In June 2020, at the height of the COVID-19 lockdown, Nature Reviews Urology published its first Pride special issue. At the time, we were the first urology journal and the first Nature Reviews journal to produce special content for Pride. Since then, numerous journals have followed suit and highlighted the importance of inclusion and understanding of underserved populations in medicine.

But 5 years later, inclusion and understanding are under threat. In the USA, funding for projects pertaining to diversity, equity and inclusion (DEI) programmes and “gender ideology” has been stopped at a federal government level, citing “immense public waste and shameful discrimination”1. In particular, grants from the US National Science Foundation that promote DEI are under threat, with those related to the concept undergoing increased scrutiny, on the basis of so-called woke keywords. In line with this approach, the President of the USA also signed an Executive Order dismantling DEI programmes in federal government, which he deemed illegal1. Globally, the way in which gender and biological sex are understood and acknowledged are becoming increasingly confused, impacting rights of trans persons, in particular regarding public spaces, and increasing the potential for violence against this population. While biological sex and gender are separate variables, an unwillingness to appreciate the ways in which they intersect, a lack of understanding of the nuances of gender, and a refusal to accept the individuals’ right to identify as they choose limits the rights of people who do not proscribe to the gender binary, increasing discrimination and, potentially, putting personal safety at risk. As we close out the first quarter of the twenty-first century, celebration and appreciation of diversity have become difficult, perhaps even dangerous.

Thus, allyship, support and understanding have never been more important, and we are thrilled to present Nature Reviews Urology’s 2025 Pride Focus issue. This year’s content largely focuses on identity, enabling and empowering patients to present their gender and sexual identity as they prefer. We present two Comments concerning care of patients with differences of sexual development, discussing timing of surgery later in life2 and reframing of language3. In this issue, you can also find a ‘user’s guide’ to pronouns4 in general, and an in-depth review of tools to understand sexual orientation, gender identity and sexual identity, including the proposal of a novel tool, the XYGO windrose5, to enable clinicians to better understand how their patients identify and, therefore, improve patient care.

Nature Reviews Urology believes that freedom to self-identify is the right of all, and we are committed to supporting Pride, now and in the future, through education, inclusion and allyship. In the beginning, Pride was a protest; now, in 2025, while we celebrate the value of diversity, we once again protest against its erosion.