Hilary Cass sent a document to every single MP and Peer, justifying and defending the puberty blockers trial

As for the made-up case (referring to a real and potentially identifiable child in such a way in the HOL would have been an actual safeguarding issue), what's interesting is that people are saying 'oh it's made up, she lied, that child doesn't exist, what a bitch' and not really looking at what she has said about it being an amalgam of several children.

That's a bit of a misrepresentation of what people have been saying.

She did lie. She should have said it was a hypothetical child, not a real one. But nobody has said 'what a bitch', or anything like that.

Instead of going 'that child doesn't exist, phew' the response should be 'fuck, there's more than one of them'.

Has nobody said that? It's certainly what I thought. The idea that there might be several, or dozens, or hundreds of children like this is horrifying.

And for the 'that's child abuse' response. Well yes, but saying that doesn't actually help that child right now, does it? How to proceed with those poor kids? If they have only just come to the attention of the clinics,

I'm honestly surprised (perhaps I shouldn't be) that a child could go from the ages of 2 to 11, without some professional that they have come into contact with (teachers, GPs...) alerting social services to the obvious abuse which is taking place. But since Dr Cass herself doesn't view this as abuse, perhaps those professionals didn't either.

@Cantunseeit · Today 08:33
Thank you for relating the tragedy of Chicken Girl. I agree the transing of two year olds is comparable, even if preferable for at least still including human interaction.

That is such an upsetting story. I wonder if she misses living with the chickens? I hope she has enough ‘human’ instincts left to enjoy being with them a bit.

Cass doesn't seem to be arguing that giving her fictional child puberty blockers is to give them time to think. She appears to be saying that this child has been socially transitioned for so long that they are unable to be reconciled with their actual sex and are fixed in their new gender so require puberty blockers prior to medically transitioning

I wonder if she'd have advocated chopping off Imane Khelif's and Caster Semenya's (or any of multiple male sports stars with the DSD 46 5-ARD) penises when they started to grow and their testicles, if these descended in puberty?

It would have been very distressing for them to discover that they were actually male. Perhaps she thinks teaching a child what sex they really are, if they had strongly believed they were the opposite, is unkind and adjusting their body to match their belief is a better option.

The kindest thing to do would be to help them reconcile with their male bodies. I suspect that's exactly what happened in private with these individuals and that, thankfully for them, they've probably all still got intact bodies.

I don't know what she has considered because she didn't tell the Lords. This wasn't a "very difficult situation and maybe transition would be better or maybe not we just don't know" kind of speech it was a "how could we consider not transitioning this poor child?" kind of speech.

But given the physical consequences of transition, and the long history of fuckups caused by medical interventions on children with DSDs to help them pass better as one sex or the other, I 'm surprised by Dame Cass' insistence that such a child is the poster child for a puberty blocking experiment.

For me it comes down to ethics.

Yes, you and I have very different opinions on the quality of the data in the proposed trial (I say it won't be high quality, from what I see you believe it will) and the data linkage study (I say it's worth seeing what the data points show when correlated, you say it's crap don't go fishing). But ultimately it's the ethics difference that is most fundamental.

Although the children are assenting, they don't really know what they are assenting to. How could any child understand agreement to possible brain damage and early osteoporosis? Although their parents are consenting how can any parents morally say yes to these things either, on behalf of their child? How many of these assents/contents have come from children and their parents believing that they'll die by suicide if they don't get this "treatment"?

That's not real consent. On the face of it, it's better than what the Nazis did to get scientific data but I'm not convinced that it is. These vulnerable children are pawns in this mess. The saddest part of all is that they and their parents have been coerced into believing that it's something that is right for them. Obviously I'm not talking about the morally corrupt Munchausen by proxy parents here (they'll probably be off buying the drugs illegally) but the likely majority of scared parents who are turning to the NHS for help.

Some food for thought on data that hasn't been gathered ethically:

https://journalofethics.ama-assn.org/article/how-should-we-regard-information-gathered-nazi-experiments/2021-01

Given these prisoners were going to die anyway, I have no doubt that some people will convince themselves that it was worth gathering valuable data before they did. I'm not suggesting you would think that but I'm genuinely confused why you wouldn't see this PB trial as equally aborrent (assuming you do think the Nazi example is such).

This is the problem with the whole trial, and its objectives and its timelines and Cass's comments on it. It's all slippery, smoke and mirrors, unfocused, scattergun. It just doesn't pass the sniff test. There is something very wrong at the heart of it, and we sense that.

Also puts a huge amount of faith in medical transitioning.

Perhaps a child who has been treated like this will always have profound psychological difficulties, but it doesn't follow that those can be solved with surgery.

💯

Blimey. How would you know that an 11 year old could never be reconciled to their actual sex? I mean know it with enough confidence to say, well fine, this way to mecication and surgery and sterility and lack of sexual function and physical urinogenital problems and whatever else because it's better than the alternative?

I mean, she probably has considered that.

On the flip side, are you really 100% certain that for a kid who is terrified to go to school in case they are discovered, that allowing puberty to progress so that they will definitely be discovered if they leave the house is the option that will cause the least harm to them?

And for the 'that's child abuse' response. Well yes, but saying that doesn't actually help that child right now, does it? How to proceed with those poor kids? If they have only just come to the attention of the clinics, then it is possible that puberty blockers could in this sort of case, give the fabled 'time to think' while the psychiatrists do more work with them to reconcile them with their sex. I don't know.

Cass doesn't seem to be arguing that giving her fictional child puberty blockers is to give them time to think. She appears to be saying that this child has been socially transitioned for so long that they are unable to be reconciled with their actual sex and are fixed in their new gender so require puberty blockers prior to medically transitioning

When I start thinking that perhaps I am failing to take into account that wrong things may be done for the greater good, I go and re-read Ursula K LeGuin's "The Ones Who Walk Away From Omelas".

Do the ends justify the means? I don't know. I know that if it were my own child (as it very easily might have been) I would find this experiment on children abhorrent, and so perhaps I should also find it so when it is not my, but someone else's, child who will suffer "for the greater good".

I also simply do not believe that any study/clinical trial carried out in "Terf Island" will be remotely persuasive to anyone who wants not to believe the results it produces. That is, anyone who wants children to be transed; there seem to be a fair few of them, and unfortunately many of them seem to have children.

Oh, the text of LeGuin's story? Here you go: www.utilitarianism.com/nu/omelas.pdf

As for the made-up case (referring to a real and potentially identifiable child in such a way in the HOL would have been an actual safeguarding issue), what's interesting is that people are saying 'oh it's made up, she lied, that child doesn't exist, what a bitch' and not really looking at what she has said about it being an amalgam of several children. Instead of going 'that child doesn't exist, phew' the response should be 'fuck, there's more than one of them'.

Well, if that's what she meant then that is what she should have said. "There are several children who... and they would benefit from..." Creating a single hypothetical case and emoting about it is not good behaviour. Neither (as has already been pointed out) is ignoring the safeguarding aspect of how a child came to be in this position in the first place and failing to consider whether blocking that child's puberty is a better way to proceed than giving a child in such an extreme situation an off-ramp.

Me too. The anecdote was a real game changer for me in terns of viewing her as prepared to stop at nothing to gaslight others. Although I did think the concerns raised about the possibility that she's felt bullied or intimidated by certain powerful transactiovists in the NHS are legitimate. Women on here are only too aware of the manner in which TRAs throw around threats towards careers, reputations and physical safety.

At the core of this, is that she and others reckon think that the long term safety and well being of a group of children is fine to sacrifice for the "greater good" and quite casually dismiss everyone pointing out that harm to one child is one child too many.

Those of us who are child & child safeguarding centred disagree. We've watched the long term abuse of children by advocates for this ideology for over a decade and now say enough. Time to stop. Literally, leave children alone.

The ethics committee and Cass herself must believe there is a realistic prospect that this treatment is beneficial to the children in the trial.

There are many, many people who will say that it has been beneficial, either to themselves or their patients, and many who say that it isn't. Clinical trials are literally the way you decide this sort of thing.

As for the made-up case (referring to a real and potentially identifiable child in such a way in the HOL would have been an actual safeguarding issue), what's interesting is that people are saying 'oh it's made up, she lied, that child doesn't exist, what a bitch' and not really looking at what she has said about it being an amalgam of several children. Instead of going 'that child doesn't exist, phew' the response should be 'fuck, there's more than one of them'.

And for the 'that's child abuse' response. Well yes, but saying that doesn't actually help that child right now, does it? How to proceed with those poor kids? If they have only just come to the attention of the clinics, then it is possible that puberty blockers could in this sort of case, give the fabled 'time to think' while the psychiatrists do more work with them to reconcile them with their sex. I don't know.

Yes... it's not just that I disagree with Dame Cass, it's that I still can't follow her reasoning.When I read the review, the recommendation for the PB trial was just one among many and of all of the recommendations it seemed the least useful. Plus it was dependent on ethical approval which based on the rest of the report I didn't think could reasonably be given, and so I assumed it probably wouldn't.. And the evidence coming in later (e.g. from Finland) hasn't produced anything to change my mind, nor Dr Cass's as far as I know.

So I can't get my head round the fact that she and I seem to agree on the facts and the evidence but she still thinks the trial should go ahead. To me the rational evidence-based decision is still that this trial is not ethical. Standard ethical practice (which I am sure Dame Cass follows) doesn't allow the position that it's OK to sacrifice one group of children to gather data that protects another group. The ethics committee and Cass herself must believe there is a realistic prospect that this treatment is beneficial to the children in the trial. I don't believe that myself, and while I accept that Dame Cass genuinely believes that I still don't see what is the rational basis for her belief.

And the fact that Cass has moved so far from her cautious neutral position that she resorted to a silly and emotionally manipulative anecdote which she has now admitted was not even a real case - that's beyond disappointing, it's disturbing.

But this isn't the first time I've seen you bring in a "balance" that ultimately becomes anti-safeguarding. In this example it's anti-safeguarding to advocate for a trial that will highly likely harm children

See, this is a problem, @BonfireLady and endemic on this section. If people can't disagree with your points, they call you a TRA and if they can't pin you as being a TRA they say that you either actively harm kids, or don't care if kids are harmed.

What is interesting here is that I am being called 'anti-safeguarding' but when you review my argument, I am arguing for robust evidence collection that can be used to stop all prescriptions of puberty blockers, globally. Protecting thousands of kids from being prescribed them.

And the response is 'ah well, those clinicians aren't going to pay attention to clinical trial results anyway'. Well their regulators might. And what total disregard for those children. Not in the UK? Don't give a toss then.

There used to be a big problem with pharmaceutical companies running clinical trials, finding the results were not to their liking and then quietly shoving the results in a drawer.

Ben Goldacre led a huge campaign a few years back for an international trials register where you have to register your trial in advance and then people can check whether the results have actually been published.

Anyway, the law in the UK was introduced in April 2026 (handy) saying that all UK trials have to be registered, and results have to be published within a year.
I can't imagine that with the huge amount of interest in this trial that they'd get away with shoving it in a drawer anyway.

https://senseaboutscience.org/alltrials/

A clinical trial on the other hand is specifically designed in advance to answer a question about the efficacy and/or safety of a treatment

The question of efficacy is what exactly?

We know these drugs stop puberty so they are effective.

We know thousands of side effects or effects as evidenced by the very short term use on other children due to their huge effects so have ample evidence of their lack of safety.

So what exactly is under investigation here?

It's not a study, it's a clinical trial.

A study can be anything anyone has decided to do. They could do an observational study where they give a drug to a handful of kids and then say they looked better and write that up. There doesn't have to be any regard for basic scientific principles to conduct a 'study' and that's why there's a lot of shitty, low-quality studies out there of the sort that people produce and say 'hah, this shows that vaccines cause autism' or 'homeopathy cures asthma' or whatever. You can also have better studies like the Finnish one. That took national patient data and carefully looked at what data fields could be used to answer questions about whether trans healthcare improved mental health. They matched their patients to controls, and they used a specific measure 'referral to severe psychiatric services' as their data point. Because it was a single, national dataset, everyone had the same data recorded in the same format. They were able to control for things like prior psychiatric history. It was a large sample size spanning a couple of decades. Pretty robust data and methodology but they still had to be careful to use words like 'associated with an increase in' rather than 'trans kids are more likely to'. They were, however, beholden to the data that they had rather than that they would like to have.

A clinical trial on the other hand is specifically designed in advance to answer a question about the efficacy and/or safety of a treatment. Patients are usually randomised to a treatment arm which is the drug under investigation, or a control group who are given the placebo (or for ethical reasons the next best treatment). Where possible, it's double blinded which means neither doctor nor patient know which medication they are getting to avoid bias. In this case because of the difficulties of blinding and placebos because the effects of puberty blockers are obvious, they are using a delayed treatment arm instead. The data that is collected is designed in advance to be the data needed in order to conduct the statistical analysis. No going 'bugger, we can't control for autism because we didn't record if they had it'.

Unlike when you go to the doctor and they type a bunch of stuff in a free text box, most data points in a clinical trial are coded so that they can be validated and analysed more easily.

And the data is cleaned to make sure that it is as complete and error-free as possible. I know someone who got called up for a covid jab as a 'vulnerable person' and he found out somehow his patient records had him as having had a transplant. Which he very much hadn't. Errors are always made when collecting data because people are human. On a trial, the data is reviewed and validated. Missing data is chased and inconsistencies are followed up (e.g. 'you have listed antibiotics as a concomitant medication but there's no associated adverse event' and they come back with 'there should be an ear infection recorded').

The locked database at the end of a trial contains data which has been collected to a much higher standard than your regular GP visit, so the statistical analysis that is run on it is generally much more robust.

The problem I have with asking people who have done a hugely damaging thing on a whim that changes their entire lives, so much so that backing down might actually destroy their whole social network if they are 'fine' with the treatment is that there is no actual definable measures beyond 'I did it and I was right'.

And the reason is because there IS no definable measure of 'transness' in the first place.

From the linked article:

"Despite the advice of leading experts from two separate gender identity clinics and the UCLH paediatric endocrinology team that I should be prescribed puberty blockers, the GP refused to dispense the prescription on the grounds of their ‘personal beliefs and ethics’. "

You'd think this clued-up determined person might have known you are allowed to change your GP. wouldn't you. And if he didn't, his mother should have done.

The reason I’ve been posting on this thread is because I read Cass’s document upthread and thought ‘fair enough - there’s bits I don’t agree with but she’s clearly thought about this reasonably’ to then read a thread about how she obviously has been receiving death threats and coerced into writing it, or she’s a mad trans activist who thinks she can turn little boys into little girls.

I think I was the first one to suggest on this thread that she might have been taking the death threats seriously and was trying to appease the TRAs. I was really trying to understand why following the cautious and measured approach of her report, she seems to have gone full-on TRA herself.

The anecdote about the fictitious 2-year-old is bizarre. If a child that age is transed, it's all about the parents. Surely she must see that? Instead of seeing this as the abuse it so clearly is, she presents it as a good reason for giving the child puberty blockers. It really does make her look as though she thinks little boys can be turned into little girls, as you put it, just as John Money did.

It felt like a pile-on when I experienced it. My reaction was to end up in floods of tears and leave for a month. I came back stronger but still resolute in my neutral position on gender identity belief. Plenty of people believe in things I don't and that's OK.

So sorry that you felt this way @BonfireLady when you’ve brought so much thoughtfulness and insight to these threads. And yes, I certainly can see that it feels like a pile on even if / when that’s not the intention.

I’ve put quite a bit of time into explaining how it’s possible to support this trial going ahead without being a mad TRA, with actually having concerns about safeguarding kids and without being forced into it by death threats. So yeah, to have someone throw the ‘I find your posts troubling crap at me, I’m pretty contemptuous of that as a tactic. I hope that contempt came through in my deliberately flippant response. And if you didn’t like it, that was the point.

Yes you have answered most questions and put across your views on Cass, that’s true. The deliberately flippant remark was, however, a common sexist trope. And yes some on this thread have conjectured about threats or Cass being a TRAs after all etc,

But I’m guessing many on this thread are just incredibly disappointed by her recent actions including creating a fictitious child to emotionally blackmail Lords into agreeing that decisions about these children ought to be clinical ones and not political ones. And disappointed and puzzled about her emailing all MPs.

The answer is likely simple human nature / human ego with her feathers being ruffled about the trial pushback and a certain amount of ego of ‘doctors know best’ along with an inability to appreciate how many doctors don’t know best.

There we are then. You agree with Cass on the trial. You’ve explained your reasons. You disagree with those who disagree with you about the likelihood of this particular trial achieving its stated aims.

Again, not sure there’s much more to said. In my view anyhow.

Great comment about anti - safeguarding @BonfireLady .