environment in which coming to good processes and conclusions about your gender identity can happen well.

And, in truth, no-one commenting who doesn’t know the child in question can say with confidence what J’s gender identity is, and it’s usually irresponsible to do so. We have the current legal decision, which says that J is a male child, assigned male at birth, who has been forced into a transgender identity by an abusive mother and so needs to be removed into his father’s care. We have the current press statement and petition from Mermaids, the transgender children’s support charity, who have worked with J and J’s family, and who say that J is a transgender girl, supported well by her mother, who has been unfairly treated by state authorities and now dangerously removed into the custody of an unsupportive father.

The result of this conflict is that J’s case has become a sort of Gender Politics Rorschach Test, in which different activists and writers can see the problems they want to see. People who are sceptical or critical of contemporary trans politics can argue that this is a case of abusive parenting, bad gender theory, political correctness getting in the way, and people trying to recruit children into trans politics. People supportive of contemporary trans politics can argue that this is a case of the transphobic state interfering in the supportive parenting of trans children, and a dangerous precedent to set in custody disputes over trans children.

I want to talk about why J’s case has become a flashpoint, both politically and philosophically, and to try and reach some conclusions about healthcare for trans children. I’ll explain why I think J’s case has been read in the way it has by trans activists, look at some of the philosophical conflicts beneath the gender politics struggle, and look at some of the specifics of trans healthcare for kids in the UK. If you want to skip to the conclusion, it’s quite simple: If you want to avoid traumatic cases like J’s, and if you want to end gender as an oppressive class system, then providing the maximum possible support for trans kids is what it looks like.

How We See J

I do not think it is responsible for most outside obsevers to reach a conclusion about J’s gender identity or what care J needs. Too many facts are in dispute, and the issue is too sensitive: what is necessary for J is for J’s parents to agree on what support J needs, with J’s guidance taking the lead, for the legal system to stay out of it as much as possible, and for expert and well-funded gender identity support to help J figure it out. People taking it upon themselves to get involved in J’s gender identity, potentially from positions of ignorance, transphobia or even abusive control, is a big part of the conflict. And the media report — including the Guardian’s as well as the tabloids’— has focussed on sensational details, has been conducted with political biases and prurient focus, and has been too quick to accept legal judgement without analysing the forces at play. I don’t want to be part of that. I will say that, personally, I find Mermaids’ account of the case to be persuasive, and that I am considering signing the petition calling for a review of the case. I will say that I absolutely find the judge’s approach to the case to be legally and morally insufficient, bordering on transphobic, whatever the truth of the matter, and that, as the Tavistock Centre recommends, gender identity should not be a matter of debate in custody disputes. Cheryl Morgan has written about these issues well.

But I am aware that those who are not hugely well-versed in trans politics, or those who have questions or criticisms of trans politics, might be confused as to why we’re so worried about the judgement, and might see us as jumping to conclusions. So I’d like to explain why we’re predisposed to see the case the way we do.

Transgender people have always been here — or rather, people we now call transgender, who disrupt, transgress, or transition across the gender norms of their society, have always been here — and transgender people have frequently been central to political struggle, but, in the Western/colonising world at least, media presence of and legal rights for transgender people is a fairly recent political phenomenon. In particular, medical support for transgender people is fairly recent, frequently contested, and still deeply insufficient. In the UK, the parliamentary report on trans healthcare was deeply scathing of current provision. For trans people, peer and familial non-acceptance of their identity is routine, harassment and discrimination are routine, and mental ill-health rates are vastly higher than in the general population, including suicide rates. (See reports from e.g. the Scottish Transgender Alliance.) We also know that trans people are subject to higher rates of criminalisation in many nations across the world, including the UK, and that sometimes trans folks’ identities are themselves criminalised, that trans identity can be used against you in court, and that trans identity puts you at greater risk of assault and murder by both individuals and the state. Counter-intutively, in the US, the murder rate of trans people is increasing even as trans political visibility increases.

The point of restating this dire situation is to emphasise this: most if not all trans folk have had to struggle against parental and state refusal to accept and support their gender identity. Trans folk still lack anything like decent medical, psychological, familial, state and peer support for their struggles with identity. Trans folk know that trans identity is already used to justify criminalisation, abuse, incarceration, medical mistreatment, and worse. Trans folk have had to fight for every inch of familial, medical and state support. Thus, of course, trans folk are justifiably protective of what’s been won so far: so used to fighting for every inch of support and acceptance, and as ready as we must be to defend it. Whatever the truth of J’s case, trans activists are ready to read the worst into it, because the worst is so often true. Moreover, the threat that the supportive parent of a trans kid could lose custody for supporting her kid is very real — likely, even — and the idea that custody rights could be mediated by a state which is still currently often and actively transphobic, and that that could happen apparently without input from gender identity experts, is deeply frightening.

Thus, readings such as Helen Lewis’s, which accept the words of the judge fairly uncritically, without a critical analysis of the way the state functions and has functioned in trans people’s lives, are deeply insufficient. When the judge’s analysis is roundly criticisecd and contradicted by the trans support organisation working with the family concerned, such readings seem even more insufficient. Again, I do not and cannot know the truth of the case, though I can reach personal decisions about my own political actions based on the balance of probability. I do want to say that trans activists concluding that this is a case of transphobic state interference is not irrational, not unfounded in the facts, not a jumping to conclusions, not activist overreach, but rather that it can be a considered decision based on very real experience.

Why are both writers like Helen Lewis and I spilling so much ink on a case where the facts are disputed, and where the fact of our spilling ink may be making matters worse for the child involved? Because J’s case has become emblematic of disputes over appropriate care for trans children, and because care for trans children has become the latest political football in the gender identity wars.

The Gender Identity Wars

This section veers into the abstractly philosophical, and, while I think that philosophical dispute underpins the material conflict, I think it’s also possible to skip to the next section if you find that stuff impenetrable, irritating or boring.

There is a line in Helen Lewis’s piece that I found very strange: “the prevailing orthodoxy [is] that gender identity is a measurable, objective phenomenon, and can be accurately gauged in a young child”. It may be possible that this is the prevailing orthodoxy in popular media (I’m not sure how one would measure such a thing), but it is not the orthodoxy espoused by the majority of the trans activists I spend time with. When I sought advice from a trans friend in exploring my own gender issues, she said to me “Explore the territory, not the map”. This is the attitude I have encountered most often: that gender identity is not measurable, not objective, but a whole mess of social/cultural/physical/psychological/political factors that each individual must, with community support, negotiate on their own terms. It is true that, when seeking medical support, trans folk or folk questioning their gender often meet the expectation that they should fit a predefined model of what transness is if they want medical help — but (a) this is the very medical support that has been shown to be insufficient, and (b) the trans folk I know are the very people leading the charge against such a restrictive approach to transness. If it is a medical orthodoxy that gender identity is objective and measurable, then it’s an orthodoxy used to restrict access to trans healthcare, and an orthodoxy that the majority of trans activists I know oppose. Why is my understanding of the activist orthodoxy so different from Helen Lewis’?

One clue is at the top of Lewis’ piece, where she says that “sex” is “biological” and that “gender” is “cultural/personal”. I’ve come across this idea from both trans activists and folk critical of trans activism, and it’s intuitive: sex is yer bits, and gender is yer brain (or what yer brain’s been made to think by its culture). I disagree. For me, a fundamental text in gender theory is Judith Butler’s Gender Trouble, in which it is argued, to summarise roughly, that sex and gender are co-produced: that there is no concept of what physical sex is pre-existing a cultural concept of what gender is. Consider what is involved in sex and gender: external genitalia, internal genitalia, secondary sex characteristics (e.g. breast tissue / adam’s apples), chromosones, hormone distribution, psychological make-up, psychological development, cultural roles, and personal response to cultural roles. Which of these are sex and which are gender? Moreover, what are we to do with the many people who don’t neatly fit into sexual dimorphism in all of the categories? People with a penis and breasts? People with XX chromosones and hormone levels more typical of people with XY chromosones? People with a scrotum and a uterus? People with “female” sex organs, “male” secondary sex characteristics (like body hair and muscular development), “female” hormonal distribution, “male” personal identity and “female” cultural roles? What I’m saying is: it’s a mess, and a cultural idea of what gender is is part of what determines which physical characteristics get divvied up into the “male” and “female” boxes. That is, there is no female sex organ without a pre-existing female cultural role (and vice versa).

But Lewis and trans activists have different reasons for claiming a sex/gender binary. I don’t know what Lewis’ precise opinions are, but I can look at the writings of Sarah Ditum and Rebecca Reilly-Cooper, who are politically aligned with Lewis, and sometimes cited or com missioned by her. Ditum uses the sex/gender binary to explain the theory that “gender is a class system”, a philosophy rooted in Simone de Beauvoir, who used the same binary: the idea here is that the cultural class system of gender, which oppresses women, has been layered over physical sexual dimorphism, because it is caused by an oppressive cultural division of reproductive labour, not by any innate gender. Reilly-Cooper uses a similar analysis. Meanwhile, trans activists have made use of the sex/gender binary in order to explain their life experience: why, despite “male” sex characteristics, do some people experience the world as a woman? The idea that sex is physical and gender personal/cultural provides one explanation. Other trans activists, including myself, say that there is no simple sex/gender binary, and that the social experience of sex/gender is produced by a combination of physical/psychological/political factors.

Both trans activist analyses threaten the theory which has underpinned a range of vital and wonderfully victorious feminist struggles. Attacking sexism has meant understanding that gender is a class system and thus waging class war. But now some trans activists are claiming that gender might have some biological roots, and other trans activists are muddying the waters of the sex/gender binary. There is, very understandably, a desire to defend the theory that gender is a class system, which has been important to feminist struggle.

But I find this a bit confusing, because I also think that gender is a class system. I appreciate and support the analysis that gender is a class system, and I want to wage class war. And so do the majority of trans activists I know and spend time with. So do the majority of trans activists whose books I’ve read, whose theory and practice has underpinned the trans movement.

Ditum characterises trans activist Julia Serano’s argument by saying that “‘subconscious sex’, rather than physical sex , is decisive in this account, so that ‘to feel like a woman’ or ‘identify as a woman” is to be a woman”. Having read Serano’s books, I think this mischaracterises Serano. While Serano does claim that some kind of biologically-rooted psychological “subconscious sex” is a factor in determining gender identity, she also says that it would be one factor among many others. She explicitly does not seek to reduce gender to a biologically-rooted subconscious sex, but rather to integrate some idea of it into our understanding of gender. That is, one can argue that there is some biological root to gender identity without arguing against the idea of gender as a class system: you can have some biological factors which, combined with social/cultural/psychological/developmental/political factors, make you a bit of a confusing mess within the class system of gender. As it happens, I do think that Serano’s political writing does de-emphasise the class-systemic aspects of gender too much, but I don’t think it contradicts them.

I think one reason for these conflicts is a shift in ontological perspective. Just as gender theorists now question the sex/gender binary, philosphers now frequently question all physical/cultural binaries: sex/gender, matter/mind, ecology/politics, action/speech, body/identity, physical/mental, and so on. An increasingly accepted idea is that the cultural determines the material and vice versa. One description for this idea is “postmodernist” (and it’s highly relevant to me that Reilly-Cooper describes herself as a “pomophobe”).

So, when I talk to trans and gender non-conforming teenagers, and one of them says to me “I just feel inside me that my true identity is as a genderqueer non-binary person, even though I was assigned ‘female’ at birth and raised as female til last year”, I don’t hear them telling me that they have some kind of purely physical, purely biological innate thing that makes their gender identity “contradict” their sexual assignment. Rather, I hear them telling me that a whole messy mix of material and cultural factors have led them to describe themselves with a term that signals “I don’t fit the gender class system”.

Reilly-Cooper says that “You do not need to have a deep, internal, essential experience of gender to be free to dress how you like, behave how you like, work how you like, love who you like. […] The solution to an oppressive system that puts people into pink and blue boxes is not to create more and more boxes that are any colour but blue or pink. The solution is to tear down the boxes altogether.” Again, the majority of trans activists that I know would agree with all those statements. They may have a different understanding of ontology from Reilly-Cooper, but the majority of trans activists I know would wholeheartedly sign up for that political programme.

Sometimes I think that Lewis/Ditum/Reilly-Cooper and writers like them misunderstand what trans activists are saying because they have a fundamentally different ontological view. Sometimes I think it’s because there are trans activists who have fairly sexist ideas of what male and female are (though I would argue there are far fewer such trans people than there are such cis people, and they exist not because of trans theory but because of a sexist society), and that these writers are too focussed on those few activists. But I think the most important factor is what I’ve alluded to above: in order to access medical support, so far, trans people have often had to describe their experiences in box-ticky ways. Indeed, we teach each other how to game the system. If I decided I wanted hormone therapy to grow breasts, I have a rough understanding of what I would need to say to a doctor to make that happen, and have friends who would help me get it right, but what I would say would not be what I believe, politically, about gender. If you don’t believe me, then have a look at the Scottish Transgender Alliance reports linked above about trans people’s experience of accessing healthcare. Trans people have been taught to misrepresent themselves in order to access the support they need.

But I also don’t want to create a false dichotomy here between “good” gender critical trans people and “bad” gender essentialist trans people. Because even if someone doesn’t know all the philosophy, or knows all the philosophy and disagrees, and says to me “I was born a woman but what I really am deep inside is a man”, I think that’s OK, and I don’t think it means they’re propping up the patriarchy. I think it means they’re a man and I should treat them as a man, and also that, because they’ve had to explore and come to terms with gender issues, they’re fairly likely to be engaged in good anti-sexist struggle. I might also find that, on conversation, they have a really rich and messy and complex received ontology, expressed in much clearer language than I’m using here — but I also might not, and that would be OK. If they support radical anti-sexist struggle, whatever their gender identity and gender theory, they’re good with me.

It might seem asburd to you that such an impenetrable-to-outsiders philosophical disagreement might underpin a major conflict within feminism. And of course it’s not so simple that “we disagree on gender theory, so we’re fighting”. Rather, conflicts have erupted over trans women’s right to access domestic violence shelters, who gets to be present in women’s spaces, what gender terminology we use when distributing feminist campaign posters, who got whose pronouns wrong, and so on, and then digging into those conflicts has involved unpacking the philosophical assumptions beneath them. Healthcare for trans children is one such conflict, and now I want to talk about what’s at stake there.

Healthcare for Trans Children

Lewis says that she wants appropriate care for trans children to be “a legitimate subject for public debate”. She raises a number of points to support this: that the majority of children currently who present gender identity issues do not grow up to be trans, that hormone therapy and gender-confirmation surgery are invasive and have many side effects, and that “socially transitioning” trans children (i.e. enabling them to live as their stated gender) makes them more likely to seek hormone therapy and gender-confirmation surgery as adults. I’d agree with all these points. What distresses me is where Lewis goes with them.

She says “There is a fine balance to be struck here. How do we best support the children who will grow up to be happy trans adults, while not inappropriately influencing the others into a course that involves lifelong medical treatment, and (usually) sterilisation? Clothes, toys, names and even pronouns all signal to children and the wider world what gender they are. There is no neutral choice.”

A lot hinges here on the words “inappropriately influencing”. The implication of that, to me, along with the points made above, is that hormone therapy and gender-confirmation surgery should be seen as the least-preferred outcome, if not as the last resort, and that actions which make them more likely may be inappropriate influence. In other words, to put it cynically, defensively, and potentially hyperbolically, it seems like Lewis wants as few trans people to bother her as possible.

Earlier on in the article, Lewis says that there is a need to distinguish between “gender dysphoria — the intense feeling of alienation from your sexed body that is normally assumed to be the foundation of transsexuality — and more general gendered preferences about toys, clothes and so on. The word ‘transgender’ collapses these differences, but in medical terms they are still important.” Note here the presence of the sex/gender binary discussed in the philosophy section above, and how it’s used to separate binarily different trans experiences. If you experience intense alienation from your sexed body, you could be a transsexual (and, presumably, qualify for more intensive transition support as a child), but if you just have cross-gendered preferences then you’re probably not. But, in my experience and my friends’ experience, gender issues are not so easily disentangled. There’s what you feel when you look in the mirror. There’s what you feel when you hear a particular name, a particular pronoun. There’s what you feel when you dress a certain way. There’s what you feel when you spend time with certain gendered groupings. There’s what you feel when you watch female characters, or read from a male perspective, or play a genderqueer computer game character. And there’s much more. In other words, there’s a mess of physical and cultural experiences which go into building a gender identity and, potentially, a conflict with the gender identity assumed to go with the sex you were assigned at birth.

Lewis’ fear, I think, is essentially that girls who like playing with guns are going to be pushed onto a railroad which leads from short hair and trousers, through a name and pronoun change, through puberty blockers (drugs which delay the hormonal onset of puberty and its associated changes in secondary sex characteristics), to testosterone patches and the fetishised and feared sex change operation. That trans activism is pushing “ordinary gender non-conformity” onto a medical railroad.

What’s weird, though, is that Lewis seeks to allay this fear by medically gatekeeping trans support. That is, she’s seeking a firm and box-confined definition of what counts as “transssexual”, which then defines who gets what sort of medical support, and which hopefully minimises the number of actual trans people. Whereas what I want is an open and exploratory definition of what counts as transgender, which enables people to access a range of peer, family and medical support structures to explore their gender identity, so that the maximum number of people can take the action they need to feel happy in themselves and are full of the buoyant energy and far-reaching analysis needed to fight the patriarchal capitalist state.

Let’s consider the real, material stuff we’re talking about in trans children’s healthcare. The treatments available on the NHS for under-17s are almost all psychotherapeutic: therapy, counselling, groupwork, family and peer support. That is, most of the care offered to children is just talking about it. Once they’ve talked about it for long enough, they may be supported in changing their gender presentation and names/pronouns. When they’re approaching puberty, they may be offered puberty blockers — a reversible drug with few known side effects. Cross-gender hormone therapy and surgery are only available to legal adults. In other words, the healthcare which Lewis is anxious to have a public debate about consists of thinking about it, openly exploring it, and buying some time to work out what you want. Only legal adults are able to access medical procedures which are less reversible and come with more long-term side effects. In other words, Lewis is worried about the exploration we can support children to do in case, once they are autonomous legal adults, they decide to seek further medical care.

(As a brief aside, I will acknowledge Lewis’ point that there’s not enough research on the potential side effects of puberty blockers. I too would like more research as a matter of good trans healthcare. But I would also acknowledge that taking medications when we’re not totally sure of the side effects or when we know there are adverse side effects is a common part of all medicine, including children’s medicine, and that taking medication which changes hormone production, whether it’s birth control or treatment for menopause, is a common part of women’s experience which is often advocated for by feminists.)

Some kids who express gender identity issues will seek hormone therapy and/or surgery as adults, and live as the gender they were not assigned at birth. Some kids who are physically intersexed will seek the psychological support needed to live in a patriarchal society as someone who does not fit into gender boxes. Some kids who are physically intersexed will later live stably in one received gender without any desire for hormonal or surgical intervention. Some kids will later take hormones to go in one direction, then stop and maybe go in another direction for a while, then shave their heads, then get breast cancer and need a double mastectomy but decide not to go for breast reconstruction, but still see themselves as women, mostly, except sometimes maybe not, maybe mostly it’s something in between that we don’t and won’t ever have a word for and that’s OK. Some kids will, as legal adults, “fully transition” to another gender, and then decide they’ve made a mistake and detransition, and it will be really hard for them, but I really don’t think that less healthcare or less trans activism would make that less likely. (It’s already statistically unlikely.) Some kids will, as legal adults, “fully transition” to another gender, and then decide that actually they would rather be genderqueer, but they still like their new bodies, thank you very much. I really want all those kids to be happy. I really want all those kids to access a wide range of well-funded peer, family, community, medical and state support so that they can go through these processes in as free and unpainful way as possible.

I just don’t see how obstructing children’s gender exploration is a good move for those who want to end the oppressive class system of gender.

To my mind, providing proper support to children to figure out their gender stuff in an open, exploratory way — a way which does not reduce them to medicalised categories or cultural boxes — is much more likely to produce a generation of astonishing, diverse, beautiful, rounded, praxis-filled, many-gendered young people who are fully primed to fight the patriarchy that’s caused them so much bother.

There are some other questions which, now I’ve got myself het up, I’d like to ask those who are critical of current trans activist ideas around supporting trans children:

  • Do you spend as much time criticising parents who strongly push a patriarchal cisgendered identity on their children (e.g. pink dresses for girls, man up attitudes for boys) as you do doubting parents supporting their trans children?
  • Do you think that people advocating for trans children’s healthcare are really a major prop of the patriarchy who need to be opposed?
  • Do you think that more trans people are sexist and are strengthening the patriarchy than cis (or, if you insist, “non-trans”) people?
  • What would be your reaction if a child was removed from his mother’s custody because she did not support his trans identity?
  • When you meet someone with a different theory of gender, what’s more important: arguing the theory or fighting together against patriarchy?
  • Isn’t it much easier to say “You do you” and then fight for access to domestic violence refuges for everyone than to argue the gender theory?
  • Aren’t kids who’ve been able to spend lots of time poking about inside and undoing gender/sex/sexuality much better equipped to fight the patriarchy?
  • Aren’t kids who’ve been properly supported to critically question gender and how they fit into it much more likely to be excellent feminists?
  • Isn’t what the death of gender as a class system might look like precisely this: a bunch of kids questioning gender in ways that to their elders are deeply confusing and conflicting?

I’m starting to get polemical because I’m hurting. I’m hurting at the patriarchal institutions which are cleverly playing off factions of feminists against each other so that their time is consumed in internecine warfare rather than fighting the patriarchy. I’m hurting at the people who call themselves feminists who won’t acknowledge and support the gender identities of my friends and me. I’m hurting at the people who call themselves feminists who won’t fight for services for all women, including trans women. I’m hurting at the people who call themselves feminists who are spending time being critical of healthcare for trans children rather than advocating for more healthcare for trans children. Right now, I’m hurting for J, a child who, whatever their gender identity, is being put through the wringer not just by parental conflict but by schools, by social services, by the courts, by the state, by the media, by me and Helen Lewis, by, of all things, gender theory, rather than everyone involved doing what’s most important: openly and exploratorily giving J the time and support necessary so that J can figure out how to live.

I’ll return to where I began: if you want to ask questions about healthcare for trans children, I fail to see how the answer can be anything other than “as much healthcare as possible”. And if you want to avoid traumatic cases like J’s, and if you want to end gender as an oppressive class system, then providing the maximum possible support for trans children is what it looks like.

Harry Josephine Giles

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