By Mathew Goldstein
Dr. Hilary Cass, former President of the Royal Colleg of Pediatrics and Child Health, recently submitted her final report and recommendations to the National Health Services (NHS) England in her role as Chair of the Independent Review of gender identity services for children and young people. The report concluded that “for most young people, a medical pathway will not be the best way to manage their gender-related distress”. Five European countries, Finland, Sweden, France, Norway, and the U.K. have recently restricted hormone treatments for adolescents and pre-adolescents with gender distress who are not intersex/hermaphroditic because of a lack of evidence of the benefits and concern about medium and long-term harms. Intersex, defined as chromosomal and phenotype inconsistency or phenotype not classifiable, characterizes about 0.018% of people [Sax L. How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 2002 Aug;39(3):174-8. doi: 10.1080/00224490209552139. PMID: 12476264.].
Additional concerns cited in the report commissioned by the NHS include that “Social justice” ideology is driving medical decision-making, and “the toxicity of the debate” has created an environment “where professionals are afraid to openly discuss their views.” That “social transition”—when children assume other gender identities—is an “active intervention” that may set youths on a path to medical transition. And that this intervention may make gender dysphoria worse. That clinicians “are unable to reliably predict which children/young people will transition successfully and which might regret or detransition at a later date.” That a disproportionate number of patients were “birth registered females presenting in adolescence. . . . a different cohort from that looked at by earlier studies.” That many parents feared their children had been medicalized by professionals who didn’t take other difficulties into account, “such as loss of a parent, traumatic illness, diagnosis of neurodiversity, and isolation or bullying in school.” That the majority of gender-dysphoric patients in early studies found that their symptoms desisted during puberty, with most coming out as gay or bisexual later.
IMO, adolescents can be encouraged to explore without medical interventions. We do not yet understand what we are doing to the young people who are being medically transitioned. There is some evidence that sex hormones have a role in brain development. One concern is that the brain is among the last organs to mature. We should accumulate sufficient evidence to confidently estimate the benefit versus harm ratio with controlled and monitored trials first, before commercializing medical gender transitioning for young people.
United States medical authorities are continuing to endorse and promote unquestioning, affirmation style, commercial medicalized gender transitioning for youth. We are doing so “on shaky foundations” according to Dr. Cass and a substantial number of other experts. Sex is observed, usually at birth, by looking at genitalia, with a chromosome assessment back up when genitalia do not suffice. Like eye color, fingerprint pattern, etc., sex is an observable biological reality. A babies name is assigned at birth. Yet the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics promote the less accurate and more politicized phrase “sex assigned at birth”. IMO, we should be protecting transgender people from hate and discrimination by expressing our solidarity with them and supporting their entitlement to be themselves and freely express themselves, not by obscuring or denying the facts about biological sex.
The National Association of Intercollegiate Athletics unanimously voted to change its policy. It now bans transgender women athletes from participating in women’s sports. IMO, that is the better policy and other sports organizations should do the same. There are some sports competitions where male puberty has no impact on performance, but the impact of male puberty on sports performance is usually substantial, lasts for years or is irreversible, and is firmly evidenced.
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