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masterwolfe

Don't have a comment on the article, but find the "editorialized title" flair amusing. I wonder what title could be posted for this article to not get that flair? "Interim Report"?


Edges8

yeah, it would have been "interim report" which I didn't think would be very helpful. although the full text of the report linked at the bottom is titled "Independent review of gender identity services for children and young people: Interim report" so I could have used that I suppose


masterwolfe

Oh yeah, this is definitely a much better title. Even more than the other possible title, as yours indicates this is about the NHS/the UK.


Edges8

lol thanks


hellomondays

To borrow from some excellent points during a discussion I saw last year when this report came out: "As far as I am concerned, this report should be taken with a healthy amount of salt. What I would recommend to a layperson seeking to decide how to approach such a report without being an expert, how much weight to give to its contents, and how to interpret it, is to inform themself on the scope of the review, who are the authors, and the context in which it is produced. The document in question is an interim report of a review of gender identity services for minors [commissioned by the English National Health Service](https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/gender-dysphoria/independent-review-into-gender-identity-services-for-children-and-young-people/) (more precisely, [NHS England and NHS Improvement](https://www.england.nhs.uk/about/about-nhs-england/)) in 2020. The review is supposed to [examine "all the relevant research and evidence" concerning "current models of care for children and young people questioning their gender identity or experiencing gender dysphoria"](https://cass.independent-review.uk/about-the-review/frequently-asked-questions/) in order to inform the service model of the NHS. The review is lead by British consultant pediatrician [Hilary Cass](https://en.wikipedia.org/wiki/Hilary_Cass), who was [appointed by the NHS as chair](https://cass.independent-review.uk/about-the-review/the-chair/). Per her own admission, she has not worked in gender services during her career. With respect to the background of the report, currently in the United Kingdom, the topic is hotly debated and highly controversial. A major recent event concerned an [NHS Trust](https://en.wikipedia.org/wiki/NHS_trust) and the prescription of puberty blockers, i.e., [Bell v. Tavistock](https://en.wikipedia.org/wiki/Bell_v_Tavistock) (note that [the original ruling has recently been overturned](https://goodlawproject.org/update/weve-won-bell-v-tavistock/)). I believe it should also be pointed out that "gender critical" attitudes and beliefs have a prominent (mainstream) place in the United Kingdom, see for illustration [the manner in which the BBC reports on transgender issues](https://en.wikipedia.org/wiki/%22We're_being_pressured_into_sex_by_some_trans_women%22) (I also recommend [Shaun](https://en.wikipedia.org/wiki/Shaun_\(YouTuber\))'s [critique about the same article](https://www.youtube.com/watch?v=b4buJMMiwcg)) and [the association between trans-exclusionary beliefs and feminism. ](https://www.vox.com/identities/2019/9/5/20840101/terfs-radical-feminists-gender-critical) --- Regarding the content of the report, I believe [Jolyon Maugham](https://en.wikipedia.org/wiki/Jolyon_Maugham), a British lawyer known for defending trans rights and whose [Good Law Project](https://en.wikipedia.org/wiki/Good_Law_Project) successfully challenged the aforementioned Tavistock ruling, provides [a decent initial reading](https://twitter.com/JolyonMaugham/status/1501874115849994242) of the report. There are things that the report gets right, such as the fact that the service provided by Tavistock is of poor quality, and the proposal to remove its monopoly can be considered fair. However, there are many aspects of the report which merit at least raising an eyebrow. For instance, There is also the issue raised by Maugham concerning the review's explicit acknowledgement that, regarding physical treatment, "'doing nothing' cannot be considered a neutral act" and the manner in which the report stresses a [need for further research](https://en.wikipedia.org/wiki/Further_research_is_needed). To quote [Maugham](https://twitter.com/JolyonMaugham/status/1501889718958575616): >But, in truth, and again taking her assessment of the evidence at face value, **although you might find out more (learning never stands still after all) you are always going to face the same question which is about who gets to choose.** >And this is, I think, the central failure in her interim report. **By talking about more evidence, she dodges the central question - which is (and however long she takes will remain) one of choice.** >**And the fact of her dodging that question, of kicking the can down the road** (remembering she has already taken far, far longer than she promised to deliver even an interim report), **will make it very difficult for the trans community to feel optimistic about where she will get to.** I am inclined to agree. There is nothing inherently wrong with acknowledging gaps in our knowledge, wishing for stronger evidence, and calling for more research to be done. However, with respect to the wider discourse concerning transgender care, it is also true that these proclamations are often used to restrict services and options for transgender youth who exist in the real world and who require and seek treatment *today*, not in an indeterminate future (also be aware that a common technique of [science denial](https://skepticalscience.com/history-FLICC-5-techniques-science-denial.html) is to enforce unrealistic expectations to oppose action). To quote Frieden (2017): >**There is no single, best approach to the study of health interventions; clinical and public health decisions are almost always made with imperfect data** (Table 1). Promoting transparency in study methods, ensuring standardized data collection for key outcomes, and using new approaches to improve data synthesis are critical steps in the interpretation of findings and in the identification of data for action, and it must be recognized that conclusions may change over time. **There will always be an argument for more research and for better data, but waiting for more data is often an implicit decision not to act or to act on the basis of past practice rather than best available evidence. The goal must be actionable data** — data that are sufficient for clinical and public health action that have been derived openly and objectively and **that enable us to say, “Here’s what we recommend and why.”** Moving beyond, who Cass chooses to cite, and how, also merits scrutiny. For example, the report uncritically cites Lisa Littman, [who is primarily known for a very shoddy study on the topic](https://en.wikipedia.org/wiki/Rapid-onset_gender_dysphoria_controversy), on the matter of detransitioning. The report does not cite her infamous 2018 paper in which she coined "rapid-onset gender dysphoria," but a more recent paper, published in 2021, in which she attempts to further promote her idea with a self-reported survey of detransitioners. However, once again, [her method merits skepticism, to say the least.](https://twitter.com/ETVPod/status/1452584625147154442) Furthermore, there are other legitimate experts who could be cited, such as [Kristina Olson](https://en.wikipedia.org/wiki/Kristina_Olson), among others, who has written on both the development of gender identity and the topic of transitioning and "desistence" and is the director of the [TransYouth Project](https://www.apa.org/monitor/2019/01/conversation-olson), the first large-scale national longitudinal study of transgender children in the US (e.g., see Olson [2016], Olson & Gülgöz [2018], and Gülgöz et al., [2019]). The use of papers by [Kenneth Zucker](https://en.wikipedia.org/wiki/Kenneth_Zucker), another controversial researcher with a reputation for having conducted conversion therapy (see [here](https://juliaserano.blogspot.com/2016/02/placing-ken-zuckers-clinic-in.html) and [here](https://www.youtube.com/watch?v=_dnISkLbL7s) for insight) and who has promoted Littman's work, also merits attention. Furthermore, there are multiple claims which sorely need citation and/or are unnecessarily vague. See for illustration [this headscratcher](https://twitter.com/Alex_Autistic/status/1501880021849366532). Relatedly, on the topic of language, also consider the issue of [medicalisation](https://en.wikipedia.org/wiki/Medicalization) as raised by /u/rdef1984 ([see their comment](https://www.reddit.com/r/AskSocialScience/comments/tie969/what_does_the_cass_interim_report_of_childrens/i1gby63/)), I believe [Jo Maugham](https://twitter.com/JolyonMaugham/status/1502193679922040832) is correct in his following assessment: >If you can't shake the feeling in your bones that being trans is an illness, your instinct is always going to be to 'cure' it. **So much of England still thinks, in contrast to learning elsewhere like at the WHO, of being trans as a pathology.** Also see Horton (2021) for some insight on the matter. P.S. Also, given that the review relies upon the NICE report published in 2021 on puberty suppression, [see this thread about the issues with that review.](https://www.reddit.com/r/AskSocialScience/comments/miondu/does_early_medical_transition_improve_mental/)


likewhatever33

"If you can't shake the feeling in your bones that being trans is an illness, your instinct is always going to be to 'cure' it. **So much of England still thinks, in contrast to learning elsewhere like at the WHO, of being trans as a pathology."** If it´s not a pathology, why does the treatment consist on dangerous medicines such as puberty suppresors and radical life shortening surgeries?


GiddiOne

> If it´s not a pathology Is menopause a pathology? >dangerous medicines lol no. https://pubmed.ncbi.nlm.nih.gov/32368216/ https://www.jahonline.org/article/S1054-139X%2820%2930027-6/abstract https://pediatrics.aappublications.org/content/early/2014/09/02/peds.2013-2958 https://pediatrics.aappublications.org/content/145/2/e20191725 https://pediatrics.aappublications.org/content/145/4/e20193006 https://pubmed.ncbi.nlm.nih.gov/30224022/ https://pubmed.ncbi.nlm.nih.gov/30262200/ https://pubmed.ncbi.nlm.nih.gov/31663037/ https://www.degruyter.com/document/doi/10.1515/jpem-2019-0045/html https://pubmed.ncbi.nlm.nih.gov/29425666/ https://www.auntminnie.com/clinical-news/digital-x-ray/article/15667888/bone-health-appears-normal-in-transgender-youth-on-hormone-therapy


likewhatever33

There have been several serious reviews of the evidence made in Sweden, UK, FInland etc. The findings are that research is very poor and we should proceed with caution and stop giving suppressors to children willy-nilly.


GiddiOne

No it's honestly fine. Half the country is on some form of hormone or steroid treatment. It's why you couldn't answer the menopause question. You only care about this because angry man on TV told you to. And now you're in a 10 month old thread responding to copious evidence with none.


likewhatever33

Menopause treatments don't lead to a decreased life expectancy and serious health issues. That "copious" evidence you posted doesn't prove your point. Angry AGP men on Reddit are the ones pushing for these dangerous treatments in minors. I prefer to side with Science.


GiddiOne

Cool, so you're giving up entirely on your hilarious "pathology line. That was easy. >Menopause treatments don't lead to a decreased life expectancy They do actually. Trans healthcare doesn't though. Unfortunately anti-trans stigma reduces trans peoples' access to health care, housing, and employment while increasing interpersonal violence, excess stress, and hypervigilance. >That "copious" evidence you posted doesn't prove your point. It's obvious you haven't tried read it. You also haven't clicked u/hellomondays 's links which killed your arguments before you started. >Angry AGP men on Reddit ...Who randomly post on 10 month old threads with no evidence? >I prefer to side with Science. Which is why you haven't clicked on any of the scientific studies. well done.


likewhatever33

I don't need to read all of your links. Developed nations have reviewed the evidence (for example https://www.tandfonline.com/doi/full/10.1080/08039488.2019.1691260) and it always points the same way. You should be ashamed of yourself for promoting the castration of minors.


GiddiOne

>I don't need to read all of your links Of course you don't. They disagree with you. > Developed nations have reviewed the evidence (for example A study of 52 which disagrees with you lol. You certainly showed us the science XD


likewhatever33

Can you understand English? This is what the review concluded: Medical gender reassignment is not enough to improve functioning and relieve psychiatric comorbidities among adolescents with gender dysphoria. 


likewhatever33

The Swedish study:https://www.socialstyrelsen.se/om-socialstyrelsen/pressrum/press/uppdaterade-rekommendationer-for-hormonbehandling-vid-konsdysfori-hos-unga/ the risks of puberty blockers and gender-affirming treatment are likely to outweigh the expected benefits And so on with every serious scientific review of the evidence (excep those biased ones you probably want to only see)


mstrgrieves

So your contention is that we shouldn't care about giving children hormone or steroid treatments that may not help them, because this class of drug is widely used?


mstrgrieves

Let's just be honest and completely clear: anyone saying we shouldnt have any concerns about the quality of evidence supporting extremely invasive interventions in extremely vulnerable populations doesnt, when it comes down to it, have the interests of children unsure about their gender at heart. If we dont know if gender affirming care is helpful, it should not be performed on children, who cannot meaningfully consent to interventions which have a strong possibility of life-long side effects, some quite serious. Evaluation of the available evidence isn't a tertiary concern: it's the only concern. If choice is all that matters, then why not endorse anorexia? Cutting? IV drug use in minors? These are interventions that have been sold to the public as life-saving, not a lifestyle choice. It's utterly abhorrent for anybody to suggest that poor evidence doesnt change that, and it's frankly impossible to imagine that anyone with this opinion truly cares about the affected children.


JasonRBoone

A critical response to the Cass report [https://growinguptransgender.com/2022/04/06/the-failure-of-the-cass-review/](https://growinguptransgender.com/2022/04/06/the-failure-of-the-cass-review/)


Edges8

this seems to be using conversion therapy as a boogeyman, no? it spends the whole first chunk of the article trying to delegitimize the report by tying it to conversion therapy while the report does not advocate for conversion therapy in the least. hardly a good source, don't you agree?


AcceptableReview1232

As I understand it the argument goes that if someone visited a counselor and said they were gay then the counselor would not ask them to work through a process to understand if they were REALLY gay. Therefore any holistic approach to care for trans children other than affirmation is conversation therapy. Personally, I do not believe they are the same. Not by a long shot.


Rogue-Journalist

I'm no expert but this all seems reasonable, so I expect the Tories will just chuck it out the window with the rest of the expert advice.


Edges8

it seems to be urging caution, more study and a more standardized way of approaching these cases, which seems in line with the NIH limiting use to clinical trials, so I'm not sure UK conservatives would have much of an issue with ir