On the So-Called Cass Review
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Evan Urquhart has a great breakdown of the so-called “Cass Review,” a nearly 388-page document commissioned by the UK’s NHS to look into the evidence for and against providing gender-affirming care for minors. Essentially, it came to a series of largely anti-trans foregone conclusions, was littered with trans-antagonistic language (for instance, as Urquhart notes, the report goes out of its way to misgender trans people of all ages at various points), and rejected evidence that was inconvenient to its desired narrative. Still, for more on this, I recommend checking out Urquhart’s post.
“What’s in the Cass Report?” (Assigned Media, Evan Urquhart, 4/15/24)
In 2020, in the UK, in an atmosphere of increasing political anger and animosity directed at the transgender community, pediatrician Hilary Cass was tasked with reviewing the state of gender-affirming care for youth by the NHS. The Final Report of the Cass Review, released on April 9th, is a 388-page document that almost immediately became the center of gravity in the ongoing political debate about how and whether to treat young people with gender dysphoria. The Report made international news and has been taken as vindication by many anti-trans activists.
A document that approaches four hundred pages will be difficult for most people to read in full, meaning that inevitably most of the public will be forced to rely on summaries provided by journalists, commentators, activists, and others. This article seeks to provide a brief but comprehensive summary for Assigned Media’s audience.
As Jules Roscoe at 404 Media notes, the report also uses AI-generated images portraying trans and nonbinary teens. One image featured in the report, of a child with pink hair, came from an Adobe Stock collection called “Non binary teen in school hallway with kids in the background. Generative AI.” While I understand not wanting to use actual photos of teens in this report, it seems just as bad to feature these sorts of stereotypes of what trans people supposedly look like.
“Review Used By UK to Limit Gender Affirming Care Uses Images of AI-Generated Kids” (404 Media, Jules Roscoe, 4/15/24)
The so-called “Cass Review” is peppered with pictures of schoolchildren and students, half of which appear to be generated by AI. Most notably, an image at the end of the “Service model” section of the report, which delineates the 32 recommendations it makes, features a non-binary child with a bleached and light pink quiff haircut. This is consistent with how generative AI tends to represent queer people—namely, white people with short textured purple or pink hair.
The report’s cover image of a child doing a wall sit in jeans also appears to be AI-generated, which is evident from their hands. Two pairs of fingers appear to be merged, while one thumb cuts into the other one.
Over at the Los Angeles Blade, Brynn Tannehill has a grim breakdown of how a future Trump administration would likely use something like the Cass Review to attack trans health care for trans people of all ages in the U.S. should he be elected.
“The Cass Review heralds how all trans medicine will die” (Los Angeles Blade, Brynn Tannehill, 4/15/24
You might think, “Oh, this is just the United Kingdom,” and that it doesn’t affect you. But it does. We have concrete evidence that Cass was coordinating with Ron DeSantis appointees, who in turn were selected for their religious fervor and connections with anti-LGBT hate groups in the US like the Alliance Defending Freedom. The Cass review illustrates how they are planning to end access to transgender health care for all adults in the US.
Basically, the process is to get a decision-making body (like the FDA) to commission a “review” of the evidence for health care for trans adults. The reviewers will be people who already know the outcome they want and who are only interested in p-hacking their way to a non-conclusion. The formula looks like this:
Do a lit review.
Find filters that excludes all of the evidence in support of health care for trans people (i.e. requiring RCT and double-blind for inclusion).
Declare that there is no evidence for transition related care.
Recommend “neutral” interventions like talk therapy, when there’s no evidence this works.
The FDA or state medical boards use the phony lit review to justify bans on the use of any off-label treatments for gender dysphoria, along with any gender confirmation surgeries.
With the death of Roe v. Wade, this is entirely legal. SCOTUS won’t stop it; they’re likely to uphold the decision-making authority of supposedly neutral medical authorities, and the lit reviews commissioned by them. If Trump is elected, this will happen nation-wide. If he isn’t, we’re going to see roughly 25 states eventually ban health care for trans adults the way they did to trans youth.
And finally, I wanted to give a big shout-out to
and hernewsletter. This week, she wrote about the intersection of the Cass Review and the Supreme Court of Arizona’s decision that triggered a 19th-century anti-abortion law. Her writing is consistently brilliant and is certainly one of the best newsletters you’re not (yet) reading.When I say things like, “The New York Times needs to hire a trans person as a columnist” or “CNN/MSNBC/etc. need to add a trans person as a paid on-air contributor,” I’m specifically referring to Branstetter and the very few on her level. The world would be a lot better off if more people were exposed to her thought-provoking essays on identity and autonomy rather than simply getting Pamela Paul’s warmed-over “I don’t like hearing someone say the words ‘pregnant person’ every once in a while” editorial every six months.
“Between Reproductive Past and Trans Future” (The Autonomy, Gillian Branstetter, 4/14/24)
On Wednesday, meanwhile, a review of gender-affirming medical practices for transgender youth in England seemed to offer a roadmap for a world without transgender youth in it. While offering a relatively mixed bag of common-sense recommendations for expanding access to hormone therapies (such as opening regional “hubs” for care to meet expanding demand and conducting more clinical research), the review—authored by Dr. Hilary Cass who previously consulted with the state of Florida in their effort to ban care for trans youth and mostly ban it for trans adults—simultaneously urges “extreme caution” for prescribing puberty blockers and claiming “for most young people, a medical pathway will not be the best way to manage their gender-related distress.”
Although the report found medical treatments were only provided to 500 British kids a year with extensive assessment (an average of over six in-office visits just to start treatments), low rates of detransition (0.5%), and not a single patient rushed into treatment without assessment, such broad diagnostics claiming the empirical evidence for gender transitions is of “poor quality” (a term it doesn’t define) have been greeted by those calling for the abolition of youth gender medicine as nothing short of complete vindication.
That’s because the Cass Review rejects the affirming model of care embraced by groups in the US like the American Psychological Association or the American Academy of Pediatrics and instead openly regards medical transitions as an unjustifiable last step to be pursued after blaming a child’s gender nonconformity on anything and everything else—social influences, comorbid mental health disorders, or the influence of social media among them. Contrary to its stated aims, the Review further pathologizes gender nonconformity itself, claiming “social transitions”—which can be as simple as a new haircut and clothes—”may change the trajectory of gender identity development” and thus should be avoided, a slippery slope argument that suggests letting your son play with Barbies will invariably lead to a vaginoplasty so best to hand him the monster truck and nip it in the bud.
Most tellingly, the review claims limiting access to hormone treatments for adults may be advisable, theorizing “a follow-through service continuing up to age 25 would remove the need for transition at this vulnerable time and benefit both this younger population and the adult population.” The overall recommendation is to force patients to wait through psychological busywork and relevant-sounding delays, implementing a largely-arbitrary set of hoops to jump through with the hopes the patient just gives up. Focus on the patient’s anxiety, focus on their autism, focus on any other issue except their gender and their desire for a sex change because, as private British medical provider GenderGP said of the report’s underlying assumptions, “cisgender lives are judged to be more valuable or desirable than transgender lives and that healthcare services should prioritise encouraging youth to assume cisgender lives, regardless of the suffering that this causes.”To anyone familiar with the complicated history of transgender medicine, the incentives, definitions, and assumptions of the Cass Review are quite familiar. For much of the last century, access to cross-gender hormones and surgeries was regarded by doctors as a last resort for any patient transgressing their gender assignment, measures to only be pursued if the patient’s gender nonconformity persisted after extensive and frequently violent forms of conversion therapy. Sex changes were not an act of autonomy for the patient as much as proof of the doctors’ ability to divine their patient’s “true sex” with the patient mostly getting in the way.
All I needed to see is that Desantis people were involved to know this would be a disaster. Sorry this asshats make trans life difficult, Parker.
Oof.
"Sex changes were not an act of autonomy for the patient as much as proof of the doctors’ ability to divine their patient’s “true sex” with the patient mostly getting in the way."
Intersex infant surgery vibes.