The government has launched a public consultation, (1) on how to make it easier for transgender people in England and Wales to change their legal gender on their birth certificates. A similar consultation closed in Scotland in March, but has not yet reported. (2)

Currently, under the Gender Recognition Act 2004 people need to be over 18, have been diagnosed with gender dysphoria, have lived in their new gender identity for two years and have obtained a certificate from a gender recognition panel before being able, legally, to change their gender.

However, a highly controversial 2016 report (3) by the Women and Equalities Committee of the House of Commons on Gender Equality, recommended reducing the age limit for hormone treatment and surgery to 16 and completely removing the process of gender recognition from its current medical and legal framework - basing gender change on self-declaration alone.

A consultation scheduled for autumn 2017 was first postponed but appeared to lose momentum (4) after chief proponent Justine Greening, then Equalities Minister, lost her cabinet post in a New Year reshuffle.

But the proposals have now reappeared under the watch of new Equalities Minister Penny Mordaunt and with the backing of Prime Minister Theresa May. May has said that she wants 'to see a process that is more streamlined and de-medicalised - because being trans should never be treated as an illness.'

The move is being justified by the results of the government's LGBT survey - the largest national survey of its kind, with over 108,000 participants - which showed that many trans people find the current process overly bureaucratic and expensive.

The key question behind these proposals is what gender dysphoria actually is. Is a 'trans woman' really a woman trapped in a man's body? Or is 'she' really just a man who has an unshakeable false belief that he is a woman? Is a biological male who has had female hormones and gender reassignment surgery really a woman, or is he just a feminised man?

As recently as 2013 this condition was called 'gender identity disorder'. (5) But it was renamed 'gender dysphoria' in the DSM-V and will be reclassified as 'gender incongruence' in the ICD-11 in 2020, (6) the implication being that it is only to be considered a mental disorder if it causes deep distress. This change appears to have been ideologically driven rather than evidence-based.

As Tom Goodfellow has written in a letter to The Times, (7) 'Gender transition, by its nature, is a medicalised process involving powerful drugs, hormones and ultimately extensive plastic surgery... So, the call for this process to be "de-medicalised" is clearly nonsense... Transgenderism is a complex issue and needs careful management. Simply legislating to allow individuals legally to self-identify will not meaningfully address any of the problems and could actually prove harmful.'

Review by Peter Saunders, CMF Chief Executive