British Pediatric Expert Warns ‘Gender-Affirming Care’ Groups in U.S. Are ‘Misleading the Public’

The publication of the U.K.’s groundbreaking Cass Review last month, addressing the flaws in the gender transition industry, resulted in a seismic shift across the pond: both England and Scotland halted the prescription of puberty blockers and hormone drugs to children, top clinical psychologists publicly apologized for their role in endorsing “gender-affirming care,” and the British National Health Service (NHS) formally defined sex as a “biological” reality, regardless of an individual’s “gender identity.” Now, the report’s author is warning the U.S. that medical organizations are “misleading” the public when it comes to gender transition procedures for children.

In an interview with The New York Times this week, Dr. Hilary Cass, former president of the Royal College of Pediatrics and Child Health, discussed how American health institutions have responded to her report’s findings on the “remarkably weak evidence” which is claimed to support gender transition procedures for minors. For example, the American Academy of Pediatrics (AAP) insisted that its support of gender transition procedures for children is “grounded in evidence and science,” while the Endocrine Society similarly said, “We stand firm in our support of gender-affirming care,” asserting that it is “needed and often lifesaving.”

“When I was president of the Royal College of Pediatrics and Child Health, we did some great work with the AAP. … But I respectfully disagree with them on holding on to a position that is now demonstrated to be out of date by multiple systematic reviews,” Cass responded. “It wouldn’t be too much of a problem if people were saying, ‘This is clinical consensus, and we’re not sure.’ But what some organizations are doing is doubling down on saying the evidence is good. And I think that’s where you’re misleading the public.”

Cass added, “You need to be honest about the strength of the evidence and say what you’re going to do to improve it.” She explained that “political duress” may be preventing “fairly left-leaning” organizations from admitting that there is little to no evidence to support subjecting children to gender transition procedures. “Medicine should never be politically driven,” Cass stated. “It should be driven by evidence and ethics and shared decision-making with patients and listening to patients’ voices. Once it becomes politicized, then that’s seriously concerning…”

“Do what you’ve been trained to do,” Cass advised American pediatricians and psychologists. She encouraged those in her field to “approach any one of these young people as you would any other adolescent,” which she explained means “taking a proper history, doing a proper assessment and maintaining a curiosity about what’s driving their distress. It may be about diagnosing autism, it may be about treating depression, it might be about treating an eating disorder.”

“What really worries me is that people just think: This is somebody who is trans, and the medical pathway is the right thing for them,” Cass continued. “They get put on a medical pathway, and then the problems that they think were going to be solved just don’t go away. And it’s because there’s this overshadowing of all the other problems.”

Cass cautioned that pediatric medicine should not be about endorsing gender transition procedures without question but should instead be “about treating [patients] as a whole person, taking a holistic approach, managing all of those things and not assuming they’ve all come about as a result of the gender distress.” She continued, “So, yes, you can put someone on a medical pathway, but if at the end of it they can’t get out of their bedroom, they don’t have relationships, they’re not in school or ultimately in work, you haven’t done the right thing by them.”

Cass further explained, “We’re failing these kids, and we’re failing other kids in terms of the amount of mental health support we have available. That is a huge problem — not just for gender-questioning young people. And I think that’s partly a reflection of the fact that the system’s been caught out by a growth of demand that is completely outstripping the ability to provide it.”

Cass also addressed that “growth of demand,” particularly the drastic increase over the past 10 years in teenage girls seeking gender transition procedures. “On the one hand, there’s a positive story about social acceptance,” The New York Times observed. “[T]hat there have always been this many trans people, and kids today just feel freer to express who they are. The other story is a more fearful one: that this is a ‘contagion’ driven in large part by social media. How do you think about it?” Cass responded, “It doesn’t really make sense to have such a dramatic increase in numbers that has been exponential. This has happened in a really narrow time frame across the world. Social acceptance just doesn’t happen that way, so dramatically. So that doesn’t make sense as the full answer.”

She did acknowledge that, due to a number of factors, teenagers today “have a much more flexible view about gender,” which she said is “potentially beneficial because they break down barriers, combat misogyny, and so on.” However, she warned, “It only becomes a challenge if we’re medicalizing it, giving an irreversible treatment, for what might be just a normal range of gender expression.”

Among other things, the nearly 400-page Cass Review, conducted over the course of four years, concluded that there is “no evidence that gender-affirmative treatments reduce” the risk of suicide, as is commonly claimed; there is “remarkably weak evidence” to support the “gender-affirming care” model; and “the majority of young people” should not be placed on puberty blockers or hormone drugs or subjected to surgery.