An overdue reckoning
THE DANGER OF PUBERTY BLOCKERS FOR KIDS HAS NEVER BEEN MORE CLEAR
THE UNSCIENTIFIC “AFFIRMATIVE” MODEL OF CARE REMAINS POPULAR IN CANADA AND IS PROBABLY HARMING CHILDREN. — ADAM ZIVO
Alandmark 400-page report published in the U.K. earlier this week has confirmed that, in most cases, gender-diverse youth should not be given puberty blockers, hormones or sex-change surgeries. British policymakers are now further restricting access to these interventions and investigating the nation’s adult gender clinics, which is a wise approach that Canada should follow.
The government-commissioned report, which was authored by retired pediatrician Hillary Cass after four years of investigative work, concluded that the evidence base for transitioning youth is “remarkably weak” and that the entire field of pediatric gender medicine is “built on shaky foundations.”
For example, of more than 100 studies examining the effects of puberty blockers and hormones on minors, only two were found to be of acceptable quality.
Globally influential treatment guidelines, such as those produced by the The World Professional Association of Transgender Healthcare (WPATH), were also found to “lack developmental rigour” and were described as “not evidence-based.”
Cass found no evidence that the effects of puberty blockers are fully reversible or that their use provides youth with “time to think” before moving onward to cross-sex hormones. In reality, blockers directly put minors at risk of sterilization and permanently reduced bone density, and pausing puberty seemed to only lock-in pediatric gender dysphoria, as 98 per cent of youth who initiated blockers progressed to sex hormones.
While activists claim that gender-distressed youth kill themselves if denied hormones and surgeries, Cass found no evidence that this was true. This validates concerns that some transgender activists use the fear of suicide to emotionally blackmail parents into unnecessarily transitioning their children, before time has had its chance to offer clarity.
There was also “no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence.”
However, as social transition appears to influence a child’s gender trajectory, Cass recommended that any such transitions should be supervised by a clinical professional as early as possible.
This implicitly rebutted the practice, now common among some schools, of socially transitioning children without parental knowledge or medical supervision.
Cass noted that puberty blockers, hormones and sex-reassignment surgeries were rarely used for youth before the 2010s. Until then, patients seeking these interventions were typically natal males who had shown signs of gender dysphoria from early childhood and were, for the most part, mentally stable.
Research on these youth was scarce, although one Dutch study seemed to show that medical transition was beneficial for this population.
But then the number of gender-distressed youth exploded and clinicians found themselves swamped with patients who abruptly self-identified as transgender in their adolescence, despite showing no early childhood signs of dysphoria, as detailed by Cass. Many of these patients came from troubled backgrounds and had concurrent mental health concerns, or developmental conditions such as autism.
In some cases, it was suspected that these patients were falsely identifying as transgender to cope with trauma or internalized homophobia, or, alternatively, were over-interpreting normal confusion that comes with growing up.
Cass noted that, based on the findings of the single aforementioned Dutch study, the use of hormones and sex-reassignment surgeries was normalized among these new patients, even though their needs clearly differed from those of their predecessors. Clinicians automatically “affirmed” these youth and, ignoring their complex mental health problems, rapidly initiated medical transition.
Clinicians did not wait for the release of stronger evidence in support of these treatments, and then ignored emerging studies which suggested that medical transition was unhelpful. As a result, some patients received substandard care.
“The adoption of a treatment with uncertain benefits without further scrutiny is a significant departure from established practice,” wrote Cass, who believed that many youth were “let down” by systemic failures.
Her report noted that online misinformation about transition has been prevalent, “with opposing sides of the debate pointing to research to justify a position, regardless of the quality of the studies.”
“There was, and remains, a lot of misinformation easily accessible online,” wrote Cass, who noted that some of this content “describes normal adolescent discomfort as a possible sign of being trans and that particular influencers have had a substantial impact on their child’s beliefs and understanding of their gender.”
Cass ultimately recommended that access to medicalized transition be limited to small clinical trials, with long-term dysphoria being a prerequisite for treatment. Instead of automatically affirming patients’ transgender self-identification, she encouraged health-care providers to holistically address patients’ mental health so that they receive the same standard of care as any other distressed youth.
In a recent interview with The Guardian, Cass noted that her research into gender care, though wide-ranging, had been partially blocked by the U.K.’S adult gender clinics, who refused to contact former patients on her behalf. All but one of these clinics also refused to share data on patient outcomes with the government, which Cass described as “co-ordinated” and “ideologically driven” obstructionism that left her “unbelievably disappointed.”
England’s National Health Service appears to have accepted Cass’ findings and recommendations and, in light of attempted obstructionism, is now commissioning a new inquiry into adult gender care, which officials say will be comparable in scope to Cass’ investigation.
According to Canadian endocrinologist Roy Eappen, Canadian policymakers should pay close attention to the Cass report, as the unscientific “affirmative” model of care remains popular in Canada and is probably harming children.
“I think that we really need to go over what we’re doing now and go with the science,” he said this week.
For years, activists around the world, including in Canada, claimed that the science on pediatric transitions was “settled” in favour of blockers and surgeries.
But that was untrue, and we need to recognize that lest we leave children irreversibly harmed.