Dr Hilary Cass has now published her long-awaited review into support and treatment options for children who suffer from gender confusion, with the paediatrician criticising “ideologically driven” clinics that refused to cooperate with her investigation and warning that the wider social debate on this issue remains “exceptionally toxic” (Sky News, Spectator, Telegraph, Times, Unherd).
The Cass Review offers a strong – some would say unanswerable – challenge to the ‘gender affirmative model’ which in recent years has become the norm in the NHS’s Gender Identity Development Service (GIDS). Faced with cases of gender distress, this approach encourages clinicians to ‘affirm’ rather than question a child’s chosen gender identity, before then putting them on a medical pathway that can have lifelong, irreversible consequences.
Part of the problem, Dr Cass says, is that as this model took hold, the process of ‘differential diagnosis’ which the NHS typically adopts during diagnosis and management of every other form of distress, was entirely ignored. Or, as the report puts it: “Some practitioners abandoned clinical approaches to holistic assessment, which has meant that this group of young people have been exceptionalised compared to other young people with similarly complex presentations.”
More generally, the Report cautions that extreme care should be taken before anyone under the age of 25 transitions; calls for an end to the prescribing of puberty blockers and cross-sex hormones to under 18s; warns that children who change gender may regret it; finds that many gender confused adolescents have experienced trauma, neglect and abuse; and says there is no “good evidence” on the long-term benefits of the treatments that have been given to children.
In other words, the days of NHS England handing out puberty blockers “as if they were sweets”, as Kathleen Stock once put it, look to be numbered. GIDS whistleblowers like Dr David Bell, Dr Kirsty Entwhistle, Dr Marcus Evans, Sue Evans and Sonia Appleby, as well as lay critics of the worst excesses of gender medicine like Graham Linehan – who lost his career and reputation at the hands of a complacent, bien pensant middle class mob for daring to speak out – have been vindicated.
Summarising the Report for the BMJ, Dr Cass stresses the point that “gender medicine for children and young people is built on shaky foundations”, and “improving the evidence base for young people is an essential next step”.
Dr Cass had in fact commissioned an independent evidence review and research programme in collaboration with the University of York and was particularly keen to conduct a research study looking at the health outcomes of 9,000 former Tavistock GIDS patients. However, this study was “thwarted” when six of the seven adult gender dysphoria clinics in question – all of which favour an ‘affirmative’ approach – did not cooperate with the research team and refused to hand over data.
“Unbelievably disappointing” is how Dr Cass described this in an interview with the Guardian. “I do think it was coordinated,” she said. “It seemed to me to be ideologically driven. There was no substantive reason for it. So I can only really conclude that it was because they didn’t feel that it was the right thing to do to try and nail down this data.”
The Report also criticises “the surrounding noise and increasingly toxic, ideological and polarised debate” that has “made the work of the Review significantly harder and does nothing to serve the children and young people who may already be subject to significant minority stress”.
No doubt there are many people who have spoken up and paid a price that will scorn the idea that the debate has been ‘polarised’ between two groups, rather than ‘suppressed’ by one ideologically driven group of neo-Lysenkoists intent on sheltering their beliefs from evidence-based critique.
In fact, beyond these snippets of diplomatic language the Report all but concedes as much. “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,” Dr Cass writes in the Report’s foreword, adding: “This must stop.”
Let us hope the only group that ever ‘started’ heed this call.
As per the Cass Review’s Interim Report, published in early 2022, clinicians at the Tavistock GIDS Clinic told the Review they felt under pressure to adopt an unquestioning affirmative approach in a manner that was at odds with the standard process of clinical assessment and diagnosis that they had been trained to undertake in all other clinical encounters.
One clinical psychologist at Leeds GIDS expressed concerns to a colleague and was promptly branded “transphobic”. The clinic’s child-safeguarding lead, Sonia Appleby, tried to report staff concerns to management, but was subsequently described as “hostile” and accused of having an “agenda”. In 2018, Dr David Bell, staff governor at the Tavistock and a distinguished psychiatrist, wrote a report that captured the concerns of ten GIDS clinicians who were frustrated and horrified about what was happening at the clinic, only to see it suppressed by GIDS. In 2019, a governor of the NHS trust in charge of the clinic resigned, claiming the “debate and discussion required is continually being closed down or effectively described as ‘transphobic”’. And so on and so forth.
As Dr Cass says, “this must stop”.
In response to the Report, the NHS is to review all transgender treatment it provides, including to adults, and treatment for any new patients aged 16 and 17 seeking to change gender at adult clinics will immediately be paused.
All good news, of course – but Debbie Hayton, writing for the Spectator, is keen to strike a note of caution.
Beyond the NHS services which the Report focuses on, private providers which “do not follow the prescribing, administration and investigation/monitoring protocols agreed and followed by the NHS”, still desperately need reining in. Sadly, the travel seems to be in the opposite direction. Back in January, Gender Plus, a private hormone clinic for transgender young people became the UK’s first to receive approval from England’s health watchdog, the Care Quality Commission. Worryingly, seven Gender Plus staff members had previously worked at the Tavistock GIDS.
