Why has the Cass Review commissioned yet more research on puberty blockers?

3 August 2022

Policy Researcher Carys Moseley comments on the news that the Tavistock clinic for children is to close, but also looks in detail at the continuing puberty blocker trials.

Last week the press was abuzz with headlines that the Tavistock gender identity clinic for children is to be shut down. It will be replaced initially by two regional gender hubs in London and the north-west of England. The NHS eventually hopes to operate up to eight regional hubs. This has been celebrated as good news by many, whilst being claimed by LGBT campaigners as a step towards cutting down waiting lists. However, great caution needs to be exercised at this point. Less celebration and more investigation is needed.

What has not been reported quite as widely is that Dame Hilary Cass, the leading paediatrician conducting a review into the GIDS, has just commissioned yet more research on how children are affected by puberty blockers. This will involve a new cohort of children, and is not just a review of existing literature. This is very troubling and shows up just how deep the problems with gender treatments lie in healthcare.

Gender identity clinic ordered to shut down

The press is reporting that NHS England ordered the GIDS to be shut down. Patients will be moved to two regional gender hubs. This sounds like a welcome and authoritative step in the right direction, but we need to be very cautious and indeed vigilant. In reality these gender hubs had already been recommended by NHS England in 2021, and the Cass Review had agreed with this.

Caution is strongly urged here for several reasons, not least the serious moral shortcomings of the Cass Review.

‘Rapid research’ on puberty blockers to be commissioned

Dame Hilary Cass wrote a letter to NHS England in July setting out recommendations for more ‘rapid research’ on how puberty blockers affect children. This has not had nearly as much press attention as the closure of the GIDS, but it is just as – if not more – important. For the fact of the matter is that this supposedly critical review is deliberately allowing the use of this ‘experimental’ quack treatment for puberty – which is not at all a disease – to continue on the NHS.

The fact is that some puberty blocking drugs have already been shown to be damaging to teenagers. Why therefore has Dame Hilary Cass called for more research?

Why has Cass commissioned research on puberty blockers?

Here is what Dame Hilary Cass told NHS England:

“As already highlighted in my interim report, the most significant knowledge gaps are in relation to treatment with puberty blockers, and the lack of clarity about whether the rationale for prescription is as an initial part of a transition pathway or as a ‘pause’ to allow more time for decision making.”

This sounds reasonable (by the standards of gender identity clinicians!), but she then went on to say this:

“For those who will go on to have a stable binary trans identity, the ability to pass in later life is paramount, and many will decide that the trade-offs of medical treatment are a price that is fully justified by the ability to live confidently and comfortably in their identified gender. The widely understood challenge is in determining when a point of certainty about gender identity is reached in an adolescent who is in a state of developmental maturation, identity development and flux.”

This makes it very clear that Dame Hilary Cass subscribes to the view that it is acceptable for some people to undergo procedures that make them look like a member of the opposite sex. This is frankly not medicine. In addition, as she is a paediatrician and not a specialist in medical care of adults, should she really be making such statements about adult lifestyles?

Medical ignorance as an excuse for more research on puberty blockers

Dame Hilary Cass goes on to make the following claim:

“We do not fully understand the role of adolescent sex hormones in driving the development of both sexuality and gender identity through the early teen years, so by extension we cannot be sure about the impact of stopping these hormone surges on psychosexual and gender maturation. We therefore have no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process.”

She goes on to explain the medical concerns more precisely:

“A further concern is that adolescent sex hormone surges may trigger the opening of a critical period for experience-dependent rewiring of neural circuits underlying executive function (i.e. maturation of the part of the brain concerned with planning, decision making and judgement). If this is the case, brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences. To date, there has been very limited research on the short-, medium- or longer-term impact of puberty blockers on neurocognitive development.”

In other words, puberty blockers could permanently damage teenagers’ ability to make good decisions. One would think that this would be enough of a warning to motivate Dame Hilary Cass to call for an absolute and permanent prohibition on puberty blockers. Unfortunately, that isn’t what she called for.

What Dame Hilary Cass called for was a new research programme enrolling teenagers who are being considered for cross-sex hormones. She wants that programme to follow up these teenagers into adulthood.

“In light of these critically important unanswered questions, I would suggest that consideration is given to the rapid establishment of the necessary research infrastructure to prospectively enrol young people being considered for hormone treatment into a formal research programme with adequate follow up into adulthood, with a more immediate focus on the questions regarding puberty blockers. The appropriate research questions and protocols will need to be developed with input from a panel of academics, clinicians, service users and ethicists.”

The reference to follow-up echoes the problem often aired that there aren’t enough follow-up studies of people undergoing gender reassignment.

The most vulnerable teenagers at the mercy of ‘science’ and ‘experts’

She justifies this continued support for research into puberty blockers as a means of filling gaps in existing knowledge (gaps which were caused by the GIDS not recording data about patients properly):

“Without an established research strategy and infrastructure, the outstanding questions will remain unanswered and the evidence gap will continue to be filled with polarised opinion and conjecture, which does little to help the children and young people, and their families and carers, who need support and information on which to make decisions.”

Note how Dame Hilary Cass complains about ‘polarised opinion and conjecture’. This is code for opposing absolute rejection of puberty blockers, cross-sex hormones and therefore the entire policy of permitting gender reassignment. Effectively this leaves the most vulnerable and suggestible teenagers at the mercy of ‘science’ and ‘experts’. We have to ask what is really going on here.

Are these teenagers going to have to sign informed consent forms? Will they be prevented from suing NHS England if they eventually find that puberty blockers damaged them?

Gender identity clinicians always supported puberty blockers

The truth is that Dame Hilary Cass’ recommendation of yet more research on puberty blockers should be treated as a major scandal. Why has she gotten away with it?

The reason is that support for puberty blockers long predates the current crop of GIDS clinicians, and definitely predates the massive upsurge in referrals since 2010. Richard Green from the gender identity clinic for adults at Charing Cross promoted their use as far back as 1992. Green was an associate of the notorious John Money. Domenico Di Ceglie, the psychotherapist who founded the GIDS in 1989, revealed as far back as 2002 that Mermaids was formed as a support group around this time and helped the GIDS be involved in a major TV programme in 1993. Mermaids was always in with the bricks of the GIDS.

In 2003 – before the Gender Recognition Act was even tabled in Parliament – GIRES, the trans children’s charity that has been around even longer than Mermaids, gave an award to two clinicians who supported puberty blockers. Gender identity clinicians and activists have always supported and promoted puberty blockers.

Anti-Christian and anti-biology worldview at the heart of the GIDS

The real problem is the anti-biology and anti-Christian philosophy at the very heart of the GIDS since it opened in 1989. The GIDS always left the door wide open for some children to live as transsexual adults. In this respect it has always failed to hold out hope of healing and restoration from gender confusion for some children. This is completely unethical.

This is the consequence of the turn in society against accepting God as having created us male and female. Instead of having a general culture in healthcare of facilitating respect for human embodiment, there is a culture that denies this for some patients.

The way forward is outside the NHS

The Cass Review’s Interim Report barely paid attention to the role of psychotherapists in treating gender-confused children at the GIDS. This was linked to the lack of attention given to the earlier literature on gender-confused children, which looked more at their family and social background. Psychotherapy addresses patients’ beliefs about themselves and others, and their significance. In side-lining psychotherapy, the Cass Review effectively side-lines consideration not only of these patients’ beliefs, but of the belief-system that normalises and perpetuates gender reassignment.

The NHS has failed gender-confused children and teenagers because it does not have a consistent worldview accepting human biology. The real needs of these children will never be met within the NHS. Good therapy needs to be available outside the NHS and outside the professional mental health bodies. The problem is that such alternative help risks being criminalised by proposals to ban ‘LGBT conversion therapy’. Whilst it is good that both Prime Ministerial candidates have pledged a crackdown on puberty blockers (no doubt running scared of public opinion), even more important is that they ditch completely government plans to criminalise ‘conversion therapy’. Then, and only then, will truly competent help for gender-confused children and teenagers be able to develop.

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