Dr. Hilary Cass Questions Efficacy of Current Gender Treatments
Renowned pediatrician, Dr. Hilary Cass, who has served the medical community in England for over three decades, recently undertook a project that has thrust her into the global spotlight. Dr. Cass was tasked with reviewing England’s treatment guidelines for the growing number of children experiencing gender dysphoria.
The State of England’s Youth Gender Clinic
The project came amidst turmoil in England’s lone youth gender clinic. In 2020, the clinic was overwhelmed with a backlog of patients, employee complaints, and a lawsuit from a former patient. The National Health Service asked Dr. Cass, a respected figure in pediatric health, to independently evaluate the situation and suggest improvements.
A Thorough Review of Gender Treatment Practices
In the four years that followed, Dr. Cass conducted comprehensive reviews of scientific studies on youth gender treatments and international guidelines of care. She also consulted with young patients, their families, transgender adults, individuals who had detransitioned, advocacy groups, and clinicians.
Findings Highlight Weak Evidence for Current Treatments
Dr. Cass’s final report, published last month, concluded that existing evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.” Consequently, the National Health Service will no longer prescribe puberty blockers outside of clinical trials. Furthermore, the report recommended extreme caution when prescribing testosterone and estrogen to young people.
European and American Responses to Cass’s Findings
While several European countries have limited treatments following similar scientific reviews, medical groups in America have endorsed the treatments as evidence-based and necessary. However, the American Academy of Pediatrics declined to comment on Dr. Cass’s specific findings.
Dr. Cass’s Perspective on the Evidence
In an interview with The Times, Dr. Cass expressed her concerns about the poor quality of evidence in the field of youth gender medicine. She emphasized the need to see young patients as whole individuals and address a broader range of challenges they may face, such as mental health issues or undiagnosed neurodiversity.
Addressing Criticism and Concerns
Despite criticisms alleging rigging due to the lack of randomized controlled trials, Dr. Cass clarified that they included about 58 percent of the identified studies that were of high or moderate quality. She also expressed disappointment at the fear of her report being weaponized to suggest that trans people don’t exist.
Understanding the Exponential Increase in Gender Care Seekers
Dr. Cass acknowledged the complexity behind the rapid increase in teens seeking out gender care over the last decade. She believes that a combination of social acceptance and social contagion might be contributing to this trend.
The Response from Britain and the U.S.
Responses to Dr. Cass’s report have been generally supportive in Britain. However, she has not received any direct contact from major U.S. health bodies or lawmakers.
Advice to American Pediatricians
Dr. Cass encouraged American pediatricians to approach each young patient as they would any other adolescent, taking a holistic approach rather than assuming that a medical pathway is the right solution for everyone. She emphasized the need for honesty about the strength of evidence and the commitment to improving it.
Final Thoughts
Dr. Cass’s work underscores the importance of robust evidence in guiding medical treatments. Her findings challenge the current approach to youth gender medicine, particularly in the U.S, and call for a more nuanced, evidence-based approach. As the dialogue around youth gender medicine continues to evolve, it is clear that the focus must always remain on providing the best care for each individual patient.
