People with a wide range of viewpoints appear to be welcoming the long-awaited Cass review of gender identity services (GIDS) for children and young people. In more legal, reality-based times, in which transness was accepted as just another example of human variant, this outcome could be to its credit: suitable for a review of scientific services by an expert clinician.
Yet, we do not live in such instances. Alternatively, in recent years, the UK has fallen to 15th in German LGBT+ justice positions (in 2016, the UK ranked third) and was highlighted by the Council of Europe alongside Hungary, Turkey, and Russia as a condition where LGBT+ rights are under attack from political figures, including institutions. A UN report immediately attributes the dangerous nature of the public conversation surrounding sexual orientation and gender identity to the increase in trans hate crimes.
This environment is crucial for comprehending the somewhat euphemistic interpretation of the Cass review. You might have assumed that Hilary Cass is in agreement with them and them alone because of the policy in the UK’s right-wing media, where fairness for transgender people is frequently and violently opposed. The Times claimed the statement “rejected” the use of puberty blockers outright. Yet, this is not the case.
Cass criticises GIDS’ lengthy waiting lists. The trans community passionately agrees with this and has been raising the alarm for years because of my voluntary soaking in this subject for almost ten years. Cass criticizes the lack of comprehensive mental health care, including medication for eating problems. Everyone who knows the first thing about the NHS cognitive health delivery may agree, as would anyone else. Case cites a lack of autism research and evaluation. Again, the area is in agreement with us because it is well-aware and unfazed by our propensity for neurodivergence. Calls for more and more regional GIDS service delivery. Unsurprisingly, the transgender area agrees. Cass bemoans the lack of a transgender peer-reviewed data center. Right there with you, Doc (even though you made a lot of the studies to be excluded).
I could go on, but you get the plan. The key phrases, when read plainly and in great belief, rarely ever get in the way of either. Care for transgender younger people that is “unhurried, alternative, healing, safe and effective”? What’s to like? This is exactly what future patients, patients, their parents, and their caregivers have been asking for all along.
In truth, there has never been a debate over how to care for transgender children and young people. Instead, individuals really motivated to create such services have been successfully sidelined by an increasingly more powerful coalition of politicians, journalists and, certainly, healthcare workers who are motivated by an anti-trans ideology – a need to assert and apparently “prove”, to exclusion of all other possibilities, that trans people like me do not, in fact, exist. And, therefore, that we do not devote the initial 18 years of ours life as children.
What some transgender adults like me worry about is that Cass has sinned and given rise to anti-trans bias.
Consider puberty blockers, for instance. Young people who want to be prescribed this earlier unambiguous puberty delayer, including those I’ve had direct contact with, typically have to wait so long for appointments that they end up in GIDS before the conversation even starts. By any standard, 378 children and young people in 2022 were eligible to receive blockades from the NHS. This is a respectable number. Similar to masculinizing or feminizing hormones for under-18s. This sounds like previously a common practice, according to the review. In reality, such a step would only be considered for someone aged 16-18 and is even rarer.
There are even more shady examples. Case makes mention of the slow and subpar services being provided by GIDS and that doctors feel unable to raise concerns. On the Today program, Justin Webb asked whether this legitimate criticism of a subpar service could be attributed to a phobia of being called “transphobic.” Cass goes some way to agreeing, but then focuses on conciliation, saying, that “whatever the reason” for clinicians’ concerns, she believes everyone was sincerely trying to do their best for their patients.
The lack of context in the report itself, where clinicians who all want the best for their young patients and who have been let down by a lack of evidence, is reflected in the lack of context in the report itself. That is not a complete picture. Take Dr. David Bell, the psychiatrist who welcomed the Cass review and wrote a critical review of the Tavistock centre. Bell is often presented as a moderate critic of GIDS and yet has argued that trans children do not exist in nature but have been invented, and that cases of gender dysphoria in children can be explained by confusion caused by sexuality, confusion caused by neurodiversity, confusion caused by abuse, trauma or mental health conditions but, crucially, never by that child being, either solely or in addition to other factors, transgender. He has described “top surgery” as “bizarre Orwellian newspeak,” the shorthand used by trans men for a masculinizing double mastectomy.
He bemoaned “sterile and lifelong patients, many of whom faced catastrophic complications,” and he used the phrase “gender-affirming surgeries for adults” in Frankenstein terms. I don’t really want to dignify this assertion with a serious refutation, so suffice it to say that regret rates for gender-affirming procedures consistently hover around a whopping 1%.
Bell’s views are echoed by Julie Bindel, who, reacting to the review, says the idea of trans children is a “crazy fallacy”, calls trans adults “fanatics in the grip of a demented doctrine”, likens us to Jimmy Savile, and thanks Cass for the “validation” her report provides. Both Bindel and Bell are members of the pressure group known as the Clinical Advisory Network on Sex and Gender.
These viewpoints fundamentally undermine trans people’s identities and the legal foundation on which our freedoms to things like dignity, privacy, and medical care are also protected. It is unacceptable to ignore such extreme opinions and to criticize them in a review that aims to improve care for gender-queer children and young people. In the clinical and cultural context we’re operating in, it continues to be crucial even if Cass gets the benefit of the doubt, perhaps simply stating that trans children and adults exist seemed too basic.
We would see the fingerprints of anti-trans ideology if the Cass review was conducted under a black light. Cass doesn’t seem to believe in this way of thinking, but I do believe she believes in evidence-based medicine and the existence of trans children. However, she must own that her review has been so heavily influenced by bias.
As her work is used, as it will be, to perpetuate a broader hostile environment towards trans people in the UK, the young people she has tried to help will, understandably, feel betrayed. I take advantage of this to urge her team to keep this in mind as she calls for a similar review of services for 17 to 25-year-olds and possibly beyond. Trans adults also need holistic, safe care (doesn’t everyone?) However, our clinics are in a dire state, and a first appointment can take up to five years. Reviews now hang over us too, making it difficult to predict how much of a Trojan horse for those who would reject or perhaps completely eliminate transgender equality from the NHS.
Dr. Cass, appeasement might get you through this short-term discomfort in the media spotlight, but please remember: it isn’t your healthcare, your rights or your everyday dignity they are trying to take away.
