…the very specific subgroup Cass referred to for whom puberty blockers were potentially beneficial.
Here is the problem - there is no actual evidence that such a group exists, nor is there any evidence that such a group, if it existed, would ever be identifiable except in retrospect. The article by Stella O’Malley that I linked to above covers this explicitly:
I call it the Cass Paradox. After four years reviewing the evidence for the medicalisation of children’s identities, Dr Hilary Cass and her team found no reliable evidence of benefit for interventions that carry risks of infertility, sexual impairment, and significant physical harm. These are consequences children are inherently too immature to fully understand. Yet Dr Cass remains open to the idea that some children may benefit, and this openness has contributed to confusion about the wider issue. The Cass Paradox highlights a review that finds no reliable evidence of benefit yet still refuses to rule out the intervention.
This inability to close the door is striking. Across clinicians and researchers who describe themselves as “gender critical” but are better named “gender critical lite”, there remains a refusal to fully say no to medical transition. They tend to subscribe to an unevidenced theory - I have a name for this too - the “tiny numbers theory”; the belief that a vanishingly small group might benefit, despite the absence of evidence.
As a basis for healthcare, this is farcical. Treatments are not justified by the possibility that someone, somewhere, might benefit. The burden of proof rests with those making the claim, yet here it is inverted and sustained through self-report and speculation. The gender critical lite crowd cannot seem to move on from this thinking, insisting on focusing narrowly on the risks of paediatric medical transition while avoiding the larger and more important question of medical transition itself.
Most people, even those with little knowledge of this issue, recognise that paediatric medical transition is a reckless and inappropriate intervention. Dr Cass is internally inconsistent in this respect, and one cannot help but think she has been politically outmanoeuvred, as seen with the shenanigans over the puberty blocker trial. It came as no surprise when the data linkage study shifted from being deemed impossible to carry out to suddenly being approved; there has clearly been significant institutional pressure in this space.
In the meantime, self-report is relied upon to keep the door ajar for medical transition for a “tiny number” of people. Even though this is not a basis for standard healthcare; self-report is inherently unreliable and does not justify medical intervention.