By Elio Wilder (they/them)
Content Warning: discussions of transphobia, mentions of homophobia
Trans youth are under attack in the UK- and the woman behind it doesn’t acknowledge that trans youth exist.
Earlier this month, the final report of The Cass Review by Dr Hilary Cass was published, recommending major restrictions on gender affirming care provided to young people in the UK.
The interim report published last year was responsible for the total ban of NHS puberty blockers for trans youth outside of clinical trials. This goes against the consensus of major medical organisations that puberty blockers are a safe and effective form of gender affirming care (Transhub, 2024).
The final report goes further, recommending hormone therapy only be provided to trans young people (16-17 yr olds) with ‘extreme caution’ (recommendation 8, p. 35).
Well not quite, Cass never actually uses the phrase ‘trans young people’. Transgender and gender diverse children and adolescents, who are easily the group most impacted by the Review, are never mentioned by Cass in its 388 pages. The only acknowledgement in the text of the existence of trans children and young people comes from quoting others (a parent, p.156, World Professional Association for Transgender Healthcare, p.131, and University of York researchers, Appx.4).
The only place Cass could be referring to under 18 year olds as trans is ‘transgender students at school’ (p.122), which she uses in the context of implying being transgender may be a ‘social contagion’.
Of those quotes in the focus group section, only one person is defined as being a ‘young trans adult’. The content of other quotes indicate other speakers are trans, yet they are merely defined as a ‘young person’ by Cass.
The Review exclusively uses phrases like ‘gender questioning children and young people’ and ‘children and young people needing support around their gender’, omitting trans and gender diverse children and young people entirely; who are a distinctly separate group. The Review only uses ‘transgender’ to refer to adults.
The Review consciously uses language to rob trans youth of their identities. It denies their right to self-determination and undermines the principle of choice as a whole.
The bias continues in the qualitative research commissioned by the Review and undertaken by the University of York (Appx.3). They interviewed just 12 young people who ‘described themselves as trans’/ ‘described themselves as non-binary’ (trans and gender diverse young people for those of us that aren’t in that habit of dismissing people’s identities) and 16 transgender and gender diverse young adults. They also interviewed two ‘detransitioners’. The Review fails to acknowledge that only 0.4% of people, who at one time considered themselves trans, detransitioned because they felt the transition was not right for them. The remaining 99.6% of this group still consider themselves trans (Gender GP, 2021). Additionally, these two ‘detransitioners’ had not used NHS services to medically transition, despite the Review being commissioned ‘to make recommendations on how to improve NHS gender identity services’.
It is clear that Cass is of the opinion described perfectly by Shon Faye in her book The Transgender Issue, ‘In this cisgender worldview, being trans is always considered an undesirable – if sometimes tolerable – result for a human being. Certain unfortunate individuals may wish to transition as adults, such a belief goes, but innocent children risk being too easily encouraged into this potential disaster and will grow up with bitter regret at what has happened to them.’ Faye continues, ‘The irony of this prejudice is self-evident: it utterly disregards the harm involved in not supporting a trans child who is certain of their identity and vocalizes it.’
This bias goes beyond language, 101 of the 103 studies demonstrating positive outcomes of gender affirming care involved in the Review were dismissed on the basis of not being randomised control trials. RCTs are an unethical method to use when studying gender affirming care as it forces half the patients through the process of ‘conversion therapy’ by forcing them to forego care. Puberty blockers are used in the treatment of both gender dysphoria and early-onset puberty and ‘Even for precocious puberty, a planned RCT into puberty blockers was unsuccessful when participants in the non-treatment arm noticed their puberty had not been blocked, and dropped out of the study in order to access puberty blockers from a different source (Mul et al., Citation2001)’ (C.Horton, 2024). It is clear Cass has intentionally decided RCTs are needed to confirm the positive outcomes of gender affirming care precisely because it is unattainable.
The Cass Review is clearly inspired by the similarly biased Florida Review, which was developed under Governor Ron DeSantis, who is also the architect behind Florida’s ‘Don’t Say Gay’ bills. Cass met with Patrick Hunter, who played a significant role in the development of the Florida Review. Florida court documents reveal Cass was ‘very interested’ in the Florida Review and that she requested and received information from Hunter pertaining to it.
Decisions and recommendations concerning gender affirming healthcare for trans and gender diverse children and young people should not be made by someone who denies the existence of trans and gender diverse children and young people.
Further reading:
What is the Cass Review and was its methodology flawed? - https://www.linkedin.com/pulse/what-cass-review-its-methodology-flawed-jamie-wareham-a0c4e
The Cass Review is bad science and should not be taken seriously be policy makers - https://transactual.org.uk/blog/2024/04/11/press-release-the-cass-review-is-bad-science-and-should-not-be-taken-seriously-by-policymakers/
The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children -https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2328249
The Cass Review Needs To Be Thrown Out Entirely. This Is Why. - https://whatthetrans.com/cass-review/
References:
https://www.gendergp.com/detransition-facts/
https://www.tandfonline.com/doi/full/10.1080/26895269.2023.2218357?src=recsys
https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2328249
https://www.linkedin.com/pulse/what-cass-review-its-methodology-flawed-jamie-wareham-a0c4e
https://cass.independent-review.uk/home/publications/final-report/
https://www.erininthemorning.com/p/cass-met-with-desantis-pick-over
https://www.transhub.org.au/under-18s
Faye, S. (2021), The Transgender Issue, An Argument for Justice, Penguin Books