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Blame parents for rejection of the Cass Review

Activists protest the NHS ban of puberty blockers earlier this year. Credit: Getty

August 16, 2024 - 3:40pm

There were always going to be dreadful responses to the Cass Review of services for children questioning their “gender identity”. It undermines some of the core tenets of trans ideology, and that means the stakes couldn’t be higher. One of the worst takes has just appeared in the Guardian, highlighting the plight of four young people who are “struggling to cope” in the wake of the report’s recommendations being accepted by the NHS.

“With puberty blockers now banned in much of the UK, those hoping for gender treatment say they have been forced into difficult decisions,” the paper claims. Its examples include “Hannah”, who “started telling her [sic] parents she was a girl, not a boy” at the age of three. This is not uncommon, especially among boys who have sisters, and research has demonstrated that most of them grow out of it.

It’s hard not to wonder how much of this “trans child” narrative is a projection by parents who want a child of the other sex. We all know couples who have gone on having children until they get the son or daughter they want, and some countries allow sex selection among embryos to the point where there’s an imbalance in the population.

A child of three can’t possibly understand the concept of a gender identity unrelated to biological sex, but he or she will pick up cues from parents who praise stereotypical behaviour. Many of these children used to end up confused, depressed and on a pathway to irreversible harm until NHS England finally banned puberty blockers for under-18s, shortly before the Cass Review was published.

“Hannah” is neurodiverse and was referred to child mental health services at the age of six. But his parents treated him as a girl and he sought puberty blockers at the Sandyford Clinic in Glasgow when he reached puberty. “The doctor was confident Hannah understood what was happening and had the capacity to consent,” his mother tells the Guardian. But then the clinic followed the example of NHS England and stopped new prescriptions for puberty blockers.

“Hannah has always said she [sic] would kill herself if she had to go through male puberty,” the mother adds. Such threats are a familiar response from children who’ve been encouraged to regard “gender-affirming” treatment as a right. But it raises a difficult question: if children’s self-diagnosis can’t be challenged, does that also apply to suicidal ideation?

The really shocking thing about hostile responses to Cass is what they reveal about the indoctrination of children. A 17-year-old trans boy — a girl, in other words — who obtained puberty blockers at the age of 14 tells the Guardian about her “huge terror” of puberty. “My body was changing in a way I actively hated,” she says.

The fact that children are being encouraged to hate their own bodies is one of the most pernicious aspects of gender ideology. But the “trans child” narrative is crucial to trans activism, which depends on the notion of an innate “gender identity” that manifests itself in infancy.

“Gender treatment” sounds innocuous, but it isn’t. There is undoubtedly a group of children who have psychological problems, including depression and anxiety, and they should be able to access appropriate treatment via the NHS. Thanks to Cass, they’re now protected from being prescribed powerful drugs that will lead to infertility and early-onset osteoporosis.


Joan Smith is a novelist and columnist. She was previously Chair of the Mayor of London’s Violence Against Women and Girls Board. Her book Unfortunately, She Was A Nymphomaniac: A New History of Rome’s Imperial Women was published in November 2024.

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UnHerd Reader
UnHerd Reader
4 months ago

Well done analysis. It might be interesting at some to find out if researchers are discussing the van Munchausen by proxy syndrome….

Talia Perkins
Talia Perkins
4 months ago
Reply to  UnHerd Reader

There is no such thing as Munchausen by proxy involved in this field more than any other.

Because you have elected to cowardly not reply before now, I will put it before you again:

“This ‘handful’ of children are innocent human beings!” <– And you want to abuse them. That is what your gender critical ideology is about — that is what you are in favor of. You want for them the lifetime of suffering! That is what forcing boys to have breasts and periods and forcing girls to have beards and deep voices is, and that is what withholding gender affirming care does.
You are complaining that a lifetime of suffering has been avoided by them, to the tune of more than 99 out of 100.
There is no trans ideology, only your gender critical ideology about transgender people, and how they must be abused for the sake of your feelings, and that is what withholding gender affirming care is. Abusing us.
“The reality is, the entire trans movement is a social engineering project paid for by perverted, predator trans billionaires” <– No idiot, transgender people have existed throughout all of human history, in every human culture.
“They have perfectly healthy bodies that are transformed into hideous facsimiles of male and female and will never be the opposite sex.” <– I understand you do not believe transgender people really exist — and that proves by itself you are a fanatic imbecile.
“Trans ideology is simply the pathway to transhumanism, the merging of biology and machine, where women will be discarded as mothers and used only for sex slaves,” <– You need to be clinically evaluated. Really.
“one that is FREE of gender constraints” <– Says the person who wants people to be forced into exhibiting a gender they do not have.

Jeremy Bray
Jeremy Bray
4 months ago

Blame hysterical activists whether parents or not.

Of course that internationally respected biologist and child psychologists Talia Perkins will be along to tell us that Cass failed to read the many examples of relevant literature that shows that trans specialist paediatricians can tell 99.9% who needs affirmative care rather than just growing out of their delusions. Detransitioners are just a drop in the ocean of happy trans individuals looking forward to a lifetime of medical care in the “right” body. So will “ethical” surgeons and medical pharmacologists be glad to have saved so many lives out of the goodness of their hearts.

Gordon Black
Gordon Black
4 months ago
Reply to  Jeremy Bray

You have nailed it, thanks.

Chris Riches
Chris Riches
4 months ago
Reply to  Jeremy Bray

Ignore TP, when she loses the arguement she reverts to type, insults!!!

Talia Perkins
Talia Perkins
4 months ago
Reply to  Chris Riches

I don’t lose the argument, because you never manage to scrape up any facts which support your claims. That is why what you call insult is only accurate description.

No opinion or person holding it forth deserves respect for free, you have to earn it.

Chris Riches
Chris Riches
4 months ago
Reply to  Talia Perkins

That’s because you’re deluded

Talia Perkins
Talia Perkins
4 months ago
Reply to  Chris Riches

Then prove that, don’t claim it. Do the heavy lifting to prove what you say.

Andrew F
Andrew F
4 months ago
Reply to  Talia Perkins

Go back on your medication.
Trans are just mentally ill people.
Unfortunately we don’t have hospitals to lock them in.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Andrew F

Except there is no mental illness they have you can name or claim to explain.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Jeremy Bray

And as is usual, you try to make it about me instead of facts, because you have no facts which support you. What you call “insult” is only accurate description.

It is on you to show what I write is not accurate.

Chris Riches
Chris Riches
4 months ago
Reply to  Talia Perkins

How narcissistic to think it’s all about you!! When you lost an argument you just revert to insult..I’m beginning to think you’re just a bot.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Chris Riches

Imbecile, Jeremy Bray whom I replied to made it about me.

What it is really about is facts you can’t stand, and can not deal with with emotional maturity — so for the sake of the lies you love you seek to abuse children. I’ve never lost an argument here because no one here has or can find any facts to the contrary of what I write.

That is why you and Jeremy make it about me.

laurence scaduto
laurence scaduto
4 months ago
Reply to  Talia Perkins

Your rhetoric makes it fairly obvious that it is about you. Why are you so angry? What’s behind this?
Are you just a bot?
Or are you Champaign Socialist?

Talia Perkins
Talia Perkins
4 months ago

No imbecile, it is about the facts. There are no facts justifying the “gender critical” ideology. I’m only here pointing that out.
It’s not about Champagne Socialist either.

UnHerd Reader
UnHerd Reader
4 months ago
Reply to  Talia Perkins

Facts, evidence.. start with Kiera Bell’s experience, follow on with Exulansic’s interviews, listen toe Ritchie Heron. Then read ‘Time to Think’ an investigation of the Tavistock Clinic…. so much in the way of facts and information to be explored.

Talia Perkins
Talia Perkins
4 months ago
Reply to  UnHerd Reader

There should be about 1500 people in Keira Bell’s circumstance in the UK — the regret rate defined as people who claim their medical transition was a mistake entire is just under 1%. You can’t by pointing out known liars such as Bell, show there is anything systemically wrong with gender affirming care as exemplified by the DSM5 & WPATH Standards of Care.
You can only by prohibiting that care force the about 150,000, as youth, to be girls forced to grow up with beards and deep voices and boys forced to grow up with breasts and periods.

There is no other to you, you are a child abuser.

Helen E
Helen E
4 months ago
Reply to  Talia Perkins

“You can only by prohibiting that care force the about 150,000, as youth, to be girls forced to grow up with beards and deep voices and boys forced to grow up with breasts and periods.”

Scrambled syntax, but we get the drift.

However, the substance is supremely mind-scrambling—e.g., “girls” (sic) “forced to grow up with beards” and “boys” (sic) “forced to grow up with breasts.”

What you refer to here by using the word “boys” is in reality bio girls who dislike the sometimes unwelcome arrival of bodily changes that signal they are no longer children. Those are girls. They aren’t boys.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Helen E

Who I refer to as boys there have a male gender and a female sex — each equally anatomical and the brain taking precedence, the whole of the personality is there.

Your delusion to the contrary makes of you a child abuser.

” bio girls who dislike the sometimes unwelcome arrival of bodily changes ” <– Have nothing to do with it.

Angst over puberty is not often or easily confused with gender dysphoria, in fact the false positive error rate is below 1%.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Chris Riches

It is not about me, it is about the facts. You and Jeremy Bray want to make it about me.

What you claim is insult is accurate description — it is on you to change it to be inaccurate.

Arkadian Arkadian
Arkadian Arkadian
4 months ago

Excellent article. Thanks.

Tom Scott
Tom Scott
4 months ago

It is obviously the parents who need the treatment.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Tom Scott

Obvious on the basis of what?

Oh, I’m sorry. You were only here for the participation trophy.

Robert White
Robert White
4 months ago

Superb. ‘[sic]’: this is obviously the way to go!
Well said, Joan, all of it.

Tyler Durden
Tyler Durden
4 months ago

Many of these families encourage gender transition because they’d rather their child change sex than be gay.
This is the underlying mentality in Iran which holds world record numbers for gender transition operations.
Gender ideology may be another symptom and byproduct of the tyranny of multiculturalism.

David Morley
David Morley
4 months ago
Reply to  Tyler Durden

Believable in Iran. Not in the U.K.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Tyler Durden

“Many of these families encourage gender transition because they’d rather their child change sex than be gay.” <– Not only happening near never, the single such case I know of was a young lady who took testosterone by informed consent because they thought their parents could deal better with a transgender son than a lesbian daughter. Inasmuch as they employed informed consent as an adult, their example has nothing to do with gender affirming care per WPATH standards of care — which are not that.

And no, Iran has nothing to do with it — in Iran, it is imposed on threat of execution — not done volitionally.

David Morley
David Morley
4 months ago

It’s hard not to wonder ….

It’s hard not to wonder about a lot of things.

I think it’s reasonable if a commenter starts a comment like this. Comments often involve a fair bit of conjecture. But from the author of an actual piece on Unherd we should expect something a bit more solid.

David Morley
David Morley
4 months ago

Could the author please link to the actual research rather than Daily Mail articles about it. The DM site is a nasty mess with all sorts of ads. Far easier to read an abstract.

Talia Perkins
Talia Perkins
4 months ago
Reply to  David Morley

It’s one of the pieces using Zucker’s/Steensma’s approach — the study ultimately involved — where they use a non-clinical definition of who is transgender and imputedly would merit recommended medical transition. They then claim any who after some period of time do not want to transition medically have been “cured” or “desisted” when in fact those same people would never have been diagnosed with such being recommended in the first place. Because it does not use the DSM5/WPATH standards of care, it has nothing to say about the clinical worth of the definitions, procedures, and concepts thereof.

https://pubmed.ncbi.nlm.nih.gov/38413534/

David Morley
David Morley
4 months ago
Reply to  Talia Perkins

Thank you for this.

I think that this also speaks to people’s concerns that some people might be diagnosed as being trans when in actual fact they are not – or perhaps not significantly so. I know you think this happens rarely in a clinical setting. Others fear it might be more frequent.

Talia Perkins
Talia Perkins
4 months ago
Reply to  David Morley

“Others fear it might be more frequent.” <– On the basis of nothing rational whatsoever, they deserve only contempt.

David Morley
David Morley
4 months ago
Reply to  Talia Perkins

The research is actually pretty fascinating.

In early adolescence, 11% of participants reported gender non-contentedness. The prevalence decreased with age and was 4% at the last follow-up (around age 26). 

That’s a very high number. Clearly way higher than the number of people who are “treated” as trans. This does suggest (though not prove) that in a clinical setting far stricter criteria are applied.

laurence scaduto
laurence scaduto
4 months ago
Reply to  David Morley

“..stricter criteria…” ?
Or simply that most people, “gender contented” or not, naturally shy away from drastic medical/surgical interventions.

Talia Perkins
Talia Perkins
4 months ago

That has nothing to do with it, as there is nothing in the study to suggest those they said were “gender non-contented” sought any medical intervention.

Talia Perkins
Talia Perkins
4 months ago
Reply to  David Morley

“This does suggest (though not prove) that in a clinical setting far stricter criteria are applied.” <– Do you think maybe so?

Chris Riches
Chris Riches
4 months ago

Perhaps its the ultimate liberal manifestation, look I’ve got a trophy trans child!!

0 0
0 0
4 months ago
Reply to  Chris Riches

It’s always smacked of this to me.. as well as a further extension of the endemic body dysmorphia of western ‘culture’.

Talia Perkins
Talia Perkins
4 months ago

“There were always going to be dreadful responses to the Cass Review of services for children questioning their “gender identity”. It undermines some of the core tenets of trans ideology” <– Of course, no such thing as “trans ideology” exists. Gender identity is simply what cisgender people can usually take for granted.

“This is not uncommon, especially among boys who have sisters, and research has demonstrated that most of them grow out of it.” <– A lie, there is no such research which is not fraudulent, or, as here — is not fraudulently cited. Joan Smith is lying to you to claim, that the research she cites shows what she claims and implies it shows. “Gender noncontentedness” is not a thing towards a DSM5/WPPATH standards of care diagnosis of gender dysphoria. The phrase is not even defined or characterized. The fact is that youth who merit a gender dysphoria diagnosis “grow of it” near never.

““My body was changing in a way I actively hated,” she says.” <- The only gender ideology which actually exists if the gender critical ideology. It’s foundational tenet is one of these two beliefs:

Gender does not physically exist, or, gender is always identical to the sex of a person.

When confronted with the heart of their evil — and obviously wrong — stupidity condensed to its essence, the gender critical shut up. They know they can make no rational case for what they insist it true. So far here they never even try.

Smith is merely expressing her horror that a girl with the misfortune to be born with testicles is not happy to have a beard and a deep voice — Joan Smith is a child abusing imbecile.

That is all that objections to gender affirming care is — the belief on the basis of nothing but lies, that the apparent sex of a person at birth should or does determine what appearance and behaviors they should be forced to have, and what gender they actually have . . .

. . . unless as with Imane Khelif, that becomes politically inconvenient for the gender critical.

Janet G
Janet G
4 months ago
Reply to  Talia Perkins

Many of us do not “have” a “gender identity”, let alone one we take for granted. I grew to adulthood before the word “gender” was used to refer to sex. Before that it was a grammatical term.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Janet G

“Many of us do not “have” a “gender identity”,” <– Of course, it is overwhelmingly likely you do.
“Before that it was a grammatical term.” <– Abject nonsense, because in English in the over 700 years it has been in use, it refers chiefly to the masculinity and femininity of people and other living things. It has never in English referred to categories of parts of speech, except when used to discuss other languages.

Chris Riches
Chris Riches
4 months ago

One up to havimg a Pomeranian in a designer handbag!!!

Chris Riches
Chris Riches
4 months ago

TP is an AI bot!!!

UnHerd Reader
UnHerd Reader
4 months ago

Excellent article. So clear. When a child is as young as 3 yrs old, their parents and family should go into therapy to figure out their Transhausen tendencies. And a sharp journalist should be asking the parents some tough questions.

Talia Perkins
Talia Perkins
4 months ago
Reply to  UnHerd Reader

Imbecile, there is no excuse to presume Munchausen by proxy is involved here more than in any other matter. The fact is, youth become aware of gender at the ages 3 to 5 typically — and quite a few transgender people are quite vocal about their problem from about that time in their life. Others immediately learn they need to keep it quiet.

You deserve sharp questions — you have them and do not answer them.

Zeph Smith
Zeph Smith
4 months ago
Reply to  Talia Perkins

Your copy/paste stuttered. (If you edit out the double-pasted identical text, this reply may not make sense to later readers).

Talia Perkins
Talia Perkins
4 months ago
Reply to  Zeph Smith

Try having a substantive reply.

Andrew F
Andrew F
4 months ago
Reply to  Talia Perkins

The only imbecile on this site is you.

Are you on day off from mental hospital?
Are your meds late?

Talia Perkins
Talia Perkins
4 months ago
Reply to  Andrew F

The only imbecile on this site is you.

Then prove it by supplying facts.

Are you on day off from mental hospital?

I have never even been thought to even maybe need such, but you do seem familiar.

Are your meds late

I have and need none but Allerfex, Allertec, and Estradiol, thank you.

Martin Goodfellow
Martin Goodfellow
4 months ago

How can a six year old possibly know what it means to ‘go through’ male puberty? How can a responsible parent take such an idea, and supposed threats of suicide seriously? This is ignorance gone off the sanity scale. I wonder, too, if there would be any help, these days, possible from Social Services.

Talia Perkins
Talia Perkins
4 months ago

Because they watch other people doing so and the results thereof. Even if blind, they hear it.

“How can a responsible parent take such an idea, and supposed threats of suicide seriously?” <– Because the prior approach to gender dysphoria before gender affirming care produced 40%+ suicidality in those with it.

Zeph Smith
Zeph Smith
4 months ago
Reply to  Talia Perkins

More than 40% committed suicide? Or more than 40% were coached by peers or activists to threaten suicide? There’s a big difference.
Do you have any peer reviewed study which compares the actual suicide rate of teens denied puberty blockers, and peers with matched comorbidities granted puberty blockers? No, of course not. But give us the closest approximation to that which you have, involving actual suicide rates and which controls for other factors.
For example, has there been a marked increase in youth suicides since the Cass report came out, as would be predicted if you were correct?

Talia Perkins
Talia Perkins
4 months ago
Reply to  Zeph Smith

“More than 40% committed suicide? Or more than 40% were coached by peers or activists to threaten suicide?” <– Neither.

“Do you have any peer reviewed study which compares the actual suicide rate of teens denied puberty blockers” <– Yes, and I have posted them here before.

“No, of course not.”‘ <– Liar.

“has there been a marked increase in youth suicides since the Cass report came out, as would be predicted if you were correct?” <– Not youth generally, fool, but among gender dypshoric youth, yes.

https://www.erininthemorning.com/p/trans-youth-suicides-covered-up-by?utm_source=publication-search

Of course your government investigated itself and said no such thing happened.

Paul Thompson
Paul Thompson
4 months ago
Reply to  Talia Perkins

Suicides are not increased due to Cass.

There are far more suicides AFTER transition than before. That’s because it is clear by then that cutting off breasts or penises is not helping the delusional psychosis .

Talia Perkins
Talia Perkins
4 months ago
Reply to  Paul Thompson

“Suicides are not increased due to Cass.”

They started with the increase in restrictions on proper care, that did became worse after the Cass Report. What I have cited proving this, you and no one else has actually addressed in any way. When someone asserts with obituaries the data is cooked, citing the data said to be cooked to the contrary is irrelevant. Also fraud.

“There are far more suicides AFTER transition than before.’ <– No liar, there are not. That is why you won’t cite anything backing up your claims.

Paul Thompson
Paul Thompson
4 months ago
Reply to  Talia Perkins

The suicide myth is toxic shit perpetuated by grooming perverts like you, Talia.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Paul Thompson

No, the toxic suicide myth is perpetuated by social conservatives like you — who claim variously the 40% is not improved by gender affirming care, and that it is caused by gender affirming care. There is no grooming involved, people are only born transgender or they are not.

Paul Thompson
Paul Thompson
4 months ago
Reply to  Talia Perkins

No child is born in the wrong body. But grooming perverts want to have sex with children and there are more and more every day. The entire LGBTQ+ group is filled with grooming perverts. That’s the real threat. LGBTQ+ perverts perverting children.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Paul Thompson

“No child is born in the wrong body.”

Why yes, you are delusional — you believe gender does not physically exist, or, is always identical to the sex of a person.

You believe that, prove it.

Andrew F
Andrew F
4 months ago

It was tried in Leeds.
It did not work out well, did it?

Talia Perkins
Talia Perkins
4 months ago

Removed as The Herd decided to not censor the original further.

Paul Thompson
Paul Thompson
4 months ago

I am part of a commission hearing the request of young persons to play on the sports teams of the other sex. For females, no problem.
We hear from males, and from the parents. We turn down the males, routinely. But what amazes me is the COMPLETE DELUSIONAL STATE of the parents. They beg to have their large sons play as females. It’s appalling.
If Kamala Harris gets elected, this will go from being a theoretical problem to a real one. Biden Admin wants to allow ANY male on female teams.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Paul Thompson

Prove it.

Paul Thompson
Paul Thompson
4 months ago
Reply to  Talia Perkins

Our decisions cannot be revealed due to state law.

Talia Perkins
Talia Perkins
4 months ago
Reply to  Paul Thompson

How convenient, liar.

Paul Thompson
Paul Thompson
4 months ago
Reply to  Talia Perkins

here’s yer good news item for tonite:
https://x.com/ttexulansic/status/1824814117548667292?s=46

Talia Perkins
Talia Perkins
4 months ago
Reply to  Paul Thompson

And?