A leading pediatrician has warned that guidelines for giving powerful hormone-disrupting drugs to children wanting to change sex are ‘out of date’, following a major study into the safety of puberty blockers.
Dr. Hillary Cass, a renowned British doctor whose groundbreaking ‘Cass Report’ led to puberty blockers being banned in Britain, said US guidelines for treating gender-confused children are ‘misleading’.
Her report, a systematic review of 300 scientific articles and surveys on gender-affirming care involving more than 113,000 children from 18 countries, concluded that the evidence for the use of the drugs in transgender children was of “poor quality” and “not reliable.”
Based on her findings, the pediatrician believes that U.S. medical organizations making recommendations for treating 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’s groundbreaking review of studies on puberty blockers for teens with gender dysphoria flew in the face of the standard orthodoxy of American physician groups, which she believes are out of step with the science.
A 2023 YouGov poll of 1,000 adults in Republican and Democratic states found that Americans largely opposed gender-affirming procedures for children
The Cass Report went against the conclusions of American medical groups such as the American Academy of Pediatrics, which she told the New York Times are a “fairly left-wing organization” whose leadership “misleads the public.”
In an interview with the TimeDr. Cass criticized the common orthodoxy among physician groups in the US, especially that which tells doctors to take what teenagers say about their gender dysphoria at face value, and rushes to prescribe them a course of lifelong – and potentially irreversible – medical treatments without investigate its consequences. complete person.
She said: ‘You can put someone on a medical path, but if at the end of the day they can’t leave their bedroom, can’t have relationships, can’t go to school or ultimately can’t work, then you haven’t done that. They didn’t do the right thing.
“So it’s really about treating them as a whole person, taking a holistic approach, keeping all these things under control and not assuming that they all came about because of the gender issue.”
In Dr.’s influential review Cass argued that two things can be true at once: widespread “social contagion” of gender dysphoria and social acceptance has driven more teens to come out as transgender.
The landmark review was commissioned by the UK’s National Health Service, which has taken a much more conservative stance when it comes to transition care for young people compared to the US, even going so far as to ban puberty blockers for teenagers.
Published last month, the report Although puberty blockers are intended to give a child more “time to think” about their gender identity and what they need, in the vast majority of cases it was concluded that “no changes in gender dysphoria or body satisfaction were demonstrated.”
She said: ‘Assessing studies looks at things like: are they following up long enough? Do they lose many patients during the follow-up period? Do they have good comparison groups?
‘All those assessments are really objective. The reason the studies are weak is that they failed in one or more of those areas.”
America has been accused of falling behind other countries when it comes to gender-affirming care.
In Britain, Sweden, France, Australia and the Netherlands, puberty blockers are not allowed for use on minors, but in the US there are no age limits.
Puberty blockers were originally developed to suppress the hormones of minors who entered puberty too early, but in the US they are prescribed off-label to people who want to change gender.
Proponents say they are lifesaving for a group prone to suicide, but critics say puberty blockers taken too young are dangerous, and suggest therapy and counseling instead.
In the US, groups such as the AAP have called this type of care medically necessary.
But Dr. Cass added, “They are an organization that I have tremendous respect for. But I respectfully disagree with them when it comes to adhering to a position that has now been shown by multiple systematic reviews to be outdated.”
Following her report, Dr. Cass received major criticism and even threats. One of the most common complaints was that the review reached a certain conclusion due to a lack of randomized controlled trials, the gold standard for research design that randomly assigns groups to a treatment or a placebo to compare the two.
But those are difficult to implement when it comes to studying gender-affirming care, in part because of the ethical concerns about depriving a group of gender-dysphoric youth placed in the placebo group of what they believe is necessary health care.
It would also take researchers years to gather useful data on the long-term physical and mental health effects of puberty-delay drugs and hormone therapies that give trans youth secondary sex characteristics, which have been shown to be irreversible.
Dr. Cass said she didn’t abandon randomized trials because there weren’t any to include in the first place. Yet they still included about 58 percent of the studies they identified on this topic that were of moderate quality or better.
High-quality studies are peer-reviewed, include a population of subjects that represents a general population, and draw conclusions that are consistent with the evidence.
According to her, too little is known about the long-term effects of puberty blockers and hormone treatments later. By delaying puberty, a young teenager also delays brain development to some extent during a crucial period of his life.
A study conducted by University College London earlier this year looked at 25 girls treated with puberty blockers and found that their IQ dropped by an average of seven points.
Dr. Cass said: ‘I can’t think of another situation where we are giving life-changing treatments and not having enough insight into what happens to those young people in adulthood.
“I’ve talked to young adults who are clearly doing well; a medical program was the right choice for them. I’ve also talked to young adults where it was a wrong decision, where they regret it, where they transitioned.”
The number of diagnoses of gender dysphoria is increasing nationally.
2020 data shows that approximately 300,000 children between the ages of 13 and 17 (1.4 percent) in the U.S. identify as transgender.
That’s double the number estimated to be transgender in 2017 an earlier 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, about three percent more than the 2017 estimate of 1.55 million.
A report from the health data analytics company found that rates of gender dysphoria increased in every state except South Dakota between 2018 and 2022.
Greater social acceptance and greater awareness of the condition among doctors may partly explain the increase in cases.
Dr. Cass said: ‘Young people growing up now have a much more flexible view of gender – they’re not stuck with gender stereotypes like my generation.
“And that flexibility and fluidity are potentially beneficial because they break down barriers, combat misogyny, and so on.
“It only becomes a challenge when we medicalize it and provide an irreversible treatment for what may be a normal form of gender expression.”