Photo by Karollyne Hubert on Unsplash
The controversial anti-trans campaigning organisation Genspect has stepped up its campaigns against trans-affirming healthcare, exploiting recent media events and misrepresenting ongoing research and developments in child and adolescent trans healthcare in the UK.
The first of the incidents reported here was an open letter to the American Academy of Pediatrics, signed among others by well-known conversion therapists. The second was a form letter targetting paediatric gender identity clinics (GICs), designed so it could be sent in by parents and other activists who support Genspect’s work. This was written exploiting a negative right-wing media momentum celebrating the shutting down of England’s only child and adolescent GIC — behind the headlines, the real story was of GIDS’ replacement and expansion with a regional hub system and plans for developing increased service in primary care.
As I show in this article, Genspect’s outreach and lobbying materials include serious distortions and provably false claims, bolstered by quotations taken misleadingly out of context to suit their agenda.
Who are Genspect?
Genspect are an international campaigning organisation founded by Irish celebrity psychotherapist Stella O’Malley in the summer of 2021. Genspect developed from, and expanded on the activities of a collection of anti-trans campaigners, with a large number of therapists and psychiatrists in its initial membership drawn from the so-called Society for Evidence-Based Gender Medicine (SEGM). We have previously reported on SEGM's associations with religious hardliners, the conversion therapy lobby, and deployment of spurious scientific claims in legal cases on the side of maintaining a ban on funding for trans healthcare.
Similarly to SEGM, Genspect has an established history of connections with members of fundamentalist religious hate groups such as Paul Hruz of the evangelical extremist anti-LGBT group ACPeds — who were listed earlier this year as part of the online conversion therapy ecosystem by the Global Project Against Hate and Extremism. Genspect also recently used an endocrinologist linked to the religiously motivated ex-LGBT charity IFTCC to make a promotional video for their “Detrans Awareness Day” event.
These are only two among a near-continuous stream of ties overlapping Genspect’s activities with religiously motivated ultraconservative anti-LGBT groups. For instance, a recent article by researcher Zinnia Jones documents a flurry of these around the recent legal attacks on trans health in Florida, for instance.
Stella O’Malley herself has been exposed in recent months, explicitly stating that her mission is to prevent as many children from transitioning as possible. In the same discussion where this comment was made, she also described teenage trans girls between 13 and 15 years old who she works with as a therapist as “autogynephiles” (a disputed term describing trans women as driven by fetishistic urges) and not worthy of others’ sympathy.
The open letter to the AAP
On 18th July 2022, Genspect published “An Open Letter to the American Academy of Pediatrics”. This was written in support of a redacted motion submitted to the AAP by SEGM member Julia W Mason, as well as four allied paediatricians. While the open letter mentions no religious or political motivations, ostensibly posing as support for evidence-based interventions, the emphasis of the letter is to request that the AAP opens beyond the existing evidence-based consensus to include the views, methods and priorities of groups like Genspect.
It draws on two systematic reviews as evidence — both from the National Institute for Health and Care Excellence (NICE) in the UK, which is renowned for the high bar it places on evidence quality. The first of these reviews investigated the evidence for the use of puberty blockers for gender dysphoria in child and adolescent healthcare. The second focused on cross-sex hormone use for children and adolescents. Genspect misrepresents these studies, saying that they show that “the benefits of these treatments are far from certain”.
Although the NICE studies do criticise the quality of the evidence and the strength of conclusions that can be drawn from it, when discussing the findings of the available evidence on cross-sex hormone treatment for adolescents with gender dysphoria, NICE said:
Results from 5 uncontrolled, observational studies suggest that, in children and adolescents with gender dysphoria, gender-affirming hormones are likely to improve symptoms of gender dysphoria, and may also improve depression, anxiety, quality of life, suicidality, and psychosocial functioning.
For the NICE systematic review on puberty blockers, the core issue was the lack of any viable comparative studies between treatment with/without puberty blockers:
A key limitation to identifying the effectiveness and safety of GnRH analogues for children and adolescents with gender dysphoria is the lack of reliable comparative studies. The lack of clear, expected outcomes from treatment with a GnRH analogue (the purpose of which is to suppress secondary sexual characteristics which may cause distress from unwanted pubertal changes) also makes interpreting the evidence difficult.
Trans health researchers in peer-reviewed journals have observed that randomised controlled trials for puberty blockers are simply not ethical or feasible.
Trans Safety network hopes that the American Academy of Pediatrics has sufficient wisdom to reject Genspect’s lobbying on this matter as scientifically incoherent and ideologically motivated. It’s especially disturbing that the important scientific inquisition being undertaken in the UK in the last few years over ensuring that there is a proper evidence basis underlying child and adolescent gender identity treatment protocols, is being misused for propaganda against trans healthcare around the world.
However, an even more concerning issue for the trans community can be found in the signatories to Genspect’s open letter.
Organisational signatories include Our Duty (whose British faction notoriously wrote violent threats towards NHS clinicians and campaigns for setting policies targeting “100% desistance”), Parents of ROGD Kids who see gender dysphoria in trans youth as a sign of psychological dysfunction rather than accepting trans people as part of normal human diversity, and the Gender Exploratory Therapy Association who campaign against conversion therapy bans and were also founded by Stella O’Malley (who plays a role in many organisations in this sector).
Additionally, individual signatories include Miriam Grossman, a one-time psychiatric consultant to the conversion therapy hate group ACPeds, who has long been criticised for promoting “gay cures”.
Another signatory is Stephanie Winn, an Oregon-based Licensed Marriage and Family Therapist who recently became a cause celebre among Gender Critical circles after she was reported to the Oregon Board of licensed therapists and counsellors on accusations of conversion therapy. Although she has played these accusations off as overblown and successfully defended against a formal investigation, Trans Safety Network have managed to locate a cached copy of a blog post which was published shortly before the complaint against her and then since deleted, entitled: So Your Kid Wants to Live as the Opposite Sex. In this article, Winn suggests that parents consider exposing their children to a range of sadistic and humiliating rituals. These including smearing henna on their chest to simulate surgical scars, forcing them to maintain an extreme haircut after they have decided they don’t want it, or subjecting them to what Winn describes as “acupuncture”. That is, inserting non-medicated needles into the skin. Rather, unlike the alternative medical practice of acupuncture, the very clear implication in Winn’s blog is that the ideal outcome would be for the child to find this upsetting or off-putting:
[I]f any family were to undertake it, could backfire. It could help your kids become more comfortable with needles and therefore more attracted to the idea of intravenous injections… That being said, how could you simulate the experience of having to inject yourself with hormones? The only idea that comes to mind is acupuncture.
NB: Transgender hormone replacement therapy is typically administered in gel, pill or injection form, or when injected, administered into large muscular tissue. HRT should never involve intravenous injection, and this error on Winn’s part demonstrates the sheer scale of her ignorance on the topic.
Also among the signatories is Stephen B. Levine, who has acted as an expert witness for anti-LGBT hate group the Alliance Defending Freedom for the last few years, making dubious claims in cases across America. (See further documentation by Zinnia Jones here: part 1, part 2)
Open letter to gender clinics
Last week, 29th July 2022, in response to an announcement of a new model for child and adolescent service provision for gender identity-related medicine in the UK, Genspect issued an open letter in PDF format, written generically so that it could be sent by activists to Gender clinics anywhere in the world. This followed key strategic approaches from the open letter to the AAP.
The new model, launched on 28th July 2022 entailed a number of reforms, responding both to a letter of recommendations for urgent trans youth health reforms made by the Cass Review, and strongly influenced by the findings of a report by the health and care regulator CQC last year which gave an “Inadequate” rating to GIDS.
The right-wing press has responded to this damning report by suggesting that GIDS was dominated by lobby groups and “emotional blackmail” (among other culture war narratives). However, the top bullet points on the CQC report focus on the way that the waiting lists at GIDS had gotten wildly out of control. This had left children and adolescents on the waiting lists who were noted to be extremely vulnerable to self-harm or suicide receiving no treatment whatsoever.
There were further issues listed around poor governance, as well as shortcomings in record keeping, particularly around consent, but the CQC report is clear to state nonetheless that:
Staff treated young people with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients
Staff referred young people to other providers for medical treatments that were consistent with good practice.
The issues reported by the CQC weren’t that of activist “capture” of GIDS, but described a service which was failing to keep up with both the bureaucratic and clinical needs created by expanding service demand. For anyone who has read the CQC report it is absolutely clear why there has been a decision to break up GIDS and replace it with a regionally distributed network — this redistribution eliminates the bottleneck which was making it impossible for many children with gender dysphoria to be seen at all. However, the right wing press have instead chosen to look past this and focus on the frustrations staff reported over their relationship with management. In cherry-picking these issues the right wing media has ignored the alarm bells about the complete lack of healthcare being provided to most patients referred to GIDS,
So, how did Genspect’s open letter represent this developing situation?
Genspect’s Stella O’Malley said:
Dr Cass has deemed the gender affirmative treatment model at GIDS as “not a safe or viable long-term option”.
What Hilary Cass’ interim report actually said was quite different: (emphasis ours)
It has become increasingly clear that a single specialist provider model is not a safe or viable long-term option in view of concerns about lack of peer review and the ability to respond to the increasing demand.
Genspect develop on this, pressing innuendo bordering on intimidation, based on an entirely fabricated claim about Hilary Cass’ report: (links in the original)
GIDS was following a gender affirmative model of care in accordance with the World Professional Association for Transgender Health (WPATH) Standards of Care version 7. We fear that your clinic is following this unsafe and unviable treatment model for gender dysphoric children. In light of the forced closure of a clinic that uses the same treatment model as your clinic, can you please answer the following questions?
But the entire premise is false here. Cass’ letter recommending the break up of GIDS never mentions the affirmative model. The interim report specifically called out the way that the centralised service made dealing with patients’ needs untenable. The interim Cass report does make reference to there existing a plurality of views among clinicians ranging from a strongly pro-affirmative model, to those who have concerns about it. It also stresses the need for consistent healthcare for patients. However, the report does not itself take a strong position on either side of this divide. This is unsurprising given that the Cass Review was yet to undertake the bulk of its research beyond collecting preliminary information to drive the next phase of research.
Similarly, neither Cass’s interim review, nor her letter of recommendations to NHS England about GIDS, have anything critical to say at all about the WPATH Standards of Care (the de-facto global standard as set by the largest global professional body on trans healthcare).
Later in the open letter, Stella repeats the same, entirely unfounded call to action:
Genspect echoes the concerns raised by Dr Cass as we advocate for a better model of care than the current gender affirmative approach as laid out by WPATH.
To repeat: Cass made absolutely no such call to abandon WPATH, and has not made recommendations in the interim report about the affirmative model one way or another.
But again, it is conceivable that in places around the world where Genspect campaigns (such as the United States where Genspect has been part of a variety of successful campaigns to reduce the availability of trans healthcare) that readers will not be familiar with the background, and be misled by cherry-picked quotes suggesting that they simply do not suggest in the original context.
Trans Safety Network approached the Cass Review for comment, and were directed to the Cass Review FAQ section on conversion therapy which states:
The Cass Review was commissioned as an independent review of NHS gender identity services for children and young people. Its terms of reference do not include consideration of the proposed legislation to ban conversion therapy.
No LGBTQ+ group should be subjected to conversion therapy. However, through its work with clinical professionals, the Review recognises that the drafting of any legislation will be of paramount importance in building the confidence of clinicians working in this area.
Trans health in the UK is undergoing a massive and much-needed overhaul, including a significant investment in research around health outcomes and treatment protocols.
In the midst of the uncertainty raised up by this, conversion therapy advocacy groups are cherry-picking and misrepresenting quotes from unfinished research processes in the UK to expand their own ideological and political lobby for undermining trans healthcare around the world.