This week, NHS England finalised its policy on use of puberty blockers for gender-questioning children, determining that this approach was both unsafe and lacking in evidence of effectiveness, and should no longer be employed as routine treatment.
For some clinicians this is vindication, years after blowing the whistle on the scandal unfolding at the Tavistock GIDS. For others still deeply committed to the idea of the “trans child”, it is a shocking assault on a stigmatised minority, withdrawing life-saving treatments, akin to outlawing abortion, genocide or other similar hyperbole.
But even those who have welcomed this decision have noted that it does not go far enough, since this policy is not binding upon private practitioners. Of particular note here is GenderGP, a private service offering blockers and hormones essentially on demand, online, with seemingly no meaningful oversight. One of the founders, Michael Webberley, was struck off, and I have previously written about Helen Webberley’s shocking medical tribunal after giving testosterone to a 12 year old girl, which resulted in only a short-lived suspension, reversed on appeal.
In response to this latest news, GenderGP released the following statement addressed to “Mums and Dads, guardians and children, teenagers and families”:
This is a terrifying time
[…]
likely to cause enormous harm and exacerbate the higher rates of suicidality
[…]
Denying essential care to any young person is not acceptable and risks harm.
[…]
GenderGP will not be following the NHS guidance
[…]
continue to fight for that child, do not let policy harm you
And although at least one NHS commissioning body is warning GPs not to accept prescriptions from GenderGP, they are still in a position to continue prescribing blockers to children, catering to a ready supply of parents terrified by media reports and statements such as the above that their nonconforming children will commit suicide if not medically transitioned.
Despite their dubious practices, GenderGP continue to operate, appearing high up in search results on topics related to gender and transition. Success begets success, and advantageous placement in Google rankings is obviously extremely helpful to a commercial, online clinic. And since Google considers Wikipedia to be a highest quality site, GenderGP will be bouyed up - however fractionally - by the links to their site coming from Wikipedia.
Wikipedia articles are supposed to be based on reliable sources, ideally high quality secondary ones with editorial oversight. Self-serving puff-pieces by commercial vendors designed to drive traffic to their services would not seem to fall under that category. Yet as of writing, there are nine such links from Wikipedia to GenderGP’s site, on subjects ranging from Breast Binding to Transgender Inequality, and all have been in place unchallenged for years.
For example, the page on breast binding contains the following:
Duct tape has also been used to bind breasts, but it is dangerous and should be avoided. It is safer to use a binder from a reputable company or a high impact sports bra.[23]
The citation there is a page on the GenderGP site extolling the benefits of using tape to flatten breasts, complete with prominent buttons to click for those wishing to advance beyond binding:
The link in the Wikipedia article does not support anything in particular as a useful citation - it is merely a spam link to a commercial service, added to pre-existing text.
When considering all of the links to GenderGP, a consistent picture emerges. It turns out that these links were invariably added between 2021 and 2022 by anonymous and throwaway users, whose sole purpose was to add links to GenderGP, sometimes with minimal relevance to the article in question. While some of these were quickly picked up and reverted as spam, most remain to this day.
In April 2022, this Malta-based IP address added citations to GenderGP on pages on transgender health care, and also conversion therapy.
Between March and May 2022, the user CreationOfTheNew made a series of edits, adding citations to GenderGP on pages on LGBT youth suicide, hot flashes, and vibrators.
In December 2021 the user ReadandWeep made a single edit to the page on “Transmisogyny”, linking a self-serving GenderGP article titled “How Fake “Experts” Are Driving the Campaign Against Trans People”, which is still there as of today.
Between November and December 2021, the user MeadowMellow added a link to GenderGP on four articles, with no other edits made.
And between 10th and 15th November 2021, this Irish IP address added the link to two pages, on progesterone, and on Real Life Experience (transgender). The page the latter links to is titled “Am I Trans Enough for GenderGP’s Assessment? Yes, You Are!”, extolling the benefits of their no-questions-asked approach:
We are here to help you transition into the body and life you were meant to have.
[…]
We’ll never act as the gatekeepers of your gender identity. GenderGP won’t ask you for questions, or even do an “am I trans quiz”.
In fact, the final edit from this IP address was made an hour before the creation of the user MeadowMellow.
It is pure speculation, but it is not a huge stretch to suggest that the IP editor added some of this link spam, realised the traceability of their IP address, before creating an account and carrying on behind greater anonymity. There might be good reasons to be suspicious that someone at GenderGP is behind that IP, but nothing beyond circumstantial evidence. Frankly, if commercial services want to spam their links on Wikipedia to boost their search rankings, then the onus is on Wikipedia to have stringent enough procedures to prevent this from happening, or for Google to have sufficient intelligence not to inflate search rankings as a result of backlinks from Wikipedia.
So why has such obvious spam not been noticed or removed at any point in the last few years, and is it simply a matter of not enough editors paying attention to those pages?
In contrast to the aforementioned page on breast binding, the Wikipedia page on the practice of “breast ironing” begins as follows:
Breast ironing, also known as breast flattening, is the pounding and massaging of a pubescent girl's breasts, using hard or heated objects, to try to make them stop developing or disappear. The practice is typically performed by a close female figure to the victim, traditionally fulfilled by a mother, grandmother, aunt, or female guardian who will say she is trying to protect the girl from sexual harassment and rape, to prevent early pregnancy that would tarnish the family name, preventing the spread of sexually transmitted infections such as HIV/AIDS, or to allow the girl to pursue education rather than be forced into early marriage. It is mostly practiced in parts of Cameroon, where boys and men may think that girls whose breasts have begun to grow are ready for sex.
Breast ironing is rightly recognised as violence against women, and acknowledged to have arisen in cultures where the sexualisation and lack of bodily autonomy of women and girls leads to these painful practices, resulting in lifelong deformity. Much easier to punish girls for men’s behaviour, than to even think of changing men’s behaviour. The page itself is flagged as being part of a series on violence against women and girls, and given that it seems unimaginable that a similar form of commercial link spam would have gone unnoticed. There’s no realistic way this page could contain links to clinics offering to carry out these procedures on minors for profit, unnoticed, as this would be widely seen as abhorrent and quickly and removed.
However, even though functionally the practice and outcome is the same as breast binding, editors on Wikipedia treat these two subjects very differently. Breast binding is considered “gender affirmation”, and the widespread view in the West is that such things are not regressive cultural practices, but entirely necessary - even life-saving - in pursuit of authentic self-realisation. Indeed, that trying to prevent such acts is hatred and bigotry. The idea that adolescent girls learning to hate and deform their bodies is in any way a form of violence against women or a result of a culture of sexualisation in exactly the same way as breast ironing is, of course, a forbidden interpretation.
These two pages are directly comparable in terms of subject matter and size, with he only real difference being prevailing cultural narrative. Both breast binding and breast ironing have received similar traffic over the last few years (with breast binding receiving a surge in attention in early 2023).
Yet this GenderGP link was added to the page on breast binding in November 2021, and has remained there ever since.
Nor can it be a matter of edits or editors, since almost six times as many editors have updated that breast binding page in that time frame (58 compared to 10), and the number of editors currently watching these pages for edits is similar (85 for breast ironing, 75 for breast binding) More eyes on the page doesn’t necessarily average out to “more accurate”, but rather “more dogmatic enforcement of prevailing cultural narratives”.
I would suggest that it is mostly because of this bias in interpretation that a clearly spam link to a commercial provider of “gender affirmation” services was allowed to remain in this page in clear breach guidelines for three years and counting. These links remain because, on the whole, Wikipedia editors believe that what GenderGP is offering is good.
Already as the puberty blockers scandal unfolds, questions are being asked as to how this was allowed to happen, and while I’m sure legislation will eventually catch up with private providers, the larger stumbling blocks are cultural ones.
That GenderGP plausibly embedded spam links in multiple Wikipedia articles and fractionally boosted their search rankings as a result is merely a tiny, pedantic part of a large and complicated story that encompasses capitalism, sexism, homophobia, technology and wild-eyed, messianic fervour.
Controversially, the “trans youth” charity Mermaids were signposting parents of vulnerable, confused children to GenderGP, something Mermaids’ former CEO Susie Green admitted, after she had left the charity to join… GenderGP.
To their shame, in an attempt to cast doubt on a 2021 National Institute of Health and Care Excellence review of puberty blockers - which found there was no evidence of the safety or efficacy of the treatments - the increasingly unscientific Science Based Medicine have cited them approvingly:
As the Gender GP writes, “The pain and distress in adolescents who face prejudice and barriers to living in their authentic gender identity cannot be alleviated by a three-monthly injection alone”.
GenderGP has resources casting doubt on regret and detransition, on rapid-onset gender dysphoria, on the ability for children to consent to permanent medicalisation, on suggesting that a child may simply grow up to be a lesbian is a form of “conversion therapy”, and on and on, all of which are echoed or cited by prominent advocates of “gender-affirmative care”. They are not outliers, but are wholly reflective of exactly the care regime that is standard in the US and which has come to be seen as virtuous, medically necessary and lifesaving.
The dominant conceptualisation that “gender identity” is some innate truth that there is a moral imperative to “affirm” has resulted in a tightly interconnected web of self-serving misinformation, linked and interlinked, repeated over and over that this is the right way to view the world and any other way is not only wrong but harmful and bigoted. Private clinicians defying NHS guidance and continuing to facilitate child transition are seen not as recklessly enabling bizarre experimental treatments with completely inadequate evidence and safeguards, but as heroes, bravely standing up to an uncaring state trying to stamp out “trans people”. This cultural narrative is sustained by its own internal logic, blind to any contradictions or nuance, and recognises only its own facts. Entirely normal child development has been simultaneously framed as both something in need of urgent, life-saving medication and something that must not under any circumstances be considered a pathology.
This understanding is what allows so many people to see the exact same practice - the intentional flattening of the healthy breasts of adolescent girls - and believe that one is violence, and the other liberation.
It is the imposition of the practice by external factors that makes it truly unacceptable. Those who are subjected to breast ironing are not truly, freely choosing this for themselves, but forced into it by circumstance, by outside pressure. Indeed, this loss of choice is what makes it so obviously wrong.
By contrast, if breast binding is in service of self-actualisation, of individual choice and transcending material limitations, pursuing an idealised, perfect inner you, then it cannot be bad. The market - dependent on an ideal of liberal, rational individuals, making free choices in their best interests - demands it. And it is the focus on an immutable, individual “identity” projected outward that allows the pretence that no external factors are at play in making that choice.
Questions about where that choice arises - about a sexist, violent, pornographic society that denigrates and objectifies the very bodies these young girls are growing into - are left unasked and rendered unaskable because the veneration of the self is sacrosanct. The act of choice makes it pure, and questioning that choice is unforgivable, a denial of autonomy, of self.
While an extension of the NHS policy on puberty blockers to cover private clinicians such as GenderGP would be welcome, it barely scratches the surface of the huge cultural reckoning we must face as this medical scandal slowly, finally begins to unravel.