NHS Report Finds Child Transgender ‘Medicine’ Built on ‘Shaky Foundations’, Rejects Puberty Blockers

The evidence for helping children to change gender including ‘social transitioning’ and hormone blockers is built on “shaky foundations”, a major review into the practice by a leading paediatrician in the United Kingdom has found.

The long-anticipated Cass report into how the tax-funded NHS treats children who believe they are trans has been published and calls for major change, saying hormone drugs should no longer be given to under-18s and that the basis of ‘treatments’ given by the NHS have been based on practices with little “developmental rigour and transparency”. Fundamentally, Dr Hilary Cass said, “When conducting the review, I found that in gender medicine those pillars are built on shaky foundations.”

The NHS — which has already ended the use of hormone blockers for children just last month — has responded to the paper, saying it will further “review the use of gender affirming hormones” and will instruct adult gender clinics to “implement a pause on offering first appointments to young people below their 18th birthday”.

In an article in the British Medical Journal accompanying the near-400-page report, Cass said in the recent past “gender care for children and young people had moved from a ‘watchful waiting’ approach to treatment with puberty blockers”.

During this time “the majority of clinical guidelines have not followed the international standards for guideline development” and the bodies influential in developing these practices ” lack developmental rigour and transparency,” the paediatrician reported.

Cass found in her report that while there is a “considerable amount of research” in the field, a systematic review of evidence discovered “poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.” The rationale for giving children puberty blockers is “unclear”, there is weak evidence it helps “mental or psychosocial health”, and the long-lasting effects on “cognitive and psychosexual development” are unknown.

In all, in a situation where clinicians are unable to determine which children “will go on to have an enduring trans identity” and which will ultimately grow out of it in time, Cass urged “extreme caution” and said, “for most young people, a medical pathway will not be the best way to manage their gender-related distress”.

On hormone blockers, which are used to stop puberty in very young children being enabled by doctors to transition, Cass said the whole rationale for giving the drugs was fundamentally a falsehood, as they had been promoted on the idea that they ‘paused’ puberty and gave young people “time to think” about what they were going through.

In reality, the report found this was not the case, there is no evidence that it reduces the risk of suicide, and there was no evidence to show that puberty blockers  “buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.”

In future, young people presenting as having “gender-related distress” should be looked at more holistically by medical professionals, and not treated simply as cases needing gender reassignment, the report said. The report found children claiming to be transgender have a higher occurrence of abusive or broken backgrounds and the rate of co-occurrence of gender issues with other matters like autism, depression, anxiety, and eating disorders, and should get treatment for those issues, a clear implication this is not presently the case.

While Britain’s controversial NHS-run transgender clinics have existed for decades, they treated small numbers of patients who, until recently, were predominantly men. Suddenly in the past decade, this has switched, with large numbers of young girls instead being funnelled through social and medical pathways. Britain’s newspaper of record The Times notes in its review of the report’s findings that 2014 is seen as a particularly pivotal year in the sudden emergence of referrals of young girls to Gender Identity Development Service (GIDS). This fact is contrasted with 2014 also being the year in which Britain’s state broadcaster the BBC released a documentary I am Leo on its channel for 6-to-12-year-olds about a 13-year-old girl ‘transitioning to male’.

This change is down to a mix of “biological, psychological and social factors”, and the report notes “online stressors” including the impact of social media and pornography on young people. Cass states: “Pornography is so widespread and normalised that children cannot ‘opt out…  frequently violent, depicting coercive, degrading or pain-inducing acts. Younger exposure had a  negative impact on self-esteem… adolescent pornography consumption is associated with subsequent increased sexual, relational and body dissatisfaction. More investigation is needed, researchers say.”

Responses to the paper have been mixed. Chief Executive Maya Forstater of Sex Matters, a pro-biology group that campaigns to protect women and children from transgender ideology, alleged hypocritical responses to the Cass Report by key players in the space, including LGBT charity Stonewall. Forstater claimed that while Stonewall now said they welcomed the review, in the recent past they had made clear they fundamentally disagreed with what would become key report findings.

Forstater stated, for instance, that Stonewall had called puberty blockers — which Cass clearly criticised — “vital” for “trans young people” and had claimed the drugs were reversible, which Cass challenges.

The Cass report follows years of controversy over the behaviour of the NHS towards children who think they are transgender, with concern leading up to the planned closure of the Tavistock Clinic, the home of the Gender Identity Development Service (GIDS) which has been the focus of Dr Cass’s investigation. That controversy promises to roll on, with Dr Cass herself noting how she had been attacked for leading the NHS-commissioned review into transgender clinics, and said the debate around the issues is “exceptionally toxic”.

She said: “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.”