This week on the Quillette podcast, I’ll be talking about the ongoing battle over transgender identity, which was the subject of a recent conference I attended in Albuquerque, New Mexico. That conference was hosted by Genspect, an international organisation that advocates for a psychotherapeutic, non-medicalised response to gender distress. Genspect also raises awareness about the serious risks associated with puberty blockers, cross-sex hormones, and surgical operations as a means to “affirm” the declared trans identity of gender-distressed individuals.

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Genspect was founded by Irish psychotherapist Stella O’Malley, who gave an opening address in New Mexico—in which she opined that we are now entering what she called Trans glasnost—which is to say, a period during which people can speak more candidly about the real reasons for the alarming spike in transgender self-identification among depressed and alienated youth. Just a few years, that kind of discussion was often stigmatised as transphobic—and it was widely claimed that arguing for any policy except reflexive “affirmation” of trans-presenting youth was inherently transphobic.

But times have changed, as many European countries have severely restricted policies that once provided youth with virtually no-questions-asked policies on youth gender transition. Leading the charge here has been the UK, where the authoritative Cass review of the medical literature in this field demonstrated that there is actually very little evidence that gender transition provides any kind of mental or emotional benefits, despite exposing recipients to abundant medical risks.

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Many US states, and even a large province in ultra-liberal Canada, have also rolled back the no-questions-asked gender affirmation policies that were rushed through in the 2010s during the first euphoric wave of transgender boosterism. At the same time, the appearance of biologically male athletes in girls’ and women’s sports has created an enormous backlash, even among progressives, against an ideological movement—some call it “gender ideology”—that purports to dispute the existence of the very real and significant biological differences between men and women.

But is the gender-critical backlash against transgender activist overreach itself now overshooting the mark? That’s the issue I’ll be discussing with my guest today, Mia Hughes, the director of Genspect Canada, who delivered a fiery speech at the Albuquerque conference.

In her speech, Hughes, who was born and raised in England, traced the extremist tendencies in modern trans activism to the evolution of a scandal-plagued group called WPATH, the World Professional Association for Transgender Health. Its formal mission is to promote a high quality of care for transgender individuals. But in recent years, it’s become better known as an aggressive cheerleader for policies that permit virtually unfettered pharmacological and surgical treatments for people suffering from gender dysphoria.

As you’ll hear, Hughes argues that WPATH’s mission was co-opted in the late 2000s and early 2010s by a subset of trans-identified biologically male activists who experience a condition known as autogynephilia—a paraphilia that causes individuals (almost invariably men) to become sexually aroused by the idea of presenting themselves as female. Their campaign to make transition therapies widely available was extremely successful, so much so that when legions of troubled adolescent girls began logging on to social media in the mid-2010s, they encountered a landscape where gender transition was being cheered on.

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Hughes argues that the real problem came when WPATH decided to “de-psychopathologise” gender dysphoria about fifteen years ago—which is to say, WPATH decided that gender dysphoria wasn’t really an affliction at all, but rather a kind of gateway into a new form of human existence. As a result, Hughes argues, being trans became trendy; and troubled youth became convinced that transition represented the solution to problems that were actually rooted in trauma, depression, autism, and other co-morbid conditions.

Provocatively, Hughes told the crowd in Albuquerque that we need to re-psychopatholigise the urge to transition—a choice of words that I worry may go too far. As you’ll hear, I argue that we need to use language that allows the people who became swept up in gender ideology to return to a common-sense approach, and that the kind of harsh language she uses may not be useful for that project.

Please enjoy my interview—and at points, debate—with Genspect Canada director Mia Hughes.

Transcript

Mia Hughes: Thank you for having me.

Jonathan Kay: So why did you have this conference in Albuquerque of all places?

MH: So, the conference was Genspect, which is an organisation founded by Stella O’Malley in 2021. Genspect is an organisation that advocates for a non-medical approach to gender-related issues. And there’s another organisation that exists in the world called the World Professional Association for Transgender Health, WPATH. WPATH is the opposite. WPATH calls for a medical approach: hormones, surgeries.

JK: We’re going to get to all that. I just want to know why I had to take two flights because I had to fly to Denver and it’s a really obscure destination.

MH: I’m getting there. This is all part of the explanation. So, in the debate surrounding gender medicine, there are two opposing views. Genspect is one, non-medical; WPATH is the other, medical. Stella O’Malley had the brilliant idea that we were going to follow WPATH around the world, wherever they have their annual conference.

JK: Okay. Yeah.

MH:  We have our annual conference in the same city at the same time. It’s the ultimate trolling basically, and they hate it.

JK: I was thinking more of a stalking metaphor, but go on.

MH:  I love it because the two worlds convene in one city, and because I’ve studied medical scandals for so long, I know that these parallel conferences are going to be excellent snapshots for medical historians when they’re looking back at this madness and they can see, where were WPATH in 2025, where were Genspect. They can look at the Albuquerque conference. And they can see, we were in Lisbon last year, so were WPATH.

JK: Oh, Lisbon sounds great. It’s just if WPATH goes to a crappy city, you have to go to a crappy city. No shade on Albuquerque. But it’s not as nice as Lisbon.

MH:  It’s definitely not as nice as Lisbon. And we were in Denver before that. Next year, I’m quite certain it’s Mexico City, which I love.

JK: See, to me, that’s where the gender wars should be fought. Stella O’Malley, your partner in crime, she let off the proceedings by saying that we are in a period of “trans glasnost,” which I thought was a fantastic line, except when we went out for drinks after I had to explain what glasnost is to everybody who was under forty.

It’s a fantastic line if you actually remember the end of the Cold War. Do you agree with that formulation? The idea of course, is that there’s a glasnost, meaning there’s a thaw. We can speak our minds without getting cancelled. People can have a debate. Do you think that formulation’s accurate?

MH:  I think it is. There are still people … We’re in Canada, so less so here, I would say. Nothing really has changed here. You can’t …

JK: Canada’s frozen in time. It’s still 2018 in Canada. Justin Trudeau isn’t the prime minister anymore, but his shadow hovers above this debate in Canada, where every woman has three penises and Pride season lasts four months.

That’s his legacy to Canada. But outside of Canada, would you say that’s accurate?

MH: Because we’ve been following WPATH all these years, I feel the balance of power has shifted. So in that sense, it’s accurate. I think Genspect has the upper hand. I think WPATH’s reputation is in tatters and the debate is on.

Trans activists still think that they have the power to destroy people. They think they have the power to silence people.

JK: In certain rarefied literary circles or activist groups that still may be possible, within those little ecosystems.

MH:  We have a long cleaning-up process to go. It’s going to get very ugly.

JK: That’s a good segue to my next question here because I love the glasnost analogy.  Stella is brilliant, so it doesn’t surprise me. However, part of me thinks in terms of revolution and counter-revolution, and I think maybe what we’re witnessing now is … you had this kind of trans rights revolution, which maybe crested in, I don’t know, 2018, 2019, 2020.

And then history works in cycles and now you have a counter-revolution where people like you are trying to bring back common sense to this discussion about gender. And the thing about counter-revolutionaries, of which you are one, is that if they’re successful, they’ve got to figure out, what do we do with all the revolutionaries?

The counter-revolution has prevailed, and now we’ve got thousands and thousands of … I’ll extend the metaphor, these revolutionaries in prison or in handcuffs. They’re not in literal prison, but you’ve got to figure out what to do. The question is, should you be merciful? By the way, I should say that’s my impulse.

You and I have had this discussion, we’ll talk more about this later, in the Malcolm Gladwell context, where if you’ve got somebody who said, “Hey, look, I got swept up in this whole genderwang thing. It was popular. I wanted to be nice and empathetic, and my niece thought she was trans for fifteen minutes. And everyone on my block, who lives in nice houses, they all had all those rainbow flags and all this stuff.” And if that person comes and says, “I was deluded, I was wrong.” Or maybe they’re more honest. They say, “I just wanted to get on board the popular thing, but now I realise that was stupid.” My impulse is to be merciful.

Let them back into the tent. “Don’t worry, brother. We have all sinned,” type thing. You seem to very much take the opposite view. You’re out for—maybe vengeance is too strong a word, but you don’t seem the forgiving type on this file.

MH:  I don’t know why I’ve given you that impression.

JK: I have receipts for some of your quotes, but just, generally speaking. Look, let’s be more specific. Malcolm Gladwell, a lot of people listening to this podcast will know, a couple weeks ago, Malcolm Gladwell, famous New Yorker writer, who wrote books like The Tipping Point most famously.

He came out, he was on a podcast and he said, “Yeah, I have a confession to make.” I’m paraphrasing here. “I have a confession to make. I was on this panel at a sports conference,” I think it was in Boston, “a couple years ago, and I gave credence to the idea that trans women are actually women in the athletic context. And that was a mistake. I shouldn’t have said that.”

And I wrote a column about it and I was like, okay. That’s terrible that Gladwell was so insincere and cynical because he admitted he had been insincere and cynical. But let’s treat him mercifully and not mob him or whatnot, because if we treat him mercifully for admitting how stupid he was acting at the height of genderwang, it’ll encourage other people who were similarly drawn into that fashionable movement.

And I’ll say, Look how nicely we treated Malcolm Gladwell. This could be you. And like you create a kind of proof of concept for reintegrating, radicalised genderwangers back into sane society. Don’t you think that’s a good approach?

MH:  We talked about Gordon Guyatt, which I’m sure we’re going to talk about later.

He does not get even a tiny glimmer of forgiveness in my mind. On Gladwell, I’m with you. On the masses who just went along with this without thinking about it, without questioning it, just because they thought it made them a good person. So let me separate it. The Gladwell type, just mindlessly going along with it, not thinking about it, if you actually at this point have, even now, if you have the courage to come out and say, I got this wrong. I said something stupid, I should never have supported it, I will fight my impulse to say, you were a moron and I will welcome you into the fold. Because you’re right. That’s the only way we get the general public, the well-meaning general public that supported something terrible to join us.

WPATH does not get any such goodwill from me. Really, truly. I think a lot of them belong in prison, and I know that sounds extreme, but when you think about people can go to prison for credit card fraud or some kind of embezzlement, financial white-collar crime, look at what these people have done and look at the actual grievous bodily harm that innocent young people have come to …

JK: If I’m interpreting you correctly, you draw a line between media types or activists who got swept up in a fashionable movement and the people who are actually at medical conferences or who were actually wielding scalpels and writing prescriptions, medicalising the transition of, in many cases, hastily processed teenagers who were confused and thought they had gender dysphoria.

Is that the distinction you’re making?

MH:  Completely. And beyond that, the people who drew up WPATH’s Standards of Care 8, I’m including the people who drew up the American Academy of Pediatrics position statement.

JK: Tell me briefly about those standards of care. Because you sometimes see that abbreviated in the literature, like SOC 8 or 7. Why is that a particularly reprehensible Standards of Care, in your mind?

MH:  It’s a complicated story. I’ll try and not go on too long. WPATH Standards of Care 8 was published in September 2022. The one before that, Standards of Care 7 was 2012. Now, Standards of Care 1–7 were not based on any evidence, but they never pretended that they were based on evidence.

They just said it’s clinical consensus. We think this is the right thing to do, but we don’t have any evidence. Standards of Care 8 they come up with these hundreds of pages of documents with tons of citations and they’re saying it’s science-based, evidence-based. It’s just a mad document.

It’s got a chapter on eunuchs, requiring gender-affirming care for men who want to be castrated. It’s got a non-binary chapter where you can get second sets of genitals and stuff, but it’s also got this adolescent chapter and it was published with minimum age recommendations in the adolescent chapter.

And it was like fourteen for cross-sex hormones, fifteen for a mastectomy, sixteen for breast implants, seventeen for penis inversion. So, shockingly awful lower recommendations anyway, and then within 24 hours those recommendations disappeared. They just vanished from the online document.

JK: The age limits vanished.

MH:  Those minimum age recommendations were just gone and nobody knew why. It was just an incredible thing to happen. And then what we got last year, June of 2024, is we found out what happened. So in the unsealed documents in a US court in Alabama, Alabama had banned youth gender medicine. ACLU launched a lawsuit citing WPATH Standards of Care 8 all the time.

So the Attorney General said, okay, then let’s see how you made this Standards of Care 8. And they had to turn over two million emails about how they made Standards of Care 8. And that’s the bombshell that we know how fraudulent it was. We know that those age recommendations, lower limits for children and adolescents, they disappeared because Admiral Rachel Levine, Biden’s Assistant Secretary for Health and Human Services at the time, demanded that they be removed because it would hurt all of the state-level legal battles about this treatment. And then we also know that they commissioned at least thirteen systematic evidence reviews upon which to build Standards of Care 8. Because they set out with this grand plan that it would be evidence-based.

JK: They’re true believers. To their credit, they actually did believe that rapid gender affirmation, including in some cases drugs and surgery, was the path to happiness and medical nirvana. They seem to have actually believed this.

They couldn’t get the evidence for it because it seems it doesn’t exist.

MH:  I don’t doubt that they believe it, but let me just say what happened to those systematic reviews. So, they commissioned at least thirteen from Johns Hopkins in 2018. They’re going to build Standards of Care 8 on those reviews. And they’re independent reviews.

Johns Hopkins, one of the best centres in the world, and the preliminary results start to come in showing there’s only very low-quality evidence, so WPATH just blocks Hopkins from publishing the reviews and then went ahead and published their Standards of Care as if the reviews had shown evidence.

You can see that in these discovery emails. So yes, they may truly still believe that they’re helping these people, and I actually think that they do. I think the psychology of the true believer is such. It’s powerful, right? So even though they know that they suppressed all the systematic reviews, which is just not how independent reviews work, even though they know that Admiral Rachel Levine had them take out the age limits, the age recommendations, they still think they’re doing the right thing and they still think that anyone who opposes it is only opposing it because of transphobia.

JK: Rachel Levine, that was the transgender member of Joe Biden’s administration.

MH:  Yeah.

JK: I can see why Genspect is so focused on WPATH. But the conference itself, WPATH got mentioned a lot and some of the biggest crowd reactions came from when speakers put up pictures of particularly notorious leaders of WPATH, but it isn’t just an anti-WPATH group, right? It has its own independent identity and mission.

MH: Mission is quite simply to advocate for a non-medical approach to these gender-related issues. Genspect wasn’t launched to be the antidote to WPATH’s poison. That’s just the way I see it, because WPATH existed promoting the medicalised approach, and then Genspect comes along and promotes the healthier, ethical psychotherapeutic approach to getting all of these people—certainly the children and the adolescents—you want to get them all the way into adulthood, get them through this crazy cultural moment, get them through the social contagion that is swirling all around them, get them through into adulthood, completely healthy and whole.

They’ve not been medicalised. And if they want to experiment with their identities, that’s fine, but no medicalisation whatsoever. But then it does extend further than that because we always talk about the lack of evidence for adolescent gender medicine because there is none.

JK: In England, the Cass Review, I think, established that point.

MH:  Cass has had little effect in the United States. The Republican states, of course … You’ve got to divide between blue and red. Cass was very important. Cass was built on its own stack of systematic reviews. So your systematic review is your gold standard in evidence-based medicine.

Take all of the evidence and you grade it very rigidly to a very rigid framework. So Cass was built on its own stack of systematic reviews. Sweden did their own. Finland did their own. Canada—and I really do want to talk about what happened with the Canadian one—but Canada’s done one. Not our government.

It was an independent group that commissioned it, and Florida’s done one. The US Department of Health and Human Services have looked at all of them, and it is absolutely completely conclusive that there’s no evidence. There’s only low-quality evidence, low to very low quality evidence for adolescent gender medicine.

Plus as well, adolescent gender medicine intervening, medicalising, an adolescent identity requires that you actually take all of the good quality evidence that we have about adolescent development, and you throw it in the rubbish bin. If you know anything about adolescent development, you would never permanently medicalise an adolescent identity.

So, it’s not just that you don’t have any evidence to support the interventions, you also have to ignore all the existing evidence, that is very high quality, about adolescent development. But then beyond that for adults, you still don’t have any evidence. Nobody talks about this but there is no evidence for any aspect of this.

There’s no good quality randomised control trial or anything that looks like reliable evidence for any aspect of gender medicine. So Genspect goes further in that we advocate for a non-medical approach for everyone because that’s the safest way.

JK: This may be where I part ways. Look, adults go in for all kinds of dubious nonsense, all sorts of cosmetic surgeries, incredibly dubious pseudoscientific wellness treatments.

It’s typically legal. Except in extreme circumstances, it’s typically legal for adults to go in for all this stuff. You don’t think it should be illegal for an adult to take steps to pharmacologically or surgically transition themselves, do you?

MH:  Let’s draw the distinction there. I’m totally okay if you want to put it in cosmetic surgery. If you want to call it medicine, there’s got to be a diagnosis and it’s got to improve health and it’s got to heal. And none of those exist in gender medicine. If you want to put it in cosmetic surgery, which is where it belongs, then the taxpayer’s not covering it because we don’t pay for cosmetic surgery.

But at the same time. If you are advocating for that, then you should also certainly be okay with people having their legs chopped off if they want to be an [amputee, you should be okay with people being blinded if they want to be blind.

JK: I’m going to push back on that.

Look, we have all heard of extreme cases of people exhibiting persistent authentic gender distress from a very young age. It’s much more rare than you would think based on the spike in self-diagnosed gender dysphoria over the last decade or two, but there are cases where people do exhibit psychologically paralysing forms of gender dysphoria, and even in those extreme cases, you don’t think it qualifies as medicine? Because there are authentic seeming testimonials from people who describe having gender dysphoria that’s so acute that it can only be palliated by actually transitioning into a simulation of what the other sex looks like.

MH:  Again, let me break that down. So you said something interesting there. “People who have experienced debilitating gender dysphoria from a young age.” So the first thing you need to understand about that cohort—and they’re normally male, some of them female, but normally male

JK: Gay men.

MH:  Exactly. Those kids, almost all of them, will grow up to be gay. We know that from solid replicated studies long-term. That means you absolutely cannot do it to any kids because you can’t intervene, you can’t interfere until they’ve reached adulthood and they’ve settled into their homosexuality.

But then you’ve got another group, and that is the autogynephilic man. He was not effeminate as a child at all. He only started with his very strong desire to be a member of the opposite sex at puberty or a bit later when it’s an erotic desire. It’s a paraphilia, and that’s what’s driving him.

But what I’m saying is the men who want their legs amputated, it’s exactly the same motivation. They’re turned on by the fantasy of becoming an amputee. The men who want to become women, typically in middle age, they’re turned on by the fantasy of becoming women. So just for consistency, if you support this cosmetic intervention for the paraphilic men who want to become women, then you have to support the intervention for the paraphilic men who want to become amputees.

So it really becomes a question of medical ethics. There’s two camps on that one. It’s how do you define harm? There’s the Hippocratic definition where harm is cutting into a healthy body. Harm is inverting a healthy penis. Harm is chopping off a healthy leg.

But then the other camp is harm, is not fulfilling this man’s paraphilic desire because then he’ll suffer and he’ll constantly be unfulfilled sexually. And so you’ve got to cut off his body parts because he might try and do it himself and many of them do. And so it is a difficult, ethical question, but it should not be, I don’t think medicine should be, give me what I want or I will kill myself. I do not think medicine should be, give me what I want or I will take a chainsaw and chop off this body part.

Medicine should be, you should have a solid diagnosis. You should know exactly what you are treating. And if you are going to do something as extreme as inverting a penis or chopping off a leg, do your long-term studies. You show me these men, the outcome is better. Because the only long-term research we have in gender medicine, the suicide rate is outrageously high, ten years post-transition. There’s no evidence that these men are happy.

JK: Yeah. Although, to be fair to both sides is that people who are trans-identified in that way often have many psychological comorbidities that lend themselves to suicide with depression and trauma and OCD.

MH: That’s my other point. Gender medicine needs to go back into that direction. What has caused this person to want to be a member of the opposite sex and have his penis chopped off? Because you hit on something there.

There’s a lot of comorbidities. He may be autogynephilic and you need to help him with those sexual urges, but he may also be autistic and have collided with the belief that his social difficulties or his dislike of his life is because he’s trans and he may have adopted the trans identity for that reason. He may be depressed, he may be in a state of extreme vulnerability.

And this was the subject of my talk in Albuquerque that has drawn so much anger from trans activists, but people become all consumed by the idea that they are trans because that idea is loose in society.

JK: What was the term you used?

MH: It’s the extreme overvalued belief. It’s when one belief takes over your whole being. So a delusion is a false belief and it’s idiosyncratic. It’s unique to the individual. It’s bizarre. It’s strange. It’s, aliens are communicating with me through the radio type. Nobody else around you shares that belief. So you are in a psychosis there. You are delusional. An obsession is intrusive or unwanted thoughts that can actually result in really compulsive behaviours because it’s distressing to the individual.

And so they’ll do little ticks and everything just to try and alleviate. It’s very disturbing and distressing for the individual. That’s your obsession, and we all know that trans is neither one of those because it’s not idiosyncratic, it’s not individual. All of society believes that there’s such a thing as a transgender person.

It’s not distressing to the individual. They love their trans identities. They’re waving their flag. A psychiatrist came up with it in 1892, the overvalued idea, and I that better than the newer term, which is extreme overvalued belief. And it’s simply, there’s an idea or there’s a false belief that is loose in your society, but it takes on this enormous power. And certain individuals, and I will say the people who internalise this belief and become all-consumed by it, are by nature people who do not have a stable sense of self.

They are people in some sort of state of vulnerability, be it simply, they’re going through puberty, which is what we’re seeing now. They haven’t yet figured out who they are and they collide with this false belief that is loose in society, which I define as just being “trans is natural and healthy.”

These kids are not identifying as having gender dysphoria. They’re not identifying as having some obscure mental illness. They’re identifying as trans, a category of person that we have elevated and we celebrate and we applaud.

JK: It’s like a new form of human existence that transcends the laws of biology. It’s like an exalted form of being.

MH: Absolutely and it’s very fashionable. It’s a fad. I know that sounds offensive to some people, but it is. The belief that trans is natural and healthy is dangerous because that means when the trans-identified person shows up for support, medical, mental health or whatever, they are viewed as being this new type of human being. And if it’s natural and healthy, why would you try and do psychotherapy to help the person not to be trans?

You wouldn’t do that because that’s “conversion therapy” in this whole new belief framework. And so because you can’t help the person not be trans, you can’t help the person overcome the belief that has all-consumed them. The only thing you can do is offer them puberty blockers, hormones, and surgeries, and so that’s why this particular belief is especially dangerous.

It draws the kids in. They identify as this new category of human being, and it’s all fun and exciting and it feels very real to them. But the medical world is also completely absorbed by this belief, completely all-consumed. So when the kid shows up, they just see a trans person and only thing they can do for that person is medicalise their bodies.

JK: I’ve spoken to trans people who describe gender dysphoria as very debilitating. That’s why sometimes the term I use is that it should be regarded as a challenge or an affliction. Do you think it’s helpful to talk about it as a mental illness? I’m not sure that’s helpful language if you’re trying to, again, steer mainstream views toward a more sensible direction. Because if you call something a mental illness, you’re feeding into the paranoid streak that exists within some of these activist movements where it’s like, aha, they want to send us to asylums. They want to treat us as if we were schizophrenic.

Unfortunately, there’s some overlap with schizophrenia. But putting that aside, isn’t it just undiplomatic to use terms like mental illness?

MH:  I’ve been facing this allegation all day, since my talk. First of all, that shows anyone who looks at it that way shows that they are prejudiced towards the mentally ill,

JK: Come on. Really? The stigma associated with that term is real. It’s a stigmatic term. You can see that, no?  

MH: But I have people near and dear to me with serious mental illness, and I do not think less of them for it. And I also know that if we denied the existence of their mental illness and pretended that they were perfectly healthy and did not get them the care that they needed, their life would be much, much worse.

The truth matters.

JK: That’s not what I’m arguing about. I’m not saying we should ignore the fact that they have a mentally rooted affliction or challenge. I’m just saying, I know people who have mental health challenges, but they wouldn’t be happy if I said, oh, you’re mentally ill. That term has an edge to it.

MH: There’s a difference between saying bipolar is a mental illness and saying directly to a person who has bipolar, you are mentally ill. So what I’m saying is identifying as a member of the opposite sex, believing yourself to be a member of the opposite sex, going so far as to have healthy, functioning body parts removed so that you turn yourself into a lifelong medical patient is not a sign of good mental health. It is a mental illness, and we need to restore clarity to this discussion. Because you can’t help these people if you are pretending that they are an entirely new category of human being, totally healthy and no mental health issues whatsoever.

JK: Yeah. I agree with that latter part.

But during your speech, you gave a very interesting historical account of how gender dysphoria as the term came to be known, was not so long ago seen as a sign of mental distress. It was seen as a sign that you were mentally unwell and that you needed help. You gave a chronology basically explaining how activists beginning in the 2010s, if I’m not mistaken, successfully lobbied to take away the stigma behind gender dysphoria, and then maybe they succeeded beyond their wildest imagination. They turned it into a kind of exalted state. If you’re not trans, you’re a muggle, and if you are trans, you’re a wizard and you have this sacred queer wisdom and stuff.

The whole thing became very weird. So I’m totally with you on how that transition hasn’t been healthy. But then in your speech you said, in this respect, you were speaking in your capacity as one of the Genspect hosts, you were saying, we need to repsychopathologise gender dysphoria. And as soon as I heard that, I was like, ooh, that’s not going to go over well.

When the average person hears, we need to repsychopathologise gender dysphoria, all they’re going to hear is the word psycho and say, wait. Mia Hughes and her friends, they’re calling trans people psychos from a political point of view and all activism is political. Isn’t that a little bit maladroit?

MH: Okay, so first of all, it is just the reversal of depsychopathologisation. In 2010, WPATH depsychopathologised, and that was what triggered this entire epidemic. In 2007, WPATH changed from the Harry Benjamin International Gender Dysphoria Association to WPATH. They had a rebrand and they went full on political from that point on. They were always dodgy and political anyway, but they went full political, just, it’s a trans activist organisation and they just like setting standards of care for an entire field of medicine. In 2010, so they’ve got a non-medical person at the helm, a woman who thinks she’s a man, Stephen Whittle, and she’s non-medical, she’s a human rights lawyer or something like that, and hardcore trans activist, and they launched their depsychopathologisation campaign.

JK: D like David.

MH: Depsychopathologisation. You can read the statement on their website. There is no science, there’s no evidence, there’s no research. It’s a political statement saying trans is natural and healthy and it’s discrimination to say otherwise. And then they march forward.

And from that point on, you cannot help a trans-identified person because if you try and do ethical psychotherapy, that’s conversion therapy because trans is natural and healthy. It’s just like gay.

JK: Wait, we’re skipping steps here. Ethical psychotherapy, meaning you sit the person down and say, when did you start feeling this way?

What else was going on in your life? Let’s talk about trauma. Let’s talk about maybe repressed homosexual feelings. That’s what you mean by ethical treatment, yes?

MH:  Yes. Find out what has caused this person to believe themselves to be trans and to seek medical intervention because it’s not a natural, healthy state.

That’s the whole point of everything I’m saying. It’s not natural, it’s not healthy. Something has happened in this person’s life that has caused them to come to this conclusion. And WPATH forbid any psychotherapeutic intervention when they depsychopathologised. The goal of depsychopathologisation was to open the door to medicalisation on demand for anyone who wants it.

That was the goal. And because bear in mind, WPATH starting around 2009, late 90s to the early 2000s, they just start to be overrun by trans-identified people who are activists, who have a very rigid: “Hormones and surgeries is a human right. It is a violation of my human rights to deny it.”

Then they go into this depsychopathologisation, but bear in mind this is 2010, we don’t yet have the social contagion, so they depsychopathologise. They open up no safeguarding, just mass medicalisation for whoever wants it. But we don’t yet have the social contagion that started in 2014, 2015.

JK: And that’s when the adolescent girls started to come in.

MH: Adolescent girls get sucked into the vortex.

But WPATH has dismantled all of the guardrails because trans is natural and healthy. And the reason that the girls all got sucked in is because WPATH and trans activists push this idea that trans is natural and healthy. They put these celebrities on the cover of magazines and they celebrate it all.

JK: Do you think WPATH maybe unleashed a monster that even they didn’t know they were doing, in the sense that back in 2010, the main drivers of this phenomenon were autogynephilic men? There’s a stigma against autogynephilia, the idea of being attracted to yourself as a woman. Think of it as a fetish.

And to be fair, I think people are demeaned as transvestites and all, they’re the subject of mockery and all that kind of thing. And so you can understand how they would advance a movement and say no, this is a natural thing and it’s fine. And that was in 2010.

Then, of course, social media came along and this depsychopathologisation process that had been unleashed was right there waiting to trap thirteen, fourteen, fifteen-year-old girls, who spent their whole day looking at Instagram, depressed, thinking, I don’t look like these cheerleaders. I guess I’m really a boy. That’s what happened.

MH:  I agree. I do not for a moment think anyone had this grand plan to dismantle all the guardrails and then trigger deliberately a social contagion. Yeah. The autogynephilic men, all they want is access to the hormones and surgeries. So they dismantle all the guardrails. They redefine being trans, get rid of any mention of paraphilia.

No mention of mental illness, no mention of sexual deviancy. Just a nice, healthy identity and we’ll just destroy anyone who disagrees, to make sure everyone goes along with it. They go on this enormous, very successful media campaign. 2014 Laverne Cox on the cover of Time Magazine, “The Transgender Tipping Point, America’s Next Civil Rights Frontier.”

And then we’re off. There’s trans celebrities everywhere and we’re celebrating them. It’s the equivalent of putting anorexic people on the cover of magazines and celebrating them for their bravery for being so thin and then triggering a social contagion of anorexia in adolescent girls.

JK: There’s a lot of people who are conservative and were very careful about criticising transgender activism for years, maybe until now, because they were wary of what had happened with gay marriage.

They saw that many conservatives had been on the wrong side of the gay marriage issue. And they didn’t want a repeat of that. And then you had this Time Magazine thing that says, “the next civil rights frontier.” Who wants to be on the wrong side of the next civil rights frontier?

It’ll be like being a segregationist in 1950 and people looking back at you and saying, oh my God, what a racist. But then that goes to this paradox, which is that when we accepted gay marriage—because in Canada, gay marriage has been around for twenty years. I don’t even know any conservatives who oppose gay marriage at this point.

Gay marriage didn’t require scalpels, it didn’t require drugs. It didn’t require new names. It didn’t require secret forms that your school had to sign. It was just like, my name’s Dave and I want to marry Joe. Can I do that? It’s like, yep. That’s what gay marriage became. How do activists, WPATH, what have you, how do they reconcile this idea that yes, being trans is natural and healthy, which is exactly why you have to go on this lifelong regime of high-tech pharmacological products?

Sterilise yourself. Chop off the following body parts. Shave off your Adam’s apple, change your voice, change your hands. Even if you were on the side of transgender rights, you take a maximalist view of trans rights, that doesn’t make any sense.

Either it’s an affliction that has to be medicalised. And I get that. There’s lots of afflictions that have to be medicalised. Or it’s this amazing natural thing and you don’t have to do anything because you can say, my name’s Dave and I’m a woman, deal with it. And you’re like, okay, that’s fine. See you on Monday. As opposed to having to sterilise yourself and spend the rest of your life on drugs. To me that doesn’t signify something that’s natural.

MH: But you hit on it perfectly. Yeah, you’re right. It’s a perfectly natural, healthy state of being that just so happens to require lifelong medical intervention, all sorts of crazy surgeries, and voice training and everything. It’s completely illogical.

It makes no sense at all, but you hit on it. People went along with it because they did a remarkable job. They made it look exactly like gay rights. They’ve got the slogans, they’ve got the rainbow flags.

JK: Oh, I got sucked into that. I believed it. I totally believed it until I saw men start to say, yes, I can actually play female sports because I’m actually a woman.

I remember thinking, yeah, good for these trans people. It wasn’t until well into the 2010s when you actually saw Leah Thomas types. I remember thinking, wait a sec. We all know you’re not actually a woman. We’re just trying to be polite, but you think you’re actually a woman who gets to play in female sports? I didn’t sign up for that. That to me was the moment.

MH: The moment that I learned that we actually were supposed to believe trans women were women, that’s when I stopped pretending to believe it. I didn’t know we were supposed to believe they were literally women. That’s just stupid.

But just to your point though, because it looked like gay rights, because they took over the LGB charity infrastructure after gay rights was won. They’re looking for a new funding source, Egale, Stonewall, HRC, all of the big ones.

JK: ACLU.

MH: ACLU was less gay rights. I’m talking the actual gay rights charities that existed for decades and fought an amazing fight.

JK: Once gay marriage became a thing, it became an easy target, right? Because.

MH: Well, they won, right? Yeah. So then it’s either close up shop or find a new campaign and a new funding source.

Because they are businesses in essence, they’ve got employees and everything. So trans rights took over the entire infrastructure of the gay rights charities and then they made it look exactly like gay rights with the flags and the slogans and the everything, And you’re right, there’s a clear right side of history with gay rights.

And so nobody wanted to get caught on the wrong side of trans rights. I was reading about the Satanic panic because I was obsessed with the Satanic panic once. In the 1980s, people thought that there was a Satanic cult network operating in American daycares.

JK: Yeah.

MH: Daycares. They thought these grandmas were raping babies in the daycare and sacrificing infants. It was complete nonsense.

JK: And five-year-olds and six-year-olds were being brainwashed and saying, oh yes, it’s true that I saw this Satanic ritual abuse.

MH: People went to prison. People did long prison sentences.

But there was an interview long after it was over. I think the article came out in 2010 or something. An article came out and then all of the big members, the psychiatrists who unleashed this insanity on people were commenting on this one article. And one of the leading figures in the Satanic panic said, “I believed in these satanic cults because I was alive during the Holocaust and in the United States, we were told that the Holocaust was happening and we didn’t believe it.” And there was this enormous guilt that people did not believe the Holocaust was happening, unimaginable evil. That’s why he believed in the Satanic cults, because that’s another unimaginable evil. They felt guilt for not believing in the Holocaust and that propelled him into believing something completely absurd.

And so I can’t help but think that there’s an element of that. The medical world feels bad about how gay people were treated, conversion therapy and all the rest. Society feels bad about how gay people were persecuted. So this new rights movement comes along.

JK: We get a redo. We get a new chance to be on the right side.

MH: We get a chance to get it right this time. And what we actually end up doing, the darkest of ironies, we actually end up supporting the new conversion therapy because most of these kids would, certainly in the beginning, before the real social contagion launched, most of the kids would’ve just grown up to be healthy, whole, homosexual adults if we had just let them make it through into adulthood.

JK: Have you had any pushback from your colleagues at Genspect about the language you used in that speech? Do you regret using that language? Do you think maybe you should have said something softer?

MH: I personally do not regret it. I’ve spent a very long time thinking about this. And I will say, I just think the time for tiptoeing around is gone. It was gone a long time ago. We’ve got kids missing body parts. We’ve got healthy children being sucked into something truly dreadful. We’ve tiptoed around it and we’re like, we better watch our language.

JK: I’m like that. I’m totally like that. I’m like that because I’m a real Canadian. You’re not a real Canadian because you come from England.

MH:  I’m not a real Canadian and honest to goodness, stop pussyfooting around them. I don’t care if I’ve offended trans activists. I literally don’t care because kids are being harmed. They’re doing terrible harm to innocent young people.

And yes, it is a mental illness. They forbid us from saying it for so long. I lost so many Twitter accounts for even implying that it was a mental illness in the pre-Elon days. It was the worst crime you could possibly commit. And so I’ve decided enough,

JK: People like you and me, we run Twitter now.

MH: I know. So fun.

JK: Yeah, it’s fun. But because all the genderwangers gone off to Blue Mastodon or whatever it’s called. But with great power comes great responsibility. I always think my first question is, how can we get this crap over with? How can we go back to a rational world where gender dysphoria was rare, responsibly treated, dealt with in a humane way and an honest way?

And to me, the quickest path to that is to use language that invites people back to the world of common sense, as opposed to getting their backs up.

MH:  I’m never going to please trans activists, and I don’t even try. I don’t care how they react. I don’t care how they feel. I just don’t care. That doesn’t mean I hate transgender people. It just means the movement itself is poison.

JK: Alright, so Mia Hughes is officially the bad cop of the TERF movement and I’m campaigning to be the good cop. Deal with me or I’ll send Mia after you. But speaking of your badass activism, I want to end with Gordon Guyatt. I confess, this is a name I did not know until a couple weeks ago.

He is an eminent researcher at McMaster University in Hamilton, Ontario, which is just about an hour and a half west of my home in Toronto. Made his name several decades ago, as I think what is considered to be the father of something called evidence-based medicine. And you touched on this earlier, evidence-based medicine, the idea that instead of just applying hunches or traditional practices or rules of thumb to medical diagnosis and treatment, you do rigorous studies of what works and what doesn’t. As you said, weighting studies according to their evidentiary value and taking a really rigorous approach to medicine and to health in general. And the backstory here is that in keeping with that evidence-based mission, him and some of his more junior colleagues at McMaster, they receive funding. That’s a whole subplot, which we don’t have to get into, looking at how good is the evidence for so-called gender-affirming care. And they broke it down to social affirmation, breast binders, the various steps along the course that kids take, puberty blockers, hormones, surgical interventions, that sort of thing. And they were going to apply their evidence-based lens to that.

And then the whole thing blew up because the idea was, oh my God, you’re questioning affirmation and you’re taking money from this other group, the SEGM that had been falsely attacked by the Southern Poverty Law Center as a hate group and all. Anyway, Canadian universities are where American universities were five years ago in terms of the politics. And this very embarrassing letter was written and it had Gordon Guyatt’s signature on it. It clearly hadn’t been written by him. It was a kind of renunciation of the idea, of the mere suggestion that affirmation was the wrong approach. It was full of slogans. It read as if it had been written at gunpoint, like it was one of these Soviet-style ideological concessions.

MH:  That’s what I said. It’s like a hostage note.

JK: Jesse Singal, who’s been on this beat for years, he wrote an article about it. I wrote an article about it. But you trumped everyone. We’re going to play a clip of it here. My jaw hit the floor. On your podcast, Gordon Guyatt who, once this thing hit, he didn’t seem to be giving interviews to anybody. He had pissed off all the trans activists, but he’d also pissed off people like me who were like, what are you doing? You’re destroying your reputation by renouncing evidence-based medicine in this one narrow context under pressure from activists.

And then in the middle of this, he gets on a video call with you. Tell us what happened on this call, because it was just crazy.

MH:  Yeah, so just to be clear, I set up the interview in May, and it happened on September 8th. So what you are just talking about blew up in August.

JK: The timing was good luck.

MH: The stars were aligned, right? But I will say, I can’t believe he showed up. But anyway, so he shows up. We clearly don’t agree and it’s getting a bit hostile and I found him, frankly, quite rude to me. But then we get towards the end, and it’s my final question in the podcast, and I ask him about this statement …

JK: This letter with his signature on it.

MH:  The McMaster statement. They make a statement because they found only very low to low quality evidence for mastectomies.

JK: Their plan was they were going to produce, I don’t know, three, four, or five papers. They have published at least two of them.

MH:  They published three. They published puberty blockers, hormones, and mastectomies for under 25s.

JK: And as consistent with what we already know, it said there’s little to no evidence that any of this produces good outcomes for gender distress.

MH: Right. So there’s little to no evidence, which means when he signed a statement, he basically, the statement said, Danielle Smith’s ban on puberty blockers on these treatments is unconscionable.

JK: Smith is the premier of Alberta, which is a Canadian province.

MH: It’s the only Canadian province that’s taken any steps to shield these kids from this scandal. And he called that ban unconscionable or the McMaster statement with his name on it called the ban unconscionable.

I must have read the statement fifty times before I interviewed him. My eyes lingered every time on the words “medically necessary.” He says, though, they’ve made a donation to Egale Canada to support their legal efforts aimed at ensuring medically necessary care for gender diverse youth continues in Canada.

So he gave money to Egale, who is trying to overturn Danielle Smith’s ban.

JK: So the money was a kind of penitence, right? For having done research that questions the wisdom of gender affirmation, right?

MH:  So “medically necessary,” these are the two key words. So I’m like, how can he call it medically necessary when he knows that there’s no good quality evidence to show that there’s benefits?

It’s not medically necessary unless you know that it actually benefits the patient group.

JK: It’s politically necessary.

MH: Okay, so I say to him. It’s my final question and I say, “I find it very strange that you signed a statement calling these treatments ‘medically necessary,’” and he just starts shouting at me.

He says, “What? That’s ridiculous. You are wrong. If you can find the words ‘medically necessary’ in my statement, I’ll have to jump off a bridge.” So then I pull up the statement, I read the paragraph with the words medically necessary, and he says, “Huh. I didn’t read that part. I didn’t write that part. That’s clearly not the part that I wrote. Why aren’t you focusing on the part that I wrote?”

JK: Just for the record, you have not tried to enforce his representation that he would jump off a bridge in these circumstances. We wish him well and we know that was just a figure of speech. Life is worth living. Don’t jump off a bridge.

MH: Don’t do it.

JK: I want to be abundantly clear. We don’t want to delete anyone’s existence.

MH: Hey, it’s his words. It’s not mine. I’m not saying he needs to go and do that. He said that.

JK: if we can reconstruct events, I’m guessing Gordon Guyatt has 150 different research projects going on. He is a complete nerd. He doesn’t have time for public relations. This whole thing is a distraction.

And a bunch of blue hairs come to him and say, oh my God, we’ve pissed off the Hamilton area transgender community. What are we going to do? We have to put out a statement. And he’s like, he’s working on some of the project and says yeah, whatever. And they said can we put your signature on it?

And he said, yeah, if it’ll make the problem go away, that’s fine. I guess one scandal is that he was pressured to disown his own research. The other scandal is that he didn’t even read this document, I guess it’s a backhanded compliment. Although both of those things are shameful, it excuses the idea that he actually meant what was in the letter. Had he chosen the words, he wouldn’t have used the terms “medically necessary.”

So in a way, he was implicitly renouncing that term. Is that accurate?

MH: Very much so. Obviously, he’s just completely destroyed Egale’s case that they’re now launching against Alberta, but it’s inexcusable to me. It’s appalling cowardice. And honestly, is there not one thing that we all learn in the school yard and that’s don’t show weakness to bullies?

So this giant in the field of medicine, one of the most renowned centres for systematic reviews in the world because it is the birthplace of evidence-based medicine. They conduct the reviews. There is nothing wrong with the reviews. They follow all of the scientific process as they should. Why didn’t they just tell trans activists where to shove it?

And the thing is, he told Jesse Singal, after they published that garbage statement that he didn’t even bother to read, he told Jesse Singal, that the local trans activists were, and I quote, “in ecstasy over that statement.” So he basically thinks his cowardice had appeased them and the whole thing was over.

But honest to God, do we not learn in school that you do not show weakness to bullies? Of course, they’re not happy. Now they’ve launched an open letter. They’re demanding the retraction of those systematic reviews that took years, there’s nothing wrong with them, and they cost an awful lot of money. These insane trans activists, and it’s signed by at least thirty faculty at McMaster.

Hundreds of trans activists are demanding a retraction of the systematic reviews. So that pathetic act of cowardice hasn’t even ended the aggression and the harassment and the bullying because you don’t show weakness to bullies.

JK: So when’s your next interview with Gordon Guyatt? Next week?

MH: I don’t think he’s going to show up again. If I tried it again, I doubt he would show up.

JK: Well Gordon, you’re always welcome on this podcast in the unlikely event you’re listening. Anglo-Canadian activist and gender-critical bad cop Mia Hughes, thank you so much for being on the Quillette Podcast.

MH:  Thank you so much for having me.