A long-awaited final report on the state of treatment for gender dysphoria in children and teens under the care of England’s National Health Service (NHS) has revealed the current clinical approach utilizing puberty blockers and cross-sex hormones is based on “remarkably weak” evidence stemming from “poor quality of the published studies,” and “misinformation” while exhibiting “expectations of care” that are “far from usual clinical practice.”
In the foreword to the report, British pediatrician Dr. Hilary Cass, who led an independent review team from the University of York, wrote that while the medical field is usually cautious in recommending new treatments for children and teens, “quite the reverse happened in the field of gender care for children”:
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. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.
“[T]he toxicity of the debate is exceptional,” Cass said about the issue of medical gender treatments for children. “The knowledge and expertise of experienced clinicians who have reached different conclusions about the best approach to care are sometimes dismissed and invalidated.”
The report’s summary clearly asserts that, while “some think the clinical approach should be based on a social justice model, the NHS works in an evidence-based way.”
“Our current understanding of the long-term health impacts of hormone interventions is limited,” the review notes as it also acknowledges the rapid surge in referrals for such medical treatment.
“The numbers of children and young people presenting to the UK NHS Gender Identity Service (GIDS) has been increasing year on year since 2009, with an exponential rise in 2014,” the report observes, noting the use of puberty blockers began following “the emergence of ‘the Dutch Protocol.’”
The review team stressed the rapid push to utilize puberty blockers, despite any evidence showing effectiveness:
Preliminary results from the early intervention study in 2015-2016 did not demonstrate benefit. The results of the study were not formally published until 2020, at which time it showed there was 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 systematic review by the University of York “found multiple studies” that show puberty blockers not only suppress puberty, but also compromise bone density.
Yet, evidence regarding the use of puberty blockers and cross-sex hormones to treat gender dysphoria “had already been shown to be weak,” with “a lot of misinformation easily accessible online” and remaining currently, the review stated.
“The World Professional Association of Transgender Healthcare (WPATH) has been highly influential in directing international practice, although its guidelines were found by the University of York appraisal process to lack developmental rigour,” the report asserts.
In March, leaked internal files from WPATH, often touted by Dr. Rachel (born Richard) Levine, a top Biden HHS official, as the premier organization for evidence-based treatment recommendations, revealed its doctors acknowledging children and teens were not capable of comprehending the possible long-term effects of the treatments and surgeries they were prescribed.
The review team notes that while research suggests gender expression is influenced by “biological predisposition, early childhood experiences, sexuality and expectations of puberty,” and, therefore, requires a “multi-disciplinary team” approach to assessing the problem areas for each individual child, “the most striking problem is the lack of any consensus on the purpose of the assessment process.”
“Some service users and advocates view an extensive exploration of other conditions and diagnoses as an attempt to find ‘any other reason’ for the person’s distress other than them being trans,” the team observes.
While the report states there are some young people for whom medical treatment for gender dysphoria will be “the best outcome,” it notes as well “young adults looking back at their younger selves would often advise slowing down” as they and their parents weigh the ramifications.
“Some may transition and then de/retransition and/or experience regret,” the review acknowledges, concluding “a medical pathway” is not the best treatment protocol “for the majority of young people”:
[T]he focus on the use of puberty blockers for managing gender-related distress has overshadowed the possibility that other evidence-based treatments may be more effective. The intent of psychosocial intervention is not to change the person’s perception of who they are, but to work with them to explore their concerns and experiences and help alleviate their distress regardless of whether or not the young person subsequently proceeds on a medical pathway.
“[N]o changes in gender dysphoria or body satisfaction were demonstrated” as a result of puberty blockers, the report plainly asserts.
The review team also addressed the controversy over social transition – what has become known as the initial phase of so-called “gender-affirming care.”
“The systematic review showed no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence,” the report concludes. “However, those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway.”
Reviewers similarly found no support for the claim by transgender activists that administering puberty blockers allows time for children and their families to consider further medical intervention:
[G]iven that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinising/ feminising hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.
“There is a lack of high-quality research assessing the outcomes of hormone interventions in adolescents with gender dysphoria/incongruence, and few studies that undertake long-term follow-up,” the review team explains.
In addition, reviewers found no evidence to support the “transition or die” claim that hormone treatment prevents a high risk of suicide in minors with gender dysphoria.
>> FINNISH STUDY: ‘GENDER-AFFIRMING CARE’ DOES NOT REDUCE YOUTH SUICIDE <<
The primary predictor of death in gender-dysphoric young people is “psychiatric morbidity,” the researchers said. “Medical gender reassignment does not have an impact on suicide risk.”
“The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist,” the Cass report concludes.
This final report stresses the need for a “holistic assessment” of children and teens referred for gender services:
This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment.
“Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress and cooccurring conditions,” the team recommends. “This should include support for parents/carers and siblings as appropriate.”
The release of the Cass report comes only days after Dignitas Infinita on Human Dignity, the most recent document from the Dicastery for the Doctrine of the Faith (DDF), was issued.
The DDF declaration addresses human dignity and reaffirms traditional teachings of the Church, including those on gender ideology and sex-change surgery.
>> READ CV’S ANALYSIS OF DIGNITAS INFINITA HERE <<
