HealthSense: is good evidence being ignored by charities concerned with gender ideology?
An article contributed to the charity HealthSense, a UK charity that has been promoting science and integrity in healthcare since 1991
Republished under the Creative Commons Attribution-NoDerivatives 4.0 International License.
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The explanation given for distress with one's sex, and the identification with the opposite sex, is that it is a matter of a "mismatch", "difference", or "discrepancy" between one's sex and "gender identity".1 However, given what we can observe happening in public life, I find this explanation appears lacking.
How can it, for example, not only apply to the large increase in girls and young women who are being referred to "gender identity" clinics,2 but also to middle-aged men, who, often after having a family, desire to identify as the opposite sex? Are both really explained by a supposed "mismatch" of "gender identity"?
I first started reading around this topic as a teenage boy, when at the onset of puberty I found myself confused with my own identity around my sex and my sexuality. I had what is today called "gender dysphoria".
At the time, I searched online to try and understand what I felt. I was intrigued by research by the Canadian psychiatrist Ray Blanchard, currently an adjunct professor at the University of Toronto, who is responsible for a large body of research into disorders of gender identity and sexual orientation.* Blanchard's hypothesis was that in males, there were two main causes for disturbances of gender identity: homosexuality or autogynephilia.
Blanchard identified the first type as when a particularly feminine boy would identify as a girl, which in most cases, would cease at the onset of puberty, when they would also have a high likelihood of being homosexual.
Blanchard identified the second type as being caused by the more unusual attraction of an otherwise typically masculine heterosexual male not only to women, but to the concept of themselves as a woman, which he termed "autogynephilia", meaning "love of oneself as a woman".3
Blanchard's hypothesis – though supported by extensive research and his definitions included in standard psychiatric manual DSM-5 – cannot be claimed to represent the consensus among medical professionals in this field. But, after reading a synopsis of his description of autogynephilia, it resonated strongly with me and I feel that this phenomenon was the source of my own problems with my identity. This has led me to question the currently popular narrative that all cross-sex identification is a supposed matter of a mismatched "gender identity" in conflict with one's “sex assigned at birth”.
What, I wonder, would be the implications for treatment for any individuals whose gender identity issues result from autogynephilia?
An evidence base or a belief system?
The meaning of the term "gender identity" itself has arguably undergone a transformation. In the past, it was used to describe the developmental stage when a child could discern their own sex,(4) however today, it carries the suggestion that people who identify as the opposite sex have some "essence" of the opposite sex: i.e., "a transgender woman is an adult natal male with a female gender identity".4
Today's conceptualisation of "gender identity" appears to be the latest formulation of what is known as the "feminine essence narrative",5 which sees transsexuals being "in some literal sense and not just in a figurative sense, women inside men's bodies".
This narrative would be impossible to prove objectively so could be said to have more in common with a belief system than an evidence base, as it appeals to some essential quality that exists outside our sexed bodies. Proponents of this view of cross-sex identification have been in a long-running academic disagreement with researchers such as Blanchard, who rather see cross-sex identification as a matter of atypical sexual orientation, resulting most usually from either homosexuality or autogynephilia.
If true, or even if the truth were to lie somewhere in between, it would have huge implications for treatment of any autogynephilic individuals. I have therefore found it concerning that the view that all cross-sex identification is a matter of an mismatched "essence" or "gender identity" has been presented uncritically as the truth by the NHS,6 healthcare organisations, charities, schools, and non-governmental organisations, despite being highly contested in research.
Loose diagnostic criteria
Furthermore, I have been concerned that teaching what is arguably a belief to children has caused an iatrogenic social contagion, primarily amongst girls, who have come to believe that they have the "gender identity" of the opposite sex.
In the last decade, there has been a drastic increase in the number of girls being referred to "gender identity" clinics which, rather than happening for any known endogenous reason,7 appears to have more in common with previous socially contagious mental health epidemics, that are common amongst this cohort, such as anorexia nervosa, repressed memory, bulimia and self-harm.8 It follows that attempts to treat this cohort under the belief that they literally have the "gender identity" of the opposite sex risk grave harms. Therefore, the need to investigate and consider any robust research evidence around outcomes that would not involve life-altering treatment is urgent.
A number of charities and NGOs are promoting a definition of "trans" that has loose diagnostic criteria, to young people who are going to be susceptible to misdiagnosing themselves with mental health disorders. One even tells children to not worry if they don't feel "trans enough". In an effort to raise the subject of atypical sexual orientation and the wider research behind the causes of cross-sex identification, I contacted charities that have amongst their charitable objects to "advance education" and "support research" around this issue, such as Gendered Intelligence and the Gender Identity Research & Education Society (GIRES).
I submitted complaints about claims – such as that gender identity issues are different from sexual orientation – which are unsupported by research. However, their responses made clear that they were not prepared to change their websites or engage in discussion about evidence. Research presenting hypotheses that challenge their definitions – even though they could have important implications for life-changing medical treatment – appears to be something that they do not want to cover with the public.
Challenging charities
I have taken this matter further with the Charity Commission,9 with the complaint that these charities are not fulfilling their charitable objects to educate the public regarding this matter, however the Charity Commission say that they: "lack the expertise and knowledge of complicated psychological and medical issues connected to gender identities." It would appear therefore that the line between what is a medical condition, and what is a matter of personal identity, has been blurred, to the point where there is no recourse to a public authority that is qualified to assess whether what charities are saying regarding matters of sex-related distress are true.
Finally, I have found it concerning that many in the medical profession itself appear to have also come to believe in "gender identity", as they offer no indication of knowing about the controversies surrounding the research in this field. The NHS presents charities such as GIRES as an authoritative source,10 despite GIRES being reluctant to engage in discussions about evidence. I believe that if more people in the medical profession knew about the research and controversy behind matters of cross-sex identification, then there would be more people sounding the alarm regarding the drastic increase in referrals in children, particularly girls, to "gender identity" clinics.
This article represents the opinion of the author. A pseudonym is used here at the author's request. In this unusual circumstance we agreed to anonymity because of the sensitivity of the topic under discussion but the issues raised here are nonetheless of interest to HealthSense readers as they are relevant to evidence-based treatment. There is no intention to invite discrimination or to invite discussion beyond the subject of evidence. We welcome courteous and respectful discussion.
* Note that "gender" used to be a polite synonym for "sex": https://twitter.com/BlanchardPhD/status/1134077549351448577
Gender dysphoria: distress or discomfort experienced due to a discrepancy between a person's gender identity and their biological sex observed at birth. Royal Society of General Practioners website (accessed 11 June 2024) https://www.rcgp.org.uk/policy/rcgp-policyareas/transgender-care
Sharp Increase in Incidence of Gender Dysphoria in Children and Young People. (website) https://segm.org/
Blanchard R. “The Classification and labelling of nonhomosexual gender dysphorias”. Archives of Sexual Behavior 18(4) 315-334 p. 323.
Byrne A. “'the sense of knowing to which sex one belongs', is universal. It is not, however gender identity as it figures in the received account of being 'trans' or 'cis'.” Trouble with Gender. Polity Press, 2023
Blanchard R. “Deconstructing the Feminine Essence Narrative".” Archives of Sexual Behavior 2008;37:434-438
"Gender dysphoria is a term that describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity." "Gender dysphoria" NHS website (accessed 11 June 2024) https://www.nhs.uk/conditions/gender-dysphoria/
Michael Bailey J and Blanchard R. “Gender dysphoria is not one thing.” 4th Wave Now website (accessed 11 June 2024) https://4thwavenow.com/2017/12/07/genderdysphoria-is-not-one-thing/
Abigail Shrier. Irreversible Damage. Regnery Publishing, 2020. p. 254
Complaint to the Charity Commission regarding Stonewall, Gendered Intelligence, GIRES, The Proud Trust and the NSPCC. https://transpolicy.substack.com/
“Think your child might be trans or non-binary?” NHS website (accessed 11 June 2024) https://www.nhs.uk/live-well/thinkyour-child-might-be-trans-or-non-binary/