In a discussion that has turned out to be incredibly dangerous, a review of the NHS’s sex identity services discovered that children and young people were let down by a lack of studies and medical research.
Dr. Hilary Cass stated that her record was focused on “how best to help the growing amount of children and young people who are seeking aid from the NHS in relation to their female identity” rather than “redefining what it means to be transgender” or “undermining the validity of transgender personalities.” Here are the article’s key results.
The information
“This is an area of extremely poor evidence,” Cass writes in the prologue to her 398-page statement.
Despite that, she continues, “People on all sides of the debate are exaggerating or misrepresenting the results of research to support their stance.” In reality, there is no solid evidence to support interventions to control gender-related distress over the long term.
When Cass began her investigation in 2020, the data center was “weak,” particularly regarding masculinizing and feminizing cross-sex estrogen and puberty blockers. That was exacerbated by the existence of “a lot of misconceptions, easily accessible online, with opposing sides of the debate pointing to study to defend a position, regardless of the quality of the reports.”
Cass gave York University the task of conducting comprehensive assessments of the data on crucial topics like puberty blockers. There is still a lack of high-quality information in this area, according to it. York academics, as part of their research, tried to document the outcomes seen among the 9,000 young people who the Tavistock and Portman NHS trust’s gender identity development service (Gids) treated between 2009-2020. But, it was “thwarted by a lack of teamwork from six of England’s seven NHS adult female service.”
According to the review, the new NHS services for these young people had regularly gathered information from which treatments work and what they are able to improve medical practice.
The conversation
Cass acknowledges that there are polarized views on how to care for young folks, both within and outside of society. Some clinicians, for instance, think that the majority of transgender people will continue to have a long-term trans identity and that beginning support should be provided to enable them to access a health pathway.
“Some people believe that we are medicalizing kids and young people whose numerous other issues are manifesting in identity confusion and anguish. The contamination of the conversation is exceptional,” the statement says.
Cass has received criticism for speaking to both parties that support the health approach and those who think more caution is required. She claims that some seasoned specialists who have offered a variety of opinions have been “dismissed and invalidated.”
There are “no other places of medical where experts are so afraid to speak out freely about their opinions,” say experts, who are criticized on social media and who use the term “name-call” to describe the worst forms of bullying. This has stopped.”
Some practitioners are hesitant to work with these young people because of the toxic nature of the argument.
The Tavistock and Portman NHS Trust
Compared to the 1990 birth-registered men who had not yet reached puberty, the Gids company saw fewer than 10 kids a year. Since the age of 16, the majority of people have received only a small amount of estrogen.
But in 2011, the UK began trialing the use of puberty blockers, as a result of the development of “the French protocol,” which involved using them from early adolescence. But, a study undertaken in 2015-16, although not published until 2020, shows “a lack of any good tangible results.”
“Puberty blockers are no longer a research-only method, but they have transitioned from being a regular clinical practice protocol in 2014.” According to the statement, this “adoption of a treatment with questionable benefits without additional scrutiny” helped to increase the demand for them among individuals.
Cass was asked to conduct her critique in 2019 following an NHS England review that examined the evidence on health treatment and found that it was “weak.”
Changing client profile
Since 2014, Gids recommendation rates have increased, but there has also changed the status of those who use services. Trans people have traditionally been predominantly transgender women who are now adults for centuries. The majority of teenagers who were born women are now in the bulk.
An audit of release notes of Gids people between 1 April 2018 and 31 December 2022 showed the youngest person was three, the oldest 18, and 73% were delivery-registered females, according to the assessment, which tries to discover why things have changed so drastically.
It looks at the decline in young people’s mental health and the effects of social media, which have placed pressure on them like no one else’s.
According to the review, “the increase in presentations to female hospitals has to some degree paralleled this decay in child and adolescent mental health.” “The prevalence of mental health issues has increased for both boys and girls, but particularly so for girls and young women.”
Youngsters who present with gender identity issues to services may also have depression, anxiety, body dysmorphia, tics and eating disorders, as well as autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD). According to the review, visits to Gids are also linked to higher than average costs of negative childhood experiences.
The review concludes that gender incongruence is the result of “a complicated interplay between physiological, psychological, and cultural components” rather than “there is no single reason for the increase in prevalence of identity incongruence or the shift in case-mix of those being referred to gender services.
Transitioning
Cass points out that a young person’s sense of their identity can change over time and be unchanging.
Young adults looking back at their younger selves would frequently advise slowing down, the report states. “While some young people may feel an urgency to transition, some young people may feel this way.
“For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some people may make a transition and then de- or re-transition and/or experience regret. All those who seek support must be taken care of by the NHS.
Social transitioning
Social transitioning is the process by which people undergo social changes in order to live as a different gender, such as changing names, pronouns, hair, or even clothing. It is something that English schools have been having to deal with in recent years.
By the time they are seen, many children and young people attending Gids have already changed their names and had already gone to school in their chosen gender, according to the Cass review.
According to the review, research on the effects of social transition is generally of poor quality and the findings are incongruent. Some studies suggest that allowing a child to transition socially may improve their social and educational participation and mental health.
Others say a child who is allowed to socially transition is more likely to have an altered trajectory, leading to medical intervention, which will have lifelong implications, when they might otherwise have desisted.
There are still many unknowns about the impact of social transition, the review concludes. “In particular, it is unclear whether it alters the trajectory of gender development, and what short- and longer-term impact this may have on mental health”.
The review advises that parents should be involved in decision-making unless there are compelling reasons to believe this could put a child at risk.
Additionally, where children are pre-puberty, families should be seen as soon as possible by a doctor with relevant experience. Additionally, it advises avoiding premature decisions and taking partial or full transitions as a way to keep options open.
Future care
According to the report, any young person seeking NHS assistance for gender-related distress should be screened to see if they have any neurodevelopmental conditions, such as autism spectrum disorder, and also be given a mental health assessment.
Due to the lack of reliable evidence that they work, NHS England has already in effect banned the use of puberty blockers. Cass discovered that there is “no evidence that puberty blockers buy time to think,” as their supporters have asserted. According to the review, there is “concern that they may change the trajectory of psychosexual and gender identity development” as well as “pose long-term risks to users’ bone health.”
There is also a lack of evidence that masculinizing and feminizing hormones improve a young person’s body satisfaction and psychosocial health, and there is concern about their impact on growth, bone health, and fertility. As their supporters have asserted, there is no proof that they lower the risk of suicide in children.
Finally, the evidence base” as weak” as it is for cross-sex hormones and puberty blockers to show whether psychosocial interventions – therapy work for those who do not receive hormone treatment.
All of this implies that “there is a significant gap in our knowledge about how best to support and help the growing number of young people who are experiencing gender-related distress in complex presentations.”
