27-28 September, Lisbon, Portugal – Several sessions at the 28th WPATH Scientific Symposium addressed converging issues in research and service delivery related to the impact of anti-gender rhetoric and attacks on gender-affirming healthcare, including hate and harassment faced by trans healthcare workers, current challenges in providing care that directly impact youth and healthcare providers, and the increasing politicization of evidence-based medicine.
In a session titled “On Being a Target: Responding to Hate and Harassment in Trans Healthcare, addressing how to respond to hate and harassment in trans healthcare, the increasing challenges healthcare providers face in trans and gender diverse care provision were explored. The speakers, Ruth Pearce, Asa Radix, and Samantha Martin, discussed the rise of the anti-trans culture wars and how these movements are constantly targeting trans studies research and healthcare practices.
One central theme of the session was the bias accusations that trans experts are facing worldwide. Anti-trans activists accuse many trans researchers and practitioners of being biased in their work, but as Ruth Pearce pointed out, this raises the question: who is more biased? She highlighted that cisgender researchers are often assumed to be neutral, but cases like the controversial Cass Review report in the UK suggest that biases can exist across all sides. Rather than fighting over who is more biased, Ruth called for a focus on achieving strong objectivity in research, where all voices are critically examined and evaluated.
Ruth also discussed the attacks on gender-neutral and inclusive language, particularly in the context of sexual and reproductive health rights. Anti-gender movements often reject terms like “birthing parent” instead of “mom” or “chestfeeding” instead of “breastfeeding,” claiming that such language is “erasing women.”
Other speakers also emphasized that disinformation plays a significant role in these attacks, especially in media and political circles. Many gender-affirming healthcare providers have been subject to transphobic and sexist harassment, receiving abusive social media comments, emails, and even threats at their workplaces.
Speakers and participants shared practical strategies for managing such harassment. Providers were advised to limit exposure to conflict by blocking replies on social media, shifting from platforms like X (formerly Twitter) to more professional spaces like LinkedIn, and removing staff contact details from organizational websites. Additionally, healthcare centers should filter media requests carefully and ensure security measures are in place to protect staff and patients.
Asa Radix, from Callen-Lorde Community Health Center, focused on the importance of staff support and well-being in facing these challenges. Asa referenced Project Veritas, a far-right activist group known for secretly recording individuals to discredit organizations, including those involved in gender-affirming care, as an example of what can happen. Anti-trans campaigns manipulate healthcare workers’ words and actions to spread misinformation. Asa shared that Callen-Lorde has implemented several protective measures, such as hiring a crisis communication firm, removing staff photos from websites, providing active shooter training, and creating secure rooms in their offices to safeguard personnel in case of physical attacks.
One concern raised by the audience was the issue of “fake patients” who arrive at their clinics—individuals who visit clinics intending to gather incriminating information or create conflicts. Asa explained that these individuals often ask unusual, strange, unreasonable or provocative questions, such as whether the clinic performs surgeries on children. Staff members have been trained to recognize these red flags and handle the situations with caution.
At the end of the session, there was an agreement on the urgent need to develop a comprehensive toolkit for practitioners and institutions that provide gender-affirming care to effectively respond to anti-trans attacks. This toolkit would offer guidance on how to respond to harassment, manage potential threats, and prepare for attacks from anti-trans rights movements. The session highlighted the importance of solidarity, preparedness, and resilience as the healthcare community navigates the increasing hostility toward trans-inclusive care.
Similar issues were addressed in a session titled “Global Perspectives & Political Directives on Adolescent Gender Care: The Good, The Bad, and The Ugly” featuring known experts in adolescent gender care, where the discussion evolved around current challenges in providing care that directly impact youth and healthcare providers. In the United States alone, 658 anti-trans bills have circulated in several States, many of which directly target gender-affirming care for youth. In several States, access to puberty blockers, hormone therapy, and gender-affirming surgeries is either banned or allowed only with parental consent and a formal diagnosis of gender dysphoria.
Speakers included Scott Leibowitz, Rosa Omarsdottir, Unnsteinn Jóhannsson, Heather Thobe, and James Byrne, and all agreed that one of the pressing issues was the prolonged waiting times for adolescents seeking gender-affirming care. Due to highly medicalized assessment processes for accessing gender-affirming care, they claim, many adolescents are left in a “state of limbo,” aggravating the emotional and psychological stress for both youth and their families, as the systems are failing to meet their needs in a timely manner.
Heather Thobe pointed out that the impact of delaying access to gender-affirming care can be profound and affect not only adolescents but their families. Heather gave some examples of families who have been disrupted in their daily lives, often having to separate siblings, travel to other states to access care or struggle to support their loved ones in a complex healthcare system.
These legislative actions are having a ripple effect, impacting not only youth but also the healthcare providers who serve them. The panelists all agreed that one of the pressing issues was the prolonged waiting times for adolescents seeking gender-affirming care. Due to highly medicalized assessment processes for accessing gender-affirming care, many adolescents are left in a “state of limbo,” aggravating the emotional and psychological stress for both youth and their families, as the systems are failing to meet their needs in a timely manner.
Many healthcare professionals also feel they are practicing under threat, with one speaker stating, “It’s an attack on us! On our work! On our families and lives!” This hostile environment has led to the closing of some clinics that were providing gender-affirming care, and even forcing some research centers to close their doors as well. For this reason, waiting lists have drastically dropped, not because there is less demand, speakers pointed out, but because there are no services.
Iceland emerged as a potential model of success for adolescent gender-affirming healthcare. Iceland’s approach to gender care has been praised for its emphasis on accessibility, regional clinics, and a less restrictive framework for providing care. The speakers encouraged other nations to look toward Iceland’s policies as an example of how gender-affirming care can be effectively integrated into national healthcare systems, offering hope for better outcomes worldwide.
The increasing politicization of evidence-based medicine in gender-affirming care and the ethical responsibilities of trans health researchers were further explored in a session on anti-trans healthcare policymaking, titled “Anti-Trans Healthcare Policymaking: Ethics and Responsibilities in Trans Health Research.” Speakers Reubs J. Walsh, Elle Lett, Noah J. Adams, and Ruth Pearce expressed concern over the rising bias, inconsistency, and imprecision in healthcare publications, also citing the Cass Review as a key example of bad practice.
Highlighting the misuse of evidence in trans health research, speakers stressed the need for both practitioners and researchers to be aware of signs of ignorance in healthcare. They cited Mikulak’s (2021) work, stating that we “need to pay attention to not only how knowledge about trans bodies and possibilities is produced, negotiated and contested, but also to moments of claimed and/or actual ignorance that take place in healthcare.” This awareness is crucial in stopping ignorant, unethical, and irresponsible practices such as delays or denials of care, negligent practices that force patients to educate their providers, and the de-prioritization of trans-specific evidence.
Ruth Pearce emphasized the importance of moving beyond flawed reports like the Cass Review. She pointed out that while the Cass Review may appear to be a robust report, a closer examination reveals “cisnormative bias” and “tokenistic consultations” as “counterfeit power”. By collecting strong evidence and raising awareness of what is actually wrong with such reports, we can move towards more accurate and ethical healthcare practices. The session underscored the responsibility of trans health researchers to challenge biased frameworks and ensure that trans communities are accurately represented in healthcare research and policymaking, with speakers calling for WPATH to conduct its own systematic reviews to counter the shift from objective, evidence-based reporting to politicized narratives.