The Cass Review

The Cass Review (2024) has dealt a blow to Gender Identity Development Services in the UK's NHS.

The focus has been on the services available to young people and has exposed a multiplicity of problems, from the evidence used to the treatment given, with little evidence on the long term outcome of treatment, with the additional problem of staffing levels, conflicts between staff, and a broader social and political environment that has only produced controversy.

As a consequence, the rational decision has been made to shut down the services available, but also has led to an ugly confrontation in the media, as some people, notably JK Rowling, have used the report to mount a broader attack on 'Transgenderism' in general, in her case naming and shaming actors in the Harry Potter film series.

Rowling seems to have hardened her stance in the last few years, but I think is actually less concerned with young people, than with the adult males who self-identify as Female to gain entrance to 'women-only' spaces, for the purposes, mostly illegal, of self-gratification or even assault. It has also become a deep problem in Sport, but in my view Rowling does not distinguish between men who self-identify as women, and men who have begun or who have completed their transition and who have as much right to be treated as women as Rowling does.
JK Rowling reignites row with Harry Potter stars Daniel Radcliffe and Emma Watson - BBC News

I feel this kind of 'debate' is unworthy of the situation young people find themselves in, which is a world away from the angry tirades one finds in Rowling and like minded-critics. She claims to be sensitive to the rights of Transgendered people, but seems only to want to support the 'nice' ones, whoever they are.

As is clear, the public needs better evidence of cause, treatment and outcome if a rational, medical and psychological course of treatment is to do justice to the person concerned. Social ostracism, abuse, and in some cases violence do nothing but make the sensitive issue harder to deal with.

Here are some of the summaries of the Cass Report-

"

• There is no simple explanation for the increase in the numbers of predominantly young people and young adults who have a trans or gender diverse identity, but there is broad agreement that it is a result of a complex interplay between biological, psychological and social factors. This balance of factors will be different in each individual.

• There are conflicting views about the clinical approach, with expectations of care at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services.

• An appraisal of international guidelines for care and treatment of children and young people with gender incongruence found that that no single guideline could be applied in its entirety to the NHS in England.

• While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.

• The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate.

• The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services.

• The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.

• The use of masculinising / feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.

• Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity."
• Final Report – Cass Review

Quote:

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Originally Posted by Stavros

The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services.

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This is the key point that is likely to be lost on the transphobic cultural warriors who will present these findings as a vindication of their views. I'll bet the politicians who have been most active in banning gender-affirming treatments won't be putting more resources into therapy for young people with gender identity issues.

This is clearly an area in which views among the medical profession are divided, which I guess is a good reason to be cautious about treatments that may have irreversible impacts until we have better research evidence. As noted in the report:
"This 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."

Some if not all the people 'engaged' in fury with 'transgenderism' are the same people who think Covid is a hoax and vaccinations don't work. There does appear to be a marginal group of people, co-ordinated or not, who regard anyone who has questions about diagnosis, treatment and definition as 'transphobic'. Their aggressive response undermines rational debate as much as the people they attack. It really is tiresome having to deal with 'Trans Exclusionary Feminists', the 'Woke Blob' and so on, mostly the creation of social media. In the long term one can only hope that the seriousness of the issue will re-focus minds on what matters most -the welfare of the children, none of whom asked for this level of attention.