Why Do UK Doctors Fear Opposing Gender Culture?

Critical thinking and open debate have long been the cornerstones of scientific and medical research. Yet, an increasing number of professionals in these fields are expressing concerns about discussing their views openly, particularly on the treatment of children questioning their gender identity.

This growing apprehension was underscored in a recent review of gender identity services for children, conducted by Hilary Cass.

Her findings pointed to a toxic atmosphere that has fostered a culture of fear among experts in the field.

Risky Topic

Doctors, academic researchers, and scientists echoed Cass’s concerns, warning that this climate has created a chilling effect on research in a critical area that requires more robust evidence.

Many professionals have reported being dissuaded from pursuing what they see as vital studies, fearing the reputational risks of entering the fraught debate.

Some described facing online harassment, the closure of academic conferences, biases in academic publishing, and the personal toll of speaking out publicly.

Channa Jayasena, a consultant in reproductive endocrinology at Imperial College London, says that medical researchers can freely explore questions without fear of judgment.

But in this field, the stakes are different. The risks lie not only in the research itself but also in how one perceives and what he believes. According to Jayasena, one has to be cautious about what he says, both at work and outside of it.

Sallie Baxendale, a professor of clinical neuropsychology at University College London’s Institute of Neurology, found herself at the center of a firestorm after publishing a systematic review on the effects of puberty blockers on brain development.

Her study raised critical questions about the nature, extent, and potential permanence of cognitive changes linked to the treatment.

The review, which summarized the current state of research, was met with swift backlash.

Baxendale has been accused of being an anti-trans activist, and that now shows up on Google, which discredits her entire academic and medical career.

This reaction reflects a broader unease within the medical community, particularly about the lack of high-quality research on gender treatments for young people, a concern highlighted by Hilary Cass in her review of gender identity services.

Juliet Singer, a consultant child and adolescent psychiatrist and former governor of the Tavistock and Portman NHS Foundation Trust, echoed these concerns.

In 2020, Singer conducted a survey of specialist child psychiatry trainees, uncovering widespread anxiety over the exponential rise in referrals to adolescent gender services, the absence of long-term studies on treatment outcomes, and insufficient evidence on the lasting effects of hormone blockers.

He noted that asking questions—such as what might be driving the sharp increase in birth-registered girls experiencing gender-related distress—was often seen as “unacceptable” by some senior leaders at Tavistock.

'Under Fire'

Commenting on the scientific merits of colleagues' work is typically a routine part of public discourse in the fields of science and health.

But when it comes to issues related to transgender care, many scientists have found themselves under fire.

Channa Jayasena recounted receiving hate mail after supporting a U.S. study in which a transgender woman was given hormones to breastfeed.

In another instance, he was accused of transphobia for commenting on research related to athletic performance in transgender women.

Jayasena feared for her safety as her quotes were weaponized, while most colleagues stay away from these topics for that reason, she said.

Another senior endocrinologist, speaking anonymously to The Guardian, described how medical professionals now share their concerns in secret, using encrypted WhatsApp groups to avoid public backlash.

This atmosphere of intimidation, Baxendale believes, is deterring younger researchers from entering the field.

Baxendale argued that the fear of scrutiny hampers efforts to build a robust medical foundation for transgender healthcare.

If leading researchers avoid the field, she warned, it risks being dominated by less rigorous scientists or those with ideological agendas.

After publishing her review, Baxendale said a senior researcher from outside the U.K. told her they had abandoned a study because the team insisted on publishing only "positive" findings.

Jayasena echoed this concern, noting a perception that research is increasingly led by "a self-selected group" with entrenched positions on either side of the debate. "Without solid evidence, there’s more room for ideology to fill the gaps," he said.

He observed that extreme views on both ends of the spectrum have further complicated the discourse

This fraught environment, he added, discourages professional bodies, scientific journals, and even the National Health Service from engaging with the topic.

Anti-Publishing Strategy

In an attempt to foster dialogue among academics, doctors, patient groups, and campaigners, Juliet Singer sought to organize a conference at Great Ormond Street Hospital in 2022.

The aim was to create a platform for open discussion that could serve as a foundation for objective research in the field of gender medicine.

The meeting was intended to be an invite-only academic event for specialist child psychiatry trainees and consultant child psychiatrists in London.

Hilary Cass was scheduled to present her interim findings, alongside a range of speakers, including former clinicians from gender identity development services, offering a spectrum of perspectives.

However, after receiving numerous complaints and making concessions to create a balanced program, the conference was abruptly canceled by Health Education England (HEE) the day before it was set to take place.

The cancellation followed a “protected whistleblower’s report” from an individual identifying as a researcher on anti-trans conspiracy theories.

Despite promises from HEE and the Royal College of Psychiatrists to reschedule the event, it has yet to happen.

The cancellation reflects a broader challenge within the field: the difficulty of getting studies published in high-profile journals.

Some researchers have raised concerns that journal editors may prefer to sidestep controversial topics rather than face potential backlash, leading to the marginalization of papers that highlight knowledge gaps in gender medicine.

As a result, these studies are often relegated to specific journals, which can then be perceived as overly critical.

Amid these concerns about research quality, the Cass report has laid the groundwork for a significant NHS trial expected to begin this year.

The trial will examine the safety and efficacy of puberty blockers, cross-sex hormones used for masculinization or feminization, and psychosocial interventions, with the goal of establishing a solid evidence base.

Many hope that the Cass report, and the NHS trial it recommends, will mark a turning point in the contentious field of gender medicine, creating space for a more constructive and evidence-driven approach.