Sorry to bump this thread, but within the last week, there has been a rather interesting news story with regard to gender identity. It certainly made mainstream headlines, anyhow.
For those not aware, the Cass Review, an NHS-commissioned review into gender identity services for under-18s, was released last week by paediatrician Dr Hilary Cass. The review was first commissioned in 2020 after a sharp rise in the number of gender-questioning patients referred to NHS gender services.
The report made 32 recommendations in total, and reported various findings and conclusions. These include:
- There was no clear explanation for the rise in the number of young people with gender dysphoria, but there was a broad agreement for attribution to a mix of biological and psychosocial factors, such as social media-related mental health problems, access to information regarding gender dysphoria and struggles with emerging sexual orientation. The report considered a rise in acceptance of transgender identities to be insufficient to explain the increase.
- The review found that gender identity treatment is “an area of remarkably weak evidence”. Cass states that “Results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”.
- The debate around how to care for young people with gender dysphoria is polarised. Some clinicians believe that most people presenting to gender services will go on to have a long-term trans identity and should be supported to access a medical pathway at an early stage. Others believe that this path prematurely medicalises young people with multiple other difficulties that are manifesting through gender dysphoria.
- Cass describes the toxicity of the debate around gender identity as “exceptional”, stating that “there are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media and where name-calling echoes the worst bullying behaviour. This must stop.”. Cass also states that the toxicity of the debate has made some clinicians fearful of working with young people with gender dysphoria.
- The review found that many people have already socially transitioned by the time they are seen clinically. This means doing things such as changing their name by deed poll and attending school in their chosen gender.
- The review found that research on the impact of social transition is generally of a poor quality and that findings are contradictory. Some studies suggest that allowing a young person to socially transition may improve mental health and social and educational participation, while others say that allowing young people to socially transition is more likely to lead to an altered life trajectory and medical intervention with lifelong implications that they may otherwise have not taken.
- With this in mind, the review declares that there are “many unknowns” about the impact of social transition, and recommends that parents should be involved in decision making unless there are strong grounds to believe that this would put a child at risk. The review recommends that where children are pre-puberty, families should be seen as early as possible by a clinician with relevant experience. It also suggests avoiding premature decisions and considering partial transition as a means of keeping options open.
- The review suggests that any young person seeking NHS help with gender dysphoria should be screened for neurodevelopmental conditions such as autism and ADHD and given a mental health assessment. This is due to a finding that among people using NHS gender services, there is a higher than average prevalence of conditions such as autism and ADHD, a higher than average prevalence of poor mental health, and also a higher than average prevalence of adverse childhood experiences (e.g. child sexual abuse).
- The review states that evidence surrounding the use of puberty blockers is weak, with no evidence that they “buy time to think” and concern that they may change the trajectory of psychosexual and gender identity development and pose risks to long-term bone health. There is also a lack of evidence to prove that masculinising and feminising hormones improve body satisfaction and psychosocial health and reduce child and adolescent suicide rates, and there are concerns over the impact on fertility, growth and bone health. As such, Cass recommends that there should be significant caution exercised in giving hormones to children below the age of 18, with them only being given where there is a strong clinical case for it. This is despite the NHS currently allowing them to be given to children as young as 16.
- Cass recommends that a “follow-through service” should be put in place for 17 to 25 year olds rather than letting them instantly transition to adult services, with caution being advised in allowing full medical transition in people below the age of 25.
As a result of the Cass review’s findings, NHS adult gender services in England are to undergo a major review, while local NHS leaders have been told to pause first appointment offers at adult gender clinics to young people who are under 18.
What do people think of the Cass Review’s findings and recommendations? I won’t profess to have too much knowledge on the topic of gender identity myself, so I think it would be unfair for all involved for me to express an overly entrenched viewpoint, but I’m willing to be informed, and I’d be intrigued to hear the views of others on this.
One thing I do agree with the review on, however, is that the debate around gender identity has been made far too toxic. The fact that people on both sides of the debate are getting utterly vilified for their views prevents a nuanced, balanced debate on the topic, in my view, and I don’t think that social media has helped with this at all.
I’m aware that this is a sensitive topic, so I sincerely apologise if I have said anything that’s construed as insensitive; that was certainly never my intent.
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