In the UK, Resistance to Transgender Activism Is Fueled by Socialized Medicine and Feminist Wine Moms

Police guard a statue of Winston Churchill during a June 2020 trans rights protest in London / Getty Images
June 29, 2021

On paper, there should be little pushback to transgender activism in the United Kingdom. Britain has strict hate speech laws and no First Amendment, and British police have arrested people for "misgendering" others on social media. Britain also lacks a religious right: In 2018, the Church of England adopted a policy of "unconditional affirmation of trans people," instructing clergy to use parishioners' preferred names.

Yet critics of trans activism have gone mainstream in the United Kingdom. Britain has seen a flowering of feminist organizations opposed to the activists' excesses, which they argue hurt women and young people, especially girls. At the same time, British courts are becoming more critical of hate speech claims: In May, a U.K. judge ruled that skepticism of trans identity is a "protected philosophical belief" under Britain's Equality Act, the same law that protects trans people from discrimination.

The British medical community is also becoming more critical of childhood gender transition. After a whistleblower alleged that the National Health Service (NHS) was prescribing puberty blockers without proper psychiatric screening, Britain's High Court in December effectively banned their use, ruling that children under 16 couldn't consent to the drugs. A few months later, U.K. health regulators concluded that the evidence for puberty blockers was "very low."

How did the pushback across the pond survive the legal and cultural forces arrayed against it? The answer is that trans activists in the United Kingdom are fighting an uphill battle of their own—not just against British feminists but also British institutions, particularly the socialist ones.

Britain's socialized health care system encourages a more conservative approach to gender reassignment than some U.S. clinics, removing the profit motive that drives the American on-demand treatment model. And British trade unions have fomented resistance to trans activism by providing a template for grassroots organizing, one being used to great effect by mothers worried about their kids.

The result has been a polarizing debate, but not along traditional ideological lines. On one side is an Americanized activist class led by LGBT organizations like Stonewall UK, named after the New York City Stonewall riots of 1969. On the other is a motley coalition of radical feminists, secular conservatives, moderate liberals, and even some trans people, who all say the activists have overstepped.

The debate kicked into high gear in 2017, when two things happened simultaneously. The number of young people identifying as transgender skyrocketed across the United Kingdom, leading to a 4,000 percent increase in referrals to the NHS's sole youth gender clinic. Trans activists also persuaded then-prime minister Theresa May's Conservative government to introduce a policy called "self-ID," which would have allowed people to change their legal gender without a diagnosis of gender dysphoria.

The proposal sparked fierce blowback from women across the political spectrum, who said it would let biological men enter areas restricted to women, including bathrooms and locker rooms, with no meaningful safeguards. Of particular concern were women's prisons: Under the proposed rules, male prisoners could transfer to female prisons simply by signing a statement affirming they were transgender. No social or physiological changes would be needed, nor would a doctor's note. Caught off-guard by the uproar, the Conservative Party backed away from self-ID in 2020.

May's miscalculation was understandable, given how uncontroversial trans rights had been in Britain for the previous decade. The Gender Recognition Act of 2004, which let individuals diagnosed with gender dysphoria change their legal gender, hadn't caused much debate. Nor had the Equality Act of 2010, which forbade discrimination against people who had undergone gender reassignment or had plans to do so. Together, those laws already allowed transgender women to access most women's-only spaces, including prisons, provided they were willing to physically transition.

It was only when activists argued that access should be based on subjective identity rather than objective benchmarks that controversy arose.

"Society had been becoming more accepting of differences," said Debbie Hayton, a British transgender woman who transitioned in 2012. "Transitioning wasn't newsworthy. People didn't ask questions because they understood there was gatekeeping."

Much of the gatekeeping fell to the NHS, which has both economic and political incentives to avoid hasty transitions.

Resources in a socialized health care system are necessarily zero-sum: The more money is spent on gender reassignment surgery, the less is left over for chemotherapy or kidney transplants. A 2016 government report on transgender equality states that NHS physicians "have a duty to ensure that the service's finite resources are spent appropriately and effectively," which is "incompatible with simply granting on demand whatever treatment patients request."

Frustrated by this more conservative approach, trans activists in the United Kingdom have looked across the pond for inspiration. The 2016 report notes that "many [trans] people now favour" the laissez-faire model "used by some providers of private care in the USA," who ask fewer questions and have much shorter wait times than the NHS.

That model is also favorable to trans activist groups themselves. The more people identify as trans, the larger the market for medical transition, meaning that U.S pharmaceutical companies have a profit motive to fund trans activism. Pfizer, which manufactures testosterone injections used in hormone replacement therapy, is a "platinum partner" of the LGBT advocacy group Human Rights Campaign, for example.

Socialized medicine doesn't always result in cautious caregiving. Before puberty blockers were put on hold in Britain, overburdened clinicians had been prescribing them without thoroughly assessing patients—partly due to activist pressure, but also because caseloads had grown too large to manage.

But the outcry that carelessness caused illustrates another safeguard built into the NHS: It is funded by the British taxpayer, which means its decisions are intrinsically political. The idea that transitioning is a private matter between patient and doctor makes sense in the United States, where the public isn't footing the bill for most treatments. It makes less sense in the United Kingdom, where everyone is paying for everyone else's health care. The case of Keira Bell, a U.K. woman who detransitioned after receiving testosterone shots at 16 and a double mastectomy at 20, outraged Brits across the political spectrum, precisely because taxpayers had funded the treatments that left her unable to breastfeed and possibly infertile.

The clash between what activists want and what the NHS can give them has a cultural dimension as well. Eighty-seven percent of Brits say they are "proud" of the NHS, making the service more popular than the armed forces or the royal family. So when LGBT groups attack the NHS for long wait times and restrictive guidelines, they are attacking an object of British patriotism—one whose socialist logic is in tension with their demands.

British socialism also helped mobilize pushback to self-ID, especially among middle-class mothers. The most outspoken opposition groups were started by women in trade unions, which have a long history of grassroots organizing in the United Kingdom. The unions themselves supported self-ID, in keeping with the official position of the Labour Party, but many of their members did not, and it was those disgruntled unionists who founded Women's Place UK, Fair Play for Women, and other grassroots groups. When they did, they brought their experience of labor activism with them.

"Leftists simply have more practice at organizing," said Mary Harrington, a British writer who describes herself as a "reactionary feminist."

Some of that organizing has involved civil disobedience. In 2018, a group of women looking to raise awareness about the risks of self-ID went swimming at a male-only pool in London, saying they "identified" as men. It worked: After police escorted the women out, the protest went viral on social media and made headlines in the British press.

The protesters had gotten to know each other through a U.K. parenting forum called Mumsnet, which Harrington described as "Prosecco 4chan." The site's pseudonymous user base has become an unlikely font for grassroots mobilization, in part because most Mumsnetters are women.

"Mothers as a group are very pragmatic," Harrington said. "You can argue about Marxist theory until the cows come home, but if a child needs feeding a child needs feeding."

That maternal pragmatism has defined the groups campaigning against self-ID, some of which spun out of Mumsnet threads. The groups don't spend much time debating the metaphysics of gender, focusing instead on practical ways to balance trans rights against the interests of biological women and young children. While a few members oppose transgenderism in principle on the grounds that it reinforces gender stereotypes, most have no such philosophical qualms. They are merely worried about the more extreme policies being proposed by trans activists, whose pronouns they consistently use.

The tent is so big that it even encompasses some trans people who fear the activists will undo their hard-won gains by going too far. "It only takes a drip-drip-drip of bad cases to eat away at acceptance we'd taken for granted," said Hayton, who has spoken at three separate events hosted by Women's Place UK. "This is not a debate between trans people and women. It's a debate between sound common sense and ludicrous policy based in fantasy."

Now, united by a common enemy, this improbable alliance is bearing fruit. The moral of the story, Harrington thinks, is that having good arguments isn't enough; winning the culture war requires institutional capital.

"This isn't really a question of free speech," Harrington said. "It's a question of institutions and power." As she sees it, the Mumsnetters succeeded because they had the right attitude: "If you won't give us any power, we're going to fucking take it."