New children's gender identity clinic, clinical trials and Cass

Here is a link to the BMJ article critiquing the main American objection to the Cass Review (which was a paper written by McNamara et al of the Yale Law School’s Integrity Project).

This BMJ article was mentioned in the Times posted article above but I thought it merited a link of its own in the thread:

Gender medicine and the Cass Review: why medicine and the law make poor bedfellows
https://adc.bmj.com/content/early/2024/10/15/archdischild-2024-327994

I was elaborating my answer about medical interventions being used in the context of distress and/or for people who are healthy.

You don't find them satisfactory and I doubt I could persuade you otherwise. I assume that we're both engaging in good faith so I shall leave it there.

This isn't a disgression at all, it's spot on IMO.

If Cass isn't a true believer that we all have a gender identity, she's certainly got me fooled! I guess it's possible - the whole section of her report that is dedicated to explaining it does read completely differently from the rest of the report. Weirdly, even some TRAs were mocking it (I remember Katy Montgomery being one who did), asking why a child's choice of toy should be used as evidence of gender identity. I'm not sure Katy et al quite understood the irony in that pushback 🤦‍♀️ This section had lots of references to papers written by "gender affirming" researchers, so perhaps she's playing a clever long game and gave a wry smile at those comments? Equally, perhaps she really does believe in it.

I don't think it matters either way whether she's a believer or not. In many ways, it's even more powerful if a believer in gender identity is saying that we need to stop how this is currently being handled and prioritise standard practices of evidence-based healthcare.

I hope you don't mind but I've added this comment to a thread about "language policing", as the Helen Joyce bit was particularly apt for where the discussion is at the moment. The whole thread is good but this would be a good place to start for its relevance:

https://www.mumsnet.com/talk/womens_rights/5185497-jk-addresses-language-policing?reply=139107788&utm_campaign=reply&utm_medium=share

They will have to be open to the possibility that the trial will fail to show that puberty blocking children is a justified “treatment”.

'Palmer said: “It looks very much like the NHS in England is going to be the world leader on producing the evidence base for this particular sector of child gender medicine, including puberty blockers'

Hmm. 'Producing the evidence base' means 'testing out dangerous drugs on children'.

Sorry. In haste so not sure if this has been posted. I hope share link works.

How the Cass Review has reshaped care for transgender children

www.thetimes.com/article/4ae7f8f1-7c44-42ef-9db2-5b3371379c19?shareToken=748de711e11daf525ff3000913523077

MrsOvertonsWindow · Today 17:16

I know there's quite a bit of criticism on here about her buying into gender identity in the report. But it seems to be essential.

I don't for a minute believe that she buys into it, I'm of the opinion that she was trying her best to appear even handed, for all the good it did her. Had she appeared partial, it would have damaged her and she had a lot of caveats along the lines of more research, of good quality is required.

I know there's quite a bit of criticism on here about her buying into gender identity in the report. But it seems to be essential. This is a fragile ideology, based on shifting sands with some very mentally unwell people caught up in it. Sticking with a determinedly respectful approach, accepting some of the basic tenets has allowed her to focus on the core of this - the lack of evidence and data and the harm this appears to pose for children and young people.

It's allowed this government to clearly support Cass that a more assertive challenging approach "taking on" some of the activists and their assertions might not have allowed. It's an almighty mess and while we need the blunt clear speaking that many women on here and others adopt, her approach has allowed thousands of medics to speak out in support (thinking of the BMA debacle) in a way that I suspect wouldn't have happened without her calm authoritative approach.

I recall reading something by Helen Joyce where she was musing on the fall out from an interview where she refused to call a transwomen she and had pissed off a commentator who regularly called out trans extremists but thought she was rude because of this. She was wondering whether at times she needed to "play the game" in the interest of moving discussions on (I think the one she was in got brought to an abrupt end because of her refusal). I don't recall her final conclusions but it made for interesting reading given that she's always so clear.

Sorry to digress .....

I can't see the similarity between your examples of people with a visible physical difference and people who just want to mimic the opposite sex.

Your examples are not about treating a mental condition with a physical treatment.

It seems like she's unravelling this massive knot, one strand at a time. It's taking such long time but it does appear that numerous medics are now retreating or speaking out and that, despite all the bad faith allegations against her, there's slow and steady progress in centring children's needs rather than trans extremism.

I think you're right MrsO

(I'm looking forward to the day when Baroness Cass and Baroness Nicholson can openly combine their thoughts from their respective different angles.... judging by Baroness Nicholson's latest genius open letter to Butlins, that would pack some punch! For now, strand by strand will do just fine)

I wasn't asking whether they needed therapy. I want to know the reason for body modification in someone whose body is healthy.

You can be healthy overall and disfigured or have a visible difference that affects the way that others treat you. Some experience distress that can be alleviated by an intervention such as body modification. Others practise self-acceptance or arrive there over time.

Many of these stories are about people with a congenital or acquired condition and their experiences. For some, the interventions did have an intention to reduce the visibility of a condition.

https://www.changingfaces.org.uk/real-stories/

https://www.savingfaces.co.uk//news-media/patient-stories/

If it's not pathological, why does it need medical treatment?

Because there has been an expansion into considering the alleviation of distress or the social model of disadvantage as a sufficient justification for medical treatment? This example involves a young woman who opted for leg-lengthening surgery. From the report and the various follow-ups over the years, she didn't have a pathology that underpinned her short stature.

https://www.dailymail.co.uk/health/article-138865/I-longed-air-hostess--I-legs-stretched.html

There was no medical need for the NHS operation but orthopaedic surgeon Dr Darren Fern decided to go ahead after a psychiatric evaluation.
https://www.dailymail.co.uk/health/article-136909/Girl-growing-dream-job.html

Has anyone actually tried to use therapy to cure gender dysphoria? Do sufferers want to be cured?

@Brainworm said that "many with the diagnosis feel very strongly that it is just a natural variation within the species and should not be pathologised". This seems to imply that they don't want to be cured. The comparison with homosexuality (which is implied by adding T to LGB) also implies that it's not something which needs to be cured, as the cure would amount to conversion therapy.

So is gender dysphoria a pathological condition which needs a cure or is it natural variation (like homosexuality) which is not pathological?

If it's not pathological, why does it need medical treatment?

Brilliant thread and thank you to everyone for sharing so much expertise.
I was interested to read Dr Cass commenting about "extremes" on both sides in terms of pressure on her and have been musing about what she meant. I assume she's reflecting the unhinged "political" pressure from transactivists on one side versus those appalled that the NHS is involved in any way with sex changes for children and young people?
It seems like she's unravelling this massive knot, one strand at a time. It's taking such long time but it does appear that numerous medics are now retreating or speaking out and that, despite all the bad faith allegations against her, there's slow and steady progress in centring children's needs rather than trans extremism.

BonfireLady · Today 14:12

In 2006, Ms Shuping said she found a psychologist willing to pour drain cleaner in her eyes to help her fulfill her wish to become blind.
The psychologist reportedly first poured numbing eye drops into each of Ms Shuping’s eyes, followed by two drops of drain cleaner.
Ms Shuping told the agency the process was extremely painful and that took around six months for the damage to fully take effect.
The psychologist was not named and it is not known if they are facing prosecution.

I mean, you fucking what?!!

Not all gender dysphoria can [yet] be explained by depression or autism and not all children grow out of it.

At the moment, the crossover with known co-morbidities is probably 97.5% (screenshot below).

The therapy book about young people with gender dysphoria written by Sue and Marcus Evans is a really accessible read. I think we'd end up with near enough 100% of cases being explained by other underlying factors if the neutral therapeutic care that they advocate for was properly put in place.

During their time at the Tavistock, the Evans did oversee some children transitioning, but it's clear from both their whistleblowing and their interviews with Benjamin Boyce and Andrew Gold (I think only Marcus has done an Andrew Gold interview) that they would likely welcome a challenge to physical medical intervention in its entirety. For example, Marcus said in the Andrew Gold interview that he didn't think that it would be possible to have an ethical trial for puberty blockers.

In their book, they draw a parallel between gender dysphoria and anorexia, where it's clear that the latter isn't treated by modifying the body to settle the distress. This is the book:

https://firingthemind.com/product/9781912691784/

It is hard to believe. The advert is still live so clearly they aren’t that bothered.

Agreed.
The other clues are that many of the supporting materials for "gender affirming care" and trans rights use US language somewhere within them, even when used within UK documents e.g. in NHS leaflets. Use of "bathrooms" and "mailman" for example. Mailman was used in a recent (awful) LGBTQ leaflet about how the removal of cancerous parts of the body could in fact be "gender affirming".

Wow. That's a phenomenal article. Thank you for sharing.

(Am currently catching up on this thread. There is some great stuff from PPs above too about "if it's not a mental health issue, what is it?" vs "if it is a mental health issue, why is the recommended treatment physical?")

Great post ⬆️⬆️⬆️

As the Cass Review says there is also no/ little evidence that psychological therapy can cure gender dysphoria either.
Not all gender dysphoria can be explained by depression or autism and not all children grow out of it.

Also not all research can have a control particularly where it’s not ethical. That doesn’t mean you don’t do the research. There are just more cautions when it comes to interpreting or generalising from It.

Like autism, many with the diagnosis feel very strongly that it is just a natural variation within the species and should not be pathologised. Often, the distress that typically comes with the 'condition' is framed as being caused by society being designed with just 'normies' in mind.

Are you really seeing a parallel between autism and someone who thinks their sexual organs are 'wrong' or one of their limbs doesn't belong to them?

Surely if someone truly believes they should have one of their limbs amputated or that their sexual organs are 'wrong', this is not 'natural variation within the species', it's pathological. How is this feeling of the body being 'wrong' caused by society?

So what are they trying to achieve with the body modifications? Your reply only makes the case for therapy as well as (or instead of?) body modification.

I wasn't asking whether they needed therapy. I want to know the reason for body modification in someone whose body is healthy.

I wonder how many children in the UK are still on puberty blockers or cross sex hormones. It makes me sick to think of it.

Good work by the Telegraph in holding their feet to the fire here. It’s hard to believe an old ad was used in error given this has been such a high profile issue in connection with the treatment of gender identity issues.

If they don't have mental health needs and their body is physically healthy, what are they trying to achieve with the body modifications?

I agree with Brainworm. For the same reason that people need support with

• plastic surgery
• major life transitions like bereavement.

Even cosmetic surgery is supposed to involve pre-screening and follow-up support (may vary with scale of the intervention).