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Can the Cass Report really be enforced? Vulnerable young children deserve justice

A protestor outside Downing Street (Vuk Valcic/SOPA Images/LightRocket via Getty Images)

A protestor outside Downing Street (Vuk Valcic/SOPA Images/LightRocket via Getty Images)


April 10, 2024   5 mins

When the US astronomer Carl Sagan stated that “extraordinary claims demand extraordinary evidence”, he was riffing on an idea that has influenced the scientific method since the mid-1700s. If we are to conclude extraordinary things, ideas that conflict with what we already think we know, then we need large amounts of quality evidence to justify doing so. The fact that we forgot to apply such basic scientific principles at the Tavistock Gender Identity Development Service (GIDS) is, in and of itself, extraordinary.

Opened in 1989, and closed following a litany of scandals last year, GIDS — the UK’s only specialist service designed to help children questioning their gender and/or identifying as transgender — drew on just one, since widely critiqued, study to underpin its practice. This, despite the fact that it has treated roughly 2,000 young people with hormone blockers and in some cases cross-sex hormones.

“The Dutch Protocol” describes a three-step treatment pathway for children with gender-related distress or incongruence. It starts at the brink of puberty with puberty blockers to prevent the development of secondary sex characteristics, is followed by cross-sex hormones that help to feminise or masculinise appearance, and then concludes with genital and/or breast surgeries in adulthood. The Dutch reported that, after puberty suppression alone, their cohort of 70 young people experienced a reduction in behavioural and emotional problems, decreased symptoms of depression and a significant improvement in functioning. Despite choosing to make medical treatments available to younger children from 2014 anyway, GIDS were not able to replicate the Dutch findings — a fact they didn’t share with the world until 2021.

Given the increasing polarity among professionals on the matter, Dr Hilary Cass, a former President of the Royal College of Paediatrics and Child Health, was employed by the NHS to conduct a review of the published evidence on the use of puberty blockers and cross-sex hormones in children and young people with gender dysphoria. In March 2021, she concluded that they had not been able to find evidence “strong enough to form the basis of a policy position”. It was clear then, at least to those paying attention, that the evidence needed to justify the existing clinical practice in Gids did not exist. And yet, it wasn’t until last month that the NHS announced it would no longer be offering puberty blockers to young people in England and Wales.

Today, as Cass finally publishes the results of her wide-ranging review, the reason seems obvious: her 388-page report concludes that, for most young people, up to the age of 25, “a medical pathway will not be the best way to manage their gender-related distress”. Commenting further on the lack of evidence, she states that not only is there no way for a clinician to accurately determine who will continue to identify as trans for life and who won’t, but that the fundamental rationale for using puberty blockers in the first place “remains unclear”. She speaks of the need to balance medical innovation with the potential “creep of unproven approaches into clinical practice” and calls for the use of “standard evidence-based” interventions instead.

Cass also makes it clear that the factors influencing gender-related distress might be as much social as psychological or biological, with a particular focus on the new cohort of adolescent girls who now make up the majority of gender clinic patients. Instead, she suggests, we need to draw on bio-psycho-social thinking to ensure that future child patients receive the safe and effective care they deserve.

The motivation behind this isn’t hard to glean. The sociological “broken windows” theory hypothesises that, once something becomes damaged just a little, it sends a message that the thing is no longer of value at all, and leads to further vandalism. At heart, the Cass Report is an attempt to prevent this from happening: it punctuates a process that, left unchallenged, might have led to further extraordinary practices creeping into other areas of psychology or medicine.

For those of us working in the field of gender, the influence of social media on adolescent mental health, in multiple and complex ways, has been undeniable. What gets less attention is the impact on us, the adults and professionals. After all, we are just as vulnerable to social influence, including misinformation. One of the factors that has led to the increased demand for medical interventions from gender-distressed young people are the ideas, widely shared on social media platforms as facts, that the medical pathway is not only safe but effective, even life-saving, for all.

Despite the absence of face validity or the long-term data needed for such certainty, some have claimed that regret rates for the surgeries many Gids patients received during early adulthood are lower than for knee surgeries. Yet, as the Cass Report highlights, some of the “facts” shared online are not certainties but myths. Sadly, for example, some young people do later experience profound regret — a reality that Cass acknowledges in her recommendation that “NHS England should ensure there is provision for people considering detransition”.

Yet rather than accept Cass’s rational, evidenced conclusions, a number of professionals and institutions will no doubt continue to argue with certainty that access to medical interventions is both a necessity and a human right. They already call for their colleagues to join them in becoming “practitioner-activists”. Others openly describe their motivation to pursue the medical approach Cass wishes to end as being “based on how passionate we are about the work”. Passion can be a good thing, of course, when aligned to evidence and fact. But when passion becomes untethered to these, or worse tethered to misinformation, it risks transporting us into a troublesome arena. Such an approach has already led to serious lapses in best practice and governance, particularly in relation to the use of puberty blockers for children. The question now is: will such extraordinary practices be able to continue post-Cass?

“The question now is: will such extraordinary practices be able to continue post-Cass?”

This is where a sense of concern starts to creep in. For while NHS England has refocused on the need for evidence-based interventions in recent years, some practitioners have already made clear their resistance to this. Last year, we heard that the endocrinologist responsible for prescribing to Gids patients had questioned whether the Cass Review was necessary in the first place. Leaders in the field of clinical psychology have also challenged the need for the review, and splits in the UK’s two psychology associations have been apparent for a while now, with one publicly criticising Cass. Remarkably, as today’s report discloses, the NHS’s adult gender clinics have also set themselves up in opposition to evidence and research, by refusing to participate in the Cass Review’s centrepiece longitudinal research study — an attempt, albeit retrospective, to follow into adulthood the 10,000 young people who’ve been through GIDS’s doors.

In an attempt to explain away such behaviour, some have sympathetically described GIDS as a “justice project”. Yet, in her interim report, published in February 2022, Cass made clear that the implications of GIDS’s approach were far more serious than this: its clinical approach, she wrote, had “not been subjected to some of the usual control measures that are typically applied when new or innovative treatments are introduced”. Just over two years later, she ends her final report by remarking that, while GIDS clinicians were “passionate and wholly committed to their care, [they] had developed a fundamentally different philosophy and approach compared to other paediatric and mental health services”. This deviation from best practice was, in other words, an injustice, and resulted in one group of children receiving less robust standards of care than others.

To mitigate this, Cass invites a return to the ordinary, and an embrace of the scientific method. And this requires sensitivity: after all, understanding why gender-distressed and non-conforming people might have been reluctant to trust ordinary science, medicine and psychology/psychiatry should also be part of the post-mortem to come. Medical approaches and institutions haven’t always been a safe place for them. Sadly, this is not the first time that gender non-conforming people have been considered so different as to require extraordinary treatment. Perhaps Cass’s recommendation to offer regular treatments to our distressed, but still ordinary, children and young people is where the true justice will begin.


Dr Anna Hutchinson is a clinical psychologist who specialises in adolescent mental health, gender and physical health. She works in the NHS and private practice.


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Mike Downing
Mike Downing
1 month ago

Well it’s a good first step, but she still feels obliged to pay lip service to ‘transgender identities ‘ whatever they are this week. I know we don’t want to get too polarised but maybe with some of this sh*te, you just have to take a deep breath and say ‘NO’.

Now where did Margaret Thatcher put that handbag ?

Neil Wareham
Neil Wareham
1 month ago

Trans ideology bears all the hallmarks of a cult belief system. There should be a further serious inquiry into how professional bodies became subject to ideological capture.

Lancashire Lad
Lancashire Lad
1 month ago
Reply to  Neil Wareham

This is a key point, and the article indicates that awareness of medical and psychology professionals being as prone to psycho-social influence as the rest of the population provides some hope that further inquiry will be pursued.

Deviation from scientific method should become open to investigation by the professional bodies in the case of treating gender dysphoria as it would in any other field of professional practice.

Both the article and report reassert the primacy of scientific method. There’s been failures in other areas such as epidemiology which have broken the trust of populations in professional probity. This was because professionals did NOT “follow the science” but lapsed into ‘belief’ and manipulation.

It’s time to bring these lapses to a halt. Medical and other care professionals who refuse to do so should be suspended and, if necessary, disbarred and even prosecuted.

David Morley
David Morley
1 month ago
Reply to  Lancashire Lad

the primacy of scientific method.

Perhaps also the humility of the scientific method. There is much we don’t know, and much we may never know, some things which are simply unknowable. Which is fine. Just don’t develop policy on the basis of these things as if they are established facts.

UnHerd Reader
UnHerd Reader
1 month ago
Reply to  David Morley

Like climate, for example. The way scepticism is treated as heresy proves this isn’t science. You don’t even need to see the “science” to know this. If the response to suggesting that ecofascists may be wrong is to try to destroy their lives then something is wrong.
This will be the next scandal.

alan jones
alan jones
1 month ago
Reply to  Lancashire Lad

The evil so called doctors who promote and enable this mutilation need to stopped permanently. Preferably by experiencing some themselves. Specifically the full William Wallace treatment.

UnHerd Reader
UnHerd Reader
1 month ago
Reply to  alan jones

They should be sectioned. The law allows it – their mental state makes them a danger to others.

Robbie K
Robbie K
1 month ago
Reply to  Lancashire Lad

Both the article and report reassert the primacy of scientific method. There’s been failures in other areas such as epidemiology which have broken the trust of populations in professional probity. This was because professionals did NOT “follow the science” but lapsed into ‘belief’ and manipulation.

Intriguing how everyone agrees with that statement on this subject but not in others that are allegedly cults or manias where it equally applies.

Stuart Bennett
Stuart Bennett
1 month ago
Reply to  Neil Wareham

That’s it in one sentence what went wrong at GIDS. When existing medical knowledge didn’t have an answer instead of doing the careful research that should have been done they filled in the blanks with post-modern activist thought w*nks and called everyone who questioned it transphobes.

Alex Carnegie
Alex Carnegie
1 month ago
Reply to  Stuart Bennett

It is not the first time that ambitious members of the caring professions have succumbed to fashionable fads and lost the plot: recovered memories, the Orkney satanic child abuse scandal, Munchausen by proxy, etc. There is a long list of occasions when “experts” proved to lack expertise or even balance and promoted slightly hysterical narratives.

Skink
Skink
1 month ago
Reply to  Alex Carnegie

What about closing the mental health hospitals, promising “community care” that did not materialize, with mentally ill folks ending up on the streets? That was mostly the shrinks’ doing.

David Morley
David Morley
1 month ago
Reply to  Neil Wareham

Yes, though ideological capture of this kind did not start with the trans issue. We need to look at ideological capture as a more generalised social pathology.

Mike Downing
Mike Downing
1 month ago
Reply to  Neil Wareham

Indeed, but having grown increasingly sceptical about the claims of organised religions (which likewise bear many of the hallmarks of a cult, or of mass-psychosis) we have filled the spiritual void in our lives with a shiny, new contender with far less to recommend it.

Maybe Aldous Huxley was right; if we just popped a Soma tablet to drive away our negative feelings, we would stop all the misplaced and misdirected yearning for ‘something else ‘ or, as the French call it the ‘au-delĂ ’

William Cameron
William Cameron
1 month ago
Reply to  Neil Wareham

Stonewall

Skink
Skink
1 month ago
Reply to  Neil Wareham

Haven’t head shrinks always been a cult? Those few who simply provide common-sense support to people in difficult circumstances are the honorable exception.

Diane T
Diane T
1 month ago
Reply to  Neil Wareham

It’s clear isn’t it that the network of gender ideologues driving this are people with power and connections within the medical profession, the University sector, the media and the Government? A veritable ‘War Room’ of strategists and soft power with a master plan and dash of fanaticism. We, the ‘great unwashed’ have only relatively recently caught on that it’s not all about dressing up and waving pretty flags, acknowledgement of and acceptance of our differences. It’s become glaringly obvious that whole sectors of society and institutions (such as universities) have been targeted and captured via an expertly planned programme of political, cultural and psychological subversion. A warped version of Aristotle – ‘Give me a child and I will show you the man’.

Samantha Stevens
Samantha Stevens
1 month ago
Reply to  Diane T

Yes in the US the Pritzker family – including Illinois Governor Bill, and his trans identifying male cousin Jennifer Pritzker – are big investors and proponents of this movement. Their money is from Hyatt Hotels.

David Lewis
David Lewis
1 month ago
Reply to  Neil Wareham

Whilst welcoming the Cass report I am wary that it perpetuates a central myth. Many life experiences simply do not fit, and should not be forced into, a medical model. ‘Gender dysphoria’ is an emotional reaction, not a ‘diagnosis’, just as we would never dream of classifying the euphoria of a positive life event a ‘diagnosis’.

Furthermore, within a medical model, the success or failure of a ‘treatment’ for ‘gender dysphoria’ must be based not on objective, reproducible scientific measurements, but on ‘patients’’ responses in questionnaires. Responses that may or may not be truthful, and may or may not be influenced by interested third parties/soshal meeja.

If Dr Cass had found ‘medical evidence’ in support of puberty blockers, I suggest we should have been just as sceptical. WE ARE USING THE WRONG MODEL.

David Buck
David Buck
1 month ago
Reply to  Neil Wareham

Neil, pls see my post re: The Association of Educational Psychologists’ (AEP) guidance – having a direct effect on psychological input on this issue to every UK school – heavily guided by ‘Stonewall’ !?

Atticus Catticus
Atticus Catticus
1 month ago

This is an excellent overview of how we got here and Dr Cass’s road map for a way out of this tragedy. Thank you Dr Hutchinson for your courage and tenacity in calling this out at Gids. Thousands will no longer be harmed by the NHS because of your decision to shine a light on this scandal. You and Dr Cass are true role models and inspirational examples of the NHS at its best, and stand in in stark contrast to the ideologues, who even now, continue to value their nonsensical beliefs above evidence in their clinical practice. Any clinicians who continue to advocate for a medical pathway on demand for these vulnerable children in the face of Cass’s damning critique should be struck off.

Jack Robertson
Jack Robertson
1 month ago

The recent decision by the US National Association of Intercollegiate Athletics to ban transgender women from competing in women’s categories came only after a dozen female athletes sued the bigger National Collegiate Athletic Association for allowing a practice they rightly argue is profoundly discriminatory against biological women.
These measured, rational intellectual arguments against this Insane Homophobic Misogynists Cult are all very well, but the elite public sentiment on gender ‘affirmation’ therapy has already turned – and the common sense of the masses never needed turning in the first place.
What’s really needed now are a) pro-bono lawsuits on behalf of detransitioners and their families whose lives have been most impacted by this Insane Homophobic Misogynists Cult; b) the public outing of and reckoning for all those senior clinical experts who created and stewarded this Insane Homophobic Misogynists Cult; and c) a forensic, retrospective public identification of and reckoning for those powerful and influential political, media and public health figures who might have helped counter and dismantle this Insane Homophobic Misogynists Cult earlier, but for various cowardly, expedient, careerist or other cynical reasons, chose not to.
The rest is just repeating what is by now an increasingly confident (and angry) ‘public debate’ majority view: a belated (re-)recognition and (re-) embrace of what should always have been an absurdly self-evident truth that ought never have been up for debate in the first place. Namely, that responding to a young, still-forming persons’ unhappiness with and in their perfectly healthy, functioning body by advocating – and clinically effecting – that their body should be poisoned with unnecessary chemicals and that pieces of their body should be surgically amputated or removed – is not the work of any sane, civilised health system.
But the crackpot barbarism of an Insane Homophobic Misogynists Cult.

N Fahey
N Fahey
1 month ago
Reply to  Jack Robertson

The fines and legal costs will always be paid by the taxpayer. What needs to be done is that the compensation needs to paid by the unions of these guilty individuals.

Stuart Bennett
Stuart Bennett
1 month ago
Reply to  N Fahey

It should come from the Tavistock Trust coffers. As a warning to any other organisation that tries to substitute quackery for science.

Jack Robertson
Jack Robertson
1 month ago
Reply to  Stuart Bennett

The key thing is to introduce fiscally punitive legal risk. The hold-out ideological cultists driving this – those ‘Never Stop Fighting’ types who regard their cult as a noble crusade – will never care who has to pay out. But the vast army of intellectual cowards, political lemmings, corporate careerists, media opportunists, economic rent-seekers, celebrity relevance-harvesters and click-hungry anonymous wannabes who have constituted their enabling Praetorian Guard for so long sure as sh*t will.
Defeating barbarism is usually not very pretty and it’s never intellectually ‘neat’. That’s why academics and intellectuals are so defenceless before it (along with quackery, grifting and moral hazard). Dr Hutchinson’s article on this topic is another very fine one, from an UnHerd crew that includes many gutsy independent thinkers who’ve been rare sources of sanity on gender disphoria for a long, mostly lonely time. But that’s shifting now, and we the great unwashed don’t really need to be yet again reminded by clever people – ruinously belatedly as far as ‘expert’ public sentiment goes – that our basic human instincts were dead right all along.
We need it to be stopped. I’m not terribly exercised by any need for retribution. I just want gender ‘affirmation’ ‘therapy’ to be prevented from ruining any more already-suffering young lives. I have no particular axe to grind against gender disphoria. I’m vaguely happy to accept that it’s a real thing…provided gender disphoria experts return to adding the clinically accurate modifier ‘…albeit very rare‘. But one doesn’t need to be an expert to know that lifelong-medicalised, permanent bodily modification in response to possible but yet unconfirmed diagnoses of it, especially in young people, is a doomed, catastrophe-in-waiting of a ‘therapy’. So, like millions and millions of stunned and appalled and increasingly angry parents worldwide, all I want is for our medical sector to stop advocating it, and stop putting it into practice: this premature pumping into healthy, functioning, physically normal young bodies of chemicals that physically harm them, and this premature surgical excision of healthy, functioning, physically normal bits off, or out, of them. As a ‘therapy’ for young people being unhappy with those bodies, FFS. For. F**k’s. Sake.
Insanity. Barbaric, anti-Hippocratic insanity.
We can’t physically prevent – kill, restrain, lock up, hound into relatively harmless exile outside civilised society – the clinicians doing this, as one could a Mengele. But as Hutchinson at least implies, the most clinically arrogant, morally obtuse and deeply cult-programmed of them are unlikely to stop just because the NHS has banned it. As with all cults, outsider status is as likely to bolster their righteous crusading determination as dampen it. Suing them – in order to scare off their wider clinical, logistic, financial, insurance, political, media and celebrity enabling mis en scene – is the next most available blunt-but-effective defensive weapon we, the stupid sane masses, have at our disposal. As I said, hardly pretty. Nobody wants to make litigation lawyers any richer than they already are, nor provide yet more public panto content-fodder for the cynical media machinery that so helped fuel this Bonfire of The Clinical Sanities in the first place.
But stop them hurting our most vulnerable, in-pain kids any further, civilised progressive humanity must.

Nancy G
Nancy G
1 month ago
Reply to  Stuart Bennett

And from the Stonewall coffers.

Diane T
Diane T
1 month ago


and, for condoning and facilitating this fantasy, in the coming years the NHS will spend ÂŁmillions – diverting taxpayers money, away from essential health services, as they fail to defend the indefensible in the law courts.

Dumetrius
Dumetrius
1 month ago

Unfortunately no-one bothered to ask Mr Sagan to provide the extraordinary evidence for his nonsensical claims about the Great Library of Alexandria, the death of Hypatia and so on.

Lancashire Lad
Lancashire Lad
1 month ago
Reply to  Dumetrius

Thanks for bringing these two particular elements of Sagan’s Cosmos series to my attention. It appears his research interests weren’t as strong in the sphere of history as in science. To put the record straight, however, they weren’t his claims but those of historians such as Gibbon.

Dumetrius
Dumetrius
1 month ago
Reply to  Lancashire Lad

That’s so, but he was extraordinarily influential and when he’s evoked as a kind of secular saint, it is typically in fields where had strong prejudices but not the knowledge to match.

Merely questioning the pronouncements of ‘Cosmos’ is enough to get you booted on lots of forums. It’s Holy Writ.

Tyler Durden
Tyler Durden
1 month ago

I fear that, ultimately, we won’t be able to stem the tide of transhumanism, for medical interventions inevitably parallel the social transformation stemming from the digital tech revolution in communication and human interaction.
The young will insist upon transformation of their sex via the gender religion, much as the liberal state will concede to the euthanasia of young people suffering the ubiquitous ‘mental health problems’, much as we currently see in the Benelux countries and may soon be adopted by Canada.

Skink
Skink
1 month ago
Reply to  Tyler Durden

Of course we will stop the tide. The trans are not reproducing. It’s a loser strategy… and soon there will be tons of middle aged folks with intractable infections due to insane surgeries… just you wait for the fury…

2 plus 2 equals 4
2 plus 2 equals 4
1 month ago

In summary:
A group of clinicians, aided and abetted by activists and pharmaceutical companies, have conspired to subvert medical ethics, standards and good practice by subjecting extremely vulnerable children to life-changing medical interventions for which there is no credible evidence base and the long-term effects of which are unknowable. They now refuse to cooperate with efforts to establish the evidence base which could inform best practice.
They should be investigated, prosecuted and struck off.
At the same time, the media and virtue-signalling celebrity commentators, with some honourable exceptions, have refused to acknowledge this scandal. Preferring to burnish their “progressive” credentials by tarnishing the reputations and ruining the careers of those who have tried to bring this scandal to public attention.
If they have any shame or journalistic integrity they will issue a public apology for failing to do their jobs as journalists and in the case of celebrities, for putting their desire for social media validation above the wellbeing of vulnerable children.

Skink
Skink
1 month ago

Didja notice? The article NEVER mentions the Big Pharma profits.

UnHerd Reader
UnHerd Reader
1 month ago
Reply to  Skink

Facts

Studio Largo
Studio Largo
1 month ago

They don’t.

Pat Thynne
Pat Thynne
1 month ago

They were also aided by Stonewall and Mermaids, both of which should be shut-down immediately. And some of the long-term impacts were known: infertility and the inability to form a satisfying sexual relationship, as well as the risk of liver cancer for girls and prostate cancer for the boys.

Christopher Michael Barrett
Christopher Michael Barrett
1 month ago

GIDS has not been closed. This is a simple verifiable fact. Why does every author on unherd keep saying GIDS closed last year? It was ORDERED to close but the two regional clinics set to take its place have not opened yet. Please get simple facts correct!

Mike Downing
Mike Downing
1 month ago

The other fly in this particular ointment is that a lot of the ‘specialists in transgender care’ are just relocating to the the devolved services.

How to kill the snake? (and where is dear Talia ?).

Lancashire Lad
Lancashire Lad
1 month ago
Reply to  Mike Downing

I fear (genuinely) for her mental health with the publishing of the Cass report and subsequent commentary.

Ian Barton
Ian Barton
1 month ago

This issue seems to have brought out the worst in “progressives”.
Nearly every time someone (including me) mentions skepticism on trans therapy (especially for children) they are met by a simplistic scathing response somehow labelling the speaker as hateful in some way.
My guess is that the critics are too lazy to have done any reading on the issue, and go along with what their lack of knowledge suggests is some form of a “kindness” related response (in line with their tribe’s view)
I also get the impression this is a more common knee-jerk reaction with those traditionally on the left 

When accused of “banging on about trans” my response has been to point out that “ I can’t get over my innate desire to stop autistic kids being mutilated 
. Sorry about that”

Julian Farrows
Julian Farrows
1 month ago
Reply to  Ian Barton

I’ve experienced the same. I think many people equate transgender with just being gay. They’ve not considered or not realized that it could lead to life-altering surgery for minors who later might regret it.

Point of Information
Point of Information
1 month ago

An intelligent and even-handed article. More of this sort of thing! Preferably on the front pages of the DT and Guardian where it used to belong.

David Morley
David Morley
1 month ago

Perhaps Cass’s recommendation to offer regular treatments to our distressed, but still ordinary, children and young people is where the true justice will begin.

Yes, where we are talking about normal prevalence of distress. But in the middle of what does look like a youth mental health crisis perhaps it’s our society which needs diagnosed.

Elizabeth Fairburn
Elizabeth Fairburn
1 month ago
Reply to  David Morley

If a “child ” cannot vote or drive or even legally have intercourse and are shielded from the press/public for any crimes they may commit until they are 16/18 – how can they possibly be mature enough to agree to changing their biological status? Didn’t we all have various fantasies at that age and want to be someone else??

David Morley
David Morley
1 month ago

Well yes, but not sure why it’s in response to my comment.

Robert Paul
Robert Paul
1 month ago

Once again, reason and evidence based medicine and best practices are asserted to inform and persuade, and yet can it defeat the ‘passionate intensity,’ of those who barricade themselves behind the wall of ‘personal freedom and human rights.’ My guess that it will be by the courts, through laws suits of detransitioners against the therapists and physicians who promote and practice the medical transition of minors as ‘necessary and safe,’ that will put this movement on pause if not a full stop.

UnHerd Reader
UnHerd Reader
1 month ago

Excellent article. The capture of so many otherwise thoughtful and caring people by ideology at the expense of evidence is a frightening modern trend we need to fight on every front. Wishful over-claiming by some in the evidence-based movement (esp in social & psychological care, but also in medicine) may have been partly at the root of this, unfortunately: there have been times in the recent past when the call for ‘only evidence-based intervention’ has itself seemed more ideologically than scientifically-led. But now we seem prone to swing to the other extreme, especially in some arenas.

Alex Lekas
Alex Lekas
1 month ago
Reply to  UnHerd Reader

I have to question whether those people truly are thoughtful and caring. These are children we’re talking about, being pushed into irrevocable permanent decisions for something that often turns out to be temporary.

Allison Barrows
Allison Barrows
1 month ago

Is there extraordinary evidence for the extraordinary claims made by the psychology “profession”? My brother-in-law was mentally and physically destroyed by a cast of characters with psych degrees. His cousin, a school psychologist, killed herself. Therapy-speak is the common language of young females who have been seduced into thinking being normal is unfashionable.
Eric Hoffer was spot on when he said everything eventually becomes a racket.

William Cameron
William Cameron
1 month ago

“NHS’s adult gender clinics have also set themselves up in opposition to evidence and research, by refusing to participate in the Cass Review’s centrepiece longitudinal research study ”
Since when did employees in the NHS get the right to refuse to assist a properly set up enquiry ?
They should be fired – today.

Dougie Undersub
Dougie Undersub
1 month ago

It’s time to stop all treatment for gender dysphoria other than talking therapies on the NHS.

Liakoura
Liakoura
1 month ago

The scale of the problem:
About 15 years ago, gender identity services were seeing about 50 predominantly birth-registered boys in childhood, according to Dr Cass.
But over the last 10 years, that number has grown to more than 3,000 young people, she told BBC Radio 4’s Today programme. “And it’s mainly birth-registered girls presenting in early teens, and often with quite complex additional problems.”
https://www.bbc.co.uk/news/health-68770641?xtor=ES-208-%5B71571_NEWS_NLB_ABC_WK15_WED_10_APR%5D-20240410-%5Bbbcnews_cassreportgendencarechildren_newshealth%5D

Alex Lekas
Alex Lekas
1 month ago

So, the report calls for using evidence-based interventions. What a stunning conclusion. When did adults become captive to the kids around them, whether it’s an 8-year-old boy claiming to be a girl or a college student who thinks the campus exists to satisfy his/her every whim?
The worst thing is that there could be 100 Cass reports, including a return to the long-forgotten scientific method, and it will have no impact on the cult. This is as true with the child mutilators as it is with the climatists. Funny how both groups love to lecture others on “the science.” More like TheScience(TM).

John Tyler
John Tyler
1 month ago

Answer to headline
 probably not so long as we remain in ECHR.

mike otter
mike otter
1 month ago

Sadly fine words butter no parsnips. People willing to mutilate kids and exploit mental illness will need more than words to stop them. Only a robust civil society can do so in a sensible way. Other societies may revert to their worst intincts and harm the child victims even more. Amongst these victims there will be a tiny% who will suffer genuine harm for having a physical gender different to their mental one. Trying to develop a diagnostic protocol for this has got to be a priority for UK/US/ANZAC, though as with many things it probably exists elswhere and just needs translated. These other things include construction contracts, tax & immigration law, privacy rights ETC ETC

mike otter
mike otter
1 month ago

The second para “designed to help children questioning their gender and/or identifying as transgender —” is interesting. Surely the gender lobby are trying get all children to question their gender not those whose questioning and ID comes from their own rational thoughts and experience?

UnHerd Reader
UnHerd Reader
1 month ago

Make it all easier that the NHS does not provide medical surgery FOC. It doesn’t save anyone’s life by mutilation

Adrian Smith
Adrian Smith
1 month ago

The article talks about the influence of social media, but most of these kids are getting the idea that they may not be the gender they think they are from PHSE at school. Yes they probably then get what to say to convince doctors to give them puberty blockers from social media.
https://www.youtube.com/watch?v=q7Mhyc4d7M4
The most shocking bit of this article for me is:
“NHS’s adult gender clinics have also set themselves up in opposition to evidence and research, by refusing to participate in the Cass Review’s centrepiece longitudinal research study — an attempt, albeit retrospective, to follow into adulthood the 10,000 young people who’ve been through GIDS’s doors.”
Just like those behind GIDs, the doctors performing no questions asked adult mutilations at tax payers’ expense are afraid of what such studies would reveal about them.

JĂŒrg Gassmann
JĂŒrg Gassmann
1 month ago

This is not a unique phenomenon in medicine. The same critique could be applied to the medical establishment’s approach to Covid. It was the same with the certainty that stomach ulcers were stress-induced. There are several other medical interventions widely prescribed today which are based on pure quackery.
Medicine is, and in Europe at least since the Middle Ages always has been, a discipline based on authority, not facts.
As Goethe wrote in “Faust”:

This was the medicine—the patients’ woes soon ended,

And none demanded: who got well?

Thus we, our hellish boluses compounding,

Among these vales and hills surrounding,

Worse than the pestilence, have passed.

Thousands were done to death from poison of my giving;

And I must hear, by all the living,

The shameless murderers praised at last!

H W
H W
1 month ago

Ours is a child-hating society. We sacrifice children on the alter of Mammon. In child policy matters, ideology combined with financial gain easily dominates over solid evidence and child well-being. Lobbyists – including a needed core of PhDs – successfully supress, grossly misrepresent,reject solid peer reviewed evidence or flat out lie and media and politicians believe them. Billions are mis-spent on institutional child care rather than provided to parents themsleves under claims that daycare is “the best start in life”, “pays for itself”, and needed so “mothers can work” despite decades of peer-reviewed evidence showing lasting harms to child well-being.

Lancashire Lad
Lancashire Lad
1 month ago
Reply to  H W

I think that’s going too far, beginning with the (seemingly ubiquitous) use of “hating” in terms of child care.

Good quality nursery provision which allows mums to return to their careers can be beneficial all round, helping to socialise the child among its peers. I speak as a grandfather whose professional daughter (a Paediatrician) studied long and hard and both mum & child are thriving.

Sheryl Rhodes
Sheryl Rhodes
1 month ago

“Remarkably, as today’s report discloses, the NHS’s adult gender clinics have also set themselves up in opposition to evidence and research, by refusing to participate in the Cass Review’s centrepiece longitudinal research study — an attempt, albeit retrospective, to follow into adulthood the 10,000 young people who’ve been through GIDS’s doors.”
What more needs to be said? No excuse can exist for refusing to study a novel and extreme medical/psychological treatment. In fact, this refusal is itself strong evidence that these treatments do NOT work—otherwise, proponents would be eager to showcase their stunning success rates.

Joann Robertson
Joann Robertson
1 month ago

The WPATH FILES was published on March 4th, 2024. It exposes WPATH, supposedly the authority on transition, for the ideology driven organization that it is. It is shocking that it has been ignored by the MSM but I think that shows the power of the gender ideologues who have captured the medical professions, the media, and governments.
The WPATH Files are easy to find on line. Read them. The mutilation of children must be stopped

UnHerd Reader
UnHerd Reader
1 month ago

As Dr. Cass reported, a long-term study on the effect of puberty blockers is needed. There is, however, a lot of anecdotal evidence concerning the blocker Lupron, the most commonly used in the U.S. There are almost 15,000 adverse effects reported to the FDA. There are forums for people who took the medication for precocious puberty (mainly women), endometriosis and prostate cancer. All of them say Lupron destroyed their lives. Adverse effects include osteoporosis, tooth loss, severe joint pain leaving them wheelchair bound and on potent pain killers, loss of cognitive ability, fractures and more. Most of the women are in their twenties. The FDA refuses to investigate whether Lupron is dangerous (duh). I would think that tens of thousands of people who have been permanently disabled by the blocker would warrant a study.

Steven Farrall
Steven Farrall
1 month ago

‘Gender distressed’. Sigh. Gender is a grammatical term. For real people the correct term is ‘sex’. The use of ‘gender’ is part of the fascist left language mangling agenda. Nineteen Eighty-Four is here, now.

jules Ritchie
jules Ritchie
1 month ago

The NHS has been paying out huge sums to these ‘doctors and specialists’ and that’s what they’ll be fighting to have continued. ‘It’s the money stupid’.

jules Ritchie
jules Ritchie
1 month ago

I just thought to ask…are private medical insurers still going to pay clinics for this barbarous activity? If patients have no access to funding for their procedures then most won’t be able to afford it. I don’t imagine that medical specialists do this work pro-bono.

David Lewis
David Lewis
1 month ago

During my childhood I wanted to be a fighter pilot and my younger brother wanted to be a Scotsman. My dream was dashed when a tape measure revealed that my legs were too long. As the son of two Welsh people born in England, the family laughed at my brother’s aspiration – there was no talk of ‘nationality dysphoria’ and a visit to the GP would have been considered absurd. Coping with disappointment is integral to childhood.

I think my parents’ greatest gift to us was not to take us terribly seriously during childhood.

UnHerd Reader
UnHerd Reader
1 month ago
Reply to  David Lewis

Giving in to a little boy’s contention that he is a girl — even if he is “feminine” (that societal prescription for girls masquerading as a description of “what all girls are like”) and is “persistent in his insistence” is colossally bone-headed, given we know that unless they’re “affirmed”, nearly all such kids desist by young adulthood. Kids do not “know who they are”.
Yes, he notices he’s different from most boys. Find him some other “feminine” boys to play with (assuming any have not yet been “socially transitioned”), so he knows boys are like that sometimes. Big deal.
I was raised by a shy, gentle, feminine father and a masculine, once-tomboy mother (who would have punched anyone who suggested she wasn’t really a woman in the face.) “Femininity” and “masculinity” may confuse children into a persistent belief they’re “really” the opposite sex. Adults should know better than to agree.