Statement from the Professional Association For Transgender Health In South Africa (PATHSA)
Executive summary
The Professional Association for Transgender Health in South Africa (PATHSA) expresses deep concern over the recent UK Supreme Court ruling that limits legal recognition of gender identity, and the endorsement of this ruling by South African politician Helen Zille. These developments reflect a pattern of misinformation, fear-based rhetoric, and transphobic framing that jeopardise access to healthcare, public trust in science, and the safety of trans and gender-diverse people. At a time when trans-specific clinics are closing in South Africa due to funding cuts, and access to hormones has been disrupted, this kind of rhetoric is especially dangerous. Gender-affirming care is not experimental — it is evidence-based, endorsed by the Psychological Society of South Africa (2013; 2025), the South African Society of Psychiatrists (2024), the World Health Organisation (WHO), the World Professional Association for Transgender Health (WPATH), and the Endocrine Society and proven to improve mental health outcomes. PATHSA calls for public discourse to be guided by compassion, constitutional values, and professional ethics — not ideology or fear. We stand with healthcare providers and trans communities and reaffirm our commitment to building a future where care is ethical, informed, and affirming of every person’s dignity.
Full statement
The Professional Association for Transgender Health in South Africa (PATHSA) is deeply concerned by the recent UK Supreme Court ruling narrowing legal definitions of sex, and by public support for this ruling from South African politician Helen Zille. Her recent statements reflect a pattern of misinformation, moral panic, and transphobic framing that undermine public trust in healthcare, distort scientific understanding, and threaten the dignity, safety, and rights of trans and gender-diverse people in South Africa.
As healthcare providers, researchers, and mental health professionals, we are committed to evidence-informed, ethical, and rights-based care. Helen Zille’s commentary, while framed as “reasoned debate,” recycles long-standing tactics used to delegitimise marginalised groups — including trans and gender-diverse people, women (cis and trans), intersex individuals, people living with HIV, and the broader LGBTQIA+ community. These tactics are familiar: they cloak moral panic in the language of concern, elevate misinformation as if it were expertise, and demand “balance” in public discourse while ignoring the lived consequences of platforming harmful views.
Freedom of speech does not mean freedom from accountability. It has been deeply distressing to witness the language used by people of influence in celebrating the UK Supreme Court’s recent ruling on trans rights. This language — dehumanising, cruel, and often cloaked in “reasoned debate” — actively celebrates harm against a minority community. Zille’s tweet referring to gender diversity as “a contagion as dangerous, socially, as Covid was, medically” is a stark example. Comparing trans people or trans rights to a viral threat invites moral panic, not dialogue. It legitimises exclusion, not concern. When this kind of rhetoric is amplified from positions of power, it does not simply misinform — it emboldens violence, deepens mistrust in healthcare, and puts lives at risk.
History has taught us grave lessons about what happens when marginalised communities are scapegoated and dehumanised. Such framing is not without consequence. It is often the precursor to systemic erosion of rights, denial of care, and broader human rights violations. In matters of public health and public trust, platforms must be used with care — not to elevate ideology over evidence, or to normalise exclusion as common sense.
PATHSA addresses the following recurring themes in her statement:
- Dividing women to undermine rights
Zille positions trans rights as being in opposition to women’s rights — a false and dangerous binary. This framing undermines the shared realities of gender-based oppression that impact trans people, non-binary people, and cisgender women alike. As healthcare professionals — including those in mental health, social sciences, and public health — we recognise that the struggle for gender equity is not a limited resource to be divided, but a shared fight against patriarchal systems that harm us all.
In reality, transphobia and misogyny are deeply intertwined. Trans women are vilified not because they threaten women’s rights, but because they challenge rigid ideas of what women should be — and because femininity itself is still viewed as inferior and suspect.
Trans people — and especially trans women — are disproportionately subjected to extreme levels of violence, exclusion, and abuse. Many have been murdered, not because they pose a threat to cisgender women, but because they are seen as a threat to cisnormative and patriarchal control, often enforced through cis male violence. The idea that women must be protected from trans women misplaces the source of harm. It distracts from the very systems of patriarchal violence and entitlement that feminism seeks to dismantle — the same systems that harm cis and trans women alike.
Excluding trans people will not safeguard women’s rights. It will only fracture the collective power needed to advance justice. A feminist and rights-based approach to health must reject false binaries and stand in solidarity across identities and movements.
- Trivialisation and outrage as strategy
The use of inflammatory examples — from product advertisements to exaggerated portrayals of trans women — is a deliberate strategy to trivialise gender diversity and provoke outrage, rather than engage with the realities of healthcare, rights, and dignity. These tactics are not contributions to reasoned debate, as Zille claims, but a form of cultural mockery that dehumanises trans people and casts doubt on their legitimacy.
When trans identities are reduced to punchlines or symbols of controversy, gender-affirming care is misrepresented as frivolous or dangerous, rather than the evidence-based, medically recognised intervention that it is. This not only fosters public misunderstanding — it contributes to an environment in which healthcare professionals are harassed, young people are denied care, and systems of support are dismantled under pressure from ideological fear campaigns.
- The “contagion” narrative and pathologising youth
The framing of gender identity — particularly among adolescents — as a “social contagion” is not grounded in scientific evidence. It stems from a widely criticised 2018 study by Littman, which introduced the concept of Rapid Onset Gender Dysphoria (ROGD) based solely on parental observations, with no direct engagement with the youth described (Littman, 2018). The study hypothesised that trans identification could be the result of social influence or peer pressure — a claim that has since been formally corrected by the journal (Littman, 2019), publicly disavowed by PLOS ONE (PLOS ONE Editorial Team, 2019), and subject to extensive methodological and ethical critique (Costa, 2019; Restar, 2020).
Despite these corrections, the idea of gender diversity as “contagious” continues to surface in public commentary and is often used to cast suspicion on the motivations, identities, and care needs of trans youth. These narratives mirror earlier moral panics about queer youth, in which identity exploration was mischaracterised as deviance or pathology. In reality, gender-affirming care is not reactive, hasty, or ideologically driven. It is evidence-based, developmentally appropriate, and aligned with international and local clinical guidelines (Hembree et al., 2017; PsySSA, 2025; Tomson, et al., 2021; WHO, 2022; WPATH, 2022). It typically includes psychosocial evaluation, family involvement, and careful clinical judgment, with many youth receiving support without medical intervention at all.
Gender-affirming care is consistently associated with lower rates of depression, anxiety, and suicidality among trans youth (Olson et al., 2016; Turban et al., 2020; The Trevor Project, 2022). The true harm lies in denial of care, public narratives that invalidate trans identities, and platforms that amplify scientifically discredited claims under the guise of concern.
- Misusing of “sex” to justify exclusion
The UK Supreme Court’s recent ruling — defining legal sex solely as assigned at birth — reflects a broader trend of using narrow biological framings to exclude trans people from rights and protections. Zille’s endorsement of this ruling rests on the same logic: that “sex” is a fixed, binary truth, and that recognising gender diversity undermines this. But this framing disregards the documented diversity of sex characteristics, including among intersex people, and conflates sex and gender as if they were interchangeable — a view not supported by medical science.
Zille argues that “sex is not a social construct, race is” — a striking admission that reinforces how constructs are acknowledged when convenient, and denied when they disrupt dominant narratives. This selective framing protects some categories from scrutiny while weaponising others. In doing so, it reproduces the very systems of classification that have historically been used to deny rights and justify violence.
While framed as “common sense,” this logic is neither benign nor scientific. It draws on long histories of using biology to police boundaries, reinforce hierarchies, and deny rights — from eugenics to racial classification to gender segregation. In this case, it is being used to determine who is legally recognised, who is excluded from care, and whose identities are viewed as real.
Gender identity is not reducible to anatomy or reproductive function. When law and public discourse reduce recognition to assigned sex, they do not clarify — they erase. And that erasure has real consequences for dignity, safety, and the ability to access care.
- Attacks on public health infrastructure and care providers
Zille’s comments about the Red Cross Children’s Hospital — and her praise of groups like First Do No Harm South Africa — publicly undermine the credibility of ethical, evidence-based medical care. These attacks endanger not only providers offering gender-affirming care, but also the trans youth and families who rely on these services. PATHSA fully supports the healthcare providers and institutions providing gender-affirming care in South Africa, all of whom adhere to international standards and local ethical guidelines.
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We are aware that some of the very sources cited here have been deliberately misinterpreted or misrepresented by those seeking to discredit gender-affirming care. This pattern — the selective citation of studies, the exaggeration of uncertainty, and the failure to reflect scientific consensus — does not reflect good faith engagement with evidence. It reflects a strategy of doubt: one that mimics the tactics used historically to undermine public health responses to HIV, harm reduction, reproductive justice, and LGBTQIA+ rights more broadly. As a professional association, we affirm that evidence must be read in context, with attention to consensus, ethics, and the real-world outcomes for those impacted. Rigorous care is not undermined by evolving science — it is shaped by it. But bad-faith distortion of science has no place in healthcare policy or public discourse.
These comments also come at a time when transgender and gender-diverse people in South Africa are already facing significant barriers to care. In early 2025, multiple clinics were forced to close following USAID funding cuts, halting hormone provision for trans people at several sites — a crisis that has left many without essential care. Research consistently shows that access to healthcare for trans people across Africa is limited by systemic stigma, lack of trained providers, and institutional neglect (Jessani et al., 2024; Müller, 2017; Zambezi & Viljoen, 2024). In this fragile context, rhetoric that delegitimises trans lives and questions the integrity of gender-affirming care does not exist in a vacuum — it adds fuel to the fire, increasing mistrust, justifying obstruction, and compounding harm.
South Africa’s Constitution (1996) guarantees the rights to dignity, equality, and access to healthcare. The Promotion of Equality and Prevention of Unfair Discrimination Act (PEPUDA, 2000) further affirms protection from discrimination based on gender identity or expression. These rights are not negotiable. Upholding them does not require choosing between groups. It requires refusing fear-based framings and recommitting to a vision of justice that includes everyone.
We remind public figures — especially those with significant political influence — that free speech does not absolve one of responsibility. That disinformation is not neutral, but harms real people.
PATHSA affirms the urgent need for public discourse on gender, healthcare, and rights to be grounded not in fear or ideology, but in compassion, evidence, and constitutional values. We remain committed to supporting healthcare providers, researchers, and trans and gender-diverse communities across South Africa in building a future where care is ethical, informed, and affirming of all people’s dignity.
References
Costa, A. B. (2019). Formal comment on: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria by Littman (2018). PLOS ONE, 14 (3), e0212578. https://doi.org/10.1371/journal.pone.0212578
Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., ... & T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102 (11), 3869–3903. https://doi.org/10.1210/jc.2017-01658
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The post Press release: On the UK Supreme Court Ruling and Public Commentary by Helen Zille first appeared on LitNet.
The post Press release: On the UK Supreme Court Ruling and Public Commentary by Helen Zille appeared first on LitNet.