Hilary Cass’s review of gender identity services for children and young people put a stop to doctors playing fast and loose with the development of youngsters in Great Britain. Her report was welcomed on both sides of the Commons, and it was reassuring to hear Wes Streeting confirm that he intends to uphold the ban on puberty blockers to under-18s.
Across the Atlantic, however, the issue is more divisive. So-called ‘red states’ are moving along British lines. Last year, Tennessee prohibited health care professionals from ‘prescribing, administering or dispensing any puberty blocker or hormone’ to children who claimed to experience gender dysphoria. Meanwhile, in blue California, Governor Gavin Newsom signed off a bill to ‘offer refuge’ to children and their families ‘if they are being criminalised in their home states’.
It’s a sorry state of affairs when troubled children become the focus of politics in this way, but that didn’t stop the New York Times piling in with an opinion piece yesterday lambasting the Cass report. The criticisms have been heard before and refuted before.
Yes, the Keira Bell judgement – which preceded the Cass review – was later overturned. But crucially because the Court of Appeal ruled that, ‘it is for doctors, not judges, to decide on the capacity of under-16s to consent to medical treatment’. Dr Cass – a former president of the Royal College of Paediatrics and Child Health – was eminently qualified, therefore, and the British government agrees.
Cass was clear when it came to puberty blockers. She cited a systematic review by the University of York that ‘found no evidence that puberty blockers improve body image or dysphoria, and very limited evidence for positive mental health outcomes’. The same could perhaps be said about chocolate bars, but doctors weren’t in the habit of prescribing confectionary to children on demand.
Humour aside, the NYT described the Cass as ‘a strange document’ and questioned not only the methodology but also the curiosity. Cass considered the reasons for ‘the increase in predominantly birth-registered females presenting to gender services in early adolescence often with complex presentations, and/or additional mental health problems and/or neurodiversity’. She did so methodically. She discussed peer and socio-cultural influences and – yes – the availability of treatment. In my personal experience (I transitioned as an adult), gender dysphoria is iatrogenic, i.e., the treatment provokes the condition.
The NYT’s challenge, though, is hardly scientific. The author summarily dismissed the Royal College of Psychiatrists’ welcome of the Cass Review, preferring to listen to the British Medical Association’s concerns. Perhaps someone might explain to her that the BMA is a trade union which has recently spent much time and effort running strikes in hospitals.
That was one snippet among many in the piece that ran to 5,000 words. There was an ongoing attempt to repudiate Cass’s work, but little on offer to refute it. Instead, the author appealed to activist organisations that supported her claims. But that is what happens when two worldviews clash, especially when – as here – they are grounded in different principles.
Either you believe that everyone has a gender identity that trumps biological sex, or you don’t. Where children are concerned, the dilemma is even more serious because the concept of gender identity led to puberty blockers and cross-sex hormones being prescribed to children too young to understand what it means to be an adult. Just because an idea is fashionable, and maybe well-supported, does not make it right.
Sadly, too many politicians and policymakers abandoned critical thinking and lapped up this new and un-evidenced ideology. It might have ‘seemed like a good idea at the time’ – the excuse sometimes offered by miscreant children – but this is medicine, and children’s development is at stake.
‘First do no harm’ is a principle that should always underpin medicine. That’s what Cass recommended, and the NYT would be wiser to recommend that approach to their readers.
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