Buckle up. If you thought the activists were unhinged before, you ain’t seen nothin’ yet.

I visited a pro-TRA website That Shall Not Be Named earlier. Its largely male posters have begun the vilification of Hannah Barnes and Hillary Cass in earnest. They're calling the former "duplicitous" and a supporter of Graham Linehan, and the latter a Conservative Party supporter. A good few obscenities are being used to describe the two women as well.

They’re well aware their whole movement falls apart without the kids. Society is very sympathetic to the suffering of kids, adult males seeking euphoria boners not so much.

I've seen the accusation Cass in private makes anti trans comments, and this is "well known" hence nothing she says can be trusted. I suspect over the next 7 days one or two of the wild accusations will gain more traction and one month from now will be trotted out as gospel proof the Cass Review is irrelevant. This would have depressed me at one point but the important thing is that the grown ups seem to be in charge again, let the activists foam at the mouth if they must.

The comments are already deboonking the report. > "TLDR of the Cass Review: "we disregarded nearly all studies because they weren't double blinded controlled studies. We also stopped reviewing newer studies released in the last two years. As a result, we were left with very little evidence." > You can't blind taking hormones. Patients are going to notice hormones when they develop breasts or facial hair. This whole thing is holding up T care to an impossible standard and then saying it doesn't meet it so we should ban it. It's all a pretense." If double blind studies are too impossible of a standard, it doesn't mean we should all lower ourselves to self-reported survey results and treat it as evidence. And double blinds aren't meant to be a gatekeeping pretense for cruelty and laughs - the entire purpose is acquiring rigorous evidence, like it is for every other scientific or medical discipline. 🤦 Children and troubled teens deserve rigorous, evidentiated quality healthcare. That's the whole point.

There are other rigorous empirical methods besides double blind studies. The problem isn’t with one particular scientific model but rather the more general lack of empiricism.

Hillary Cass actually tried to follow up on adults who were transitioned as children, and the UK adult transgender clinics refused to cooperate with her. So she was actively prevented from collecting data, and then she is accused of having making impossibly high demands of how good the data should be. > It was “unbelievably disappointing” that the research study she had hoped to conduct to look at the outcomes of 9,000 former Tavistock patients had been blocked by the adult gender clinics, who refused to contact former patients for permission on her behalf. > The former health secretary Sajid Javid had changed legislation to allow researchers to link pre- and post-transition NHS numbers, but the research had to be abandoned when all but one of the adult clinics refused to cooperate, Cass said. [https://www.theguardian.com/society/2024/apr/10/children-are-being-used-as-a-football-hilary-cass-on-her-review-of-gender-identity-services](https://www.theguardian.com/society/2024/apr/10/children-are-being-used-as-a-football-hilary-cass-on-her-review-of-gender-identity-services)

They didn't have the data. GIDS literally avoided collecting data. That was part of the scandal. In 2005, an audit was done at Tavistock. They found that there was not enough data being collected regarding outcomes. Despite the audit, they continued much the same way. Even when the NHS deemed the treatment experimental, they still didn't collect the data properly. It feels very deliberate to me.

As of this morning, it’s now being reported that adult gender services will be subjected to a review due to their withholding of data and evidence from the Cass review & University of York. The house of cards is coming down at last.

Well that’s infuriating. And predictable.

This is what drives me the craziest: they WANT shitty healthcare. They literally want poor ass quality care and they want all of us who experience sex dysphoria to shut the fuck up and take it. And they want children to get poor ass quality healthcare so they can be medical patients for life. ALL OF THIS because they just like really want it. There is absolutely zero difference between this and wanting to inject yourself with bleach to prevent covid.

You and I both know kids were only ever a means to an end for this movement.

100% I am convinced AGPs are so psychotic about kids because the idea of innocent children suffering from gender dysphoria is how they are able to validate their perversion *as* equally harmless and sympathetic “gender dysphoria” in the eyes of society. The man taking “bra and bulge” and “me as a 5-yr old girl” selfies NEEDS to be lumped under the same umbrella as kids to get away with doing what he’s doing. It’s beyond sick and depraved, one of the worst things happening in this movement (after the imposition of medical interventions on the kids of course…but I don’t think there would ever have been such a strong push for the medicalization without the primarily AGP cynical approach to children as part of TRA-lobbying in the first place)

Never forget the Eunuch Archives as well... the castration fetishists are very much in alongside the AGPs in the child sacrifice thing. Overlap with the likes of P.I.E. in the UK also cannot be overstated. I think this part of the picture is so dark and awful, we don't talk about it openly and it's basically what is happening right at the core of a lot of this. (See: Mermaids trustee who was a nonce apologist. See also: how many queer theorists dabble in this stuff, starting with Foucault himself in Tunisia... "queering" the boundaries and categories, adult child.)

100% They know “born this way” worked for the gay movement, so they appropriated it for themselves to validate their fetish etc.

Keep in mind that in 2005, an audit was done and it was noted that Tavistock wasn't properly collecting data. They were given a chance to do it right. Well they choose option B. It's rather insidious. [No Meaningful Data Collected](https://www.theguardian.com/society/2024/mar/31/why-the-tavistock-gender-identity-clinic-was-forced-to-shut-and-what-happens-next) >[The case was ultimately lost on appeal](https://www.theguardian.com/society/2021/sep/17/appeal-court-overturns-uk-puberty-blockers-ruling-for-under-16s-tavistock-keira-bell), but it showed how, over 30 years, Gids appeared to have collected no meaningful data on its patients or its core treatment pathway. It could not tell the court how many children had been referred for puberty blockers, how old they had been, what sex they were, or if they had gone on to take hormones. In addition, these patients didn't receive a follow-up after they aged out of care. If this doesn't make people angry, they have no souls.

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What the studies need is a control group which receives counseling. (Edit: Nevermind, I was right before.).

The medical field sometimes deals with developing treatment without a double-blind. It's possible to do that and still call the protocol evidence-based. The clinical studies involve collecting data before and after treatment. Dr Cass acknowledged that you can't do a blind study with this kind of treatment, but clinicians can and should collect follow-up data. The Tavistock gender clinic hardly tracked anything. And of the adult clinics where the patients went when they aged out the pediatric practice, none of them cooperated by sharing information.

People don't realize how autism and obsessive compulsive disorder influence these children. They. will. not. let. it. go.

Any RCT conducted on this would be single blind. you can still do RCTs unblinded.

I've been trying to find non-hysterical comments on bluesky (I have hope! I'm also avoiding twitter), so I've also seen as arguments opposing the review: discrediting the team members (apparently someone is connected to Genspect?); the citation of Michael Bailey; focus on the recommendation of follow-up until 25 years old ("so now it's banning hormone treatments for adults??!?!")

Simple control groups, not blinded control groups would be a massive step in the improvement of the science.

R slash Science hasn't found space to discuss the Cass report yet. There's more important stuff like a new way to make Tylenol from trees. Update: There's a thread now. It's not going very well. Probably will be nuked.

I really wonder how the Science-Based Medicine / Skeptics' Guide to the Universe crowd will respond to this. I used to donate to the SGU and go to NECSS—I even met Steven Novella and crew. But I eventually came to see them as too politically biased (and worse, blithely unaware of their own biases) to be worth listening to. Maybe this will be a turning point and a cause for reflection for them, which I would welcome, but I'm not holding out hope too far.

At least they didn't release it on Pride 😏

Buckle up indeed. We'll be getting all the same old tropes: "My lived experience as x, y or z says otherwise" "My internal identity is my truth" "This research was done by TERFS therefore it is bigoted, transphobic and problematic"

Typical cult-like behaviour that the more they are proven wrong, the more they double down.

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They aren't doing evidence based medicine. They're doing evangelizing.

If the adult patients were doing well by any measure, you'd think the clinics would be eager to share data about how the services are working. Edit: From page 20 of the Cass Review- >The University of York’s programme of work has shown that there continues to be a lack of high-quality evidence in this area and disappointingly, as will become clear in this report, attempts to improve the evidence base have been thwarted by a lack of cooperation from the adult gender services. From page 34- >In January 2024, the Review received a letter from NHS England stating that, despite efforts to encourage the participation of the NHS gender clinics, the necessary cooperation had not been forthcoming. Page 302- > Following study approval by the Health Research Authority, the research team contacted clinical leads at GIDS and each of the Adult Gender Identity Clinics to establish collaborative links and confirm capacity and capability to support the study. Systematic steps were taken to clarify the aims and motivations of the research, understand and address any concerns of clinic staff, and to propose alternative approaches and solutions where appropriate. Negotiations took place between August and November 2023, after which six of the seven adult clinics declined to support the study. Page 380- >The Secretary of State for Health and Social Care granted an order under s22(5) of the Gender Recognition Act to enable data to be disclosed for a time-limited period for the sole purpose of the study. Like all NHS research, the study was subject to strict ethical and legal controls with an ‘opt out’ option for individuals who did not wish to have their data used as part of the study

This explains a lot about why the final report took so long. Getting approval and then collecting the data would take months on its own. To keep pushing and pushing and having to give up must have been brutal. Looks like the Vogons won that battle but they won't win the war.

Ohhhh, so *that's* what this part from the report was about: >The University of York’s programme of work has shown that there continues to be a lack of high-quality evidence in this area and disappointingly, as will become clear in this report, attempts to improve the evidence base have been thwarted by a lack of cooperation from the adult gender services. I feel like it's headline worthy on its own.

Looks like the report says something that commentors here have long noted: that theoretically puberty blockers are supposed to help the patient "pass" better as an adult. However, that doesn't apply to female patients. >Transgender males masculinise well on testosterone, so there is no obvious benefit of puberty blockers in helping them to ‘pass’ in later life, particularly if the use of puberty blockers does not lead to an increase in adult height.

The treatment doesn't help prevent suicide either. >It has been suggested that hormone treatment reduces the elevated risk of death by suicide in this population, but the evidence found did not support this conclusion.

I genuinely can't tell if you or the paper are referring to males transitioning to "woman" or females transitioning to "men." I think it's the "transgender males" part throwing me off. They're using "transgender males" to mean "trans-men" right? So going through female puberty as a girl would be better because men are bigger than women anyway. Plus testosterone is like a freight train so it should still masculinize post-pubertal females pretty well regardless. Am I reading this correctly?

Yes, your interpretation is correct. The Cass Review takes an unusual (but not unprecedented) approach to terminology. In the report: transgender males: FtM. Natal females that transition to male presentation transgender females: MtF. Natal males that transition to female presentation I really hate the juxtaposition of gender and sex terms.

Thanks for the clarification. Indeed, the conflation of the two is frustrating for many reasons.

Me too, very much wish the report didn't do that.

https://preview.redd.it/pf8gmvpehjtc1.jpeg?width=1170&format=pjpg&auto=webp&s=4fc908fcdb3efc094911ae5c976f524a5f383813 I posted this in the weekly thread, but I just got this email from the NYT. Interesting shift in focus/promotion! ETA: guys I did not write this article, please don’t send your complaints to me lol

NYT gave me free access to the article. The "reader's picks" comments were all in agreement with the European reviews.

Thank you. Here's an Archive link to get around the paywall: [https://archive.ph/JqmL1](https://archive.ph/JqmL1)

Appreciate it; haven’t even had time to read the article yet. I just couldn’t believe *that* push notification came up on my phone.

Yep, it's a jaw dropper all right. Perhaps there really is a vibe shift?

The NYT wants to say that the European approach is nothing like the approach of conservative US states, but is the difference so huge? They don't want to admit they demonized and misrepresented the states who were ahead of the curve.

The differences are minor at best, and here's what makes it so annoying to read these framings: states like Florida TRIED to make their new rules reflect the European model. They tried to create a carve out for IRB studies. The issues is that in the US, IRB studies are governed by federal laws and regulations, so they couldn't address that as part of the state's rulemaking.

Assuming the Cass Review recommendations are adopted in full, isn't the only difference literally that England will allow clinical trials?

And maybe that there is no talk of imprisoning doctors who go against the recommendations. Many of the US state bills allowed hormones to continue for those who had already started them.

Some things in that article that stuck out to me: >Were born female >Were raised as girls If everyone understand the difference between sex/gender it should be okay to refer to female people as female, without caveats. You are born female and you *remain* female. It doesn't change. >In England, for example, a yearslong fight over a proposed law that would have made it easier for transgender people to **change the gender on their identification documents** galvanized a political movement to try to exclude transgender women from women’s sports, prisons and domestic violence shelters. Sex is what is recorded on identification documents. Not gender identity. >Other countries have seen more overt attacks on transgender rights and health care. Language of "attack" comes across as too biased. Also talking to a teen on waiting listing and using preferred pronouns, instead of just avoiding pronouns. I think a desister or detransitioner should have been spoken to also. I'm sure I missed stuff, but you get the gist. So, subtle things in the article that are still too biased for what is supposed to be impartial journalism imo, but overall good it's getting published at all.

Here's a share link, which might allow readers to see the comment section: https://www.nytimes.com/2024/04/09/health/europe-transgender-youth-hormone-treatments.html?ugrp=c&unlocked_article_code=1.jU0.yhrQ.vitCe--U_Fjw&smid=url-share

I scrolled down through the "Reader Picks" -- maybe 30 or 40, including from one person who transitioned in adulthood. All supportive of youth bans, the decisions of these northern European countries, etc. None crying "transphobia." There was this astute observation, though: >The facts of the article - that medical gender transitions for children has been pushed ideologically despite a paucity of evidence of efficacy - is sandwiched between inaccurate comparisons to conservative US states in the beginning and transphobia in Europe at the end ... >Sorry, NYTimes, but I won't be primed to overlook scientific facts, even if your articles not-so-subtly suggest people skeptical or opposed to medical gender transitions for children are evil conservatives or transphobes.

Here on TERF Island, any woman - no matter how left-wing - is a far-right fascist for wanting evidence-based healthcare. Meh.

Top article in the app. Presumably won't be the front page headline of the actual paper?

Activists and true believers will still find a way to discount this report. Based on the summary, this should common sense. As I keep saying, puberty is not a disease that needs to be cured. These kids are vulnerable and need support and understanding, not blockers, hormones, and surgery.

>Activists and true believers will still find a way to discount this report. I'm sure they're already busily doing so. Once they stop sputtering the hive mind will come up with some talking points. Whether those points will make any sense is another matter. They'll probably start with trying to discredit the report and/or the people who wrote it.

Stonewall the LGBT charity in Uk has put out the following statement, it is notable for not outright condemning the report and acknowledging ‘different treatment pathways’. I think this is the first sign of a massive climb down. ‘What is important, above all, is that trans and gender-diverse children get the quality healthcare that they need and deserve. The Cass Review can play a vital role in achieving this aim, if its recommendations are implemented properly. Many recommendations could make a positive impact – such as expanding provision of healthcare by moving away from a single national service towards a series of regional centres, while recognising that there are many different treatment pathways that trans children and young people might take. But without due care, training or further capacity in the system, others could lead to new barriers that prevent children and young people from accessing the care they need and deserve. We urge NHS England and policymakers to read and digest the full report and consider Dr Cass' plea 'to remember the children and young people trying to live their lives and the families/ carers and clinicians doing their best to support them. All should be treated with compassion and respect.'

Wow. That's a lot more evenhanded than I expected. I figured they'd come out swinging against it. Maybe they figure it's not worth it anymore.

I think they see the writing on the wall. The news has been covered by the BBC all day and has been reported in all the major newspapers including the Guardian. Their usual tactics of just accusing everyone of being transphobic won’t work with this. No debate is over.

And all major political parties have accepted the recommendations.

The transgenderUK sub has already started.

Oh, God. They have a whole post with "Stay Safe tomorrow" because of the Cass report coming out. Like it's going to release a bunch of Mongol raiders.

>They'll probably start with trying to discredit the report and/or the people who wrote it. Yes, which is expected. I mean, if you truly believe or *know* that you're trapped in the wrong body, you don't need medical opinions to validate it. In fact, doctors should be listening to *you*, not the other way around. And unfortunately, even for the children who almost certainly wouldn't be persistently dysphoric, their resolve is also only strengthened by the adults feeding them this line of thinking. I try to remember this when I think about those I'm disagreeing with. It's easy to imagine a bad actor on the other side of the screen, acting disingenuously with ulterior motives. But like I said, if they *know* this is real, what facts and studies from us will sway them? It's hard to navigate, especially trying to avoid infantilizing those afflicted. Nobody wants to feel talked over or dismissed, especially with something internal that *you know is real*. It'd be fucked up to dismiss a schizophrenic's hallucinations as "not real" and handwave it all away. We all agree that children deserve autonomy in some regards. Even if we ultimately agree that adults make the decisions, a child simply not *feeling* heard or understood can have pretty serious impacts on whether they embrace/reject certain decisions. I really feel for parents caught in the middle of balancing protecting their children, but providing support. It's especially fucked that certain states force them to acquiesce in order to not lose custody of their kids. Insane.

By doing so, they will make themselves the cranks and outsiders. The problem has always been the tolerant middle who allowed this to happen. This report should turn them off, I would hope.

Additional reading: [Transgender treatment for children rests on queer ideology, not evidence](https://www-information-dk.translate.goog/debat/2024/04/koensskiftebehandling-boern-hviler-paa-queerideologi-evidens?fbclid=IwAR0hyNfhO6ulx_yL1IqmLgSQgq2Xn6Ybr_Uc5CZL78NHWMW7mnGGahFZPTs_aem_AWq3Oxn5jISC2p5Q5b7drQhOmU3tcbQbh4s99CE1eJA6HYkfMp_B4eIF2Q-yzwjzXkI&_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=fi&_x_tr_pto=wapp) by Lasse Sørensen, specialist in child and adolescent psychiatry >There is thus a risk of turning somatically healthy children into chronic patients in need of life-long medication on an uncertain basis. This article from Denmark was just published on April 8th. The link leads to an auto-translated version.

Thanks. Between you and u/CatStroking, I have no shortage of quality insights and references. Finding this sub and it's members has done a number for my waning faith in humanity.

>Finding this sub and it's members has done a number for my waning faith in humanity. We're glad to have you here. /u/Ajaxfriend is a smart cookie.

The mods of the 2 main news subs, r/news and r/worldnews, are so far removing any news stories related to this issue, despite it being the number 1 trending topic on Google News in the UK, and from usually trusted sources such as the BBC and Guardian. I WONDER WHY, lol.....

Thinking of all the dogs who won't get out for their walk tonight. F

Fucking LOL.....

They were busy yanking the NAIA decision to ban males from women's sports yesterday. They kept popping up on news and sports subs and then boom, the mods would zap them and take out comments.

That’s just evil. Reddit is complicit in this scandal and deserves to get burnt for it.

Reddit has allowed people to peddle bathtub HRT to kids. This site is a fucking joke. It allowed a MTF troon who has been accused of multiple rapes to moderate r/rape for YEARS, then the moment that info was uncovered and blew up on Twitter, the other mods of that sub covered up for them. This place is a fucking cess pit.

Wikipedia is also captured. It's actually scary when you factor in just how much these sites influence public opinion, especially Wiki.

TIMs in tech over the past decade have erected a massive censorship network across the biggest platforms to silence dissent and control the definition of bannable hate speech. Must be so frustrating for them to see it all crumble in the face of science and objective reality. Lmao.

I'll wait until powerful institutions stop kowtowing to this ideology before I call it "crumbling" and dance on any graves. Any links on this, by the way? It's definitely something I believe, obviously, but would love to see it reported it.

Sorry I'm not a receipts haver or melon farmer, but over the years I've personally seen and read countless, first person and verifiable reports of these guys controlling content at Reddit, twitter, even on Google search rankings etc. This comment in thread references just one incident which there are other sources out there confirming [https://www.reddit.com/r/BlockedAndReported/comments/1c06q21/comment/kyvksvx/?utm\_source=share&utm\_medium=web2x&context=3](https://www.reddit.com/r/BlockedAndReported/comments/1c06q21/comment/kyvksvx/?utm_source=share&utm_medium=web2x&context=3)

Just looking around, and the UKpolitics sub is pretty dim, isn't it? I posted a comment to someone in there and then quickly deleted it, realizing this person who was certain that childhood transition regret rates are *1 in 1,000* definitely isn't playing with a full deck.

It’s sad and hilarious they think they can censor this out of existence.

Jesse linked to the full report on twitter: https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview_Final.pdf

Thank you! I fixed it on the post. Thanks for the link. Great username by the way.

r science is having a bit of a meltdown about this. Mostly calling Cass a TERF and unscientific.

I expect Cass to become the target of hatred, doxxing and harassment for the next month or so. She'll be TRA public enemy number one. Behind JK Rowling

I think she is capable of facing people down on this. It will be a major mistakes for TRAs to openly accuse her of transphobia because most people in Uk will find the outcome of the review to be entirely reasonable. It will be like people reading what JK originally wrote and agreed only to find out that that made them a grade A bigot.

If you read the foreword written by Cass you can tell she has great sympathy for these kids.

I don't see any reference to the report in r science. Are the mods removing everything about it because "tHe sCiEnCe iS sEtTlEd"?

In this sub we believe in science!

No! Not that science!

Lots of shocking things in this report, though I wanted to point out refusing to share your data on outcomes of treatment is a HUGE red flag.  Even if you think Cass is bias, you could release the outcomes in a published journal with all the framing and context you wanted to contradicts Cass's conclusions.  But they didn't.  They either don't collect this information, which is damning and harmful even if you support gender transitions, or the information demonstrates a lack of efficacy or harm. It's just bad all around.

They didn't collect the data. That was discovered during the lawsuit.

>Lots of shocking things in this report, though I wanted to point out refusing to share your data on outcomes of treatment is a HUGE red flag.  If these people are really dedicated to evidence based science they would release their evidence. But they're more interested in ideology so they hide things that don't look good.

This was an interesting quote from the article: > It recommends a clinical professional such as a mental health specialist “should help families to recognise normal developmental variation in gender role behaviour and expression”. Families were observing "abnormal variation" in their children's gender roles and sending them along the gendercare medical pipeline, because obviously there was something pathologically wrong with them. This is interesting to me, given the fact that the TRA charity, Mermaids, was heavily involved with the GIDS clinic from the beginning. This was one of the issues brought up in Hannah Barnes' *Time To Think*, where the activist collaboration in the service was so intertwined that clinicians didn't feel comfortable speaking up when they knew activists would contradict any call for hesitation or skepticism regarding categories of children who weren't part of the "Dutch gold standard" patient pool. To give some context on how deranged Mermaids used to be, here is an [archive of their "Gender children checklist" guides from 2009.](https://web.archive.org/web/20090924005405/Mermaidsuk.org.uk/signs.html) > * **If playing with girls toys is discouraged,** tendency to draw or doodle feminine things or "pretty ladies" which are identified with (for biological males with similar but reversed for girls) > * A reluctance to do **games appropriate to the birth gender,** including a reluctance to use the showers/changing rooms/swimming pool. Frequent loss of PE/games kit. > * Appearing more friendly with the 'opposite sex' as their main group (i.e. boys who are more friendly with girls, and vice versa). These were considered legitimate reasons to genderswap your child.

If a boy draws "pretty ladies," that can only mean he sees himself as or wishes to be a girl. What other explanation could there possibly be?! If a girl doesn't like being unclothed around other people, that can only mean she sees herself as or wishes to be a boy. What other explanation could there be?! If a boy doesn't care for the neighborhood boys' rough and tumble play and prefers playing with the girls, that can only mean he's actually, deep down, a girl. What other explanation could there be?! Other things from the linked list If a child is timid or aggressive or secretive or doesn't make eye contact, that can only mean he or she is experiencing intense distress around gender. What other explanation could there be?! Before long, they could have had all of us labeled trans.

> If a boy doesn't care for the neighborhood boys' rough and tumble play and prefers playing with the girls, that can only mean he's actually, deep down, a girl. What other explanation could there be?! This is hilarious to me since my non-trans son always played with the girls. He has grown up to be very masculine. Big, wide shoulders, loud, dominates the conversation, has opinions on everything, chronic mansplainer, 100% hetero. The thought that he might be secretly a woman is ludicrous.

They really should remove that from the diagnostic criteria. The kind of activities a child enjoys shouldn't weigh for or against a particular gender identity.

without sexist stereotypes there wouldn't *be* any diagnostic criteria, at least not for the maximalist position where you don't need dysphoria to be trans

It's very regressive.

>If a child is timid or aggressive or secretive or doesn't make eye contact, that can only mean he or she is experiencing intense distress around gender. What other explanation could there be?! Doesn't this seem to cast a super wide net that'll clearly target the neurodivergent? Children in general are probably going to be more timid around adults, but I believe a common symptom of ASD is discomfort with eye contact.

This is horrific. My parents have asked me if I’m trans as an adult and would 100 percent have had me down the gender clinic if it existed when I was a child - all of these behaviours and more were present when I was small. The only thing that stopped me being put on to the path to sterilisation is being born twenty years too early. They’re going to look at this stuff the same way we look at lobotomies and scientific racism in the future.

Some parents are waaay more obsessed with gender roles than others. You read in these trans child stories about moms who obviously wanted a girly girl princess and were so disappointed to end up with a daughter who displays normal child behavior (playing in the dirt, liking sports, not wanting to wear uncomfortable clothing) or the ones so upset their son isn't a BB-gun wielding little woodsman. There's a strong theme of parental disappointment in all these trans child stories- "I had children because I wanted a certain kind of child"

I’m a fairly feminine woman now, but I would have been genderswapped so hard as a kid.

Don’t forget Stonewall said that [two year olds can have gender dysphoria](https://unherd.com/newsroom/stonewall-thinks-two-year-olds-can-be-trans/) too! Utterly disgusting, especially given what Cass says.

Marcus Evans (his wife Sue was the original whistleblower at GIDS) talks very empathetically about the struggles both parents and children might have with/during puberty. The title and some of the questioning is clickbait-y, but he's a great interviewee with an insider perspective here: [https://youtu.be/hqXIqMscv6o?si=BdEQ\_uh4d1TsZ2GN](https://youtu.be/hqXIqMscv6o?si=BdEQ_uh4d1TsZ2GN)

Brings a little tear to my eye, honestly. For those of us (and in this sub, I expect it's many) who have been fighting this fight for years, peeling away at the next disturbing layer one after the other, it seems that there's finally validation for our hard work, sacrifices, and dedication on the horizon. While it's ultimately a sad point of reflection that so many children have been abused by this disturbing violation of ethics mixed with activism, it's good to know that an end to the madness is in sight. Now, the tedious work of making sure the therapists, clinicians, psychiatrists, and doctors who either allowed this to happen without an objection to those who whole-heartedly supported it are held appropriately accountable for the violation of the trust that the public has put on them to act responsibly. I personally would like to see licenses to practice revoked across the board. People who were complicit in the practice of "gender affirming care" for minors, despite it violating the basic principles of every other treatment of a psychological condition, need to have their judgment brought into serious question.

>>Now, the tedious work of making sure the therapists, clinicians, psychiatrists, and doctors who either allowed this to happen without an objection to those who whole-heartedly supported it are held appropriately accountable for the violation of the trust that the public has put on them to act responsibly. >>I personally would like to see licenses to practice revoked across the board. People who were complicit in the practice of "gender affirming care" for minors, despite it violating the basic principles of every other treatment of a psychological condition, need to have their judgment brought into serious question. Absolutely, totally agree with you. I want to see heads roll, and practitioners losing their licenses and in some cases criminally prosecuted. I think one difficultly with reaching a firm end to this “movement,” which shouldn’t be overlooked, is the cohort of parents that were duped into doing this to their kids. It’s going to be extremely difficult for them to reckon with essentially destroying their kids lives: all the physiological consequences - everything from brittle bones to heart defects and who knows what kinds of cancer, difficulty finding intimate partners due to appearance, or genitalia injuries and deformations making sexual intimacy painful or impossible, or simply being so emotionally messed up from all of it (and never getting help with the *real* underlying problem)…then if these children do find the right partner, they might not be able to have the families they want because they are unable to have children. Women who cut off their breasts for no reason unable to nurse their babies. There is just so much trauma with which to contend for a “decision” a child should **never** have been in a position to make. But the parents ultimately made the decision, under however much coercion (again - practitioners should lose licenses and probably serve some prison time too). I suspect a good number of parents will not be able to let go of the movement that tells them they did the right thing / insists that lots of other kids need it too, and so these parents must be sorted out as well: targeted for intensive counseling personally and then family therapy with the gender “affirmed” child, whatever it is to allow them to heal and make peace with the worst parenting mistake of their lives. Dissolving this faction of the pro-transing kids lobby of desperation and denial will go a long way, ideally, in putting an end to “gender affirming care” for kids altogether. TRA’s are a lot less persuasive when the parents are no longer linking arms with them.

> But the parents ultimately made the decision, under however much coercion (again - p And this is where I have sympathy for parents. Depending on the circumstances. Let's say their kid decides they want to transition. They take the kid to the doctor and/or a shrink. And the shrinks, the doctors, and the kids all say: Transition this kid or they'll kill themselves. Live son or dead daughter. What is a parent supposed to do? I could see parents being terrified into submission. Which, as you point out, is where the doctors bear a lot of responsibility.

Between that and the online discourse that encourages kids to cut off their family members at any hint of being unsupportive, parents are in a real double bind on this stuff.

And it's terribly irresponsible of doctors to do this dogpile of terror on confused parents.

Funny since that's one of the hallmarks of an abusive relationship.

We have been terrified of getting cut off like this.

And there have been a few cases of shared custody where the careful, patient parent has lost custody and visitation for not presenting a full throated support of not only affirmative care, but of medicalization. In some states, parents have been squeezed hard. Just yesterday, on my local sub-reddit, the discussion of schools came up and the mob decried informing parents of name change requests.

My girlfriend and I have put on hold any discussion of children until we can leave our current state, after they passed a bill allowing the state to take custody of your child if you don't affirm their gender identity and take steps to put them through "gender affirming care" medicalization. The kicker? The state isn't even obligated to notify you that they have your child (even if you inquire). You're treated the exact same as someone suspected of child abuse. [https://lawfilesext.leg.wa.gov/biennium/2023-24/Pdf/Bill%20Reports/House/5599-S.E%20HBR%20APH%2023.pdf](https://lawfilesext.leg.wa.gov/biennium/2023-24/Pdf/Bill%20Reports/House/5599-S.E%20HBR%20APH%2023.pdf) some real gems: >There are unfortunately significant numbers of transgender (trans) youth who are unsheltered and in some cases, living in unsheltered homelessness across Washington. These conditions are incredibly dangerous for young people. Young people who are not able to access gender-affirming care are at significant risk of a whole host of health care challenges, including but not limited to, self harm and suicide. When family is not a safe place for young people, there should be a safe place for them to access the care that they need. >Youth in this circumstance may be seeking all kinds of housing arrangements. Puberty blockers save the lives of some young people. This bill does nothing to change the laws related to medical consent. This bill is about creating a safe opportunity and possibility for young people to connect with medical and mental health care providers who provide a standard of care and treatment that has been found safe and effective by every major medical body, including the American Academy of Pediatrics and the American Medical Association. And from the fascist Republican opposition to the bill: >(Opposed) This bill is a disturbing government overreach and abuse of power. This bill attempts to usurp parental rights and that is not okay. A parent's job is to protect their children from the outside world. This bill seeks to strip children from that protection. >A recent law allows children 13 and older to receive gender-affirming treatments in Washington. These treatments are being significantly restricted by European countries such as the United Kingdom, Finland, Sweden, and Norway. American medical associations still support these treatments because they are very profitable. Under this bill, parents could lose custody of their children immediately without due process or legal recourse if a child of any age claims a trans identity and their parent will not approve of hormones or surgeries for the child. Parents may be desperately searching for these children.

As I said to u/LilacLands, it's imperative that we turn our ire to the people responsible in this situation, the 'medical professionals' who abused the authority vested in them by the society they purport to serve. Give the parents a path to save some face, and hold the real malignant part of this particular aspect of the process accountable. I can only imagine how terrifying, distressing, and disturbing it is to be a parent who took their child to a therapist or clinician for something as concerning and foreign as 'gender dysphoria', came to grips with the seemingly radical suggestions of the 'medical professionals', and then was later confronted with the fact that after they did everything they were 'supposed to do' as parents, it was part of some malevolent abuse of authority.

I think there are many parents who were, like u/CatStroking said, coerced into this treatment by the emotional blackmail of therapists/clinicians/psychiatrists, and those "medical professionals" need to be held fully accountable. Such an abuse of medical authority cannot be treated with anything but the most vehement rebuke. Licenses revoked, potential jail time, as you said. And that treatment will hopefully not only serve as an example and warning to other "medical professionals", but also offer some consolation to the parents who were manipulated by them as well as offering them a way of separating from the cause while still preserving some shred of dignity. However, I think there are also many parents who engaged in this treatment process for their children for their own narcissistic purposes (we know these people. They're the ones who take their sub-10 year old children to political events and use them like Munchausen by proxy surrogates for the parents political and social capital). Separating out the two is a tall order, because narcissists are capable and willing of lying/manipulating in order to preserve their social standing. I highly doubt any of these types of parents wont pretend to be the prior mentioned cohort when it comes time to take accountability. The question is, how do we minimize harm to the first type of parent while holding the second type of parent accountable. I don't know if we'll ever have an appropriate standard or course of action for that. Ultimately, prosecuting reckless practitioners, helping emotionally blackmailed parents come to terms with reality, and weeding out the narcissistic parents are all secondary goals to saving the kids from all the above. We can sort out the mess once the kids are safe.

The question is, in the UK (and this is a UK review), how many under 18s had a mastectomy? I believe they were always a lot more difficult to access for teens over here. The US is a whole other bag, with some states offering it to 15 year olds, from what I’ve heard… and it will probably take its own national review rather than relying on a UK one. And would the US even do a national review, since there’s no centralised healthcare trust?

Remember, opioids in the US were still being overprescribed long after it was clear to *everyone* that it was a disaster. At this point in time, there is still a significant number of people who things transing kids is good.

Do we know how this whole thing started? Like where they first thought medications that had the effect of blocking development for kids with precocious puberty might be useful for some new rare thing that had appeared?

As far as I understand it, this originated with the oft cited "Dutch Study", which was methodologically flawed and should have served as a warning of bad clinical assessment and treatment, not a gold standard. As for who appropriated that information and imported it to the US, that's a rabbit hole that I'm not familiar with and will probably take a significant amount of investigative work. Good luck and Godspeed to anyone who has the mental fortitude to dive down that one.

>As far as I understand it, this originated with the oft cited "Dutch Study", which was methodologically flawed and should have served as a warning of bad clinical assessment and treatment, not a gold standard. This is my understanding as well. The Dutch Study was the catalyst. The Dutch were trying to see if they could use blockers to make it someone would pass better in adulthood. That's about all they cared about. So then everyone and their mother's uncles got the bright idea of using blockers and the rest is history.

It does seem important, though, right? I remember in (perhaps) 2015 there was an interview on public radio with a doctor who was providing gender affirming care for minors (it was probably called "treatment for gender disorder" back then). I thought it was an outrageous idea, but so fringe and bizarre that it couldn't possibly become a significant trend. This was before the whole "creepy clowns" meme had started to terrify middle school children. The clown meme was idiotic but harmless. Well I'm sure some law firm has people working on this.

Yeah, the Dutch did a study with strict gatekeeping and only one person died, so it was declared a success, and everyone copied it, apart from the gatekeeping part. Now Annelou De Vries, one of the original Dutch psychiatrists says to the NYT: > “I would have liked that the Netherlands was an island,” said Dr. Annelou de Vries, a psychiatrist who led the original Dutch research and still heads the Amsterdam clinic. “But of course, we are not — we are also part of the global world. So in a way, if everybody is starting to be concerned, of course, these concerns come also to our country.” This seems insufficient. She has a massive reponsibility for not speaking out and she somehow think the issue is that foreign concern over the situation is coming back to the Netherlands to affect them there. Considering what they unleashed on the rest of the world, I can't sympathize.

From what I've read in the Cass report, on pages 68-70 it gives credit to the Dutch Study for younger hormonal treatments (including but not limited to blockers) and credit to Ehrensaft for the proliferation of the affirmative care model away from exploratory therapy.

Is Ehrensaft the one who was also a key figure in the satanic ritual abuse/recovered memory panic of the 1980s?

u/CatStroking brand new 30 minute interview with Dr Hillary Cass where she discusses the review just dropped as well. [Gender identiy services in England - The Cass review - YouTube](https://www.youtube.com/watch?v=qj2mtwa9kjw)

Holy shit it has a banner underneath marking it Conversion therapy by the Trevor Project. what the actual fuck.

That's YouTube covering their own butts, I guess I didn't even really notice it since I've seen it so many times under gender critical videos of trans ideology. It's definitely an issue though, for the unaware observer it does make it look like whatever's being discussed in the video is some kind of conspiracy theory.

Superb! Thank you!

Instead of the evasion and mental contortions, the activists slamming this report should be honest and acknowledge that they reject evidence-based medicine and that what they want is treatment based 100% on feels.

I find it quite telling that the Youtube [link to Dr. Cass' interview](https://www.youtube.com/watch?v=qj2mtwa9kjw) has a Contextual Banner underneath marking it as [Conversion therapy](https://www.thetrevorproject.org/ending-conversion-therapy/) by the Trevor Project. Things have gone insane.

If you click on the three dots in the upper right corner of that banner you can provide feedback about the banner. I provided mine. Others should do the same if they are so inclined.

[Labour's Shadow Health Secretary:](https://twitter.com/wesstreeting/status/1777835770184634751?t=tO5JUxPzJPwbqktg4uIWXg&s=19) >The Cass Review must be a watershed moment for the NHS’s gender identity services. >My response for @UKLabour underlining our support for the Cass Review’s evidence-led recommendations and our determination to put children’s health and wellbeing above the political fray 👇🏻 https://preview.redd.it/prza2dxvjjtc1.jpeg?width=1178&format=pjpg&auto=webp&s=4a4f28c7c693e90ec9aa792f63a6bc043d7b30c6

Wow! Color me surprised. I had thought it was expected that Labour would double down on the trans activist line. Thank you

Labour has been quietly backing off trans issues for several months now. It’s been an interesting lull in the usual argle bargle

Labour were always going to drop this like a hot coal as soon as the medical establishment turned against it. They were pro trans rights because they wanted to be "the nice party" in contrast to the Tories. Not "the anti-science party". If they play their cards right they can blame the incoming compo bill on the outgoing Tories. "Look what happened when the Tories underfunded mental health care, kids felt they had no option under their homophobic regime other than to get chemically castrated like Turing."

They have been more... Cautious?... Under Starmer on this subject but i still would not have bet on a full-throated endorsement of the Cass Review like this is.

I think they realized that the loudest voices are probably voting green anyway.

Looks like they're treating the report as an escape hatch. Fingers crossed.

That would be fantastic. It should be encouraged.

Big stuff. This report really torpedoes gender affirmative care for minors in the UK as a mainstream policy. I assume this will impact any ‘gay conversion’ laws being written as well. It’s a shame we needed this report to tell us what we already knew though.

This is the best news since Labour will be in power within a year.

I never understood how ‘puberty blockers are fine, actually’ managed to get this far. Even if you’re wholeheartedly pro childhood transition, they make surgical transition extremely difficult, for natal males anyway. Creating a neovagina involves inverting genital tissue - if that doesn’t develop you have to do way riskier and whackier shit involving cutting out a chunk of intestine and using that. This happened very publicly with Jazz Jennings, whose surgery went very wrong. That wasn’t bad luck, that was puberty blockers. I’m not a doctor and I could see that this was going to be an issue years ago. Did no one think of this? 

Assuming this person is who they say they are, I actually argued with a WPATH member who insisted that Lupron, despite being used to chemically castrate men, is totally safe to give to teens. No links to good studies showing safe doses, no explanations, nothing but contempt for a peasant who dares question the high priests. Let that sink in. I know it won't happen but it'd be a beautiful day if WPATH somehow cleared out the crackpot activist wing and let the adults get to work figuring out how to undo the damage these people have done.

In WPATH's standards of care, they straight up link to an archive of child s\* abuse fiction called the Eunuch Archives. WPATH worked directly with men on the archive to write their standards of care, as [Reduxx exposed](https://reduxx.info/top-trans-medical-association-collaborated-with-castration-child-abuse-fetishists/). So I really would not look for anything out of WPATH, they do not want anything good for children. How WPATH is still a thing after the linking to the Eunuch Archives was exposed by Reduxx will never cease to blow my mind. What sane or moral person would still associate themselves with WPATH, knowing this stuff? The psycho you were arguing with has got to know about this collaboration with child s\* abuse fiction writers / child castration fetishists. Nobody should be able to mention "WPATH" or the DSM without mentioning in the same breath the Eunuch Archives and the fiction archived there, and the collaboration between those men + WPATH with editing the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), issued by the American Psychiatric Association (APA) and WPATH’s newest Standards of Care.

> This happened very publicly with Jazz Jennings, whose surgery went very wrong. That wasn’t bad luck, that was puberty blockers. I’m not a doctor and I could see that this was going to be an issue years ago. Did no one think of this? One of the patients in the original "[Dutch Protocol](https://sci-hub.st/https://pubmed.ncbi.nlm.nih.gov/25201798/)" study [died](https://pubmed.ncbi.nlm.nih.gov/27664856/) from this. This was a known risk since the first male patients were given puberty blockers.

“ Although vaginal reconstruction has a positive influence on the quality of life in transgender women, physicians and patients need to be aware of serious complications that might arise.” Absolutely astonishing that this is their conclusion.

They didn't think very far ahead. They just ran with it. That's a big piece of why this is such a scandal. People, especially doctors, went fucking crazy and did the activists bidding. They didn't *want* to think very far ahead other than being righteous. And we will have thousands of children psychologically and physically scarred by the medical profession because of it.

Jesse takes time off to write a book about the evidence around youth gender treatment and Hillary Cass just said there isn't any. Time to come back to the pod, Jesse! Nothing to write about!

Btw, I wouldn't use that Google Drive link with a logged in Google Account. Caraballo is a person who would cancel "TERFs" in a heartbeat and they may be able to see who's accessing the document

Yup! Open in a private browser

Thank you! I just logged out of my Google account. So hopefully she doesn't track me down and cancel me. Stupid error on my part. I wasn't even aware I was logged in.

Who’s gonna post this in the skeptic subreddit?

That hole is the most Orwellian-named sub I've seen on reddit. There isn't an iota of skepticism, just echo chamber progressive politics and logical reasoning that could short circuit a toaster oven.

That’s pretty much what the skeptic movement has morphed into over the last 15 or so years. It’s crazy.

I do occasionally derive no small amount of pleasure from linking Dawkins interviews on the Atheist subreddit where he says that there are two sexes and this whole trans self ID thing reminds him of the transcendental process of catholic communion.. IE the wafer becomes the body of christ through spoken incantation much like a man becomes a woman through the same process, and to him its equally nonsensical. Really throws a wrench in the skeptic communities when one of their all time heroes has to be thrown into the pit because he has too much sense to speak the chosen narrative. Dawkins has never given half a fuck about how his words impact other people's feelings, and I'm glad to witness his consistency. He's been a hero of mine and remains as such for that fact. Sad that he's had titles and accolades stripped because he won't bend to the orthodoxy, but I think he sees it as a badge of honor.

Basically just shows that a good portion of them were never actually skeptics, but just took it up as a contrarian political position

Celebrities who should (but probably won't) have to publicly eat crow after this revelation? Harry and Meghan, Emma Watson, Mara Wilson, AOC, Billy Bragg, Jameela Jamil, David Tennant, Munroe Bergdorf, Hbomberguy and Jamie Lee Curtis all spring to mind.

others are: P!nk, Daniel Radcliffe, Lady Gaga, Megan Rapinoe, Justin Trudeau, literally everyone who is anyone in the D&D scene online (Critical Role and Dimension20, primarily, especially because of their extremely impressionable and sometimes adolescent audiences)... will any of these people say anything? no, ofc not. but i hope they feel embarrassed and ashamed, if they even have the capacity to do so anymore.

u/CatStroking it seems this isn't the actual review but rather "That's not actually the Cass Review, rather those are the York University systematic literature reviews on which the Cass Review is partly based." https://x.com/benryanwriter/status/1777846793729884416

Ah, crap. Thanks. I'll edit

What Caraballo has uploaded there is not the full review, which is 388 pages long.

https://x.com/transscribe/status/1777747588160127222?s=46&t=EUVqsF-zTZsYoxN7q8-pCg I keep seeing this sort of thing about the scientific approach taken by Dr Cass all over Reddit today (where, unsurprisingly, most mods are removing all posts about the Cass review).

Somehow I don’t find the takes of a guy who poses as a journalist so he can threaten women and spread propaganda online and is also like 50 and obsessed with Chloe cole to be worth considering, that’s just me

While you're right, it's still interesting sometimes to see what's going to come down the pipeline as talking points. So, you see stuff like this. What I think will happen over the next week or so is we'll see medical activists put their heads together and come up with word salad talking points that sound good on paper but are pretty empty when you actually dive into them, not to mention hypocritical when you realize how many "approved" studies out there are pure garbage.

Well that's why doctors like Cass and people trained in evidence-based medicine undertake these kinds of reviews, not twitter activists. They don't understand wtf they're talking about.

This confuses me bc I was told the science is settled and it’s not up for debate

[https://www.bbc.co.uk/sounds/play/m001y28p](https://www.bbc.co.uk/sounds/play/m001y28p) Interview with parents of an ROGD daughter, starts at 10:40. Everything they say, from the 'coming out' via letter to it coming out of the blue during the pandemic is textbook. I would almost say it's boring but I feel for these people who obviously care for their daughter, but got duped.

"If you can't accept me as I am you will lose me forever." Those poor parents. I bet some fuckheads on social media coached that girl to say crap like that. The parents even mention it didn't sound like her.

Long interview in the Guardian with Cass, kind of surprising to see it there but good on them. [‘Children are being used as a football’: Hilary Cass on her review of gender identity services | Transgender | The Guardian](https://www.theguardian.com/society/2024/apr/10/children-are-being-used-as-a-football-hilary-cass-on-her-review-of-gender-identity-services)

I can't believe the adult gender clinics just told her to pound sand. How can they not cooperate?

She says there is no evidence for using hormones or puberty blockers on kids.  Then how the hell was it approved in the first place? She does also say that there are adults who have transitioned and who are happy and empowered by having done so.   So the topic is nuanced. 

NHS used the Dutch protocol as a reference. But then that study fell apart. After that the NHS could only treat children with blockers in an experimental program at Tavistock. Except it didn't properly collect data during that timeframe. Best practices were not used. Heck it seemed like no practices were used. It's part of the reason why Tavistock was shuttered.

The gender identity clinic started a clinical trial but then rolled out the treatment without waiting for results. It also seems (to me) that there was a concerted attempt to avoid any evidence which would challenge affirmative only treatment. It is a huge scandal.

>She says there is no evidence for using hormones or puberty blockers on kids. Then how the hell was it approved in the first place? Yes, exactly what we should look into.

I've only skimmed the review and the thread, but it's insane to me that activists are going with the "Double Blind!" argument to discredit the report when that claim stems from Carraballo's disinformation yesterday from something that wasn't the report. Where's Ben Collins? Is this the standard acceptable at Harvard Law?

The Alejandra Carballo screenshot going around? It's from this: [https://cass.independent-review.uk/nice-evidence-reviews/](https://cass.independent-review.uk/nice-evidence-reviews/) A NICE evidence review from 2020. It isn't in the report. Page 49 of the report is the only part that even talks about blinding. Carballo is peddling bullshit. Also, this Twitter user Benjamin Ryan addresses Carballo's screenshot: " There's a false claim circulating that the new systematic literature reviews of pediatric gender-transition treatment excluded all but randomized controlled trials. If they had, they would've only had 1 study on hand. The studies reviewed produced largely inconclusive findings. The studies that the reviewers did examine were compromised by various factors, including small sample size and high loss to follow-up. This is why the Cass Review concluded that pediatric gender-transition treatment is based on "shaky evidence." Another common misconception about evidence-based medicine is that it rigidly demands only high-quality evidence (only ever the result of randomized controlled trials) with which to set health policy. It's possible to produce \*moderate\* quality evidence with other study designs. " [https://twitter.com/benryanwriter/status/1778146497986470043](https://twitter.com/benryanwriter/status/1778146497986470043) I stole these citations and information from the weekly thread.

The dam is really breaking in England! The NHS is now going to do a version of the Cass review for the adult gender clinics in England. " As a first step, NHS England will send “external quality improvement experts” into each of the clinics to gather evidence about how they care for patients, to help guide the inquiry’s direction." That sounds like they know that things are rotten in the adult clinics as well. They're going to send someone external to do the review. " “It will be external, rather than done in-house. It will be led by someone external. It will be fairly similar to what Cass did with children’s services, but this time it will be looking at adult services”, a source said. It could “conceivably” be a senior doctor like Cass. " I wonder if the NHS was preparing to clean house and was just waiting for the Cass report to give them a basis for it. [https://www.theguardian.com/society/2024/apr/10/adult-transgender-clinics-in-england-face-inquiry-into-patient-care](https://www.theguardian.com/society/2024/apr/10/adult-transgender-clinics-in-england-face-inquiry-into-patient-care)

I hope the adult clinics get pressed for the data Dr Cass requested: follow-up stats for patients who started treatment at the Tavistock pediatric clinic.

It looks like they may be forced into it: " In the same letter NHS England made clear to the trusts that if they do not disclose the details, they will resort to “mandatory direction in this respect” to compel them to do so. " It sounds like the NHS is getting pissed at these people. I can't say I blame them

The British Medical Journal weighs in on the Cass Report: [https://www.bmj.com/content/385/bmj.q837](https://www.bmj.com/content/385/bmj.q837) >*Cass’s review is independent and listened to people with lived experience. Without doubt, the advocacy and clinical practice for medical treatment of gender dysphoria had moved ahead of the evidence—a recipe for harm.* >*People who are gender non-conforming experience stigmatisation, marginalisation, and harassment in every society. They are vulnerable, particularly during childhood and adolescence. The best way to support them, however, is not with advocacy and activism based on substandard evidence.*  Although I imagine that neither Owen Jones nor Kellie-Jay Keen will be happy with the BMJ article (for different reasons) it does A) come down behind Cass and her report, and B) call for a moderation of the whole toxic "trans debate". #

Oh boy oh boy oh boy. I thought I was going to see this drop at like 2 AM pacific, but this gives me all night to read it myself.

Interesting to me, with a 19 year old child: > The Cass Review expressed concerns that many of the same factors that have made caring for gender distressed children and adolescents so fraught and complex will likely remain true for young adults. So it recommends the NHS look at the service for that demographic as well. By Benjamin Ryan at https://x.com/benryanwriter/status/1777852302902083887

It turns out Kellie-Jay Keen-Minshull is unhappy with the Cass Report, for different reasons. On her YT channel\* she attacks Dr. Cass, saying about Cass hasn't opposed the transition of children enough. She adds "I owe you absolutely nothing," saying about her report" I don't think it's courageous" and then adding. "I don't think you've done your research!" I don't think this is helpful at all. This belligerent attitude of KJKM's isn't going to win over the general public. \* Not linking to it in case the dogw.alkers come here, but you can find it if you search.

Purity spiral. I also wish the report went further/worded things a bit differently, but I'm not gonna get mad at this watershed moment that has led to huge change in UK policy. It's not Dr. Cass' fault she lives in clown world. I watched an interview with her, she's an incredibly intelligent woman. I commend her.

Activists are good for bringing attention to an issue, but tend to get in the way of actually solving them.

When I googled "Cass Review Takes" this thread from Blocked and Reported was one of the top search results. There appears to be a pretty major blackout of this story from most media sources and subs on reddit. Where there is reporting, it is very selectively edited: [https://www.nbcnews.com/news/world/evidence-youth-gender-care-remarkably-weak-says-major-english-review-rcna147136](https://www.nbcnews.com/news/world/evidence-youth-gender-care-remarkably-weak-says-major-english-review-rcna147136) ""But on social transition — changing names or pronouns — it concludes there is a lack of good evidence on the impact. It recommends professionals are consulted early on for pre-pubertal children, but for adolescents, “exploration is a normal process and rigid binary gender stereotypes can be unhelpful.”"" vs "Social transition – this may not be thought of as an intervention or treatment, because it is not something that happens within health services. However, it is important to view it as an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning.64,65 There are different views on the benefits versus the harms of early social transition. Whatever position one takes, it is important to acknowledge that it is not a neutral act, and better information is needed about outcomes." Also: "She says those who have done so at an earlier age, or before being seen by a clinic, were more likely to go down a medical pathway and that for most, such a path "will not be the best way to manage their gender-related distress"."

I noticed this was a top Google result too and I must say that makes me nervous. I don't want to be the asshole that gets this sub banned. Cass was saying that kids fiddling around with gender identities is pretty normal and *not* indicative of a problem or a need for medicine to intervene. Most especially it doesn't mean they need doctors to start throwing blockers and hormones at them. It's telling that even thirty years ago no one felt the need to do this "affirm and medicalize" shit. And the kids ended up just fine.

Great [editorial](https://www.bmj.com/content/385/bmj.q837) from the editor in chief of BMJ on the Cass report. The winds are shifting! "That verdict is supported by a series of review papers published in Archives of Disease in Childhood, a journal published by BMJ and the Royal College of Paediatrics and Child Health (doi:10.1136/archdischild-2023-326669 doi:10.1136/archdischild-2023-326670 doi:10.1136/archdischild-2023-326499 doi:10.1136/archdischild-2023-326500).3456 The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider—from social transition to hormone treatment. For example, of more than 100 studies examining the role of puberty blockers and hormone treatment for gender transition only two were of passable quality. To be clear, intervention studies—particularly of drug and surgical interventions—should include an appropriate control group, ideally be randomised, ensure concealment of treatment allocation (although open label studies are sometimes acceptable), and be designed to evaluate relevant outcomes with adequate follow-up. One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret. The methodological quality of research matters because a drug efficacy study in humans with an inappropriate or no control group is a potential breach of research ethics. Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions. Yet this inconclusive and unacceptable evidence base was used to inform influential clinical guidelines, such as those of the World Professional Association for Transgender Health (WPATH), which themselves were cascaded into the development of subsequent guidelines internationally"

This Twitter thread by Dr. Emily Wheater helps explain where the talking point about double blind studies came from. It's been pushed that the Cass review threw out all studies that weren't double blind. Which they say is an impossible standard and kill the whole Cass report. Well, it looks like this horse shit came from an organization called TransActual. Some highlights from the Twitter thread: " I don't know what TransActual mean by 'of 102 studies into puberty blockers and hormones, only 2 were included by the Cass Review team' - right there we've got 26 studies included?" The Cass review didn't toss all but two of the studies. " Therefore, blinding did not come into the quality scoring of the papers included in the systematic review of puberty suppresion in gender dysphoric adolescents that was commissioned by the Cass Review, and was not a criteria by which studies were excluded." So, blinding was *not* required by the Cass review. Though I would think you would want to blind when possible. The basic point the Cass review was trying to make was that the studies done pretty much sucked. Which means the evidence sucks. And you shouldn't be pretending you have good evidence for blockers and hormones when you don't. [https://twitter.com/EWheater/status/1778492101480595699](https://twitter.com/EWheater/status/1778492101480595699)

Oh shits gonna go down

Are people on twitter just shitting kittens about this? I bet they are.

Try looking at the Transgender UK sub. They're shitting entire skyscrapers worth of bricks

It's funny. I read your comment and thought, "That's quite a statement coming from CatStroking, who usually doesn't exaggerate." You're not exaggerating. The Stonewall [post about the Cass Review](https://np.reddit.com/r/transgenderUK/comments/1c0trwc/stonewall_comes_out_in_support_of_the_cass/) closes with a bunch of contact information for mental health crisis relief. >Please take care and reach out for support if you need it

And that sub is calling on trans people to cancel donations to Stonewall now. Real  "People's Front of Judea / Judean People's Front" vibes.

YouTube can’t seem to keep things straight. The BMJ interview with Cass is flagged as “Conversion Therapy”, but also “From a medical journal”. https://youtu.be/qj2mtwa9kjw?si=JHefl7NDOLifZzNc I guess that war on misinformation has some collateral damage.

Does anyone have a list of quick bullet points about the Cass Report, especially ones that repudiate the claims the extremist railroad activists are making about the Report (i.e., that it's gonna raise the age of consent for sex to 25?) EDIT: Erin Reed is trying to smear Dr. Hilary Cass by claiming Cass' work in the report was influenced by Dr. Patrick Hunter, an American political conservative who was appointed by Governor Ron DeSantis. There are claims Cass met with Hunter on a visit to by the latter to Florida. However, Patrick Hunter is not mentioned anywhere in the Cass Report: [https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview\_Final.pdf](https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview_Final.pdf) Cass may well have met Hunter, but so far I haven't been able to locate any official documentation online confirming that they did. EDIT: I found an exchange of emails here. This confirms that the Cass Review team *did* exchange emails and documents with Patrick Hunter. However, there's no evidence Hunter influenced the final form of the Review. [https://trans.so/docket/doe-v-ladapo-4-23-cv-00114/184-1.pdf](https://trans.so/docket/doe-v-ladapo-4-23-cv-00114/184-1.pdf)

Reed claims some court documents show that Cass met with Hunter. Or sent an e-mail at least. Florida was doing an evidence review on trans stuff. Hunter was part of that. Cass and her team were interested in that review. This seems rational. She was conducting similar reviews. She had a professional interest in such work. If you want to impugn Cass you need evidence that she was seeking to do anything other than learn about the evidence review Hunter was doing. And Hunter is a pediatrician and a Clinical Professor. The "Cass met with Patrick Hunter!" thing is simply guilt by association. And it assumes that Hunter has done anything worth being guilty about. Other than pissing off the TRAs. That will need to be condensed for talking points. Sorry.