The former president of the Royal College of Pediatrics and Child Health told the New York Times that pro-LGBTQ U.S. medical organizations that continue “doubling down” on subjecting children to “life-altering treatments” are caving to political pressure and ultimately “misleading the public” as a result.
Dr. Hilary Cass, who, in her country, led a “systematic review” of studies and guidelines pertaining to the treatment of gender-confused children with puberty blockers and cross-sex hormones, concluded the evidence for this “medical pathway” was “remarkably weak.”
The Times noted that, when asked to comment on Cass’ review and interview comments, Dr. Ben Hoffman, president of the American Academy of Pediatrics (AAP), which has backed the “gender-affirming” model of medical transition for minors, said his group had reviewed the report and “added it to the evidence base undergoing a systematic review.”
“Any suggestion the American Academy of Pediatrics is misleading families is false,” Hoffman told the Times.
Also according to the Times, U.S. health officials did not respond to a request for comment about Cass’ report, and the Endocrine Society replied that the final review “does not contain any new research” that would dispute its guidelines.
Cass said that while she has done “some great work” in the past with AAP, she “respectfully disagrees” with the group’s decision to hold on to “a position that is now demonstrated to be out of date by multiple systematic reviews”:
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. You need to be honest about the strength of the evidence and say what you’re going to do to improve it.
The AAP, Cass added, is “a fairly left-leaning organization” that is “fearful of making any moves that might jeopardize trans health care right now.”
Cass said no one from U.S. government health agencies, medical organizations, or lawmaking bodies has reached out to her about her final report.
The pediatrician also noted that, in her own country, “both of our main parties have been supportive of the report, which has been great.”
When asked what she would say to American pediatricians regarding the care of children and adolescents with gender issues, Cass replied:
Do what you’ve been trained to do. So that means that you approach any one of these young people as you would any other adolescent, 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.
Cass has persistently emphasized that children with gender identity issues are likely suffering from other psychological or familial distress that is not being addressed because the field of gender medicine is strongly tied to a political activist base.
“[T]he toxicity of the debate is exceptional,” Cass wrote in the report. “The knowledge and expertise of experienced clinicians who have reached different conclusions about the best approach to care are sometimes dismissed and invalidated.”
She described to the Times the situation of a healthcare professional seeing a “trans” child and deciding immediately on “the medical pathway.”
“[A]nd then the problems that they think were going to be solved just don’t go away,” she explained. “And it’s because there’s this overshadowing of all the other problems.”
“So it really is about treating them 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 advised.
Cass’ final report and recommendations ultimately led England’s National Health Service (NHS) to stop the prescription of puberty blockers outside of clinical trials.
“The original rationale for use of puberty blockers was that this would buy ‘time to think’ by delaying onset of puberty,” the report observed:
However, no changes in gender dysphoria or body satisfaction were demonstrated. …[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.
Similarly, the review team noted that “[i]t has been suggested that hormone treatment reduces the elevated risk of death by suicide in this population, but the evidence found did not support this conclusion.”
The final report also led NHS to rewrite its constitution with the expectation that “sex” will be defined as “biological sex,” without reference to the language of gender ideology.
Cass said her two primary takeaways from her review are “just how poor the evidence base is in this area” and the failure of the medical pathway model to view gender confusion in children as part of a “much broader range of challenges that they have, sometimes with their mental health, sometimes with undiagnosed neurodiversity.”
