Open Letter from Genspect to Wes Streeting

16 January 2026

Dear Secretary of State,

We are writing in response to your remarks of 13 January regarding the PATHWAYS trial. We welcome your acknowledgement of the serious failings identified by the Cass Review and your commitment to evidence-based paediatric healthcare. Our main concern is that the clinical trial you defend rests on a diagnostic concept—gender incongruence—whose origins are political rather than scientific, rendering it an inappropriate basis for medical intervention in young people.

Your letter states that your approach thus far “has been led by the evidence, not ideology,” and asserts that “gender incongruence is [a] real and internationally recognised disorder,” defined in ICD-11 as “a marked and persistent incongruence between an individual’s experienced gender and the assigned sex.”

Yet this ICD-11 category did not emerge from new scientific discoveries. It is the product of a decades-long depsychopathologization campaign by activists and advocacy organisations, whose explicit goal was to remove psychiatric framing and guardrails around hormonal and surgical interventions, secure third-party payment for these treatments, and ultimately implement a transition-on-demand model across the entire field of gender medicine.

This ambitious campaign succeeded. Over successive revisions, diagnoses such as “gender identity disorder” and “transsexualism” were deliberately reshaped and relocated, shifting language away from any implication of mental disorder and towards a vague condition involving an inner identity at odds with the body. The ICD-11 construct of gender incongruence is the culmination of that process: an impressive political achievement, to be sure, but a far cry from the rigorous scientific inquiry upon which medicine ought to be built.

The activist influence is clear in the language itself. “Experienced gender” is an unfalsifiable inner claim, not a measurable clinical marker. “Assigned sex” is not a scientific term; it is activist language designed to obscure the reality that sex is determined at conception, observed before or at birth, and plainly immutable. When such concepts are written into diagnostic criteria, ideology forms the foundation of treatment before any discussion of interventions even begins.

This is especially important in the context of children and adolescents. The young people now being diagnosed under this framework are not a discrete, clearly understood patient group. They include boys and girls with very high rates of autism; adolescents with long-standing mental health problems and trauma; young people struggling with emerging same-sex attraction; and teenagers who have misinterpreted the normal discomfort of puberty as a sign they are transgender because they are coming of age in a culture saturated with the messaging of trans rights. Their distress is real. But the idea that it is best conceptualised as “gender incongruence” requiring medical intervention is a contested ideological view, not an established scientific fact.

It is crucial not to exceptionalise this group of young people. They are children and adolescents like any other, meaning all the well-established rules of child and adolescent development apply to them equally. On that basis, the “triple lock” of safeguards described in your letter cannot address the fundamental ethical problem: no child or adolescent is capable of giving “informed assent” to such drastic, life-altering interventions.

A young person may be able to memorise a list of risks and repeat them back to a clinician, but that does not mean they comprehend what lifelong infertility, impaired sexual function, or permanent changes to their body will mean at 25, 35 or beyond. Moreover, parental consent cannot make up for the child’s lack of maturity, nor can a national multidisciplinary team override what decades of high quality developmental science tells us about adolescents’ limited capacity to foresee long-term consequences and the importance of keeping future options open.

You argue that, with the strongest safeguards in place, the PATHWAYS trial is “the only way” to manage “the risks to young people who are using puberty suppressing hormones in an unmanaged way and the risks to young people experiencing extreme mental anguish by not accessing puberty suppressing hormones.” We agree that unregulated self-medication is dangerous, and that some young people are in profound distress. But it does not follow that testing a highly invasive medical treatment on healthy adolescents given an activist-crafted diagnosis is the only or best response.

Instead, it is vital to address the underlying reasons why so many healthy young people feel compelled to pursue these drastic medical interventions. This requires the courage to confront the root cause: these youth are caught up in a powerful, internet-fuelled social phenomenon—a culture-bound event driven by the messaging of the trans rights movement.

It is time to face the fact that, as a society, we have let these young people down by allowing them to be exposed to a political ideology with no grounding in truth at a crucial stage of their identity development—an ideology that untethered them from reality and convinced them that drastic medical interventions were the only solution to their pain. The answer is to restore reality carefully and compassionately, not to conduct a clinical trial that legitimises the very belief system that put these youth in harm’s way in the first place.

If your government is serious about protecting young people and being led by evidence, you will halt the PATHWAYS trial before it begins.

With sincere respect,

Genspect