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Original poster

The Cass report - Peer review

177 replies

BeizenderKarneval · 28/05/2025 06:47

There has been some peer review work done on the Cass review, something that a lot of us in the industry knew was problematic but that has been used by government and a number of notably outspoken individuals to justify their hateful positions

The results and conclusions are quite compelling, and I urge you to read them for yourselves:

Critically appraising the cass report: methodological flaws and unsupported claims

I find this section especially interesting:

“It undermines the legal competence of both children and adults to access medical treatment and dismisses almost all existing clinical evidence on trans people’s healthcare by applying impossible evidence standards which, if applied to other medicines would invalidate more than three quarters of the existing treatments used in paediatric care which, like puberty blockers, are currently being prescribed off-label.”

The report’s primary conclusions rest on excluding 98% of the relevant evidence on the safety and efficacy of puberty blockers and hormones for lack of blinding and controls.

What this means is that they require studies in which some patients are given the treatment, and others are unknowingly given placebos.
This is not only a clear breach of medical ethics and monstrous suggestion, but also impossible due to the obviousness of the impacts of puberty blockers and hormones.

The report also strays far beyond its scope and competence in recommending a review of adult services and in suggesting that young people ought to stay under the care of children and young people’s services until the age of 25.
The latter is based on highly questionable understandings of brain development which have been repeatedly debunked as an oversimplification of the constant changes in human neurology over the course of our lives.

This recommendation, especially in a context of an already broken system of care for both adults and children, has the potential to have a significant negative impact on the lives and wellbeing of trans people in the UK.
Underpinning this report is the idea that being trans is an undesirable outcome rather than a natural facet of human diversity.

This is clear not only from the recommendations but also from the exclusion of trans researchers from the design of the review process and the links individual members of the research team have to anti-trans groups, which the Cass team were warned about.

I look forward to an interesting dialogue.

Critically appraising the cass report: methodological flaws and unsupported claims - BMC Medical Research Methodology

Background The Cass Review aimed to provide recommendations for the delivery of services for gender diverse children and young people in England. The final product of this project, the Cass report, relied on commissioned research output, including quan...

https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-025-02581-7

OP posts:
Thread gallery
8
NotBadConsidering · 28/05/2025 08:15

It always amazes me how willing people are to justify sterilising children. Whatever it takes, they’ll do it.

Tootingbec · 28/05/2025 08:18

TangenitalContrivences · 28/05/2025 07:06

@BeizenderKarneval What’s off with the BMC “critique” in a nutshell

  • Built-in activism, not neutrality – several authors hold positions in WPATH, TransKids Belgium, Trans Healthcare Action, etc. That’s a vested-interest crew assessing a report that threatens their professional/ideological turf. Bias is declared in the “Competing interests” section but never mitigated
  • Wrong tool for the job – they wave the ROBIS checklist at the Cass systematic reviews, yet ROBIS only tells you whether a review followed its own protocol, not whether the underlying evidence is any good. They never re-examine the primary studies Cass flagged as weak, so their “high risk of bias” stamp is beside the point
  • Nit-picking protocol tweaks while ignoring substance – Cass reviewers dropped grey literature and non-English papers to keep to peer-reviewed clinical data (standard practice). The BMC authors shout “bias!” but never show that any excluded study would actually change a single conclusion
  • One-size-fits-all search gripe – they complain Cass used the same search strategy across seven reviews, but those searches were broad MEDLINE/Embase sweeps; no evidence is given that relevant trials were missed. It’s speculation dressed up as methodology
  • Moving goal-posts on quality scoring – they slag Cass for using AGREE-II and an adapted Newcastle-Ottawa Scale, yet elsewhere praise affirmative-care reviews that use exactly the same or flimsier scoring systems. That’s a double standard they don’t acknowledge
  • Selective outrage over “deviations” – every literature review tweaks its protocol as it goes. Cass logged major changes on PROSPERO; the BMC team call this “unexplained”, but the change notes are public. Pot, kettle.
  • No alternative synthesis – they never pool the data themselves, run a meta-analysis, or offer new numbers. It’s arm-chair criticism: knock the method, duck the evidence.
  • Skates over the wider picture – Sweden, Finland, Norway and now the NHS have all tightened youth gender-medicine on the same evidential grounds Cass highlights. The paper pretends Cass is an outlier and doesn’t grapple with that international convergence.
  • Rhetoric over rigour – loaded phrases like “double standard” and “misrepresentation of evidence” pepper the text, yet each claim is backed only by the authors’ own ROBIS ratings – a circular argument.
  • Published in a methods journal, not a clinical one – handy if you want to debate paperwork rather than patient outcomes.

In short: lots of activist energy, little fresh data, and no dent in Cass’s core finding – the evidence base for medicating gender-distressed kids is still wafer-thin.

💅👏💅👏💅👏💅

Llamasarellovely · 28/05/2025 08:20

TangenitalContrivences · 28/05/2025 07:06

@BeizenderKarneval What’s off with the BMC “critique” in a nutshell

  • Built-in activism, not neutrality – several authors hold positions in WPATH, TransKids Belgium, Trans Healthcare Action, etc. That’s a vested-interest crew assessing a report that threatens their professional/ideological turf. Bias is declared in the “Competing interests” section but never mitigated
  • Wrong tool for the job – they wave the ROBIS checklist at the Cass systematic reviews, yet ROBIS only tells you whether a review followed its own protocol, not whether the underlying evidence is any good. They never re-examine the primary studies Cass flagged as weak, so their “high risk of bias” stamp is beside the point
  • Nit-picking protocol tweaks while ignoring substance – Cass reviewers dropped grey literature and non-English papers to keep to peer-reviewed clinical data (standard practice). The BMC authors shout “bias!” but never show that any excluded study would actually change a single conclusion
  • One-size-fits-all search gripe – they complain Cass used the same search strategy across seven reviews, but those searches were broad MEDLINE/Embase sweeps; no evidence is given that relevant trials were missed. It’s speculation dressed up as methodology
  • Moving goal-posts on quality scoring – they slag Cass for using AGREE-II and an adapted Newcastle-Ottawa Scale, yet elsewhere praise affirmative-care reviews that use exactly the same or flimsier scoring systems. That’s a double standard they don’t acknowledge
  • Selective outrage over “deviations” – every literature review tweaks its protocol as it goes. Cass logged major changes on PROSPERO; the BMC team call this “unexplained”, but the change notes are public. Pot, kettle.
  • No alternative synthesis – they never pool the data themselves, run a meta-analysis, or offer new numbers. It’s arm-chair criticism: knock the method, duck the evidence.
  • Skates over the wider picture – Sweden, Finland, Norway and now the NHS have all tightened youth gender-medicine on the same evidential grounds Cass highlights. The paper pretends Cass is an outlier and doesn’t grapple with that international convergence.
  • Rhetoric over rigour – loaded phrases like “double standard” and “misrepresentation of evidence” pepper the text, yet each claim is backed only by the authors’ own ROBIS ratings – a circular argument.
  • Published in a methods journal, not a clinical one – handy if you want to debate paperwork rather than patient outcomes.

In short: lots of activist energy, little fresh data, and no dent in Cass’s core finding – the evidence base for medicating gender-distressed kids is still wafer-thin.

Good Lord that was a thing of beauty.

ArabellaScott · 28/05/2025 08:21

unwashedanddazed · 28/05/2025 08:04

OP you seem like an awfully clever industry insider. Do you think you can persuade Johanna Olsen-Kennedy to stop withholding the findings of her 7 million dollar, longitudinal study into puberty blockers?

I'm sure it'll put all our minds at rest, providing all that much sought evidence.

Sure would be good to see that.

TheywontletmehavethenameIwant · 28/05/2025 08:25

'something that a lot of us in the industry...' glad to see there's recognition at last that this barnpot ideology is an industry, not a fact of life, but something people can make a living at.

Your understanding of peer review is woefully lacking and this report doesn't come anywhere close to being such a thing. It's just a piece of subversion identifying as a report. 👎

Original poster
BeizenderKarneval · 28/05/2025 08:27

TangenitalContrivences · 28/05/2025 07:06

@BeizenderKarneval What’s off with the BMC “critique” in a nutshell

  • Built-in activism, not neutrality – several authors hold positions in WPATH, TransKids Belgium, Trans Healthcare Action, etc. That’s a vested-interest crew assessing a report that threatens their professional/ideological turf. Bias is declared in the “Competing interests” section but never mitigated
  • Wrong tool for the job – they wave the ROBIS checklist at the Cass systematic reviews, yet ROBIS only tells you whether a review followed its own protocol, not whether the underlying evidence is any good. They never re-examine the primary studies Cass flagged as weak, so their “high risk of bias” stamp is beside the point
  • Nit-picking protocol tweaks while ignoring substance – Cass reviewers dropped grey literature and non-English papers to keep to peer-reviewed clinical data (standard practice). The BMC authors shout “bias!” but never show that any excluded study would actually change a single conclusion
  • One-size-fits-all search gripe – they complain Cass used the same search strategy across seven reviews, but those searches were broad MEDLINE/Embase sweeps; no evidence is given that relevant trials were missed. It’s speculation dressed up as methodology
  • Moving goal-posts on quality scoring – they slag Cass for using AGREE-II and an adapted Newcastle-Ottawa Scale, yet elsewhere praise affirmative-care reviews that use exactly the same or flimsier scoring systems. That’s a double standard they don’t acknowledge
  • Selective outrage over “deviations” – every literature review tweaks its protocol as it goes. Cass logged major changes on PROSPERO; the BMC team call this “unexplained”, but the change notes are public. Pot, kettle.
  • No alternative synthesis – they never pool the data themselves, run a meta-analysis, or offer new numbers. It’s arm-chair criticism: knock the method, duck the evidence.
  • Skates over the wider picture – Sweden, Finland, Norway and now the NHS have all tightened youth gender-medicine on the same evidential grounds Cass highlights. The paper pretends Cass is an outlier and doesn’t grapple with that international convergence.
  • Rhetoric over rigour – loaded phrases like “double standard” and “misrepresentation of evidence” pepper the text, yet each claim is backed only by the authors’ own ROBIS ratings – a circular argument.
  • Published in a methods journal, not a clinical one – handy if you want to debate paperwork rather than patient outcomes.

In short: lots of activist energy, little fresh data, and no dent in Cass’s core finding – the evidence base for medicating gender-distressed kids is still wafer-thin.

Interesting response. And, unusually for MN, well thought out, superficially free of conditioned bias, and rational. Thank you.

OP posts:
DefineHappy · 28/05/2025 08:27

It’s always the same, isn’t it? Same tone, same querulous demands that women should shut up and listen to the important truth being bestowed upon us… Pathetic, unscientific drivel.

BonfireLady · 28/05/2025 08:38

BeizenderKarneval · 28/05/2025 08:27

Interesting response. And, unusually for MN, well thought out, superficially free of conditioned bias, and rational. Thank you.

Show quote history

Great! What is your 'well-thought out, superficially free of conditioned bias and rational' response to each of the points it raises, OP?

NotBadConsidering · 28/05/2025 08:38

well thought out, superficially free of conditioned bias, and rational

Like the Cass Review.

LizzieSiddal · 28/05/2025 08:43

DefineHappy · 28/05/2025 08:27

It’s always the same, isn’t it? Same tone, same querulous demands that women should shut up and listen to the important truth being bestowed upon us… Pathetic, unscientific drivel.

👏👏👏

And don’t forget the telling off and name calling when actual facts are pointed out.

JasmineAllen · 28/05/2025 08:55

Igneococcus · 28/05/2025 07:19

There has been some peer review work done on the Cass review, something that a lot of us in the industry knew was problematic but that has been used by government and a number of notably outspoken individuals to justify their hateful positions

Which "industry" is that?

The industry of making money from vulnerable children and their parents.

Original poster
BeizenderKarneval · 28/05/2025 08:56

fromorbit · 28/05/2025 07:32

Thanks for coming for Mumsnet to tell us all about the stuff we overlooked. It is mostly women here so it is possible we missed something. Only Surprise!!! Guess what we already have a thread on this paper, because round here we look at all the evidence usually before anyone else.

You might be surprised by this, but we have open debate here . You don't get this on corporate male focused forums like Reddit where opposing evidence is closed down and banned. This concept of open debate is why Mumsnet keeps winning. Surprised you missed the existing thread here really. You know forums have search capabilities right?

The new paper has obvious flaws and has been debunked here and elsewhere online. TangenitalContrivences above sums it up.* *Basically it is arguing Cass should have used a bunch of extra low evidence reports, while failing to turn up any high quality evidence the Cass reviewers missed. So this just reinforces the facts about the Cass Report we already knew, there were lots of bad science they didn't use. Just turning up MORE weak evidence doesn't show anything. It is the usual attempt to try to undermine Cass by slight of hand without actual scientific proof. The new paper's authors also have obvious biases.

If you want to overturn Cass you need actual strong evidence based science. The Gender industry makes billions of dollars. There are 100,000s of patients surely you must be able to prove all the medical action a good idea from the existing data and patient records. Right? All the follow up patient care they did?

Why can't it do this? The gender industry has had TWO YEARS now since the review was published in April 2024, more if you remember the Cass Review was commissioned in 2020. Plus all the other reviews in other countries which had similar results which predate Cass such as Finland [2020] Sweden [2021]. Clock ticking.

The reason it can't is the gender industry is about making money, and bizarre gender experiments, not good patient outcomes. That is why you lose and keep losing. Try open scientific discussion where you assume that it is possible that mistakes have been made. Humans are emotional, scientific malpractice occurs, that is why we use the strongest evidence and the scientific method.

Existing thread
https://www.mumsnet.com/talk/womens_rights/5333913-cass-report-biased-and-unreliable

"You don't get this on corporate male focused forums like Reddit where opposing evidence is closed down and banned."

Not strictly on topic (we'll get back to that soon) but I have seen emotive and hateful comments like this a few times on MN.

Can someone please explain where this seething anger for Reddit came from? Is it because Reddit is bigger and more popular than MN?
Is it because MN have been exposed to one or two threads on a certain sub-Reddit and decided the entire forum is awful?
I'm genuinely confused as to whether this anti-Reddit bile comes from.

On the second point, I've never heard of opposing evidence being closed down and banned on Reddit (maybe it does and I only look at the balanced, kinder sub-Reddits?), but shutting people down for epxressing an opinion that doesn't align with the cult does happen on MN, doesn't it?
I know MN has a reputation across the internet for conditioned bias and bullying behaviour, but much like your Reddit obsession I think that's probably unfair and it's only certain sub-fora of MN - and certain posters - who are responsible for that reputation, which is a little sad.

OP posts:
eatfigs · 28/05/2025 08:58

BeizenderKarneval · 28/05/2025 08:56

"You don't get this on corporate male focused forums like Reddit where opposing evidence is closed down and banned."

Not strictly on topic (we'll get back to that soon) but I have seen emotive and hateful comments like this a few times on MN.

Can someone please explain where this seething anger for Reddit came from? Is it because Reddit is bigger and more popular than MN?
Is it because MN have been exposed to one or two threads on a certain sub-Reddit and decided the entire forum is awful?
I'm genuinely confused as to whether this anti-Reddit bile comes from.

On the second point, I've never heard of opposing evidence being closed down and banned on Reddit (maybe it does and I only look at the balanced, kinder sub-Reddits?), but shutting people down for epxressing an opinion that doesn't align with the cult does happen on MN, doesn't it?
I know MN has a reputation across the internet for conditioned bias and bullying behaviour, but much like your Reddit obsession I think that's probably unfair and it's only certain sub-fora of MN - and certain posters - who are responsible for that reputation, which is a little sad.

Show quote history

This is some very silly trolling. Even your first post of the thread was better than this.

Original poster
BeizenderKarneval · 28/05/2025 09:01

eatfigs · 28/05/2025 08:58

This is some very silly trolling. Even your first post of the thread was better than this.

Show quote history

Case in point, I see. But if you don't feel able to respond to the question it might be better to leave it to others.

Again, I really want to know where this anti-Reddit hatred comes from. I've seen it many times on MN from many posters and now it's cropped up in this thread, I'd like to know why.

OP posts:
JasmineAllen · 28/05/2025 09:01

which is a little sad.

😂😂😂😂😂

ArabellaScott · 28/05/2025 09:02

JasmineAllen · 28/05/2025 09:01

which is a little sad.

😂😂😂😂😂

IKR

Igneococcus · 28/05/2025 09:03

Why focus on the dig on Reddit? Why not respond to the post that challenge your OP, or answer the question what "industry" you're talking about?

Original poster
BeizenderKarneval · 28/05/2025 09:03

Anyone with an intelligent response? Anyone at all?

<crickets>

OP posts:
Igneococcus · 28/05/2025 09:05

BeizenderKarneval · 28/05/2025 09:03

Anyone with an intelligent response? Anyone at all?

<crickets>

Well, not from you, it seems.

Helleofabore · 28/05/2025 09:06

unwashedanddazed · 28/05/2025 08:04

OP you seem like an awfully clever industry insider. Do you think you can persuade Johanna Olsen-Kennedy to stop withholding the findings of her 7 million dollar, longitudinal study into puberty blockers?

I'm sure it'll put all our minds at rest, providing all that much sought evidence.

I would really like to see that study too.

TheOtherRaven · 28/05/2025 09:07

ArabellaScott · 28/05/2025 07:49

Yes, the use of 'industry' is what jumped out at me, too.

Gotta keep those bucks rolling in!

Show quote history

This.

This is like the endless shouting that the SC judgment doesn't count because 'trans voices weren't consulted' (wrong) and two individuals weren't allowed to intervene (normal procedure, and no argument or information to be offered that wasn't already present.)

But that doesn't compute because wrong answer and this is a political movement that cannot do facts or reality or information, regardless of how proven or how perfectly gathered, because everything has to serve the feelings in the right way. There has to be a way to deny it and make it go away, because it's threatening the stability of the fiction for some, and threatening the income for others.

JasmineAllen · 28/05/2025 09:10

Igneococcus · 28/05/2025 09:03

Why focus on the dig on Reddit? Why not respond to the post that challenge your OP, or answer the question what "industry" you're talking about?

Because like so many TRA posters they come on MN with the sole aim of patronising and trying to irritate. Don't expect any pertinent questions to be answered because they never are.
Eventually they get bored and toddle off.

BiologicalRobot · 28/05/2025 09:11

This has been done to death since the report has come out, ie debunked and the Cass Report stands strong. Try searching for it if you are actually interested in the answers.

There has been some peer review work done on the Cass review, something that a lot of us in the industry knew was problematic
Which industry? Pharmaceuticals?

DragonRunor · 28/05/2025 09:13

BeizenderKarneval · 28/05/2025 08:56

"You don't get this on corporate male focused forums like Reddit where opposing evidence is closed down and banned."

Not strictly on topic (we'll get back to that soon) but I have seen emotive and hateful comments like this a few times on MN.

Can someone please explain where this seething anger for Reddit came from? Is it because Reddit is bigger and more popular than MN?
Is it because MN have been exposed to one or two threads on a certain sub-Reddit and decided the entire forum is awful?
I'm genuinely confused as to whether this anti-Reddit bile comes from.

On the second point, I've never heard of opposing evidence being closed down and banned on Reddit (maybe it does and I only look at the balanced, kinder sub-Reddits?), but shutting people down for epxressing an opinion that doesn't align with the cult does happen on MN, doesn't it?
I know MN has a reputation across the internet for conditioned bias and bullying behaviour, but much like your Reddit obsession I think that's probably unfair and it's only certain sub-fora of MN - and certain posters - who are responsible for that reputation, which is a little sad.

Show quote history

The problem with Reddit is that, very often, posts opposing the GI view get deleted, even when they are making strong, logical, supported points - so it’s never possible to have an actual discussion.Unlike Mumsnet.

Here you are completely free to make your points (respectfully), so please do answer Tangential’s very good points, or can we assume you have backed away from your initial post?

TangenitalContrivences · 28/05/2025 09:15

BeizenderKarneval · 28/05/2025 08:56

"You don't get this on corporate male focused forums like Reddit where opposing evidence is closed down and banned."

Not strictly on topic (we'll get back to that soon) but I have seen emotive and hateful comments like this a few times on MN.

Can someone please explain where this seething anger for Reddit came from? Is it because Reddit is bigger and more popular than MN?
Is it because MN have been exposed to one or two threads on a certain sub-Reddit and decided the entire forum is awful?
I'm genuinely confused as to whether this anti-Reddit bile comes from.

On the second point, I've never heard of opposing evidence being closed down and banned on Reddit (maybe it does and I only look at the balanced, kinder sub-Reddits?), but shutting people down for epxressing an opinion that doesn't align with the cult does happen on MN, doesn't it?
I know MN has a reputation across the internet for conditioned bias and bullying behaviour, but much like your Reddit obsession I think that's probably unfair and it's only certain sub-fora of MN - and certain posters - who are responsible for that reputation, which is a little sad.

Show quote history

Why Reddit is the worst place for debate, information and improving yourself as a human being:

  • Up-vote/down-vote dog-pile – posts that chime with the crowd rocket to the top, while awkward opinions get buried out of sight, so you only ever see what’s already popular.
  • Sorting by “best” – by default Reddit shows the highest-scoring comments first; once an idea’s on top it soaks up even more up-votes (rich-get-richer), locking the narrative in place.
  • Karma chasing – folk learn fast that agreeable takes earn internet points, so they self-censor anything spicy to protect their score.
  • Moderator bias – each subreddit’s mods set the rules and boot out posts that clash with their worldview; if you’re off-script your comment can vanish without warning.
  • Rule creep & “quality” filters – broad rules like “no low-effort” or “stay on topic” let mods bin dissent while claiming it’s just housekeeping.
  • Brigading & community overlap – when one big sub decides something, users swarm others to mass-vote, drowning alternative voices in minutes.
  • Algorithmic recommendations – Reddit steers you toward subs that match what you already up-vote, so you’re forever swimming in the same ideas.
  • Fear of dog-piles – seeing others get down-voted to oblivion puts lurkers off sharing contrary views, reinforcing the echo all over again.