The universe needs a warrior like Hillary Cass right now. She has sparked one of our culture’s most contentious debates: how should the medical industry respond to the increasing number of young people seeking gender transition through hormonal therapies and puberty blockers? After more than three years of research, Cass, a pediatrician, produced a report for the National Health Service in England notable for its empathy for people on all sides of this issue, its humility in the face of complex social trends we don’t fully understand, and its intellectual integrity as we seek to determine which treatments truly benefit those patients experiencing distress. With remarkable courage, she demonstrates how careful scholarship can redirect debates often marred by acrimony and intimidation onto more rational grounds.
The intent of her report is clear to the reader. According to Cass, a former head of the British Royal College of Pediatrics and Child Health, “This assessment is not about undermining the validity of transgender identities, challenging individuals’ right to self-expression, or encroaching on people’s healthcare rights. It’s about determining the best approach to healthcare and how to best assist the increasing number of young people and children seeking support from the NHS regarding their gender identity.”
This issue begins with a puzzle. The number of children seeking to transition their gender has surged in recent years for reasons that remain unclear, though the overall number remains relatively small. Leading this trend are adolescents assigned female at birth, for reasons that are also unclear, whereas prior to the late 2000s, it was predominantly adolescents assigned male at birth seeking these interventions.
To explore these shifts, doctors and researchers have proposed several theories. One posits that more transgender individuals are now seeking these interventions. Another suggests that young people are influenced by a culture encouraging identity exploration and experimentation. A third theory proposes that the prevalence of mental health issues among youth may contribute to gender dysphoria. Cass approaches these theories with skepticism in her report due to insufficient evidence. These are individuals, she asserts, who are forming their own identities.
The rise in requests for medical transitioning has become entwined with what some activists and doctors on the left view as the new civil rights frontier. Following a couple of small Dutch studies demonstrating improved well-being with such treatments, medical institutions in the US and Europe have increasingly embraced medical interventions. However, a 2022 Reuters investigation found that some British clinics were prescribing puberty blockers without thorough assessments: None of the 18 US facilities Reuters examined provided extensive assessments before prescribing puberty blockers.
Yet, scientists who questioned the prevailing narrative faced severe backlash. Sallie Baxendale, a professor of medical neurology at University College London, published a review of studies this year examining the effects of puberty blockers on brain development. Concluding that significant questions remain about the therapy, she quickly became a target. Speaking to The Guardian, she said, “I’ve been accused of being an anti-trans campaigner, and that now comes up on Google and is never going to go away.”
