Updates

CRITIQUE OF THE CASS REVIEW (ENGLAND/NHS)

YALE UNIVERSITY

An Evidence-Based Critique of “The Cass Review” on Gender-affirming Care for Adolescent Gender Dysphoria

Excerpt

“As researchers and pediatric clinicians with experience in the field of transgender healthcare, we read the Review with great interest. The degree of financial investment and time spent is impressive. Its ability to publish seven systematic reviews (SRs), conduct years’ worth of focus groups and deeply investigate care practices in the UK is admirable. We hoped it would improve the public’s awareness of the health needs of transgender youth and galvanize improvements in delivery of this care. Indeed, statements of the Review favorably describe the individualized, age-appropriate, and careful approach recommended by the World Professional Association for Transgender Health (WPATH) and the Endocrine Society. Unfortunately, the Review repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculation. Many of its statements and the conduct of the York SRs reveal profound misunderstandings of the evidence base and the clinical issues at hand. The Review also subverts widely accepted processes for development of clinical recommendations and repeats spurious, debunked claims about transgender identity and gender dysphoria. These errors conflict with well-established norms of clinical research and evidence-based healthcare. Further, these errors raise serious concern about the scientific integrity of critical elements of the report’s process and recommendations.

In the short time since its release, the Review has been used to justify restrictions on healthcare for transgender youth. In March 2024, the NHS announced that it would deny puberty-pausing medications to those under age 18 outside of a research setting. In June 2024, the NHS Health Secretary cited the Review as the rationale for emergency regulations that criminalize the supply of puberty-pausing medications to new patients under 18 in England, Scotland, or Wales. This ban, which applies only to the treatment of gender dysphoria, labeled these medications as a “serious danger to health.” These medications remain freely available for other pediatric health needs, of which precocious puberty, endometriosis, and fertility preservation prior to chemotherapy are some.

The Cass Review has already been cited in U.S. legal battles over transgender rights. It is likely to feature heavily in the months and years to come. From 2022 through 2024, twenty-five US states enacted legislation that bans gender-affirming healthcare for transgender youth. Litigation is ongoing in at least ten states, and the nation’s highest court has agreed to hear one case, United States v Skrmetti, in the fall 2024 term. Other nations’ health ministries are anticipated to use the Cass Review to inform their own policies on access to youth gender care."

Note: The US v Skrmetti case asks "Whether Tennessee Senate Bill 1 (SBl), which prohibits all medical treatments intended to allow "a minor to identify with, or live as, a purported identity inconsistent with the minor's sex" or to treat "purported discomfort or distress from a discordance between the minor's sex and asserted identity, violates the Equal Protection Clause of the 14th Amendment."

(Argument in the case was heard on December 4, 2024; decision pending.)

ALL OUT ATTACK ON THE TRANS COMMUNITY

Jan 21 - Trump announces that there are only 2 sexes

Feb 12  - Jennifer Boylon comments (Left)

Just 2 months later,  this is where we stand  (Below)

On April 9, Massachusetts House Democrats, voted in favor of a budget that included a Republican amendment banning transgender participation in sports - the first such a measure to pass in a ‘blue’ state. Failing to find the courage to outright defeat the provision, and fearing  a vote would put its members on record supporting the Massachusetts transgender community, the Democratic caucus  offered a weak amendment allowing the original sports ban to take effect only after its impacts were studied. Their assumption being, that with control of the legislature a study would never be done, thus killing the provision. 

This unconvincing rationalization to assuage those the party abandoned gives no protection should control of the legislature change or the Trump administration intervene.  In either case, other transgender civil rights will be threatened or erased.

The sports ban is a Trojan Horse.

This is no longer a time to hope and wish. It is a time to act. A time to make your representatives in Massachusetts and in Washington  accountable. Call them, write to them, insist that they act to protect and offer safety to those in need even if it means taking personal risk.

MASSACHUSETTS MUST CONTINUE TO BE A SAFE AND SUPPORTIVE HOME FOR OUR TRANSGENDER NEIGHBORS