US Gender Affirming Model Ignores UK Cass Review on Puberty Blockers

Research: Gender Medicine in the US: How the Cass Review Failed to Land

Introduction

The just-published Cass Review on transgender care for young people has been instrumental in the UK, where puberty-blocking drugs are no longer prescribed outside of research protocols.

But in the United States, where the “gender-affirming” model of care and intensive treatment is the norm, the impact of Cass’s four-year investigation and final report has been largely ignored, according to journalist Jennifer Block. in The BMJ today.

Main summary

The review concluded that the evidence on the use of hormones and puberty blockers in children and adolescents experiencing gender-related distress is wholly inadequate and called for a more holistic approach to care.

It also found that the links between evidence and medical guidance are often unclear and rely heavily 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 has been apparent consensus in key areas of practice even though the evidence is poor,” Cass wrote.

However, the American Academy of Pediatrics (AAP) and the Endocrine Society have stood by their guidelines, while the American Psychological Association, the American Psychiatric Association, and the American College of Obstetricians and Gynecologists have remained 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 that has pushed for systematic reviews and evidence-based research. getting closer.

Oregon pediatrician and SEGM member Julia Mason adds:

“Parents and their children are being misled in clinics across the country. There is no evidence that giving puberty blockers followed by hormones and surgery is life-saving care and there is growing evidence that the harms outweigh the advantages”.

Not everyone has joined the consensus, Block notes. Scot Glasberg, former president of the American Society of Plastic Surgeons and now president of the Plastic Surgery Foundation, told The BMJ that the organization will publish “reliable, high quality” guidelines, but like Dr. Cass, we have found that the literature is of low quality and of little value in dictating surgical care. We are trying to be very measured and not get into the difficulties that some of the other organizations have gotten into.

Similarly, The Wall Street Journal The editors said that the review. “shows wisdom and humility in his treatment of young people, in contrast to ideological conformity in American medical associations,” while Washington Post and Boston Globe published opinions that amplified Cass to advocate for a more precautionary path forward. But many media, including STAT News, cnnand American scientistwho have published many articles favorable to the affirmative model, have so far ignored Cass.

So far, outspoken opinion leaders have not reconciled their statements with the growing list of contradicting systematic reviews, Block adds.

Yale Pediatrician Meredith McNamara Called Puberty Blockers “one of the most compassionate things a parent can give for a transgender child,” and in testimony before the United States Congress, warned that when gender-affirming attention “If it is interrupted or restricted, suicide, depression, anxiety, eating disorders and poor quality of life follow.”

Alejandra Caraballo, a Harvard Law School professor with more than 160,000 X followers, also tweeted before the report’s release last month that she had “he ignored almost all the studies,” a claim that Cass called “disinformation.”

But Erica Anderson, a clinical psychologist and former president of USPATH, says the Cass report will “stand the test of time.”

“I’m already hearing from the boards of directors and trustees of some hospital systems that they are starting to get nervous about what they have allowed. So I think that will accelerate change within American healthcare.”