By Erin Reed | LONDON, UK – On Tuesday night, Dr. Hilary Cass released a final review commissioned by the British/UK National Health Service (NHS), widely expected to pin gender-affirming treatment. The document met these aspirations, calling for limits on gender-affirming care and social change, and actually advocated for blocking trans people under the age of 25 from entering child treatment.
To support these recommendations, the evaluation dismissed over 100 studies on the efficacy of transgender care as never sufficiently high quality, applying standards that are impossible and never required of most other neonatal medicine.
Conducted in a way similar to the anti-trans assessment by the DeSantis-handpicked Board of Medicine in Florida, which Cass apparently collaborated on, the document and its reviews are likely to support further reprisals on transgender care globally.
32 tips for how trans attention may be conducted within NHS England were included in the 388-page report. It incorrectly asserts that there is “no good evidence” to support trans attention and calls for restrictions on transgender care for those under the age of 18, but does not support a complete ban.
The document endorses the idea that being transgender may be caused by anxiety, sadness, and OCD problems, despite the American Psychological Association, the largest internal organization in the world, rebutting this as lacking information.
It also claims that transgender individuals can be “influenced” into being trans, a nod to the discredited theory of social contagion and rapid onset gender dysphoria, rejected by over 60 mental health organizations.
Finally, it appears to support restrictions on transgender people under the age of 25, stating that they should not be denied the entry to adult care facilities.
To support these recommendations, the report was released alongside “reviews” of the evidence surrounding transgender care, using these reviews to assert that there is “no good evidence” for gender-affirming care.
According to the Newcastle-Ottawa Scale, a subjective scale criticized for its shortcomings and potential unreliability due to a high risk of bias, 101 out of 103 studies on gender-affirming care were dismissed for not being of “sufficiently high quality,” according to a closer examination of the reviews released alongside the Cass report.
This critique is particularly significant given the contentious political nature of the subject and connections between reviewers, Cass, and anti-trans organizations.
The Human Rights Campaign has criticized the Cass Review as politically motivated, much like the Florida Review, which used a similar tactic to justify state-wide transgender rights restrictions.
Notably, during the Republican administration’s Republican Governor Ron DeSantis’ meeting with anti-trans Catholic medical association member Patrick Hunter, who had a significant influence on the creation of the Florida Review and Standards of Care.
Prior to working on a transgender care strategy, the governor was specifically chosen by the governor because he has shown vehement opposition to LGBTQ+ and transgender people. According to court documents, the Florida review was allegedly created and manipulated with the intention of having “care effectively banned” from the beginning.
The Florida Review was slammed by Yale Researchers as “not a serious scientific analysis, but rather, a document crafted to serve a political agenda,” and much of their full critique is applicable to the Cass Review as well.
In those meetings, Cass apparently took interest in Florida’s anti-trans expert report, according to emails from trial exhibits uncovered by transgender researcher Zinnia Jones, such as this email confirming that a meeting took place:
Paul,
See the information that was sent to me from the Cass Review in the attached image. I forgot to mention that they were very interested in the McMaster University report and the Florida evidence review. She applauded the accomplishments made at that institution under Gordon Guyatt’s direction. At Dr. Cass’s request, I sent them a copy of the Florida evidence review.
Notably, Patrick Hunter has been identified as part of a network of anti-trans experts who seek to roll back gains for queer and trans rights by the Southern Poverty Law Center, and both the Florida Review and the Cass Review serve those functions.
One of the most contentious chapters of the Cass Review discusses social transition, which advises that medical professionals see those who are considering social transition as soon as possible. It asserts that social transition may be able to “change the outcome of gender identity development,” a claim that, in part, lacks the level of validation or proof needed for transgender care.
Significantly, there has been discussion about prohibiting social transition in schools, even with parental consent. Former prime minister Liz Truss’ most recent bill would have prohibited public officials from using language or treating children “in a way inconsistent with their sex,” leaving it unclear how people should be treated differently based on their sex.
In addition, The Cass Review makes an argument about gendered toys, suggesting that preferences for trucks for boys and dolls for girls might have a biological basis, despite significant uproar over such claims. A recent study casts doubt on earlier monkey studies used to refute previous claims that toy preferences had been used to explain biological differences.
It is widely believed that toy choice and other gender role behaviors are solely the result of social influences; this is a common assumption. For instance, that girls will only receive dolls to play with and boys will only be given trucks to do so. Although this is partially accurate, Cass writes in the report that there is proof that prenatal and postnatal hormonal factors influence these behaviors.
To support arguments around potentially high detransition/desistance rates, Cass repeatedly cites Ken Zucker, including the often-challenged “85%” rate from his research. Notably, Zucker has recommended that parents withhold “wrongly-gendered” toys from their children as a strategy to change their gender identity.
The emphasis on those between the ages of 17 and 25 is of particular note. According to the Cass review, transgender people shouldn’t be placed in adult care until they’re 25 years old. The reason for doing this is that those who have been waiting for youth care, with waitlists frequently lasting longer than five years, are also credited with reducing the time they have taken to qualify for adult services.
Instead, the review proposes a “follow through” service, declaring transgender 17-25 year old’s as “vulnerable. What kind of limitations would this follow-through service have, at this time.
It appears that those concerns were well justified within a day of the Cass Review’s publication. NHS England announced that it would be launching a review into “the operation and delivery of adult GDCs” in a report released by The Guardian.
The review team at the [Cass] review team had concerns about clinical practice, particularly in regard to people with complex co-presentations and undiagnosed conditions. The decision to launch a review into adult care was justified.”
Experts in transgender healthcare from all over the world objected to the findings of the Cass Review right away. Dr. The findings and recommendations were criticized by Portia Predny, vice president of the Australian Professional Association for Trans Health, as they were in conflict with the most recent scientific evidence, expert consensus, and the majority of clinical guidelines around the world.”
The Review commissioned several systematic reviews into gender-affirming care by the University of York, but it appears to have ignored a significant number of studies demonstrating the benefits of gender-affirming care, according to a statement from the Professional Association for Transgender Health Aotearoa. In one review, 101 out of 103 studies were dismissed.”
There is plenty of evidence to support the claim that gender affirming care saves lives. Numerous studies have demonstrated that gender-affirming
care significantly reduces suicidality, with some showing a decrease in suicidality by up to 73%.
A review compiled by Cornell University, which compiled over 50 journal articles on the topic, shows the efficacy of transgender care. These findings were recently refuted in a study by the Journal of Adolescent Health that found that puberty blockers significantly reduced depression and anxiety.
The Lancet, a medical journal with widespread praise, published a letter stating that gender affirming care is lifesaving preventative care in response to all of these studies and more. The most powerful and significant medical organizations support transgender medicine.
The largest psychological organization in the world, the American Psychological Association, recently and historically, passed a recent and historic policy resolution that states that being trans is not “caused” by things like autism and PTSD.
Although the Cass Review’s full impact is unknown for a while, it is likely to have a significant impact on England, where transgender care is already tightly regulated and requires incredibly long waitlists.
Additionally, it is possible that anti-trans organizations in the United States will use the review to support further care bans. However, the review is unlikely to receive much cred from many United States judges, legislators in states with strong political opposition to care, and medical organizations that have remained steadfast in combating anti-trans disinformation, similar to other “reviews” conducted in countries or states like Florida, where transgender medical rights are under attack.
However, the Cass Review continues to advance the same types of attacks that have been carried out in Florida, and its recommendations could have a significant negative impact on transgender people around the world.
