The Cass Review criticizes the lack of robust evidence for puberty blockers and hormone treatments in transgender youth, challenging the dominant medical practice in the United States. She calls for a more cautious approach to transgender care, citing insufficient evidence and questionable medical guidelines.
The Cass Review highlighted significant gaps in the evidence supporting the use of puberty blockers and hormones in transgender young people, arguing for a more holistic approach. Although influential in the UK, these findings have been largely ignored in the US, where medical associations continue to support gender-affirming treatments, despite criticism of the supporting evidence.
The recent Cass review into transgender support for young people played a key role in the UK, where the prescription of puberty “blocking” drugs outside of research protocols has now stopped.
But in the United States, where an intensive treatment-based, “gender-affirming” model of care is the norm, the impact of Cassa’s four-year investigation and final report has been largely ignored, journalist Jennifer Block reveals in BMJ today (May 23).
Critique of evidence and medical guidelines
The review concluded that the evidence for the use of puberty blockers and hormones in children and adolescents with gender-related problems is grossly inadequate and called for a more holistic approach to care.
“Parents and their children are being misled in clinics across the country. There is no evidence that the use of puberty blockers followed by hormones and surgery can save lives, and there is increasing evidence that the harms outweigh the benefits. — Julia Mason, pediatrician
It also found that the links between evidence and medical advice are often unclear and are largely based on guidelines from the World Professional Association for Transgender Health and the Endocrine Society, which themselves lack scientific rigor.
“This approach may explain why there is apparent consensus on key areas of practice despite little evidence,” Cass wrote.
Response from the American Medical Association
Still, the American Academy of Pediatrics (AAP) and the Endocrine Society stood by their guidelines, while the American Psychological Association, the American Psychiatric Association, and the American College of Obstetricians and Gynecologists remained largely silent on Cass.
“Unfortunately, Cass doesn’t seem to be penetrating the public consciousness,” says Zhenya Abbruzzese, co-founder of the Society for Evidence-Based Gender Medicine (SEGM), a group of researchers and clinicians who have advocated for systematic reviews and evidence-based studies. access.
Clinician concerns and misleading practices
Julia Mason, an Oregon pediatrician and SEGM member, adds, “Parents and their children are being misled in clinics across the country. There is no evidence that puberty blockers followed by hormones and surgery can save lives, and there is growing evidence that the harms outweigh the benefits.
Not everyone joined the consensus, Block notes. Scot Glasberg, former president of the American Society of Plastic Surgeons, now president of the Foundation for Plastic Surgery, told the BMJ that the organization would publish “reliable, high-quality” guidelines, but “like Dr. Cass, we found the literature to be of poor quality and of low value in dictating surgical care We try to be very measured and not get into the difficulties that some other organizations have found themselves in.
Media reaction and alternative voices
On the same way, The Wall Street Journal The editors stated that the magazine “shows wisdom and humility in dealing with young people, in contrast to the ideological conformity of the American medical associations”, while The Washington Post AND The Boston Globe published opinions that prompted Cass to advocate a more cautious way forward. But many outlets, including STAT news, CNNAND Scientific Americanwho have published numerous articles supporting the affirmative model, have so far ignored Cass.
So far, outspoken thought leaders have failed to reconcile their statements with a growing list of conflicting systematic analyses, Block adds.
Different opinions and the way forward
Yale pediatrician Meredith McNamara called puberty blockers “one of the most compassionate things a parent can agree to for a transgender child” and, in testimony before the US Congress, warned that when gender-affirming care “is cut off or limited, suicide, depression, anxiety, eating disorders and poor quality of life occur.
Alejandra Caraballo, a Harvard Law School professor with more than 160,000 X followers, also tweeted before the report’s release last month that it “ignored almost all the studies,” which Cass called “misinformation.”
But Erica Anderson, a clinical psychologist and former president of USPATH, says the Cass report will “stand the test of time.” “I can already hear the boards and administrators of some hospital systems starting to worry about what they’ve allowed. So I think this will accelerate change within the American health care system.
Cass’s firm attitude
In the face of criticism, Cass was adamant: “It wouldn’t be too much of a problem if people said, ‘That’s the clinical consensus and we’re not sure.’ But what some organizations are doing is doubling down on their claims that the evidence is good,” she told za The New York Times. “And I think that’s where you’re misleading the public.” »