Hilary Cass, a renowned consultant paediatrician, agreed to review global research into puberty blockers for NHS England in the fall of 2019. She expected it to be a quick, easy process.
On the day of her evaluation into gender identity providers, which has become one of the most contentious evidence review projects in new clinical history, she laughed grimly as she said,” I thought it would be a couple of afternoons a month for six months and then I could get home and get on with my pension.”
The project has turned into” a 24-hour obsession to try to improve points,” which places her in the middle of a conversation she describes as harmful, politicized, and ideological.
Cass ‘ assessment is written in a calmly scientific manner, but there are times when her rage over how NHS England handled a generation of young children is barely concealed.
Practitioners have become “fearful”. The available information is “poor”. Her efforts to conduct a crucial and in-depth analysis of the outcomes of all 9, 000 children and adolescents treated at the Tavistock and Portman gender identity development service ( Gids ) clinic between 2009 and 2020 were” thwarted.”
Cass is unwavering about the fact that her recommendations will be very contentious and that some young children who are waiting for treatment will be offended by her conclusions. She is also adamant about taking young people’s best interests seriously.
” We’ve let them down because the research is n’t good enough and we have n’t got good data”, she said.
People perpetuate the contamination of the debate, which is unfair to the toddlers who are entangled in it. This group may become showing more kindness to because the children are being played as basketball.
She has examined all the available information on which gender medicine has been based nationally, and she has attempted to answer the strange question of why the number of children in the UK and other developed countries started to rise exponentially in 2014, and why so many more ladies started seeking treatment. ( In 2011- 12 there were just under 250 visits to the company, in 2021- 22 this had risen to more than 5, 000 visits. )
In response to the closure of the Tavistock patient’s Gids center last month, which was brought about as a result of her time research, she has also been given the task of making clear tips about how services may be improved. In the future she wants companies to offer a wide selection of treatments, more that having “tunnel perspective” on sex.
She does n’t even think future clinics should have a gender in the name, arguing that we should “move away from just calling these gender services because young people are not just defined by their gender.”
Cass claims it is not her job to make a comment about whether some professionals may be subject to disciplinary action because of what went wrong.
” I do n’t think you can point a finger at anyone in particular, it’s been a system failure”, she said.
People are now reluctant to work in this field because the debate’s poisoning has been so great.
According to health experts, there was a sense of dread that “being called transphobic if you take a more optimistic approach.”
Some professionals expressed “fearfulness about what colleagues may state if they speak up and express an opinion that is not constant with ours” while others were concerned that they might be accused of conducting” conversion therapy” if, once more, they take a careful or exploratory strategy.
Over the past 15 years, the result of this rising apprehension among clinicians has been that many children exploring their gender ( which Cass describes as” a normal process” in adolescence, not necessarily requiring any NHS input ) have been prematurely deviated to chronically oversubscribed specialist clinics and have been sat on waiting lists for years without any support.
” There are many more young people who are questioning their gender today. What’s really important is that they have a place to talk to someone about that and work through it.” The problem has been that whilst they’ve sat on a waiting list, they just have n’t had that help. They’ve just had the internet to help them and that’s not always helpful.
When there might have been many different ways to deal with their distress, they’ve come to a premature conclusion and foreclosed options. They should have someone to talk to them much earlier than they narrow their options, in my opinion, and this is not going to happen quickly.
Cass is of the opinion that a minority of young people should choose medical transition, but she is clear that there is n’t enough solid evidence to support the use of hormones in children and adolescents.
Her earlier research has resulted in NHS England’s decision to stop prescribing puberty blockers to children, and new research advises “extreme caution” before prescribing masculinizing and feminizing hormones to under-18s.
” We’ve got it locked into this focus on medical interventions. And certainly some of the young adults told us that they wish they knew there were more ways to be trans than just a binary medical transition,” she said.
A significant portion of her report examines whether nature, nurture, or other factors are the best explanation for the soaring numbers of referrals to gender clinics. Cass draws nuanced conclusions, but she acknowledges that Generation Z has never before experienced social media and the internet.
” It’s a social experiment – we do n’t know what that’s done for the generation that’s coming through – what has been good and what is bad,” she said”. We do need to consider the impact of social media, not just in terms of influencers but also about the effects of long hours on social media, since biology has n’t changed in the last few years.
She continued,” There was some very dangerous influencing going on. Some of them give them very unbalanced information. All the evidence indicates that family support is really important to people’s well-being, according to her. Some were told parents would not understand, forcing them to actively distance themselves from their parents or actively separate from them.
She acknowledged that some children might have suffered harm from misprescribed hormone treatments, but it was impossible to say how many. We really do n’t know how many children and young people have benefited versus how many have suffered because we lack adequate follow-through data. We urgently need to get that information.”
The adult gender clinics had blocked the research study she had hoped to conduct because it was “unbelievably disappointing” because they had refused to contact former patients for permission on her behalf.
Sajid Javid, the former health secretary, had amended the law to permit researchers to link pre- and post-transition NHS numbers, but the study had to be abandoned when all but one of the adult clinics, according to Cass, refused to cooperate.
” I do think it was coordinated. It seemed to me to be ideologically driven,” she said”. There was no compelling justification for it. So I can only draw the conclusion that it was because they did n’t believe it to be the best course of action to try to pin down this information.
Cass claimed that although she had a distant relative who had a trans identity, this connection had not had an impact on her outlook. They were a different generation and passed away very late in life.” I do n’t believe there were any really transferrable messages to sort of this group of young people,” she said.
