Today, the “Cass Report” on treatment of gender-distressed children and young people was released. The focus of the report is the British National Health Service, but the implications are, we can hope, wider-ranging.
An excellent thread of links from Genspect.
An entire field of medicine aimed at enabling children to change gender has been “built on shaky foundations”, the chairwoman of an NHS review has concluded.
Dr Hilary Cass found that there was no good evidence to support the global clinical practice of prescribing hormones to under-18s to halt puberty or transition to the opposite sex.
This method of medical intervention for young people who identify as transgender has become embedded in clinical guidelines around the world over the past two decades. Thousands of children have received puberty blockers on the NHS since 2011, and referrals to its youth gender identity service have increased 100-fold in little over a decade.
Cass, a former president of the Royal College of Paediatrics and Child Health, was commissioned by NHS England in 2020 to review services for children with gender dysphoria. Her final report has endorsed a fundamental shift in approach away from medical intervention towards a holistic model that addresses other mental health problems the children may have…
….
The report contains 32 recommendations for overhauling services. “For most young people, a medical pathway will not be the best way to manage their gender-related distress,” Cass said, adding that children must be seen “as a whole person and not just through the lens of their gender identity”.
She said it was vital that services take into account high rates of autism and mental health problems in children identifying as transgender.
The report is the world’s biggest review into the contested field of trans healthcare, and involved patients, families, academics and doctors.
This is how, over a decade, vulnerable children in this country were betrayed on an epic scale, fed puberty-blocking drugs that in many cases were followed by radical procedures. This institutionalised abuse was based on the flimsiest scientific evidence and became established practice in the health service. In her review of the NHS Gender Identity Development Service (Gids) at the Tavistock Clinic, now released in full, Dr Hilary Cass lays bare a scandal measured in ruined lives.
The review is a damning indictment of clinicians and others, including some parents, who allowed a developing obsession with gender to obscure the actual problems of many of the children involved. Problems like autism and adverse experiences in childhood — more common in those referred to Gids — were ignored in favour of the newly-fashionable diagnosis of gender dysphoria. No one involved appeared to notice that this affliction, which if genuine should have been reasonably constant in the rate of presentation, ballooned over time.
It should have been obvious that this explosion in cases was due to societal shift and misdiagnosis of various forms of mental distress rather than a discrete condition. But the NHS continued to rely on sloppy research to justify life-changing treatment. Treatment, moreover, that should have been allowed only when those children attained majority. Instead, youngsters were prescribed puberty blockers, which were intended to slow down sexual development and give patients a breathing space in which to consider their true wishes and options. But these powerful drugs may impede brain maturation, weaken bones, stunt growth, and cause depression and anxiety. In some patients these effects may turn out to be permanent. Yet despite being no longer prescribed by the NHS, puberty blockers are still available online and in private clinics. This trade must be banned as a matter of urgency.
The recklessness with which this policy was pursued verges on the criminal. Some victims are now trying to reverse the damage. In a survey of 237 “detransitioners”, 70 per cent said their “gender dysphoria” turned out to be due to other issues. Writing in this newspaper, Sajid Javid, the former health secretary, argues that for too long “extreme gender ideology” trumped the interests of children. The trans lobby has distorted public life in Britain, from the hounding of women who affirm the immutability of biological sex to the torturous pronoun etiquette of Whitehall. These excesses may be greeted with mere bemusement by future generations. For those who suffered at the hands of Gids, the emotions will be much stronger.
A reminder of what this treatment entails:
First, self (and parental) diagnosis. The “affirmation” model insisted on by activists puts the patient’s self-understanding and desires at the center of treatment. Anything else is decried as “gate-keeping.”
Secondly, specifically, as I detailed here, the medical course begins with puberty blockers, which are used off-label and have been sold as an almost harmless “pause button.” Of course there is no such thing at all, and further, puberty is not just about sprouting body parts and hair. It is a complex process involving all parts of the body, including the brain, and the question of what these blockers do to the whole person is..unanswered. Unknown.
Yet they have been prescribed to children and those who question the wisdom of this have, of course, been condemned for their hate and worse.
Puberty blockers, followed by cross-sex hormones and perhaps by surgery, especially for girls seeking elective mastectomies.
I have written about this a great deal, so I won’t repeat all of that, but I do want to point out a couple of aspects of the report and the discussion as it’s evolving that are worth noting, aside from the fundamental medical scandal.
First, Dr. Cass was impeded from gathering data for her report. NHS clinics refused to share data and had to be impelled to do so.
Cass’s review is written in a calmly clinical tone but there are moments when her anger about how NHS England has cared for a generation of vulnerable children is barely disguised.
Clinicians have become “fearful”. The available evidence is “poor”. Her efforts to conduct a vital and comprehensive study into the outcomes of all 9,000 children and adolescents treated at the Tavistock and Portman gender identity development service (Gids) clinic between 2009 and 2020 were “thwarted”…
…It was “unbelievably disappointing” that the research study she had hoped to conduct to look at the outcomes of 9,000 former Tavistock patients had been blocked by the adult gender clinics, who refused to contact former patients for permission on her behalf.
The former health secretary Sajid Javid had changed legislation to allow researchers to link pre- and post-transition NHS numbers, but the research had to be abandoned when all but one of the adult clinics refused to cooperate, Cass said.
“I do think it was coordinated. It seemed to me to be ideologically driven,” she said. “There was no substantive reason for it. So I can only really conclude that it was because they didn’t feel that it was the right thing to do to try and nail down this data.”
Secondly, while this is not the subject of the report, what is being discussed and must be discussed in the wake of its release is the years-long effort by activists and organizations to silence questioning and critical voices.
And by “silence” – I mean showing up en masse in masks with noisemakers any time women gather to question this ideology and its impact on children and youth, threatening, surrounding, attempting to drown out. By “silence” I mean attempting to deplatform and get gender dissenters fired, to loses publishing deals and speaking opportunities.
I will end this post with a couple of banger links on this score, but I’ll add – this applies to you, Catholics. Catholic activists and public voices who have attempted to characterize a cautious and holistic view of the problems of these kids as hate-filled-transphobia that’s not only anti-trans-kids but anti-Jesus, too.
Those who wanted the Cass Review to come down harder on those who have let children down for far too long will be disappointed. Personally, I’d like all of those who said that dangerous puberty blockers were merely a ‘pause’, or who told parents their children were at risk of suicide if not affirmed in their cross-sex identities, to be put in stocks outside the General Medical Council. The adults who allowed vulnerable kids to be experimented upon should not get away with this. I wanted Cass to run a clean, truthful sword through the tangled ideology of gender identity. But I can understand why she did not.
Those who wanted the Cass Review to come down harder on those who have let children down for far too long will be disappointed. Personally, I’d like all of those who said that dangerous puberty blockers were merely a ‘pause’, or who told parents their children were at risk of suicide if not affirmed in their cross-sex identities, to be put in stocks outside the General Medical Council. The adults who allowed vulnerable kids to be experimented upon should not get away with this. I wanted Cass to run a clean, truthful sword through the tangled ideology of gender identity. But I can understand why she did not.
The answers to these questions could make for very uncomfortable reading for many in the NHS.
But today, perhaps above all, we should remember that teaching young people to interpret all their turmoil about who they are and what they hope to become through the lens of ‘gender,’ and then tying that to potentially irreversible interventions on their bodies, is a very very very harmful thing to have done.
Finally (for now) Victoria Smith:
The people who support the use of puberty blockers, cross-sex hormones and, eventually, “gender affirming” surgeries for young females will tell you they are being kind. They are no doubt geared up to deem anything in the Cass report which challenges their position to be “hate”. They will have all of their false equivalences with 1980s homophobia at the ready. They think they have the perfect answer to young, female desperation. You solve it with drugs, needles, knives and slogans. If a girl doesn’t fit the world into which she is growing, you don’t change the world, or enable her to find a space; you help her to cut pieces of herself away.
What I see in this position — and what I think we should be calling out more and more — is a total lack of empathy. There is no true kindness in it. There’s no curiosity, no compassion, no willingness to put oneself on the line for the sake of, what? Just some unhappy uterus owners. Just their sadness and their lesser female bodies. The assumption seems to be that if some female people are not buying into the whole femininity package, one might as well write them out of the girlhood story entirely. One has the excuse that they do not wish to be part of it, either. It’s not a good enough one.
Set aside all the “protect trans kids” slogans, and what do we have? Traumatised girls who are told by the world that there’s nothing to be done. Their pain at being female can’t be resolved. Their discomfort never eases, and anyone who tells them otherwise simply isn’t taking it seriously. True pain, they are told, comes from within and it is fixed. Thinking that you might ever overcome it — that you could one day feel at home in the body that you have and are — is likened to believing one might grow out of being gay. As though these two things are remotely comparable. As if despising your own flesh is as natural as loving the flesh of another.
I think it is obscene to respond to the agony of young girls by saying, yes, okay. If this pain is deep and enduring enough, we will wage war on your body on your behalf. Enough of the cutting and starving. We will drug you. We will remove your breasts for you. If all else fails, we might even help you to die. This is absolute capitulation to the idea that if you cannot cope with where your female body positions you — if you just can’t take it — that body is to blame. It lets everyone and everything else off the hook. It tells you that you are on your own.
Right now, children’s publishing lauds books which essentialise female body hatred under the guise of trans inclusion. Criticism is dismissed with glib claims that “young people” or “youths” (never children) “know themselves” (any woman who ever recalls wanting to take a knife and slice off her emerging breasts or thickening thighs, take note). It is as if adults have forgotten what growing, development, time, even are. I have teenage sons. I am constantly struck by how intensely they feel, but also how rapidly they are changing. However much they know, they cannot know what it is like to be older. They won’t until they get there. The same is true for all of us. To observe this is no judgement on anyone. ..
I do think it could be better, though. Lots of us do, not because we underestimate the degree of despair, but because we don’t. It is laughable to think that anything is cured by the lazy rubber-stamping of female pain. “Let the boys have their porn and any girls who can’t hack it know where the door out of femaleness is” is not a reasonable way to treat other humans. Neither is “if you hate your body so much, we will hate it, too”.
Girls — future women, whatever you call them or do to them — are worth more than this. If you can’t be bothered to consider this, at least stop claiming to be kind.