The Cass Report Should Be the End of Gender-Affirming Care

In 2020 the British National Health Service commissioned a report on pediatric gender care. The job of sifting the evidence was given to Dr Hilary Cass. After four years, her final report is set to be released Wednesday. The gist appears to be that the case for hormones and other gender-affirming care is very weak.

Children have been let down by a lack of research and “remarkably weak” evidence on medical interventions in gender care, a landmark review says.

The Cass Review, published on Wednesday by paediatrician Dr Hilary Cass, calls for gender services for young people to match the standards of other NHS care…

“There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour.”

The Telegraph has an overview of some of the findings and recommendations. With regard to puberty blockers, research by the University of York found no evidence they have an impact on gender dysphoria.

The former president of the Royal College of Paediatrics and Child Health said there was no evidence the drugs “buy time to think” or “reduce suicide risk”…

Dr Cass stated there was “concern that [puberty blockers] may change the trajectory of psychosexual and gender identity development” with most patients going on to take cross-sex hormones as a result.

She said the NHS should exert “extreme caution” in giving out cross-sex hormones to under-18s as the research carried out by her review concludes there is “a lack of high-quality research” on their effectiveness.

In general, Dr. Cass’s conclusions are that treatment should slow down so permanent decisions are made by adults rather than kids.

Under-25s should not be rushed into changing gender, but should receive “unhurried, holistic, therapeutic support”, Dr Cass concluded. She said “life-changing” decisions must be properly considered in adulthood, noting that brain maturation continues into the mid-20s…

It suggests that too many decisions about changing gender have been rushed, with too little consideration given that children might regret their actions in later life.

The report also highlights the fact that children presenting as trans often have other serious problems in their lives.

Childhood trauma, neglect and abuse feature heavily in the cohort of patients seeking gender changes, the report shows.

It cites a systematic review that found that in some services, as many as two thirds of those referred had suffered some kind of neglect or abuse, with high levels of parental mental illness, substance abuse and exposure to domestic violence. The research found about half of cases had suffered from maternal mental illness or substance abuse while almost 40 per cent had experienced paternal mental illness or substance abuse.

Dr. Cass specifically criticized WPATH for a lack of evidence underlying its standards.

Dr Cass said it was “extremely disappointing” to find World Professional Association of Transgender Healthcare (WPATH) guidelines which were taken as an industry standard and adopted very widely internationally, “were very, very poorly evidence-based”.

Her review really ought to cause some serious rethinking about gender-affirming care. Of course the activists for this particular cause won’t be dissuaded so easily. Dr. Cass will just become their new target for ridicule. No doubt the pushback will be in full swing tomorrow.

For now thought, Dr. Cass gave an interview about her report to a medical journal. I’ll highlight one thing she said about 21 minutes in. “The guidelines that recommend puberty blockers are not doing so on the basis of evidence,” she said. She continued, “The guidelines that have sort have been accepted as kind of industry standard in this area, WPATH…They’re now on their 8th revision. WPATH 7 they still hadn’t had a systematic review. WPATH 8 which is the current version was the first to have a systematic review and the systematic review showed pretty weak evidence but they didn’t actually base their recommendations on that systematic review. So it’s been very driven by what people in that field think.”

Cass added, “The guidelines that are most based on the evidence are the Swedish and the Finnish guidelines and they suggest a much more conservative approach, similar to our recommendations because the evidence isn’t there. And genuinely I can’t think of another area of pediatric care where we give young people a potentially irreversible treatment and have no idea what happens to them in adulthood.”