Cass Report

[d4m10n]

A thread by Hannah Barnes on the history of the BMA's interaction with the Cass Review

She is one of my favorite writers on this topic, along with the three Helens (Lewis, Joyce, Pluckrose) and of course Kathleen Stock and Holly Lawford Smith. Come to think of it, only Barnes focused narrowly on youth gender medicine rather than gender transition more generally.

 

[d4m10n]

Three decades of ‘Dutch Protocol’ research has not produced reliable evidence

https://www.tandfonline.com/doi/epdf/10.1080/17405629.2026.2680285

 

[Elaedith]

AFAIK, only the one has been published, and WPATH upset the researchers by trying to manipulate the content while demanding that they state the review is independent. There is a summary here.

Just updating the link to the evidence of WPATH suppressing publication of the systematic reviews underpinning its guidelines, since it had moved. The summary and evidence can be found here.

 

[Pixel42]

Puberty blockers trial can start recruiting children after judge rejects legal challenge

Campaigners brought the legal action to try and stop the trial going ahead.

www.bbc.co.uk

 

[Planigale]

Puberty blockers trial can start recruiting children after judge rejects legal challenge

Campaigners brought the legal action to try and stop the trial going ahead.

www.bbc.co.uk

A recent Cass interview was interesting, out of two thousand children referred to the new gender dysphoria service only 15 have moved to hormonal treatment so they certainly aren't pushing them into this, and those moving to hormonal therapy will be carefully monitored and supported. The much bigger problem was children on hormonal therapy from sources outside of the NHS, mainly abroad.

 

[Darat]

I can't make my mind up - we obviously shouldn't be using puberty blockers to treat kids who may be trans because we don't have the science to show that is a good treatment path so we need good science, which requires clinical trials, but is it ethical to even do such trials based on the slight evidence we have at the moment?

 

[Elaedith]

A recent Cass interview was interesting, out of two thousand children referred to the new gender dysphoria service only 15 have moved to hormonal treatment so they certainly aren't pushing them into this, and those moving to hormonal therapy will be carefully monitored and supported. The much bigger problem was children on hormonal therapy from sources outside of the NHS, mainly abroad.

Do you have a link to that interview? By hormone treatment, do you mean cross-sex hormones?

 

[Planigale]

Do you have a link to that interview? By hormone treatment, do you mean cross-sex hormones?

The interview was on BBC radio, I'll see if I can find a link but since I can't remember what program I may not be able to do so (her figures were more specific than two thousand).

I actually meant puberty blockers.

 

[theprestige]

I can't make my mind up - we obviously shouldn't be using puberty blockers to treat kids who may be trans because we don't have the science to show that is a good treatment path so we need good science, which requires clinical trials, but is it ethical to even do such trials based on the slight evidence we have at the moment?

The way I see it, we have so little evidence on this subject that "kids who may be trans" is practically begging the question.

There might not be anything there that needs these experiments.

We can also do research on consenting adults, on outcomes from surgical and chemical intervention. That might give us some insights into the overall risk vs reward of such interventions, before we start testing them on children.

There's something a little unsettling about a conversation of the form,

"We need to do this to children without any science."

"No. That's bad."

"Okay, fine. We need to start child experiments as soon as possible. Happy now?"

ETA: Not you, Darat. Just... in general. I'm a little disappointed that the chief result of the Cass Report seems to be an accelerated program of child experimentation, rather than a step back and re-evaluation of the entire ethical landscape of trans-affirming care. (Though I do admit a certain passing sensation of "oh, so now you care about the ethics of trans-affirming care for minors?" But I don't know where you stood on this prior to the Cass Report, so it's probably a feeling best ignored.)

 

[Emily's Cat]

"We need to do this to children without any science."

"No. That's bad."

"Okay, fine. We need to start child experiments as soon as possible. Happy now?"

This behavior in the government and medical fields would be why some people view it as a crime against humanity.

 

[Gulliver Foyle]

I can't make my mind up - we obviously shouldn't be using puberty blockers to treat kids who may be trans because we don't have the science to show that is a good treatment path so we need good science, which requires clinical trials, but is it ethical to even do such trials based on the slight evidence we have at the moment?

Running the trials is a lot more ethical than coming up with your conclusion and then speaking with lots of transphobic groups* to invent evidence for your position.

*Including neo nazi groups.

 

[d4m10n]

Ah yes, the infamous swastika footnotes in the Cass Report.

 

[Planigale]

The way I see it, we have so little evidence on this subject that "kids who may be trans" is practically begging the question.

There might not be anything there that needs these experiments.

We can also do research on consenting adults, on outcomes from surgical and chemical intervention. That might give us some insights into the overall risk vs reward of such interventions, before we start testing them on children.

There's something a little unsettling about a conversation of the form,

"We need to do this to children without any science."

"No. That's bad."

"Okay, fine. We need to start child experiments as soon as possible. Happy now?"

ETA: Not you, Darat. Just... in general. I'm a little disappointed that the chief result of the Cass Report seems to be an accelerated program of child experimentation, rather than a step back and re-evaluation of the entire ethical landscape of trans-affirming care. (Though I do admit a certain passing sensation of "oh, so now you care about the ethics of trans-affirming care for minors?" But I don't know where you stood on this prior to the Cass Report, so it's probably a feeling best ignored.)

Puberty blockers are used in children, to delay puberty in those with premature puberty. So there is some knowledge about their effects. There is also knowledge about the consequence of natural delayed puberty, and delayed puberty due to other conditions. So this is not an utterly unknown area.

Delaying puberty for a period so long as puberty does subsequently occur is not going to have terrible health consequences. The much bigger risk if from the life long hormone therapy needed to feminise or masculinise.

Delaying puberty from 12 to 16 may be a better option than giving feminising or masculinising hormones earlier in childhood. It gives a chance for some second thoughts, it can avoid surgery. Then consent for further therapy can be given by a 16 yr old 'adult'.

The present service does seem to be providing significant psycho-social support such that the vast majority of children referred aren't proceeding to puberty blockers but a few are.

 

[Emily's Cat]

Puberty blockers are used in children, to delay puberty in those with premature puberty. So there is some knowledge about their effects. There is also knowledge about the consequence of natural delayed puberty, and delayed puberty due to other conditions. So this is not an utterly unknown area.

Delaying puberty for a period so long as puberty does subsequently occur is not going to have terrible health consequences. The much bigger risk if from the life long hormone therapy needed to feminise or masculinise.

Delaying puberty from 12 to 16 may be a better option than giving feminising or masculinising hormones earlier in childhood. It gives a chance for some second thoughts, it can avoid surgery. Then consent for further therapy can be given by a 16 yr old 'adult'.

The present service does seem to be providing significant psycho-social support such that the vast majority of children referred aren't proceeding to puberty blockers but a few are.

Delaying puberty in a normally developing child for more than just a few months has very serious negative consequences. There are lots of negative effects, but one of the largest is bone density.

Puberty is a two-part process, governed by both the pituitary and the adrenal glands. The adrenal prompts growth of fine armpit, pubic, and leg hairs on children of both sexes, prompts rapid growth of the long bones in the legs and arms, and when that spurt is finished it signals the growth plates on those bones to close. The accretion of density in those long bones, however, is governed by the pituitary.

GnRH agonists halt the pituitary process. They don't affect the adrenal process at all. That means that if GnRH blockers are in use, the bones grow longer, but they don't grow stronger. They become brittle and weak. And if the growth plates close while blockers are in use there is no way to ever achieve normal bone density.

The pituitary is also involved in the maturation of the sexual reproductive system. In females, hips widen, lactation glands mature, the uterus enlarges, and eggs begin reaching maturity and being released. In males, the penis elongates, the testes descend away from the body, and sperm production begins.

The pituitary is also involved in sex-related development. It plays a role in the development of sexual bonding (as opposed to friendship bonding), cognitive development, and many secondary sex characteristics - things that are driven by sex, but aren't actually reproductive in nature. Things like thickening of the vocal chords, facial hair growth, thickening of leg and arm hair in males; accumulation of fat deposits in the hips and buttocks in females. It also is fairly strongly responsible for our brains and bodies developing the ability to experience sexual arousal and orgasm.

Locking a child out of the fruition of their developmental process, because some adults wish they had a different body type, is reckless endangerment of children in the pursuit of a social experiment driven by a small but vocal group of people who cannot accept their own bodies.

 

[theprestige]

Puberty blockers are used in children, to delay puberty in those with premature puberty. So there is some knowledge about their effects. There is also knowledge about the consequence of natural delayed puberty, and delayed puberty due to other conditions. So this is not an utterly unknown area.

Delaying puberty for a period so long as puberty does subsequently occur is not going to have terrible health consequences. The much bigger risk if from the life long hormone therapy needed to feminise or masculinise.

Delaying puberty from 12 to 16 may be a better option than giving feminising or masculinising hormones earlier in childhood. It gives a chance for some second thoughts, it can avoid surgery. Then consent for further therapy can be given by a 16 yr old 'adult'.

The present service does seem to be providing significant psycho-social support such that the vast majority of children referred aren't proceeding to puberty blockers but a few are.

Please see Emily's Cat's debunking of this post, above.

 

[angrysoba]

Ah yes, the infamous swastika footnotes in the Cass Report.

Putting the SS into CaSS, no doubt.

 

[Planigale]

Delaying puberty in a normally developing child for more than just a few months has very serious negative consequences. There are lots of negative effects, but one of the largest is bone density.

Puberty is a two-part process, governed by both the pituitary and the adrenal glands. The adrenal prompts growth of fine armpit, pubic, and leg hairs on children of both sexes, prompts rapid growth of the long bones in the legs and arms, and when that spurt is finished it signals the growth plates on those bones to close. The accretion of density in those long bones, however, is governed by the pituitary.

GnRH agonists halt the pituitary process. They don't affect the adrenal process at all. That means that if GnRH blockers are in use, the bones grow longer, but they don't grow stronger. They become brittle and weak. And if the growth plates close while blockers are in use there is no way to ever achieve normal bone density.

The pituitary is also involved in the maturation of the sexual reproductive system. In females, hips widen, lactation glands mature, the uterus enlarges, and eggs begin reaching maturity and being released. In males, the penis elongates, the testes descend away from the body, and sperm production begins.

The pituitary is also involved in sex-related development. It plays a role in the development of sexual bonding (as opposed to friendship bonding), cognitive development, and many secondary sex characteristics - things that are driven by sex, but aren't actually reproductive in nature. Things like thickening of the vocal chords, facial hair growth, thickening of leg and arm hair in males; accumulation of fat deposits in the hips and buttocks in females. It also is fairly strongly responsible for our brains and bodies developing the ability to experience sexual arousal and orgasm.

Locking a child out of the fruition of their developmental process, because some adults wish they had a different body type, is reckless endangerment of children in the pursuit of a social experiment driven by a small but vocal group of people who cannot accept their own bodies.

This argument is predicated on puberty never occurring. Puberty occurs earlier now than it historically did. Delaying puberty to 16 means

females, hips widen, lactation glands mature, the uterus enlarges, and eggs begin reaching maturity and being released. In males, the penis elongates, the testes descend away from the body, and sperm production begins....The pituitary is also involved in sex-related development. It plays a role in the development of sexual bonding (as opposed to friendship bonding), cognitive development, and many secondary sex characteristics - things that are driven by sex, but aren't actually reproductive in nature. Things like thickening of the vocal chords, facial hair growth, thickening of leg and arm hair in males; accumulation of fat deposits in the hips and buttocks in females. It also is fairly strongly responsible for our brains and bodies developing the ability to experience sexual arousal and orgasm.

still happens just later. You are creating a straw man argument, your case is based on puberty never occurring.

By studying carefully the consequences in the few who opt after intensive psycho-social input for puberty delay, we will know if the consequences are as terrible as you claim. It is better that this happens in a well monitored system rather than the way it does in many parts of the world.

I appreciate that your simplistic description of the physiology of puberty is intended for others but I don't need educating on endocrinology. We usually wouldn't treat delayed puberty in clinic until 16, just exclude conditions that might cause it. You state with certainty things that are not so certain, e.g. the association of delayed puberty with bone density. some studies show this some don't. this is one of the things that will be monitored, and could potentially be treated if it was an issue.

 

[Pixel42]

Is it not the case that there is a limit to how long puberty can be delayed before the window closes, as it were, and it does indeed never occur, so that the body essentially remains in a juvenile state? I got that impression from what I've read, but I may have misunderstood.

 

[theprestige]

This argument is predicated on puberty never occurring. Puberty occurs earlier now than it historically did. Delaying puberty to 16 means

still happens just later. You are creating a straw man argument, your case is based on puberty never occurring.

By studying carefully the consequences in the few who opt after intensive psycho-social input for puberty delay, we will know if the consequences are as terrible as you claim. It is better that this happens in a well monitored system rather than the way it does in many parts of the world.

I appreciate that your simplistic description of the physiology of puberty is intended for others but I don't need educating on endocrinology. We usually wouldn't treat delayed puberty in clinic until 16, just exclude conditions that might cause it. You state with certainty things that are not so certain, e.g. the association of delayed puberty with bone density. some studies show this some don't. this is one of the things that will be monitored, and could potentially be treated if it was an issue.

Why is delaying puberty even necessary here in the first place?

 

[Planigale]

Why is delaying puberty even necessary here in the first place?

Fair question.

Since I am not participating in the service I don't know what the criteria are. My guess is that despite psychological intervention the child finds the progression to developing the secondary sex characteristics of the gender with which they do not identify so distressing that it is a threat to their health. In girls this might involve anorexia and extreme exercise to self delay puberty. A multi -disciplinary team might conclude that delaying puberty might allow time for psycho-social interventions to work.