One of the questions I’m asked most often is: ‘Don’t you ever get tired of talking about trans?’ Which is fair enough given my work at Genspect, which advocates for a non-medical approach to gender distress; my book, When Kids Say They’re Trans; and the Channel 4 documentary I presented, Trans Kids: It’s Time to Talk.

But the honest answer is no. Not because of ‘trans’ per se, but because of what the trans issue has uncovered. The subject itself isn’t endlessly fascinating – I’ve always been a generalist and never been a single-issue zealot. However, the trans issue is a prism through which almost every major cultural, political, ethical and psychological question of our age is refracted. The debate around transgender identity exposes problems that extend far beyond medicine or mental health. That’s why I no longer define trans as an ‘unfolding medical scandal’ but an ‘unfolding medical and institutional scandal’. To name just a few areas:

Medicine and healthcare

‘Gender medicine’ has revealed what happens when medicine becomes consumer-driven. Technical advances have made possible a growing number of elective medical interventions – gender medicine, commercial surrogacy, assisted dying, some forms of abortion – which are increasingly presented as ‘healthcare’ simply because they are medically possible. The distinction between treating illness and fulfilling consumer demand has become dangerously blurred.

Then there’s the mess currently being created by the mental-health industry, which is never more prominent than within the trans debate. A culture of over-medicalisation, over-diagnosis and affirmation has transformed healthcare from what was once a process of exploration, uncertainty and psychological growth into little more than emotional validation. Therapy has shifted from helping people understand themselves to helping them feel affirmed and supported. Psychiatrists seem to slip into prescribing a pill for every ill, psychologists increasingly offer a diagnosis for every ill, while psychotherapists like myself slide into empathy and affirmation for every ill.

Academia and education

Like healthcare, universities increasingly resemble consumer-driven businesses, anxious to keep their customers happy. I had always imagined universities as places whose purpose was to move us from darkness into light through the pursuit of truth. The poor quality of much research on gender medicine exposed just how vulnerable academia has become to ideology.

Until you study the literature yourself, it’s difficult to appreciate just how shoddy the majority of trans research is, with tiny qualitative studies featuring self-selected participants reporting satisfaction, extraordinarily high rates of participants lost before they can be followed up, and remarkably little emphasis on objective outcomes such as employment, educational attainment, psychiatric admissions, hospitalisations, physical health or suicide.

The low quality of transgender research also led me to realise that many other disciplines – including vast sections of feminism, queer studies and postmodernism – rest on similarly fragile foundations.

It’s not only universities, though. Until quite recently, many schools across the Western world were shaped, however imperfectly, by Judeo-Christian values. As religion receded from education, the vacuum has been increasingly filled by postmodern ideas about identity, power and truth, often with remarkably little public debate about the consequences. Ironically, the resulting dogmatic culture within schools today reminds me very much of my own Catholic education.

The startling speed with which transgender ideology became embedded in education systems across the Western world exposed just how easily a new orthodoxy can become accepted, taught and defended by entire institutions. The trans issue has also led me to realise how schools today are increasingly viewed by policymakers not as places of learning but as opportunities for social engineering. As education appears to be less about transmitting knowledge and more about shaping young minds, fundamental questions about its direction become unavoidable.

Journalism

Investigative journalism once prided itself on holding power to account without fear or favour, and on comforting the afflicted while afflicting the comfortable.

Today, too much of it is characterised by fear, conformity and self-censorship. Mainstream journalism is either dying or being radically transformed by the digital age. Editors are scrambling to keep publications alive, retain subscribers and survive in an unforgiving online marketplace. The result is a chaotic, nervous and reactionary mainstream that feels a very long way from Bernstein and Woodward. Outlets that pander to trans identities and preferred pronouns tend to also toe the elite line on every other contentious issue.

Politics

The trans debate also crystallises how politicians, just like editors of mainstream media, generally behave like market researchers rather than leaders. Every difficult decision is filtered through polling, electoral calculation and fear of upsetting vocal activist groups. At the same time, more and more policy is shaped by NGOs and quangos that often exercise significant influence without corresponding accountability. Leadership requires the courage to persuade the public that something is right; too often today, politicians simply tell the public what they think it wants to hear.

The new left

The decision of the left to swap class politics for identity politics has been both maddening and fascinating to watch through my splayed fingers. The unanticipated – and, let’s face it, largely unfathomable – swerve of large sections of the contemporary left towards advocating for the lifelong medicalisation of children who will one day become infertile and sexually impaired has yet to be fully analysed. Nobody yet knows why this movement that once championed the downtrodden, the importance of fair economics and equal rights now embraces self-reported identity, subjective truth and moral certainty, but it is important to reflect on it.

Contemporary censorship

My experiences of being cancelled, censored and censured for speaking truthfully about trans issues have shown me that modern censorship isn’t like Soviet Russia or the East German Stasi. There are no jackboots ensuring everyone stays in step. Instead, contemporary censorship more closely resembles the culture I experienced growing up in the Catholic Church, where public shaming made the policing of acceptable thought remarkably effective. Today’s censorship is led by relentless finger-wagging moralism from the new left and reinforced by professional regulators, social media moderation, reputational threats and institutional pressure.

The arts

This has probably been my greatest disappointment (with some honourable exceptions, of course). Where are the protest songs? Where are the novels exposing the madness of contemporary society? Writers, filmmakers, musicians and artists have historically challenged orthodoxies and taken risks. Instead, the trans issue has revealed vomit-inducing pretence, sanctimony and cowardice in the arts. Art should be unsettling and thought-provoking, not sanctimonious and self-serving, yet here we are.

Sport

Few areas depend more obviously on measurable reality than competitive sport. Fair competition based on strength, speed and weight is foundational to athletic competition. Yet even here trans ideology has managed to overwhelm common sense.

Arguably, it was sport that finally brought the trans issue to the attention of the wider public. Watching men punch women in a boxing ring seems to have awakened an atavistic instinct in many men to protect women from male violence. Organisations such as SheWon and HeCheated, documenting the growing tally of lost medals, lost scholarships and lost opportunities, are helping to expose the real-world consequences of the trans issue in these Alice in Wonderland days.

Sex

The trans debate raises much broader questions about sexuality itself. How should society handle issues such as pornography, grooming, censorship and consent? What does it actually mean to be lesbian or gay in an era where biological sex is increasingly treated as optional? It has also reopened questions many assumed had already been settled. What does it mean to be male or female? How much of our identity is rooted in biology? Are sex differences fundamental or merely social?

Also, the trans debate, via autogynephilia, asks how society should respond to sexual deviance. What should we do when a man – and it is almost always a man – performs a sexual fetish in public? How should children be protected from sexual content?

I remember when I was a young adult arguing passionately against censorship and in favour of unrestricted free expression. Then my opponent stopped me in my tracks by saying that he didn’t want his eight-year-old watching Blue Velvet. I suddenly realised that defending absolute freedom for adults also meant accepting that children would be exposed to sexual violence, gimp masks and sadomasochism. The trans debate highlights how freedom and protection sometimes pull in opposite directions, and that every society has to decide where it draws that line.

Parenting

The trans issue has also exposed the consequences of over-parenting and the many issues with the child-led approach. A generation repeatedly told they are uniquely special can come to believe that they really are exceptional. Some children respond by coming to believe that ordinary human limitations are intolerable, and their identity is uniquely special, exceptional and should be celebrated and carefully protected.

The impact of contemporary child-rearing, combined with a culture that glorifies youth and beauty, has produced a generation shaped by social media, cosmetic surgery, filters, relentless comparison, therapeutic language and rampant individualism. Never before have adolescents and young adults had so many tools for self-expression and self-promotion while often appearing so uncertain about who they actually are. In a culture that prizes authenticity above almost everything else, they have become preoccupied with discovering their ‘true self’, while seeming paradoxically more performative, more anxious and more inclined to use products and medical interventions to create their ‘real self’.

While too much responsibility is lumped on parents today, at the same time, the diminishing power and status of parents is notable. Over-policing and nanny-state officials have led to children being removed from home, just because parents have informed their daughter that she was not really a boy. While this may seem far-fetched, it is important to know that the UK government’s new Conversion Practices Bill promises to criminalise parents who insist on speaking the truth to their trans-identified children. Within this new culture, identity has become the new secular religion, and ‘identifying as’ has become one of its central and sacred rituals. In this context, parents are regarded as ‘dangerous’ if they don’t affirm the child’s new identity.

The explosion of special needs

The extraordinary rise in autism, ADHD and other diagnoses raises profound questions. Are we identifying genuine need more effectively, or are we increasingly medicalising ordinary human variation? What kind of society are we creating if ever larger numbers of young people grow up believing they are fundamentally impaired?

With 40 per cent of students at Stanford University receiving disability accommodations, and more than 100,000 adults in the UK receiving benefits with ADHD as their main condition, these questions can no longer be dismissed as marginal. The trans debate brings the tension into sharp focus because so many gender-distressed young people are neurodivergent, receive significant accommodations and, at the same time, are regarded as fully capable of consenting to irreversible medical interventions.

The contradiction was starkly illustrated by the recent case raised by the MP Gregory Stafford in the UK parliament of a 23-year-old who required a key worker to accompany him wherever he went because of his extensive emotional support needs, yet this vulnerable adult was nevertheless approved for NHS genital surgery just last year.

Extreme tolerance

Perhaps the most sobering lesson of the trans debate has been how quickly ordinary people adapt to extraordinary situations. We like to imagine we would have resisted the great moral failures of history. Yet practices that would have been considered plainly unacceptable only a decade ago are already becoming normal. Hilary Cass recently described the case of a two-and-a-half-year-old who had been socially transitioned by well-meaning but profoundly misinformed parents.

The internet has allowed people with the most extreme interests and behaviours to find one another, organise, normalise themselves and increasingly demand recognition as protected identities rather than simply being tolerated as oddballs within the community. At the same time, the ideal of ‘live and let live’ has gradually evolved into a culture of extreme tolerance, where every lifestyle, every identity and every preference is presumed to be acceptable.

Karl Popper’s paradox of tolerance remains as relevant as ever. A civilised society cannot survive if it refuses to defend the very norms that make civilisation possible. The speed with which the boundaries of the acceptable can shift has reminded me just how frighteningly fragile civilisation really is.

Philosophy

The trans issue has highlighted the biggest question of all – what makes you, you? Is there such a thing as an authentic self? Are we born with an inner identity waiting to be discovered, or is identity something gradually formed through our relationships, experiences and responsibilities? What happens when different people’s needs conflict? Can compassion for one group create injustice for another?

The digital revolution

Finally, of course, there is the internet itself. Until Elon Musk’s acquisition of Twitter / X, our limited ability to analyse, criticise or question trans issues online was distinctly alarming. Yet online life has supercharged social contagion. Ideas have always found ways to spread, of course – from dancing crazes to eating disorders, suicide clusters and moral panics. However, digital platforms and social media have amplified and spread transgender ideation at unprecedented speed and scale.

We are living through a technological revolution comparable to the arrival of the printing press, one that is simultaneously reshaping knowledge, authority, identity, relationships and politics. The Twitter Files exposed how a small number of tech bros have the capacity to shape public discourse, suppress information and influence democratic debate on a global scale. The rise of block buttons, deplatforming, algorithmic censorship and now AI-driven content moderation (and social engineering) is already shaping our world in ways we have yet to fully understand.

So no, I don’t get tired of talking about the trans issue. Not because I think transgender identity is the most important question facing society. It’s because the trans debate isn’t really about trans – it’s about the kind of society we are becoming. This issue is the clearest lens through which we can study the disintegration of almost every major institution across the Western world.

Stella O’Malley is the director and founder of Genspect.