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Pediatrician and consultant Hilary Cass conducted a comprehensive and lengthy review of international research into gender therapy for children for NHS England. They concluded that the lack of research and evidence on transgender medical interventions such as puberty blockers and body-modifying surgeries is failing children.
Dr. Cass said the pillars of gender medicine are 'built on shaky foundations', and found a serious lack of evidence on the effects of puberty blockers and hormone treatments on children.
Dr. Cass further said that health care for people questioning their gender “needs a total overhaul.” Nevertheless, “there is a notable and necessary distinction between trans identity and transition as a medicalization.”
In an article for the British Medical Journal (BMJ), Dr. Cass said that while medicine is typically based on the pillars of integrating the best available research evidence with clinical expertise and patient values and preferences, he “ Found that those pillars of gender therapy are built on shaky foundations”.
In compiling the comprehensive report, he envisioned a six-month part-time review. But it became “a 24-hour obsession with trying to help make things better”.
Puberty blockers were banned in the UK in children outside of clinical research due to CAS's prior findings.
An overview of the main findings in the final report:
- There is no simple explanation for the increase in the number of predominantly young people and young adults with trans or gender diverse identities, but there is widespread agreement that it is the result of a complex interplay between biological, psychological and social factors. . This balance of factors will vary from person to person.
- There are conflicting views about the clinical approach, with expectations of care at times far from usual clinical practice. This has made some practitioners fearful of working with gender-questioning young people, despite their presentation being similar to that of many children and young people presenting to other NHS services.
- An evaluation of international guidelines for the care and treatment of gender nonconforming children and young people found that no single guideline could be fully implemented across the NHS in England.
- Although a considerable amount of research has been published in this area, systematic evidence reviews have demonstrated the poor quality of published studies, meaningThere is no reliable evidence base on which to make clinical decisions, or to make informed choices for children and their families.
- The strengths and weaknesses of the evidence based on child and youth care are often misrepresented and exaggerated in scientific publications and social debate.
- The controversy surrounding the use of medical treatments has diverted attention from what individual care and treatment aims to achieve for individuals seeking support from NHS gender services.
- The rationale for early puberty suppression remains unclear, with weak evidence regarding effects on gender dysphoria and mental or psychosocial health. The effects on cognitive and psychological development remain unknown.
- TeaDespite long-standing use in the adult transgender population, the use of masculinizing/feminizing hormones in people under the age of 18 also presents many unknowns. The lack of long-term follow-up data on those starting treatment at a younger age means that we have insufficient information about the range of outcomes for this group.
- Clinicians are unable to determine with any certainty which children and youth will go on to acquire a permanent trans identity.
- For most young people, the therapy route will not be the best way to manage their gender-related crisis. For those young people for whom a therapeutic pathway is indicated, it is not sufficient to provide it without addressing wider mental health and/or psychosocially challenging problems.
- Innovation is vital if medicine is to move forward, but there must be a proportionate level of monitoring, oversight and regulation that does not impede progress as well as preventing unproven approaches from entering clinical practice. Innovation should be driven by and contribute to the evidence base.
You can read the full report here.
Author JK Rowling provided insight on the implications of the study.
Over the past four years, Hillary Cass has led the strongest review ever of the medical evidence for infections in children. Just hours after it was released to the press and public, the sentiment among committed thinkers has begun to double. 1/6 https://t.co/J4fA4JYgkC
– JK Rowling (@jk_rowling) 10 April 2024
Fans' lament over child mutilation led to a cruel community note on X.
President of Emma Russell, president of Scottish Labor Students, wrote on X, “The CAS Review is a methodologically flawed, ideologically driven study that is not worth the paper it is printed on. The Labor Party and Wes Streeting must stand up against the erosion of trans rights and trans healthcare provisions. This is absolutely important.”
Community Notes reacted strongly, saying, “The study conducted by Dr Cass, far from 'methodologically flawed' and 'ideologically led', has been 4 years in the making and has been approved by the Royal College of Paediatrics and Child Health It was conducted by the former Chairman of the The poster is ideal.,
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