The booming “gender-affirming care” industry suffered a devastating hit with the release of a long-awaited British review that found “remarkably weak evidence” to support treating children and young adults with gender-transition drugs and surgeries.
The four-year study, commissioned by the National Health Service of England and overseen by Dr. Hilary Cass, cited the “poor quality” of published research and concluded that for most young people, “a medical pathway will not be the best way to manage their gender-related distress.”
“This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint,” said the 388-page report, “The Cass Review.” “The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”
Dr. Cass, a pediatrician, was firmly in the corner of children struggling with gender identity, calling for evidence-based treatment and improved mental-health assessments, but her damning findings represent a vindication for skeptics of “gender-affirming care” for minors.
British author J.K. Rowling, a longtime critic of the gender-identity movement, called the independent report’s findings “a watershed moment” and the “laying bare of a tragedy,” citing the children who have been “irreversibly harmed.”
“I understand that the review’s conclusions will have come as a seismic shock to those who’ve hounded and demonised whistleblowers and smeared opponents as bigots and transphobes, but trying to discredit Hilary Cass‘s work isn’t merely misguided,” said the “Harry Potter” writer on X. “It’s actively malign.”
Leading up to the report’s release, NHS England announced last month that it would no longer routinely prescribe puberty blockers for adolescents, saying there was “not enough evidence to support the safety or clinical effectiveness” of the drugs.
Indeed, the Cass Review took a dim view of puberty blockers, saying there was little evidence that they accomplish their originally intended purpose of giving adolescents “time to think” about their gender identity.
Instead, the report cited evidence showing that “no changes in gender dysphoria or body satisfaction were demonstrated” from being placed on puberty blockers. In addition, the “vast majority” of those patients ultimately moved on to sex-change hormones.
The report cast doubt on the transgender movement’s trump card: That without drugs and surgeries, young people are at greater risk of suicide.
As the question facing parents of gender-confused children goes: “Do you want a dead son or a live daughter?”
“It has been suggested that hormone treatment reduces the elevated risk of death by suicide in this population, but the evidence found did not support this conclusion,” the review said.
The report’s recommendations included better training for gender clinicians; holding gender-transition treatment to the same standard as other medical services; expanding clinic capacity and providing more resources for detransitioners, those who change their minds about changing their sex.
In addition, sex-change hormones should not be prescribed before age 16, and even then, there “should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18.”
In the U.S., 22 states have restricted gender-transition treatment for those under 18 over the objections of LGBTQ groups such as the Human Rights Campaign, which argues that “age-appropriate, medically necessary, gender-affirming healthcare for transgender adolescents and teens is critical, often life-saving, care.”
The LGBTQ group Stonewall U.K. said it supported some of the report’s recommendations and disagreed with others, saying they could “lead to new barriers that prevent children and young people from accessing the care they need and deserve.
“We know that elements of the review and how it is covered in the news may cause concern for trans children and young people and their loved ones,” said Stonewall in a statement. “What is important, above all, is that trans and gender-diverse children get the quality healthcare that they need and deserve. The Cass Review can play a vital role in achieving this aim, if its recommendations are implemented properly.”
As in the U.S., British clinics have seen a sharp rise in the number of adolescents seeking sex-change services, particularly among girls.
From 2009 to 2016, the NHS Gender Identity Service saw the number of children and adolescent referrals soar from 15 to 1,766, with an exponential increase in 2014.
The report traced the surge to a 2011 British trial study based on the so-called “Dutch Protocol,” which pioneered the early use of puberty blockers for children with gender dysphoria. The British trial showed “a lack of any positive measurable outcomes.”
“Despite this, from 2014 puberty blockers moved from a research-only protocol to being available in routine clinical practice and were given to a broader group of patients who would not have met the inclusion criteria of the original protocol,” the Cass Review said.
Dr. Cass also warned that the fraught political climate is hindering the open inquiry needed for medical research.
“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 behavior. This must stop,” the review said. “Polarization and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.”
The Alliance Defending Freedom, which has advocated for state bans on gender-transition procedures for minors, urged U.S. officials to examine the Cass Review and “take steps to protect our children from these unproven and dangerous procedures.”
“Children struggling with their sex deserve the best possible care, and — as this independent review from Dr. Cass shows — that does not include rushing children to permanently alter their bodies,” said ADF vice president of litigation strategies Jonathan Scruggs. “For years, activists have relied on their own consensus to push experimental procedures on kids, but as the years have gone on, the body of evidence continues to grow in favor of biological reality and common sense.”
Several Western European nations, including Finland, Norway and Sweden, have also pulled back on their gender-transition protocols for minors in recent years.
• Valerie Richardson can be reached at vrichardson@washingtontimes.com.