May 17, 2024 - 4:30pm

A month after the publication of her report into youth gender services in the UK, Dr Hilary Cass has been doing the rounds in the American media. This week, she gave an interview to the New York Times on her research, which found “remarkably weak” evidence for paediatric gender transitions.

Speaking to the NYT, she said that “the real problem is that the evidence is very weak compared to many other areas of paediatric practice”, adding, “I can’t think of any other situation where we give life-altering treatments and don’t have enough understanding about what’s happening to those young people in adulthood.”

The Cass Report cast serious doubts on the model in use in many Western countries, including the US, in which clinicians automatically affirm children’s transgender identities and recommend cross-sex medical interventions for minors. While the UK was quick to restrict puberty blockers and other interventions in light of the report, the American medical establishment has doubled down on supporting gender transitions for young people.

The Endocrine Society, which supports puberty blockers and cross-sex hormones for minors, told the NYT this week that the Cass Report “does not contain any new research” that would contradict those guidelines.

Stephen Hammes, the organisation’s president, also defended its position in the Wall Street Journal last year. “More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide,” he wrote.

The American Academy of Pediatrics, one of the most vocal champions within the US medical establishment of child gender transitions, declined to comment on the Cass Report for the NYT story and instead reiterated its opposition to legal restrictions on the practice. The AAP’s 2018 statement in support of child gender transitions calls for minors to have access to “comprehensive, gender-affirming, and developmentally appropriate health care”, for doctors to advocate for laws expanding access to such treatments, and for children’s medical charts to reflect their gender identity rather than their biological sex.

The American Medical Association, which supports cross-sex treatments for minors and resolved last year to intensify its lobbying efforts in support of youth access to gender transitions, has not yet made a public statement on the Cass Report.

Meanwhile, the World Professional Association for Transgender Health (WPATH) said Cass’s review was “rooted in the false premise that non-medical alternatives to care will result in less adolescent distress for most adolescents”.

While many Western countries are restricting transgender treatments for children, there’s no end in sight in the US, where the debate has taken on distinctly partisan contours. Red states have attempted to ban the procedures, while the Biden administration has promoted childhood gender transitions throughout the federal government.

Politicians and media outlets have often sought advice on transgender issues from these medical organisations, whose guidelines are formed by a small number of vocal activists with views which do not necessarily reflect those of the majority of members. The AAP’s guidance on child gender transitions, for example, was written by a single doctor. Cass described the relationship between these groups as an “echo chamber” in an interview with NPR this month, saying there was a circularity to their guidance.

The groups have thousands of members, most of whom do not specialise in gender and are not deeply involved in the organisation, meaning the members who themselves work in gender clinics are often the ones writing these guidelines.

“What some organisations are doing is doubling down on saying the evidence is good. And I think that’s where you’re misleading the public,” Cass told the NYT. “You need to be honest about the strength of the evidence and say what you’re going to do to improve it.” She added, citing the AAP: “I wonder whether, if they weren’t feeling under such political duress, they would be able to be more nuanced, to say that multiple truths exist in this space.”


is UnHerd’s US correspondent.

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