Netherlands Puberty Blocker Review Comes to Opposite Conclusion, Dismisses Cass Review

'He' has also said that she is not attached to pronouns as a signifier of self. It is you who is imposing them.

Absolutely. To me it's very clear from the clinical literature and patient accounts that this is not at all an adequate explanation in many cases. We have a gender critical, sex realist trans person on this thread. His gender incongruence persists despite his very fixed immersion in sex realist perspectives and rejection of gender stereotypes

This is what Cass wrote about 'Jo'. You said Jo was a stupid example. Why is it stupid?

“There was considerable discomfort in the House and more widely on social media about my account of ‘Jo’, a biologically male child who was socially transitioned to a girl at 2½ and presented at around 10-11 afraid to go to secondary school for fear of being ‘outed’, later retreating to their bedroom and developing weak bones due to inactivity. ‘Jo’ is not a specific case, but represents a group of similar children being seen in the new services, and previously at the Tavistock. Although social transition is usually later (from 4 onwards), I was told during the Review about children who had been transitioned at Jo’s age and younger. “I have been asked why safeguarding procedures would not have been initiated when ‘Jo’ was a toddler, but these children are frequently living in stealth (i.e. those around them do not know their biological sex) and do not come to medical attention until much later as puberty looms. A male child who has socially transitioned at 4 and presents at 11 will have next to no recollection of being a boy. They are not making a decision to be a girl – by that time they just believe themselves to be a girl and have no frame of reference to think differently. Even with input from the very skilled therapists in the new services, encouraging them to think more flexibly about their identity is rarely successful, regardless of what their natural trajectory would have been if they had not been socially transitioned at that very early stage.”

It's bizarre though. Children like Jo are going to know they're not like the girls every time they look inside their pants, social transition or not. They might believe that the doctors will have a magic fix so they can grow up to be women but that's just not going to be true.

The poor kid may be totally screwed up already but how is blocking his puberty giving him oestrogen and then cutting off his penis going to unscrew him?

I suppose it is technically possible to get all the way to the end of Primary school without realising that if you have a penis that makes you a boy. It does indicate a very unusual set of circumstances though and should, in itself, give clinicians pause for thought about what else has been going on in that family and with that child. Combined with the 'transing' by the parent(s) it shouts for involvement from safeguarding authorities and many years of high quality, non-affirmative therapy, probably well into adulthood, to limit the damage. As you say, the solution is not to set up an entire medication pathway to compound the damage.

I suppose it is technically possible to get all the way to the end of Primary school without realising that if you have a penis that makes you a boy. It does indicate a very unusual set of circumstances though and should, in itself, give clinicians pause for thought about what else has been going on in that family and with that child. Combined with the 'transing' by the parent(s) it shouts for involvement from safeguarding authorities and many years of high quality, non-affirmative therapy, probably well into adulthood, to limit the damage. As you say, the solution is not to set up an entire medication pathway to compound the damage.

I suppose it is technically possible to get all the way to the end of Primary school without realising that if you have a penis that makes you a boy.

I don't believe that it is possible even with brainwashing by transactivist parents. The fictional "Jo" is a figment of Baroness Cass's imagination. She says it was based on what she has been told by parents who have transed their children but I suspect she is exaggerating to support her argument in favour of the PB trial. In any case parents who "trans" a two year old child are hardly going to be reliable sources as they are so invested in their child being "trans".

I suppose it is technically possible to get all the way to the end of Primary school without realising that if you have a penis that makes you a boy.

I don't believe that it is possible even with brainwashing by transactivist parents. The fictional "Jo" is a figment of Baroness Cass's imagination. She says it was based on what she has been told by parents who have transed their children but I suspect she is exaggerating to support her argument in favour of the PB trial. In any case parents who "trans" a two year old child are hardly going to be reliable sources as they are so invested in their child being "trans".

I agree that it's a figment of her imagination and unrealistic. But How does this case justify the trial? Surely it would be the opposite? If this were really the kind of thing going on..?

I agree that it's a figment of her imagination and unrealistic. But How does this case justify the trial? Surely it would be the opposite? If this were really the kind of thing going on..?

I agree that it's a figment of her imagination and unrealistic. But How does this case justify the trial? Surely it would be the opposite? If this were really the kind of thing going on..?

Welcome to our world

A world where fictional and wildly unrealistic stories are invented and then presented as if they were meaningful examples of kids with gender dysphoria in policy debates?

Any luck with that clinical literature that shows that social factors don't adequately explain gender incongruence in some people? Preferably something fairly recent where modern psychological treatments have been used intensively within a neutral, exploratory approach rather than in a gender-affirming framework.

A world where it seems that we cannot trust anyone who has any sort of finger in the gender-affirming care pie.

Is that how you see Cass?

Well quite, "Jo" doesn't justify it at all. "Jo"s story has shades of David Reimer and that didn't have a happy ending.

Well quite, "Jo" doesn't justify it at all.

In Cass's argument "Jo" justifies the trial of PBs because otherwise the parents will buy Lupron for their child on the dark web.

Which is no justification at all.

It’s difficult to point to one study that proves the cause of gender dysphoria—psychological conditions rarely have that kind of evidence. My view comes from the broader body of clinical literature and patient accounts.

Taken together, they point away from the idea that gender incongruence is simply the internalisation of gender stereotypes or social expectations.

For example:

• Many trans people grow up in families with very traditional views about sex and gender, where being trans is actively discouraged or rejected. Yet their gender incongruence persists despite those social pressures.
• Many trans people have interests, personalities and behaviours that are typical of their natal sex, yet still experience profound gender incongruence.
• There are masculine trans women and feminine trans men, which is difficult to reconcile with the idea that transition is simply a desire to conform to gender stereotypes.
• Some trans people explicitly reject gender stereotypes, gender as a construct and hold sex-realist views, yet their gender incongruence persists.

If gender incongruence were fundamentally caused by internalising gender stereotypes, we would expect trans people to hold more rigid stereotypes than everyone else. In fact, the evidence points in the opposite direction: transgender children tend to endorse gender stereotypes less strongly and are more accepting of gender non-conformity than their cisgender peers (eg Olson, K. R., & Enright, E. A. (2018). Do transgender children (gender) stereotype less than their peers and siblings? Developmental Science, 21(4), e12606. https://doi.org/10.1111/desc.1260

Most importantly, the detailed accounts of persistent gender dysphoria simply don’t read as “I believed boys should do X and girls should do Y.” They are far more consistently described / characterised as a deeply embodied experience of incongruence with one’s sexed body. Whatever its ultimate cause, that experience appears to involve how the brain perceives and represents the body, not merely internalised beliefs about gender roles.

None of this proves a single cause of gender dysphoria. But it does make the hypothesis that it is fundamentally caused by internalised gender stereotypes an inadequate and entirely unconvincing explanation of the body of evidence.

It’s difficult to point to one study that proves the cause of gender dysphoria—psychological conditions rarely have that kind of evidence. My view comes from the broader body of clinical literature and patient accounts.

Taken together, they point away from the idea that gender incongruence is simply the internalisation of gender stereotypes or social expectations.

For example:

• Many trans people grow up in families with very traditional views about sex and gender, where being trans is actively discouraged or rejected. Yet their gender incongruence persists despite those social pressures.
• Many trans people have interests, personalities and behaviours that are typical of their natal sex, yet still experience profound gender incongruence.
• There are masculine trans women and feminine trans men, which is difficult to reconcile with the idea that transition is simply a desire to conform to gender stereotypes.
• Some trans people explicitly reject gender stereotypes, gender as a construct and hold sex-realist views, yet their gender incongruence persists.

If gender incongruence were fundamentally caused by internalising gender stereotypes, we would expect trans people to hold more rigid stereotypes than everyone else. In fact, the evidence points in the opposite direction: transgender children tend to endorse gender stereotypes less strongly and are more accepting of gender non-conformity than their cisgender peers (eg Olson, K. R., & Enright, E. A. (2018). Do transgender children (gender) stereotype less than their peers and siblings? Developmental Science, 21(4), e12606. https://doi.org/10.1111/desc.1260

Most importantly, the detailed accounts of persistent gender dysphoria simply don’t read as “I believed boys should do X and girls should do Y.” They are far more consistently described / characterised as a deeply embodied experience of incongruence with one’s sexed body. Whatever its ultimate cause, that experience appears to involve how the brain perceives and represents the body, not merely internalised beliefs about gender roles.

None of this proves a single cause of gender dysphoria. But it does make the hypothesis that it is fundamentally caused by internalised gender stereotypes an inadequate and entirely unconvincing explanation of the body of evidence.

One doesn't need to have some concept of the reality of gender to have sex dysphoria existing. Brains get stuff wrong. Anorexia doesn't have an underlying reality of people having an independently existing mind-BMI, the mind is just stuck in a dangerous rut where its perceptions and reality wildly diverge.

One doesn't need to have some concept of the reality of gender to have sex dysphoria existing

Right exactly! That's what I'm trying to say.

A common mistake is to assume that, in order to experience dysphoria, someone must first adopt a particular theory of gender, but that isn't the case at all. A person can experience dysphoria regarding of their theories about gender and sex. Young children often experience dysphoria before they have any sophisticated ideas about gender identity, gender roles, or philosophy. The distress appears as an immediate, embodied sense that something is wrong about their sexed body or being treated as a member of that sex category. It isn’t reasoned into existence.

Where I think your argument becomes confused is in two ways.

First, you move from “the brain generates the experience” to “the brain is getting reality wrong.” Those aren’t the same thing. People often misunderstand trans people as being "deluded" about their bodies, but that isn’t generally what’s being described. Trans people are not under the illusion that they have different sexual anatomy. They know what their bodies are. The distress isn’t caused by a false belief about their anatomy; it’s caused by the fact that their anatomy is experienced as profoundly wrong or incongruent.

More fundamentally, contending that gender isn't "real" highlights another misunderstanding. No one is suggesting that gender is an independent object in the world. Gender identity is simply the language given to describe a psychological experience.
While gender identity itself isn't a "thing" the psychological experience of it is real. This is true of any psychological experience. Pain isn’t an independently existing entity. Hunger isn’t. Our sense of body ownership isn’t. They’re subjective experiences generated by the brain, but they’re nonetheless real features of human experience.

This is an interesting X thread:

https://x.com/wontsomeonethi2/status/2069800467811459454

The poster is a developmental psychologist who says she has spoken to Cass and that Cass knows that these children are not 'true trans'.