the standards are much lower if we take the attitude that - rather than provide care on the basis of the best available evidence - we remove .all care until we have enough long term data from control trials. Imagine if we applied this standard to other areas of healthcare - services for kids with eating disorders, mental health services more broadly, etc etc- we’d be left with very little left.
Curiously Cass recommends scaling up mental health services for gender dysphoric children, but there are no long term control trials demonstrating the benefits of these! (in fact the evidence suggests that psychological interventions can be distressing and harmful, particularly where they involve gatekeeping, or are experienced as forms of conversion therapy). I cannot see how the hypocrisy here is being missed.
Why are you so afraid of tracking the outcomes
I am not at all afraid of this, I’m in favour of it absolutely. ( Based on my own knowledge and research, I have zero doubts that it would demonstrate that for the overwhelming majority of patients, access to cross sex hormones - especially without having to go through endogenous puberty- improves long term outcomes for trans people across a range of wellbeing measures ).
But we need to sort out 1) what outcomes we are tracking and why and 2) through what type of methodologies this can be done both practically and ethically in this area of medicine.