BBC interview with Cass. 'Both sides weaponised'

Cass’ position , as I understand it, is that she thinks that there are ‘many ways in’ to a ‘trans identity’ and this needs to be matched by many ways out. I think she is suggesting (from her research, which has been extensive) that there may be a very small number of people whose ‘way in’ may be linked to a condition (maybe mental health, may be neurodevelopmental) that we know little about. I think she is referring to people for whom there aren’t other more likely explanations for their dysphoria symptoms - and their symptoms reach clinical levels of impairment, meaning their quality of life is significantly impacted.

There is nothing from what she has said that makes me think she is thinking about people who are preoccupied by how they are perceived by other people. I am confident she is thinking about children who are agoraphobic, self harming, school refusing etc. who make sense of their difficulties as being because they cannot tolerate being the sex they are, for whom there aren’t any other hypotheses explaining this (eg SA, homosexuality, autism) and while they cannot change sex, hormone treatment could reduce symptoms and improve participation and access to activities that will improve their quality of life.

I understand why there is so much scepticism about this - the vast majority of children have trans identities because of a shit show of other factors at play. What I have trouble accepting is the absolute certainty that people cling to in stating that she is wrong. There are few people who have had access to evidence that Cass has - it’s quite something to suggest that she has less insight than them.

Sterilising children because of gender stereotypes is also an insane thing to do. But here we are.

That's a very different question to whether or not it should be done at all. I don't know how you design a study for this, because I don't really know what the harm is that the drugs are helping to avoid in these otherwise healthy children (which is presumably why the suicide narrative was pushed so hard because without that, there's no sufficiently serious risk of harm attached to not using them).

I don't know what a 'better with' outcome is supposed to look like. I don't really understand the point of the puberty blockers from a medical point of view. 'Buying time' is meaningless. If they are being used as a way of helping a child with puberty phobia cope with their anxiety, it's completely at odds with how anxiety for all other phobias is treated. If it's cosmetic then surely the outcome can't be measured because it's not how the individual feels about their appearance, it's about how other people feel about it.

What evidence are you drawing on when you say (what I think you are saying) that you know for certain that there can not be a rare condition whereby the symptoms are distress in one’s sexed body for which causation is not linked to likely causation (autism, SA, gender non conformity etc.).

I struggle to see how being open to such a condition existing, especially when encountering children for whom this seems to be the case, is akin to being a climate change denier.

But are the planned tests for evidence even going to be the right ones after this cohort of children are sacrificed? Will the trial run for long enough?

To spare the next generation of children from online influencers and idiot parents willing to believe that taking lupron for cosmetic purposes is a good idea, we need a solid body of evidence proving the harm, and the only way to get that is to sacrifice some children now.

I thought Cass made a lot of sense, actually. Very clear that social media has pushed the idea of 'trans' on children, especially girls, that there is a complete lack of understanding of what the drugs and surgery route actually entails, and that the 'trans' child should be a unicorn and most of us should never encounter one.

I'm on the fence about the puberty blockers trial. I hate that they've been given that inane cutesy name, for starters, having been on them twice for endometriosis I cannot understand how giving them to a healthy adolescent can ever be considered a good idea. The side effects are awful - bone pain, joint pain that kept me awake at night, sweats, broken teeth, my hair fell out, I gained weight, I had nightmares and I felt constantly panicky and upset. But she is right when she says that, thanks to the tavistock and their failed record keeping, we don't have clear evidence of what happens when these drugs are used in this cohort, and having a decent body of evidence is needed to push back against the arguments for their use. Unfortunately, the only way to get it is to harm another cohort of children.

Abortion and assisted dying were/are illegal and the public debate has been in relation to whether laws should be changed.

If there had never been laws around abortion or assisted dying, I’m not sure there would be appetite to introduce them. I don’t think there is an appetite to introduce laws around medical treatment.

When it comes to vfm decisions about treatments, these are made by NICE, not the public or government- as I understand it.

Oh absolutely! An ethical minefield.

I expect most people would have huge issues with this however. Purposefully disabling people seems like an insane thing to do.

You’d never say it for any other mental illness

Niche example, but there have been cases of Body Integrity Dysphoria resolved by limb amputation. I don't think it's unreasonable to say that a 'tiny, tiny' number of people will need to medically transition in order to have the best shot at life.

I expect there will be a significant difference between those who 'need', and those who 'want' though.

I don’t think elements relating to social policy should be brought into the decision making

It is the initial decision to allow those sorts of treatments to be permitted that I am talking about. Surely society has some input to make? Abortion? Assisted dying? Expensive cancer drugs?

The reason we are where we are is, in part, professionals making a parallel diagnosis and passing the children onto another part of the system that does the same. Therapists diagnose distress, refer to endocrinology who prescribe drugs and refer back to therapists. Therapists are trained to look at mental health, endocrinology hormone levels. No one is trained to know who will persist throughout their lives and will have no regret about the consequences of the treatment.

The end result is a transitioned adult, but at no point has 'trans' been diagnosed. No one can have a consultation with a pre pubescent girl or boy and know that their lives are going to be better for being on this pathway.

Cass is saying that there is bound to be some children who persist with these feelings all of their lives, and if PB help in some way, and are not dangerous, this part of the system is safe.

She's supporting this system. As long as each step in considered safe, and while the idea some adults knew they were trans from childhood persists, the system will not stop.

Those saying her argument is 'balanced' - it's like being balanced between a climate change denier and a climate change expert (a tightrope walk the BBC also tried to maintain for a long time). One is completely and fundamentally wrong and it is dangerous to pretend otherwise.

That’s quite difficult though, when the whole purpose of the treatment appears to be about how the patient is perceived by other people.

For example, any history of sexual abuse, indicators of non heterosexuality, autistic traits, mood disorders, social struggles etc would automatically exclude inclusion in the study. You would be left with probably fewer than 2 or 3 children (nationally) for whom eligibility was applicable.

Exactly. But without first excluding these comorbidities the trial will be on the wrong basis.

Even if certain children are excluded because of those other factors, the trial is highly questionable.

Back in the day, decisions about eligibility for medical treatment of gender dysphoria required patients to demonstrate that they understood that the treatment was not going to actually change their sex. This was prior to any physical treatment for children, and I think this eligibility criteria has been weakened by the mangling of language (e.g sex assigned at birth and acquired gender). I would like this to be reinstated.

I don’t think elements relating to social policy should be brought into the decision making, beyond making it clear that the law is subject to change and that ‘rights’ are liable to change over time and treatment decisions should sit outside of this for both the clinicians and patients

@Brainworm Her PB trial position is, as I understand it, that there are case studies indicating that there is a rare condition for which puberty blocking followed by cross sex hormones produces the best outcomes for those with the condition.

Even if that is the case and we could identify those children with 100% accuracy, we still need to have a discussion about whether giving them the means by which to deceive others about their sex for the rest of their lives is the best outcome for society as a whole. Do the needs of the few outweigh the safeguarding needs of the many?

Well that's sad for those people who want to pass more effectively as adults (men - women can take T as adults). But I don't think experimenting on children can be justified because of it.

But there are people who wish they were taller, whose lives would probably be improved by being taller but leg lengthening operations are rightly seen as extreme and not regularly used, why is it ok for this group of people to go through life unhappy with their bodies but not another group? You can’t change sex, pretending you can only hurts trans people who by their very nature are already somewhat fragile.

Guidance was first proposed in 2018. A lot of pain on both sides would have been avoided if it had happened then, and the law clarified as happened with the Supreme Court judgment.

Though, having gone through puberty the issue of finding it more difficult to " pass" raises its head.....which then brings us neatly around to all of those AGP men who have been cross dressing since childhood, and who represent much of the noise, and create the narrative, around child transition.

I agree with those who are finding Cass’ position balanced and well thought through.

Her PB trial position is, as I understand it, that there are case studies indicating that there is a rare condition for which puberty blocking followed by cross sex hormones produces the best outcomes for those with the condition, but the quality of evidence is weak and more robust evidence is needed.

I find the certainty of the people on here that there is no such condition surprising. I think Cass’ points about ideological blindness are probably true. I suspect that valid points about AGP, safeguarding, autism, trauma, single sex provision etc. do interfere with people’s openness to there being a rare condition. Perhaps the most significant influencing factor could be that when encountering 20 children wanting to transition, at most 1 is likely to have the rare condition. Whilst many children have been adopting trans identities (this is declining now), the majority have not been pursuing medical treatment, and so most people will not have met 20 in the first place.

I am not in favour of the clinical trial as it stands. I think its stance is too experimental. I think an ethical trial could be conducted if the inclusion criteria were much, much tighter. For example, any history of sexual abuse, indicators of non heterosexuality, autistic traits, mood disorders, social struggles etc would automatically exclude inclusion in the study. You would be left with probably fewer than 2 or 3 children (nationally) for whom eligibility was applicable.

Its telling that those advocating for the trial would object to the above saying that such inclusion criteria discriminates against certain groups, but this highlights their mindset being that the trial is a means to accessing desired treatment rather than a genuine trial set up to generate evidence to support informed decision making.

'She added: "There are a tiny number of people who will never be comfortable with their biological sex, with the gender associated with their biological sex.
"And for them, a medical pathway is the only way they're going to live their life comfortably. And we don't understand why that is, but we have to try and help those people thrive as much as the young people who are going to grow out of this."'

Surely the obvious answer is to wait and see which ones grow up and comprise the 'tiny number' who then benefit from medical treatment, rather than prematurely put children on a damaging medical pathway 'just in case'?

It is actually 'a tiny, tiny number of children will never be happy in their body, so we must give them the means to attempt to deceive other people and themselves about their true sex, and thereby create a whole raft of safeguarding issues'.

When did we ever have a conversation about whether society wanted to sanction that?