Katie Roche's Blog

The Cass Review: A Triumph for Science over Ideology

The media coverage of the Cass review into treatment for Gender Dysphoria for children in the UK has been impossible to miss. You can download the report here if you haven't already read it. The report has already begun to change how Gender Dysphoria in children is treated. Because of the report, all four nations of the UK have suspended prescribing puberty blockers to children. There is a similar review planned into adult services.

The overarching theme of the report is the lack of high-quality research into Gender Dysphoria and its treatments. Many studies only followed patients up for a short time, or had a high drop-out rate. This has been known about for a long time. Indeed, a study by the University of Birmingham in 2004 came to the same conclusion. (Although the University of Birmingham study concentrated on adults with Gender Dysphoria). So, why did so many children receive unproven treatment for so long?

It appears that for many years, gender medicine has been regarded as “special”. Being transgender has been viewed as a civil rights issue, rather than a medical condition. As such, the treatment doesn't require the same standard of evidence as other areas of medicine. Supporters of the affirming approach follow the narrative that people with Gender Dysphoria are “born in the wrong body”. And that the only way to resolve this is to make their body “right”. Those who deny this are cruel bigots who wish to drive people with Gender Dysphoria to suicide. Amongst those who support the affirming approach are doctors and researchers who believe so strongly in it that they are unprepared to carry out research that may not validate their beliefs. Consequently, many people have received treatment that hasn’t been tested in the same way that “normal” medical treatment is. Note that part of the reason the NHS uses the affirming approach is because of a Human Rights Act ruling. Indeed, across the world, gender medicine is driven by activism rather than science. But what does the science say?

Lots of studies show that short-term, the affirming approach gives patients high satisfaction. But does that satisfaction last? Could there be a honeymoon period, where someone is initially satisfied, but then they come to regret the treatment later? This frequently happens with Body Dysmorphia, where patients who have cosmetic surgery are usually happy with the results at first. But then their negative feelings about their body return. Studies that only track patients for a short time or that have a high drop-out rate might not capture that.

Also, does the fact many people with Gender Dysphoria say they are happy with their treatment mean it works? It's difficult to say. At first glance, the high satisfaction rate would support the effectiveness of the affirming approach. But remember there are people who swear by discredited treatments: homeopathy, chiropractic or acupuncture to give a few examples. The NHS doesn’t routinely offer these treatments because there is no evidence that they work. Nor do they accept “lived experience” as evidence of their effectiveness. NHS resources are limited. Treatments have to provide value for money. It’s not clear that the affirming approach does that.

It’s time to move away from activist-driven medicine and toward science-led medicine. Right now, we can’t say if puberty blockers are safe, or if gender transition is the best treatment for Gender Dysphoria. The research hasn’t been done. If this situation is ever going to improve, then critics of transgenderism must be listened to. Not dismissed as bigots. Will we look back in 20 years or more and say “what on earth were we thinking? Why did we do this?” Treatments have turned out to be dangerous when they were initially thought to be safe. Look at lobotomies, Thalidomide, and vaginal mesh. Will the affirming approach to Gender Dysphoria turn out to be same?

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