A leading pediatrician has warned that guidelines for giving powerful hormone-disrupting drugs to children who want to change gender are “outdated”, following a major review into the safety of puberty blockers.
Dr Hillary Cass, a renowned British doctor, whose landmark ‘Cass Report’ succeeded in restricting puberty blockers in the UK, said US guidelines on treating gender-confused children are ‘misleading’.
Their report, a systematic review of 300 scientific articles and surveys on gender-affirming care that included more than 113,000 children from 18 countries, concluded that the evidence on medication use in transgender children was of “poor quality” and “not reliable”.
Based on her findings, the pediatrician believes that American medical organizations that offer recommendations for the treatment of trans youth “should be honest about the strength of the evidence” supporting the use of puberty blockers in minors and make improvements to their guidelines. .
Dr. Hilary Cass’ landmark review of studies on puberty blockers in adolescents with gender dysphoria went against the standard orthodoxy held by American medical groups, which she says are out of step with the science. .
A YouGov poll conducted in 2023 among 1,000 adults in Republican and Democratic states found that Americans were largely against gender affirmation procedures for children.
The Cass Report It ran counter to the conclusions of American medical groups like the American Academy of Pediatrics, which he told the New York Times was a “pretty left-wing organization” whose guidance is “misleading the public.”
In an interview with TimesDr. Cass criticized the general orthodoxy among medical groups in the US, particularly that which tells doctors to take what teenagers say about their gender dysphoria at face value, hastily setting them on a course of lifelong, and potentially irreversible, medical treatments without examining the whole person.
She said, “You can put someone on a medical path, but if they end up not being able to leave their bedroom, not having relationships, not being in school, or ultimately not working, you have nothing to do.” They didn’t do the right thing on their part.
“So it’s really about treating them as a whole person, taking a holistic approach, managing all of those things and not assuming that all of them arose as a result of gender distress.”
Dr. Cass’s influential review said two things could be true at once: A widespread “social contagion” of gender dysphoria and social acceptance has encouraged more teens to come out as trans.
The landmark review was commissioned by the UK’s National Health Service, which has taken a much more conservative stance when it comes to transitional care for young people compared to the United States, going so far as to ban puberty blockers. for teenagers.
Published last month, The report concluded that in the vast majority of cases, while puberty blockers are intended to give the child more “time to think” about their gender identity and what they need, “no changes in gender dysphoria or body satisfaction”.
She said: ‘Evaluation of studies looks at questions such as: are they followed for long enough? Do they lose many patients during the follow-up period? Do you have good comparison groups?
‘All of those evaluations are really objective. The reason the studies are weak is because they failed in one or more of those areas.
The United States has been accused of lagging behind other countries when it comes to gender-affirming care.
In the United Kingdom, Sweden, France, Australia, and the Netherlands, the use of puberty blockers is restricted to minors, but in the US there are no age limits.
Puberty blockers were originally developed to suppress the hormones of minors who began puberty too early, but in the US they are prescribed off-label to people seeking to make a gender transition.
Advocates say they save lives for a suicide-prone group, but critics say puberty blockers taken too young are dangerous and suggest therapy and counseling instead.
In the United States, groups like the AAP have called this type of care medically necessary.
But Dr Cass added: ‘They are an organization for which I have enormous respect. But I respectfully disagree with them about holding on to a position that has now been shown to be outdated according to multiple systematic reviews.’
Following her report, Dr. Cass received immense criticism and even threats. One of the most common complaints was that the review was biased toward a certain conclusion due to a lack of randomized controlled trials, the gold standard for study design that randomly assigns groups to a treatment or a placebo to compare the two.
But they are difficult to pull off when it comes to studying gender-affirming care, in part because of ethical concerns about depriving a group of youth with gender dysphoria placed in the placebo group of what they say, It is necessary medical attention.
It would also take researchers years to collect usable data on the long-term physical and mental health effects of puberty-delaying medications and hormone therapies to give trans youth secondary sexual characteristics, which have been shown to be irreversible.
Dr. Cass said she did not omit randomized trials because there were none to include in the first place. However, they still included about 58 percent of the studies they identified on the topic, which were of moderate quality or better.
High-quality studies have been peer-reviewed, include a subject population that represents a general population, and reach conclusions that match the evidence.
Very little is known, he said, about the long-term effects of puberty blockers and subsequent hormone treatments. By delaying puberty, a teenager also delays brain development to some extent during a crucial time in her life.
A study by University College London earlier this year looked at 25 girls treated with puberty blockers and found there was an average seven-point drop in their IQ.
Dr Cass said: “I can’t think of any other situation where we provide life-changing treatments and don’t understand enough what happens to those young people in adulthood.”
‘I’ve spoken to young adults who are clearly thriving – a medical path has been the right thing for them. I’ve also spoken to young adults where they made the wrong decision, where they regret it, and where they abandoned transition.’
Diagnoses of gender dysphoria are increasing across the country.
Data from 2020 showed that about 300,000 children ages 13 to 17 (1.4 percent) in the U.S. identified as transgender.
That’s double the estimated number of transgender people in 2017 in a previous report by the same researchers, although they used different estimates.
Overall, there were an estimated 1.6 million transgender people in the United States in 2020, up about three percent from the estimate of 1.55 million in 2017.
A report from the health data analytics firm shows that the rate of gender dysphoria increased in every state except South Dakota from 2018 to 2022.
Greater social acceptance and greater awareness of the disease on the part of doctors may partly explain the increase in cases.
Dr Cass said: “Young people growing up now have a much more flexible view on gender – they’re not trapped in gender stereotypes like my generation was.”
‘And that flexibility and fluidity are potentially beneficial because they break down barriers, combat misogyny, etc.
“It only becomes a challenge if we are medicalizing it, giving it irreversible treatment, for what might just be a normal range of gender expression.”
