The Cass Review

If you haven’t yet been acquainted with a  transgender issue confronting some family member or friend, odds are that it is just a matter of time, as the  transgender issue is a hot topic just about everywhere. What is the best thing to do for these gender confused children and adolescents?  As best I can tell up to this point there has been no scientific study examining this subject … that is until just recently.

From Epoch Health:

In April, England  published the Cass Review, “most comprehensive summary on transgender-youth medicine,” psychologist Erica Anderson, who identifies as transgender and has a doctorate in clinical psychology, told The Epoch Times.

The review was chaired by Dr. Hilary Cass, British honorary physician, consultant in pediatric disability, and former president of the Royal College of Paediatrics and Child Health.

The Cass Review is based on the work of 237 papers, including 214 studies, 21 guidelines, and two position statements, which covered data of over 113,000 children and young people. The authors also analyzed anonymized data from over 3,700 children diagnosed with gender dysphoria, survey responses from professionals, and numerous interviews and testimonies from stakeholders of the issue.

Additionally, Dr. Cass also interviewed numerous transgender youths, adults, parents of these children, advocacy groups, psychologists, pediatricians, and related clinicians, both British and international, though the number of interviewees was undisclosed. She also wanted to do a follow-up with 9,000 patients referred to England’s Tavistock Centre, but that could not be done due to the lack of cooperation from all but one adult clinic.

The Cass Review is not about “rolling back on people’s rights to healthcare,” Dr. Cass wrote in the review’s foreword. “It is about what the healthcare approach should be.”

The review stated that there is insufficient evidence to demonstrate the long-term benefits of medicalizing children who want to identify as a different gender. Instead, the review recommends focusing on psychotherapy. In addition the review found insufficient and inconclusive evidence demonstrating the effectiveness and benefits of gender reassignment treatments for children. Additionally, many of these children are on the autism spectrum and share mental comorbidities often overshadowed by the medicalization model.

Dr. Cass hence advised cautionary psychological interventions, while also leaving room for children to explore their identities.

The review presented the following findings and recommendations:

1. Psychotherapy Is Recommended

There is evidence that psychotherapy can help address mental health conditions, such as depression and anxiety, common among transgender youths, and hormone interventions often overshadow these therapies. The review highlighted that psychotherapy is not the same as conversion therapy, as it is not about changing a child’s perception of who they are but exploring the cause of their concerns and experiences and helping alleviate distress.

2. Partial Social Transitioning Is Preferred

The systematic reviews did not show clear evidence of the positive or negative effects social transitioning has on mental health. Social transition generally refers to a person making only social changes, including altering hair and clothing and changing names and pronouns, instead of medical changes to live as a different gender.

While it is unknown whether social transitioning contributes to gender dysphoria, the review authors speculated that a partial transition may be more advantageous and offer greater flexibility to help children explore and express their gender identities.

3. Hormonal Treatments Not Recommended Except Under Research Conditions

Effectiveness and risks: The review showed no significant improvements in gender dysphoria symptoms or body satisfaction from medicalization. While some reports showed short-term improvement in mood when patients began hormonal treatment, the magnitude of such improvement was small.

Hormonal treatment, which refers to the use of puberty blockers and cross-sex hormones, is not recommended for minors due to the permanence of its effects. 

As a consequence of the Cass Review, England may be the third country to withdraw from a “gender-affirming” treatment pathway due to recommendations from this long-awaited report. (Finland and Sweden made similar changes in 2023.)

In closing, if someone relates that a physician said, “would you rather have a dead daughter or a live son,” caution is advised before acting on such a threatening obviously guilt ridden statement. Notably, the Cass Review did not support the claim that hormonal treatment reduced the risk of suicide.

5/9/24