Surely many readers know of the Cass Review, a 2020 report (a final version came out this year) on the treatment of gender dysphoria in Britain. Headed by Hilary Cass, a retired pediatrician and former president of the Royal College of Paediatrics and Child Health, the report summarized the methods and results of the National Health Service’s (NHS’s) treatment of gender-dysphoric youths. It also commissioned several independent studies of that treatment. The results were damning for the NHS, whose treatment was shown to lack evidential underpinnings. The effects of widely used puberty blockers and other hormones, for example were not known well enough to be prescribed, and “affirmative” psychosocial therapy was not shown to be efficacious.
As Wikipedia notes, the report had several effects, effectively stopping or slowing “affirmative therapy” in Britain. The most important result was the closing of the Tavistock Gender Centre, the only place in the UK that would treat gender-dysphoric children and adolescents, and in a strongly “affirmative” way. Its functions were farmed out to several other places that will be much less “affirmative” in the sense of not using only merely therapeutic assessments followed by immediate dosage with hormones. And puberty blockers, as in some other European countries, will now be regarded as part of clinical trials instead of as routine care, for we really don’t know the long-term effect of such blockers. What we do know is that a majority of gender-dysphoric children, if left medically untreated, will resolve their issues without hormones or surgery, often coming out as bisexual or gay.
NHS England responded positively to the interim and final reports. As of April 2024 they have implemented a number of measures. The Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust closed in March 2024. Two new services, located in the north west of England and in London, opened in April 2024, which are intended to be the first of up to eight regional services. These will follow a new service specification for the “assessment, diagnosis and treatment of children and young people presenting with gender incongruence”. Puberty suppressing hormones are no longer routinely available in NHS youth gender services. New patients that have been assessed as possibly benefiting from them will be required to participate in a clinical trial that is being set up by the National Institute for Health and Care Research. A new board, chaired by Simon Wessely will encourage further research in the areas highlighted in the review as having a weak evidence base.
The report didn’t show that such interventions definitely weren’t useful; rather, it showed that the evidence for their usefulness was inconclusive. In that light, it seems judicious to slow down, provide assessment therapy rather than “affirmative” therapy, and dial back the use of hormones in young people. (My own view is that hormone or surgical intervention should occur only when youths are considered to be mature enough to make important decisions about their lives; perhaps 18?).
There’s a new article in the reputable British Medical Journal detailing how American gender activists, wedded to “affirmative therapy,” have largely ignored the Cass report. The intentions of such activists—to somehow “fix” gender dysphoria—are well-meant, but these activists are deeply afflicted with a resistance to new data that don’t support their ideas. The Cass Report, therefore, had to be ignored because it might make them change their minds—and their practice.
Click to read:
A few excerpts, showing that some Americans do agree with Cass’s conslusions about inconclusive data:
The American Academy of Paediatrics (AAP) and the Endocrine Society have stood by their guidelines. The Cass review “does not contain any new research that would contradict” them, the Endocrine Society said in a statement WPATH [World Professional Association for Transgender Health] issued an email statement that Cass “is rooted in the false premise that non-medical alternatives to care will result in less adolescent distress,” and added on 17 May that its own guidelines were “based on far more systematic reviews [than] the Cass review. As The BMJ reported last year WPATH’s own systematic review, one of an unknown number commissioned for the eighth version of its Standards of Care—just two were published—concluded that the strength of the evidence to support the mental health benefits of hormones was “low” and that it was “impossible” to conclude how they affect suicide risk.
Under pressure from some members, the AAP announced last year that it would commission an independent systematic review of the evidence for the affirmative model—at the same time that it reconfirmed its 2018 statement in support.7The BMJ obtained a new resolution dated 1 April that asks the organisation to “issue an interim update to the 2018 policy statement based on the best available evidence to date.”
“The time has passed for yet another systematic review,” says Julia Mason, an Oregon paediatrician and member of SEGM who has submitted several resolutions, including the April 2024 one, to AAP for more evidence based guidance. “We now have a dozen high quality reviews (eight Cass, two NICE, one Swedish, one German) all pointing to significant issues with the purely affirmative model of care,” she says. “Parents and their children are being misled in clinics all over the country. There is no evidence that giving puberty blockers followed by hormones and surgery is lifesaving care, and there is mounting evidence that the harms might outweigh the advantages.” The AAP did not respond to The BMJ’s request for comment.
The American Psychological Association, American Psychiatric Association, and American College of Obstetricians and Gynecologists, which have position statements in support of the affirmative model, have remained silent about Cass. Only the psychology group responded to The BMJ, saying that it is studying the Cass report, but “we stand by the statement.”
. . . But many outlets historically aligned with advocacy positions have held back on any ink. STAT News, which “delivers trusted and authoritative journalism about health, medicine, and the life sciences,” has so far ignored Cass (as well as The BMJ’s request for comment). So has CNN. Jesse Singal, one of the first American journalists to expose the potential harms of youth gender treatment, reported on his Substack that the legacy news network had recycled the pronouncement that “gender affirming care is medically necessary, evidence based care” in 35 separate articles over the past two years, practically verbatim. (CNN did not explain, and did not respond to a query from The BMJ.) “Many outlets dug themselves into a deep hole on this issue by simply acting as stenographers and megaphones for activist groups rather than doing their jobs,” wrote Singal.
There are other descriptions of how American gender activists have deliberately ignored the Cass Report, but I can’t resist putting up what the BMJ says about my least favorite popular scientific magazine, one that’s been resolutely rah-rah for “affirmative care” over the years:
Singal has also called out Scientific American for not covering the Cass report, while on 20 April running a question and answer piece with a prominent advocate of gender affirming care titled “Anti-trans efforts use misinformation, epistemological violence, and gender essentialism.” The oldest continuously published magazine in the US, Scientific American, has run several articles favourable to the affirmative model in recent years. In “Why anti-trans laws are anti-science,” written in 2021 and republished in 2023, the magazine’s editors stated that it is “unscientific and cruel” to claim that treatments are “unproven and dangerous” or that “legislation is necessary to protect children.” According to a 2022 article, “What the science on gender affirming care for transgender kids really shows,” data “consistently show that access to gender affirming care is associated with better mental health outcomes.” “Decades of data support the use and safety of puberty pausing medications,” declared one 2023 piece.
The magazine’s editor in chief, Laura Helmuth, has promoted these pieces on Twitter/X with declarations like, “The research is clear, and all the relevant medical organisations agree”; policies that restrict treatments are “dangerous, cruel, bigoted, and contrary to all the best scientific and medical evidence.” She’s also disparaged inquiries on the subject. In a February 2023 tweet, Helmuth included gender affirming care among a list of “things we don’t need to be both-sidesing, be ‘objective,’ or be ‘just asking questions!’ about.” Neither Helmuth nor the magazine’s publisher, Springer Nature, responded to a detailed email referencing the articles and more than 15 tweets.
I predict that in years to come both doctors and the public will look back on “affirmative therapy” as a maladaptive blip in scientific medicine: a practice that went full steam ahead propelled by ideology rather than science. I am not, of course, disagreeing that some gender-dysphoric youths can be helped by surgery and medicine, for many trans people have affirmed that transitioning improved their lives. But some success stories don’t mean that affirmative therapy leading to hormone treatment and perhaps surgery is the best treatment for everyone who’s uncomfortable with their gender.
The Cass Review should be mailed to every US congressperson. Every.
May not make the slightest bit of difference of course.
It’s increasingly “upsetting” being an American these days.
In other news, the “fancy” US-built pier in Gaza (which was good for just 2-3 weeks), is about to be permanently dismantled in July. ~320 million USD. That’s how much it cost the tax payers. It’s mind boggling.
That BMJ essay is something a congressperson is perhaps more likely to read than the Cass Report. The BMJ piece is very well written and very well organized. It would be great to have that go to every US congressperson!
Thanks Cransdale. Can you provide a link?
Here is a link
https://www.bmj.com/content/385/bmj.q1141
Thank you Cora.
The link, as usual, is obtained by clicking the headline. I just checked, and it is working fine,. (I think it says “click to read”, which is always the case.)
Sorry. 🙂
Missed that. My bad.
It might be good to send it to the CCSSO (Council of Chief State School Officers) in DC which is the national organization of state superintendents of public instruction and to the NSBA (National School Boards Association) which is the national association of all local school boards in the U.S. this will put it into play as information for all US k-12 publics school systems.
+1
I agree with most of Jerry’s views here. But the more I read and think about these things (and interact with the trans people I know well), the less I agree that “some gender-dysphoric youths can be helped by surgery and medicine.” There are of course distressed people who are deeply unhappy with their bodies and sexuality. They deserve love and care and psychiatric assistance. But I can’t agree that surgically removing healthy reproductive organs (much less creating simulacra of the organs of the other sex) is in any sense a helpful way to treat a psychiatric illness. Self-reported affirmation by trans people that medical and surgical intervention improved their lives is the weakest possible evidence for that hypothesis. The trans people I know who are fairly happy and fairly well adjusted are theatre kids who were already FH&FWA, then transed for social reasons, and remained FH&FWA. The trans people I know who were miserable and maladjusted before transing are also M&M after transing. In both types of cases it’s the social and cultural circumstances that seem to determine happiness, not the transing itself. But I’d guess that in both types of cases both the happy and the miserable individuals would report being happier after transing. It would take a level of self-awareness that most of us (including me) don’t have to realize and admit that coming out to your wife at age 50 as a “woman”, and blowing up your marriage and getting kicked out of the household, did not lead to an improvement in life circumstances.
+1
Blockers, cross-sex-hormone-therapy and sex-change-surgery should be prohibited until age 18, other than in exceptional circumstances (such as precocious puberty).
Mike’s comment brings up a very important ramification of married people changing their legal gender. The spouse who is not changing is now in a legally same-sex marriage. Some spouses will divorce their former partner, but some spouses, because of religion, cannot divorce. In the UK there is a possibility of annulment of the marriage. At any rate this is a very significant issue for spouses and children.
I reluctantly agree that its best to wait on medical intervention. Although I am convinced that some children really are trans, there are so many accounts of volatility of the condition, especially at an early age, that we can’t know where a given child will wind up within the spectrum at a later age. “Many” are going to be gay, for example. This is according to research cited above, and according to various other examples that are well publicized.
America and Canada are too far gone for the Cass Review to make a difference. Facts are optional in the New Lysenkoism.
Amazingly, these people think that the Cass Review is on the same level as Andrew Wakefield’s vaccine–autism paper. But *they* are the ones promoting the use of Lupron (the synthetic hormone used for chemical castration, etc.) on “transgender” children.
The irony is that Lupron has long been supported by anti-vaxxers as a supposed “treatment” for autism. And now they’re using it on the gay autistic children that they’ve gaslighted into believing that they’re members of the opposite sex.
They are the real Wakefield equivalents. Not Cass.
I’m all in favor of piling on Helmuth’s reign at SciAm – hopefully someday it can get back to non-partisan science.
Gender reassignment surgery probably does help some people. Lobotomies probably helped some people as well. It doesn’t mean that the surgery is humane or the best treatment available. Youth by their very nature don’t necessarily know what is best for their long-term health and happiness. In my teens there was a point when I thought that if I could just smoke pot and eat fritos every day that I could be happy forever. Luckily my parents did not affirm my life choice.
“if I could just smoke pot and eat fritos every day that I could be happy forever. Luckily my parents did not affirm my life choice.”
Brought a smile to my face!
The problem is that medicine in the USA is profit-oriented. Expensive surgery or long-term drug treatment makes more money for its practitioners and excessive profits for the pharmaceutical companies. The NHS does not make a profit.
This is just one example of why health care in the USA costs twice as much as a proportion of GDP as it does in Europe, and half of that is government money anyway for Medicare, Medicaid, veteran’s care and emergency services.
Much of the fight over gender-“affirming” care is whether what is in reality cosmetic surgery and medical tattooing should be covered by third-party Health insurance on the strength of a highly contagious made-up theory that casts it as medically necessary treatment. Life-saving even! Regardless of whether the third parties being demanded to pay are public or private, and regardless of the profit motive, the wind would dump out of the sails of this branch of medicine and surgery if insurance and government put its foot down and said, “We won’t pay. This isn’t what medicine is for. Body-affirmation is cosmetic.”
You are correct that this treatment, like everything else, is fabulously more lucrative in the United States than anywhere else in the world. But “anywhere else” includes Canada, where doctors have to accept the regulated government reimbursement as the only lawful payment for medically necessary care. There are long queues for free, “medically necessary” gender-driven mastectomy because plastic surgeons can make far more money doing cosmetic surgery for “Show me your VISA card.” At the other end of the value chain, GPs dishing out hormones can’t get rich off it, although dealing with patients who are happy because you gave them what they wanted is a nice break from the usual grind of untreatable problems. (An insight here is that nurse-practitioners cannot bill insurance yet they seem to be making out OK prescribing hormones over Zoom for a nice fee to patients they will never meet in real life. Ain’t on-line commerce wonderful?)
Yet despite the more niggardly reimbursement generally (for everything), Canada has gone head, heart, and soul down the same hysterical activist rabbit hole as the United States. Could it just be that we believe we are doing God’s work and we won’t listen to foreign devils named Cass?
I think that this also explains other medical policies in which the USA is an outlier, such as recommending no treatment for scoliosis and umbilical hernia until they progress to a degree requiring surgery, and also recommending circumcision of all boys.
As someone (I think, Mark Twain) said, paying a doctor to amputate a leg may lead to a situation when the doctor decides that he needs the money more than the patient needs the leg.
I’ve been reading through the comments and wondering if someone would hit on the financial gain aspect. I have been wondering about this factor for a long time. I love Maya’s quote below about the “doctor maybe needing the money more than the amputee needed the leg”. Sad but true.
Wait, I thought that all good, caring, intelligent, and educated people supported gender-affirming care? I mean, who could be opposed to affirmation? One might as well be opposed to solutions, to patriotism, to protection, to freedom, to Science, to health care, to kindness, to love. Alas, much harm and evil has hidden behind euphemisms.
Since our concern was speech, and speech impelled us
To purify the dialect of the tribe
And urge the mind to aftersight and foresight,
Let me disclose the gifts reserved for age
To set a crown upon your lifetime’s effort.
First, the cold friction of expiring sense
Without enchantment, offering no promise
But bitter tastelessness of shadow fruit
As body and soul begin to fall asunder.
Second, the conscious impotence of rage
At human folly, and the laceration
Of laughter at what ceases to amuse.
And last, the rending pain of re-enactment
Of all that you have done, and been; the shame
Of motives late revealed, and the awareness
Of things ill done and done to others’ harm
Which once you took for exercise of virtue.
Then fools’ approval stings, and honour stains.
T. S. Eliot, Little Gidding
I love Little Gidding. I don’t understand it, but I love it.
“A blip” is a bit of an understatement, Professor.
I’m with SEGM et. al. that it’ll be looked back on – all the chemical soup and surgical mutilation – with the same regret and horror we look back on lobotomy.
See SEGM https://en.wikipedia.org/wiki/Society_for_Evidence-Based_Gender_Medicine
and Genspect (the excellent Stella O’Malley)
https://en.wikipedia.org/wiki/Genspect
– for a deeper dive into medical social contagions over time.
And Michael Schellenberger has this year joined the effort against the “Affirmation Model” with the WPATH files.
The files are horrendous.
D.A.
NYC
Did you know Scientific American has a history of appointing dodgy editors? The Reverend George Dyson was tried for the murder of his lover’s husband in London in 1886, but got off. He is generally believed to have at least been an accessory, having supplied the poison used, and did not report what he knew afterwards and the scandal cost him his clerical appointment. He moved to the USA, changed his name to John Bernard Walker, married and became editor of Scientific American in 1913. In 1916 he had his wife committed to an asylum, but she escaped and was found in his apartment dead of coal gas poisoning. Interestingly, he had made a great display for his neighbours of not being able to open his door, and eventually cut his way in, thus making sure there were witnesses when her body was found. This was ruled a suicide, although his reputation was again damaged. He died in 1928.
Hmmm, I don’t remember reading that in their “50, 100, and 150 Years Ago” column!
I remember Alfred Hitchcock considered making a film about the poisoning case. I didn’t realize there was a Scientific American connection!
Fascinating.
I’m struck by the phrase epistemological violence. What does it mean? It seems to be one of those newly coined woke code words. I’m trying to wrap my head around how knowledge, or the study of it, can cause forceful injury. If it just means lies, it would be stronger prose to say lies.
Struck me, too.
I think it means teaching/indoctrination of Wrongthink.
Literal Violence!!!1!!
This “maladaptive blip” has undoed my conviction that gender transition is the best treatment for anyone suffering from gender dysphoria. So I really don’t think “blip” is the most appropriate word to describe this period in medical science.
It’s been driven not by science but by a highly aggressive group of “trans women.”
I’ve read several articles on this. They lobbied the politicians hard and it worked.
I fear that the American health system won’t wake up to this until the lawsuits from damaged/sterilised teens start coming in.
Agree…. I also wonder if insurance companies will start to balk at paying for this “experimental” treatment.
There are a lot of factors behind the US (and Canada’s) refusal to acknowledge the problems with Affirmative Care and pediatric sex trait modification, but one of the most prominent I think is the conviction that this is a civil rights issue.
As soon as transgender identity was put in the same category as race and sex orientation, the existence of “trans kids” — people born knowing “who they are” and experiencing the excruciating agony of being denied recognition as whole and legitimate members of society — was ensured. The Cass Report casts doubt on both aspects of this. Children might be wrong about being transgender; the pain of not passing might not be worth any cost.
If we’re approaching these findings from a civil rights perspective, this is like saying gay kids are “confused” or black kids should buck up and suffer the indignities of sitting in the back of the bus. The script on how to respond to this bigotry is already written.
Nobody here will be surprised that the anti-science goons over at FTB are not happy with the Cass Report.
They’re now citing former ‘skeptic’ turned rape apologist Rebecca Watson on the matter. That well-known biologist!
Rich, for your own sanity, stay out of that place!