The Cass report and Britain’s unforgivable puberty blockers scandal

British children who identify as transgender have been let down badly by a National Health Service that succumbed to an activist lobby.

That is the obvious conclusion to make after Dr. Hilary Cass published her final report this morning as part of the Independent Review of Gender Identity Services for Children and Young People.

In her report, Cass suggests that there is a serious lack of evidence about the long-term impact puberty blockers and other cross-sex hormones are having on children.

While the original rationale for puberty blockers was to give children “time to think” about transitioning, the report dismantles this argument, pointing out that the “vast majority” of children move from puberty blockers to cross-sex hormones, and:

…there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.

Despite this, the report says researchers could find no evidence that puberty blockers improved children’s body dysmorphia or body image.

The medicalization of children who might simply have been distressed by the idea of puberty and growing up is a scandal of epic proportions

Cass concludes that most young people should not be going down the medical route if they have gender-related distress, adding that for young people “for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems such as family breakdown, barriers to participation in school life or social activities, bullying and minority stress.”

She argues that the treatment of children with “gender-related distress” should be “more closely aligned with usual NHS clinical practice that considers the young person holistically.”

The days of NHS England handing out puberty blockers and cross-sex hormones to children — some of whom had complex needs — is hopefully behind us. These children need support, not unquestioning affirmation. The stakes are enormous, as Cass indicates.

The medicalization of children who might simply have been distressed by the idea of puberty and growing up is a scandal of epic proportions. Never before have doctors told children they could press pause on puberty, and never before have children — or in some cases, their parents — demanded it.

Of course, not all children who were caught up in this mess were prescribed puberty blockers and cross-sex hormones — many more were “socially transitioned.” That could mean children wearing clothes normally worn by the opposite sex, or changing their name, perhaps coloring their hair, and then demanding that everyone uses a different pronoun for them.

Cass discussed social transitioning in her interim report two years ago. It was “not a neutral act,” she said, but an active intervention that “may have significant effects on the child or young person in terms of their psychological functioning.” These are actions with consequences, and she now adds:

When families/carers are making decisions about social transition of pre-pubertal children, services should ensure that they can be seen as early as possible by a clinical professional with relevant experience. [my emphasis]

This may mean that school policies on social transitioning need updating. Much attention has been given to the outrageous decisions of schools to keep parents in the dark about their children transitioning. One mother from the West Country, for example, told the Telegraph that she only discovered her daughter had been allowed to change gender at school when teachers called her “he” at a parents’ evening. In other cases, however, parents are very much aware of what is going on and may even be driving their children’s cross-sex identification. Those cases may cause an even bigger headache for policy makers, who have placed a large emphasis on the view of parents.

When a distinguished former president of the Royal College of Paediatrics and Child Health makes these recommendations, lessons need to be learned, and not just by the NHS. The doctors, teachers, parents — and indeed politicians — who facilitated this outrage need to wake up to the damage that is being done to the next generation. This is not a drill; children are still being harmed.

This report focuses on NHS services which, quite frankly, are already broken. But private practice cannot be ignored either.

This sector desperately needs reining in, but the travel seems to be in the opposite direction. In January, the Care Quality Commission approved yet another private gender clinic that can prescribe hormones to those over the age of sixteen.  GenderGP — another private clinic — is unrepentant on this. Responding to updated NHS specifications, the clinic announced that it would “continue to provide puberty blockers and gender-affirming hormones to patients who need them.”

The Cass report relays the concerns of the Multi-Professional Review Group, established in 2021 following concerns about the Gender Identity Development Service. The MPRG noted the number of children who had commenced private puberty blockers and pointed out that:

Private providers do not follow the prescribing, administration and investigation/ monitoring protocols agreed and followed by the NHS.

The law needs to step in and prevent giving puberty blockers and cross-sex hormones to children distressed about their bodies — whoever is footing the bill. That should mean all young people under the age of eighteen. Sixteen is too young for treatment. If it is illegal to sell cigarettes or fireworks to sixteen- and seventeen-year-olds, then surely the same restrictions should apply to drugs that can disrupt their development and leave their bodies with permanent damage.

Overseas clinics are hardly likely to change their ways in response to UK laws, however. In the United States the elevation of “transgender youth” seems to have become a matter of faith within the Democratic Party. Last month, Joe Biden proclaimed that the Department of Justice has “taken action to push back against extreme and un-American State laws targeting transgender youth and their families.” The man appears to have lost the plot.

Cass wisely recommends that:

The Department of Health and Social Care should work with the General Pharmaceutical Council to define the dispensing responsibilities of pharmacists of private prescriptions and consider other statutory solutions that would prevent inappropriate overseas prescribing.

We need to protect British children from Biden administration-esque folly. It is already illegal to take British girls overseas for female genital mutilation. Perhaps those who source puberty blockers and cross-sex hormones from elsewhere in the world for children need dealing with in a similar way?

With a general election looming in the UK, Rishi Sunak has a choice. He can do what is right and expedite legislation to protect children or prevaricate and leave it to his successor. Keir Starmer struggles to define a woman; would he really have the bottle to stand up the LGBTQ+ activists within his party and tell them that children are more important than their luxury beliefs about gender identity? The time to act is now.

This article was originally published on The Spectator’s UK website.