& the Growing Impact
by Debra Baty
“In summary, the care for <18s in England will no longer be based on the “gender-affirming” model of care but instead will treat youth with gender distress similarly to how it treats youth with other developmental struggles. Further, with the announcement of the adult gender clinic review, England starts a new chapter in the history of gender medicine, with a new focus on vulnerable gender-dysphoric young adults.”1
Photo by Paul Skorupska on Unsplash
The above is taken from the Society for Evidence-Based Gender Medicine’s preliminary response to the Cass Report, released in April of this year. In a separate review, psychotherapist and author Stella O’Malley writes:
“Following four years of careful study of roughly 9000 children who received treatment at the Gender Identity Development Services (GIDS) at the Tavistock in London, the Cass Report is finally finished. The independent review of data came to the same conclusion as every other independent review: there is insufficient evidence to justify the use of medical interventions for the treatment of gender dysphoria.”2
The study was conducted by Dr. Hillary Cass, a physician and former president of the Royal College of Paediatrics and Child Health in England. Among the findings is confirmation that puberty blockers have been used off-label without sufficient evidence of benefit or knowledge of harms, and the use of circular referencing, rather than a systematic review, as a basis for the “gender affirming care” model. This poor quality of evidence was passed around between WPATH, The American Academy of Pediatrics (AAP), and the Endocrine Society (ES), each using the other as a reference, with no one stepping up to note the claims being made about “gender affirming care” were unsubstantiated.
To clarify, in England, those experiencing discomfort with their gender were being referred to a specialty clinic which, for the most part, practiced what is known as “diagnosis overshadowing,” where all problems faced by an individual were attributed to gender, to the neglect of other issues such as depression, anxiety, autism, sexual or domestic abuse, etc. This practice has now been rejected in favor of a more holistic approach.
A few good reviews can be found here:
The Final Cass Review and the NHS England Response
The Truth About the Cass Review - Hannah Barnes interview by Louise Perry
One of the impacts of the report, as noted in the quote at the top of this edition of R4R, has been the decision by the National Health Service of England to conduct a similar review of the clinics treating adults with gender dysphoria.3
This was in part due to the concerns raised by the Cass review that a vulnerable group of 17-25-year-olds (who can access adult GDCs) represents fundamentally the same group of youth as the <18s, and needs similar protections from non-evidence-based practices. Further, whistleblower complaints from adult clinics corroborated concerns that vulnerable adults were not receiving proper evidence-based care. The refusal by all but one adult gender clinic to cooperate in the outcome analysis for the 9,000 patients as part of the Cass review likely contributed to NHSE’s determination to investigate the adult service. Adult gender dysphoria clinics see patients aged 17 and upwards, and NHSE has written to require them to halt appointments with 17-year-olds.4
Another decision made after the report was the demand for the release of follow-up information on 9,000 young patients who went through gender affirmation treatment in England by their National Health Department administrators. Noted in the Cass Report was the refusal to disclose whether or not these individuals changed their minds after going through gender transition.
National Health Secretary Victora Akins stated:
“It is disgraceful that adult gender clinics have not co-operated with the vital University of York research to link data on children at the Tavistock so that we can understand their journey into adulthood.
“This Government took the unprecedented step of changing the law to make this possible. There can be no further delay on their full participation. I know that NHS England will use all the powers at their disposal to compel this if they have to.
“Nothing less than full cooperation by those clinics in the research is acceptable.”5
Also, in the wake of the Cass Report, Scotland has announced discontinuing the use of puberty blockers for individuals under 18 years old with gender dysphoria. (England announced ceasing this practice just before the Cass Report was released).
At this time, European countries are dropping “gender affirming care” practices in quick succession. As for the US - things are different in our medical and mental health care systems. Bans against puberty blockers and cross-sex hormones for treatment of gender dysphoria exist in 23 states.6 Currently, there are several court cases by those who had undergone such treatment only to find later that they had made a terrible mistake. It may take a series of lawsuits to bring changes in practice here.
1
https://segm.org/Final-Cass-Report-2024-NHS-Response-Summary
2
https://genspect.org/reflections-on-the-cass-report/
3
https://segm.org/Final-Cass-Report-2024-NHS-Response-Summary
4
Ibid.
5
https://www.telegraph.co.uk/news/2024/04/10/nhs-bosses-ordered-reveal-fate-of-young-trans-patients/
6
https://twitter.com/benryanwriter/status/1780646347722375630
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