Catching up with Cass

Must-read analysis of April's game-changing Cass Review

The April 10 release of the Cass Review in England led many there to claim that the end of the gender-affirming model had arrived.

The Review was reported on across the British mainstream media, and within days Scotland followed England in banning the prescription of puberty blockers in state-run medical settings.

NHS England’s statement on the Cass Review stressed that its findings would have international relevance, and Dr Cass’s report will be a key factor as Canada, Australia and the US grapple with challenges to the dominance of the gender-affirming model.

Dr Hilary Cass (a paediatrician and former President of the Royal College of Paediatrics and Child Health) led a four-year independent review of gender identity services in England, and her recommendations highlighted concerns about lack of evidence for the medical treatment of gender dysphoria, about the hostile climate in which clinicians operate, and about a lack of credible professional guidelines.

This month, we highlight some of the most important analyses of The Cass Review. We hope that these articles point the way to the beginning of a long process of extricating evidence-based care from the morass of ideology into which it has sunk.

Paul Garcia-Ryan on letting therapists be therapists

We were excited to see Paul Garcia-Ryan’s opinion piece in The Washington Post, “A new report roils the debate on youth gender care”. The article drew US mainstream media attention to Dr Cass’s emphasis on the hostile conditions and “bullying behavior” experienced by clinicians.

Paul wrote:

“When it comes to youth gender treatments, though, professionals who raise concerns have been censored and subjected to reputational damage, threats to their license and doxing. As a result, countless gender nonconforming young people have been badly served”.

The British Medical Journal calls for attention to the evidence

The British Medical Journal’s editor, Kamran Abbasi, voiced full support for the Cass Review in his article “The Cass review: an opportunity to unite behind evidence informed care in gender medicine”. He wrote:

“The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider—from social transition to hormone treatment”.

UN Special Rapporteur says the Cass Review will protect girls

The UN Special Rapporteur on violence against women and girls, Reem Alsalem, wholeheartedly endorsed the findings of the Cass Review. She wrote:

“The Cass review findings and recommendations are seminal, and its implications go beyond the United Kingdom. While the Cass Review may not have framed its conclusions and findings explicitly in human rights language, it has – in my view – very clearly shown the devastating consequences that policies on gender treatments have had on human rights of children, including girls. These policies have breached fundamental principles, such as the need to uphold the best interest of the child in all decisions that affect their lives, and the right of children to the highest attainable standards of health”.

Therapy First’s next webinar is on Monday 13th May. Join our presenter Elliot Kaminetzky PhD to explore gender identity and OCD. All are welcome: clinicians, parents, educators and those with an interest in gender. Details and tickets here.

A homophobic medical scandal

Same-sex attracted young people have suffered disproportionately from the harms of the gender-affirming model. The Gay Men’s Network’s response to The Cass Review condemned the homophobia inherent to the model, and called for a reassessment by the many leading gay rights organizations who have supported it.

They wrote:

“The recommendations of the Cass Review represent a return to the evidence-based norms of medicine. It is frankly terrifying they were ever abandoned in the first place. We wish to emphasise this was primarily a homophobic medical scandal. Staff at the Tavistock famously told a dark “joke” saying “soon there will be no gay people left”. Institutional homophobia must not be overlooked, edited out or erased from the post-Cass discussion. Homophobia ran riot because staff were too scared of accusations of transphobia”.

David Brooks says Dr Cass is a hero

High-profile New York Times columnist David Brooks praised Dr Cass’ methodical and empathetic approach in his opinion piece “The Courage to Follow the Evidence on Transgender Care”.

Brooks urged the US to follow her example in putting evidence before politics. He wrote:

“Hilary Cass is the kind of hero the world needs today. She has entered one of the most toxic debates in our culture: how the medical community should respond to the growing numbers of young people who seek gender transition through medical treatments, including puberty blockers and hormone therapies. This month, after more than three years of research, Cass, a pediatrician, produced a report, commissioned by the National Health Service in England, that is remarkable for its empathy for people on all sides of this issue, for its humility in the face of complex social trends we don’t understand and for its intellectual integrity as we try to figure out which treatments actually work to serve those patients who are in distress”.

Psychologists hold their profession to account

Sixteen senior British clinical psychologists wrote to The Observer to point out the widespread failure of their profession to act to prevent children being harmed, stating that “We are ashamed of the role psychology played in gender care”.

They wrote:

“These were psychology-led services. Whether intentionally or not, and many were doing their best in an impossible situation, it was clinical psychologists who promoted an ideology that was almost impossible to challenge; who, as the Cass report found, largely failed to carry out proper assessments of troubled young people, and thus put many on an “irreversible medical pathway” that in most cases was inappropriate; and who failed in their most basic duty to keep proper records”.

Hannah Barnes asks how we allowed this to happen.

Journalist and author Hannah Barnes (whose book Time to Think was critical in drawing public attention to the excesses of the gender-affirming model) asked questions many of you will have been asking for years. How did this happen in plain sight? How did it take a decade to recognise concerns that were voiced early on?

Barnes’ article in The New Statesman, “The Cass review into children’s gender care should shame us all” concluded:

“Lessons must be learned. Because this story teaches us that bad things can happen when good people do, and say, nothing”.

The likely costs of persisting with the gender-affirming model grow ever higher

The editorial board of Quillette contrast the basic common sense of the Cass Review with the intense state of confusion found in our culture - in which all over the world, moderates drawing attention to evidence-based concerns about child transition have had their lives and careers ruined.

Their article, “The Cass Effect”, finds it unlikely that this confusion will quickly resolve. However, they point out that a seminal contribution of Dr Cass’ report is that the space for those involved to claim that they “just didn’t know” is fast reducing:

“Until recently, clinicians rushing to “affirm” a trans child’s beliefs could credibly claim to have simply been swept along by an ideological movement that presented itself as progressive, humane, and even revolutionary. But the release of Dr Hilary Cass’s landmark report has rendered that claim untenable. And those who pretend otherwise should be judged accordingly if they persist in endangering the children entrusted to their care”.

May news from Therapy First

We are holding our May webinar on Monday 13th. Join our presenter Elliot Kaminetzky PhD to explore gender identity and OCD. All are welcome: clinicians, parents, educators and those with an interest in gender. Details and tickets here.

If you’re a clinician looking to connect with likeminded colleagues, you may be interested in our inaugural summer Members’ Retreat in the Pennsylvania countryside. Details and booking information are here.

Therapy First also featured recently on Buck Angel’s YouTube channel, describing some of the bullying and harassment our members are receiving as they attempt to work with gender-distressed youth. Watch the video here.

Thank you for reading, and wishing you a warm and prosperous May!