I would actually argue that there are three discrete groups.
- Birth registered males with childhood onset gender dysphoria.
- Birth registered females with adolescent onset gender dysphoria.
- Birth registered males who transition after age 25 or so when their brain has fully developed.
There may be some trans identifying people who do not fit into any of these categories, but I think the vast majority will be one of the above.
The Cass review concerns essentially the first two groups.
The Dutch protocol is based on a study with a small sample size, about 70 patients if I remember correctly, all from the first group. Essentially the entire evidence base for the use of puberty blockers comes from this study, and the protocol itself states that the use of puberty blockers is only indicated where the child has experienced persistent long-term gender dysphoria which does not resolve itself by puberty, and where the child does not have any other psychiatric comorbitities, such as autism.
The first point to note is that these criteria would exclude essentially all patients in the second group from being eligible for puberty blockers. There is absolutely no evidence to support their use in birth registered females with adolescent onset gender dysphoria. So people like Keira Bell have been absolutely let down. All birth registered females with gender dysphoria have been let down, because there is almost no research about the causes of or appropriate treatment for their dysphoria, so everyone in this group who has been prescribed puberty blockers, testosterone or had gender affirming surgery has been the subject of a medical experiment. What we need is research to find out why so many young people in this demographic are suddenly identifying as transgender. I imagine many women could have a good guess, but that is not the same as proper, high quality research.
The second point is that even for the first group, the evidence to support the use of puberty blockers is not great. I am not a doctor, not an expert, and I don't presume to know better than those who are. I do not trust the doctors who have been prescribing these treatments, but I do trust Dr Hilary Cass, who acknowledges that medical transition may be the right treatment for a small number of people. I think we also need more research to identify the potential causes of gender dysphoria in these very young children, which are likely to be different to the causes of gender dysphoria in the second group. Jackie Green may have been convinced that she was a girl from very early childhood, but we also know that Jackie's father is homophobic. Even if gender dysphoria manifests itself early and does not resolve, should we really be prescribing puberty blockers, cross sex hormones and surgery in cases where there is evidence to suggest the cause of the dysphoria may be environmental rather than innate?
Finally, the third group. Probably the most difficult of all to categorise. Perhaps it doesn't make sense to refer to them as one group, as it may include people who have always had gender dysphoria but did not acknowledge it until adulthood, as well as people with different reasons for identifying the way they do. I do not want to say anything to risk having this post deleted, but given that Stonewall and other LGBTQ+ organisations have lobbied for people without a diagnosis of gender dysphoria to be able to change their legal sex, I think we must acknowledge the possibility that not all of the people in the third group actually have dysphoria.
Either way, the people in the third group were allowed to go through puberty. In many cases they were able to have a healthy sex life and even have children of their own before deciding to transition. Their brains were fully developed when they chose to embark on any kind of medical transition. Many of them are only on female sex hormones, the effects of which on the male body are temporary, and do not intend to have any surgery. This means that they are more able to detransition without any permanent effects on their body, compared to people who have had surgery or birth registered females who have used testosterone. Some of them may feel that if they had had access to puberty blockers, they would have been better able to "pass" as women and may have avoided a lot of misery and pain. This is a valid point of view. At the same time, if they had had access to puberty blockers they may have ended up with serious physical health issues affecting their quality of life in other ways. They are not the right people to be criticising the Cass report. These are people who were spared the harm that has been done to children in the last ten years. They are not in the group of people Dr Cass is talking about, and the reasons behind their decision to transition are most likely completely different.
Let's hear from Ritchie Herron, let's hear from Sinead Watson, let's hear from Keira Bell. Let's also hear from children currently on the waiting list for gender identity clinics, and their parents, because I am very afraid that these people will be forgotten about.
But I could not be less interested in hearing India Willoughby, a 58 year old newsreader who has fathered a child with her own sperm, dismissing the findings of Dr Hilary Cass, an experienced consultant paediatrician who has been working on this for over four years.