After the Cass Review, we must not push trans youth into the online Wild West
EARLIER this year, I was leafing through a book shop and happened upon a new memoir by the writer Lucy Sante, I Heard Her Call My Name. It ticked many of my boxes. Sante lived through Seventies and Eighties New York, my favourite place and time for non-fiction literature. She was friends with sketchy experimental rock musicians, artists and filmmakers, my favourite cast list.
I Heard Her Call My Name is the story of her late transition, which begins at 65. She is twice married, an academic. First falteringly, then emboldened by a touching exposition of the biological and philosophical questions she asks herself and looks for help online, never hiding from the tricky stuff. It is a deeply felt work. I couldn’t get it out of my head.
This week, the final report and recommendations of Dr Hilary Cass to the NHS on the treatment of transgender youth has travelled everywhere. The Cass Review has been greeted by triumphalist cheers from some quarters, dismissed outright by others. As much as Dr Cass takes care to distance herself from online hatred traded on the subject with a concerned, conciliatory tone in the 288-page document, it cannot help but draw further dividing lines between medical practitioners, their patients, families and advocacy groups on the most effective care for trans youth. These divisions have been accepted, in full, by both the parliamentary Conservative and Labour parties, suggesting that whatever happens in the forthcoming general election, there will be no separation on the issue of transgender healthcare.
Added to the recent closure of the one dedicated British youth gender identity clinic at the Tavistock, leaving a waiting list of more than 5,000 across the country and the blanket banning of puberty blockers, this may lead young trans people to feel like they have fewer places to turn. This is clearly not Dr Cass’s intention.
But a pattern has emerged politically in Britain, that restricting freedoms — specialised hospitals, medicines — is the preferable road to trans youth healthcare than expanding them. The end of the Gender Identity Development Service at the Tavistock was the first time I saw a chilling online celebration at the closure of part of a British medical facility.
Obviously, Sante is not of the age demographic, or indeed nationality, to be impacted by the Cass Review and its political proponents. Yet still her book resonated in the light of a formal document on how to help transgender youth. Part of the reason she had thought transitioning an impossibility as a teen, then a 20, 30, 40 and 50-something, was because she had nobody to talk with about her deeply complicated relationship with her birth gender and its potential for mutability.
In her sixties, she found TikTok accounts, online forums, Reddit groups, YouTube videos, AI apps, a whole raft of international communities online which enabled her to feel the exhilarating possibility of change ahead.
Just to reiterate, Sante was in her mid-sixties when she began transitioning. She was not 14, diving into the online abyss, looking for quick solutions to immediate problems. She had over 50 years of unanswered questions to ask about what transition might mean for her.
The sensitivity of her writing reminded me of the virtuoso trans-masculine musician Beverly Glenn-Copeland, who once explained to me that his transition in his seventies had been facilitated by conversations with young people online, with whom he felt affinity, kinship and shared experience. It reminded me of another book I’ve recently devoured, Judith Butler’s Who’s Afraid of Gender?, a surprise Sunday Times bestseller. Butler’s is a wide-reaching academic tract which positions the brutality of the British gender debate on the worldwide stage next to the anti-trans political heft anchored by Jair Bolsonaro, Donald Trump, Viktor Orbán, Giorgia Meloni and Vladimir Putin. It takes judicious aim at The Vatican’s arch hypocrisy on child abuse. Online dialogue is short, sharp, reactive and can be vituperative. Conversely, we may be living through a golden age of trans-adjacent literature. When young people have nowhere to go, they go to the internet. It is the one place where there is always a friend, an enemy, an alternative, a shady salesman flogging unregulated hormone pills. Sante, Glenn-Copeland and older trans folk are experienced enough to know how to navigate this minefield. Kids aren’t. We restrict services for their wellbeing at our peril, leaving them unguided in the unruly playing field online.
A pattern has emerged politically that restricting freedoms on this healthcare is better than expanding them