‘This must stop’ Dr Cass says the toxicity of the trans debate made the work of her review harder

Dr Hilary Cass said the “toxic” transgender debate made the work of her review harder. The paediatric consultant said the report, which she has been working on for four years, resulted in her being “criticised” by all sides of the debate for considering the other’s viewpoint. Dr Cass said the “toxicity of the debate is exceptional” in the foreword of the long-awaited report. She said there were “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”. Dr Cass, the former president of the Royal College of Paediatrics and Child Health, began her review into children’s transgender health services in January 2020. Her final report, published more than four years later, came with a plea for the toxic debate to come to end. “This must stop,” she said. “Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional,” she wrote. “I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution.” An underlying theme of the Cass review is the vast amount of missing evidence available from which to draw any conclusions, including the use of powerful puberty blocking drugs and other hormone treatments, as well as social transitioning – where children are allowed to use the pronouns of their preferred gender, dress accordingly, and choose which facilities such as toilets and changing rooms to use - and other interventions. “This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint,” she said.