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Cass Review of gender transition

A safe pair of hands, velvet gloves, and still a stiletto in the heart of trans ideology

24 March 2022

Gender Identity Development Service (Gids) London headquarters, The Tavistock Centre.

Paediatrician Hilary Cass has completed an interim report (The Cass Report) into the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS foundation trust in London. It follows last year's judgement in the case of Keira Bell, banning under 16s from puberty-blocking drugs. The ruling was quickly reversed, but criticism of the unit has continued.

Last spring, the Care Quality Commission demanded monthly updates on numbers on waiting lists and actions to reduce them in a highly critical report on GIDS.

The interim Cass report focuses on capacity and recommends a network of regional hubs to provide care to young people with gender incongruence or dysphoria, and blames a significant rise in referrals leading to overwhelmed staff and waiting lists of up to two years The number of referrals to the service went from 138 in 2010-11 to 2,383 in 2020-21.

"Differing views and lack of open discussion about the nature of gender incongruence in childhood and adolescence – and whether transition is always the best option – means that patients can experience a “clinician lottery”, says the new review,

It notes that the clinical approach used by GIDS “has not been subjected to some of the usual control measures typically applied with new treatments". There is an issue of “diagnostic overshadowing”. Once gender dysphoria is diagnosed other issues and mental health problems are ignored. "There is still a lot we don’t know about the long-term effects” of hormone treatments.

The review group raises serious concerns about the lack of data collection by GIDS especially on outcomes for the recent increase in girls questioning their gender identity.

So, the treatments are not open to full discussion, are not based on the evidence and evaluation normally used in medical science and the ideology leads to other health issues being ignored. There is a lack of interest in the results of treatment for patients. Despite the polite tone this is an utterly damning report.

But Dr. Cass reserves a sharper tone for an opinion piece in the British Medical Journal.

She notes the weak evidence base underpinning the current practice of prescribing pubery blockers and following up with cross-sex hormones.

Cases had arisen from around 50 in 2009 to over 2700 in 2019/20. The early cases were:

"predominantly birth registered males presenting with gender incongruence from an early age" and switched to:, "predominantly birth registered females presenting with teenage onset of reported gender-related distress".

 "In addition, approximately one third of children and young people referred to GIDS had autism or other types of neurodiversity.

The reasons for these changes were not adequately investigated or understood.

…Some clinicians also reported feeling unable to undertake the process of assessment and differential diagnosis that would be the norm in their clinical practice because they perceived that there is an expectation of an unquestioning affirmative approach".

As a result, a majority refer directly to GIDS.

"At present the professional community does not have a shared understanding about the meaning of gender dysphoria in young people, and the extent to which it can be an inherent and immutable phenomenon, or a more fluid and temporal response to a range of developmental, social, and psychological factors."

The Cass Review is in a safe pair of hands. The wording is professional and non-judgemental.

The argument is damning.

A specialist area of medicine with a small number of patients is overwhelmed by a new cult that demands affirmation of gender dysphoria, a common condition of puberty, as a requirement for gender transition. The new patient base, the massive overrepresentation of children with autism, all this is ignored, as is the necessity of formal assessment of the future health of the patients.  The majority of doctors stay out of the way because of the threatening absolutism of the trans lobby.

Trans ideology is not a purely medical issue. It is a class issue. Medical reports can point out the absurdity and danger of some of the treatments.  Feminists, socialists and political representatives have to assert the material reality of the life we live and oppose the cultists who damage children and silence opposition.  Behind the silence lie trade unionists and parliamentarians willing to sacrifice the health of children to protect their own position.

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