The only summary of the Cass Report that I need

I keep hearing from anti-trans activists that this major review of the literature on the efficacy of transgender treatments, the Cass Report, confirms their position, which I don’t understand. What I’ve read of the report isn’t very overwhelming at all. Rather than wading into almost 400 pages of text, though, I thought this succinct summary of the whole thing was very good.

A systematic review collects all the published research in an area and ranks the research based on how likely it is to be reliable. The weakest form of evidence are case reports, where a doctor formally writes up an anecdote about a patient. The strongest form of evidence are randomized controlled trials where patients are randomly assigned to some type of medication or intervention, or to no intervention, or to a placebo, and the groups are compared to see how an intervention compares to alternatives/no treatment/placebo. Systematic reviews of several interventions for trans youth were undertaken by the University of York including puberty blockers, cross sex hormones, social transition, and psychosocial support measures.

The results of each of the systematic reviews was to characterize the overall evidence as weak, which was the Report’s most significant finding and has been widely reported. When looking more granularly at the York papers, a pattern appears of some papers showing a psychological benefit of the intervention, a smaller number showing no change positive or negative, and no papers showing any psychological harm. For example, in the systematic review of the evidence on puberty blockers, several included studies suggested psychological benefits to treatment in a range of areas, while a smaller number of studies found no significant impact. This was summarized in both the papers and the Report as “weak evidence” but could also be accurately described as “weak evidence (in favor of treatment).”

That the evidence was weak is not an indictment of the report — by their nature, case reports are necessarily weak. The alternative is to do controlled experimentation on human children, which is going to be even more problematic! The weak evidence is what we have, and that evidence says that, for the sake of the children, we should be treating kids.

The report itself actively endorses the use of puberty blockers, as well as other treatments, in addition to further studies of their effects. However, it takes a very conservative position on when young people should be allowed to take them, and even discouraged social transitioning in young children.

A full programme of research should be established to look at the characteristics, interventions and outcomes of every young person presenting to the NHS gender services.
The puberty blocker trial previously announced by NHS England should be part of a programme of research which also evaluates outcomes of psychosocial interventions and masculinising/ feminising hormones.

So I don’t get it. Why are the trans haters treating this as a vindication of their position? What I’m seeing is a cautious, conservative review that is compelled by the evidence to give cautious, conservative recommendations in favor of some degree of treatment, and I don’t care how much Helen Lewis and The Atlantic strain to twist it into a condemnation of American policy.

As usual, expect the issue to continue to be unresolved as ideology is used to torment trans kids further.


  1. raven says

    When looking more granularly at the York papers, a pattern appears of some papers showing a psychological benefit of the intervention, a smaller number showing no change positive or negative,
    and no papers showing any psychological harm.

    This sentence seems to sum it up.

    None of the studies found that there was any psychological harm to the children.
    Some of the papers showed a psychological benefit from the interventions.

    This could be summarized as likely to help some children and not harm any children.

  2. Dunc says

    Why are the trans haters treating this as a vindication of their position?

    It’s not like they have a particularly robust or healthy relationship with evidence in general, so why should they be any different here? Also, they’re the sort of people who hear “the evidence for X is weak” as “X is completely made-up!”

    Anyway, most of them haven’t read it either, but are only reading summaries from other people who share their preconceptions. How accurate do you imagine those summaries are? How many of those providing them have actually read the report themselves, or even a moderately accurate summary of it?

  3. raven says

    This meta analysis doesn’t exist in a vacuum.
    There have been lots of studies on Trans people and their medical treatments.

    A recent study found that the regret level of Trans people who have undergone surgery is 1%. This is very low.
    Half of all people in the USA regret getting married and 8% regret having children. 2024

    The lowest estimate I’ve seen for regret after gender-related care is based primarily on people who have had gender-affirming surgery. A recent systematic review and meta-analysis—a type of study where the authors aggregate lots of papers into one big estimate—that combined such studies found an overall rate of 1 percent for regret after surgery for both transmasculine and transfeminine surgeries. This echoes other large cohorts which have found that only a tiny proportion of the people who have these surgeries eventually report regretting the procedure.

  4. cartomancer says

    If my only hobby were raving bigotry in the face of all the evidence then I’d probably just assume all the studies say what I want them to also.

    My biggest problem with the Cass Report, though, is that it does not speak out as forcefully as necessary against the transphobes who blight our culture at the moment. It has some guarded and mild language about “not letting this be a culture war issue”, but given that the root of all our problems with transphobia comes from politically motivated right wing agitators this is insufficient. The biggest obstacle to the health and wellbeing of trans people today is this network of suppurating bigots, and to pretend that isn’t the case is a dereliction of duty for someone writing a report into the state of trans healthcare.

  5. Hex says

    No, that is not the only summary you need. There is a far more in depth one here:

    There’s info and links on more problems here:

    The report is rife with awfulness. It starts from the premise of cis-supremacy. It cites a far-right youtuber at §2.18 who uploads loads of anti-trans propaganda. The cover is even fucking AI-generated (look at the fingers!)

    I am fucking begging cis people to stop treating us like we have a disease and need to be “cured”. It would do all of them a service to read Whipping Girl by Julia Serano before even drawing a breath to say what they think about trans people.

  6. raven says

    This Cass report is new and people are still studying it.
    Here is one opinion from Canada.

    What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth
    Review of evidence published as part of sweeping Cass Review on youth gender care
    Lisa Johnson · CBC News · Posted: Apr 15, 2024

    “There actually is a lot of evidence, just not in the form of randomized clinical trials,” said Dr. Jake Donaldson, a family physician in Calgary who treats transgender patients, including prescribing puberty blockers and hormone therapy in some cases.
    Donaldson says, in the patients he treats, he’s seen dramatic improvement in the quality of life for transgender youth on puberty blockers.

    “If a transgender youth is refused medication and is forced to go through a puberty that does not match their gender identity, that will put them in a body that will make them stand out as a transgender individual for the rest of their lives.”
    Wong agrees there is often a lack of high-quality studies in pediatrics, saying 75 per cent of medications prescribed to children are used “off-label” because they were never tested on children.

    This Cass report doesn’t really change anything.

    For various reasons we don’t always have “high quality” studies of various treatments in medicine.
    Which doesn’t mean we don’t treat patients.
    We look at the evidence we have and make informed decisions based on that and previous experience and use that for treatment decisions.

  7. raven says

    From the article above:

    What does ‘low-quality evidence’ mean?
    The gold-standard in determining effectiveness of a treatment is a randomized controlled trial where neither patient nor doctor know if they are receiving the treatment or the placebo.

    But Wong says that’s not always feasible.

    Beyond ethical concerns of doing such a trial on the mental health of young people with gender dysphoria, there would be no way to keep participants in the dark.

    “Within a few months, it’s obvious to the person that they’re on puberty blockers or they’re not on puberty blockers. So … they have feelings and they have impressions of what they should be going through,” Wong said. “So that’s going to influence the study itself.”

    There are good reasons why there isn’t a lot of “high quality” clinical trial data for Trans medicine in children.

    .1. Ethics.
    These are children we are talking about, not mice or lab rats.
    You often can’t randomize them into control and treatment groups, if one of those groups is possibly or likely to harm children included in that group.

    What are you going to do? Count the number of suicides in children who don’t get puberty blockers and go through puberty versus those who receive blockers?

    .2. How are you going to blind these trials?

    What the researchers have been doing instead is using case reports, surveys, and interviews.
    To call these “low quality” is misleading.
    They aren’t the best evidence but they aren’t useless either. It is still data.

    A lot of physicians who treat Trans people aren’t impressed with the Cass report.
    They are calling it biased against Trans people and Trans medical care.

    Ladha wondered if the review was “coming from a place of bias.”

    “I think the framing of it really made it feel as though it was trying to create fear around gender-affirming care,” she said.

    Donaldson called the systematic review paper and the broader Cass Review “politically motivated.”

  8. Hex says

    The idea that doctors who have been the primary gatekeepers for trans healthcare and have forced us to jump through hoops and “prove” ourselves for hormones and gender-affirming surgeries that are awarded to cis people without issue know better than ACTUAL TRANS PEOPLE is beyond ridiculous. I’m so fucking tired of me and my loved ones and community and all trans people around the world pathologized and treated as lesser than cis people and our healthcare and basic rights and humanity held hostage by them. If what you wrote were the only issues you have with the Cass report and you think it is mild rather than actively damaging and harmful PZ, I am BEGGING you to read Whipping Girl, talk to actual trans people about this stuff, and to not even for a second give cis people a hint of authority over our lives.

  9. says

    I believe you! I read the Cass report after reading Helen Lewis’s tortured explication of it, and was mainly relieved that it wasn’t as, shall we say, British as she made it sound. But still, Cass made it as conservative as she possibly could, despite all the evidence saying the opposite.

  10. raven says

    Cass Review Finds Weak Evidence for Puberty Blockers, Hormones in Youth Gender Care
    — Review leader Hilary Cass, MD, says medical treatment for gender is “built on shaky foundations”
    by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today April 10, 2024

    Last Updated April 16, 2024

    Bolling said a number of studies of gender-affirming care are progressing and should be reporting out soon. While it’s impossible to do a randomized controlled trial (RCT) in this setting — and the NHS program will not be an RCT — there are research methods, such as case matching, that can help deliver quality evidence.

    Will experts accept a research base that doesn’t include RCTs? “We’re going to have to,” Bolling said. “I don’t know how we do it any other way. There’s a research structure you can use to give you meaningful and good data. Maybe not RCT-level, but still pretty good.”

    This Cass report isn’t going to change anything.

    .1. It is already being attacked by all the other medical groups involved in Trans health care.

    .2. Dr. Cass herself is overstating her case here.
    Calling Trans medicine as being built on “shakey foundations” is just wrong.
    It’s built on data from hundreds of studies.
    The data could be better as right now this health care is new and a work in progress.
    We are designing studies to get that data right now. It will take time.

    Claiming Trans health care is build on “shakey foundations” doesn’t mean that it is wrong or harmful. It means we could use some more data.
    In the end, all that new data might be an incremental improvement and that is it.

    .3. For obvious reasons, we aren’t going to be doing a lot of Randomized Controlled Clinical Trials.

  11. kome says

    This is comparable, in a way, to how anti-vaxxers insist that new vaccines are not tested against placebo-controlled randomized trials and how that is proof the vaccines are dangerous. What people who parrot this line are missing is some basics of how scientific research in practice actually works, they’re simply relying on an overly simplistic grade-school understanding of how scientific research is conducted. The standard research design for new medicines when it gets to human trials is not merely placebo-controls but what are called active-controls. There’s still a control condition, but instead of it being against a saline injection or sugar pill, it’s against the currently accepted standard treatment/inoculation regime. It is this way because the comparison of interest is not “does this new thing do better than nothing” but “does this new thing work at least as well as the current standard of care.”

    Likewise, the TERFs’ call for a double-blind RCT for trans-affirming health care as the only way to get real evidence that trans-affirming care is positive is beyond the pale fucking ignorant of how scientific research works in practice. How do you possibly double-blind anyone to whether or not they get called by their preferred pronouns or are permitted to dress in the clothes they feel matches their gender identity?

    Internal validity of research is certainly important, but ecological validity is also pretty damned important to a lot of scientific research. Human-subjects oriented fields – from medicine to linguistics – do not study phenomena that could possibly exist absent an influential ecological context. Prioritizing context-less research designs as the gold standard of evidence is just wrong. Science operates best on the basis of a varied suite of research designs with different emphases on internal and external validity. Science operates best by integrating the findings from these disparate and diverse research designs. Science also does some of its best work by recognizing the limitations of certain designs or analytical approaches to address certain research questions.

    But we all know that goal of TERFs is, like the goal of anti-vaxxers, not to champion good science. It’s to use an incorrect understanding of science as a cudgel to beat down everyone who disagrees with them.

  12. chrislawson says

    The Cass Report may be being exaggerated by transphobes, but as others have pointed out, it is still deeply flawed and uses poor arguments essentially to camouflage transphobia as thoughtful concern.

    The report uses evidence-weighting scales designed to assess the effect of simple interventions (e.g. one or a few given medications) on easily measurable outcomes (e.g. blood pressure) that involve large numbers of study participants. Some of the larger meta-analyses have huge sample sizes (this one has n > 30 million). This is not applicable to transgender health care where the numbers are much smaller than, say, hypertension, where the interventions are more complex, and where the outcomes are harder to measure.

    Despite this, there have been a number of well-conducted RCTs on gender-affirming care, and they consistently show reductions in dysphoria and suicidality compared to placebo. And we’re talking huge effect sizes here, such as ‘60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up’.

    Just to put this into perspective, here’s a review of FDA drug approvals for 2022:

    The 37 drugs approved in 2022 were evaluated in 413 studies (mean [SD], 11.19 [13.04] studies per product; range, 1-68). A total of 227 studies (55%) were classified as randomized; 87 (21%) used single-group designs. Most studies (79%) received industry sponsorship, less than 1% were sponsored by the National Institutes of Health, and 2% represented a collaboration between the National Institutes of Health and a nonindustry source (Table).

    Twenty-four drugs (65%) were approved based on a single study. Only 4 drugs (abrocitinib, oteseconazole, xenon Xe 129 hyperpolarized, and tirzepatide) were approved based on 3 or more studies (Figure). Among the 413 studies available for analysis, 165 (40%) were completed a mean of 8.4 (60.6) months before approval. Results were posted for 103 studies (25%) and, in 24 (6%) studies, results were first posted within 6 months after approval.

    So, yes, this is US rather than UK drug regulation, and many of those drugs were approved with weak evidence bases because they’re for cancers and other serious conditions that have no effective alternatives. But gender dysphoria and secondary suicidality are also serious conditions with no effective alternatives, and the hormones used in gender care have been known and studied for decades.

    The Cass Report is essentially Hill & Knowlton-style FUD for the conservative UK government — talk about weak evidence and needing more studies as a pretext to refusing treatment to people with severe depression and dying by suicide. If Cass really gave a flying **** about trans people, the concusion would be ‘the evidence is not as strong as we would like, but what evidence we have shows important benefits with gender-affirming care at very low risk; accordingly, gender-affirming care should be available to anyone who requests it while we continue to build the evidence base, and we should be prepared to change or abandon care strategies as evidence changes.’

    I’m not going to fisk the report, but I can tell you from reading parts of it that Cass has on several occasions misrepresented the evidence, especially on rates of detransitioning, and clearly finds it impossible to accept the reasons the infamous Bell v Tavistock decision was overturned on appeal.

    Cass is directly responsible for closing England’s only public gender clinic for young people and children. One of her criticisms was that the waiting times were too long…well now they’re infinite. She told the Guardian this week ‘She is not even sure that future clinics should have gender in the name, noting that we should “move away from just calling these gender services because young people are not just defined by their gender”’ (I assume she is also going to recommend closing all women’s health clinics forthwith). She thinks that only a minority of young trans people should ever be allowed hormonal care, because apparently making recommendations on weak evidence is OK when she does it. She intimated to the Guardian that doctors who offered affirming care could possibly face disciplinary proceedings, while generously acknowledging ‘it is not her job to comment,’ which apparently does not count as a comment. She accused gender clinics of malicious secrecy because they wouldn’t give her unfettered access to patient files — yes, the data would be deidentifed, but as a working paediatrician she should know full well that even deidentified data sharing requires consent. She demanded all gender clinics immediately stop taking appointments for patients under 18 — that’s right, she demanded that they shouldn’t even be accepting appointments. If you’re 14 and suicidal, just wait four years to see an adult clinic, or see doctors with no expertise in gender care because we’re closing all those clinics!

    If you want to read what actual trans people think of the Cass Report, this is a good place to start.

  13. chrislawson says

    Also, while dismissing gender-affirming care because there aren’t enough RCTs, the Cass Report includes qualitative research from interviews…so apparently non-RCT evidence is good enough to report when it suits them.

  14. raven says

    The more I read about Hilary Cass and this report the more appalled I become.

    Dr Cass told BBC Radio 4’s Today programme that clinicians were concerned about having “no guidance, no evidence, no training”.

    She said “we don’t have good evidence” that puberty blockers are safe to use to “arrest puberty”, adding that what started out as a clinical trial had been expanded to a wider group of young people before the results of that trial were available.

    This is absurd and it is just wrong.

    Where does she think puberty blockers come from and why do we use them?
    These are very old drugs.


    Puberty blockers have been used on-label since the 1980s to treat precocious puberty in children,[16] and were approved for use in treating precocious puberty in children by the U.S. Food and Drug Administration (FDA) in 1993.[17] Puberty blockers are also commonly used for children with idiopathic short stature, for whom these medications can be used to promote development of long bones and increase adult height.[15] In adults, the same drugs have a range of different medical uses, including the treatment of endometriosis, breast and prostate cancer, and polycystic ovary syndrome.[18]

    These are “.. gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens (e.g. testosterone) and estrogens (e.g. estradiol).”

    They’ve been in use for a number of indications since the 1980s. That is 40 or so years.


    While few studies have examined the effects of puberty blockers for gender non-conforming and transgender adolescents, the studies that have been conducted generally indicate that these treatments are reasonably safe, are reversible, and can improve psychological well-being in these individuals.[26][27][28] A 2020 review published in Child and Adolescent Mental Health found that puberty blockers are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.[20] A 2022 review published in the Annual Review of Medicine found clearly beneficial, lifesaving impacts of puberty blockers on a scale of up to six years, but found research lacking beyond that time frame.[29]

    Hilary Cass is simply flat out lying here.

    FWIW, puberty blockers are used because they are also reversible.
    When you stop taking them, puberty then starts up.

    A 2024 systematic review by University of York published as part of the Cass Review found limited high-quality research on puberty suppression among adolescents experiencing gender dysphoria or incongruence.
    No conclusions on impact on gender dysphoria, mental health and cognitive development could be drawn.

    They are really flat out lying here again.
    There are a number of studies published that show favorable outcomes for using puberty blockers in Trans medical care.

    What Hilary Cass just did was arbitrarily label these studies low quality and throw them out.
    Meanwhile what she and the Transphobe do is use low quality studies of their own and pretend they are the definitive studies. When they aren’t just making stuff up.

  15. raven says

    The Cass report is worthless Transphobic garbage.
    This is from a BBC interview with Hilary Cass.

    In essence, Dr Cass says children have been “let down” by a failure to base gender care on evidence-based research.

    “The reality is we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” she writes.

    This is just wrong and she is lying.
    We have hundreds of studies and decades of experience with treating Trans people.
    We don’t know everything but we know a lot.
    She is making the mistake that because we don’t know everything, we should do nothing.

    Hilary Cass:
    Dr Cass repeats previous warnings there was no clear evidence on whether social transitioning had positive or negative mental health outcomes.

    She says those who have done so at an earlier age, or before being seen by a clinic, were more likely to go down a medical pathway and that for most, such a path “will not be the best way to manage their gender-related distress”.

    She doesn’t know that.
    She has no data on these points whatsoever.
    It is simply as assertion without proof or data and may be dismissed without proof or data.

  16. Prax says

    @Hex #5,

    No, that is not the only summary you need. There is a far more in depth one here:

    Just took a look at that, and yeah, it’s pretty damning. Cass judges that the evidence for medical intervention is not as strong as we would like (something you could say about just about any treatment) and then concludes “so we should use other approaches instead,” which is a completely unjustified leap. Is there stronger evidence for any other approach–including doing nothing? If not, then we should continue medical intervention while, of course, also continuing the research into its efficacy.

    And using unlabeled AI-generated pictures of trans youth is just silly.

  17. nomdeplume says

    Why the hatred for the choices other people make about how they live their own lives?

  18. says

    Why are the trans haters treating this as a vindication of their position?

    For the same reason they’re citing the Tavistock ruling, and for the same reason US gun-rights advocates cite the Heller ruling: it’s a bluff. And if the Cass report is almost 400 pages, that makes it a somewhat harder bluff to call.

    So thanks, PZ, for bringing this to our attention.

    My biggest problem with the Cass Report, though, is that it does not speak out as forcefully as necessary against the transphobes who blight our culture at the moment.

    If the Cass report is supposed to be about the safety or efficacy of gender-affirming medical/mental-health care, then it has to stick to that narrow slice of the overall issue. If they’d said anything about the bigotry and culture-war part, the transphobes would scream bloody murder about how “partisan” and “polemical” and “unscientific” it was.

  19. Silentbob says

    Read every comment by raven in this thread. They’re all right on the money.

    One of the best reviews of the “Cass Review” I’ve read is by Gender GP. They’re a private service for trans healthcare in the UK, so could be considered biased. But I can’t see anything to fault in their discussion of all the problems in the Cass Review.

    The Cass Review is a profoundly flawed document that could result in significant harms to trans youth and young trans adults if its recommendations are implemented. Not only does it engage in flagrant evidence denial, but it makes several inaccurate claims and recommendations that are not supported by any evidence at all. Moreover, its openly cisheteronormative agenda, whereby cisgender identities are judged to be more desirable or legitimate than transgender identities, enacts the prejudice that is suffered by the trans community in the United Kingdom. It is our position that the Cass Review is an unethical and unscientific document that serves to legitimise a system that commits sustained injustices and harms to the trans community.

    I had high hopes this Cass would be a person of integrity and do an honest review of the evidence that forms the international consensus on trans healthcare. But alas, it has become crystal clear that the “Review” was a sham. The institutionally transphobic NHS in the UK simply doesn’t want to provide trans healthcare. But they needed an excuse to ignore the international consensus. So they commissioned an “independent” review that set an impossibly high bar for evidence, used that to throw out literally 98% of the evidence, and then claim that since there’s no evidence the international consensus can be ignored. Then the NHS can say we’re stopping trans healthcare because the Cass Review said so! It seems to have been nothing more than an exercise in manufacturing a reason to stop trans healthcare.

    I think this cartoon by Katy Montgomerie (who is herself trans) sums the whole thing up perfectly:

  20. Silentbob says

    Randomized-controlled trials are methodologically inappropriate in adolescent transgender healthcare

    The absence of RCTs studying the impact of gender-affirming care on the mental health and well-being of transgender adolescents does not imply that these interventions are insufficiently supported by evidence. Although RCTs are considered high-quality evidence because of their ability to control for unmeasured confounders, the impossibility of masking which participants receive gender-affirming interventions and the differential impact of unmasking on adherence, withdrawal, response bias, and generalizability compromises the value of RCTs for adolescent gender-affirming care. RCTs are methodologically inappropriate for studying the relationship between gender-affirming interventions and mental health. These methodological considerations compound the serious ethical concerns raised by RCTs in adolescent transgender healthcare. Given the limitations of RCTs, complementary and well-designed observational studies offer more reliable scientific evidence than RCTs and should be considered of sufficient quality to guide clinical practice and policymaking. Adolescent trans healthcare is on solid footing.

  21. says

    The board of inquiry was deliberately set up to exclude any participation by trans people and deliberately sought out the views of anti-trans groups; for example, Cass met with the freak show that masquerades as medical authorities in the state of Florida under Ron de Santis. The report isn’t so much as to be read critically, as to be cited by government uncritically in service of continuing the same horrific policies that have led to multiple people dying on NHS multi-year waiting lists for a first consultation.
    There are so many things wrong with the document that if I were to start it would be difficult to avoid overflowing the comment length. One particularly terrible recommendation, which amounts almost to a justification for conversion therapy, is that for pre-pubescent children the possibility of exploring social transition should generally be resisted except under medical supervision.
    Pre-pubescent children are typically androgynous. Social transition for such a gender dysphoric child amounts to possibly using a different name, pronouns, and finding them different clothing, which can happen years before a medical intervention is required. The frequent story from trans adults in the UK when consulting their GPs ranges from the minority that are supportive, to a majority that disapprove of their being trans, to those who express outright hostility (with the possibility of some malpractice thrown in, such as refusing to continue medication prescribed by other doctors). The policy requiring medical supervision for what is in many cases a change in social status also fails to take into account that most GPs will neither have received any medical training with respect to trans medicine, nor will have viewed obtaining such knowledge as part of the ongoing refreshment of their skills. The Cass report is basically a justification for medical mistreatment on the one hand, while pushing trans children toward conversion therapy sneakily rebadged as ‘exploratory therapy’.

  22. Owlmirror says


    Why are the trans haters treating this as a vindication of their position?

    Further down in the very page you linked, there is a section on the recommendations of the Cass Report:

    Cass Report Recommendations
    The Report included many recommendations for treatment of youth presenting at gender clinics in England. Some of these were fairly technical, describing proposed relationships between NHS entities such as regional centers, centralized authorities, and local/tertiary providers. Other recommendations were broader. These included the recommendation to provide more psychosocial interventions, to explore all non-medical treatment options, to treat social transition as a serious intervention that might lead to a transgender identity, to prohibit puberty blockers outside of a research study, and limit the provision of cross-sex hormones to the rarest of cases. The recommendations synthesize a view of medical transition as a bad outcome to be avoided, and a belief that gender dysphoria can be successfully treated non-medically, despite no non-medical interventions being evaluated in any of the series of systematic reviews that found weak evidence in favor of puberty blockers, cross-sex hormones, social transition, and psychosocial support for young people on waiting lists or undergoing medical interventions.

    I would say that those recommendations could well be roughly summarized as “medically, treat being trans as a bad thing”, which is certainly something that trans haters would consider to be vindicating.

  23. jeanmeslier says

    It is downright baffling how Cass apparently thinks one would take her as “scientific” and “objective” if she meets with one of the biggest fascists /his staff , that are out there, who has focused all his efforts on eradicating those she claims to “investigate”

  24. says

    The institutionally transphobic NHS in the UK simply doesn’t want to provide trans healthcare. But they needed an excuse to ignore the international consensus.

    More to the point, I suspect the NHS needed an excuse to do what they may have felt they had no choice but to do: cave to a baying mob of mindless haters in a time of spineless incompetent right-wing Tory misrule. Judging by the trolls I’ve seen screaming about trans people on the ‘Tubes, they seem utterly divorced from reality and totally uncaring about facts, reason or consequences; and have been whipped up into endless implacable hate by a steady diet of lies and disinformation.

    And the interest-groups feeding them all this disinformation won’t be stopping in the UK either. They’re planning to use the momentum they got in the UK to get the same results in other countries. (So, again, thanks, PZ, for posting about this and providing a place for fact-checking and commentary.)

  25. raven says

    This is an example of how Hilary Cass flat out lies.

    BBC interview:

    Hilary Cass:
    Dr Cass repeats previous warnings there was no clear evidence on whether social transitioning had positive or negative mental health outcomes.

    Actually there is in fact published evidence on the effect of social transitioning in children on their mental health.

    Pediatrics. 2016 Mar; 137(3):

    Mental Health of Transgender Children Who Are Supported in Their Identities
    Kristina R. Olson, PhD,corresponding author Lily Durwood, BA, Madeleine DeMeules, BA, and Katie A. McLaughlin, PhD

    These findings suggest that familial support in general, or specifically via the decision to allow their children to socially transition, may be associated with better mental health outcomes among transgender children. In particular, allowing children to present in everyday life as their gender identity rather than their natal sex is associated with developmentally normative levels of depression and anxiety.

    Hilary Cass simply throws out any studies that don’t agree with her biased and bigoted views of Trans people.

    She in fact, threw out or ignored most of the medical studies on Trans people and their health care.

  26. jeanmeslier says

    @27 if most major psychological , biological, medical and anthropological societes and even the WHo disgrees with you, you should maybe start reflecting, but she does not seem to be too eager about ethics, science , let alone “freedom” and wellbeing, as no conservative ever

  27. says

    She in fact, threw out or ignored most of the medical studies on Trans people and their health care.

    Whaddaya expect? She was chosen to head that project for the explicitly stated reason that she had absolutely no connection, knowledge, training, stake or experience in trans healthcare. And she brought with her lots of other people whose lack of qualification was their sole qualification to be there. Which is absolutely consistent with right-wingers’ well-known hatred of experts, expertise, knowledge and knowledgeable people. As a character in a William Gibson novel said, they don’t know shit about anything and hate everyone who does.


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