Shiloh
Editor, Senior Moderator
Source: https://thedispatch.com/article/the-cass-review-wont-go-away/
The Cass Review Won’t Fade Away
How youth gender medicine broke almost every liberal institution it touched.
By Jesse Singal
Apr 22, 2024
Anyone who reads the Cass Review, and who then reads most recent mainstream American media coverage of youth gender medicine, will be gobsmacked.
The review, spearheaded by the respected British pediatrician Hilary Cass (and ably summed up in The Morning Dispatch last week), explains that youth gender medicine “is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”
Cass and her colleagues arrived at this conclusion after an ambitious yearslong effort to interview clinicians, parents, and patients about their experiences with the National Health Service’s youth gender medicine system. She also commissioned a sizable bundle of independent systematic reviews evaluating both the evidence for puberty blockers and hormones, as well as the quality of recommendations published by influential groups like the World Professional Association for Transgender Healthcare. Overall, dozens of studies were collected and evaluated by the team at the University of York, and this culminated in Cass delivering a damning verdict on the present state of youth gender medicine and the professional guidelines surrounding it.
In her report, Cass clarifies that her goal is not to question whether some young people are “really” transgender. She acknowledges that some young people are in tremendous distress about their gender, and she doesn’t deny the fact that some may benefit from blockers and/or hormones. Her argument, which in any other context would not be controversial, is simply that powerful medical treatments should be underpinned by quality evidence—and that that clearly isn’t the case here. Cass also focuses on the need to ensure youth referred to gender clinics receive the proper screening and assessment before medical interventions are undertaken, especially for the growing subset of these youth who are autistic or who have mental-health comorbidities that, some experts believe, can significantly complicate the diagnostic process in these settings.
Cass’ findings led to significant new restrictions on puberty blockers and hormones for youth in the U.K. The changes follow similar decisions based on comparable (albeit less ambitious) reviews in countries like Finland, Sweden, and Norway. Other European nations seem poised to follow suit.
On the other hand, the vast majority of American media coverage has for years touted the safety and efficacy of these treatments. In some cases, writers and reporters denounced the foolishness (if not transphobia) of those who exhibit undue skepticism toward them. These articles are often festooned with quotes from psychologists, psychiatrists, and endocrinologists with extremely impressive credentials—the sorts of people we are told to trust—reinforcing the view that if these treatments have any risks or unknowns, they are small, easily swamped by their salutary effects. A certain message has been delivered with the repetition of a drumbeat: An informed, compassionate person should support access to youth gender medicine...
The Cass Review Won’t Fade Away
How youth gender medicine broke almost every liberal institution it touched.
By Jesse Singal
Apr 22, 2024
Anyone who reads the Cass Review, and who then reads most recent mainstream American media coverage of youth gender medicine, will be gobsmacked.
The review, spearheaded by the respected British pediatrician Hilary Cass (and ably summed up in The Morning Dispatch last week), explains that youth gender medicine “is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”
Cass and her colleagues arrived at this conclusion after an ambitious yearslong effort to interview clinicians, parents, and patients about their experiences with the National Health Service’s youth gender medicine system. She also commissioned a sizable bundle of independent systematic reviews evaluating both the evidence for puberty blockers and hormones, as well as the quality of recommendations published by influential groups like the World Professional Association for Transgender Healthcare. Overall, dozens of studies were collected and evaluated by the team at the University of York, and this culminated in Cass delivering a damning verdict on the present state of youth gender medicine and the professional guidelines surrounding it.
In her report, Cass clarifies that her goal is not to question whether some young people are “really” transgender. She acknowledges that some young people are in tremendous distress about their gender, and she doesn’t deny the fact that some may benefit from blockers and/or hormones. Her argument, which in any other context would not be controversial, is simply that powerful medical treatments should be underpinned by quality evidence—and that that clearly isn’t the case here. Cass also focuses on the need to ensure youth referred to gender clinics receive the proper screening and assessment before medical interventions are undertaken, especially for the growing subset of these youth who are autistic or who have mental-health comorbidities that, some experts believe, can significantly complicate the diagnostic process in these settings.
Cass’ findings led to significant new restrictions on puberty blockers and hormones for youth in the U.K. The changes follow similar decisions based on comparable (albeit less ambitious) reviews in countries like Finland, Sweden, and Norway. Other European nations seem poised to follow suit.
On the other hand, the vast majority of American media coverage has for years touted the safety and efficacy of these treatments. In some cases, writers and reporters denounced the foolishness (if not transphobia) of those who exhibit undue skepticism toward them. These articles are often festooned with quotes from psychologists, psychiatrists, and endocrinologists with extremely impressive credentials—the sorts of people we are told to trust—reinforcing the view that if these treatments have any risks or unknowns, they are small, easily swamped by their salutary effects. A certain message has been delivered with the repetition of a drumbeat: An informed, compassionate person should support access to youth gender medicine...