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, and is on the advisory group for Sex Matters. Her book Unfortunately, She Was A Nymphomaniac: A New History of Rome’s Imperial Women was published in November 2024.

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