'Culture war' that threatens transgender rights

Amnesty International has warned that the Cass Review’s findings have been weaponised by online trolls and used by politicians to spread moral panic

Caption: Image created on Canva by Frankie Crew

Caption: Audio version of the story

The review was intended to clarify the problems faced by patients and healthcare professionals in NHS gender clinics. Yet, the findings have been met with a wave of criticism from LGBTQ+ support groups who believe that the report is not clear enough and leaves room for misconceptions and hostility towards patients.

Dr Hilary Cass's review of paediatric NHS gender services found that young people had been let down. It stated that care was “falling off a cliff edge” once teens reached 17 years old, because of the lack of follow-on services. Also, that gender care was an “area of remarkably weak evidence” with “no good evidence on the long-term outcomes of interventions to manage gender-related distress”.

Specifically, Cass's conclusions on the safety and effectiveness of puberty blockers – estimated to be taken by less than 100 young people in the UK – caused the biggest concern. These have now been banned for under 18s in NHS gender identity clinics as a result. Prominent critics of transgender rights advancements hailed the findings as exposing a medical scandal in which the media is complicit.

Caption: Chris Northwood is worried about the state of gender healthcare. Taken by Frankie Crew.

Caption: Noah regularly updates his social media followers about his health care 'journey'. Photographs taken by Noah de la Torre.

Caption: Noah regularly updates his social media followers about his healthcare 'journey'. Photographs taken by Noah de la Torre.

Chris Northwood, Manchester's first ever openly transgender councillor believes that the coverage of the Cass Review was done quite dishonestly and was used to reinforce people’s existing agendas. “The recommendations are quite poor and weak, and it’s left itself open for people to project whatever they want on to it,” says Chris, who is worried about the polarisation of the debate. "What it actually says it that there's no good evidence in either direction, but people have been led to their own conclusions."

Chris considers access to healthcare to be one of the biggest challenges for transgender people. “Quality of care is variable. The way people are often being treated whilst on waiting lists is horrendous. We’re seeing primary care providers becoming more and more hesitant to take on shared agreements because of the fear of the culture war.”

Noah de la Torre is an early years educator and a trans man, who began medically transitioning in May 2023. Having questioned his gender since the age of seven and beginning to socially transition at 13, he’s found it “quite difficult” to get the right medical support. The NHS target for a first appointment at a gender clinic is 18 weeks, but many people have reported waiting more than five years. He opted for the private route but found that even getting referrals or information transferred through the NHS was a struggle.

“I feel very comfortable being online as a trans person, but I’m a lot more scared in the real world. He references a specific occasion, when Prime Minister Rishi Sunak proclaimed at the Conservative Party Conference that: “A man is a man, and a woman is a woman. That’s just common sense”, as well as the mocking of the leader of the opposition for his party’s stance on trans issues at Prime Minister’s Questions, when the mother of Brianna Ghey – a 16-year-old transgender girl who was murdered in a pre-meditated attack - was in attendance. Noah feels that this encouraged others to make similar remarks to him in public and feels uncomfortable in crowded spaces as a result.

Issues surrounding trans identities have been increasingly debated by leading politicians. The rights of transgender individuals to share spaces in toilets, prisons, and hospitals have been discussed. More prominently, the impact of shared sporting competitions and equal access to healthcare facilities. For Rishi Sunak and the Conservatives, the debate represents an opportunity to prove a point of difference between them and the Labour Party ahead of the next general election.

One of the government’s new policies is a ban on trans women inhabiting female-only wards in hospitals. The proposed changes to the NHS constitution would see trans and non-binary patients treated in separate single rooms – raising concerns about access to healthcare. A report by Trans Lucent previously revealed, via a series of freedom of information requests, that not a single complaint had been made about this issue by patients in NHS hospitals across the UK. Sir Keir Starmer’s opposition party have sustained a significant lead in the polls for the past 18 months – and despite being mocked by the government – have taken a similar stance on trans issues, reversing plans for self-identification and committing to single-sex spaces in ‘unequivocal terms’.

jane fae, director of Trans Actual and chair of Trans Media Watch, is critical of the outcomes of the Cass Review and has directly challenged her in meetings. She is unhappy with many of the responses she’s received. “It’s terrifying being a trans person in the UK at the moment,” admits jane. “The media reporting and political speeches are giving a green light to thugs to have a go at us. It makes me afraid to go out and it limits me.” Hate crimes against transgender people in England and Wales rose for a third successive period in 2022-23 to 4,732 – the highest on record.

jane believes that there is a persistent media and political narrative aimed at questioning the validity of transgender identities to gain an electoral advantage. She describes it as a balance between “utterly cynical power politics” and “genuine detest” for trans people. “I think it’s horrendous that my right to live without being abused and possibly attacked in the street is being used as a political football”.

Chris Northwood calls it “a constant pressure to roll back our rights protections” as trans issues aren’t being debated in a meaningful way. The debate is “rooted in fears or hypotheticals or caricatures of trans existence because the people who are framing it are transphobic.” As Chris sees it, this allows people to escalate their negative views because there is a “culture that’s saying that this can happen with impunity”.

Chris raises the point of representation. If she wins the seat of Manchester Central for the Liberal Democrats at the next general election, she will become only the second transgender Member of Parliament in the United Kingdom’s history. The lack of prominent voices is perhaps because, according to the latest census results, only 0.5% of the population (in England and Wales) are registered as transgender. According to Chris, it is impossible to have a meaningful conversation about trans-specific issues without the presence of transgender individuals.

“We’re not seen as an identity, we’re seen as an ideology,” she explains. “This leads to a debate that is “about us and away from us”. Chris Northwood argues that trans people are held to a different standard in the media and that “holding the entire community to the bar of the worst person in it is unacceptable.” She wants the debate to be “dragged back down... to become rooted in the reality of what trans people’s lives are and not focusing on the few bad apples”.

Caption: Hate crimes against transgender people in England and Wales from 2011 to 2023. Figures from the Home Office. Graph created by Frankie Crew.

“I think it’s horrendous that my right to live without being abused and possibly attacked in the street is being used as a political football”

- jane fae, Director of Trans Actual and Chair of Trans Media Watch

Some who thought that the Cass Review might draw a line under the medical dilemmas will be disappointed. Doctors and researchers have been abused for their attempts to provide safe and effective treatments, while many transgender people feel isolated and vilified for fighting for the care they need. Details of a further study into the effects of puberty blockers in adults are set to be announced by the end of the year.