LONDON – Children who question their gender identity are being let down by lack of evidence and a toxic political debate, according to a report Wednesday from a senior doctor in England.
Dr. Hilary Cass said there is “no good evidence on the long-term outcomes of interventions to manage gender-related distress,” and young people have been caught up in a “stormy social discourse” about the issue.
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“Ideology on all sides has directed care, rather than care being directed by normal principles of pediatrics and mental health,” said Cass, a retired clinical pediatrician appointed to lead a review of gender services for young people by the state-funded National Health Service.
On April 1 doctors in England’s public health system stopped prescribing puberty-blocking hormones to children and young people with gender dysphoria. The decision came after recommendations in Cass’ earlier interim report, which said there is not enough evidence about the potential benefits and harms of the blockers, which help prevent people from developing physical features not in line with their gender identity, such as beards or breasts.
The decision — which is not an outright ban on puberty blockers — was criticized by some transgender campaigners and is being closely watched in the United States. Transgender medical care for minors is endorsed by major U.S. medical associations, but several Republican-led states have banned puberty blockers and other treatment for transgender youth — and, in some cases, adults.
Cass’ report, which runs to almost 400 pages, said that “for most young people, a medical pathway” is not the best way to deal with gender-related issues.
Cass said young people questioning their gender identity should be given “a holistic assessment” including screening for neurodevelopmental conditions such as autism, and a mental health assessment.
She urged “extreme caution” about giving children or teens masculizing or feminizing hormones — testosterone or estrogen — to people under 18.
Prime Minister Rishi Sunak welcomed the review’s recommendation of caution.
“We simply do not know the long-term impacts of medical treatment or social transitioning on them, and we should therefore exercise extreme caution,” he said.
Critics accuse Sunak’s Conservative government of weaponizing the issue of gender identity as part of a “culture war” electoral strategy. The government recently issued guidelines for schools that said teachers should not be required to address children by their preferred pronouns.
In her report, Cass said there was “no clear evidence” that social transition in childhood — such as changing names or pronouns — has any positive or negative mental health outcomes.
The report also concluded that there is no simple explanation for why the number of young people identifying as transgender has shot up in recent years in the U.K. and other countries.
“There is broad agreement that it is a result of a complex interplay between biological, psychological and social factors,” the report said. “This balance of factors will be different in each individual.”
The LGBTQ rights group Stonewall said many of the report’s recommendations “could make a positive impact.”
“But without due care, training or further capacity in the system, others could lead to new barriers that prevent children and young people from accessing the care they need and deserve," said the group’s director of campaigns and human rights, Robbie de Santos.