For those unfamiliar the Cass Review is a review commissioned by NHS England, whose outward intent was to review existing services and the current evidence base when it comes to providing healthcare to children with gender dysphoria. It would offer criticism of existing issues (of which there are many) and provide recommendations for a modern system of care. In its own words:
The Review was published on Wednesday, and it does the opposite. The recommendations that it outlines, and that NHS England will adopt, will deny trans children the ability to delay puberty, and risks suspending their ability to transition. It has led to international healthcare organisations speaking out against it, and the actions taken in England run in stark contrast to guideline updates published recently for Germany, Austria and Switzerland.
This will be the go-to argument in stripping back access to healthcare for trans children in the UK, and it's worth being aware of its apparent and numerous flaws. It's also likely that this will be referenced by anti-trans organisations in other countries moving forward, in their own attacks on trans healthcare. For that reason, particularly for those in the US and Europe, it's worth some familiarity with the Review to best push back against those championing it.
It's important to understand initially how out of step it is with current medical consensus though, and for that the Professional Association for Transgender Health Aotearoa (PATHA) put out a statement on the Cass Review:
They also joined with AusPATH, the Australian Professional Association for Trans Health, in a joint statement:
equalityaustralia.org.au
The benefits of gender affirming care are not an unknown. It was only last year that medical journal The Lancet published a letter regarding its importance:
So what happened? Well it's interesting to look at who Hilary Cass affiliates herself with. It turns out that this isn't the first time she's taken an interest in the banning of healthcare for transgender children. Many here will know how awful things are for trans people in Florida right now. Well, it turns out Cass is quite familiar as well:
View: https://x.com/ErinInTheMorn/status/1778186418499756249
In the UK it seems Hilary Cass is also, at the very least, interested in the known anti-trans hate group TransgenderTrend:
Still though, how do you get around the amount of existing evidence that shows gender affirming care to be a beneficial approach to caring for trans children? Well, you deem it not fit for purpose and move on. In the instance of one area of the review, 101 out of 103 studies were dismissed. On what grounds though?
View: https://twitter.com/Esqueer_/status/1777755823743054120
For those unaware, some studies can opt to be blind or double-blind in nature. In the former the participants between two control groups don't know which group has the placebo and which the real drug. In the latter, neither do the researchers. However this approach, despite being important, can be both unethical and impractical in nature when it comes to healthcare and particularly healthcare for children. When it comes to puberty blockers for children suffering from gender dysphoria, it would be unethical to give only half of the participants the ability to block puberty, forcing the other half through it unnecessarily. It would also be an impossible blind to uphold by its very nature, as it will quickly become apparent which group had blockers when one start going through puberty and growing breasts or facial hair.
Yet this bar – that existing studies should have used blinds – is maintained and used to reject existing comprehensive evidence around the benefits of existing models of care.
It's worth noting at this point that this is all borne out of an alleged concern over the safety of using puberty blockers. I'm sure many of you have heard of them, they can be used to give transgender children time to further consider their options before going through puberty in either direction and having their body irreversibly change. They're also used by cisgender children in cases of precocious puberty and considered safe:
For reference, I'm also on Triptorelin to block my production of hormones which I then counter with estrogen gel. I had my latest injection last week. These are drugs considered safe for cisgender children for delaying puberty, trans adults for gender dysphoria and transition, and men with prostate cancer. Yet despite this, we are expected to believe there is some great concern when it comes to their use for trans children, in delaying their puberty and giving them the time needed to make a decision.
The report is no strangers to claims without evidence though, as we can see below:
TransActual have put out a comprehensive briefing on the Cass Report. If you're reading this I highly recommend reading through it. It's long but it covers a lot of the holes in the Review, a couple of which I'll touch on but I want to first draw attention to a section of their opening text:
This really is it distilled down. It's clear through much of the report that a child transitioning is seen as a negative. That the distress of trans children is an acceptable expense in ensuring cisgender children don't pursue transition and regret it. Which, while we're talking to it, it's worth noting that of the 3,499 patients audited as part of the Review fewer than 10 detransitioned and only 2 of those were spoken to. This is a regret rate of 0.2%; a figure in line with other studies and far below many other medical interventions. In addition, while it is claimed that children are being rushed into a default path of medicalisation, only 27% of the patients reviewed were referred to endocrinology for puberty blockers:
Elsewhere the briefing notes the bias NHS England has exhibited against trans people through past actions and their approach to the report, including barring trans people from being a part of the core team while inviting advocates of conversion therapy – something recognised as torture by the UN – on board:
So it is clear that NHS England had an intended result in mind, when they had already taken action to prevent trans children accessing puberty blockers a month prior to the report being published. Which makes it unsurprising that despite the ignoring of all existing evidence, it running counter to global medical and psychological consensus, the removal of trans voices and advocates from any part of the approvals process, ties to the United States and their trans healthcare bans, and providing no evidence for the recommendations it makes, NHS England have immediately pursued action in banning puberty blockers for children and are likely to implement other aspects of its recomendations.
They also plan to prevent children accessing puberty blockers privately:
...and with trans healthcare for children severely restricted, their target shifts to adults, as a review into our healthcare becomes the priority:
This focus on adult care is aided by the Cass Review, which adopts the language of the NHS' recent 0-25 approach (itself a good system that prevents a hard switch to separate adult services upon turning 17 in favour of a tapered approach between then and 25) to scope creep into recommendations around adult care:
This would see young trans people face further delays in starting transition, with youth care based around conversion models and therapy over medical treatment bleeding into adulthood and up to 25. This recommendation infantilises adults and suggests people remain vulnerable and cannot be certain of the care they need up until they're 25. It's worth noting another section of the briefing mentioned earlier, that touches on this cut-off point:
As it stands now though, the report and subsequent actions by NHS England will work to deny a generation of trans children the ability to live as themselves. It contradicts the multitudes of research and observational evidence of practitioners around the world, it opposes medical consensus that's well established and practiced around the world. Here is a piece from the parent of a trans child, and her perspective:
I'll also include a thread on the recent guidelines being put together by Austria, Germany and Switzerland around trans youth and their care. It maintains and furthers the international standard of care for young trans people, and runs in complete and stark contrast to the Cass Review:
There is a lot more to this, like the recommendation for restricting trans children from socially transitioning (changing clothes, name, pronouns etc.) without clinical approval, but hopefully the above combined give a clear sense of how flawed the Review is from a scientific perspective, and how attacks on the trans community are progressing in the UK.
Much love to my trans siblings in these dark times. Take care of yourself and unplug when you need to.
🌷
The Review was published on Wednesday, and it does the opposite. The recommendations that it outlines, and that NHS England will adopt, will deny trans children the ability to delay puberty, and risks suspending their ability to transition. It has led to international healthcare organisations speaking out against it, and the actions taken in England run in stark contrast to guideline updates published recently for Germany, Austria and Switzerland.
This will be the go-to argument in stripping back access to healthcare for trans children in the UK, and it's worth being aware of its apparent and numerous flaws. It's also likely that this will be referenced by anti-trans organisations in other countries moving forward, in their own attacks on trans healthcare. For that reason, particularly for those in the US and Europe, it's worth some familiarity with the Review to best push back against those championing it.
It's important to understand initially how out of step it is with current medical consensus though, and for that the Professional Association for Transgender Health Aotearoa (PATHA) put out a statement on the Cass Review:
They also joined with AusPATH, the Australian Professional Association for Trans Health, in a joint statement:
Cass Review out-of-line with medical consensus and lacks relevance in Australian context - Equality Australia
10 April, 2024 – England’s Cass review ignores the consensus of major medical bodies around the world and lacks relevance within an Australian context, say medical practitioners, trans advocates, parents and human rights groups. The Cass review downplays the risk of denying treatment to young...
equalityaustralia.org.au
The benefits of gender affirming care are not an unknown. It was only last year that medical journal The Lancet published a letter regarding its importance:
So what happened? Well it's interesting to look at who Hilary Cass affiliates herself with. It turns out that this isn't the first time she's taken an interest in the banning of healthcare for transgender children. Many here will know how awful things are for trans people in Florida right now. Well, it turns out Cass is quite familiar as well:
View: https://x.com/ErinInTheMorn/status/1778186418499756249
In the UK it seems Hilary Cass is also, at the very least, interested in the known anti-trans hate group TransgenderTrend:
Still though, how do you get around the amount of existing evidence that shows gender affirming care to be a beneficial approach to caring for trans children? Well, you deem it not fit for purpose and move on. In the instance of one area of the review, 101 out of 103 studies were dismissed. On what grounds though?
View: https://twitter.com/Esqueer_/status/1777755823743054120
For those unaware, some studies can opt to be blind or double-blind in nature. In the former the participants between two control groups don't know which group has the placebo and which the real drug. In the latter, neither do the researchers. However this approach, despite being important, can be both unethical and impractical in nature when it comes to healthcare and particularly healthcare for children. When it comes to puberty blockers for children suffering from gender dysphoria, it would be unethical to give only half of the participants the ability to block puberty, forcing the other half through it unnecessarily. It would also be an impossible blind to uphold by its very nature, as it will quickly become apparent which group had blockers when one start going through puberty and growing breasts or facial hair.
Yet this bar – that existing studies should have used blinds – is maintained and used to reject existing comprehensive evidence around the benefits of existing models of care.
It's worth noting at this point that this is all borne out of an alleged concern over the safety of using puberty blockers. I'm sure many of you have heard of them, they can be used to give transgender children time to further consider their options before going through puberty in either direction and having their body irreversibly change. They're also used by cisgender children in cases of precocious puberty and considered safe:
https://www.bsuh.nhs.uk/library/wp-...-LHRH-analogue-treatment-Puberty-Blockers.pdf
For reference, I'm also on Triptorelin to block my production of hormones which I then counter with estrogen gel. I had my latest injection last week. These are drugs considered safe for cisgender children for delaying puberty, trans adults for gender dysphoria and transition, and men with prostate cancer. Yet despite this, we are expected to believe there is some great concern when it comes to their use for trans children, in delaying their puberty and giving them the time needed to make a decision.
The report is no strangers to claims without evidence though, as we can see below:
TransActual have put out a comprehensive briefing on the Cass Report. If you're reading this I highly recommend reading through it. It's long but it covers a lot of the holes in the Review, a couple of which I'll touch on but I want to first draw attention to a section of their opening text:
This really is it distilled down. It's clear through much of the report that a child transitioning is seen as a negative. That the distress of trans children is an acceptable expense in ensuring cisgender children don't pursue transition and regret it. Which, while we're talking to it, it's worth noting that of the 3,499 patients audited as part of the Review fewer than 10 detransitioned and only 2 of those were spoken to. This is a regret rate of 0.2%; a figure in line with other studies and far below many other medical interventions. In addition, while it is claimed that children are being rushed into a default path of medicalisation, only 27% of the patients reviewed were referred to endocrinology for puberty blockers:
Elsewhere the briefing notes the bias NHS England has exhibited against trans people through past actions and their approach to the report, including barring trans people from being a part of the core team while inviting advocates of conversion therapy – something recognised as torture by the UN – on board:
So it is clear that NHS England had an intended result in mind, when they had already taken action to prevent trans children accessing puberty blockers a month prior to the report being published. Which makes it unsurprising that despite the ignoring of all existing evidence, it running counter to global medical and psychological consensus, the removal of trans voices and advocates from any part of the approvals process, ties to the United States and their trans healthcare bans, and providing no evidence for the recommendations it makes, NHS England have immediately pursued action in banning puberty blockers for children and are likely to implement other aspects of its recomendations.
They also plan to prevent children accessing puberty blockers privately:
...and with trans healthcare for children severely restricted, their target shifts to adults, as a review into our healthcare becomes the priority:
This focus on adult care is aided by the Cass Review, which adopts the language of the NHS' recent 0-25 approach (itself a good system that prevents a hard switch to separate adult services upon turning 17 in favour of a tapered approach between then and 25) to scope creep into recommendations around adult care:
This would see young trans people face further delays in starting transition, with youth care based around conversion models and therapy over medical treatment bleeding into adulthood and up to 25. This recommendation infantilises adults and suggests people remain vulnerable and cannot be certain of the care they need up until they're 25. It's worth noting another section of the briefing mentioned earlier, that touches on this cut-off point:
As it stands now though, the report and subsequent actions by NHS England will work to deny a generation of trans children the ability to live as themselves. It contradicts the multitudes of research and observational evidence of practitioners around the world, it opposes medical consensus that's well established and practiced around the world. Here is a piece from the parent of a trans child, and her perspective:
https://inews.co.uk/opinion/child-trans-help-transition-fear-others-wont-cass-report-3001571
I'll also include a thread on the recent guidelines being put together by Austria, Germany and Switzerland around trans youth and their care. It maintains and furthers the international standard of care for young trans people, and runs in complete and stark contrast to the Cass Review:
There is a lot more to this, like the recommendation for restricting trans children from socially transitioning (changing clothes, name, pronouns etc.) without clinical approval, but hopefully the above combined give a clear sense of how flawed the Review is from a scientific perspective, and how attacks on the trans community are progressing in the UK.
Much love to my trans siblings in these dark times. Take care of yourself and unplug when you need to.
🌷
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