For years, critics have raised serious concerns over the shoddy evidence behind gender-affirming care, the aggressive, no-questions-asked model for treating gender dysphoria in young people.

Those critics now have a powerful ally in England, according to a landmark report commissioned by the National Health Service (NHS) and released last evening, April 9. The leader of the four-year study, Dr. Hilary Cass, just confirmed what they’ve been saying all along: gender medicine is “built on shaky foundations” and the evidence used to justify it is “remarkably weak.”

As we wrote here, the American Academy of Pediatrics recently doubled down on its commitment to gender-affirming care, tossing aside the traditional “watching and waiting” protocol. Under that approach, doctors proceeded with caution, allowing gender-dysphoric children to naturally progress through puberty while treating them with counseling and psychotherapy rather than sex-altering drugs.

But now, based on evidence that has been challenged as fraudulent and misleading, doctors readily “affirm” a child’s stated desire to change genders by prescribing puberty-blocking drugs, cross-sex hormones, and irreversible surgeries.

Meanwhile, the number of detransitioners who have come to regret these life-altering drugs and procedures is mounting, and so are the lawsuits, including ones we’ve covered here. They say they were used as guinea pigs to test out a reckless, unscientific treatment plan.

The new report from England agrees.

From the British Medical Journal:

Clinical guidelines used widely around the world to treat children and adolescents who raise issues about their gender were developed in breach of international standards on guideline development, a review set up by NHS England has concluded.

The review … calls for far reaching changes to the way children and adolescents with gender dysphoria and gender incongruence are treated. In an interim report in 2022 it recommended that these young people be brought within the mainstream NHS and treated by multidisciplinary teams that would look at them holistically, providing psychosocial interventions where needed.

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Cass noted, “The World Professional Association of Transgender Health (WPATH) has been highly influential in directing international practice, although its guidelines were found by the University of York’s appraisal to lack developmental rigour and transparency.”

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Cass’s review pointed out that although most of the guidelines described insufficient evidence about the risks and benefits of medical treatment “many then went on to cite this same evidence to recommend medical treatment.”

Although the final report was just released, the NHS has already started to respond to its earlier findings. England’s sole provider of gender identity services, the Tavistock and Portman NHS Foundation Trust, was closed down last month based on an interim report that it was “not a safe or viable long-term option.” And as we reported here, puberty blockers were also discontinued at that time.

The Cass report found “the evidence for the indicated uses of puberty blockers and masculinising/feminising hormones in adolescents are unproven and benefits/harms are unknown.” Because of the potential risks puberty blockers pose to to neurocognitive development, psychosexual development and longer-term bone health, they should only be offered under a research protocol.

“The reality is we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” Cass says in the report.

Young people who think they want to change sex often present with a host of mental health issues, including trauma, abuse, and autism. The report recommends practitioners treat these young people “holistically” and not solely on the basis of their gender presentation.

“You don’t make those decisions in a state of mental distress,” Cass told the editor of the British Medical Journal in an interview.

For teenagers, a lot of things feel urgent, she reminded the audience. But those feelings, including discomfort with their gender, can change over time: “What we don’t know, is whether it’s going to feel the same for them in five to ten years time.”

And as the report reveals, there was never enough research to support these radical treatments in the first place. “I can’t think of another area of pediatric care,” said Cass, “where we give young people potentially irreversible treatments and have no idea what happens to them in adulthood.”

Full interview with the BMJ here:

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