There are many ways to assess the utility of a policy. One way is to simply ask who favors the policy. There are many known bad actors who wear their bigotry on their sleeve, so if you find them favoring something, there may be something wrong with it.
The anti-trans frenzy is peaking in England this week following the release of a much-anticipated review by Dr. Hillary Cass on transgender care. Many anticipated that the report would serve as a pretext to ban transgender care in England, and it appears to have been crafted to provide just such a rationale. Nations already enacting restrictive laws against transgender individuals will likely use it as justification for further discrimination. In the United States, far-right Christian nationalist groups, including Heritage Foundation (retweeted), Association of Christian Schools International, and the Alliance Defending Freedom, have cited it to support anti-trans legislation they are involved in drafting or lobbying. The Cass Review is an exercise in politics with predetermined conclusions, not science and medicine, and health authorities worldwide should reject its findings.
Uh-oh. Far-right conservative Christian groups in America are cheerleading for the Cass Report? But I thought England had embraced a “defanged” version of Christianity that would never harm gentle, diverse souls, and there they go, welcoming the rabid version of Protestantism that was supposed to only exist in the Colonies!
We can also ask whose opinions Dr Cass found worthy and interesting.
After a series of political attacks on transgender people and rising anti-trans sentiment in the country, the NHS commissioned a review and tapped Dr. Hillary Cass, a pediatrician whose list of follows on social media include extremist anti-trans sources such as Transgender Trend (which argues, as is obvious, that being transgender is a “trend”), the LGB Alliance (a LGB group that believes in “dropping the T,” or transgender people), and Graham Linehan (an anti-trans activist and comedian), along with many other noted anti-trans voices.
While collecting anecdotes about the harms that transgender care does, Dr Cass was unable to find any significant evidence of such care damaging patients. I would offer an anecdote of my own, about how anti-trans ideology does great harm, needing only to list Graham Linehan, a fanatic whose anti-trans fervor has destroyed his own family, wrecked his career, and demolished his reputation. Case closed.
To demonstrate the great damage that the report does to human beings, though, we only have to look at its immediate consequences. The Scotland health service is now taking away puberty blockers from their patients!
Scotland’s only clinic to offer treatment to gender-questioning young people has paused prescribing puberty blockers and cross-sex hormones in light of last week’s publication of the Cass review.
The Sandyford clinic, based in Glasgow, which offers a range of services including emergency contraception, abortion and support for sexual assault victims as well as transgender healthcare, posted a service update online on Thursday morning.
It stated: “Referrals from the Sandyford sexual health services to paediatric endocrinology for the prescription of puberty suppressing hormones have been paused for any new patients assessed by our young person’s gender service.
“Patients aged 16 to 17 years old who have not been treated by paediatric endocrinology, but who are still seeking treatment for their gender incongruence, will no longer be prescribed gender-affirming hormone treatment until they are 18 years old.”
And puberty and sexual development are allowed to march onwards, compounding their effects and worsening the psychological conflicts these people already have, and requiring greater medical effort to roll them back years later. A cruel move.
America is watching, and eagerly anticipating making young people similarly miserable on this side of the Atlantic.
PZ just said some of what I posted this morning on the earlier thread.
I’m just going to Xpost it again here.
You can see what Hilary Cass’s plans are for Trans people by reading it.
This is from a BBC interview with Hilary Cass.
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.
It’s not a mistake though, she is discarding 30 years worth of research and just ignoring it.
Another lie.
There are published studies on exactly this point. Here is one:
Part 2 The Final Solution to the Trans Problem by…Hilary Cass
Here is Hilary Cass’s plan for Trans children.
It is to minimize the number of Trans children and keep them from Transitioning to their identified gender.
She doesn’t know that.
She has no data on these points whatsoever.
It is simply an assertion without proof or data and may be dismissed without proof or data.
You can see what her plan is here.
.1. Identify young children who are Trans.
.2. Prevent them from socially transitioning.
.3. Keep children from going down the medical pathway, whatever that means.
Probably, it means no puberty blockers, no cross hormone therapy until they are 18 and no longer children.
.4. Hilary Cass “….“will not be the best way to manage their gender-related distress”.
So how will Hilary Cass manage children’s “gender-related distress” if it isn’t socially transitioning or medically?
It’s not too clear here.
My best guess is that they want or already have set up clinics to simply try and talk these children out of being Trans and Transitioning to their identified gender.
It’s basically a form of conversion therapy.
Will it work?
Are they going to set up her demanded Randomized Clinical Trials and look at the outcomes? (No, of course not. These are hypocrites as well as hater.)
I don’t know. I’m not in the UK.
I suspect if her Children’s Trans Prevention Clinics cost money, the UK NHS might not bother with them. It’s not like the NHS has a lot of extra money lying around.
They just might not treat Trans children at all.
Wait until they are 18 and offer minimal treatment.
@pz
Thank you for covering trans issues as well as open to revising your positions on things as you learn more. <3
It feels really surreal to be in a very accepting part of the world where everyone just treats me kindly. And yet there is all this ugliness swirling just outside my little bubble. When I tell people what’s going on they are completely horrified as they just don’t know. It is generally a really scary time and it’s nice to see people doing what they can.
It’s actually all about the money and the current government wanting to get rid of the NHS and replace it with a US-style health system.
The Cass report is pretty standard from that viewpoint – she stresses the need for more resources and research with the various agencies involved and in response these are being shut down because “the money isn’t there” to do the research required.
This has been the standard for any review of any health services over the last 14 years (neurology, mental health services, dentistry, etc, etc). The waiting lists are longer and NHS treatment minimal across the board through deliberate Tory government policy.
It’s not mainly about punching down at trans teens (although they aren’t averse to doing that), but more about eviscerating the NHS.
As to why they’d want to do that – well there’s a lot of money to be made out of a fully private healthcare system.
It should be noted that the full range of treatments are available privately.
Republicans are always quick to point out that gender-affirming care wreaks permanent, irreversible change in people’s bodies.
But they rarely say that puberty does that, too.
Fuck this shit makes me furious. What’s worse is that when we point out the inevitable children’s suicide we’ll be tut-tutted for not respecting the dead.
Trans cartoonist Sophie LaBelle has several comics about Cass on ExTwitter.
https://twitter.com/AssignedMale
So what.
.1. So does pregnancy and childbirth.
Just about every person who goes through that is going to notice something.
A few will die from it.
“In 2021, 1,205 women died of maternal causes in the United States”
.2. So does cosmetic surgery.
.3. High school sports.
Particularly football.
.4. Sports in general but particularly pro football.
“Concussions and play-related head blows in American football have been shown to be the cause of chronic traumatic encephalopathy (CTE)”
We’ve had to invent a new syndrome for that, Chronic Traumatic Encephalopathy, CTE.
.5. War.
This is obvious.
A lot of the damage from modern war is invisible, traumatic brain injuries and PTSD.
The GOP doesn’t have the slightest problem promoting permanent irreversible changes in people’s bodies.
They are the ones who are with some success trying to outlaw abortion and birth control, forced birthers.
They also don’t have a problem starting and continuing our many wars.
Afghanistan and Iraq were GOP wars that we are still paying for.
It is irrelevant anyway.
We don’t do irreversible Trans surgery or irreversible anything to Trans children.
It is a free country still and people over 18 are legal adults and can make their own decisions about what they want done to their bodies.
Far be it from me to toot my own horn … but who am I kidding?
More info at Wonkette.com and more mockery at the PervertJustice substack:
https://www.wonkette.com/p/the-cass-review-hey-what-does-uk
https://pervertjustice.substack.com/p/hillary-cass-takes-a-trans-census
andywuk@4–
You are being far too generous. Yes, the Cass Report fits well within the Tory defund-everything mindset, but its promotion of malicious and false anti-trans talking points and its extraordinary abuse of systematic review processes to exclude all evidence in favour of gender affirming care is far more motivated by a desire to actively harm trans people.
In the UK there was a notorious law in the late 80s/90s called “Section 28”, born out of a moral panic about gay people, that prohibited “the promotion of homosexuality” in schools. The panic being that gay activists were turning kids gay. It institutionalised homophobia for a generation, until the government had to humbly apologise for it in the 21st century.
Cass is Section 28 for a new generation… but worse. Section 28 at least didn’t go after healthcare. People will (and already have) die from this attempt to frame trans people as a contagious psychopathology. Inevitably, the government will end up humbly apologising for the “Cass Report” and the NHS adoption of it’s recommendations – but that’s little comfort for the generation that will have to live through it.
I would bet folding money that most of the impassioned objection to puberty blockers comes from conservative Xtian men who are absolutely terrified of someday, somewhere, feeling sexual attraction to a trans woman who was able to stop male puberty before it turned her physicality into something she did not want.
Right-wing Xtian conservatives don’t really have much to fear from a 6’4″ tall trans woman with an Adam’s apple and size-13 high heels. Hell, they can always gang up with 4 or 5 of their good ol’ boys and beat her up. But a trans woman who looks exactly like a cis woman? OMG, they could totally hit on her, not realizing she was trans, and that would make them TURN INSTANTLY GAY, and make their dicks shrivel up and fall off!!!
Today’s Washington Post has an editorial titled “Youth gender care is resting on shaky ground,” by Paul Garcia-Ryan, who is president of something called “Therapy First.” The op-ed uncritically supports the Cass Review and dutifully parrots the transphobes’ complaints about the “persecution” of transphobes who say things that make them sound like transphobes.
The bigots have their rallying-point, and their latest excuse to be bigots. That’s what the Cass Review was made for.
A question for raven:
With respect to minors, there are some decisions that minors are allowed to make for themselves, and other decisions that the adults in their lives are allowed to make for them. Usually it depends on how high the stakes are. And there seems to be near-universal agreement that if the stakes are high enough, they either have to wait or get the adults responsible for them to go along.
Bottom surgery has high stakes and is irreversibly life changing. Is there a principled reason to exempt it from the general principle that kids don’t get to make high-stakes, irreversible, life changing decisions? I don’t doubt that for a lot of trans kids it’s probably the right decision, so it’s more a question of who gets to make the call.
David Brooks just published a column on the Cass Review, which I refuse to read.
It is a good question.
I don’t have any special insight into the answers though.
I would just have to go with the medical consensus.
The surgery can wait until the children are legal adults at age 18.
Even today, most Trans people haven’t had bottom surgery.
These are still uncommon procedures.
I’m sure this is for a variety of reasons.
Despite all the stereotypes of the Trans haters, at least some Trans people retain their fertility and can and do have children.
A survey from 2020. “19% of transgender adults in the US are parents”.
The second important point is that these days, it is politically impossible to do gender affirming surgery on anyone under age 18.
The current panic and frenzy directed against Trans people would make any place doing such surgery at risk of up to mob violence attacks.
At the very least every politician and law enforcement would be after them as soon as they found out about it.
AFAIK, no hospital will perform Trans surgery on anyone under age 18 and if you look, they say that on their websites.
The regret level for Trans people having surgery is 1%.
This is very low.
The regret level for people getting married in the USA is 50%.
The regret level for people making the life changing, irreversible decision to have children is 8-12%.
You would think having children is an irreversible decision but parents often try to reverse it anyway. There isn’t a day that goes by where we don’t read about a parent killing their kids.
More often they are abandoned to the foster care system or one parent just walks out and never comes back, usually but not always the father.
The reason for the low regret level is somewhat known.
Patients are carefully selected and screened for this type of surgery.
It isn’t undertaken lightly or carelessly.
PS The Cass Review made a big deal out of people detransitioning.
Which is so rare as to barely be above zero.
Anyone who wants to detransition can just…detransition.
It is a free country and no one is going to stop them.
In fact, whatever medical help they need is widely available.
This isn’t and never has been any sort of problem or issue.
Thank you for your thoughtful response. That was very helpful as I’m still struggling through some of these issues.
I hang out a lot at Kevin Drum’s blog. The community there is mostly cool, but every time KD posts something about trans issues a half-dozen anti-trans bigots show up and utterly stink up the comment thread. So when I saw awomanofnoimportance’s question @14 I assumed she was a troll trying to set up a gotcha moment.
I have to give raven credit for assuming the best and taking the question at face value, and also credit to awoman for being a sincerely curious person and not the troll that I first thought.
When I was in my activist heyday, we NEVER called for surgery to be available for under-18s. That went hand in hand with our refusal to accept the establishment and fucked up families forcing genital surgery on intersex infants. We knew the damage that did, b/c we were working hand in hand with intersex activists (indeed, a small but important few of us were both trans and intersex).
Since then I’ve heard of a few cases where exceptions were made for people below 18. They were always 16-17 and always had a long history of suicidality that the doctors didn’t think would be relieved without surgery, for reasons that were understandably kept private in their clinical notes and other documents of the trans child’s medial history.
Remember that surgery is different from puberty blockers and other hormone therapy. We don’t typically show others our genitals. And while, yes, their are still public showers in schools were it’s not easily avoidable, that sort of thing is being reduced. It is possible to get an exemption from PE or a private shower accommodation nowadays. While fitting in is important for every adolescent (more important than I wish it was) and while bullying and other things are real risks, the state of your genitals shouldn’t normally be a risk factor.
That said,
1) Not all schools are competent at addressing bullying. Not all schools even try to address bullying. The more external pressure you’re under, the more desperate you might feel.
I am not a doctor, and I don’t like second guessing them, but my instinct is that if you’re not stable enough to wait 2 years for surgery.
While those external pressures (including from family, if any) can be excoriating, any pressure to have surgery early becomes a reason for a trans person later to question how much agency they really had. Did they get to choose? Or were they forced by circumstances? This isn’t an insurmountable psychological issue, but questioning yourself after the fact this way is stressful and for some the process sucks quite a lot. VERY FEW end up thinking that they shouldn’t have had surgery, but a still small but much larger fraction does think that they should have waited.
Given all this, a forced-wait policy for surgery would seem to be little difficulty for the vast majority of trans kids, especially if they got the support that they otherwise need (like puberty blockers). For those to whom the wait does seem like an impossible burden, I worry about their state of mind but if they actually have consistent, supportive care anchored by at least one constant member on their care team that they know that they can talk to, then in theory I would be okay with a bypass process that requires advocacy and documentation from their long-term specialist. I am not in favour of a child being allowed to demand surgery right away or within a short time after starting treatment.
Note that this ethically requires the rest of us to make sure that we’re providing trans teens adequate care so that the number of these situations is minimized and so that any doctor that has to make a decision about bypass has enough experience with a particular patient to make some difficult judgement calls.
I think the alternative is allowing a teen who has their custodial parents’ permission to have surgery younger, perhaps as young as 16. I don’t like that option. I would much rather implement actual supports and pay for specialists so that the child feels comfortable knowing that they can get what they need.
But if we as a society won’t pay for care, then I think we as a society don’t get to force our choices on the child even though they’re a child.
It’s a bargain. You say you care about these kids and you just don’t ant them to get hurt? Fine. Implement the policies and assign the budgetary money to make sure that they aren’t hurt. If you turn your back on them during the care process, you can’t show up later and lecture them about how they’re handling difficult circumstances when you’re the one who left them on their own to handle difficult circumstance.
That’s a generic “you” talking about a society, btw. Not you personally.
Anyway, this is all to say that the ethical reason for making an exception exists, but the only time it should apply is if we’ve already failed our own ethical duties.
I’d rather society just do the right thing and a limit of 18 years of age be implemented on surgeries (with extremely rare bypass available only when requested by an experienced specialist, and only with very clear and very stringent conditions that make sure that this does not become routine).
If, however, in 15 or 50 years there’s new research that says those conditions should be relaxed, then whatever. I’m not that specialist and I’m happy to inform my decisions based on that.
I don’t have peer reviewed research, but I do have a hell of a lot of experience as a trans person and with other trans persons, and this is what I would do unless and until we have better information than I have now — which is quite a lot, but anecdotal.
When they looked at people who had undergone social OR medical transition under the care of Britain’s NHS, the number was 10. not 10%, 10. That was out of just over 3k. (I don’t remember the exact number, but pretty sure it was 3100-something). It’s not clear how many of those 10 might have socially transitioned without medical treatment or how many might have used puberty blockers and then decided later not to continue, which would have been a perfectly appropriate use of puberty blockers which are supposed to allow time for the child’s mind to think about all the big questions involved here.
So at worst 10/3100, but possibly more like 5-9 / 3100?
In any case, the numbers out of the UK were insanely low.
@ ^
Allow me.
Square brackets in original, ellipsis is mine.
Source:
https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview_Final.pdf (Page 168.)
If my mental arithmetic is correct that’s 0.3% detransitioners.
@ ^
Crunching the numbers from page 168 on how many got puberty blockers, the detransition rate is 1.37%.
@ ^
And that’s assuming <10 means 10. X-D
It could be two for all we know.
Thanks, Bob. I knew I read it, but I read the whole damn thing + thousands of pages of commentary from others and I simply did not remember where I had seen the numbers (also didn’t remember the numbers exactly either, but at least I knew enough to not bullshit people with precision that I didn’t have).
Not seeing the justification for using recipients of puberty blockers in the denominator, though.
@14
I’m not Raven, but I’ll answer. This is an interesting claim that is wildly divorced from those made by Cass and other prominent transphobes. Transphobes are not arguing that “kids can’t decide to get medical transition, therefore the adults can decide for them.” That isn’t a position you’ll find any famous transphobes taking.
Instead, the position of all prominent transphobes is that the government must decide to bar all trans minors from accessing endocrine health care, regardless of the position of any adults in their lives.
Again, that is not the position taken by any prominent transphobes. Their position is that the adults responsible for trans kids cannot make any decision on behalf of trans kids. The position you are calling “near-universal” is not, in fact, held by Cass or any other anti-trans politicians.
When I was four years old, I got one of my internal organs removed. I had no understanding of what the organ they were removing was. That was a “high-stakes, irreversible, life changing decision.” It also wasn’t my decision. I had no input in it whatsoever. It was my parents’ decision. That is how “high-stakes, irreversible, life changing decisions” about health care for children are usually made.
If you really wanted to apply the “general principle” to the case of trans children, you would have to support trans children of any age (even toddlers!) getting bottom surgery with their parents’ permission. That’s how virtually all other high-stakes medical procedures are handled.
That’s even how genital surgeries for cis kids are handled now: If a 2-year-old cis boy loses his penis in a car crash, his parents would have the right to get him a phalloplasty. Very few people would argue that he should have to wait until he’s 18 to get bottom surgery, or that his parents would be committing “child abuse” by getting him treatment. The belief that some medical treatment is such a big deal that neither children nor their parents can decide to get it and only the government can decide is uniquely applied only to trans minors.
Side note:
Ack, messed up that last quote. And I even checked the preview! I wish there was an edit button here. Let me fix it here:
Both vaginoplasty and phalloplasty are reversible. An orchiectomy is not. I don’t think reversibility is relevant, seeing as almost everyone uncritically accepts irreversible surgeries on cis kids, but I’m curious whether you would be okay with a child getting a vaginoplasty but not an orchie?