Many answers missing about transgender youth
It’s become impossible to speak rationally, without denunciation and vituperation, about the transgender debate. Toxicity is rife at both ends of the spectrum.
Trans activists are over the top, demonizing and cancelling and TERF-ing (trans-exclusionary radical feminism) anyone who questions the wisdom of aggressive, sometimes irreversible intervention.
Political conservatives have exploited the unease around not just transitioning gender but biological men using women’s dressing rooms, washrooms, participating in women’s sports, and placed in women’s prisons and halfway houses — the latter especially traumatizing for women who’ve been sexually assaulted by men. Right-wing rhetoric goes much deeper as well, routinely focusing on — tormenting — people who are the process of transitioning or have already transitioned.
But the primary consideration, underscored by what should be respect and kindness for all, is the potential harm being done to children and adolescents when so little is known — the peer-reviewed literature scant, the long-term effects unclear — about the physical, psychological and emotional impact on transitioning youth who’ve identified as trans and undertaken treatment that ranges from puberty blockers to surgery.
There is a troubling void here about what works and what might be dangerous, precisely because the supporting science is weak and disputed.
This is at the core of an exhaustive and rigorous report, led by British pediatrician Dr. Hilary Cass — past president of the Royal College of Paediatrics and Child Health — commissioned by the U.K.’s National Health Service, released this week.
“The rationale for early puberty suppressions remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health,” says the Cass Review. It recommends that children wishing to transgender should be given more “holistic” treatment, including screening for autism (a disproportionate number are on the autism spectrum disorder) and a broader mental health assessment.
The review was commissioned in 2020 after the number of adolescents who’d presented to the NHS Gender Identity Development Service — run by a trust and shut down last year after some clinicians within the organization reported their fears that patients were being referred too quickly to gender transitioning — began to rise rapidly and dramatically. The number of patients seeking trans treatment had soared from about 50 in 2009 to nearly 1,800 in 2016, to 5,000 in 202122 and, before the GIDS was shuttered, 5,800 children were on the waiting list, according to the NHS. The swell was largely driven by patients raised as girls.
Research by England’s University of York, run in tandem with the review, found evidence was “severely lacking” on the impact of puberty blockers and cross-sex hormones, while the majority of clinical guidelines were found not to have followed international standards. In fact, most of the gender dysphoria clinics to which patients from GIDS were moved refused to provide any of their data for the Cass Review. NHS has now demanded it all be turned over and the clinics instructed to end appointments for everyone under age 18.
“The adoption of a treatment with uncertain benefits without further scrutiny is a significant departure from established (medical) practice,” states the 388-page Cass Review. “There are few other areas of health care 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.”
The report says the boom in adolescents seeking to change sex can’t be explained alone by the fact that trans identities are now generally more accepted by the (western) world at large, though this, the report attests, is a large part of it. It argues that the surge must be analyzed in the context of a boom in mental health problems among young British people in the past decade, a constituency ill-served, while youth have been inundated by trans-promoting messaging on social media and YouTube videos being absorbed particularly by generation Z and generation Alpha (those born since 2010), who’ve grown up with “unprecedented’’ online lives.
“Biology hasn’t changed and adult biology hasn’t changed in the last few years,’’ Cass said in a BBC interview Wednesday. “So it’s not that that’s changed things. I don’t think that young people today are being exposed to more abuse, or trauma or so on, than previous generations. We do have to think very seriously about the impact of social media.’’
According to the report, girls spend many more hours using social media than boys — three or more hours a day by 43 per cent of them, compared to 22 per cent of boys. This might go a long way toward explaining why the explosion in youth seeking to transgender is exponentially higher for “birth-registered” girls presenting in their early teens, many experiencing mental distress, anxiety and depression associated with body image, at a time when they are struggling with changes brought on by puberty onset.
Many, in fact, later desist, says the report, identifying as lesbian, non-binary or asexual.
Cross-sex hormones, says the review, should be provided only to children over 16 and even then, with “extreme caution.” As Cass concludes, it is essential to guard against “the creep of unproven approaches in clinical practice.”
While puberty blockers were promoted by the trans community and some medical organizations as providing an opportunity for youth to press pause on gender-maturing characteristics — giving them time to explore their identity — the review found no evidence that blockers improved a youth’s body dysmorphia or body image. Rather, there was concern about treatments “built on shaky foundations” that “may change the trajectory of psychosexual and gender identity development.”
Primum non nocere. First, do no harm — the Hippocratic Oath.
A new review in the U.K was commissioned in 2020 after the number of adolescents seeking gender transitioning treatment began to rise rapidly and dramatically