The Hidden Case of Ewan Forbes:

Sexology, Law, and the Lost

Generation of Trans Lives
1962-1996
Zoë Playdon
Emeritus Professor of Medical Humanities
University of London
 WARNING

THIS PRESENTATION CONTAINS

DESCRIPTIONS OF
INSTITUTIONALISED VIOLENCE
AGAINST TRANS PEOPLE
 Key Take-Aways
• Until 1970, UK trans people were able to self-identify, access elective
affirmative medical care, correct their natal Birth Certificates, and live
in complete legal equality.
• After 1970, UK trans people’s civil liberties were removed, they were
socially ostracised, and subjected to a brutal NHS regime that
included compulsory sterilisation.
• Change only came about in 1996 when a trans woman defeated the
UK government in the European Court of Justice.
• For thirty years, UK trans people were subject to combined legal
exclusion, social ostracism, and biological eradication
 Four Questions

• How did this happen?

• Why does almost no-one know it happened?

• What was its impact on NHS trans healthcare?

• Where are we today?

Richard von Krafft-Ebing
 First Trans Diagnostic Criteria
• Cases 129 and 130:
Diagnostic criteria for ‘Metamorphosis Sexualis without Paranoia’ provided by
Typical Patient Narrative of a trans woman and a trans man, both anonymised.
• Law of the Sexual Homologous Development:
‘The tendency of nature in the present stage of evolution is the reproduction of
monosexual individuals, and the law of experience teaches that cerebral centre is
normally developed which corresponds with the sexual glands’ (p. 345)
• Guidelines:
Being trans a natural variation of sex development, endocrinologically based, and
to be supported medically provided heteronormative behaviour is present.
 ‘First Wave’ trans activism:
production of ‘true story’ narrative
as survival guide for other trans people
Lili Elbe, Paris, 1926
 Childhood Diagnostic Criteria
Krafft-Ebing Lili Elbe
Appearance Appearance
Very pretty as a little child with blonde locks and I had long, fair locks, snow-white skin . . . Strangers
transparent skin often took me for a girl
Deportment Deportment
Very obedient, quiet and modest Mother loved to dress me up
Socialisation Socialisation
Preferred playing with girls who treated me as a girl Played with eleven girls
Preferences Preferences
Developed a taste for beautiful clothing Cleverest of all children in knitting and embroidery
Personal and Perceived Identity Personal and Perceived Identity
At the age of twelve or thirteen I had a definite As an eight-year-old my two brothers often
feeling of preferring to be a young lady bantered me for my ‘girl’s voice’
Schoolmates gave a girl, who had exactly my A girl put her hat on my head for fun. ‘Doesn’t he
features, my name and me hers look like a proper girl?’ she cried.
 L: Hirschfeld’s
Institute for Sexual Sciences,
Berlin 1919

R: Nazis burn books,

including those taken
from Hirschfeld’s Institute,
Berlin 10 May 1933
Mark Weston, 1936
Born 1912 to Forbes-Sempill aristocratic
Aberdeenshire family

Self-identified, affirmative medical care

as a child

Attended Aberdeen medical school and

became local GP

1952 corrected Birth Certificate to marry

1965 next in line for primogeniture

baronetcy Ewan Forbes, Aberdeen Medical School
Yearbook, 1944
New York, 1968 Yale University Press, 1987
Dr Harry Benjamin, 1885-1986
Dr Richard Green and Professor John Money
 University of Southern California Digital Library
https://digitallibrary.usc.edu/CS.aspx?VP3=DamView&VBID=2A3BXZ8L5OHN4&SMLS=1&RW=1596&RH=1236
Dr John Randell, Head of NHS Charing
Cross Gender Identity Clinic, defined its
purpose as to ‘breed out of our
inheritance those with psychopathic and
adverse genetic propensities . . . Some
form of eugenics, in fact.’ (p. 146)

Charing Cross
Hospital, Strand,
London
 Consequences for Ewan

• Ewan was medically classified as ‘intersex’ when he corrected his birth

certificate and married
• Mid-1950s, US psychiatrists lobbied to reclassify it as mental illness
• 1962 UCLA first Gender Identity Clinic ‘cures’ gay men, lesbians, and
trans people with conversion practices
• 1969 First International Symposium on Gender Identity takes over and
centralises NHS services at Charing Cross Hospital
• Ewan now medically reclassifiable as floridly psychotic lesbian
 Daily Mirror
Aberdeen Press and Journal 31 December 1965 p 1
Guardian, 31 December 1965,
4 January 1966 p. 1
p. 1
• Blackmail, family betrayal, a
secret letter, sudden death
• Ewan falsifies medical evidence
for court
• The judge speaks out against
‘certain trans-sexuals’ who ‘bring
disastrous consequences’
• Ewan gains his primogeniture
baronetcy, creating a
constitutional crisis
• Court records removed and
everyone involved sworn to
secrecy: ‘some interests are more
important to protect than the
Ewan and his wife, Patty, 1960s
rights of individuals’
Arthur Corbett, heir to Lord Rowallan, with April Ashley Lord Justice Roger Ormrod
 April’s Show-Trial
• April hadn’t corrected her birth certificate so no legal marriage in
existence
• Talbot v Talbot, a similar but non-aristocratic case dismissed out of
hand by same judge because no legal marriage in existence
• April’s case given seventeen days in court
• Series of medical tests ordered by judge, focussing especially on
April’s vagina. Results he didn’t like had to be done again
• Invented a legal definition of sex which suppressed senior medical
and scientific opinion and determined future clinical practice
 Legally-imposed Clinical Guidelines

• ‘Psychological sex’, decisive for Ewan, is rejected

• Trans people redefined as mentally ill homosexuals
• April ‘a pastiche of femininity’ – masquerade trope
• Shoulders wider than hips
• Genital obsession:
• Vagina moistened by sweat glands
• Three-finger test for vaginal size
• Perineal length distinguishes vaginal
intercourse from pseudo-anal intercourse
• New, factitious criteria for determining sex:
• Chromosomes
• External genitalia
• Gonads
• Decision became an international ‘super-precedent’
 Consequences:
Trans lives 1970 - 1996

• Birth certificates no longer able to be corrected

• Can’t marry or adopt
• No employment rights – the Institute of Personnel Management
advised immediate dismissal of trans employees
• Sent to wrong sex prison
• Private medical history on display to administrators
• Driving licences secretly coded
• Deadnamed and misgendered on key documentation
‘Second Wave’ Trans Activism
Self-Help Association for Transsexuals, 1980
 Consequences:
Trans Pseudo-medicine
• New NHS psychiatric-led, centralised, abusive medical regime
• Unregulated and arbitrary: patients ‘earned’ medical care by compliance with all
and any demands from psychiatrists
• Effectively a system of conversion practices
• Patients rejected for not having paid employment, not being obedient enough, not
being ‘feminine’ or ‘masculine’ enough
• Access to essential medicines conditional on agreeing to sterilisation because
mentally ill:
‘I ……………. of ……………… do consent to undergo the removal of the male genital organs
and fashioning of an artificial vagina as explained to me by ……………. (surgeon). I
understand that it will not alter my male sex and that it is being done to prevent a
deterioration in my mental health.’
1930s Germany
1990s UK

1950s US
 1979
International
Gender
Symposium
replaced by
HBIGDA
(now WPATH)
© Alex Coombs
Trans History: From Ancient Times
to the Present Day (2025)
 BBC iPlayer, A Change of Sex, 1980, 1994 and 1998
‘the extraordinary attitude of the medical profession . . .Julia’s NHS psychiatrist appeared
to wield absolute power over her future . . . like a Soviet commissar explaining that
patients existed to serve the health needs of the State, not vice versa’
Richard Last, ‘Stepping Out of Line’, Daily Telegraph, 17 October 1980, p. 15.
 Consequences:
Trans Exclusion
• Extensive social ostracism:
• Expect to lose friends and family
• Expect to be expelled from your church, your clubs, your sports
• Expect to have to move house and change your job
• Always conceal your past and monitor your conversation
• Always avoid police and all interactions with officialdom
• Humiliating interactions with officialdom
• Combination of legal exclusion, medical sterilisation, and social ostracism
constitutes genocide: biological and cultural extermination
• No record of number of trans people who survived this regime – not part
of the public health record
 The Wednesbury Test
• Legal standard of ‘unreasonableness’: so unreasonable that no
reasonable person acting reasonably could have made it
• Not unreasonable for an employer to follow guidelines of the
Institute of Personnel Management
• Not unreasonable for an employer to seek to protect employees
from predatory, masquerading, psychotic trans people
• Not unreasonable for an employer to seek to protect customers
from interactions with such people
• Not unreasonable for an employer to argue that employing such a
person would compromise their business effectiveness
 ‘Equal Misery’ Argument
• Sex Discrimination Act 1975 demanded equal treatment in
employment for men and women
• Legally, if an employer would dismiss both trans men and trans
women, that was considered equal treatment: they were equally
dismissed and equally miserable
• Discrimination required a ‘third party comparator’: a trans man doing
the same job for the same organisation who was treated more
favourably i.e. not dismissed for being trans
• Deemed unchallengeable – if a ‘third party’ did exist, the employer
just had to dismiss them too, to achieve ‘equality’
‘Third Wave’ Trans Activism

Professor Stephen Whittle

 1996 P v S and Cornwall County Council
• P’s CEO, S, offers a massively improved contract, then dismisses her
when he discovers she is trans and completing ‘transition’ that year
• P creates new argument: instead of the required ‘third party
comparator’ she compares her situation before and after S realised
she was trans
• No UK law to support this but European Equal Treatment Directive
might: have to try and succeed at ‘domestic remedies’ first
• P wins in Industrial Tribunal in 1993 and case referred to ECJ
• P wins in European Court of Justice 1 May 1996
European Court of Justice, 1996

Advocate General Tesauro:

‘what is at stake is a universal fundamental

value, indelibly etched in modern legal
traditions and in the constitutions of the
more advanced countries: the irrelevance of
a person’s sex with regard to the rules
regulating relations in society'
Gender Identity Research & Education
Society

Terry Reed OBE and Bernard Reed OBE

Chessington World of Adventures v Reed

[1997] IRLR 556, EAT
https://shorturl.at/enEH7
 Progress 1996 - 2019
• 1996 P v S and Cornwall County Council
• 1996 R v Registrar General for England and Wales
• 1999 A, D and G v North West Lancs Health Authority
• 2002 Goodwin v United Kingdom
• 2002 UK government formally recognises that being trans is not a mental illness
• 2004 Gender Recognition Act
• 2008 Trans: A practical guide for the NHS
• 2010 Equality Act
• 2012 Trans and intersex people: Discrimination on the grounds of sex, gender identity, and gender
expression
• 2016 Women and Equalities Committee, Transgender Equality Report
• 2018 UK LGBT Action Plan
• 2019 Consultation on GRA reform
 2013 #Transdocfail
• Doctor told me gay trans men don't exist. I am one. And this guy gives interviews in
the press.

• My voice therapist wanted my old name. I think she wanted to refer to <oldname>'s
voice. Kept talking about how "real women" speak

• At a psychiatric assessment: "you can do what you want to your body, but you'll
always know you're not *really* a woman

• Got told off by CHx for not presenting as feminine enough when wearing jeans the Dr.
was female and also wearing jeans West London Mental Health NHS Trust Gender
Identity Clinic.
 Trans Healthcare Today
• 2019 World Health Organisation relocates trans from ‘Mental and
Behavioural Disorders’ to ‘Sexual Health’.
• 2019 New NHS Service Specifications: Gender Identity Services for
Adults
• 2023 New Interim Service Specification for Specialist Gender
Incongruence Services for Children and Adolescents
• Current healthcare guidelines from GMC, BMA, and Royal Colleges for
Paediatrics; General Practice; and Obstetrics and Gynaecology
• Royal College of Physicians provides three Certificates to credentialise
GIC workers
 NHS England Adult Waiting Times
• London: 60 months Exeter: 87 months Leeds: 57 months
• Sheffield: 62 months Northants: 53 months
• London Waiting List December 2023:
• Number on waiting list: 14,491
• Number of referrals received in the month: 156
• Number of first appointments offered in the month: 33
• Total appointments offered in the month: 711
• November 2022: High Court challenge to waiting times on grounds of
discrimination failed
• July 2023: Permission to challenge decision refused
 Child and Adolescent Services
• Tavistock Clinic effectively closed following Cass Review Interim Report
February 2022
• Referrals 2021: 2,401; 2022 3585
• Around 1,000 being seen patients at closure
• No new appointments and no statistics for current demand
• Waiting lists now estimated at 5 – 6 years
• Puberty blockers to be prescribed only as ‘part of a formal research
framework’
• Accessing HRT or blockers from private providers may result in GPs
invoking safeguarding procedures
 CP-182 Patient Visits GP for help
New Welsh Gender
Identity Care Pathway GP refers direct to Welsh © Jenny-Anne Bishop
2020 Gender Service in Cardiff
Black: Main Pathway
Blue: Secondary Pathways
Welsh Gender Service
(WGS)
WGS = Welsh Gender Service (Cardiff)

LGT = Local Multi-disciplinary Gender

Team inc. Prescribing GP
Triages Patient
DES = Direct Enhanced Service
(GP Hormone Prescribing)

Adds Patient to waiting list

c. 12-15 Months (2023)

1st Assessment and Blood Tests

2nd / 3rd Follow-up & Blood Tests Referral to

at 3-6 month Intervals NHS England
providers for those
wanting Surgery
Referral to Local Gender Team (LGT)
for those wanting Hormones
LGT GP Prescribes, monitors and Stabilises
Hormones for c.1year

Discharge to Local GP Enhanced Service (DES/ LES) for lifelong Hormone

prescribing & monitoring + Lifespan Trans Health Care- Screening, DEXA Scans,
Cotraception, fertility, sexual health, etc.
Hub and Spoke Model
LGT = Local Gender Team

DES = Directed Enhanced

(Hormone) Service

Local Gender Teams:

HB1 = BCUHB
HB2 = C&VUHB
HB3 = ABUHB
HB4 = Powys UHB
HB5 = Swansea Bay UHB
HB6 = HDUHB
HB7 = Cwm Taf MUHB

© Jenny-Anne Bishop
 Primary Care Guidelines
• Trans people are entitled to high-quality healthcare
• But have worse health outcomes and experiences
of healthcare than cis patients
• Diagnostic overshadowing common
• Right to privacy, dignity, and confidentiality
• Illegal to share patient’s trans status without
their informed consent
• Require informed consent to enter trans status on
patient’s medical records
• Must prescribe when required by secondary or
tertiary medicine
• Professional misconduct to deadname or
misgender a trans patient
 End of Life Issues
• Will they be treated as their real sex?
• Will they be called by their real name?
• Will they be penalized for being trans?
• Will an undertaker or register office deny them their real sex and name?
• Will hostile family members take over their care or be the only people allowed
access?
• Will they be abused by patients, doctors, staff?
• Will they be treated as mentally ill?
• Will their privacy be breached?
• Will their body be a ‘freak show’ (i.e. cis obsession with trans genitalia)?
 End of Life Experiences
• Refused HRT been taking for decades
• Not allowed to dress or groom as wish
• Abuse from other patients/ residents
• Carers refuse to bathe
• Carers refuse to touch
• Expected to teach carers about being trans
• Deadnamed and misgendered at burial
• Sexual, financial, emotional, physical abuse and exploitation
• Planned, concealed self-euthenasia
 Trans Human Rights Today
• Succession to the Crown Act 2013: primogeniture removed from monarchy
• 2013 – 2020 six Bills to end primogeniture entirely all failed
• By 2018, new anti-trans-equality groups, operating with media lobbying ‘terf’, ‘gender
critical’, ‘biological feminist’ ideologies
• Coalition of creationists and conspiracy theorists: manufacturing doubt, trolling, pile-on;
slurs of masquerade, sexual predation and ‘infection’
• July 2019 LGBT Action Plan shelved by new Prime Minister
• 2020 Failure of GRA reform to provide self-declaration and remove exclusions to
parenthood, property inheritance, state benefits, competing in sports, and marriage in
church
• April 2022 Any ban on conversion practices will exclude trans people
• December 2023 Schools’ Guidance positions trans as a ‘belief’
 Anti-gender funding sources
in Europe 2009-20018
Total of USD707.2million from 54 organisations in the
US, Russia, and Europe (excluding Russia)

USD81.3million from 10 US Christian Right bodies, supported by

alt- and far-right foundations

USD188.2million from Russian organisations associated with

two Russian oligarchs, Vladimir Yakunin and Konstantin Malofeev

USD437.7million from 20 European private foundations

supported by new transnational NGO alliances for anti-abortion,
and anti-LGBTQ campaigning, ultra-right social media platforms,
and far-right Christian politics.
 Intersections:
Terfs and Conservative Evangelicals
‘in sheer tirelessness and depth of ignorance , the anti
- trans activism of certain conservative evangelical
lobbyists in organisations like the Christian Institute ,
Christian Concern , and the Family Education Trust is
rivalled only by ‘ TERFs ’ in the style of Keen , Stock
and Rowling’ (p. 17)

‘My argument is that the operative locus of the

alliance between conservative evangelicals and anti -
trans feminists, lying far beneath the superficial
embrace of ‘ biological reality ’ as the final arbiter in
matters of social categorisation, and beneath even
the affective expression of visceral fears of cis
annihilation , is an intersecting fundamental
opposition, on grounds of moral intuition rather than
empirical principle, to dualistic philosophies that
separate the mind or soul or spirit from the body – or, Pluto Press, 2023
in a slightly different formulation , philosophies that
Anti-trans and white supremacism

White supremacism anxiety about ‘replacement

theory’ (a conspiracy to replace ‘white’ people
with people of colour)

Mirrored by anti-trans anxiety about trans

people being a ‘social contagion’

Both underpinned by eugenic colonial mindset

called ‘neoprimitivism’, nostalgic longing for
certainty based on the ascendancy of ’real’
people (white, European, able-bodied,
middle-class, cis, heterosexual) in a diverse
and increasingly uncertain world

Pink News, 31 August 2020

 Conversion Practices
• Pseudo-medicine: faradic and emetic aversion conditioning; insulin-
induced coma; ECT; desistance ‘therapy’; reparative ‘therapy’;
deferral ‘therapy’; verbal abuse; public humiliation; personal shaming;
coercive control.
• Faith groups: ’prayer and exhortation’; starvation; sleep deprivation;
stress positioning; forced confinement; ‘corrective rape’; exorcism.
• Classified as torture by United Nations.
• April 2022 Global Faith Commission: over 100 religious leaders sign-
up to Safeguarding Principles to ban conversion practices.
• UK government will not end conversion practices for trans people
 The Book’s Message
• Trans rights are now everyone’s
rights
• Rights you take for granted can
be removed in an instant
• What has been done to trans
people could be done to you or
your loved ones
• It is everyone’s task to fight for
trans equality, for restoration of
trans rights, and for reparation