Interesting that Alejandra Caraballo has repeated on Bluesky the false claim that the Cass review rejected nearly all studies for not being blinded RCTs, along with the screenshot that is compiled from the 2020 NICE review, not the final 2024 Cass review. The original claim was made on Twitter/X in April 2024 shortly after the publication of the Cass review. From what I can see, it appears to have been posted on Bluesky 27 days ago, unless I am misunderstanding something. The archive note says the post was first made in April but was first seen on Bluesky in November. I don't think there can be any doubt that Caraballo knows the claim to be false by now.
Cass Report
- Thread starter d4m10n
- Start date
Louden Wilde
Critical Thinker
NYT notes in their reporting today on the (US) Supreme Court & the Tennessee Law on "gender-affirming" Care:
"Most doctors in the United States support gender treatments for adolescents, based on guidelines written by professional medical groups. But in Europe, countries including Sweden, Finland, Norway and Britain have limited gender-related medical treatments for teenagers after scientific reviews that found weak evidence of long-term benefits.....In Britain, restrictions on access to medical treatments for minors followed a yearslong review of the medical evidence by Dr. Hilary Cass, one of the country’s leading pediatricians. Her final report concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.”
"Most doctors in the United States support gender treatments for adolescents, based on guidelines written by professional medical groups. But in Europe, countries including Sweden, Finland, Norway and Britain have limited gender-related medical treatments for teenagers after scientific reviews that found weak evidence of long-term benefits.....In Britain, restrictions on access to medical treatments for minors followed a yearslong review of the medical evidence by Dr. Hilary Cass, one of the country’s leading pediatricians. Her final report concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.”
d4m10n
Penultimate Amazing
It might well be noted that the evidence will remain remarkably weak in the U.S. if half the states follow the example of Tennessee while the other half uncritically adopt the endocrine pathway without ever requiring trials to be run, that is, studies randomly assigning some patients to other treatment modalities.
From the NYT article: "The main evidence of the care’s benefits comes from a small study from a clinic in the Netherlands in the 1990s, which found that teenagers who medically transitioned experienced long-term mental health gains. " The problems with these studies were already discussed previously in another thread. This is a good analysis.
People who didn't like the conclusions of the Cass report nitpick over methodology but provide no new facts or analysis.
Yes and the evidence is unlikely to ever convince anyone. As far as I can tell, just about everyone has already made up their minds including the folks that could most be relied to actually do the studies. To be clear, I think some folks are ideologically captured on both sides of this issue. Maybe someone in Europe can actually provide good evidence one way or the other but as far as I can tell, not in the US.
d4m10n
Penultimate Amazing
Subjects who survived the process of transition experienced those gains; at least one died as a result of gender affirming surgery.
This is just crazy, though. It is nigh impossible to point to a single study which randomly assigned some juvenile patients to talk therapy (attempting to adjust their minds to come to terms with their changing bodies) and randomly assigned other juvenile patients to the new and completely different treatment modality (attempting to adjust their bodies to fit their desired self image). Tavistock—to take one prominent example—literally flipped from one approach to the opposite approach without ever once scientifically studying which approach yields better results.
Emily's Cat
Rarely prone to hissy-fits
Humorous sidebar to a serious discussion...
Three times in a row I read this as "No-one at all".
d4m10n
Penultimate Amazing
I did too! Then I had to Google b/c I thought we were being punked.
angrysoba
Philosophile
I think the Cass Report actually did change a lot of minds or at least settle questions that they may have had about the efficacy of the treatments on gender dysphoria and mental health outcomes. I think it won’t settle anything in the US though.
d4m10n
Penultimate Amazing
I would argue that the report is much more unsettling than settling; the overall thrust is that we don't have enough evidence yet to say which treatments are best for the (rapidly expanding) clinical population being treated.
angrysoba
Philosophile
Possibly unsettling in more than one way.
Speaking of which, Jesse Singal has a new article out on the Economist about how "America’s best-known practitioner of youth gender medicine is being sued".
Link
It's paywalled, so you may have to get an account to read either a small number of free articles a month, or of course subscribe and read more.
If you want to see more about the story he's also decided to put more details up on... Bluesky. Which hasn't gone down well with many of the residents there.
d4m10n
Penultimate Amazing
I thought he was kicked off today. 
Louden Wilde
Critical Thinker
It's the Odysseus strategy!
Pixel42
Schrödinger's cat
The most unsettling part is that the organisation that had (or at least should have had) a lot of such evidence refused to hand it over to Cass, despite being ordered to do so by NHS England.
Matthew Best
Penultimate Amazing
Seems to still be there, but the replies to just about anything he posts are something to see. It's kind of weird seeing how intolerant people are when they see someone who they accuse of being intolerant.I thought he was kicked off today.
angrysoba
Philosophile
I think his account or profile was briefly put into some kind of moderation then restored. So he is now free to have untold numbers of posts telling him to eat various forms of bodily excretions and sexual organs. I mean, his opponents don’t seem to be putting forward arguments that put themselves in a good light. I think someone should point that out to them.
Singal's article is available on archive.is.
Olson-Kennedy, is the same doctor who recently said she doesn't want to publish the results of a major long-term study into puberty blockers because the findings don't show mental health benefits. (This is available on archive.is too).
Pixel42
Schrödinger's cat
Interesting BBC article on the ethics of the forthcoming clinical trial of puberty blockers recommended by Cass.
Puberty blockers: Can a drug trial solve the big debate?
The government has pledged to determine the evidence - and establish whether the benefits outweigh any potential harms of prescribing puberty blockers to children questioning their gender
www.bbc.co.uk
Also talks about it on his podcast blocked and reported. He posted on bluesky and twitter and apparently got the exact results you'd expect both platforms.
Rolfe
Adult human female
It appears that he is now the most blocked person on BlueSky.
angrysoba
Philosophile
People really want him off...
Jesse Singal (@jessesingal.com)
Daaaaaaaaamn, they are going to do a class-action lawsuit to compel Bluesky to ban me. I'm sorry but this site is amazing and every new post like this further justifies my decision to come here and try to build a platform. It is SO much more exciting than c2024 Twitter.
bsky.app
They want to go through the courts. Don't think it's going to happen somehow.
d4m10n
Penultimate Amazing
Whenever I see someone resorting to non-arguments (e.g. SLAPP-style lawsuits, coordinated blocking/banning, personal attacks) to rebut someone's good faith arguments (e.g. Singal's various articles summarizing and mainstreaming ideas found in systemic reviews such as the Cass Report), I tend to interpret that move as a sort of white flag as far as arguments themselves are concerned. Would-be cancelers are basically admitting that they cannot win in the sphere of ideas and evidence.
d4m10n
Penultimate Amazing
There was a time when I thought all skeptics understood this, but now huge swathes of so-called skeptics reveal they are no different from scientologists or religious fundamentalists. It's depressing.
I do actually find it quite fascinating to try to work out whether people who repeatedly lie about the methodology used for the Cass review know that they are lying and don't care because they think it is justifiable to 'lie for Jesus', or if they really believe what they are saying. If they believe what they are saying (such as studies being rejected for not being blinded, or 100 studies being rejected), it can only be because they have swallowed activist propaganda with no fact checking at all, and studiously rejected all corrections as being transphobic lies. At some point, that type of belief system becomes so irrational it is almost delusional, or else is indistinguishable from lying. If somebody only believes an objectively and verifiably false statement because they have studiously projected their beliefs from contrary evidence, at what point can we say they are either lying or delusional? If beliefs are evidence-based they don't need to be shielded from contrary evidence.
I don't think it's that deep, I think a lot of people just are way better at repeating things that sound right to them at first glance, than they are at fact checking (and certainly better at that than evaluating papers or metastudies). Add to that a few people who should be more critical (ie people that others will trust) but are softpedaling it for personal reasons. It doesn't take more than that to make a social snowball.
It's the same phenomenon that gets you ten influencers making videos about some journalist 'being too stupid to know thing about game' about a journalist's article that talks about thing about game. Because one influencer made a slapdash video and nine more copied it without reading the journalist's article. And most of the ten influencers' audience won't either, cause neither the audience nor the influencer are there for fact checking, or even to actually talk about the journalist's article. They're there to bitch about their favorite grievances.
It's not a phenomenon that's unique to any one cohort. People just do this. People are largely uncritical and tied together by percieved social bonds.
It really only takes a handful of people who don't like the results and criticize it unfairly, to get this result.
I listened to a few critiques of Cass myself and I agree with some of them but I can also see it's got a point. But I already know how to read papers and studies and I've got time and interest. Lay people just hear whatever they are primed to hear and don't have the interest, tools, or energy to look further. But they DO have a 'repost' button or whatever.
Click.
It's the same phenomenon that gets you ten influencers making videos about some journalist 'being too stupid to know thing about game' about a journalist's article that talks about thing about game. Because one influencer made a slapdash video and nine more copied it without reading the journalist's article. And most of the ten influencers' audience won't either, cause neither the audience nor the influencer are there for fact checking, or even to actually talk about the journalist's article. They're there to bitch about their favorite grievances.
It's not a phenomenon that's unique to any one cohort. People just do this. People are largely uncritical and tied together by percieved social bonds.
It really only takes a handful of people who don't like the results and criticize it unfairly, to get this result.
I listened to a few critiques of Cass myself and I agree with some of them but I can also see it's got a point. But I already know how to read papers and studies and I've got time and interest. Lay people just hear whatever they are primed to hear and don't have the interest, tools, or energy to look further. But they DO have a 'repost' button or whatever.
Click.
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What lithrael said. Most folks just find someone they trust, typically someone they mostly agree with and run with that. So, yes there are some folks that are just lying about the cass report and a lot more people that trust those people on the issue.
Now, I trust Singal no this issue but I'm not all that versed in reading scientific medical reviews so maybe I shouldn't. IDK, maybe I should figure out what the Cass report actually says and whether its valid or not, but I don't have that time.
Now, I trust Singal no this issue but I'm not all that versed in reading scientific medical reviews so maybe I shouldn't. IDK, maybe I should figure out what the Cass report actually says and whether its valid or not, but I don't have that time.
theprestige
Penultimate Amazing
Which critiques do think have merit?
Matthew Best
Penultimate Amazing
I have a Bluesky account, which has made zero posts and zero replies so far. I'm already blocked by 323 people because I follow Jesse Singal.
I honestly don't remember. I'd have to read the report again. I just remember I could see where some critcal commenters were coming from. They certainly weren't show stoppers. The meat of the report is solid.
There are some legitimate criticisms of the methodology and procedures used for the Cass research programme and of the way the final report was written, and also room for genuine differences of opinion regarding the overall strength of evidence and how it should translate into practice. However, every 'critique' I have seen was obviously written for political purposes (in that the same criticisms of methodology would not have been made had the report reached different conclusions) and full of incoherencies, misleading statements, or downright falsehoods.
It is interesting to note that the recent New Zealand report into puberty blockers rated the evidence much more harshly than Cass (using GRADE which resulted in most studies being rated as low quality and all as having serious or critical risk of bias) but it doesn't seem to have attracted any attention or criticism from activists, probably partly because it was not immediately translated into dramatic changes in practice. People can disagree with using the results of Cass to ban puberty blockers, but that does not make the methodology used invalid. When people lie about methodology and validity of findings because they don't like the way the findings are being applied, they are abandoning science.
An example is the Yale Integrity Project piece which was rushed out expressively to try to discredit Cass for litigation purposes, and to be quoted by people who don't understand anything but think 'Yale' sounds impressive. Singal has written a good analysis of this. There is also this peer-reviewed response in BMJ.
Yeah, I've seen a few of those too, and more to the point of the subject of 'what is up with people's evaluation skills' these are the ones that look credible to the already-convinced 'I only have 5 minutes for this and I'm already burnt out' crowd, and which get shared because of that, and then of course you get more of them written by magazine sites chasing clicks.
The more boring deep dive podcasts that try to present a rounded picture of the report without looking like they're friends with mumsnet or whatever, sometimes end up getting DESCRIBED by the committed as totally gutting the report by other committed people who told them so, when in real life nobody more than half-listened and heard lukewarm critique but expect from the reputation of the show/speaker that it's generally gonna be on side for them, and THEY already feel (by nothing but implication) that the report must be crap, so they know without checking (or even in spite of checking) that the podcast they like must back them up.
Puberty blockers are to be banned indefinitely in Northern Ireland following the Cass report, it was announced yesterday. A UK-wide indefinite ban is expected later this week. The ban does not apply to clinical trials, so will not prevent the trial recommended by Cass going ahead.
jt512
Illuminator
- Joined
- Sep 24, 2011
- Messages
- 4,627
When you take into account that the reason the clinical population has rapidly expanded is that normal, troubled girls are, under the influence of social contagion and "progressive" teachers and school counselors, being brainwashed into believing that they are really boys, the default treatment modality becomes obvious. In fact, you don't even need a double-blind study. More instructive would be to randomize kids to woke and non-woke schools, assuming you could even ethically justify the woke arm).
Rolfe
Adult human female
I don't think they should even be contemplating a clinical trial on human subjects before completing comprehensive animal testing that demonstrates safety. This simply would not happen in any other area of medicine.
The single animal study I am aware of demonstrated cognitive changes in young sheep which would be considered devastating to an adolescent human being. And that's before we even consider the physical effects on things like bone density.
The trans-activist response to this study was to mock the idea that sheep could be considered in any way comparable to human beings and to dismiss the expertise of the senior scientist involved because he is a veterinary surgeon.
Perhaps worse still, the evidence of bone density effects (in human patients) was concealed by the researchers involved by presenting the results as showing no change in bone density while the children were on treatment. Concealing the fact that at the time they were treated normal adolescents' bone density increases markedly. The puberty blockers had prevented this normal development.
In a sane world where proper animal trials were carried out and a proper retrospective analysis was undertaken of the results recorded in patients who already received the treatment, I don't believe this would ever get as far as a human trial.
The single animal study I am aware of demonstrated cognitive changes in young sheep which would be considered devastating to an adolescent human being. And that's before we even consider the physical effects on things like bone density.
The trans-activist response to this study was to mock the idea that sheep could be considered in any way comparable to human beings and to dismiss the expertise of the senior scientist involved because he is a veterinary surgeon.
Perhaps worse still, the evidence of bone density effects (in human patients) was concealed by the researchers involved by presenting the results as showing no change in bone density while the children were on treatment. Concealing the fact that at the time they were treated normal adolescents' bone density increases markedly. The puberty blockers had prevented this normal development.
In a sane world where proper animal trials were carried out and a proper retrospective analysis was undertaken of the results recorded in patients who already received the treatment, I don't believe this would ever get as far as a human trial.
The most complete review of the neuropsychological effects of puberty blockers AFAIK is Baxendale (2024). Not surprisingly, she was attacked by activists. I saw paper blasting her for basing the claim that 'puberty blockers are dangerous' on animal studies and single-case or tiny sample human studies, ignoring the fact that this was a comprehensive review of all the known literature (16 studies) and these are the only studies available. Eleven were animal studies. The only human study that had a pre-treatment baseline was one on children receiving treatment for central precocious puberty, which showed an average loss of 7 IQ points.
In regards to both cognitive and bone density effects, the key question with treating those who cease puberty blockers and go through natal puberty is whether they catch up with peers. But in relation to gender issues, most children on blockers go straight to cross sex hormones and never go through natal puberty. The effects of this are unknown, as far as I'm aware. The sheep study suggests effects may not be fully reversible.
This is an odd situation where some think it completely unethical to deny children blockers and others think it equally unethical to conduct a trial.
In regards to both cognitive and bone density effects, the key question with treating those who cease puberty blockers and go through natal puberty is whether they catch up with peers. But in relation to gender issues, most children on blockers go straight to cross sex hormones and never go through natal puberty. The effects of this are unknown, as far as I'm aware. The sheep study suggests effects may not be fully reversible.
This is an odd situation where some think it completely unethical to deny children blockers and others think it equally unethical to conduct a trial.
d4m10n
Penultimate Amazing
I wonder if the dysphoria rates are particular high in this UK city.