Cass review: how has report affected care for transgender young people? - The Guardian 2/7/25

[UtopiaPlanitia]

Article in The Guardian tweeted by Biology in Medicine on TwiX (https://x.com/biologyinmed/status/1943616841152114706)

https://archive.ph/lfWGI

https://www.theguardian.com/society/2025/jul/02/cass-review-how-has-report-affected-care-for-transgender-young-people

Review led to profound changes, some of which made young people feel unsupported, yet new clinics are opening

'The Cass effect
Fourteen months later and the exponential rise in referrals for NHS care has halted, with figures showing a sharp reduction from up to 280 referrals a month at the Tavistock to between 20 and 30 a month this year, a 10th of the earlier rate.

James Palmer, the medical director for specialised services at NHS England, who is responsible for implementing the recommendations of Cass, suggests a number of factors are behind the decrease. Young people can now only be referred for the youth gender service through mental health or paediatric specialists, rather than by a GP.

Palmer also believes the reduction is partly because of the “change in philosophy” brought in by Cass about hormone treatments. Her review concluded there was “remarkably weak evidence” that puberty blockers(prescribed to give young people experiencing distress and dysphoria about their bodies time to consider their next move) and cross-sex hormones (which masculinise or feminise people’s appearances) improve young people’s wellbeing and there was concern they may harm health.'

😂

The problem of peer review is that within a discipline such as gender studies the reviewers will also be academics whose careers are tied into this system. I believe the Cass review points out the problems of insular citing of works from academics within a small self serving group. The same can be said for peer review. For the Journal of Gender Studies 'Reviewers are chosen based on their expertise in specific areas within gender studies, their research experience, and their experience as peer reviewers.' I suspect not research in biological sciences, medicine or other more rigorous disciplines.

Deary me. Lindsay, Boghossian and Pluckrose must be at it again...

Why on earth would the Cass report be "peer reviewed"? It's not a piece of research. Dr Cass was commissioned by the government to chair a review and make recommendations. Which she did.

I agree that criticizing what she wrote as "self published" as if that was a flaw is possibly quite the stupidest comment written on this entire subject and demonstrates a total lack of understanding of her role.

Imagine offering up that prolific insane liar 'Erin' as a source for anything.

Imagine using the word policy as a verb, too.

There is not a single study that shows any benefit of puberty blockers for children.

Yep.

🤣🤣 I missed the memo that it was comedy night tonight

Hilary must have spent a fortune on the photocopying of her 80+ page leaflet.

All that collating and stapling too 🤣

🤣🤭

This has been mentioned before, but I do seriously wonder if 'gender dysphoria' is in fact 100% social contagion. The book, The Transsexual Phenomenon, sent off a shock-wave in the 60s; for the first time it was suggested that you could change the presentation of your sex. I think this planted seed for many men who would become part of the first wave of clients of the newly opened gender clinics of the 70s, examples include Renée Richards and Jan Moris. Both of whom would write widely read books would further fan the flame. To put it directly, if these men had not been exposed to the idea that it was possible to socially transition, it would not have occurred to them that they had a condition that made it necessary.

It was only when it became widely known, though social media, that it was possible for young people to receive trans medicine, did referrals skyrocket. And it should also be noted that, like the 70s gender clinics, checklists were circulated about how to answer diagnostic questions in order to fit the criteria for gender dysphoria in order to receive trans gender medical care.

At the end of the day it probably all comes back to Christine Jorgensen.

Jorgensen seems to be a classic example of transing away the gay.

I was wondering if I should make a new thread for this but I'll put it here cause it kind of fits.
"In 2022, it emerged that a senior consultant at the centre had admitted that its treatments were not backed by “robust evidence” and that they largely relied on self-diagnosis, with clinicians “basically just going on what they [the patient] tell you”."
It's almost as if the self-indulgent gibberish they publish in The Journal of Gender Studies and similar publications is of absolutely no use to clinicians in addressing their patients' issues.

https://www.thetimes.com/article/d73ec83b-71ed-4b8f-ba8b-6c046eff5900?shareToken=40facafce102e49f3e476f76ce3f6297

Readers Note:

It was admitted under oath in Skrmetti in the Supreme Court by ACLU lawyer Strangio that suicides are thankfully rare in young people with transgender identities.

https://x.com/leorsapir/status/1864793635406963173?s=46

So, posters describing medical treatments as ‘life saving’ are spreading harmful and dangerous misinformation.

The suicide myth seems to have appeared at around the same time as the invention of "trans children".

It seems they had to up the ante a bit when they started to promote the idea that children could be transsexual. If you're going to suggest that children are a part of a sexually motivated movement you've got to have a pretty good reason for doing so.

It was published in the Journal of Gender Studies, not a scientific journal. Peer review isn’t the scientific process.

You appear to be very, very confused about academic research and what science and the scientific process are.

Here are international reviews that all indicated that there was low quality evidence that medical treatments for children are improving those children’s lives. Which was the finding of the Cass report:

NICE finding

arms.nice.org.uk/resources/hub/1070905/attachment

The summary of the conclusion is

Conclusion

The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.

Canada

https://nationalpost.com/news/canada/transgender-treatments-for-kids
https://archive.ph/fLMxA

"The Canadian team combed the available evidence, pooling the results of research on puberty blockers and gender affirming hormones for children and youth up to age 26. They graded the evidence using a scoring system co-developed by Dr. Gordon Guyatt, a celebrated McMaster scientist who coined the phrase evidence-based medicine.

Article content

After screening 6,736 titles and abstracts involving puberty blockers, only 10 studies were included in their review. While children who received puberty blockers compared to those who don’t score higher on “global function” — quality of life, and general physical and psychological wellbeing — the evidence was of “very low certainty.” Very low, meaning researchers have “very little confidence in the effect estimate” and that the true effect “is likely to be substantially different from the estimate of effect.”

The studies also provided low certainty of evidence on the impact of puberty blockers on depression. While they may decrease depression in “male-to-female participants,” they didn’t decrease depression scores in the female-to-male group. “We are very uncertain about the causal effect of the (drugs) on depression,” the researchers wrote.

“Most studies provided very low certainty of evidence about the outcomes of interest thus, we cannot exclude the possibility of benefit or harm,” they said."

Here are the studies referenced in the article from McMaster University

https://adc.bmj.com/content/archdischild/early/2025/01/24/archdischild-2024-327909.full.pdf

And

https://adc.bmj.com/content/archdischild/early/2025/01/24/archdischild-2024-327921.full.pdf

New Zealand

https://www.health.govt.nz/news/additional-safeguards-for-puberty-blockers

Publication date: 21 November 2024
The Ministry of Health is today releasing an evidence brief and position statement on the use of puberty blockers for gender identity issues and outlining a more cautious approach to their use.
The evidence brief shows a lack of good quality evidence to back the effectiveness and safety of puberty blockers when used for this purpose.

France

The latest from National Academy of Medicine, France. They have issued a press release about treatment for gender disphoria in children and adolescents.

SEGM have translated it, but also linked up the original version.

segm.org/France-cautions-regarding-puberty-blockers-and-cross-sex-hormones-for-youth

Sweden

http://genderreport.ca/the-swedish-u-turn-on-gender-transitioning/

I could also find and link up the same findings for Finland, Norway, Denmark and I believe Germany if I found them. All had teams, iirc, who made the same statement about low quality of evidence as the Cass Report.

I believe there must come a time when it has to be admitted that if a slew of independent country’s teams all found the same low quality of evidence as Dr Hilary Cass, that anyone declaring Cass debunked is just deliberately spreading falsehoods.

The several systematic reviews commissioned by Dr Cass and peer reviewed are published here:
https://adc.bmj.com/pages/gender-identity-service-series

I know Aida’s thoughts on this are amusing but equally is this what trans reddit/other TRA communities think? that Dr Cass just took it upon herself to do this

also as we know TRA include a large number of ppl with IT knowledge/skills, theyre clearly all over SEO because when you Google the Cass review the first thing that comes up is transactual comment piece on it

Absolutely. You see it all over Reddit and the like, where kids are coached to make claims to their clinical team in order to get blockers or hormones or surgery.

They know the diagnostic criteria, know the triggers for referral, and just say it.

On that aspect of coaching this paper is well worth a read.

journals.sagepub.com/doi/full/10.1177/26344041211010777

Published April 22, 2021
Kasia Kozlowska, Georgia McClure et al

Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service

Part of the conclusion

Our findings indicate that engagement with families, a trauma-informed model of mental health care, and ongoing discourse pertaining to the effects of unresolved trauma and loss need to be part of all gender dysphoria clinics and the services with which they collaborate. Because of their impact on subjective well-being and the development of the self, specific loss and trauma events present crucial opportunities for both long-term psychotherapy and more immediate, targeted treatments. The move to a more comprehensive, holistic model of care—one that takes into account the individual’s developmental history and the experiences that make up that history—has also been echoed in the work of other clinician-researchers (D’Angelo, 2020a; Entwistle, 2019; Giovanardi et al., 2018; Kozlowska et al., 2021; Williamson, 2019).

Our study found that the children and families who came to the clinic had clear, preformed expectations: most often, children and families wanted a diagnosis of gender dysphoria to be provided or confirmed, together with referral to endocrinology services to pursue medical treatment of gender dysphoria. Parents (vs. children) also largely came with the same expectations, though they were more likely to be interested in incorporating holistic (biopsychosocial) elements, including treatment of mental health comorbidities, family support/therapy, and long-term psychotherapy for the child. It was our impression that these expectations had been shaped by the dominant sociopolitical discourse—the gender affirmative model. It will be interesting to track the expectations of children and families in the years to come as sociopolitical discourses become more varied and diverse and as the voices are heard of both those who have done well and those who not done well via the medical pathway.

Our study also found that despite the high rates of family conflict, relationship breakdowns, parental mental illness, and maltreatment (see Table 3)—and our own clinical perspective that both individual and family work were indicated for the majority of families—few families rated themselves as being in a clinically severe range on self-report (SCORE-15). Coupled with the dominant sociopolitical discourse—the gender affirmative model that prioritizes the medical treatment pathway—it is not surprising that the large majority of children and families were not motivated to engage in or to remain engaged in ongoing therapy. These data bring three important phenomena into focus. First, when children and families were given the space and structure to tell the child’s developmental story—nested in the story of the family—they were able to identify and provide a detailed narrative of the key issues that had contributed to the child’s presentation and distress. Without this space and structure, the issues remain undeclared and unaddressed. Second, some families—but also some clinicians—function within a non-holistic (non-biopsychosocial) framework where the child’s developmental experiences are disconnected from their clinical presentation. This non-holistic framework is likely to promote a healthcare delivery model that dehumanizes the child (by not examining the child’s and family’s lived experience) and that promotes medical solutions (correcting the identity/body mismatch) for a problem that is much more complex. Third, as noted earlier, our experience suggests that, insofar as the gender affirmative model is taken as equivalent to medical intervention, clinicians (including ourselves) who work in gender services are coming under increasing pressure to put aside their own holistic (biopsychosocial) model of care, and to compromise their own ethical standards, by engaging in a tick-the-box treatment process. Such an approach does not adequately address a broad range of psychological, family, and social issues and puts patients at risk of adverse future outcomes and clinicians at risk of future legal action.

It's a systematic review. Do you have an alternative systematic review or meta analysis to recommend, which includes risk of bias and study quality?
Or do you not know what those terms mean, rather like Jack Turban?

Thanks @Helleofabore ! What a great paper

It is a piece of research - systematic reviews are a kind of research. But don't worry, it has several spin off reviews that are in peer reviewed journals.