In May of this year, the UK government passed an emergency ban on the use of puberty blockers in trans healthcare. These restrictions followed the recommendations in the Cass Review’s final report. Health Secretary Wes Streeting announced on 11th December, earlier this week at the time of publication, that the ban will be extended indefinitely. One gets the impression that there was little doubt about this outcome past all the talk of uncertainty. The below article investigates the conditions that have enabled a profound attack on young trans people’s autonomy.

We encourage readers to stand in solidarity with the action network Trans Kids Deserve Better. Young trans people need support now as much as ever.

The Cass Review is a Youth Liberation Issue

Among trans people in the UK, the following is now common knowledge: one of the central functions of anti-trans discourse is to create ambiguity. In this capacity, the point of debate is not to persuade the public so much as to create enough doubt for transphobia to proceed by default. We will add that recent British trans discourse has taken a turn towards performed ignorance; now, increasingly alongside the more familiar transphobia is one which makes fewer explicit, positive claims and accomplishes its aims by appearing to refuse all claims to knowledge actively. It aims for particular institutions rather than the general public, and currently, it predominantly targets trans children and adolescents.

Within this discourse, gender identity is – to quote the Department for Education’s proposed school guidance from December 2023 – “a highly sensitive, complex issue, which is still not properly understood.” Repression is made to seem the sensible (frequently: “cautious”) option in light of daunting complexity. The Cass Review is a feat of uncertainty. It asserts ignorance and lays the groundwork for anti-trans restrictions to appear as the safe option.

Jules Gill-Peterson observes in Histories of the Transgender Child that the American life sciences have often and variously used children as a metaphor for biological plasticity. Young trans people in the UK are living through a similar process, and in this discourse the indeterminacy is psychological and subjective as well as physical. Over the last few years – with a significant turning point being the 2020 High Court judgement on the Bell v Tavistock trial – childhood and adolescence have become the frontiers of British transphobia. This has happened partly because childhood as a concept has been a useful bearer of ideas of confusion and uncertainty. The Cass Review and its far-reaching effects are born in this context.

The Review takes childhood to represent a point of malleability at which gender is not set in stone, and transness is to be warded off. Because this angle is key to understanding the report, we will substantiate it with several quotes. The final report is grounded in references to children’s identities being indeterminate:

“Some of you will also become more fluid in your gender identity as you grow older. We do not know the ‘sweet spot’ when someone becomes settled in their sense of self, nor which people are most likely to benefit from medical transition.“

Sometimes the indeterminacy is somatic before it is psychological, for instance, in a passage wondering whether young trans adults might have turned out cis if only they had gone through endogenous puberty:

“If a young person is already on puberty blockers they will need to make the decision to consent to masculinising/feminising hormones at a point when their psychosexual development has been paused, and possibly with little experience of their biological puberty.“

This is all supplemented by appeals to the possibility that socialisation can permanently alter a child’s life trajectory:

“Others consider that a child who might have desisted at puberty is more likely to have an altered trajectory [after social transition], culminating in medical intervention which will have life-long implications.“

[…]

“However, in an NHS setting it is important to view [social transition] as an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning and longer-term outcomes.“

The report ascribes malleability to young people and arrives at a study of indecisiveness that demands medical and social restrictions for the sake of caution. Transition is represented as an intervention in identity development, and cisness is considered a neutral option. In this context, even the report’s calls to reduce waiting lists take on an opportunistic tone:

“It is only when [children and adolescents] have been on very long waiting lists, and sidelined from usual care in local services, that they are forced to do their own research and may come to a single medical answer to their problems.“

More broadly, trans children and adolescents – both in the report and its attendant political and journalistic discourse – are rarely attributed agency. The patients in the report are “gender-questioning,” or passively experiencing “gender-related distress.” The patient’s self-determination is eliminated; the language functions to create a state of uncertainty wherein young trans people are interminably “trying to make sense of” their feelings. Gender is reduced to distress, then the distress is identified with childhood or adolescent confusion; finally it is up to (cisgender) adults to work it out for them, or to enforce a cisness that appears to be the default.

Such paternalism – already the preferred mode of anti-trans medical gatekeepers – is possible here because the report concerns children and adolescents, and can therefore make use of well-established precedent in removing young people’s social and medical autonomy. More concretely, the report banks on families and schools to restrict children’s and adolescents’ agency.

Last year’s aforementioned school guidance on “gender questioning children” repeatedly cites the Cass Review’s interim report; we believe this goes some way to explaining a set of operative similarities. The guidance tells school staff, as the Cass Review does medical professionals, that young people’s gender identity is near-unknowably complex; that transition is an active intervention; and therefore that there are a host of complicating factors for which to look out. Intricate layers are built on the confusion and indeterminacy with which young people have been identified.

The image of the confused child disqualifies young trans people from claiming authority on their own gender, and in so doing leaves an absence of knowledge. The absence enables transphobes to enforce cis identity, thereby making practical use of the malleability they perceive in young people. We will later show that their techniques are ready-at-hand in the institutions of the school and the family. In schools this careful folding of knowledges and precedents is likely to create conditions which resemble the effects of Section 28, both in their uncertainty and in their acquiescence to norms that appear safe and default.

Although the December guidance is still under consultation, some of its suggestions are provisionally repeated in more recent school guidance from September 2024. If and where any of this is implemented, it will likely be done to the effect that transition is delayed while adults wait (perhaps hope) for a certain solidification of identity to happen in a young person living under conditions of repression and implicit shame.

Gendered socialisation will be subordinated to the aim of maintaining a sex binary as best as possible; in this respect, there is precedent in, for example, the psychologist John Money’s unsuccessful attempts to control the gender identity of children through sex assignment and gendered socialisation. Institutional transphobia has long been grounded in the disempowerment of young people. Certainly, the Cass Review betrays a paranoia that children are malleable enough to be turned trans, but just as present is the confidence that they are politically malleable enough to be made cis.

The discourse of malleability – much like Money’s social determinism – is overlaid on concrete power arrangements. For instance, according to the school guidance’s suggestions, a young person who wants to socially transition at school should first obtain parental consent, except in the case (“very rare”, we are told) where this may put them at risk. The effect – as has been pointed out by many trans people before us – will be that some young people are put at risk, and many more will not feel comfortable trying to socially transition. In instances where the young person can socially transition, the school is still to police uniforms, pronouns, bathroom access, and participation in sports, mainly according to assigned sex at birth.

These restrictions are stricter than those currently possible for adults. Parents are given the final say over their children’s gender, and a host of additional repressions are built on the existing apparatuses of paternalistic control in schools. A system of intense, standardised, and compulsory education can only function with a degree of authoritarianism, and it is an authority which is reproduced in various rituals of control which implicate, inter alia, children’s freedom of movement and presentation.^[1] The transphobia of caution and paternalistic restriction, therefore, finds close affinity with those procedures which are, for better or for worse, essential parts of the current school system.

In the most consequential sense, the malleability referenced in the school guidance and the Cass Review turns out to be a matter of political agency. The Review’s proposition that young people are psychologically plastic would not be relevant if not for a deeper malleability: adolescents, and especially children, are more susceptible to control and conversion. Young people are targeted here not just for the discursive convenience of the figure of the uncertain or confused child, but for the social reality of young people’s family-based and school-based repression.

It is therefore worth asking: when support is offered to families and carers of new referrals to the Children and Young People’s Gender Services, of what will that support consist? We cannot definitively answer, but we believe that this is, to an extent, part of a broader question: in light of the Cass Review, what is the message being sent to families and carers on whether and how they should exercise their undue power on a child’s ability to socially transition?

Gill-Peterson observes a common path towards parental acceptance in her essay ‘The Logic of Protection’. Parents are reluctant to allow their child to transition; the child becomes increasingly miserable; eventually the parents are swayed; the child happily transitions, and the parents realise their mistake. The situation should not happen in the first place. Nevertheless, the Cass Review, with its resultant discussion and medical guidance, might intervene even here inasmuch as it generalises a young trans person’s distress, removes their ability to self-narrate, and offers the promise of potential alternative treatments which may be more convenient for their legal guardians if not for the young people themselves.

Regarding medical practitioners, it should be said ignorance is already widespread. Magdalena Mikulak’s study ‘For Whom is Ignorance Bliss?’ finds that among GPs, there is a lack of knowledge not only about trans people but about the GMC’s guidelines on trans healthcare, and about “the existing processes and the trans health pathway” altogether. GPs often believe it’s their role to determine who is trans; the Cass Review will not help. What concerns us more here, though, is a passivating kind of ignorance.

Mikulak observes that some GPs feel “discomfort,” “nervousness,” and “lack of confidence” around trans healthcare. Recent events have only consolidated the problem. Since the Cass Review, the RCGP website has advised most GPs against bridging prescriptions and shared care for gender-affirming healthcare on the grounds of lack of “expertise.” We are seeing the complicating effects of the epistemic uncertainty Cass initially draws out of childhood, but which by no means affects only children.

The techniques used against young trans people can be, and often are, used against all trans people. When recent discussion does not conceal trans people’s agency through infantilisation, it does it by highlighting elevated rates of neurodivergence among trans people instead; these are not separable discourses. The Cass Review’s final report asks practitioners to take note of “any sensory issues that may be contributing to the distress;” the RCGP’s guidance advises doctors to “take a holistic approach, considering neurodiversity.” If there has been a shift towards performed ignorance, that ignorance has its root in the perceived incapability of self-knowledge in young and neurodivergent people.

Kathleen Nicole O’Neal observes in Ageism: A Pillar of Ableism that the denial of young people’s agency “has set the precedent” for the treatment of those who are perceived as “lacking the capacities of the average adult human being.” When a neurodivergent person is infantilised, it is a matter of political precedent; this means so long as young people are institutionally disenfranchised, there is a fault line under the freedom of every trans person.

Transphobic caution relies on paternalisms which have long been present in the parental power to represent and determine the lives of children, and which are ritualised in the modern school. Therefore, the Cass Review is a youth liberation issue. The issue runs as deep as the way we raise children, and it extends as far as the bodily autonomy of all trans people living in the UK.

Blanchard, Shrier, Cass

We will refer in this section to the exigences of economic production and reproduction, and their roles in transphobia. When we use these terms, we have in mind the reproduction of the productive life of a society within a gendered capitalist division of labour; therefore our use of the terms will sometimes overlap with, and sometimes depart from, various Marxist feminist discussions of social reproduction.

The sexologist Ray Blanchard’s typology, wherein transfeminine people are either autogynephiles or homosexual transsexuals (HSTS), has had historical use as a psychiatric means of pathologising trans identities and thereby restricting and determining access to medical transition. A discussion of all of the framework’s features is outside the scope of this essay, but we posit that one way to understand it is as a typology of labor and family status. First, we note that in his discussion of autogynephilia, Blanchard objects to transition on moral grounds relating to work and familial duty:

“Forty years ago, an autogynephile’s decision to transition to the female role often had negative consequences in the personal and employment spheres. Now that decision is as likely to get them praised for courage as it is to get them criticized for selfishness and irresponsibility.“

And for Blanchard, choosing not to transition is:

“a logical choice of treatment if the patient has a marriage that he [sic] wants to maintain or a valued career that would inevitably suffer if he attempted to transition to the female role.“

It is significant that Blanchard places emphasis on work and family as reasons a patient ought not to transition. In the context of anti-trans employment discrimination, and bearing in mind that autogynephile describes a kind of trans woman unlikely to remain in, or fall into, a heteronuclear arrangement, we might view this as a moral effect of the nuclear family organisation of production and reproduction. That is, if a patient is a reliable worker in a family, then for Blanchard she ought to remain where she is.

The relative legitimacy allotted to the counterpart HSTS might be partially understood in this context, where the HSTS is understood to be a subclass who is already feminised. Before we substantiate this claim, it is worth noting that the defining criteria at both ends of the typology are malleable and indistinct enough to allow for a degree of interpretative agency on the sexologist’s part. For Blanchard, sleeping with men is not necessarily evidence that a patient is HSTS; and self-reports are to be scrutinised due to the likelihood of “heterosexual” trans women lying to avoid prejudice when seeking surgery.^[2]

We therefore posit that two of the more material distinguishing factors between those labelled autogynephile and HSTS are age and marital status; Blanchard himself observes that so-understood HSTS trans women are generally younger, and likelier to be unmarried. Therefore those trans women who have already established careers and families before transitioning are to be contained; on the other hand, the trans women who are likelier within this framework to be allowed medical support are those who are already visibly queer, who are transitioning young enough to not have formed a family, and who are less likely to have a stable job – in other words those trans women in whom there is less to preserve, from the moral standpoint informed by production and reproduction.

Writer McKenzie Wark makes an observation related to ours: “when homosexuality was still a criminal offense the ‘loss’ of so-called HSTS subjects to transition wasn’t important.” For the so-called autogynephile, on the other hand, Blanchard‘s recommendation is clear:

“For mild or intermittent gender dysphoria, counselling or cognitive behavior therapy may be sufficient to help the patient through “flare-ups” of dysphoric feelings.“

In this typology, transness that threatens already-established career or family life is to be contained where possible; and transness that is likelier to have already precluded stable employment or family life is not considered to be worth recovery. We would suggest that, almost paradoxically, the greater degree of access to gender-affirming healthcare for HSTS trans women is partially an effect of perceived irrecoverability.

But we would miss something about the framework if our discussion ended here. After all, it is not just the HSTS who is viewed as irrecoverable. Ray Blanchard does not recommend the autogynephile trans woman master her gender and become male so much as compromise and live out gender non-conformity in private. “In my opinion,” Blanchard tells us, “people can be taught not to do what they want – […] but they cannot be taught not to want what they want.” That is, Blanchard is aware that his patients have a degree of freedom and that he cannot undo their transness altogether, so instead the patient is to be contained.

The way trans subjects are discursively framed partially depends on the possibility of their recoverability into cisheterosexuality. We will suggest that in some instances, those in which the complete prevention of a person’s transition appears socially possible, categories emerge to affirm that the subject is cis, so as to suggest that the cisness can and must be recovered. We have seen that the Cass Review achieves it in its construction of subjects who are malleable and, in one way or another, confused about their identity; and we will see that the same sleight takes place in Abigail Shrier’s conservative tract ‘Irreversible Damage’.

By drawing on the unsupported Rapid Onset Gender Dysphoria (ROGD) hypothesis, and through conversation with the parents of a group of transmasculine adolescents (although the latter are misgendered throughout the text), Shrier establishes a group of trans persons who have supposedly developed dysphoria through social contagion.

Inasmuch as it blames the corrupting influence of trans social media circles, Shrier’s text can be read as a futile attempt to reverse an impressive expansion in trans life and consciousness which, as Jules Joanne Gleeson notes in Transition and Abolition: Notes on Marxism and Trans Politics, has been set into motion by a gradual expansion in networks of distribution of resources and knowledge, accelerated by the internet inter alia.

But the book is not written idly: Shrier’s intended audiences are parents and medical professionals, and her aim is to encourage and guide a shoring-up of cis male and female embodied roles, via the adults who are in a position of direct power over trans adolescents. The text is punctuated with references to those adults who are truly trans – for this, we read beyond recovery – by way of contrast to the adolescents whose trans identity must be suppressed.

Gleeson observes that “heterosexual families are prone to trying to recreate themselves in their own image.” Conversion often operates through the family: anti-gay conversion practitioner Joseph Nicolosi Sr even harnesses this in his Parent’s Guide to Preventing Homosexuality; and as Gleeson notes, the anti-trans conversion practitioner Kenneth Zucker’s patients were mainly brought to him by their parents.

Parental anxiety (along with parental power) has and continues to play a role also in the so-called corrective surgeries performed on intersex persons; there is a long history of parents collaborating with the medical disciplines as part of the enforcement of a gendered order. It is in this sense that Shrier calls on a history of familial gendered violence.

We posit that Shrier’s text is partially informed by her investment in a gendered division of labor. Indeed, even on the book’s cover – which features a child with a blank hole where a uterus might be expected – Shrier makes use of affects bound up in the expectation for women (and eventually girls) to bear and rear children. Equally striking is the engagement with feminism that occurs in one of the book’s late chapters. The chapter has no immediate relation to the rest of the text; for this reason, we will quote it extensively:

“Though it’s often considered insulting to note, women in the aggregate have different preferences: we tend to put “people jobs” over “thing jobs,” as someone once put it to me. This has caused feminists a great deal of consternation. Pricked by the embarrassment of natural differences between men and women, they blame society and insist women need to be taught to adopt different preferences.“

[…]

“Nothing I have written here should be taken to discourage young women from wanting to become CEOs or math professors. (Does this even need to be said?) The point is only that women need to own up to a hard truth: We assume – so often, so immediately – that the guys have it better, that whatever men want must be better, too.“

“We allow others to denigrate motherhood; we denigrate motherhood ourselves. We treat stay-at-home moms as the most contemptible of life’s losers.“

Here is an effort to valorise the care jobs that post-industrial society offers women, as well as the culturally and materially imposed roles of working or stay-at-home motherhood; these roles appear now in Shrier’s text as the predestined outcome of biological differences. We will not be the first to observe that a right-wing feminist current, reformist and conciliatory, runs through the gender critical movement. What concerns us is the relation, finally, back to the core subject matter of the book:

“We must stop. It’s a dumb habit, thoughtless and base. It reflects an unflattering insecurity we shouldn’t indulge. The jealousy at its heart suggests that either we believe women aren’t truly capable, or they have somehow been duped, made victims by a “system” that, generation after generation, locks us out and shuts us in with so many glass ceilings and walls. It’s an exhausting set of untruths. Worst of all, girls are listening.“

“They don’t know it’s all tongue-in-cheek. They don’t realize we’re merely garnering support for women’s causes, bargaining with the culture for better jobs and greater pay. They don’t know we’re merely whipping the pols. They actually believe us.“

Shrier’s feminism is one of gendered difference. But here it is concerned specifically with bargaining for better pay within the fields currently occupied by women. Some Marxist feminists have argued that capital’s abjected activity, such as child-rearing and housework – that which is necessary for capital’s reproduction, but cannot be subsumed into capitalist production – is extracted from women, along with the lower-paid waged labor in feminised professions. The process is mystified by so-called knowledges of women’s biological tendency towards caring, nurturing activities. We see exactly such a mystification in this chapter, with its references to natural differences that result in a gendered labor divide.

Here (in Shrier’s imagination, at least), transmasculine people don’t represent a disavowal of gendered difference in the abstract but rather a disavowal and potential demystification of a concrete regime of gendered difference, one that is based in a division of labor both inside and out of the family. One animating force in Shrier’s text, then, is an investment in the morality stemming from the movement of capital’s abjected and less-valued activity towards those who are designated women.

In an interview following the Cass Review’s final report, Hilary Cass explains why the systematic review described existing studies on cross-sex HRT as ‘low-quality’. Among other things, she posits employment rate as a so-far unmeasured criterion by which transition’s value should be assessed:

“Yes, because we need to follow up for much longer than a year or two to know if you continue to thrive on those hormones in the longer term. And we also need to know, are those young people in relationships? Are they getting out of the house? Are they in employment? Do they have a satisfactory sex life?

What are the things that matter to them, and are they achieving those things?“

Cass cannot be unaware of the economic exclusion faced by trans people in the form of employment and housing discrimination; therefore it is as though she says this by way of response. If so, anti-trans prejudice is being treated here as an economic inconvenience and a personal failure to be resolved by restricting trans healthcare.

There is a wider and perhaps tangential point to be made about the medical relation with the requirements of production. Psychiatry can have the effect of discipline more than treatment; often it achieves this indirectly, by attempting to individually treat distress or dysfunction which might be more fruitfully thought in terms of a patient’s relation to their social context.

In Psychiatric Hegemony, Bruce Cohen offers that one reason for the increase in diagnoses of ADHD in children is that schools, having internalised a market demand for disciplined and self-regulated workers, require levels of organisation and attention that render some children

disordered in the school context. We believe that this particular example is in keeping with the social model of disability, a lens through which disability is a description of the relation between a person and their social environment. Psychiatry, which can only shape the individual and not the social relations in which they are involved, tends to follow the needs of capitalist production.

Within the bounds of psychiatry, tensions between a person and the expectations of the institutions to which they are bound (“duties in the workplace,” and “his or her place in the classroom” to quote the DSM-5 entry on ADHD) can only be addressed at the individual level. Diagnosis and treatment therefore tend towards normalising individuals with respect to capitalist exigencies.

Cass is not acting as a psychiatrist, and it would regardless be a mistake to take her entirely at her word; as Erin Reed has pointed out, it is suspect that everything Cass would like to measure is socially “impacted by anti-trans sentiments.” Nevertheless, Cass’s position – as someone working with a medicalised transness, by which we mean a transness that has been inserted into the framework of a medical condition – is analogous to psychiatrists as discussed by Cohen, and she strikes a familiar chord in her proposal to assess transition in social and economic terms. Medical transition should not be treated like a medical condition; this point cannot be expanded further without a change in topic, therefore it will be fleshed out by the following section.

Conclusion: Distress and Recovery

Some of the most repressive forces of our time can be understood as treatments of distress, insofar as we understand that distress is often the sign of conflicted or unrealised desire. Fascism, as a regressive resolution of social conflicts between regressive and progressive values, addresses some individuals’ distress in its own way: it resolves their internal conflict as the liberation of reactionary and capitalistic desires and behaviours, and the forceful repression of everything else.

The psychiatrists who force or encourage their patients to adapt, mask or stay in the closet can also claim, as Blanchard does, to resolve a certain distressing inner conflict. This means that even if the Cass Review were unbiased, and even if its effects had been limited to its particular context, it would still be concerning that transition has been viewed through the individualising and distress-focused lens of a medical condition. To index bodily autonomy to a set of objective (or even subjective) criteria is in this case to make stigma and social exclusion into a basis for further oppression.

In his article ‘Did the NHS Ever Stop Funding Conversion Therapy?’, Ilya Maude analyses a set of techniques practiced at the Tavistock which are aimed at the treatment of ‘gender-related distress’, and which are cited in the Cass Review’s recommendations section. Within this framework, trans patients engage with therapists as subjects who are distressed about gender; dysphoria is removed from its context and treated as alienated pain, with cognitive behavioural therapy recommendations including ignoring thoughts, and restricting gender-affirming behaviours such as binding. We will quote Maude here on distress:

“As we can see from the history of diagnoses like hysteria and drapetomania, reducing distress and dissatisfaction is not an inherently ethical goal.“

A rise in repressive forces can be understood partially as a response to the distressing appearance or intensification of desires, thoughts and feelings that the current order makes difficult, shameful or impossible; here, networks of trans consciousness give rise to such desire as much as do the multiple public service crises, the fall in effective wages, and the disabling school system. But resolution of distress is only as ethical as its end goals: its tendency towards greater or lesser freedom, the adequacy or inadequacy of the resolution it presents.

We should suspect any attempt in the medical context to reduce trans people to a condition of suffering; this framework makes it possible to deny healthcare, or to suggest other treatments that amount to conversion therapy. With this in mind, we will clarify something of our own position: transness is self-determining and self-determined. We are sympathetic to those who emphasise the pain of dysphoria at stake in medical gatekeeping; we believe nevertheless that treating transness as a medical condition facilitates transphobic repression. As Abigail Thorn observes, the assumption that medical practitioners “have the right to control who may transition and who may not” follows from the premise that transness is a pathology.

Medical conditions are externally determined by a medical professional, and transness is not. For Thorn, the bodily autonomy of trans patients should be taken as an axiomatic principle. We believe Thorn is correct when she says that, although evidence suggests that hormone blockers do effectively alleviate the distress of trans patients, efficacy of treatment is in the first place “the wrong question to be asking.” We will close with two brief, related observations.

First, the Cass Review offers a one-sided framing wherein puberty blockers are an intervention and endogenous puberty is the natural course. The framing makes more sense so long as the report ignores the agency of its trans patients and instead treats them as passive sufferers of a medical condition. There is an intervention necessary in denying someone control over their body, and there is no neutral choice in this context.

Second, the pathologisation of transness introduces and rationalises types of scrutiny that are absurd when taken in light of the social context in which transition takes place. The assertion of trans identity depends to a significant extent on social enablement, which is to be distinguished from social contagion. Gleeson notes that the open living of trans identity depends on ”education, confidence and consciousness,” all of which are currently dependent on the development and reach of trans communities which make transition possible through the labor involved in sharing knowledge and practical advice. In this context, the medical lens is noticeably incompatible with transness. Lisa Littman, author of the initial study on ROGD, justifies her work with the following claim:

“I was surprised that no one had yet explored potential contributors to the recent dramatic demographic and clinical changes in adolescents seeking care for gender dysphoria. I believe that when a population seeking care for a condition drastically changes, it is the responsibility of the clinicians and researchers to start asking questions. Why is this change happening? Is the condition in the new population different from the condition in past populations? Without research to explore these questions, we don’t know if the treatments used for previous populations will be helpful or harmful to this new population.“

This particular medical logic – that of attaching healthcare to a set of symptoms and a corresponding set of outcomes – necessitates the episodic denial of agency to groups of trans persons; within this framework, developments in trans consciousness will repeatedly be initially understood in terms of new demographic profiles and unknown treatments. If a matter of personal agency is jammed into the logic of medical treatment (as opposed to medical facilitation of transition), the same old senseless gatekeeping, scrutiny, and conversion will be once again presented as though they are reasonable.

The unasked question is whether hormonal transition needs to be subjected to medical logics, which ones, to which extents, and why. In this light, it is worth comparing and contrasting the provision of hormone blockers to another pillar of bodily autonomy; abortion is a matter of personal agency which incidentally involves medical assistance. We join many trans people before us in suggesting that this would be a healthier model for transition.

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^{[1] ‘}Why do Schools and Prisons Have So Much in Common?’, BetterSchooling

^{[2] ‘}The concept of autogynephilia and the typology of male gender dysphoria’, Ray Blanchard; ‘Clinical patterns among male transsexual candidates with erotic interest in males’, Frank Leavitt

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