Stephen Whittle

Expert or Activist?

Stephen Whittle. Photo credit: Manchester Metropolitan University

In January 2016 UK House of Commons Women and Equalities Committee (WEC) published a report on “trans” equality in the UK. The WEC was set up in 2015 to hold the UK Government to account for its commitments regarding equalities. The 2016 report concluded that the Gender Recognition Act 2004 (GRA) should be updated: “Its medicalised approach pathologises “trans” identities and runs contrary to the dignity and personal autonomy of applicants. The Government must update the Act, in line with the principle of gender self-declaration.”

In 2018, in response to the issues raised, the UK prime minister launched an inquiry. The WEC published its final report and recommendations in December 2021. As part of the inquiry, 2000 pieces of written evidence were submitted, including a document submitted by Stephen Whittle. Whittle, a “trans”-identified female, is a garlanded Professor of Equalities Law at Manchester Metropolitan University and was also the special advisor for the 2016 report. This piece is not an analysis of the two WEC reports or the GRA legislation but rather examines some of Whittle's assertions in her written evidence in the context of her dual status as an expert in equalities law and as a campaigner or activist.

In February 2022, as part of Oxford University's LGBT month, Whittle gave a lecture on her life and her dual career as an activist for “trans” rights and an academic. Twinkly-eyed, with a snow-white beard and affable manner, Whittle is given a glowing introduction by the Vice-Chancellor of Oxford University who praises her academic work and lists her many achievements. The impression given is that this person is a sober, balanced academic held in high regard in the academy.

Whittle's written evidence to the inquiry for the reform of the GRA has several elements that are surprising given this introduction. At first sight, her arguments seem carelessly written, inconsistent and hyperbolic. For example, she states that removing the medical diagnostic requirements to obtain a GRC provides “an unquantifiably large set of benefits” to people who are otherwise excluded from “benefits” that others take for granted. Removing some requirements for a GRC would only benefit those seeking a GRC in the first place, so it is hard to see how “others” would take these benefits for granted.

On the question of the £140 fee that used to be required to obtain a GRC, she writes that the Remission of Fees process is complex, intrusive and challenging, and speculates that it puts people off applying for a GRC. She says the costs are not excessive, but the cost of applying for recognition of one's gender identity “adds insult to injury” due to the other costs faced by “trans” people. She lists items—such as binders and electrolysis— that “trans”-identified people may need to buy to help them “pass,” implying that the fee for the GRC is too expensive on top of these costs, and yet elsewhere she states, “The fee, per se, is not a problem.” Whittle's written evidence contains misleading and obfuscating assertions that seem to be driven by rhetorical expediency in the manner of an activist rather than an academic expert.

Whittle is in fact, clear that her academic work is motivated and underpinned by her activism. In her preface to The Transgender Studies Reader (2006) which she co-edited, she writes that teaching in the academy is “an activist process.” In 1992 Whittle co-founded Press For Change (PFC), an organisation dedicated to campaigning for the “equality and respect of “trans” people in the UK.” Whittle also set up the FTM network, a self-help group for “trans”-identified females. She has actually been involved in activist groups since she was a teenager. She was a member of an organisation called the Manchester Radical Lesbian Collective and attended the 1974 Women's Liberation Conference in Edinburgh with them. On returning from this conference she started identifying as a man and became involved with the Beaumont Society, which provides support for transvestites.

An objective of PFC was to change the way the media represented “trans”-identified individuals. They courted the press, offering them stories of “transsexual life” on the condition that the angle was positive. This strategy to change the representation of “trans” people in the press was intended to change wider attitudes in society. It underpinned the primary objective of Press for Change which was to change the law to ease the problems faced by “trans”-identified people. The strategy was to change public policy by bringing cases through the court system until they got to the European Court of Human Rights (ECHR). PFC called out to the community asking for people with cases they could bring to the courts. These cases they bought to the ECHR were significant catalysts in the introduction of equality legislation in European countries as well as the United Kingdom. The Gender Recognition Act 2004 was a response to a ruling in the 2003 case, “Christine Goodwin vs The United Kingdom.” (Whittle claims this as a victory of PFC.) The ECHR ruled that the lack of legal recognition of Goodwin's changed gender had led to a violation of Article 8 (the right to marry) and Article 12 (the right to found a family life).

In the written evidence Whittle argues that the acquisition of a gender recognition certificate affords what she describes as a “core human right..., the recognition of one’s gender identity.” This is a puzzling assertion coming from an expert in Equalities law. As the United Nations states, “Human rights are rights we have simply because we exist as human beings—they are not granted by any state.” In applying for a GRC people aren't applying for a human right, but putting a legal process in place so they can access legal protections that if absent would violate their human rights, as noted in the Goodwin case. Perhaps this is a problem of style. Or perhaps Whittle is engaged in hyperbole, which would be expected from an activist, but not from a legal expert.

As a Professor of Equalities Law, Whittle seems strangely indifferent to the concerns or rights of any other group. She writes that it is a “legal abhorrence” if someone who holds a GRC is excluded from single-sex services, but she fails to address the impact on other users of that service. She claims this policy would be counter to the European Convention on Human Rights, the Human Rights Act 1998, and the GRA 2004, but she doesn't offer any legal analysis or explanation for her position. She calls for more clarity but makes no counter-proposal. Whittle's proposed solution “to meet the concerns of women” who worry “that predatory men may take advantage of any system without any diagnostic requirement” is for the government to make it a crime with a “significant penalty” for a “false application.” She does not suggest how to implement this, for example, she does not elaborate on what a “false application” would look like.

The campaign to remove medical diagnosis to obtain a GRC

Perhaps the most extraordinary claim Whittle makes in the WEC written evidence is that the NHS burdens “trans”-identified teenagers with mental health problems with more serious diagnoses as punishments for bad behaviour. Whittle's partisanship is grounded in her personal beliefs, and she is personally strongly defended against the psychotherapeutic approach to understanding or treating “trans” identities. Whittle presents the attempts of the medical staff to get the girls to use their birth names as evidence of institutional “transphobia.” She writes:

If they [trans-identified adolescent girls in care] respond in any way negatively, they discover themselves being given a more serious diagnosis long after the initial concerns have been resolved. In one case, a young trans person sectioned as a consequence of self-harming ‘due to anxiety’, was reassessed as having a bipolar disorder after they tried invoking their right to change their name. In a second case, long after commencing eating and gaining a normal weight, a young trans man’s anorexia was newly diagnosed as schizophrenia after he had thrown his own mobile phone at a wall when a male staff nurse refused to use the name on his statutory declaration of name change.

Whittle often accuses medical staff of failing her by attributing all of her medical issues to her “trans” status. In this light, it might seem surprising that she describes the anorexia and self-harming behaviour on the part of these girls as simply due to their “untreated gender incongruence.” She reports that she has been working with individuals to get their sections removed in order to get them out of hospital. This is a very troubling revelation given the huge rise in “trans”-identified adolescent girls over the past 20 years and the fact that anorexia, the most deadly of mental health conditions, is a common co-morbidity within this group. 

In describing these cases Whittle makes pointed use of the term “incongruence” rather than “dysphoria.” In her written evidence to the WEC, answering the question “Should the requirement for a diagnosis of Gender Dysphoria be removed [to obtain a Gender Recognition Certificate]?" Whittle responds that the United Kingdom is “a member” of the World Health Organisation so they are obliged to stop using the term. She writes: “To retain the diagnostic requirement requires clinicians to engage in a complex lie, as they have to diagnose a condition that from 2022, due to the UK’s membership of the WHO, can no longer exist in the UK’s medical lexicon.”

The term “gender dysphoria” was replaced by “gender incongruence” in the WHO's recent update to its International Classification of Diseases, ICD-11. The condition was also reclassified so it now appears under the chapter “Conditions related to Sexual Health.” In the Oxford lecture Whittle repeats her argument that the GRA amendment should remove the medical requirements to bring the legislation in line with WHO ICD-11. She reports that it “says [trans people] don't have a mental health condition. We have gender incongruence and it can be treated.” The treatment that she refers to is affirmative hormone treatments and surgeries and not psychotherapeutic interventions.

Whittle's assertions have been accepted by the UK Government. The WEC report was published in December 2021. The Government's response, published in 2022 states that “Being transgender is not a mental illness” and promises to remove the references to gender dysphoria as a “disorder” in the legislation. The requirement for a diagnosis of “gender dysphoria” has been removed in the proposed Gender Recognition Reformation (Scotland) Bill. The policy memorandum specifically references the reports written by the WEC.

“The Enemy I had to Defeat”

Whittle has written that “trans” people live in “spheres of pain” and suffer fear, intimidation, shame and stigma. The root of the word “dysphoria” means something like “hard to bear.” “Dysphoria” seems like a good word to describe the experiences of “trans”-identified people, and is still used by psychologists and counsellors, so why is she opposed to the word? Whittle is clear that one of the aims of her activism is to remove the association of “transgender” identity with mental health. In the preface to The Transgender Studies Reader (2006) she writes:

In the 1990s a new scholarship, informed by community activism, started from the premise that to be trans was not to have a mental or medical disorder. This fundamental shift was built upon within academia. [...] The work of trans academics and theorists is increasingly moving trans people away from the discredited status of being mentally disordered.

Whittle concludes that “transgender” people are “Finally being able to accept our own sanity.” Writing in 2006, in Where Did We Go Wrong? Feminism and Trans Theory—Two Teams on the Same Side? published within the Transgender Studies Reader, Whittle recalls that she felt personally attacked both in the 70s when she first pursued medical interventions to “transition” and again when she undertook her academic work on the subject. She writes that in both cases she felt “washed out, mangled and hung out to dry.” She explicitly rejects a list of (presumably) proffered diagnoses including internalised misogyny and homophobia, oedipal complexes to her father and her mother and what she describes as “an obsessive compulsive disorder.” She expresses a deep hostility to these possible explanations of her gender dysphoria. Her disgust is such that she describes them as “diarrhea.” She reports that she felt she had to “pass” the “examinations” of the “psycho-experts” who “acted as the gate keepers to the medical professionals... who would provide hormones and surgery.” She writes that the “pyscho-experts” became “the enemy I had to persuade or defeat to enter through the gateway.”

The intervening years do not appear to have softened her opinion. In the 2022 Oxford lecture, she said: “The fact that you want us to have a psychiatric diagnosis that we are disturbed in some way, shape or form because that's what you're requiring of us, from doctors who, you know, don't have the faintest idea of what it is really like to be this.” The word “disturbed” is a term that is used by medical professionals to describe emotional distress, impaired reasoning or interrupted biological processes in the brain. Whittle's conflation of receiving a psychiatric diagnosis of gender dysphoria with being “disturbed” (she uses it in the derogatory sense common in the English vernacular) is an intimation of her own beliefs, and a willful misapprehension of the term when used as a descriptive in the medical context.

Gender Dysphoria

Whittle's written evidence echoes her earlier writing. She argues that the requirement for a diagnosis of gender dysphoria as a condition of receiving a GRC is an “intrusive” and “ham-fisted” gate-keeping process. She backs up this claim by referring to the 2016 “Transgender Equality” Report, published by the Women and Equalities Committee at the House of Commons as evidence. She writes, “The report was particularly important in creating the momentum for simplifying the process to create a more inclusive, accessible law.” However, her evidence does not make clear that she was the special adviser for that report. She is quoting herself.

The Women and Equalities Committee Third Report of Session 2021-22, printed 15 December 2021 presented recommendations to the Government based on the inquiry. Nancy Kelley of Stonewall is quoted saying that a diagnosis of gender dysphoria “reinforces the false belief that being “trans” is a mental illness.” The report echoes Whittle's claim that the change in the WHO's ICD-11 means that the UK has an obligation “to move to the new standards for diagnosis in which gender dysphoria has been extinguished.” Professor Alex Sharpe, a “trans”-identified male and professor of law at Warwick University (who campaigns for so-called “gender fraud” to be decriminalised) also echoes Kelly and Whittle citing WPATH, adding implausibly that it is “an organisation that is often neglected in debates and does not ever seem to be consulted, even though it is quite clearly the lead medical body in this field.”

Whittle's argument that the UK is obliged to reflect the changes in language in the WHO ICD-11 seems to be overstated. The WHO is a branch of the United Nations. The UK is a United Nations member state. The WHO creates a Country Cooperation Strategy (CCS) for member states which serves as a guide to deliver on health priorities, measure impact and track health-related goals. The ICD is a classification system designed to enable member states to record, report, analyse, and interpret data relating to mortality and morbidity. As far as I can see there is no legal imperative to use the terms in any other context, though there might be a case for practical purposes.

Circumlocutions: A recursive relationship Between ICD-11 and WPATH

In the written evidence to the WEC and again in the Oxford Lecture Whittle appeals to the authority of the seventh version of the WPATH Standards of Care (SOC v7) and the WHO ICD-11. However neither in the Oxford Lecture nor within her written evidence, nor even in her biography on her MMU profile, does she make it clear that she was the President of WPATH from 2007-2009, during the development of the SOC v7. She has had a long association with WPATH and its predecessor organisation. She is listed as a member of a panel talking about legal issues at the XIV HBIGDA Symposium at Ulm University in Germany as early as 1995. Furthermore, it is not clear that the advisory committee who rewrote the classification for Gender Dysphoria in the ICD-11 are themselves members of WPATH.

The WHO Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was made up of Jack Drescher, Peggy Cohen-Kettenis, and Sam Winter. Although many people cite WPATH and the ICD as separate authorities, in effect it is the same authority, as the members of WGSDSH who advised the WHO on the reclassification are long-standing members of WPATH. In 2012 they wrote a paper giving their rationale for changing gender identity diagnoses in a paper called “Minding the body: situating gender identity diagnoses in the ICD-11.” There is a clear statement that they are part of WPATH within the paper.

In the ICD-11 there are now two entries for what is now listed as gender incongruence, “HA60 Gender incongruence of adolescence or adulthood” and “HA61 Gender incongruence of childhood.” They appear under the chapter “Conditions Related to Sexual Health” rather than “Mental, behavioural or Neurodevelopmental Disorders.” They sit uncomfortably alongside biological diseases of sexual function. This is particularly marked in relation to HA61, where gender incongruence is defined as “a strong dislike” of anatomy or secondary sex characteristics. Conditions that have a strong resemblance to gender incongruences such as body dysmorphic disorder and bodily distress disorder remain in Section 6.

The 2012 paper gives a history of diagnostic placement in classification systems such as the WHO ICD and the DSM. This serves as a proxy for a history of the development of the body of medical knowledge. They do give a partial history of “transsexualism” and “transgenderism,” but it is not complete and makes some big jumps in time and context. At one point it follows a discussion about the case of Christine Jorgensen in the 1950s to later noting the rising increase in diagnoses at the time of writing in 2011. The authors do not specify any figures or offer any demographic analysis. They only mention one case study—that of a gay man which dates back to 1969—with the focus set on the attitudes of the doctors at that time.

The group insists that gender dysphoria is not a mental health issue whilst acknowledging that its aetiology (or cause) is unknown. At the same time, they claim that “gender incongruence” as they have rechristened it, requires immediate medical treatment. They argue that “gender dysphoria” is now an invalid term as some individuals don't suffer from distress due to their gender identity because they know they can access “puberty-suppressing treatments.”

The WGSDSH posit that the removal of gender identity classifications from an association with mental health would remove the burden of social stigma suffered by “trans”-identified people. They present the removal of homosexuality from the DSM-II in 1974 as an equivalent precedent. They state if gender dysphoria was similarly removed from the ICD-11 it would “entirely eliminate the psychiatric and mental stigmatization of transgender people.” This argument inadvertently suggests that by simply listing a condition in the ICD-11 then psychiatric professionals are complicit in the stigmatisation of the group of people. It is not clear what they mean by “mental stigmatization” because they never define this. 

This flawed reasoning also (presumably inadvertently) implies a slur upon people with conditions that are listed under mental disorders. Depression, autism spectrum disorder, selective mutism, and generalized anxiety disorder all remain listed under Section 6, but I don't feel that there is a particular social stigma about these conditions. Recent research has found a link between inflammation and certain mental health disorders. Would it remove the social stigma around, for example, schizophrenia or psychoses if they were removed from section 6 and listed in section 4 “Diseases of the immune system?" It is an illogical argument. They are however careful to explain that “Gender Incongruence” has been kept in a chapter on “disorders” simply to ensure that people can access treatment through health insurance systems.

The WGSDSH presents some evidence to back up their arguments which inevitably undermines them. For example, they argue that it is no longer appropriate to link gender identity diagnoses with paraphilias and diagnoses of sexual dysfunction. Yet they make a reference to Ray Blanchard's and Ann Lawrence's research. They do not describe the research or use the word “autogynaephilia.” Instead, they use the word “transvestism.” They write “the line then drawn between transvestism and some cases of transsexualism is not as sharp as once believed.” They suggest that transvestism was a term once used to describe homosexual men. Thus they implicitly collapse the group of “trans”-identified men who are gay and “trans”-identified men who are autogynaephiles together. This fudge seems to have been made to justify moving “gender incongruence” to the chapter on sexual health. Collapsing these two groups together is also used to justify the removal of the cross-listing to sexual paraphilias. This is strange as Blanchard's work makes clear that autogynaephilia is a paraphilia. Implying that transvestism is associated with homosexuality is also an odd thing to do, given that the group have specifically mentioned that homosexuality was removed from the classifications system. In addition, because it has no demographic analysis or description the paper does not distinguish this group from children, teenagers, or women.

The paper makes some insinuations that seem out of place in an academic medical article written by veteran medics. They argue that if the theories to explain “transsexualism” of the 70s had suggested an aetiology of “hormone imbalance” rather than “sexual deviation” then “gender dysphoria” would have been placed in the chapter on endocrine, nutritional and metabolic diseases. As veterans of the field, they know that “trans”-identified people do not have a “hormone imbalance.” It is hard to believe but they seem to be backing up their argument by creating a fiction about speculative theories of the 70s.

They say that many individuals seeking “transition” do not otherwise have a mental health disorder. But this is another surprising assertion coming from medical professionals. Many people with other kinds of mental health issues do not have any other mental health disorders. They talk about the stigmatisation of “trans”-identified people and how burdensome this is, and yet they make a very surprising suggestion that if denied hormones through normal routes “trans”-identified people might “contract HIV” though using hormones procured via the black market and thus “create a larger public health problem.”

The reasoning of the WGSDSH closely echoes Whittle's views and her language, which is unsurprising as these are the arguments made by WPATH. They describe mental health professionals as “gate-keepers” and claim that this causes conflict which stops people from accessing counselling and therapy (which they recommend to prepare for the hardships of “transition.”) They describe a state of “being transgender.” They claim that having a diagnosis associated with poor mental health means that “transgender” people are not viewed “as competent to make certain legal decisions.” The evidence they offer to support this claim is that some countries do not allow people to change their sex at will on official documents such as passports. These seem weak arguments to me as the population, in general, is all beholden to decisions made by bureaucrats and this isn't generally understood as a reflection of the competence of service users.

Most surprisingly, given that these individuals are all psychologists and psychiatrists, the WGSHSD insinuate that mental health professionals are making work for themselves, positing that their involvement with “transgender” people should follow “standards of care, clinical necessity and health system policies” rather than being “artificially sustained by a mental disorders classification.” They declare that medical treatment is necessary for “trans”-identified individuals, referring to it as “transition services.” They caution that if “gender incongruence” is removed from the classification system then it would lead to the loss of health insurance coverage and this would also have legal implications.

As Whittle invokes the authority of the WHO to back up her arguments for legislative reform so the WGSDSH back up their claims by referring to the resolutions of the Council of Europe Commissioner for Human Rights (2009) and the European Parliament (2011). The European Parliament resolution “roundly condemns that homosexuality, bisexuality and “transsexuality” are still regarded as mental illnesses by some countries” while calling for the “de-psychiatrisation of the transsexual, transgender journey.” The language seems uncannily familiar. A provisional review of the publications of the European Parliamentary Research Service finds references to Whittle's academic work. But the real point to note here is that policymakers and legislators look to the medical professional to back up the changes and the medical establishment looks to policymakers and legislators to back up their recommendations for standards of care.

All the members of the WGSDSH are members of WPATH, and yet they cite the WPATH to back up their arguments. They cite “civil societies and professional organisations” that campaigned for the removal of gender identity diagnoses from the mental disorders chapter. But they do not explain that these are all “transgender” advocacy groups. The WGSDSH and WPATH seem to have been won over by the arguments of “trans” activists with similar beliefs to Whittle, which is unsurprising as she was the President of the organisation from 2007-2009. WPATH has always been strongly influenced by “trans”-identified people. In fact, HBIGDA was partially funded by a “trans”-identified female named Reed Erikson, a millionaire industrialist who was a patient of Harry Benjamin.

WPATH and the long debate with regard to Gender Dysphoria

Arguing against the requirement for a diagnosis of gender dysphoria to obtain a GRC, Whittle claims that, “in 2011... WPATH said ‘Being transsexual, transgender, or gender nonconforming is a matter of diversity, not pathology.’” This is a direct quote from the 2011 WPATH SOC v7. But Whittle has made a very selective quote. The phrase is actually the sub-heading of the title “Paragraph III, The Difference Between Gender Non-Conformity and Gender Dysphoria.” The subsequent discussion is a careful explanation of several key terms including gender dysphoria, gender non-conformity, and social stigma:

Psychological distress caused by gender non-conformity is an outcome caused by social stigma inflicted upon the individual which then affects their relationships... Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics.)

This paragraph is followed by a strange statement. Explaining that gender dysphoria can be treated by medical interventions, the author notes that it can lead to mental disorders. However, the text stresses:

Thus, transsexual, transgender, and gender-nonconforming individuals are not inherently disordered. Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatment options are available. The existence of a diagnosis for such dysphoria often facilitates access to health care and can guide further research into effective treatments.

It is worth comparing this description of mental health problems faced by “trans”-identified people with Whittle's writing. In the Preface to the Transgender Studies Reader, she writes, “Telling the trans story gives trans people a voice and tells of their anguish... “It allows trans people to claim a unique position [...]and [...]to welcome the rage afforded by that experience of suffering.” Whittle's description of the experience of “trans”-identified people strongly corresponds with the WPATH's definition of gender dysphoria as an internal response to external forces.

The concept of gender dysphoria was folded into the foundation of WPATH. The organisation was originally called Harry Benjamin International Gender Dysphoria Association (HBIGDA). Founded in 1979, it renamed itself to WPATH in 2007. The WPATH SOC v6 asks “Are Gender Identity Disorders Mental Disorders?" It defines a mental disorder as a “behavioral pattern” that results in “adaptive disadvantage” or causes “personal mental suffering” to an individual. It stresses that this is not “a license for stigmatization” or the deprivation of civil rights, and notes that a formal diagnosis is important for getting health insurance coverage and for research purposes. The most recent version of the WPATH SOC v8 (2022) states:

While Gender Dysphoria is still considered a mental health condition in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5-TR) of the American Psychiatric Association. Gender incongruence is no longer seen as pathological or a mental disorder in the world health community. Gender Incongruence is recognized as a condition in the International Classification of Diseases and Related Health Problems, 11th Version of the World Health Organization (ICD-11).

This statement has a number of slippery elements. It suggests that there is a fundamental difference between gender dysphoria and gender incongruence, rather than a rechristening in different classification systems. Juxtaposing the statement that gender incongruence is not considered a “pathological or a mental disorder” in the “world health community” before the reference to the WHO ICD-11 implies a connection but whatever “world health community” is supposed to imply it does not refer to the WHO or the ICD. The word “pathology” is often used colloquially with a negative inference, but its primary meaning is the science of the cause and effect of disease. Any requirement for medical treatment to any physical or mental health condition presupposes that it might still be truly described as pathological, whatever the label we attach to it.

Another Point of View

Dr Steven Levine was chair of the fifth edition of (what was then) the HBIGDA SOC (SOC v5). In September 1983, at the Eighth HBIGDA International Symposium on Gender Dysphoria, he presented a paper arguing for the “psychotherapeutic value” of “perceiving gender dysphoria as a form of mental illness.” He seems to be answering a debate that is already in train. Levine posits that preoccupations with gender can be an attempt to provide a solution for other problems or a defence against painful perceptions, and that “the preoccupation may mask more serious difficulties from the individual and the professionals.” He left the WPATH after the publication of SOC v5 because he felt it had prioritised advocacy activities over the scientific approach. Having worked with “transsexual” people since 1973 Levine is strongly critical of WPATH's promotion of the affirmation model of surgeries and hormones. His belief, based on clinical experience, is that hormones and surgery do not help most patients. Levine believes that the medical chain of trust has broken down in—what he continues to describe as—the field of gender dysphoria. He believes doctors should offer a psychotherapeutic approach to patients before life-changing and irreversible medical interventions such as surgery and hormone treatment.

As a “trans”-identified person who is strongly defended against the psychotherapeutic approach affirmative hormones and surgery seem to have had a good outcome for Whittle as an individual, but this is not the case for everyone. She considers psychologists and psychiatrists as gate-keepers—and they are—but it's not to stop her from getting the treatment that she wants. It's to stop other people from being harmed by being injected with irreversible hormones and medical treatments that are not helpful for individuals. I have largely focused on the requirement for a diagnosis of gender dysphoria in order to obtain a GRC, but I don't know whether it is the right tool for the job or not. Its purpose must have had a gate-keeping process, ultimately intended to protect “trans”-identified people from being slurred by association with people who want to take advantage of it for nefarious reasons.

It goes without saying that legislators should consult “trans”-identified people when considering changes to the law. Activists such as Whittle have a lifetime of experience which must be drawn upon. It is common for political activists to be involved in legislative processes, and to develop expertise in their subject. However, it seems that the expertise that the government is drawing upon in the field of “trans”-rights is enmeshed at every level with activists with a strong bias towards “trans”-ideology and the affirmative approach. Whittle justifies her calls for legislative changes by citing the work of WPATH, which she was President of, and the WHO ICD WGSDSH, which are members of WPATH. The WGSDSH working group cite legislative changes to justify changes in the classification systems, which are in turn used to justify changes to legislation.