The Trans Agenda #23 - Relentless attacks on trans people dominate all media
News you need, the perspective you won't find anywhere else. The trans community's guide to UK news, media and politics and our place in it.
The Trans Agenda #23
[11 April 2024]
Welcome to The Trans Agenda, a newsletter that will arrive in your inbox Monday and Thursday if you are subscribed. You can also read it on Substack and on Trans Writes.
Publications known for taking an anti-trans stance are and will be referenced and linked. Often, these are the most comprehensive sources for these stories because of their obsession with trans people. I give a summary for those stories so you can make the choice if you want to click the link or seek out more information elsewhere.
As always, if you have any suggestions, I’m open to feedback and you can contact me using the links on this page near the bottom.
The Trans Agenda
NEWS & POLITICS
17-year-old trans boy felt ‘worthless’ before his death, inquest hears [Pink News]
I like to open the Trans Agenda with what I think is the most important story in the UK for trans people. While most people will think that is the Cass review, it is not. It is Charlie Millers and all the Charlie Millers who are now guaranteed to follow because of Cass.
17-year-old Charlie Millers died at Prestwich Hospital, Manchester, in December 2020 amidst struggles with mental health, experiences of trauma including acid attacks, sexual abuse, bullying, and being misgendered by healthcare professionals. His mother described him as an amazing individual who loved Morris dancing and football, highlighting his deep struggles from an early age, which included severe self-harm and suicidal thoughts. Despite supposed strict observation, Charlie suffered a fatal hypoxic brain injury.
The Cass review: A government-sanctioned attack on trans lives
I originally wrote a lengthy piece for this section but published it yesterday as a stand-alone piece that you can read here if you haven’t already seen it. In short, the Cass Review is a government-backed attack on trans rights. It deliberately silenced trans voices, ignored established medical evidence, and was shaped by individuals that have a history of promoting harmful conversion therapy. The review's recommendations pose grave risks for trans youth by restricting crucial care. This calculated agenda, celebrated by hate groups and endorsed by politicians like the Tories and Labour’s Health Secretary, Weasel Streeting, reveals an orchestrated campaign to deny trans people basic rights and healthcare. However bad you thought it was going to be, it was worse. The fact that the reporting of the report resulted in #GlinnerWasRight trending should be all you need to know, really.
Stonewall backs the Cass review [Stonewall]
They have basically backed conversion therapy for all trans people up to the age of 25 and have rightly received the appropriate backlash from the wider LGBTQ+ community.
The Cass fightback begins [Dr Rob Agnew]
The Chair of Section of Psychology of Sexualities, British Psychological Society posted on LinkedIn, “Bad news for our trans youth this morning, but let's be honest, we knew it was coming.
“In 2021/22 I reviewed the WPATH guidelines for the General Medical Council for a fitness to practice lawsuit in trans youth healthcare provision. The conclusions and the consequences of Cass are out of step with better quality, more comprehensive reviews, and out of step with approaches in other countries.
“So over the coming days I, and many other clinicians, will be having a look at the final Cass Review in detail and trying to answer the question 'Why was Cass unable to find the research needed to provide trans youth with vital medical approaches that other countries found?'.”
Cass report must not be ‘spun’ by opponents of trans healthcare, says Labour MP [Pink News]
Labour MP Nadia Whittome warns against the misinterpretation of the Cass report by opponents of trans healthcare. Whittome, advocating for the trans community, emphasises the necessity of engaging with experts and the community to fully grasp the report's implications without allowing it to fuel the ongoing cultural war against trans people.
Weasel Streeting says he regrets saying trans men are men and trans women are women [Wes Streeting]
Good job he isn’t set to become the new health secretary when Labour win the election…oh wait…
UK government taking advice on trans people from lay people [source]
Sex Matters are one of the organisations who have worked closely with the government on their anti-trans policies despite having absolutely no expertise in the area. This was highlighted this week when an Australian justice refused evidence from Sex Matter's director, Helen Joyce, on the basis that she is nothing more than a layperson.
Man guilty of abusing Labour MP who supported a trans mum [Pink News]
Paul Fogg, 40, received a suspended sentence for abusing Labour MP Clive Lewis on social media and voicemail, following Lewis's support for a trans woman breastfeeding her child. Fogg was ordered to undergo rehabilitation and avoid contact with Lewis.
World netball ban trans women from netball [Natalie Washington]
Meanwhile, Netball Australia rejects World Netball's transgender ban [Daily Mail].
Leader of world’s largest paedophile ring says trans people threaten the ‘dignity’ of humans [Al Jazeera]
Pope Francis, head of an organisation that is responsible for sexually abusing millions of children, and then actively covering it up, thinks trans people are an issue.
Keep an eye out for…
It’s going to be all about Cass for the foreseeable future so expect a lot of truly awful takes and a lot of gaslighting, especially in the Sunday papers with the usual mouthpieces Stock, Bindel, Sodha et al at the forefront.
MEDIA & PAPERS
UK government is GB News’ largest advertiser [GB News Spin Room]
The UK government spent an estimated £132k in March on advertising on GB News, making it the largest single advertiser on the channel by both number of ads and amount spent.
Open Democracy cuts fifth of staff, including head of news and political correspondent [Press Gazette]
Open Democracy is reducing its workforce by about 20%, impacting roles including the head of news and a political correspondent, as it grapples with economic challenges and a decline in funding. This move, affecting around 10 employees from a team of 52, is part of efforts to reach a break-even point amidst rising inflation and an uncertain funding landscape. The organisation expressed gratitude towards the departing staff for their contributions.
Sun halves losses, Times titles grow revenue, TalkTV losses rise to £88m [Press Gazette]
The Sun halved its annual losses, benefiting from lower phone-hacking costs, while The Times saw revenue growth but a 17% profit drop due to increased expenses. TalkTV's losses widened to £88m after its first year. The Sun's revenue fell 5%, impacted by the print market decline and changes in social media. Nonetheless, The Sun's US website and UK betting and gaming sectors experienced growth.
GB News hires first US correspondent in expansion of GBN America [Press Gazette]
GB News has appointed Steven Edginton as its first US correspondent, expanding its American presence with the launch of GBN America, aimed at both British expats and Americans interested in a ‘British’ perspective on US events.
THE PAPERS
The Guardian
Tuesday 9 April
Wednesday 10 April
![Thousands of children unsure of gender identity ‘let down by NHS’ Landmark report blames ‘toxic’ trans debate and unproven treatments The Guardian10 Apr 2024Denis Campbell Amelia Gentleman Robyn Vinter PHOTOGRAPH: GUY BELL/REX/SHUTTERSTOCK ▼ Trans Pride London marchers in July 2022. Referrals to gender identity services soared after 2014 Thousands of vulnerable children questioning their gender identity have been let down by the NHS providing unproven treatments and by the “toxicity” of the trans debate, a report has found. The UK’s only NHS gender identity development service used puberty blockers and cross-sex hormones, which masculinise or feminise people’s appearances, despite “remarkably weak evidence” that they improve the wellbeing of young people and concern they may harm health, Dr Hilary Cass said. Cass, a leading consultant paediatrician, stressed that her findings were not intended to undermine the validity of trans identities or challenge people’s right to transition, but rather to improve the care of the fast-growing number of children and young people with gender-related distress. But she said this care was made even more difficult to provide by the polarised public debate and the way in which opposing sides had “pointed to research to justify a position, regardless of the quality of the studies”. She added: “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.” NHS England commissioned her inquiry in 2020 amid rising concern over the care provided by the Tavistock and Portman NHS mental health trust’s gender identity development services (Gids). From 2009 to 2020, it treated about 9,000 children and young people, with an average age at referral of 14. The inquiry has already led to NHS England shutting Gids, banning puberty blockers and switching to a new “holistic” model of care in which under-18s experiencing confusion about their gender identity will routinely receive psychological support rather than medical intervention. “For most young people, a medical pathway will not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems,” said Cass, who is a former president of the Royal College of Paediatrics and Child Health. The report recommends that all such young people should be screened to detect neurodevelopmental conditions, such as autism spectrum disorder, and there should be an assessment of their mental health, because many who seek help with gender identity also have ADHD, anxiety or depression, for example. Some transgender adults “are leading positive and successful lives, and feeling empowered by having made the decision to transition”, Cass said. However, “I have spoken to people who have detransitioned, some of whom deeply regret their earlier decisions”, she added. “Whilst some young people may feel an urgency to transition, young adults looking at their younger selves would often advise slowing down”, the report says. “Some of the young adults said to us they wished they’d known when they were younger that there were more ways of being trans than just a binary medical transition”, Cass told the Guardian. The report outlines how the Tavistock trust began prescribing puberty blockers more widely in 2014 despite a lack of evidence that they helped. Cass said gender-questioning children had been “let down” by the NHS, health professionals and a “woeful” lack of evidence about what works. “One of the things that has let them down is that the toxicity of the debate has been so great that people have become afraid to work in this area. “A majority of people have been so afraid, because of the lack of guidance, lack of research, and how polarised this is that they’ve passed [patients] straight on to Gids.” Wes Streeting, the shadow health secretary, said: “Today’s report must provide a watershed moment for the NHS’s gender identity services. Children’s healthcare should always be led by evidence and children’s welfare, free from culture wars. “Clinicians and parents alike want the best for children at this crucial developmental stage. This report provides an evidence-led framework to deliver that.” Professor Sallie Baxendale, a professor of clinical neuropsychology at University College London, said Cass’s report “has laid bare the worrying lack of evidence to support the treatments that were prescribed by NHS clinicians to children with gender distress for over a decade”, adding: “These treatments inflicted significant harm on some of the most vulnerable children in our society. “Exceptionalism often lies at the heart of medical scandals when services go rogue and start to operate outside of the normal parameters of clinical practice.” However, Dr Aidan Kelly, a clinical psychologist specialising in gender who left the Tavistock in 2021, said the NHS was struggling to recruit skilled and experienced people to run the planned eight clinics that would provide the new, broader model of care. “Although Gids wasn’t perfect, we had a service with a history and expertise,” he said. “There were things that needed to change but at least holding on to the knowledge that was accrued over time would have made sense to me.” Disputing many of Cass’s findings, he said that a recent German review had found that puberty blockers were safe and effective. NHS England’s switch to a wholly different way of treating young people confused about their gender identity has left England “out of step with the rest of the world”, he added. Cass disclosed in the report that six of the NHS’s seven specialist gender services in England for adults had “thwarted” an attempt by York University, at her request, to obtain and analyse the health outcomes of people who had been treated by Gids in order to improve future care. The refusal to cooperate was “coordinated” and seemed “ideologically-driven”, she told the Guardian. Clinicians caring for those with gender-related distress are very divided on how best to do that, she acknowledges in the report. Cass said that “online influencers” had played a key role in fuelling confusion among young people about gender identity and what to do. Commenting on the report, the prime minister, Rishi Sunak, said: “We simply do not know the longterm impacts of medical treatment or social transitioning on them, and we should therefore exercise extreme caution. We acted swiftly on Dr Cass’s interim report to make changes in schools and our NHS, providing comprehensive guidance for schools and stopping routine use of puberty blockers, and we will continue to ensure we take the right steps to protect young people.” ‘Young adults looking at their younger selves would often advise slowing down’ Dr Hilary Cass Paediatrician Article Name:Thousands of children unsure of gender identity ‘let down by NHS’ Publication:The Guardian Author:Denis Campbell Amelia Gentleman Robyn Vinter Start Page:1 End Page:1](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F82b0f809-15fb-41e6-8261-affc7f5adc2d_595x735.png "Thousands of children unsure of gender identity ‘let down by NHS’ Landmark report blames ‘toxic’ trans debate and unproven treatments The Guardian10 Apr 2024Denis Campbell Amelia Gentleman Robyn Vinter PHOTOGRAPH: GUY BELL/REX/SHUTTERSTOCK ▼ Trans Pride London marchers in July 2022. Referrals to gender identity services soared after 2014 Thousands of vulnerable children questioning their gender identity have been let down by the NHS providing unproven treatments and by the “toxicity” of the trans debate, a report has found. The UK’s only NHS gender identity development service used puberty blockers and cross-sex hormones, which masculinise or feminise people’s appearances, despite “remarkably weak evidence” that they improve the wellbeing of young people and concern they may harm health, Dr Hilary Cass said. Cass, a leading consultant paediatrician, stressed that her findings were not intended to undermine the validity of trans identities or challenge people’s right to transition, but rather to improve the care of the fast-growing number of children and young people with gender-related distress. But she said this care was made even more difficult to provide by the polarised public debate and the way in which opposing sides had “pointed to research to justify a position, regardless of the quality of the studies”. She added: “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.” NHS England commissioned her inquiry in 2020 amid rising concern over the care provided by the Tavistock and Portman NHS mental health trust’s gender identity development services (Gids). From 2009 to 2020, it treated about 9,000 children and young people, with an average age at referral of 14. The inquiry has already led to NHS England shutting Gids, banning puberty blockers and switching to a new “holistic” model of care in which under-18s experiencing confusion about their gender identity will routinely receive psychological support rather than medical intervention. “For most young people, a medical pathway will not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems,” said Cass, who is a former president of the Royal College of Paediatrics and Child Health. The report recommends that all such young people should be screened to detect neurodevelopmental conditions, such as autism spectrum disorder, and there should be an assessment of their mental health, because many who seek help with gender identity also have ADHD, anxiety or depression, for example. Some transgender adults “are leading positive and successful lives, and feeling empowered by having made the decision to transition”, Cass said. However, “I have spoken to people who have detransitioned, some of whom deeply regret their earlier decisions”, she added. “Whilst some young people may feel an urgency to transition, young adults looking at their younger selves would often advise slowing down”, the report says. “Some of the young adults said to us they wished they’d known when they were younger that there were more ways of being trans than just a binary medical transition”, Cass told the Guardian. The report outlines how the Tavistock trust began prescribing puberty blockers more widely in 2014 despite a lack of evidence that they helped. Cass said gender-questioning children had been “let down” by the NHS, health professionals and a “woeful” lack of evidence about what works. “One of the things that has let them down is that the toxicity of the debate has been so great that people have become afraid to work in this area. “A majority of people have been so afraid, because of the lack of guidance, lack of research, and how polarised this is that they’ve passed [patients] straight on to Gids.” Wes Streeting, the shadow health secretary, said: “Today’s report must provide a watershed moment for the NHS’s gender identity services. Children’s healthcare should always be led by evidence and children’s welfare, free from culture wars. “Clinicians and parents alike want the best for children at this crucial developmental stage. This report provides an evidence-led framework to deliver that.” Professor Sallie Baxendale, a professor of clinical neuropsychology at University College London, said Cass’s report “has laid bare the worrying lack of evidence to support the treatments that were prescribed by NHS clinicians to children with gender distress for over a decade”, adding: “These treatments inflicted significant harm on some of the most vulnerable children in our society. “Exceptionalism often lies at the heart of medical scandals when services go rogue and start to operate outside of the normal parameters of clinical practice.” However, Dr Aidan Kelly, a clinical psychologist specialising in gender who left the Tavistock in 2021, said the NHS was struggling to recruit skilled and experienced people to run the planned eight clinics that would provide the new, broader model of care. “Although Gids wasn’t perfect, we had a service with a history and expertise,” he said. “There were things that needed to change but at least holding on to the knowledge that was accrued over time would have made sense to me.” Disputing many of Cass’s findings, he said that a recent German review had found that puberty blockers were safe and effective. NHS England’s switch to a wholly different way of treating young people confused about their gender identity has left England “out of step with the rest of the world”, he added. Cass disclosed in the report that six of the NHS’s seven specialist gender services in England for adults had “thwarted” an attempt by York University, at her request, to obtain and analyse the health outcomes of people who had been treated by Gids in order to improve future care. The refusal to cooperate was “coordinated” and seemed “ideologically-driven”, she told the Guardian. Clinicians caring for those with gender-related distress are very divided on how best to do that, she acknowledges in the report. Cass said that “online influencers” had played a key role in fuelling confusion among young people about gender identity and what to do. Commenting on the report, the prime minister, Rishi Sunak, said: “We simply do not know the longterm impacts of medical treatment or social transitioning on them, and we should therefore exercise extreme caution. We acted swiftly on Dr Cass’s interim report to make changes in schools and our NHS, providing comprehensive guidance for schools and stopping routine use of puberty blockers, and we will continue to ensure we take the right steps to protect young people.” ‘Young adults looking at their younger selves would often advise slowing down’ Dr Hilary Cass Paediatrician Article Name:Thousands of children unsure of gender identity ‘let down by NHS’ Publication:The Guardian Author:Denis Campbell Amelia Gentleman Robyn Vinter Start Page:1 End Page:1")
![What the report says ‘The toxicity of debate is exceptional. It must stop’ The Guardian10 Apr 2024Denis Campbell and Sally Weale PHOTOGRAPH: GUY SMALLMAN/GETTY IMAGES ▲ The NHS Tavistock Centre’s gender identity service became embroiled in controversy The evidence “This is an area of remarkably weak evidence,” Cass writes in the foreword to her 398-page report. Despite that, she adds: “Yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the longterm outcomes of interventions to manage gender-related distress.” When Cass began her inquiry in 2020 the evidence base, especially about puberty blockers and cross-sex hormones, was “weak”. That was exacerbated by the existence of “a lot of misinformation, easily accessible online, with opposing sides of the debate pointing to research to justify a position, regardless of the quality of the studies.” Cass commissioned York University to undertake systematic reviews of the evidence on key issues, such as puberty blockers. It found that “there continues to be a lack of high-quality evidence in this area”. York academics, as part of their research, tried to document the outcomes seen among the 9,000 young people treated by the Tavistock and Portman NHS trust’s gender identity development service (Gids) between 2009 and 2020. However, it was “thwarted by a lack of cooperation from [six of England’s seven NHS] adult gender services”. The debate Cass acknowledges that the discussion around how to care for such young people is very polarised, both among health professionals and in wider society. For example, some clinicians believe that most people who present to gender services “will go on to have a long-term trans identity and should be supported to access a medical pathway at an early stage”. “Others feel that we are medicalising children and young people whose multiple other difficulties are manifesting through gender confusion and genderrelated distress. The toxicity of the debate is exceptional,” the report says. “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media and where namecalling echoes the worst bullying behaviour. This must stop.” Tavistock and Portman NHS trust When its Gids service was set up in 1989 it saw fewer than 10 children a year; mainly birth-registered males who had not reached puberty. Most received therapy and only a few hormones from the age of 16. But in 2011 the UK began trialling the use of puberty blockers as a result of the emergence of “the Dutch protocol”, which involved using them from early puberty. However, a study undertaken in 2015-16, although not published until 2020, shows “a lack of any positive measurable outcomes”. “Despite this, from 2014 puberty blockers moved from a researchonly protocol to being available in routine clinical practice.” Changing patient profile Referral rates to Gids have rocketed since 2014, but there has also been a shift in the profile of those using services. For centuries transgender people have been predominantly trans women who present in adulthood. Now the vast majority are teenagers who were registered as female at birth. An audit of discharge notes of Gids patients between 1 April 2018 and 31 December 2022 showed the youngest patient was three, the oldest 18, and 73% were birthregistered females, according to the review, which tries to discover why things have changed so dramatically. One area it explores is the deterioration in mental health among young people, and the links with social media, which have brought pressures to bear on them that no previous generation has experienced. “The increase in presentations to gender clinics has to some degree paralleled this deterioration in child and adolescent mental health,” the review says. “Mental health problems have risen in both boys and girls, but have been most striking in girls and young women.” Youngsters who present with gender identity issues to services may also have depression, anxiety, body dysmorphia, tics and eating disorders, as well as autism spectrum disorder (ASD) and/ or attention deficit hyperactivity disorder (ADHD). Referrals to Gids are also associated with higher than average rates of adverse childhood experiences, the review says. “There is no single explanation for the increase in prevalence of gender incongruence or the change in case-mix of those being referred to gender services,” the review says, concluding instead that gender incongruence is a result of “a complex interplay between biological, psychological and social factors”. Transitioning Young people’s sense of their identity is not always fixed and can evolve over time, Cass says. “Whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down,” the report says. “For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/retransition and/ or experience regret. The NHS needs to care for all those seeking support.” Social transitioning This is the process by which individuals make social changes in order to live as a different gender, such as changing name, pronouns, hair or clothing, and it is something that schools in England have been grappling with in recent years. According to the Cass review, many children and young people attending Gids have already changed their names by deed poll and attend school in their chosen gender. The review says research on the impact of social transition is generally of a poor quality and the findings conflicted. Some studies suggest that allowing a child to socially transition may improve mental health and social and educational participation. Future care The report says that in future any young person seeking the NHS’s help with genderrelated distress should be both screened to see if they have any neurodevelopmental conditions, such as ASD, and also given a mental health assessment. NHS England has already in effect banned the use of puberty blockers because of the limited evidence that they work. Cass found that there is “no evidence that puberty blockers buy time to think” – which their advocates have claimed. There is also “concern that they may change the trajectory of psychosexual and gender identity development” as well as pose long-term risks to users’ bone health, the review says. Lastly, the evidence base showing whether psychosocial interventions – therapy – work for those who do not undergo hormone treatment is “as weak” as for puberty blockers and cross-sex hormones. All this means that there is “a major gap in our knowledge about how best to support and help the growing population of young people with genderrelated distress in the context of complex presentations.” Article Name:What the report says Publication:The Guardian Author:Denis Campbell and Sally Weale Start Page:7 End Page:7](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F8c24fc80-8cf8-4368-aea4-73ccf2ec71f4_1179x725.png "What the report says ‘The toxicity of debate is exceptional. It must stop’ The Guardian10 Apr 2024Denis Campbell and Sally Weale PHOTOGRAPH: GUY SMALLMAN/GETTY IMAGES ▲ The NHS Tavistock Centre’s gender identity service became embroiled in controversy The evidence “This is an area of remarkably weak evidence,” Cass writes in the foreword to her 398-page report. Despite that, she adds: “Yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the longterm outcomes of interventions to manage gender-related distress.” When Cass began her inquiry in 2020 the evidence base, especially about puberty blockers and cross-sex hormones, was “weak”. That was exacerbated by the existence of “a lot of misinformation, easily accessible online, with opposing sides of the debate pointing to research to justify a position, regardless of the quality of the studies.” Cass commissioned York University to undertake systematic reviews of the evidence on key issues, such as puberty blockers. It found that “there continues to be a lack of high-quality evidence in this area”. York academics, as part of their research, tried to document the outcomes seen among the 9,000 young people treated by the Tavistock and Portman NHS trust’s gender identity development service (Gids) between 2009 and 2020. However, it was “thwarted by a lack of cooperation from [six of England’s seven NHS] adult gender services”. The debate Cass acknowledges that the discussion around how to care for such young people is very polarised, both among health professionals and in wider society. For example, some clinicians believe that most people who present to gender services “will go on to have a long-term trans identity and should be supported to access a medical pathway at an early stage”. “Others feel that we are medicalising children and young people whose multiple other difficulties are manifesting through gender confusion and genderrelated distress. The toxicity of the debate is exceptional,” the report says. “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media and where namecalling echoes the worst bullying behaviour. This must stop.” Tavistock and Portman NHS trust When its Gids service was set up in 1989 it saw fewer than 10 children a year; mainly birth-registered males who had not reached puberty. Most received therapy and only a few hormones from the age of 16. But in 2011 the UK began trialling the use of puberty blockers as a result of the emergence of “the Dutch protocol”, which involved using them from early puberty. However, a study undertaken in 2015-16, although not published until 2020, shows “a lack of any positive measurable outcomes”. “Despite this, from 2014 puberty blockers moved from a researchonly protocol to being available in routine clinical practice.” Changing patient profile Referral rates to Gids have rocketed since 2014, but there has also been a shift in the profile of those using services. For centuries transgender people have been predominantly trans women who present in adulthood. Now the vast majority are teenagers who were registered as female at birth. An audit of discharge notes of Gids patients between 1 April 2018 and 31 December 2022 showed the youngest patient was three, the oldest 18, and 73% were birthregistered females, according to the review, which tries to discover why things have changed so dramatically. One area it explores is the deterioration in mental health among young people, and the links with social media, which have brought pressures to bear on them that no previous generation has experienced. “The increase in presentations to gender clinics has to some degree paralleled this deterioration in child and adolescent mental health,” the review says. “Mental health problems have risen in both boys and girls, but have been most striking in girls and young women.” Youngsters who present with gender identity issues to services may also have depression, anxiety, body dysmorphia, tics and eating disorders, as well as autism spectrum disorder (ASD) and/ or attention deficit hyperactivity disorder (ADHD). Referrals to Gids are also associated with higher than average rates of adverse childhood experiences, the review says. “There is no single explanation for the increase in prevalence of gender incongruence or the change in case-mix of those being referred to gender services,” the review says, concluding instead that gender incongruence is a result of “a complex interplay between biological, psychological and social factors”. Transitioning Young people’s sense of their identity is not always fixed and can evolve over time, Cass says. “Whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down,” the report says. “For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/retransition and/ or experience regret. The NHS needs to care for all those seeking support.” Social transitioning This is the process by which individuals make social changes in order to live as a different gender, such as changing name, pronouns, hair or clothing, and it is something that schools in England have been grappling with in recent years. According to the Cass review, many children and young people attending Gids have already changed their names by deed poll and attend school in their chosen gender. The review says research on the impact of social transition is generally of a poor quality and the findings conflicted. Some studies suggest that allowing a child to socially transition may improve mental health and social and educational participation. Future care The report says that in future any young person seeking the NHS’s help with genderrelated distress should be both screened to see if they have any neurodevelopmental conditions, such as ASD, and also given a mental health assessment. NHS England has already in effect banned the use of puberty blockers because of the limited evidence that they work. Cass found that there is “no evidence that puberty blockers buy time to think” – which their advocates have claimed. There is also “concern that they may change the trajectory of psychosexual and gender identity development” as well as pose long-term risks to users’ bone health, the review says. Lastly, the evidence base showing whether psychosocial interventions – therapy – work for those who do not undergo hormone treatment is “as weak” as for puberty blockers and cross-sex hormones. All this means that there is “a major gap in our knowledge about how best to support and help the growing population of young people with genderrelated distress in the context of complex presentations.” Article Name:What the report says Publication:The Guardian Author:Denis Campbell and Sally Weale Start Page:7 End Page:7")
Thursday 11 April
The Times
Tuesday 9 April
Wednesday 10 April
Thursday 11 April
![Gender clinics in minister’s sights after refusing to share data Eleanor Hayward - Health Editor Victoria Atkins said clinics must provide patient data Adult NHS gender services face being overhauled amid mounting anger from ministers over their “completely unacceptable” refusal to participate in medical research. Dr Hilary Cass revealed that six of the seven NHS adult gender clinics “thwarted” her report on children’s ser- vices by failing to share data on the long-term consequences of medical interventions. The NHS has now ordered a separate independent review of services for adults amid concerns that they have been “captured by ideology” and are rushing hundreds of vulnerable young women on to male sex hormones or into sex-change surgery. Victoria Atkins, the health secretary, discussed the issue with Amanda Pritchard, chief executive of NHS England, yesterday and said it was essential that clinics comply with a legal obligation to provide follow-up data on patients who had undergone hormone treatment. Atkins told The Times: “It is completely unacceptable that the University of York has not been able to carry out its research to inform the Cass review because of the lack of participation from adult gender clinics. “The government took the unprecedented step of changing the law to make the necessary data linkage from those children seen at the Tavistock possible to enable this work. Nothing less than full co-operation by those clinics in the research is acceptable.” Wes Streeting, the shadow health secretary, said Cass’s report had raised “scandalous” concerns and he was “pretty angry” at the revelation that adult clinics refused to co-operate. “I want to send a clear message to them [the adult clinics] that, under a Labour government, there will be accountability for that — you’re not going to get away with it, ” he told The Sun’s Never Mind the Ballots online show. As well as criticising the clinics for their lack of co-operation, Cass also called for greater scrutiny of the treatment provided to adults in her review, which was published yesterday. There has been a surge in referrals of mainly young women who can be prescribed life-altering hormones or surgery after just two appointments. Women under the age of 25 now make up 70 per cent of referrals to adult NHS gender clinics and a high proportion suffer mental health issues. Under the present NHS guidelines, they can be prescribed testosterone after two consultations, causing them to grow beards and their voices to break. Some are also offered double mastectomies at NHS clinics. In response to the Cass review, NHS England wrote to the chief executives of NHS trusts providing services for adults with gender dysphoria. The letter informed them of a major Cass-style review of how adults are treated, highlighting concerns about clinical practice “particularly in regard to individuals with complex co-presentations and undiagnosed conditions”. It also noted the “lack of a robust evidence base” for medical treatments, such as masculinising and feminising hormones. The clinics were warned that their refusal to co-operate with the Cass review had prevented the progression of world-leading research aimed at tracking the outcomes of thousands of patients undergoing gender-affirming treatment. They were told to share the data immediately to “avoid the need for mandatory direction”, meaning that they could face legal action. Adult services were outside the remit of the Cass review, which was commissioned in 2020 to look at services for children under the age of 18. However, her report noted major concerns about how teenagers “fall off a cliff edge” in care when they reached 17 and were transferred to adult centres, even though brains do not stop maturing until the age of 25. Cass recommended the creation of a new “follow-through service” for those aged 17 to 25, who now make up the bulk of those treated at adult services, with more than 500 in this age group referred each month. Her report highlighted how there was no good evidence to support a medical pathway of “gender-affirming” care that has been embedded in clinical guidelines around the world. Helen Joyce, director of Sex Matters, the campaign group, said: “Adults, just as much as children, deserve evidencebased care and the evidence is equally lacking in adult gender medicine as it is in paediatric services. “Even above age 25, gender distress may be accompanied by other mental health vulnerabilities, such as internalised homophobia, undiagnosed autism, or depression, anxiety or eating disorders.” Dr Louise Irvine, co-chairwoman of the Clinical Advisory Network on Sex and Gender, another campaign group, said that growing numbers of the young women undergoing lifealtering surgery were regretting it and hoping to “detransition”. Campaigners pointed out that the majority of girls and young women referred to gender clinics were sexually attracted to women and said medical interventions were an “assault on young lesbian lives”. Bev Jackson, co-founder of the charity LGB Alliance, said: “The medical malpractice exposed so clearly by Hilary Cass has particularly affected lesbian teens. In the new homophobia that has captured today’s youth culture, they are getting the message that they are really boys and hormones will fix them.”](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F7e335c7d-cd25-46b2-be99-0112d478313c_568x734.png "Gender clinics in minister’s sights after refusing to share data Eleanor Hayward - Health Editor Victoria Atkins said clinics must provide patient data Adult NHS gender services face being overhauled amid mounting anger from ministers over their “completely unacceptable” refusal to participate in medical research. Dr Hilary Cass revealed that six of the seven NHS adult gender clinics “thwarted” her report on children’s ser- vices by failing to share data on the long-term consequences of medical interventions. The NHS has now ordered a separate independent review of services for adults amid concerns that they have been “captured by ideology” and are rushing hundreds of vulnerable young women on to male sex hormones or into sex-change surgery. Victoria Atkins, the health secretary, discussed the issue with Amanda Pritchard, chief executive of NHS England, yesterday and said it was essential that clinics comply with a legal obligation to provide follow-up data on patients who had undergone hormone treatment. Atkins told The Times: “It is completely unacceptable that the University of York has not been able to carry out its research to inform the Cass review because of the lack of participation from adult gender clinics. “The government took the unprecedented step of changing the law to make the necessary data linkage from those children seen at the Tavistock possible to enable this work. Nothing less than full co-operation by those clinics in the research is acceptable.” Wes Streeting, the shadow health secretary, said Cass’s report had raised “scandalous” concerns and he was “pretty angry” at the revelation that adult clinics refused to co-operate. “I want to send a clear message to them [the adult clinics] that, under a Labour government, there will be accountability for that — you’re not going to get away with it, ” he told The Sun’s Never Mind the Ballots online show. As well as criticising the clinics for their lack of co-operation, Cass also called for greater scrutiny of the treatment provided to adults in her review, which was published yesterday. There has been a surge in referrals of mainly young women who can be prescribed life-altering hormones or surgery after just two appointments. Women under the age of 25 now make up 70 per cent of referrals to adult NHS gender clinics and a high proportion suffer mental health issues. Under the present NHS guidelines, they can be prescribed testosterone after two consultations, causing them to grow beards and their voices to break. Some are also offered double mastectomies at NHS clinics. In response to the Cass review, NHS England wrote to the chief executives of NHS trusts providing services for adults with gender dysphoria. The letter informed them of a major Cass-style review of how adults are treated, highlighting concerns about clinical practice “particularly in regard to individuals with complex co-presentations and undiagnosed conditions”. It also noted the “lack of a robust evidence base” for medical treatments, such as masculinising and feminising hormones. The clinics were warned that their refusal to co-operate with the Cass review had prevented the progression of world-leading research aimed at tracking the outcomes of thousands of patients undergoing gender-affirming treatment. They were told to share the data immediately to “avoid the need for mandatory direction”, meaning that they could face legal action. Adult services were outside the remit of the Cass review, which was commissioned in 2020 to look at services for children under the age of 18. However, her report noted major concerns about how teenagers “fall off a cliff edge” in care when they reached 17 and were transferred to adult centres, even though brains do not stop maturing until the age of 25. Cass recommended the creation of a new “follow-through service” for those aged 17 to 25, who now make up the bulk of those treated at adult services, with more than 500 in this age group referred each month. Her report highlighted how there was no good evidence to support a medical pathway of “gender-affirming” care that has been embedded in clinical guidelines around the world. Helen Joyce, director of Sex Matters, the campaign group, said: “Adults, just as much as children, deserve evidencebased care and the evidence is equally lacking in adult gender medicine as it is in paediatric services. “Even above age 25, gender distress may be accompanied by other mental health vulnerabilities, such as internalised homophobia, undiagnosed autism, or depression, anxiety or eating disorders.” Dr Louise Irvine, co-chairwoman of the Clinical Advisory Network on Sex and Gender, another campaign group, said that growing numbers of the young women undergoing lifealtering surgery were regretting it and hoping to “detransition”. Campaigners pointed out that the majority of girls and young women referred to gender clinics were sexually attracted to women and said medical interventions were an “assault on young lesbian lives”. Bev Jackson, co-founder of the charity LGB Alliance, said: “The medical malpractice exposed so clearly by Hilary Cass has particularly affected lesbian teens. In the new homophobia that has captured today’s youth culture, they are getting the message that they are really boys and hormones will fix them.”")
Daily Mail
Tuesday 9 April
Wednesday 10 April
![AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA ■ Pillars of gender treatment built on ‘shaky foundations’ ■ Caution needed before youngsters change pronouns ■ Evidence severely lacking over use of puberty blockers Daily Mail10 Apr 2024By Alex Ward, Shaun Wooller and Harriet Line CHILDREN given NHS transgender treatment have been set on a path of irreversible change despite scant medical data, a report has concluded. NHS gender identity services for children and young people have been based on ‘remarkably weak evidence’, the independent review by leading paediatrician Dr Hilary cass warned. Her study, commissioned nearly four years ago, makes 32 recommendations to overhaul NHS trans services to improve the care that children receive. Prime Minister rishi Sunak welcomed the report and called for ‘extreme caution’ in treating youngsters in the future. campaigners hailed it as ‘a return to common-sense decision-making’. in other developments: ■ Dr cass said the ‘toxicity of the debate’ over trans care for children was ‘exceptional’ – and revealed she was herself singled out for criticism during her work; ■ The report said there was a ‘lack of high-quality research’ on the effects of giving children puberty blockers and hormones, and recommended that NHS England establish its own research programme; n Long NHS waiting lists were said to have driven trans children into the arms of private clinics, with GPs ‘ pressurised to prescribe’; n Dr Cass laid the groundwork for schools to introduce clearer guidance when dealing with trans children, ending the exclusion of parents; n The report called for the creation a separate service for those wanting to ‘de-transition’, where a gender transition is stopped or reversed; n Dr Cass recommended a ‘follow-through service’ for 17 to 25-year- olds to protect teenagers ‘falling off a cliff edge’ in care when they hit 17. n NHS England launched a similar review of adult gender services led by an independent expert. Dr Cass warned that her review had been hampered by how polarised the debate on trans care for children has become. She said medical professionals had been left ‘[too] afraid to openly discuss their views’. Dr Cass said: ‘ Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional. ‘I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution. ‘This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate. ‘There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop. Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.’ Dr Cass described having come into contact with some ‘very aggressive people’ during meetings as part of her work. The report found evidence for the use of puberty blockers and hormone treatments relied heavily on ‘shaky foundations’ and guidelines not backed by science. Dr Cass addressed recent debates over ‘social transitioning’, such as changing names and pronouns. The report found those who socially transition at an earlier age or before seeing a medical professional were ‘more likely to proceed to a medical pathway’. She said ‘the importance of what happens in school’ cannot be over- estimated and said parents must not be excluded from conversations over their children’s welfare. Unregulated private clinics were singled out for some of Dr Cass’s toughest criticism as she echoed GPs’ warnings over prescriptions issued by services based abroad. The review said family doctors had ‘expressed concern about being pressurised to prescribe hormones after these have been initiated by private providers’. It said no GP should be expected to ‘ enter into a shared care arrangement with a private provider’, especially one acting outside NHS guidance. Mr Sunak said the report emphasised the need for caution over treatment. He said: ‘We simply do not know the long-term impacts of medical treatment or social transitioning on children. ‘The wellbeing and health of children must come first.’ Helen Joyce of charity Sex Matters, said: ‘ Hilary Cass’s report demolishes the entire basis for the current model of treating gender- distressed children. ‘It is a shameful day for NHS England, which for too long gave vulnerable children harmful treatments for which there was no evidence base. ‘Cass’s review is a breath of fresh air, marking a return to common-sense decision-making and evidence-based medical treatment.’ A spokesman for Bayswater, a group that supports parents of trans children, said the Cass Report ‘represents a sea change in the treatment of trans-identified children and young people’. The report was also welcomed by Labour. Shadow health secretary Wes Streeting described it as ‘ a watershed moment for the NHS’s gender identity services’. The report comes weeks after NHS England confirmed it would no longer prescribe children puberty blockers at its gender identity clinics, saying there is not enough evidence to support their ‘ safety or clinical effectiveness’. A spokesman said: ‘ NHS England is very grateful to Dr Cass and her team for their comprehensive work.’ ‘Pressurised to prescribe’ DENYING the ‘ rights’ of children to transition between genders has long been seen by the illiberal Left as grand heresy. Anyone expressing concern that young people were being encouraged to make lifechanging decisions they might later bitterly regret had to be ruthlessly pilloried. Julie Bindel, who writes in today’s Mail, novelist JK Rowling and our own Sarah Vine have suffered the vilest of online abuse for daring to challenge the trans lobby’s manic evangelism. But the tide is turning. Today, with publication of the Cass Review into how the NHS should treat young people presenting with ‘gender dysphoria’, those brave dissenters are finally vindicated. Children ‘caught in the middle’ of a polarised gender row. Puberty blockers damaging young bones. GPs pressured into prescribing hormone drugs. Scant consideration given to long- term consequences. Ideology rather than science driving the debate. It is a litany of shame. Let this be a line in the sand. Until now, a hectoring minority has dominated this toxic debate – to the detriment of who knows how many young people. No longer must their braying be allowed to drown out the voice of reason and common sense. Article Name:AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA Publication:Daily Mail Author:By Alex Ward, Shaun Wooller and Harriet Line Start Page:1 End Page:1](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F8ca7d1ae-997b-49c6-8262-be3f3eef5d21_560x700.png "AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA ■ Pillars of gender treatment built on ‘shaky foundations’ ■ Caution needed before youngsters change pronouns ■ Evidence severely lacking over use of puberty blockers Daily Mail10 Apr 2024By Alex Ward, Shaun Wooller and Harriet Line CHILDREN given NHS transgender treatment have been set on a path of irreversible change despite scant medical data, a report has concluded. NHS gender identity services for children and young people have been based on ‘remarkably weak evidence’, the independent review by leading paediatrician Dr Hilary cass warned. Her study, commissioned nearly four years ago, makes 32 recommendations to overhaul NHS trans services to improve the care that children receive. Prime Minister rishi Sunak welcomed the report and called for ‘extreme caution’ in treating youngsters in the future. campaigners hailed it as ‘a return to common-sense decision-making’. in other developments: ■ Dr cass said the ‘toxicity of the debate’ over trans care for children was ‘exceptional’ – and revealed she was herself singled out for criticism during her work; ■ The report said there was a ‘lack of high-quality research’ on the effects of giving children puberty blockers and hormones, and recommended that NHS England establish its own research programme; n Long NHS waiting lists were said to have driven trans children into the arms of private clinics, with GPs ‘ pressurised to prescribe’; n Dr Cass laid the groundwork for schools to introduce clearer guidance when dealing with trans children, ending the exclusion of parents; n The report called for the creation a separate service for those wanting to ‘de-transition’, where a gender transition is stopped or reversed; n Dr Cass recommended a ‘follow-through service’ for 17 to 25-year- olds to protect teenagers ‘falling off a cliff edge’ in care when they hit 17. n NHS England launched a similar review of adult gender services led by an independent expert. Dr Cass warned that her review had been hampered by how polarised the debate on trans care for children has become. She said medical professionals had been left ‘[too] afraid to openly discuss their views’. Dr Cass said: ‘ Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional. ‘I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution. ‘This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate. ‘There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop. Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.’ Dr Cass described having come into contact with some ‘very aggressive people’ during meetings as part of her work. The report found evidence for the use of puberty blockers and hormone treatments relied heavily on ‘shaky foundations’ and guidelines not backed by science. Dr Cass addressed recent debates over ‘social transitioning’, such as changing names and pronouns. The report found those who socially transition at an earlier age or before seeing a medical professional were ‘more likely to proceed to a medical pathway’. She said ‘the importance of what happens in school’ cannot be over- estimated and said parents must not be excluded from conversations over their children’s welfare. Unregulated private clinics were singled out for some of Dr Cass’s toughest criticism as she echoed GPs’ warnings over prescriptions issued by services based abroad. The review said family doctors had ‘expressed concern about being pressurised to prescribe hormones after these have been initiated by private providers’. It said no GP should be expected to ‘ enter into a shared care arrangement with a private provider’, especially one acting outside NHS guidance. Mr Sunak said the report emphasised the need for caution over treatment. He said: ‘We simply do not know the long-term impacts of medical treatment or social transitioning on children. ‘The wellbeing and health of children must come first.’ Helen Joyce of charity Sex Matters, said: ‘ Hilary Cass’s report demolishes the entire basis for the current model of treating gender- distressed children. ‘It is a shameful day for NHS England, which for too long gave vulnerable children harmful treatments for which there was no evidence base. ‘Cass’s review is a breath of fresh air, marking a return to common-sense decision-making and evidence-based medical treatment.’ A spokesman for Bayswater, a group that supports parents of trans children, said the Cass Report ‘represents a sea change in the treatment of trans-identified children and young people’. The report was also welcomed by Labour. Shadow health secretary Wes Streeting described it as ‘ a watershed moment for the NHS’s gender identity services’. The report comes weeks after NHS England confirmed it would no longer prescribe children puberty blockers at its gender identity clinics, saying there is not enough evidence to support their ‘ safety or clinical effectiveness’. A spokesman said: ‘ NHS England is very grateful to Dr Cass and her team for their comprehensive work.’ ‘Pressurised to prescribe’ DENYING the ‘ rights’ of children to transition between genders has long been seen by the illiberal Left as grand heresy. Anyone expressing concern that young people were being encouraged to make lifechanging decisions they might later bitterly regret had to be ruthlessly pilloried. Julie Bindel, who writes in today’s Mail, novelist JK Rowling and our own Sarah Vine have suffered the vilest of online abuse for daring to challenge the trans lobby’s manic evangelism. But the tide is turning. Today, with publication of the Cass Review into how the NHS should treat young people presenting with ‘gender dysphoria’, those brave dissenters are finally vindicated. Children ‘caught in the middle’ of a polarised gender row. Puberty blockers damaging young bones. GPs pressured into prescribing hormone drugs. Scant consideration given to long- term consequences. Ideology rather than science driving the debate. It is a litany of shame. Let this be a line in the sand. Until now, a hectoring minority has dominated this toxic debate – to the detriment of who knows how many young people. No longer must their braying be allowed to drown out the voice of reason and common sense. Article Name:AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA Publication:Daily Mail Author:By Alex Ward, Shaun Wooller and Harriet Line Start Page:1 End Page:1")
![AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA ■ Pillars of gender treatment built on ‘shaky foundations’ ■ Caution needed before youngsters change pronouns ■ Evidence severely lacking over use of puberty blockers Daily Mail10 Apr 2024By Alex Ward, Shaun Wooller and Harriet Line CHILDREN given NHS transgender treatment have been set on a path of irreversible change despite scant medical data, a report has concluded. NHS gender identity services for children and young people have been based on ‘remarkably weak evidence’, the independent review by leading paediatrician Dr Hilary cass warned. Her study, commissioned nearly four years ago, makes 32 recommendations to overhaul NHS trans services to improve the care that children receive. Prime Minister rishi Sunak welcomed the report and called for ‘extreme caution’ in treating youngsters in the future. campaigners hailed it as ‘a return to common-sense decision-making’. in other developments: ■ Dr cass said the ‘toxicity of the debate’ over trans care for children was ‘exceptional’ – and revealed she was herself singled out for criticism during her work; ■ The report said there was a ‘lack of high-quality research’ on the effects of giving children puberty blockers and hormones, and recommended that NHS England establish its own research programme; n Long NHS waiting lists were said to have driven trans children into the arms of private clinics, with GPs ‘ pressurised to prescribe’; n Dr Cass laid the groundwork for schools to introduce clearer guidance when dealing with trans children, ending the exclusion of parents; n The report called for the creation a separate service for those wanting to ‘de-transition’, where a gender transition is stopped or reversed; n Dr Cass recommended a ‘follow-through service’ for 17 to 25-year- olds to protect teenagers ‘falling off a cliff edge’ in care when they hit 17. n NHS England launched a similar review of adult gender services led by an independent expert. Dr Cass warned that her review had been hampered by how polarised the debate on trans care for children has become. She said medical professionals had been left ‘[too] afraid to openly discuss their views’. Dr Cass said: ‘ Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional. ‘I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution. ‘This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate. ‘There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop. Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.’ Dr Cass described having come into contact with some ‘very aggressive people’ during meetings as part of her work. The report found evidence for the use of puberty blockers and hormone treatments relied heavily on ‘shaky foundations’ and guidelines not backed by science. Dr Cass addressed recent debates over ‘social transitioning’, such as changing names and pronouns. The report found those who socially transition at an earlier age or before seeing a medical professional were ‘more likely to proceed to a medical pathway’. She said ‘the importance of what happens in school’ cannot be over- estimated and said parents must not be excluded from conversations over their children’s welfare. Unregulated private clinics were singled out for some of Dr Cass’s toughest criticism as she echoed GPs’ warnings over prescriptions issued by services based abroad. The review said family doctors had ‘expressed concern about being pressurised to prescribe hormones after these have been initiated by private providers’. It said no GP should be expected to ‘ enter into a shared care arrangement with a private provider’, especially one acting outside NHS guidance. Mr Sunak said the report emphasised the need for caution over treatment. He said: ‘We simply do not know the long-term impacts of medical treatment or social transitioning on children. ‘The wellbeing and health of children must come first.’ Helen Joyce of charity Sex Matters, said: ‘ Hilary Cass’s report demolishes the entire basis for the current model of treating gender- distressed children. ‘It is a shameful day for NHS England, which for too long gave vulnerable children harmful treatments for which there was no evidence base. ‘Cass’s review is a breath of fresh air, marking a return to common-sense decision-making and evidence-based medical treatment.’ A spokesman for Bayswater, a group that supports parents of trans children, said the Cass Report ‘represents a sea change in the treatment of trans-identified children and young people’. The report was also welcomed by Labour. Shadow health secretary Wes Streeting described it as ‘ a watershed moment for the NHS’s gender identity services’. The report comes weeks after NHS England confirmed it would no longer prescribe children puberty blockers at its gender identity clinics, saying there is not enough evidence to support their ‘ safety or clinical effectiveness’. A spokesman said: ‘ NHS England is very grateful to Dr Cass and her team for their comprehensive work.’ ‘Pressurised to prescribe’ DENYING the ‘ rights’ of children to transition between genders has long been seen by the illiberal Left as grand heresy. Anyone expressing concern that young people were being encouraged to make lifechanging decisions they might later bitterly regret had to be ruthlessly pilloried. Julie Bindel, who writes in today’s Mail, novelist JK Rowling and our own Sarah Vine have suffered the vilest of online abuse for daring to challenge the trans lobby’s manic evangelism. But the tide is turning. Today, with publication of the Cass Review into how the NHS should treat young people presenting with ‘gender dysphoria’, those brave dissenters are finally vindicated. Children ‘caught in the middle’ of a polarised gender row. Puberty blockers damaging young bones. GPs pressured into prescribing hormone drugs. Scant consideration given to long- term consequences. Ideology rather than science driving the debate. It is a litany of shame. Let this be a line in the sand. Until now, a hectoring minority has dominated this toxic debate – to the detriment of who knows how many young people. No longer must their braying be allowed to drown out the voice of reason and common sense. Article Name:AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA Publication:Daily Mail Author:By Alex Ward, Shaun Wooller and Harriet Line Start Page:2 End Page:2](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F54539b6b-43db-47d5-9556-7fc69258ec80_798x777.png "AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA ■ Pillars of gender treatment built on ‘shaky foundations’ ■ Caution needed before youngsters change pronouns ■ Evidence severely lacking over use of puberty blockers Daily Mail10 Apr 2024By Alex Ward, Shaun Wooller and Harriet Line CHILDREN given NHS transgender treatment have been set on a path of irreversible change despite scant medical data, a report has concluded. NHS gender identity services for children and young people have been based on ‘remarkably weak evidence’, the independent review by leading paediatrician Dr Hilary cass warned. Her study, commissioned nearly four years ago, makes 32 recommendations to overhaul NHS trans services to improve the care that children receive. Prime Minister rishi Sunak welcomed the report and called for ‘extreme caution’ in treating youngsters in the future. campaigners hailed it as ‘a return to common-sense decision-making’. in other developments: ■ Dr cass said the ‘toxicity of the debate’ over trans care for children was ‘exceptional’ – and revealed she was herself singled out for criticism during her work; ■ The report said there was a ‘lack of high-quality research’ on the effects of giving children puberty blockers and hormones, and recommended that NHS England establish its own research programme; n Long NHS waiting lists were said to have driven trans children into the arms of private clinics, with GPs ‘ pressurised to prescribe’; n Dr Cass laid the groundwork for schools to introduce clearer guidance when dealing with trans children, ending the exclusion of parents; n The report called for the creation a separate service for those wanting to ‘de-transition’, where a gender transition is stopped or reversed; n Dr Cass recommended a ‘follow-through service’ for 17 to 25-year- olds to protect teenagers ‘falling off a cliff edge’ in care when they hit 17. n NHS England launched a similar review of adult gender services led by an independent expert. Dr Cass warned that her review had been hampered by how polarised the debate on trans care for children has become. She said medical professionals had been left ‘[too] afraid to openly discuss their views’. Dr Cass said: ‘ Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional. ‘I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution. ‘This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate. ‘There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop. Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.’ Dr Cass described having come into contact with some ‘very aggressive people’ during meetings as part of her work. The report found evidence for the use of puberty blockers and hormone treatments relied heavily on ‘shaky foundations’ and guidelines not backed by science. Dr Cass addressed recent debates over ‘social transitioning’, such as changing names and pronouns. The report found those who socially transition at an earlier age or before seeing a medical professional were ‘more likely to proceed to a medical pathway’. She said ‘the importance of what happens in school’ cannot be over- estimated and said parents must not be excluded from conversations over their children’s welfare. Unregulated private clinics were singled out for some of Dr Cass’s toughest criticism as she echoed GPs’ warnings over prescriptions issued by services based abroad. The review said family doctors had ‘expressed concern about being pressurised to prescribe hormones after these have been initiated by private providers’. It said no GP should be expected to ‘ enter into a shared care arrangement with a private provider’, especially one acting outside NHS guidance. Mr Sunak said the report emphasised the need for caution over treatment. He said: ‘We simply do not know the long-term impacts of medical treatment or social transitioning on children. ‘The wellbeing and health of children must come first.’ Helen Joyce of charity Sex Matters, said: ‘ Hilary Cass’s report demolishes the entire basis for the current model of treating gender- distressed children. ‘It is a shameful day for NHS England, which for too long gave vulnerable children harmful treatments for which there was no evidence base. ‘Cass’s review is a breath of fresh air, marking a return to common-sense decision-making and evidence-based medical treatment.’ A spokesman for Bayswater, a group that supports parents of trans children, said the Cass Report ‘represents a sea change in the treatment of trans-identified children and young people’. The report was also welcomed by Labour. Shadow health secretary Wes Streeting described it as ‘ a watershed moment for the NHS’s gender identity services’. The report comes weeks after NHS England confirmed it would no longer prescribe children puberty blockers at its gender identity clinics, saying there is not enough evidence to support their ‘ safety or clinical effectiveness’. A spokesman said: ‘ NHS England is very grateful to Dr Cass and her team for their comprehensive work.’ ‘Pressurised to prescribe’ DENYING the ‘ rights’ of children to transition between genders has long been seen by the illiberal Left as grand heresy. Anyone expressing concern that young people were being encouraged to make lifechanging decisions they might later bitterly regret had to be ruthlessly pilloried. Julie Bindel, who writes in today’s Mail, novelist JK Rowling and our own Sarah Vine have suffered the vilest of online abuse for daring to challenge the trans lobby’s manic evangelism. But the tide is turning. Today, with publication of the Cass Review into how the NHS should treat young people presenting with ‘gender dysphoria’, those brave dissenters are finally vindicated. Children ‘caught in the middle’ of a polarised gender row. Puberty blockers damaging young bones. GPs pressured into prescribing hormone drugs. Scant consideration given to long- term consequences. Ideology rather than science driving the debate. It is a litany of shame. Let this be a line in the sand. Until now, a hectoring minority has dominated this toxic debate – to the detriment of who knows how many young people. No longer must their braying be allowed to drown out the voice of reason and common sense. Article Name:AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA Publication:Daily Mail Author:By Alex Ward, Shaun Wooller and Harriet Line Start Page:2 End Page:2")
![We went to see our daughter get a school prize and it was handed to a boy called ‘Tommi’ It’s taken 20 years of women like me facing intimidation, death threats and wrecked livelihoods for the voice of sanity to be finally heard A mother’s heartbreaking story of how teachers kept her in the dark over her 14-year-old’s transition... Daily Mail10 Apr 2024by Sue Reid by Julie Bindel Patricia and Michael were bursting with pride that their 14- year- old daughter was in line for an essay-writing prize at her annual school awards ceremony. they arrived early to get seats with a good view of the event, held at the end of the summer term two years ago. the couple were already aware that the large secondary school in northern England was a proud champion of the trans-rights lobby charity Stonewall, with posters celebrating ‘LGBtQ+ diversity’ plastered over the entrance hall. But nothing could have prepared them for what happened that day. to their shock, the child who received the prize was not their daughter tania who had left home that morning. instead, a young figure in grey trousers with fair curly hair, slicked back by gel, appeared when the headteacher called up a ‘tommi’ to the platform. it soon dawned on the middle- class couple what was happening. ‘My daughter had changed her name and her pronouns,’ Patricia said yesterday. ‘at school, she was living as a boy and no one had told us. ‘the teachers were supporting her lifechanging decision. Some staff celebrated our daughter’s changed identity behind our backs. ‘a few had offered to put her in touch with their own adult transgender friends. She had, we discovered, become the school’s poster child for inclusivity and diversity. ‘at one stage her picture with her new name “tommi” was displayed by teachers in the school as a fine example of a transgender pupil’s success story.’ today, Patricia is still reeling from the experience. She has shared her family’s story with the Mail in light of the publication of the long-awaited cass report into NHS care for gender- questioning children and adolescents — the findings of which are expected to reshape treatment for those under the age of 18. Following this seminal review, gender-confused children will be moved away from drugs such as puberty-blockers and cross-sex hormones in favour of a more ‘holistic’ approach to treatment, focusing among other things on their mental health. it is welcome news for most parents. But Patricia is cautious. ‘the cass findings come too late for my daughter,’ she says, angrily. ‘almost all tania’s friendship group, who she speaks to online, are transgender. Most of her teachers are Stonewall supporters. School staff have even donated various pieces of second-hand male school uniform to her.’ it is the school that Patricia blames most for her daughter’s desire to change gender. Before tania joined secondary school, she was a high-achieving, confident child — happy to play with both girls and boys. ‘She never showed any sign of gender distress. But, unfortunately, as a bright child who wanted to please her teachers, she was mercilessly bullied by other girls,’ says Patricia. But it was only during the autumn term, after the awards ceremony, that Patricia discovered the extent of what she sees as the school’s treachery. ‘i had no information from the school. all the communication (email or otherwise) used her female pronouns and legal name. ‘i was confused, terrified and tried to remember anything that could have started this metamorphosis,’ she says. ‘i recalled that one dinner time, when she was 13, she began to discuss sexual orientation and pronouns. ‘tania then said she had been studying gender at school through what i now know is the Government-approved and compulsory “relationships and Sex Education” curriculum. ‘the daughter we love informed us she had chosen her pronouns but they were secret. My blood ran cold.’ When Patricia and Michael confronted the school after the awards ceremony, they were met with hostility. ‘the “safeguarding team” called in to see us and told us we parents had no rights. all that mattered was the “child’s voice”. We were told that the cass inquiry findings [ which had been commissioned a couple of years prior], whatever they were, would be completely disregarded by the school.’ Patricia adds: ‘During one meeting, a safeguarding teacher continued to refer to my daughter as male without any regard for our feelings. it felt personal, as though she was baiting me to see how far i could be pushed before i snapped.’ tania’s parents finally appealed for help from the school’s assistant head. they begged her to reverse the name and pronoun changes. ‘She listened to me attentively, nodding at all the right moments’, says Patricia. ‘But then she waved us out of her office, telling me that it was quite possible for a child to “safely transition”. ’ On her 16th birthday this year, without the permission of her parents, both in their 40s, tania changed her name to tommi by deed poll. She now wears heavy-duty army shorts and a hoodie, with men’s shoes on her feet. When out, she uses a male lavatory and speaks with a deep voice to emulate an adolescent boy. and although tania is not (yet) taking puberty- blockers or sex- change hormones, Patricia worries about her mental wellbeing. ‘She continues to live with us, but has rejected us as parents, ditto her younger sister and other members of the wider family. ‘teachers should realise that strong family connections are one of the most dominant factors in a child’s future happiness and success. they put up a wedge between the two.’ Patricia says the school has wielded enormous power over tania’s adolescent life. What has happened to her is going on in many state and private schools. ‘i cannot go near my daughter’s big red-brick building without feeling a deep sense of fear for her future.’ All names have been changed. ‘Safeguarding’ team said parents had no rights She wears army shorts and uses male lavatory THE damage wrought by two decades of slavish obedience to an ideological cult cannot be overstated. So many children and adolescents have been victims of the trans delusion. They have had their bodies mutilated, their mental health wrecked, their relationships with parents and siblings destroyed, their education shattered — all based on the crazy fallacy that there is any such thing as a ‘transgender child’ or that it is possible for a prepubescent to be ‘trapped in the wrong body’. My main emotion, as I read the Cass Review yesterday, was not relief — but anger. Yes, I’m glad the tide is finally turning against this oppressive, toxic dogma. But people like me have been speaking out against it for more than 20 years. We have faced constant intimidation, violence, even death threats. Some of us have seen our livelihoods wrecked. Academics have been sacked, whistleblowers have been hounded out. Why has it taken so long for the voice of the Establishment to be raised in defence of sanity? A few heroic figures have been willing to sacrifice their careers by speaking a self- evident truth — that unhappy, confused children cannot be ‘fixed’ by a toxic cocktail of medications. This ought to be obvious: these drugs can cause deep mental damage and often physical risks. Encouraging children to live a lie, meanwhile, means creating a lifelong psychological mess. YET far from standing up to the mob mentality, most political leaders have been craven. Last year, Sir Keir Starmer, our probable next prime minister, couldn’t commit himself: the best he could do was declare that, ‘99.9 per cent of women haven’t got a penis’, implying that one in 1,000 do. In her measured report, Dr Hilary Cass recommends a ‘ holistic approach’ to treating young people questioning their gender identity, focusing on mental health rather than physical and medical interventions. But how can I feel relieved to read this when I’ve watched this quasi-religious movement take control of all our major governmental bodies — including the NHS? In its worst incarnations, trans cultism is akin to the ancient belief in possession by demons. Rather than addressing complex mental health problems or hang-ups about sexuality, thousands of children have been told that their true ‘identity’ can be imprisoned within their flesh. It’s positively medieval. Yet this notion has infected almost every school, even at nursery level. Last Saturday, a woman contacted me in despair after finding that her ten-year- old daughter had been allowed (perhaps encouraged) by teachers to ‘transition’ at school. In an account with troubling echoes with the one Sue Reid recounts in the Mail today, she described how her daughter sets out each morning in a girl’s uniform, then changes into boy’s clothes on arrival at school. Teachers and classmates call her by a new, male name. She uses the boys’ bathrooms and plays sports on the boys’ teams. Incredibly, the school gave no hint of this to her parents. How can anyone in authority think this was right or healthy? This poisonous, divisive trend has been spreading for years. The fact that the NHS is belatedly recognising it is hardly a cause for unbridled celebration. I first became aware of it in 2003, when writing about the increasing normalisation of adult transexuality and its threat to women’s hard-won rights. A charity called Mermaids, I was appalled to find, which described itself as a support group for children and teenagers with ‘gender identity disorder’, had seen a big increase in inquiries since its inception in 1995. For several years, Mermaids had been proclaiming the existence of ‘trans children’ and recommending physical, even lifechanging, interventions to allow them to live as the opposite sex. These youngsters, some just 14, were having invasive treatments, such as puberty-blockers. Despite the lack of knowledge about the drugs’ long- term effects, they were being prescribed to ever-younger children. Puberty-blockers were characteristically sold as a way of ‘buying time’ for children who might decide to embrace sex- change procedures when they were older. It was, their advocates claimed, a way of ‘pushing the pause button’ on adolescence. What bilge. It’s incredible any educated person, let alone a doctor or nurse, could ever have given that claim credence. Puberty is a period of confusion, emotional turmoil and physical discomfort — especially for girls. And, whatever sex, our bodies change. We become sexually aware and fertile. We look, feel and think differently, often from one week to the next. Pretending that this confusing, overwhelming process can just be ‘paused’, like a videotape, is a perversion of reality. WE DON’T yet know the full damage puberty- blockers can cause, but already we’re seeing evidence that they increase the incidence of cancers, multiple sclerosis and osteoporosis or brittle bones in young adults. If that’s the danger after ten or 15 years, what could be the outcome after 25 or 30? I fear the irrevocable damage from these drugs is going to be much worse than we yet imagine, a medical disaster on a scale that outstrips the thalidomide scandal. And that’s just the drugs. The irreversible medical procedures, literally carving up the sexual organs of people barely out of their teens, are shocking. How can so many have remained silent while a taxpayerfunded NHS clinic amputated young women’s breasts? So yes, I welcome the Cass Review, but only because I, like so many, have been desperate to hear any kind of official recognition that immense harm is being done to children by this collective madness. The report begins with an overly defensive statement, promising young people that Gender Identity Development Services ( GIDS), including hormone treatments, will not be stopped. Well, they should be. Dr Cass ought to be throwing out the notion on the first page that there is any such thing as a ‘trans child’. We all want everyone, most of all vulnerable children, to have access to good healthcare. But puberty- blockers that put children on a pathway to sex-change surgery should not be considered healthcare. The review acknowledges that children and adolescents coming to GIDS clinics often present with a wide range of overlapping medical and psychological problems, or ‘co-morbidities’. Clinicians seeing these children should be alert for undiagnosed depression, eating disorders, neuro- diverse conditions such as autism and other hidden problems, as well as family issues such as sexual or physical abuse, neglect or violence in the home. Instead, transgender ideology overrules all other concerns. Very serious issues such as child sex abuse may well be going undetected in the rush to encourage children ‘be their true selves’. But, in the activists’ eyes, being their true selves typically amounts to an obscene parody of 1950s gender norms, where ‘being a girl’ means to wear pink dresses and have pigtails and ‘ being a boy’ means to push Tonka toys through sandpits. If you break that mould, you must be in the wrong body. We need to say it without fear. I have long doubted that there is such thing as a ‘transgender child’. The underlying causes of ‘gender dysphoria’ are mental distress, ill-health and trauma. Yes, some adults grow up to suffer from this complicated condition, and seem to find life intolerable unless they live as the opposite sex. But children are another matter altogether: they deserve protection. AND it is telling that the highest proportion of girls presenting as ‘trans boys’ to gender services in 2022 was in Blackpool. This Lancashire resort also suffers the highest rate of children in care and the highest reported rate of child sexual abuse. There is a direct correlation between these horrific statistics. Telling a child in care who has endured traumatic abuse that their real problem is their ‘gender identity’ is at odds with their sexual organs is worse than wrong- headed. It ought to be criminal. For many years, children in care homes were prey to monsters in plain sight such as Jimmy Savile and Cyril Smith. Now they are equally defenceless against fanatics in the grip of a demented doctrine, who are telling them that the way to be happy is to change their bodies with powerful drugs, starting along the path to surgical mutilation. As long as the NHS and other government bodies hold back from fully condemning trans ideology, the fight for truth will have to be waged by individuals who are prepared to face down the mob. I did exactly that last month, at the first conference of the Clinical Advisory Network on Sex and Gender in Euston, Central London. The attendees were made up of sensible, eminent professionals including psychologists, counsellors and doctors critical of the trans dogma. Our slogan was the time-honoured motto of all medicine, one recently forgotten by too many of its shameful practitioners: First Do No Harm. But the baying protesters trying to shut us down by throwing smoke bombs and screaming threats were hoping to do harm, not only by calling for our blood, but through the cruelty of inflicting a mass sexual experiment on children. Dr Hilary Cass has been at pains to stress that her review is only an interim report, with more work yet to come. So far, what she has published does not go far enough. But I’m glad for the validation it gives to campaigners who have pleaded so long for sanity. I’m glad, too, for the promise of more research to come. We’ve all got a long road ahead. Article Name:We went to see our daughter get a school prize and it was handed to a boy called ‘Tommi’ It’s taken 20 years of women like me facing intimidation, death threats and wrecked livelihoods for the voice of sanity to be finally heard Publication:Daily Mail Author:by Sue Reid by Julie Bindel Start Page:11 End Page:11](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fd1ef8ef9-db23-4937-b049-972fc3cd4cb5_1125x705.png "We went to see our daughter get a school prize and it was handed to a boy called ‘Tommi’ It’s taken 20 years of women like me facing intimidation, death threats and wrecked livelihoods for the voice of sanity to be finally heard A mother’s heartbreaking story of how teachers kept her in the dark over her 14-year-old’s transition... Daily Mail10 Apr 2024by Sue Reid by Julie Bindel Patricia and Michael were bursting with pride that their 14- year- old daughter was in line for an essay-writing prize at her annual school awards ceremony. they arrived early to get seats with a good view of the event, held at the end of the summer term two years ago. the couple were already aware that the large secondary school in northern England was a proud champion of the trans-rights lobby charity Stonewall, with posters celebrating ‘LGBtQ+ diversity’ plastered over the entrance hall. But nothing could have prepared them for what happened that day. to their shock, the child who received the prize was not their daughter tania who had left home that morning. instead, a young figure in grey trousers with fair curly hair, slicked back by gel, appeared when the headteacher called up a ‘tommi’ to the platform. it soon dawned on the middle- class couple what was happening. ‘My daughter had changed her name and her pronouns,’ Patricia said yesterday. ‘at school, she was living as a boy and no one had told us. ‘the teachers were supporting her lifechanging decision. Some staff celebrated our daughter’s changed identity behind our backs. ‘a few had offered to put her in touch with their own adult transgender friends. She had, we discovered, become the school’s poster child for inclusivity and diversity. ‘at one stage her picture with her new name “tommi” was displayed by teachers in the school as a fine example of a transgender pupil’s success story.’ today, Patricia is still reeling from the experience. She has shared her family’s story with the Mail in light of the publication of the long-awaited cass report into NHS care for gender- questioning children and adolescents — the findings of which are expected to reshape treatment for those under the age of 18. Following this seminal review, gender-confused children will be moved away from drugs such as puberty-blockers and cross-sex hormones in favour of a more ‘holistic’ approach to treatment, focusing among other things on their mental health. it is welcome news for most parents. But Patricia is cautious. ‘the cass findings come too late for my daughter,’ she says, angrily. ‘almost all tania’s friendship group, who she speaks to online, are transgender. Most of her teachers are Stonewall supporters. School staff have even donated various pieces of second-hand male school uniform to her.’ it is the school that Patricia blames most for her daughter’s desire to change gender. Before tania joined secondary school, she was a high-achieving, confident child — happy to play with both girls and boys. ‘She never showed any sign of gender distress. But, unfortunately, as a bright child who wanted to please her teachers, she was mercilessly bullied by other girls,’ says Patricia. But it was only during the autumn term, after the awards ceremony, that Patricia discovered the extent of what she sees as the school’s treachery. ‘i had no information from the school. all the communication (email or otherwise) used her female pronouns and legal name. ‘i was confused, terrified and tried to remember anything that could have started this metamorphosis,’ she says. ‘i recalled that one dinner time, when she was 13, she began to discuss sexual orientation and pronouns. ‘tania then said she had been studying gender at school through what i now know is the Government-approved and compulsory “relationships and Sex Education” curriculum. ‘the daughter we love informed us she had chosen her pronouns but they were secret. My blood ran cold.’ When Patricia and Michael confronted the school after the awards ceremony, they were met with hostility. ‘the “safeguarding team” called in to see us and told us we parents had no rights. all that mattered was the “child’s voice”. We were told that the cass inquiry findings [ which had been commissioned a couple of years prior], whatever they were, would be completely disregarded by the school.’ Patricia adds: ‘During one meeting, a safeguarding teacher continued to refer to my daughter as male without any regard for our feelings. it felt personal, as though she was baiting me to see how far i could be pushed before i snapped.’ tania’s parents finally appealed for help from the school’s assistant head. they begged her to reverse the name and pronoun changes. ‘She listened to me attentively, nodding at all the right moments’, says Patricia. ‘But then she waved us out of her office, telling me that it was quite possible for a child to “safely transition”. ’ On her 16th birthday this year, without the permission of her parents, both in their 40s, tania changed her name to tommi by deed poll. She now wears heavy-duty army shorts and a hoodie, with men’s shoes on her feet. When out, she uses a male lavatory and speaks with a deep voice to emulate an adolescent boy. and although tania is not (yet) taking puberty- blockers or sex- change hormones, Patricia worries about her mental wellbeing. ‘She continues to live with us, but has rejected us as parents, ditto her younger sister and other members of the wider family. ‘teachers should realise that strong family connections are one of the most dominant factors in a child’s future happiness and success. they put up a wedge between the two.’ Patricia says the school has wielded enormous power over tania’s adolescent life. What has happened to her is going on in many state and private schools. ‘i cannot go near my daughter’s big red-brick building without feeling a deep sense of fear for her future.’ All names have been changed. ‘Safeguarding’ team said parents had no rights She wears army shorts and uses male lavatory THE damage wrought by two decades of slavish obedience to an ideological cult cannot be overstated. So many children and adolescents have been victims of the trans delusion. They have had their bodies mutilated, their mental health wrecked, their relationships with parents and siblings destroyed, their education shattered — all based on the crazy fallacy that there is any such thing as a ‘transgender child’ or that it is possible for a prepubescent to be ‘trapped in the wrong body’. My main emotion, as I read the Cass Review yesterday, was not relief — but anger. Yes, I’m glad the tide is finally turning against this oppressive, toxic dogma. But people like me have been speaking out against it for more than 20 years. We have faced constant intimidation, violence, even death threats. Some of us have seen our livelihoods wrecked. Academics have been sacked, whistleblowers have been hounded out. Why has it taken so long for the voice of the Establishment to be raised in defence of sanity? A few heroic figures have been willing to sacrifice their careers by speaking a self- evident truth — that unhappy, confused children cannot be ‘fixed’ by a toxic cocktail of medications. This ought to be obvious: these drugs can cause deep mental damage and often physical risks. Encouraging children to live a lie, meanwhile, means creating a lifelong psychological mess. YET far from standing up to the mob mentality, most political leaders have been craven. Last year, Sir Keir Starmer, our probable next prime minister, couldn’t commit himself: the best he could do was declare that, ‘99.9 per cent of women haven’t got a penis’, implying that one in 1,000 do. In her measured report, Dr Hilary Cass recommends a ‘ holistic approach’ to treating young people questioning their gender identity, focusing on mental health rather than physical and medical interventions. But how can I feel relieved to read this when I’ve watched this quasi-religious movement take control of all our major governmental bodies — including the NHS? In its worst incarnations, trans cultism is akin to the ancient belief in possession by demons. Rather than addressing complex mental health problems or hang-ups about sexuality, thousands of children have been told that their true ‘identity’ can be imprisoned within their flesh. It’s positively medieval. Yet this notion has infected almost every school, even at nursery level. Last Saturday, a woman contacted me in despair after finding that her ten-year- old daughter had been allowed (perhaps encouraged) by teachers to ‘transition’ at school. In an account with troubling echoes with the one Sue Reid recounts in the Mail today, she described how her daughter sets out each morning in a girl’s uniform, then changes into boy’s clothes on arrival at school. Teachers and classmates call her by a new, male name. She uses the boys’ bathrooms and plays sports on the boys’ teams. Incredibly, the school gave no hint of this to her parents. How can anyone in authority think this was right or healthy? This poisonous, divisive trend has been spreading for years. The fact that the NHS is belatedly recognising it is hardly a cause for unbridled celebration. I first became aware of it in 2003, when writing about the increasing normalisation of adult transexuality and its threat to women’s hard-won rights. A charity called Mermaids, I was appalled to find, which described itself as a support group for children and teenagers with ‘gender identity disorder’, had seen a big increase in inquiries since its inception in 1995. For several years, Mermaids had been proclaiming the existence of ‘trans children’ and recommending physical, even lifechanging, interventions to allow them to live as the opposite sex. These youngsters, some just 14, were having invasive treatments, such as puberty-blockers. Despite the lack of knowledge about the drugs’ long- term effects, they were being prescribed to ever-younger children. Puberty-blockers were characteristically sold as a way of ‘buying time’ for children who might decide to embrace sex- change procedures when they were older. It was, their advocates claimed, a way of ‘pushing the pause button’ on adolescence. What bilge. It’s incredible any educated person, let alone a doctor or nurse, could ever have given that claim credence. Puberty is a period of confusion, emotional turmoil and physical discomfort — especially for girls. And, whatever sex, our bodies change. We become sexually aware and fertile. We look, feel and think differently, often from one week to the next. Pretending that this confusing, overwhelming process can just be ‘paused’, like a videotape, is a perversion of reality. WE DON’T yet know the full damage puberty- blockers can cause, but already we’re seeing evidence that they increase the incidence of cancers, multiple sclerosis and osteoporosis or brittle bones in young adults. If that’s the danger after ten or 15 years, what could be the outcome after 25 or 30? I fear the irrevocable damage from these drugs is going to be much worse than we yet imagine, a medical disaster on a scale that outstrips the thalidomide scandal. And that’s just the drugs. The irreversible medical procedures, literally carving up the sexual organs of people barely out of their teens, are shocking. How can so many have remained silent while a taxpayerfunded NHS clinic amputated young women’s breasts? So yes, I welcome the Cass Review, but only because I, like so many, have been desperate to hear any kind of official recognition that immense harm is being done to children by this collective madness. The report begins with an overly defensive statement, promising young people that Gender Identity Development Services ( GIDS), including hormone treatments, will not be stopped. Well, they should be. Dr Cass ought to be throwing out the notion on the first page that there is any such thing as a ‘trans child’. We all want everyone, most of all vulnerable children, to have access to good healthcare. But puberty- blockers that put children on a pathway to sex-change surgery should not be considered healthcare. The review acknowledges that children and adolescents coming to GIDS clinics often present with a wide range of overlapping medical and psychological problems, or ‘co-morbidities’. Clinicians seeing these children should be alert for undiagnosed depression, eating disorders, neuro- diverse conditions such as autism and other hidden problems, as well as family issues such as sexual or physical abuse, neglect or violence in the home. Instead, transgender ideology overrules all other concerns. Very serious issues such as child sex abuse may well be going undetected in the rush to encourage children ‘be their true selves’. But, in the activists’ eyes, being their true selves typically amounts to an obscene parody of 1950s gender norms, where ‘being a girl’ means to wear pink dresses and have pigtails and ‘ being a boy’ means to push Tonka toys through sandpits. If you break that mould, you must be in the wrong body. We need to say it without fear. I have long doubted that there is such thing as a ‘transgender child’. The underlying causes of ‘gender dysphoria’ are mental distress, ill-health and trauma. Yes, some adults grow up to suffer from this complicated condition, and seem to find life intolerable unless they live as the opposite sex. But children are another matter altogether: they deserve protection. AND it is telling that the highest proportion of girls presenting as ‘trans boys’ to gender services in 2022 was in Blackpool. This Lancashire resort also suffers the highest rate of children in care and the highest reported rate of child sexual abuse. There is a direct correlation between these horrific statistics. Telling a child in care who has endured traumatic abuse that their real problem is their ‘gender identity’ is at odds with their sexual organs is worse than wrong- headed. It ought to be criminal. For many years, children in care homes were prey to monsters in plain sight such as Jimmy Savile and Cyril Smith. Now they are equally defenceless against fanatics in the grip of a demented doctrine, who are telling them that the way to be happy is to change their bodies with powerful drugs, starting along the path to surgical mutilation. As long as the NHS and other government bodies hold back from fully condemning trans ideology, the fight for truth will have to be waged by individuals who are prepared to face down the mob. I did exactly that last month, at the first conference of the Clinical Advisory Network on Sex and Gender in Euston, Central London. The attendees were made up of sensible, eminent professionals including psychologists, counsellors and doctors critical of the trans dogma. Our slogan was the time-honoured motto of all medicine, one recently forgotten by too many of its shameful practitioners: First Do No Harm. But the baying protesters trying to shut us down by throwing smoke bombs and screaming threats were hoping to do harm, not only by calling for our blood, but through the cruelty of inflicting a mass sexual experiment on children. Dr Hilary Cass has been at pains to stress that her review is only an interim report, with more work yet to come. So far, what she has published does not go far enough. But I’m glad for the validation it gives to campaigners who have pleaded so long for sanity. I’m glad, too, for the promise of more research to come. We’ve all got a long road ahead. Article Name:We went to see our daughter get a school prize and it was handed to a boy called ‘Tommi’ It’s taken 20 years of women like me facing intimidation, death threats and wrecked livelihoods for the voice of sanity to be finally heard Publication:Daily Mail Author:by Sue Reid by Julie Bindel Start Page:11 End Page:11")
In reference to that Julie Bindel article, if you do a search you will find Julie Bindel talking about how trans women absolutely can be and are lesbians in a video that was definitely filmed within the last two decades despite what she says in that piece.
![AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA ■ Pillars of gender treatment built on ‘shaky foundations’ ■ Caution needed before youngsters change pronouns ■ Evidence severely lacking over use of puberty blockers Daily Mail10 Apr 2024By Alex Ward, Shaun Wooller and Harriet Line CHILDREN given NHS transgender treatment have been set on a path of irreversible change despite scant medical data, a report has concluded. NHS gender identity services for children and young people have been based on ‘remarkably weak evidence’, the independent review by leading paediatrician Dr Hilary cass warned. Her study, commissioned nearly four years ago, makes 32 recommendations to overhaul NHS trans services to improve the care that children receive. Prime Minister rishi Sunak welcomed the report and called for ‘extreme caution’ in treating youngsters in the future. campaigners hailed it as ‘a return to common-sense decision-making’. in other developments: ■ Dr cass said the ‘toxicity of the debate’ over trans care for children was ‘exceptional’ – and revealed she was herself singled out for criticism during her work; ■ The report said there was a ‘lack of high-quality research’ on the effects of giving children puberty blockers and hormones, and recommended that NHS England establish its own research programme; n Long NHS waiting lists were said to have driven trans children into the arms of private clinics, with GPs ‘ pressurised to prescribe’; n Dr Cass laid the groundwork for schools to introduce clearer guidance when dealing with trans children, ending the exclusion of parents; n The report called for the creation a separate service for those wanting to ‘de-transition’, where a gender transition is stopped or reversed; n Dr Cass recommended a ‘follow-through service’ for 17 to 25-year- olds to protect teenagers ‘falling off a cliff edge’ in care when they hit 17. n NHS England launched a similar review of adult gender services led by an independent expert. Dr Cass warned that her review had been hampered by how polarised the debate on trans care for children has become. She said medical professionals had been left ‘[too] afraid to openly discuss their views’. Dr Cass said: ‘ Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional. ‘I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution. ‘This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate. ‘There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop. Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.’ Dr Cass described having come into contact with some ‘very aggressive people’ during meetings as part of her work. The report found evidence for the use of puberty blockers and hormone treatments relied heavily on ‘shaky foundations’ and guidelines not backed by science. Dr Cass addressed recent debates over ‘social transitioning’, such as changing names and pronouns. The report found those who socially transition at an earlier age or before seeing a medical professional were ‘more likely to proceed to a medical pathway’. She said ‘the importance of what happens in school’ cannot be over- estimated and said parents must not be excluded from conversations over their children’s welfare. Unregulated private clinics were singled out for some of Dr Cass’s toughest criticism as she echoed GPs’ warnings over prescriptions issued by services based abroad. The review said family doctors had ‘expressed concern about being pressurised to prescribe hormones after these have been initiated by private providers’. It said no GP should be expected to ‘ enter into a shared care arrangement with a private provider’, especially one acting outside NHS guidance. Mr Sunak said the report emphasised the need for caution over treatment. He said: ‘We simply do not know the long-term impacts of medical treatment or social transitioning on children. ‘The wellbeing and health of children must come first.’ Helen Joyce of charity Sex Matters, said: ‘ Hilary Cass’s report demolishes the entire basis for the current model of treating gender- distressed children. ‘It is a shameful day for NHS England, which for too long gave vulnerable children harmful treatments for which there was no evidence base. ‘Cass’s review is a breath of fresh air, marking a return to common-sense decision-making and evidence-based medical treatment.’ A spokesman for Bayswater, a group that supports parents of trans children, said the Cass Report ‘represents a sea change in the treatment of trans-identified children and young people’. The report was also welcomed by Labour. Shadow health secretary Wes Streeting described it as ‘ a watershed moment for the NHS’s gender identity services’. The report comes weeks after NHS England confirmed it would no longer prescribe children puberty blockers at its gender identity clinics, saying there is not enough evidence to support their ‘ safety or clinical effectiveness’. A spokesman said: ‘ NHS England is very grateful to Dr Cass and her team for their comprehensive work.’ ‘Pressurised to prescribe’ DENYING the ‘ rights’ of children to transition between genders has long been seen by the illiberal Left as grand heresy. Anyone expressing concern that young people were being encouraged to make lifechanging decisions they might later bitterly regret had to be ruthlessly pilloried. Julie Bindel, who writes in today’s Mail, novelist JK Rowling and our own Sarah Vine have suffered the vilest of online abuse for daring to challenge the trans lobby’s manic evangelism. But the tide is turning. Today, with publication of the Cass Review into how the NHS should treat young people presenting with ‘gender dysphoria’, those brave dissenters are finally vindicated. Children ‘caught in the middle’ of a polarised gender row. Puberty blockers damaging young bones. GPs pressured into prescribing hormone drugs. Scant consideration given to long- term consequences. Ideology rather than science driving the debate. It is a litany of shame. Let this be a line in the sand. Until now, a hectoring minority has dominated this toxic debate – to the detriment of who knows how many young people. No longer must their braying be allowed to drown out the voice of reason and common sense. Article Name:AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA Publication:Daily Mail Author:By Alex Ward, Shaun Wooller and Harriet Line Start Page:16 End Page:16](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F7fd1d7d8-5370-4439-a3b0-6c56cd97f88d_460x679.png "AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA ■ Pillars of gender treatment built on ‘shaky foundations’ ■ Caution needed before youngsters change pronouns ■ Evidence severely lacking over use of puberty blockers Daily Mail10 Apr 2024By Alex Ward, Shaun Wooller and Harriet Line CHILDREN given NHS transgender treatment have been set on a path of irreversible change despite scant medical data, a report has concluded. NHS gender identity services for children and young people have been based on ‘remarkably weak evidence’, the independent review by leading paediatrician Dr Hilary cass warned. Her study, commissioned nearly four years ago, makes 32 recommendations to overhaul NHS trans services to improve the care that children receive. Prime Minister rishi Sunak welcomed the report and called for ‘extreme caution’ in treating youngsters in the future. campaigners hailed it as ‘a return to common-sense decision-making’. in other developments: ■ Dr cass said the ‘toxicity of the debate’ over trans care for children was ‘exceptional’ – and revealed she was herself singled out for criticism during her work; ■ The report said there was a ‘lack of high-quality research’ on the effects of giving children puberty blockers and hormones, and recommended that NHS England establish its own research programme; n Long NHS waiting lists were said to have driven trans children into the arms of private clinics, with GPs ‘ pressurised to prescribe’; n Dr Cass laid the groundwork for schools to introduce clearer guidance when dealing with trans children, ending the exclusion of parents; n The report called for the creation a separate service for those wanting to ‘de-transition’, where a gender transition is stopped or reversed; n Dr Cass recommended a ‘follow-through service’ for 17 to 25-year- olds to protect teenagers ‘falling off a cliff edge’ in care when they hit 17. n NHS England launched a similar review of adult gender services led by an independent expert. Dr Cass warned that her review had been hampered by how polarised the debate on trans care for children has become. She said medical professionals had been left ‘[too] afraid to openly discuss their views’. Dr Cass said: ‘ Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional. ‘I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution. ‘This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate. ‘There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop. Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.’ Dr Cass described having come into contact with some ‘very aggressive people’ during meetings as part of her work. The report found evidence for the use of puberty blockers and hormone treatments relied heavily on ‘shaky foundations’ and guidelines not backed by science. Dr Cass addressed recent debates over ‘social transitioning’, such as changing names and pronouns. The report found those who socially transition at an earlier age or before seeing a medical professional were ‘more likely to proceed to a medical pathway’. She said ‘the importance of what happens in school’ cannot be over- estimated and said parents must not be excluded from conversations over their children’s welfare. Unregulated private clinics were singled out for some of Dr Cass’s toughest criticism as she echoed GPs’ warnings over prescriptions issued by services based abroad. The review said family doctors had ‘expressed concern about being pressurised to prescribe hormones after these have been initiated by private providers’. It said no GP should be expected to ‘ enter into a shared care arrangement with a private provider’, especially one acting outside NHS guidance. Mr Sunak said the report emphasised the need for caution over treatment. He said: ‘We simply do not know the long-term impacts of medical treatment or social transitioning on children. ‘The wellbeing and health of children must come first.’ Helen Joyce of charity Sex Matters, said: ‘ Hilary Cass’s report demolishes the entire basis for the current model of treating gender- distressed children. ‘It is a shameful day for NHS England, which for too long gave vulnerable children harmful treatments for which there was no evidence base. ‘Cass’s review is a breath of fresh air, marking a return to common-sense decision-making and evidence-based medical treatment.’ A spokesman for Bayswater, a group that supports parents of trans children, said the Cass Report ‘represents a sea change in the treatment of trans-identified children and young people’. The report was also welcomed by Labour. Shadow health secretary Wes Streeting described it as ‘ a watershed moment for the NHS’s gender identity services’. The report comes weeks after NHS England confirmed it would no longer prescribe children puberty blockers at its gender identity clinics, saying there is not enough evidence to support their ‘ safety or clinical effectiveness’. A spokesman said: ‘ NHS England is very grateful to Dr Cass and her team for their comprehensive work.’ ‘Pressurised to prescribe’ DENYING the ‘ rights’ of children to transition between genders has long been seen by the illiberal Left as grand heresy. Anyone expressing concern that young people were being encouraged to make lifechanging decisions they might later bitterly regret had to be ruthlessly pilloried. Julie Bindel, who writes in today’s Mail, novelist JK Rowling and our own Sarah Vine have suffered the vilest of online abuse for daring to challenge the trans lobby’s manic evangelism. But the tide is turning. Today, with publication of the Cass Review into how the NHS should treat young people presenting with ‘gender dysphoria’, those brave dissenters are finally vindicated. Children ‘caught in the middle’ of a polarised gender row. Puberty blockers damaging young bones. GPs pressured into prescribing hormone drugs. Scant consideration given to long- term consequences. Ideology rather than science driving the debate. It is a litany of shame. Let this be a line in the sand. Until now, a hectoring minority has dominated this toxic debate – to the detriment of who knows how many young people. No longer must their braying be allowed to drown out the voice of reason and common sense. Article Name:AT LAST, A VOICE OF SANITY ON CHILDREN AND TRANS DOGMA Publication:Daily Mail Author:By Alex Ward, Shaun Wooller and Harriet Line Start Page:16 End Page:16")
Thursday 11 April
Telegraph
Tuesday 9 April
![‘Children must not be rushed to transition’ Major NHS report warns mental health may be bigger factor for young people The Daily Telegraph9 Apr 2024By Daniel Martin DEPUTY POLITICAL EDITOR CHILDREN who believe they are transgender may actually have mental health issues, a landmark report is set to find this week. It is expected to advise that children should not berushed on to a path to change gender, and that they receive counselling which addresses the mental health issues they may have rather than being put on drugs. Dr Hillary Cass, a paediatrician, will tomorrow unveil her long-awaited review into how transgender children are supported and the medical treatment they receive. It comes amid concern that children are being allowed to change gender in school without their parents’ knowledge or consent, and after the routine prescription of puberty blockers was banned by NHS England. The Telegraph understands that the report will find that children who think they are trans disproportionately have mental health issues, a difficult family situation or have suffered from abuse. They are also more likely to be neurodiverse. It is expected to suggest that these children need counselling to tackle these problems holistically, rather than them automatically being put on a path to change gender. The report is expected to warn that it is wrong to assume it is in the best interest of children who think they are trans to change gender, and urge extreme caution over the use of drugs such as puberty blockers and cross-sex hormones to facilitate this, even once someone is over 18 years old. The review is also said to express concern about a significant rise in the number of young girls wanting to become boys, and say this group needs more support. Yesterday, Downing Street said the Government would act on the basis of the report to ensure children and adolescents are kept safe. The Prime Minister’s spokesman said: “We have talked about the importance of children and adolescent safety and wellbeing being paramount. “That is part of previous work such as the NHS announcement to end the routine prescription of puberty blockers, it is behind our robust and clear guidance to schools, [and] it is categorical that social transitioning is not a neutral act and no one should be forced to use preferred pronouns or accept contested beliefs as fact. “We’ve also said there’s more to do in this area and we will look at the review when it’s published.” The spokesman added: “The Government has taken a number of steps in this area, recognising the effect that social transitioning can have on children and adolescents, and we’ve made clear that single sex spaces must be protected.” The interim Cass report in 2022 said that children being allowed to socially transition in schools – changing their name and pronouns, and being allowed to use the toilet and changing rooms of the gender they identify as – was “not a neutral act”. It also raised concerns about the NHS’S gender identity and development service at the Tavistock and Portman NHS trust in London. Dr Cass’s final report is expected to conclude that there could be many complex reasons a child may think they are in the wrong gender. Dr Cass’s report is understood to say that prepubescent children should not be put on the same “pathway” as older adolescents who wish to identify as the opposite gender. It is expected to warn that children may experience “psychological” repercussions as a result of being allowed to change their name and pronoun to the gender of their choice. Last month, the NHS announced an immediate ban on prescribing puberty blockers to under-18s unless they are part of a clinical trial. Ministers said the “landmark decision” was in children’s “best interests” and would help to ensure youngsters who feel their gender is not the same as their sex are treated using medical evidence. Article Name:‘Children must not be rushed to transition’ Publication:The Daily Telegraph Author:By Daniel Martin DEPUTY POLITICAL EDITOR Start Page:1 End Page:1](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fcddebde5-fbdc-4c7a-b0a8-a17ebcc38853_475x757.png "‘Children must not be rushed to transition’ Major NHS report warns mental health may be bigger factor for young people The Daily Telegraph9 Apr 2024By Daniel Martin DEPUTY POLITICAL EDITOR CHILDREN who believe they are transgender may actually have mental health issues, a landmark report is set to find this week. It is expected to advise that children should not berushed on to a path to change gender, and that they receive counselling which addresses the mental health issues they may have rather than being put on drugs. Dr Hillary Cass, a paediatrician, will tomorrow unveil her long-awaited review into how transgender children are supported and the medical treatment they receive. It comes amid concern that children are being allowed to change gender in school without their parents’ knowledge or consent, and after the routine prescription of puberty blockers was banned by NHS England. The Telegraph understands that the report will find that children who think they are trans disproportionately have mental health issues, a difficult family situation or have suffered from abuse. They are also more likely to be neurodiverse. It is expected to suggest that these children need counselling to tackle these problems holistically, rather than them automatically being put on a path to change gender. The report is expected to warn that it is wrong to assume it is in the best interest of children who think they are trans to change gender, and urge extreme caution over the use of drugs such as puberty blockers and cross-sex hormones to facilitate this, even once someone is over 18 years old. The review is also said to express concern about a significant rise in the number of young girls wanting to become boys, and say this group needs more support. Yesterday, Downing Street said the Government would act on the basis of the report to ensure children and adolescents are kept safe. The Prime Minister’s spokesman said: “We have talked about the importance of children and adolescent safety and wellbeing being paramount. “That is part of previous work such as the NHS announcement to end the routine prescription of puberty blockers, it is behind our robust and clear guidance to schools, [and] it is categorical that social transitioning is not a neutral act and no one should be forced to use preferred pronouns or accept contested beliefs as fact. “We’ve also said there’s more to do in this area and we will look at the review when it’s published.” The spokesman added: “The Government has taken a number of steps in this area, recognising the effect that social transitioning can have on children and adolescents, and we’ve made clear that single sex spaces must be protected.” The interim Cass report in 2022 said that children being allowed to socially transition in schools – changing their name and pronouns, and being allowed to use the toilet and changing rooms of the gender they identify as – was “not a neutral act”. It also raised concerns about the NHS’S gender identity and development service at the Tavistock and Portman NHS trust in London. Dr Cass’s final report is expected to conclude that there could be many complex reasons a child may think they are in the wrong gender. Dr Cass’s report is understood to say that prepubescent children should not be put on the same “pathway” as older adolescents who wish to identify as the opposite gender. It is expected to warn that children may experience “psychological” repercussions as a result of being allowed to change their name and pronoun to the gender of their choice. Last month, the NHS announced an immediate ban on prescribing puberty blockers to under-18s unless they are part of a clinical trial. Ministers said the “landmark decision” was in children’s “best interests” and would help to ensure youngsters who feel their gender is not the same as their sex are treated using medical evidence. Article Name:‘Children must not be rushed to transition’ Publication:The Daily Telegraph Author:By Daniel Martin DEPUTY POLITICAL EDITOR Start Page:1 End Page:1")
Wednesday 10 April
![NHS to review all trans treatment Evidence for letting children change gender built on shaky foundations, says Cass report The Daily Telegraph10 Apr 2024By Michael Searles, Laura Donnelly and Daniel Martin THE NHS will review all trans treatment, as a landmark report says that the evidence for allowing children and young people to change gender is built on “shaky foundations”. Dr Hilary Cass, a paediatrician, today publishes her review into the support and treatment offered to children who believe they are transgender, and warns that extreme care should be taken before anyone under the age of 25 transitions. It also calls for an end to the prescribing of any powerful hormone drugs to under-18s; warns that children who change gender may regret it; finds that many have experienced trauma, neglect and abuse; and says there is no “good evidence” on the long-term outcomes of treatments given to children. The review warns of pressures on families, with parents feeling forced to allow their children to transition so they are not labelled transphobic. Dr Cass declares that “gender medicine for children and young people is built on shaky foundations”. In response, the NHS is to review all transgender treatment it provides, including for adults, and treatment for any new patients aged 16 and 17 at adult clinics will immediately be paused. Rishi Sunak has welcomed the recommendations, highlighting the sharp rise in recent years in children, particularly girls, questioning their gender. Backing Dr Cass’s call for all cases to be treated with “great care and compassion” he said: “We simply do not know the long-term impacts of medical treatment or social transitioning on them [children], and we should therefore exercise extreme caution.” The 388-page report took four years to produce, amid mounting concern that children are being allowed to change gender in schools and by doctors without question. Dr Cass, the former president of the Royal College of Paediatrics and Child Health, cautions against hasty decisions while children’s brains are developing, calling for “unhurried, holistic, therapeutic support” for those aged between 17 and 25. She adds that “life-changing” decisions must be properly considered in adulthood, noting that brain maturation continues into the mid-20s. Dr Cass says that the regional centres recommended in her interim report, to provide mental health and other support to children who want to change gender, should care for people aged up to 25. Dr Cass says the “toxicity of the debate is exceptional” and that she had been “criticised” by all sides. “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop,” she urges. In a letter to Dr Cass seen by The Telegraph, the NHS has said it will undertake an external review of all its adult gender clinics and has instructed them “to implement a pause on offering first appointments to young people below their 18th birthday”. The letter, written by John Stewart, NHS England’s national director of specialised commissioning, said it would also “review the use of gender affirming hormones ... similar to the rigorous process that was followed to review the use of puberty suppressing hormones”. Children’s clinics have been overwhelmed by referrals in the past decade, now receiving more than 1,600 referrals a year, compared with 50 in 2009. An NHS spokesman said: “The NHS has made significant progress towards establishing a fundamentally different gender service for children and young people – in line with earlier advice by Dr Cass... by stopping the routine use of puberty-suppressing hormones and opening the first of up to eight new regional centres... We will set out a full implementation plan following careful consideration of this report.” ‘There should be a distinction for the approach taken to preand postpubertal children’ CHILDREN who think they are transgender should not be rushed into treatment they may regret, a landmark report has concluded. The report by paediatric consultant Dr Hilary Cass has made 32 recommendations, including: calling for the “unhurried” care of those under 25 who think they may be transgender; an end to the prescribing of powerful hormone drugs to under 18s; and early help for primary school children who want to socially transition – which means using a name and pronouns of their preferred gender and being treated as though they are that gender. The Telegraph has summarised the report’s key findings: Last month, the NHS banned the prescribing of puberty blockers outside of clinical trials. However, Dr Cass has gone further and said children who think they are transgender should not be given any hormone drugs at all until at least 18. The former president of the Royal College of Paediatrics and Child Health said there was no evidence the drugs “buy time to think” or “reduce suicide risk”. While the drugs can suppress puberty, research commissioned by the review and carried out by the University of York found the drugs have no effect on the person’s body satisfaction or their experience of gender dysphoria – where the person feels they are a different gender to the sex they were born – despite this being the reason they had been prescribed. Dr Cass stated there was “concern that [puberty blockers] may change the trajectory of psychosexual and gender identity development” with most patients going on to take cross-sex hormones as a result. She said the NHS should exert “extreme caution” in giving out crosssex hormones to under 18s as the research carried out by her review concludes there is a “a lack of high-quality research” on their effectiveness. She said their use should be incorporated into the puberty blocker trial. Dr Cass said all children and teenagers should be given time “to keep options open during this development window” and that this would allow time to diagnose and treat other conditions while preserving fertility. She said doctors must be able to “refer to the longer-term benefits and risks” of treatment options but this was “not currently available” for children experiencing gender incongruence or dysphoria. A systematic review by the University of York of more than 1,000 children who had been treated by the Tavistock, found that 7.4 per cent of under-16s given puberty blockers stopped their treatment. It found that the younger children started treatment, the more likely they were to continue on to cross-sex hormones, which means the drugs “are not buying time to think”. It had also been suggested that the drugs could improve body image and psychological wellbeing – however, the review found “no changes in gender dysphoria or body satisfaction were demonstrated.” Families should be able to see a medical profession such as a child psychologist or paediatrician as quickly as possible if a primary school child wants to socially transition, the report recommends. Dr Cass states that while “exploration is a normal process” in teenagers, children who are yet to go through puberty will have been affected by “parental attitudes and beliefs”. She states the importance of “avoiding premature decisions” and seeking help early on to understand the child’s behaviour and assess whether they are experiencing any mental health issues or distress. Research conducted for the review found that prepubescent children who socially transition – which means a child being treated as their preferred gender, including using their chosen pronouns and name, and allowing them to use the facilities such as lavatories and changing rooms of their choice – were more likely to undergo medical treatment later. She suggests that a “partial rather than full transition can be a way of ensuring flexibility and keeping options open until the developmental trajectory becomes clearer”. “There should be a distinction for the approach taken to pre- and post-pubertal children,” she said. “This is of particular importance in relation to social transition, which may not be thought of as an intervention or treatment because it is something that generally happens at home, online or in school and not within health services.” The report finds that “social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence”. The younger children are when they present with “gender incongruence” the more likely they are to move on from that phase, it says. “The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist.” It recommends a clinical professional such as a mental health specialist “should help families to recognise nor Parents feel forced to allow their children to transition so they are not labelled transphobic Dr Cass said her review heard concerns from many parents about their child being socially transitioned and affirmed in their expressed gender without parental involvement. Such cases often involved an adolescent who had “come out” at school while expressing concern about how their parent might react. “Some parents felt ‘forced’ to affirm their child’s assumed identity or risk being painted as transphobic and/or unsupportive,” the report said. In a small number of cases, there were concerns that parents were “consciously or unconsciously” influencing their child’s gender expression, it said. “It is very important that the child/ young person’s voice is heard and that perceptions of gender identity represent the child/young person’s sense of self,” it said. Under-25s should not be rushed into changing gender, but should receive “unhurried, holistic, therapeutic support”, Dr Cass concluded. She said “life changing” decisions must be properly considered in adulthood, noting that brain maturation continues into the mid-20s. The report found that “clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity”. Young adults aged 17 to 25 who want to change gender should be seen by “a follow-through service” rather than sent straight to an adult clinic, the report concludes. The NHS has been accused of fast-tracking thousands of teenagers to adult clinics, because they would not be seen before their 17th birthday, and prescribing them cross-sex hormones. Dr Cass said these people were still at a “vulnerable stage in their journey” and that regional centres offering gender services for children, as well as mental health assessments and support, should care for those aged up to 25 or link up with such services. The consultant paediatrician said it was not possible to “know the ‘sweet spot’ when someone becomes settled in their sense of self ” but that decisions should not be rushed before an individual becomes a mature adult at about 25. “When making life-changing decisions, what is the correct balance between keeping options as flexible and open as possible as you move into adulthood, and responding to how you feel right now?” she wrote in the report’s foreword. The report said far more consideration should be given to reaching a point of maturity before taking a decision. “It used to be thought that brain maturation finished in adolescence, but it is now understood that this remodelling continues into the mid-20s as different parts become more interconnected and specialised,” the report notes. “Changes in the limbic area, which is ‘present-orientated’ and concerned with risk taking and sensation seeking, begin with puberty; this part of the brain becomes super sensitised, drives emotional volatility, pleasure and novelty seeking, and also makes adolescents more sensitive to social rejection, as well as vulnerable to addiction and a range of mental health problems,” the review continues. “The ‘future orientated’ prefrontal cortex matures later, with development continuing into an individual’s 20s, and … is concerned with executive functions such as complex decision making, rational judgement, inhibition of impulsivity, planning and prioritisation,” it states. Childhood trauma, neglect and abuse feature heavily in the cohort of patients seeking gender changes, the report shows. It cites a systematic review that found that in some services, as many as two thirds of those referred had suffered some kind of neglect or abuse, with high levels of parental mental illness, substance abuse and exposure to domestic violence. The research found about half of cases had suffered from maternal mental illness or substance abuse while almost 40 per cent had experienced paternal mental illness or substance abuse. An early study of UK cases referred to gender services found one quarter of children had spent some time in care. More than four in 10 cases had experienced living with only one parent, with almost as many having experience of family mental health problems. The report shows that rates of mental ill-health have risen among children and young people, especially girls and young women. This comes in parallel with the rising numbers seeking help from NHS gender clinics, where the biggest rise has been among those registered as female at birth, seeking help in adolescence to change gender. Within this group, there are higher levels of neurodiversity and mental health issues, it says, calling for a “holistic” appraisal of the young patient, not solely in terms of their gender-related distress. “Children/young people referred to NHS gender services must receive a holistic assessment of their needs to inform an individualised care plan. This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment,” it states. The report advises children expressing a desire to change gender are given time to think before being rushed into a decision they may regret. It suggests that too many decisions about changing gender have been rushed, with too little consideration given that children might regret their actions in later life. A survey included in the findings found “the history of the child/young person’s gender journey was rarely examined closely for signs of difficulty, regret or wishes to alter any aspect of their gender trajectory.” Evidence considered by the Cass review included talking to those who have transitioned to the opposite sex and those who have detransitioned back. It found that “whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down”. It continued: “For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/ retransition and/or experience regret. The NHS needs to care for all those seeking support.” Data on the number of adults who have detransitioned are scarce, but the report said the number was “increasing”. A 2021 study found that 70 per cent of people detransitioning had another condition in the first place, while 23 per cent were actually gay, lesbian or bisexual. Article Name:NHS to review all trans treatment Publication:The Daily Telegraph Author:By Michael Searles, Laura Donnelly and Daniel Martin Start Page:1 End Page:1](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Feb2a88b3-78a6-4347-ac2b-590e89409492_477x763.png "NHS to review all trans treatment Evidence for letting children change gender built on shaky foundations, says Cass report The Daily Telegraph10 Apr 2024By Michael Searles, Laura Donnelly and Daniel Martin THE NHS will review all trans treatment, as a landmark report says that the evidence for allowing children and young people to change gender is built on “shaky foundations”. Dr Hilary Cass, a paediatrician, today publishes her review into the support and treatment offered to children who believe they are transgender, and warns that extreme care should be taken before anyone under the age of 25 transitions. It also calls for an end to the prescribing of any powerful hormone drugs to under-18s; warns that children who change gender may regret it; finds that many have experienced trauma, neglect and abuse; and says there is no “good evidence” on the long-term outcomes of treatments given to children. The review warns of pressures on families, with parents feeling forced to allow their children to transition so they are not labelled transphobic. Dr Cass declares that “gender medicine for children and young people is built on shaky foundations”. In response, the NHS is to review all transgender treatment it provides, including for adults, and treatment for any new patients aged 16 and 17 at adult clinics will immediately be paused. Rishi Sunak has welcomed the recommendations, highlighting the sharp rise in recent years in children, particularly girls, questioning their gender. Backing Dr Cass’s call for all cases to be treated with “great care and compassion” he said: “We simply do not know the long-term impacts of medical treatment or social transitioning on them [children], and we should therefore exercise extreme caution.” The 388-page report took four years to produce, amid mounting concern that children are being allowed to change gender in schools and by doctors without question. Dr Cass, the former president of the Royal College of Paediatrics and Child Health, cautions against hasty decisions while children’s brains are developing, calling for “unhurried, holistic, therapeutic support” for those aged between 17 and 25. She adds that “life-changing” decisions must be properly considered in adulthood, noting that brain maturation continues into the mid-20s. Dr Cass says that the regional centres recommended in her interim report, to provide mental health and other support to children who want to change gender, should care for people aged up to 25. Dr Cass says the “toxicity of the debate is exceptional” and that she had been “criticised” by all sides. “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop,” she urges. In a letter to Dr Cass seen by The Telegraph, the NHS has said it will undertake an external review of all its adult gender clinics and has instructed them “to implement a pause on offering first appointments to young people below their 18th birthday”. The letter, written by John Stewart, NHS England’s national director of specialised commissioning, said it would also “review the use of gender affirming hormones ... similar to the rigorous process that was followed to review the use of puberty suppressing hormones”. Children’s clinics have been overwhelmed by referrals in the past decade, now receiving more than 1,600 referrals a year, compared with 50 in 2009. An NHS spokesman said: “The NHS has made significant progress towards establishing a fundamentally different gender service for children and young people – in line with earlier advice by Dr Cass... by stopping the routine use of puberty-suppressing hormones and opening the first of up to eight new regional centres... We will set out a full implementation plan following careful consideration of this report.” ‘There should be a distinction for the approach taken to preand postpubertal children’ CHILDREN who think they are transgender should not be rushed into treatment they may regret, a landmark report has concluded. The report by paediatric consultant Dr Hilary Cass has made 32 recommendations, including: calling for the “unhurried” care of those under 25 who think they may be transgender; an end to the prescribing of powerful hormone drugs to under 18s; and early help for primary school children who want to socially transition – which means using a name and pronouns of their preferred gender and being treated as though they are that gender. The Telegraph has summarised the report’s key findings: Last month, the NHS banned the prescribing of puberty blockers outside of clinical trials. However, Dr Cass has gone further and said children who think they are transgender should not be given any hormone drugs at all until at least 18. The former president of the Royal College of Paediatrics and Child Health said there was no evidence the drugs “buy time to think” or “reduce suicide risk”. While the drugs can suppress puberty, research commissioned by the review and carried out by the University of York found the drugs have no effect on the person’s body satisfaction or their experience of gender dysphoria – where the person feels they are a different gender to the sex they were born – despite this being the reason they had been prescribed. Dr Cass stated there was “concern that [puberty blockers] may change the trajectory of psychosexual and gender identity development” with most patients going on to take cross-sex hormones as a result. She said the NHS should exert “extreme caution” in giving out crosssex hormones to under 18s as the research carried out by her review concludes there is a “a lack of high-quality research” on their effectiveness. She said their use should be incorporated into the puberty blocker trial. Dr Cass said all children and teenagers should be given time “to keep options open during this development window” and that this would allow time to diagnose and treat other conditions while preserving fertility. She said doctors must be able to “refer to the longer-term benefits and risks” of treatment options but this was “not currently available” for children experiencing gender incongruence or dysphoria. A systematic review by the University of York of more than 1,000 children who had been treated by the Tavistock, found that 7.4 per cent of under-16s given puberty blockers stopped their treatment. It found that the younger children started treatment, the more likely they were to continue on to cross-sex hormones, which means the drugs “are not buying time to think”. It had also been suggested that the drugs could improve body image and psychological wellbeing – however, the review found “no changes in gender dysphoria or body satisfaction were demonstrated.” Families should be able to see a medical profession such as a child psychologist or paediatrician as quickly as possible if a primary school child wants to socially transition, the report recommends. Dr Cass states that while “exploration is a normal process” in teenagers, children who are yet to go through puberty will have been affected by “parental attitudes and beliefs”. She states the importance of “avoiding premature decisions” and seeking help early on to understand the child’s behaviour and assess whether they are experiencing any mental health issues or distress. Research conducted for the review found that prepubescent children who socially transition – which means a child being treated as their preferred gender, including using their chosen pronouns and name, and allowing them to use the facilities such as lavatories and changing rooms of their choice – were more likely to undergo medical treatment later. She suggests that a “partial rather than full transition can be a way of ensuring flexibility and keeping options open until the developmental trajectory becomes clearer”. “There should be a distinction for the approach taken to pre- and post-pubertal children,” she said. “This is of particular importance in relation to social transition, which may not be thought of as an intervention or treatment because it is something that generally happens at home, online or in school and not within health services.” The report finds that “social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence”. The younger children are when they present with “gender incongruence” the more likely they are to move on from that phase, it says. “The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist.” It recommends a clinical professional such as a mental health specialist “should help families to recognise nor Parents feel forced to allow their children to transition so they are not labelled transphobic Dr Cass said her review heard concerns from many parents about their child being socially transitioned and affirmed in their expressed gender without parental involvement. Such cases often involved an adolescent who had “come out” at school while expressing concern about how their parent might react. “Some parents felt ‘forced’ to affirm their child’s assumed identity or risk being painted as transphobic and/or unsupportive,” the report said. In a small number of cases, there were concerns that parents were “consciously or unconsciously” influencing their child’s gender expression, it said. “It is very important that the child/ young person’s voice is heard and that perceptions of gender identity represent the child/young person’s sense of self,” it said. Under-25s should not be rushed into changing gender, but should receive “unhurried, holistic, therapeutic support”, Dr Cass concluded. She said “life changing” decisions must be properly considered in adulthood, noting that brain maturation continues into the mid-20s. The report found that “clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity”. Young adults aged 17 to 25 who want to change gender should be seen by “a follow-through service” rather than sent straight to an adult clinic, the report concludes. The NHS has been accused of fast-tracking thousands of teenagers to adult clinics, because they would not be seen before their 17th birthday, and prescribing them cross-sex hormones. Dr Cass said these people were still at a “vulnerable stage in their journey” and that regional centres offering gender services for children, as well as mental health assessments and support, should care for those aged up to 25 or link up with such services. The consultant paediatrician said it was not possible to “know the ‘sweet spot’ when someone becomes settled in their sense of self ” but that decisions should not be rushed before an individual becomes a mature adult at about 25. “When making life-changing decisions, what is the correct balance between keeping options as flexible and open as possible as you move into adulthood, and responding to how you feel right now?” she wrote in the report’s foreword. The report said far more consideration should be given to reaching a point of maturity before taking a decision. “It used to be thought that brain maturation finished in adolescence, but it is now understood that this remodelling continues into the mid-20s as different parts become more interconnected and specialised,” the report notes. “Changes in the limbic area, which is ‘present-orientated’ and concerned with risk taking and sensation seeking, begin with puberty; this part of the brain becomes super sensitised, drives emotional volatility, pleasure and novelty seeking, and also makes adolescents more sensitive to social rejection, as well as vulnerable to addiction and a range of mental health problems,” the review continues. “The ‘future orientated’ prefrontal cortex matures later, with development continuing into an individual’s 20s, and … is concerned with executive functions such as complex decision making, rational judgement, inhibition of impulsivity, planning and prioritisation,” it states. Childhood trauma, neglect and abuse feature heavily in the cohort of patients seeking gender changes, the report shows. It cites a systematic review that found that in some services, as many as two thirds of those referred had suffered some kind of neglect or abuse, with high levels of parental mental illness, substance abuse and exposure to domestic violence. The research found about half of cases had suffered from maternal mental illness or substance abuse while almost 40 per cent had experienced paternal mental illness or substance abuse. An early study of UK cases referred to gender services found one quarter of children had spent some time in care. More than four in 10 cases had experienced living with only one parent, with almost as many having experience of family mental health problems. The report shows that rates of mental ill-health have risen among children and young people, especially girls and young women. This comes in parallel with the rising numbers seeking help from NHS gender clinics, where the biggest rise has been among those registered as female at birth, seeking help in adolescence to change gender. Within this group, there are higher levels of neurodiversity and mental health issues, it says, calling for a “holistic” appraisal of the young patient, not solely in terms of their gender-related distress. “Children/young people referred to NHS gender services must receive a holistic assessment of their needs to inform an individualised care plan. This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment,” it states. The report advises children expressing a desire to change gender are given time to think before being rushed into a decision they may regret. It suggests that too many decisions about changing gender have been rushed, with too little consideration given that children might regret their actions in later life. A survey included in the findings found “the history of the child/young person’s gender journey was rarely examined closely for signs of difficulty, regret or wishes to alter any aspect of their gender trajectory.” Evidence considered by the Cass review included talking to those who have transitioned to the opposite sex and those who have detransitioned back. It found that “whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down”. It continued: “For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/ retransition and/or experience regret. The NHS needs to care for all those seeking support.” Data on the number of adults who have detransitioned are scarce, but the report said the number was “increasing”. A 2021 study found that 70 per cent of people detransitioning had another condition in the first place, while 23 per cent were actually gay, lesbian or bisexual. Article Name:NHS to review all trans treatment Publication:The Daily Telegraph Author:By Michael Searles, Laura Donnelly and Daniel Martin Start Page:1 End Page:1")
![NHS to review all trans treatment Evidence for letting children change gender built on shaky foundations, says Cass report The Daily Telegraph10 Apr 2024By Michael Searles, Laura Donnelly and Daniel Martin THE NHS will review all trans treatment, as a landmark report says that the evidence for allowing children and young people to change gender is built on “shaky foundations”. Dr Hilary Cass, a paediatrician, today publishes her review into the support and treatment offered to children who believe they are transgender, and warns that extreme care should be taken before anyone under the age of 25 transitions. It also calls for an end to the prescribing of any powerful hormone drugs to under-18s; warns that children who change gender may regret it; finds that many have experienced trauma, neglect and abuse; and says there is no “good evidence” on the long-term outcomes of treatments given to children. The review warns of pressures on families, with parents feeling forced to allow their children to transition so they are not labelled transphobic. Dr Cass declares that “gender medicine for children and young people is built on shaky foundations”. In response, the NHS is to review all transgender treatment it provides, including for adults, and treatment for any new patients aged 16 and 17 at adult clinics will immediately be paused. Rishi Sunak has welcomed the recommendations, highlighting the sharp rise in recent years in children, particularly girls, questioning their gender. Backing Dr Cass’s call for all cases to be treated with “great care and compassion” he said: “We simply do not know the long-term impacts of medical treatment or social transitioning on them [children], and we should therefore exercise extreme caution.” The 388-page report took four years to produce, amid mounting concern that children are being allowed to change gender in schools and by doctors without question. Dr Cass, the former president of the Royal College of Paediatrics and Child Health, cautions against hasty decisions while children’s brains are developing, calling for “unhurried, holistic, therapeutic support” for those aged between 17 and 25. She adds that “life-changing” decisions must be properly considered in adulthood, noting that brain maturation continues into the mid-20s. Dr Cass says that the regional centres recommended in her interim report, to provide mental health and other support to children who want to change gender, should care for people aged up to 25. Dr Cass says the “toxicity of the debate is exceptional” and that she had been “criticised” by all sides. “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop,” she urges. In a letter to Dr Cass seen by The Telegraph, the NHS has said it will undertake an external review of all its adult gender clinics and has instructed them “to implement a pause on offering first appointments to young people below their 18th birthday”. The letter, written by John Stewart, NHS England’s national director of specialised commissioning, said it would also “review the use of gender affirming hormones ... similar to the rigorous process that was followed to review the use of puberty suppressing hormones”. Children’s clinics have been overwhelmed by referrals in the past decade, now receiving more than 1,600 referrals a year, compared with 50 in 2009. An NHS spokesman said: “The NHS has made significant progress towards establishing a fundamentally different gender service for children and young people – in line with earlier advice by Dr Cass... by stopping the routine use of puberty-suppressing hormones and opening the first of up to eight new regional centres... We will set out a full implementation plan following careful consideration of this report.” ‘There should be a distinction for the approach taken to preand postpubertal children’ CHILDREN who think they are transgender should not be rushed into treatment they may regret, a landmark report has concluded. The report by paediatric consultant Dr Hilary Cass has made 32 recommendations, including: calling for the “unhurried” care of those under 25 who think they may be transgender; an end to the prescribing of powerful hormone drugs to under 18s; and early help for primary school children who want to socially transition – which means using a name and pronouns of their preferred gender and being treated as though they are that gender. The Telegraph has summarised the report’s key findings: Last month, the NHS banned the prescribing of puberty blockers outside of clinical trials. However, Dr Cass has gone further and said children who think they are transgender should not be given any hormone drugs at all until at least 18. The former president of the Royal College of Paediatrics and Child Health said there was no evidence the drugs “buy time to think” or “reduce suicide risk”. While the drugs can suppress puberty, research commissioned by the review and carried out by the University of York found the drugs have no effect on the person’s body satisfaction or their experience of gender dysphoria – where the person feels they are a different gender to the sex they were born – despite this being the reason they had been prescribed. Dr Cass stated there was “concern that [puberty blockers] may change the trajectory of psychosexual and gender identity development” with most patients going on to take cross-sex hormones as a result. She said the NHS should exert “extreme caution” in giving out crosssex hormones to under 18s as the research carried out by her review concludes there is a “a lack of high-quality research” on their effectiveness. She said their use should be incorporated into the puberty blocker trial. Dr Cass said all children and teenagers should be given time “to keep options open during this development window” and that this would allow time to diagnose and treat other conditions while preserving fertility. She said doctors must be able to “refer to the longer-term benefits and risks” of treatment options but this was “not currently available” for children experiencing gender incongruence or dysphoria. A systematic review by the University of York of more than 1,000 children who had been treated by the Tavistock, found that 7.4 per cent of under-16s given puberty blockers stopped their treatment. It found that the younger children started treatment, the more likely they were to continue on to cross-sex hormones, which means the drugs “are not buying time to think”. It had also been suggested that the drugs could improve body image and psychological wellbeing – however, the review found “no changes in gender dysphoria or body satisfaction were demonstrated.” Families should be able to see a medical profession such as a child psychologist or paediatrician as quickly as possible if a primary school child wants to socially transition, the report recommends. Dr Cass states that while “exploration is a normal process” in teenagers, children who are yet to go through puberty will have been affected by “parental attitudes and beliefs”. She states the importance of “avoiding premature decisions” and seeking help early on to understand the child’s behaviour and assess whether they are experiencing any mental health issues or distress. Research conducted for the review found that prepubescent children who socially transition – which means a child being treated as their preferred gender, including using their chosen pronouns and name, and allowing them to use the facilities such as lavatories and changing rooms of their choice – were more likely to undergo medical treatment later. She suggests that a “partial rather than full transition can be a way of ensuring flexibility and keeping options open until the developmental trajectory becomes clearer”. “There should be a distinction for the approach taken to pre- and post-pubertal children,” she said. “This is of particular importance in relation to social transition, which may not be thought of as an intervention or treatment because it is something that generally happens at home, online or in school and not within health services.” The report finds that “social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence”. The younger children are when they present with “gender incongruence” the more likely they are to move on from that phase, it says. “The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist.” It recommends a clinical professional such as a mental health specialist “should help families to recognise nor Parents feel forced to allow their children to transition so they are not labelled transphobic Dr Cass said her review heard concerns from many parents about their child being socially transitioned and affirmed in their expressed gender without parental involvement. Such cases often involved an adolescent who had “come out” at school while expressing concern about how their parent might react. “Some parents felt ‘forced’ to affirm their child’s assumed identity or risk being painted as transphobic and/or unsupportive,” the report said. In a small number of cases, there were concerns that parents were “consciously or unconsciously” influencing their child’s gender expression, it said. “It is very important that the child/ young person’s voice is heard and that perceptions of gender identity represent the child/young person’s sense of self,” it said. Under-25s should not be rushed into changing gender, but should receive “unhurried, holistic, therapeutic support”, Dr Cass concluded. She said “life changing” decisions must be properly considered in adulthood, noting that brain maturation continues into the mid-20s. The report found that “clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity”. Young adults aged 17 to 25 who want to change gender should be seen by “a follow-through service” rather than sent straight to an adult clinic, the report concludes. The NHS has been accused of fast-tracking thousands of teenagers to adult clinics, because they would not be seen before their 17th birthday, and prescribing them cross-sex hormones. Dr Cass said these people were still at a “vulnerable stage in their journey” and that regional centres offering gender services for children, as well as mental health assessments and support, should care for those aged up to 25 or link up with such services. The consultant paediatrician said it was not possible to “know the ‘sweet spot’ when someone becomes settled in their sense of self ” but that decisions should not be rushed before an individual becomes a mature adult at about 25. “When making life-changing decisions, what is the correct balance between keeping options as flexible and open as possible as you move into adulthood, and responding to how you feel right now?” she wrote in the report’s foreword. The report said far more consideration should be given to reaching a point of maturity before taking a decision. “It used to be thought that brain maturation finished in adolescence, but it is now understood that this remodelling continues into the mid-20s as different parts become more interconnected and specialised,” the report notes. “Changes in the limbic area, which is ‘present-orientated’ and concerned with risk taking and sensation seeking, begin with puberty; this part of the brain becomes super sensitised, drives emotional volatility, pleasure and novelty seeking, and also makes adolescents more sensitive to social rejection, as well as vulnerable to addiction and a range of mental health problems,” the review continues. “The ‘future orientated’ prefrontal cortex matures later, with development continuing into an individual’s 20s, and … is concerned with executive functions such as complex decision making, rational judgement, inhibition of impulsivity, planning and prioritisation,” it states. Childhood trauma, neglect and abuse feature heavily in the cohort of patients seeking gender changes, the report shows. It cites a systematic review that found that in some services, as many as two thirds of those referred had suffered some kind of neglect or abuse, with high levels of parental mental illness, substance abuse and exposure to domestic violence. The research found about half of cases had suffered from maternal mental illness or substance abuse while almost 40 per cent had experienced paternal mental illness or substance abuse. An early study of UK cases referred to gender services found one quarter of children had spent some time in care. More than four in 10 cases had experienced living with only one parent, with almost as many having experience of family mental health problems. The report shows that rates of mental ill-health have risen among children and young people, especially girls and young women. This comes in parallel with the rising numbers seeking help from NHS gender clinics, where the biggest rise has been among those registered as female at birth, seeking help in adolescence to change gender. Within this group, there are higher levels of neurodiversity and mental health issues, it says, calling for a “holistic” appraisal of the young patient, not solely in terms of their gender-related distress. “Children/young people referred to NHS gender services must receive a holistic assessment of their needs to inform an individualised care plan. This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment,” it states. The report advises children expressing a desire to change gender are given time to think before being rushed into a decision they may regret. It suggests that too many decisions about changing gender have been rushed, with too little consideration given that children might regret their actions in later life. A survey included in the findings found “the history of the child/young person’s gender journey was rarely examined closely for signs of difficulty, regret or wishes to alter any aspect of their gender trajectory.” Evidence considered by the Cass review included talking to those who have transitioned to the opposite sex and those who have detransitioned back. It found that “whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down”. It continued: “For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/ retransition and/or experience regret. The NHS needs to care for all those seeking support.” Data on the number of adults who have detransitioned are scarce, but the report said the number was “increasing”. A 2021 study found that 70 per cent of people detransitioning had another condition in the first place, while 23 per cent were actually gay, lesbian or bisexual. Article Name:NHS to review all trans treatment Publication:The Daily Telegraph Author:By Michael Searles, Laura Donnelly and Daniel Martin Start Page:6 End Page:6](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5a18581c-7f38-4538-b36b-2a693f54a541_475x751.png "NHS to review all trans treatment Evidence for letting children change gender built on shaky foundations, says Cass report The Daily Telegraph10 Apr 2024By Michael Searles, Laura Donnelly and Daniel Martin THE NHS will review all trans treatment, as a landmark report says that the evidence for allowing children and young people to change gender is built on “shaky foundations”. Dr Hilary Cass, a paediatrician, today publishes her review into the support and treatment offered to children who believe they are transgender, and warns that extreme care should be taken before anyone under the age of 25 transitions. It also calls for an end to the prescribing of any powerful hormone drugs to under-18s; warns that children who change gender may regret it; finds that many have experienced trauma, neglect and abuse; and says there is no “good evidence” on the long-term outcomes of treatments given to children. The review warns of pressures on families, with parents feeling forced to allow their children to transition so they are not labelled transphobic. Dr Cass declares that “gender medicine for children and young people is built on shaky foundations”. In response, the NHS is to review all transgender treatment it provides, including for adults, and treatment for any new patients aged 16 and 17 at adult clinics will immediately be paused. Rishi Sunak has welcomed the recommendations, highlighting the sharp rise in recent years in children, particularly girls, questioning their gender. Backing Dr Cass’s call for all cases to be treated with “great care and compassion” he said: “We simply do not know the long-term impacts of medical treatment or social transitioning on them [children], and we should therefore exercise extreme caution.” The 388-page report took four years to produce, amid mounting concern that children are being allowed to change gender in schools and by doctors without question. Dr Cass, the former president of the Royal College of Paediatrics and Child Health, cautions against hasty decisions while children’s brains are developing, calling for “unhurried, holistic, therapeutic support” for those aged between 17 and 25. She adds that “life-changing” decisions must be properly considered in adulthood, noting that brain maturation continues into the mid-20s. Dr Cass says that the regional centres recommended in her interim report, to provide mental health and other support to children who want to change gender, should care for people aged up to 25. Dr Cass says the “toxicity of the debate is exceptional” and that she had been “criticised” by all sides. “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop,” she urges. In a letter to Dr Cass seen by The Telegraph, the NHS has said it will undertake an external review of all its adult gender clinics and has instructed them “to implement a pause on offering first appointments to young people below their 18th birthday”. The letter, written by John Stewart, NHS England’s national director of specialised commissioning, said it would also “review the use of gender affirming hormones ... similar to the rigorous process that was followed to review the use of puberty suppressing hormones”. Children’s clinics have been overwhelmed by referrals in the past decade, now receiving more than 1,600 referrals a year, compared with 50 in 2009. An NHS spokesman said: “The NHS has made significant progress towards establishing a fundamentally different gender service for children and young people – in line with earlier advice by Dr Cass... by stopping the routine use of puberty-suppressing hormones and opening the first of up to eight new regional centres... We will set out a full implementation plan following careful consideration of this report.” ‘There should be a distinction for the approach taken to preand postpubertal children’ CHILDREN who think they are transgender should not be rushed into treatment they may regret, a landmark report has concluded. The report by paediatric consultant Dr Hilary Cass has made 32 recommendations, including: calling for the “unhurried” care of those under 25 who think they may be transgender; an end to the prescribing of powerful hormone drugs to under 18s; and early help for primary school children who want to socially transition – which means using a name and pronouns of their preferred gender and being treated as though they are that gender. The Telegraph has summarised the report’s key findings: Last month, the NHS banned the prescribing of puberty blockers outside of clinical trials. However, Dr Cass has gone further and said children who think they are transgender should not be given any hormone drugs at all until at least 18. The former president of the Royal College of Paediatrics and Child Health said there was no evidence the drugs “buy time to think” or “reduce suicide risk”. While the drugs can suppress puberty, research commissioned by the review and carried out by the University of York found the drugs have no effect on the person’s body satisfaction or their experience of gender dysphoria – where the person feels they are a different gender to the sex they were born – despite this being the reason they had been prescribed. Dr Cass stated there was “concern that [puberty blockers] may change the trajectory of psychosexual and gender identity development” with most patients going on to take cross-sex hormones as a result. She said the NHS should exert “extreme caution” in giving out crosssex hormones to under 18s as the research carried out by her review concludes there is a “a lack of high-quality research” on their effectiveness. She said their use should be incorporated into the puberty blocker trial. Dr Cass said all children and teenagers should be given time “to keep options open during this development window” and that this would allow time to diagnose and treat other conditions while preserving fertility. She said doctors must be able to “refer to the longer-term benefits and risks” of treatment options but this was “not currently available” for children experiencing gender incongruence or dysphoria. A systematic review by the University of York of more than 1,000 children who had been treated by the Tavistock, found that 7.4 per cent of under-16s given puberty blockers stopped their treatment. It found that the younger children started treatment, the more likely they were to continue on to cross-sex hormones, which means the drugs “are not buying time to think”. It had also been suggested that the drugs could improve body image and psychological wellbeing – however, the review found “no changes in gender dysphoria or body satisfaction were demonstrated.” Families should be able to see a medical profession such as a child psychologist or paediatrician as quickly as possible if a primary school child wants to socially transition, the report recommends. Dr Cass states that while “exploration is a normal process” in teenagers, children who are yet to go through puberty will have been affected by “parental attitudes and beliefs”. She states the importance of “avoiding premature decisions” and seeking help early on to understand the child’s behaviour and assess whether they are experiencing any mental health issues or distress. Research conducted for the review found that prepubescent children who socially transition – which means a child being treated as their preferred gender, including using their chosen pronouns and name, and allowing them to use the facilities such as lavatories and changing rooms of their choice – were more likely to undergo medical treatment later. She suggests that a “partial rather than full transition can be a way of ensuring flexibility and keeping options open until the developmental trajectory becomes clearer”. “There should be a distinction for the approach taken to pre- and post-pubertal children,” she said. “This is of particular importance in relation to social transition, which may not be thought of as an intervention or treatment because it is something that generally happens at home, online or in school and not within health services.” The report finds that “social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence”. The younger children are when they present with “gender incongruence” the more likely they are to move on from that phase, it says. “The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist.” It recommends a clinical professional such as a mental health specialist “should help families to recognise nor Parents feel forced to allow their children to transition so they are not labelled transphobic Dr Cass said her review heard concerns from many parents about their child being socially transitioned and affirmed in their expressed gender without parental involvement. Such cases often involved an adolescent who had “come out” at school while expressing concern about how their parent might react. “Some parents felt ‘forced’ to affirm their child’s assumed identity or risk being painted as transphobic and/or unsupportive,” the report said. In a small number of cases, there were concerns that parents were “consciously or unconsciously” influencing their child’s gender expression, it said. “It is very important that the child/ young person’s voice is heard and that perceptions of gender identity represent the child/young person’s sense of self,” it said. Under-25s should not be rushed into changing gender, but should receive “unhurried, holistic, therapeutic support”, Dr Cass concluded. She said “life changing” decisions must be properly considered in adulthood, noting that brain maturation continues into the mid-20s. The report found that “clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity”. Young adults aged 17 to 25 who want to change gender should be seen by “a follow-through service” rather than sent straight to an adult clinic, the report concludes. The NHS has been accused of fast-tracking thousands of teenagers to adult clinics, because they would not be seen before their 17th birthday, and prescribing them cross-sex hormones. Dr Cass said these people were still at a “vulnerable stage in their journey” and that regional centres offering gender services for children, as well as mental health assessments and support, should care for those aged up to 25 or link up with such services. The consultant paediatrician said it was not possible to “know the ‘sweet spot’ when someone becomes settled in their sense of self ” but that decisions should not be rushed before an individual becomes a mature adult at about 25. “When making life-changing decisions, what is the correct balance between keeping options as flexible and open as possible as you move into adulthood, and responding to how you feel right now?” she wrote in the report’s foreword. The report said far more consideration should be given to reaching a point of maturity before taking a decision. “It used to be thought that brain maturation finished in adolescence, but it is now understood that this remodelling continues into the mid-20s as different parts become more interconnected and specialised,” the report notes. “Changes in the limbic area, which is ‘present-orientated’ and concerned with risk taking and sensation seeking, begin with puberty; this part of the brain becomes super sensitised, drives emotional volatility, pleasure and novelty seeking, and also makes adolescents more sensitive to social rejection, as well as vulnerable to addiction and a range of mental health problems,” the review continues. “The ‘future orientated’ prefrontal cortex matures later, with development continuing into an individual’s 20s, and … is concerned with executive functions such as complex decision making, rational judgement, inhibition of impulsivity, planning and prioritisation,” it states. Childhood trauma, neglect and abuse feature heavily in the cohort of patients seeking gender changes, the report shows. It cites a systematic review that found that in some services, as many as two thirds of those referred had suffered some kind of neglect or abuse, with high levels of parental mental illness, substance abuse and exposure to domestic violence. The research found about half of cases had suffered from maternal mental illness or substance abuse while almost 40 per cent had experienced paternal mental illness or substance abuse. An early study of UK cases referred to gender services found one quarter of children had spent some time in care. More than four in 10 cases had experienced living with only one parent, with almost as many having experience of family mental health problems. The report shows that rates of mental ill-health have risen among children and young people, especially girls and young women. This comes in parallel with the rising numbers seeking help from NHS gender clinics, where the biggest rise has been among those registered as female at birth, seeking help in adolescence to change gender. Within this group, there are higher levels of neurodiversity and mental health issues, it says, calling for a “holistic” appraisal of the young patient, not solely in terms of their gender-related distress. “Children/young people referred to NHS gender services must receive a holistic assessment of their needs to inform an individualised care plan. This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment,” it states. The report advises children expressing a desire to change gender are given time to think before being rushed into a decision they may regret. It suggests that too many decisions about changing gender have been rushed, with too little consideration given that children might regret their actions in later life. A survey included in the findings found “the history of the child/young person’s gender journey was rarely examined closely for signs of difficulty, regret or wishes to alter any aspect of their gender trajectory.” Evidence considered by the Cass review included talking to those who have transitioned to the opposite sex and those who have detransitioned back. It found that “whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down”. It continued: “For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/ retransition and/or experience regret. The NHS needs to care for all those seeking support.” Data on the number of adults who have detransitioned are scarce, but the report said the number was “increasing”. A 2021 study found that 70 per cent of people detransitioning had another condition in the first place, while 23 per cent were actually gay, lesbian or bisexual. Article Name:NHS to review all trans treatment Publication:The Daily Telegraph Author:By Michael Searles, Laura Donnelly and Daniel Martin Start Page:6 End Page:6")
Thursday 11 April
![‘There was no exploration of why I felt the way I did’ ‘Detransitioner’ Keira Bell sued the Tavistock over her treatment. She tells Ed Cumming that she feels vindicated by the Cass Review The Daily Telegraph11 Apr 2024 “I feel very vindicated,” says Keira Bell. “The Cass Review is another moment that adds to that feeling. But it’s just the tip of the iceberg.” Bell, 27, became the most prominent former patient of the Tavistock gender clinic as a result of her determination to expose the trauma she experienced at the centre as a teenager. She is speaking to The Telegraph as the conclusions of Dr Hilary Cass’s final review into gender identity services emerge after four years of painstaking work by one of the country’s top paediatricians. As widely expected, the report found that children had been badly let down by the NHS, particularly the Gender Identity Development Service (Gids) at the Tavistock, in London. Despite “remarkably weak” evidence, clinicians, responding to a surge in referrals, put thousands of children on irreversible courses of treatment, prescribing puberty blockers and hormones to help them change gender. “For people like me who have been involved as whistleblowers, this isn’t news, obviously,” Bell says. “There’s much more to be revealed. But the Cass Review is a start.” The review is the final stage of a process that began in late 2018, when parents of patients first wrote to the Tavistock’s trust to raise concerns about the speed of treatment. The Tavistock Gids closed last month. More than five years after that letter, thousands of young people, families and campaigners hope that the Cass Review will draw a line under a scandal that has shamed the NHS. None more so than Bell, who is perhaps the most prominent “detransitioner” in the UK, a young woman who has gone through hell at least twice, first in having changed her gender to male and regretted it, and then come forward to share her experience in public and fight a landmark legal case. There is no celebration in her voice, only perhaps a sense of relief that everything she has been through in recent years might not have been for nothing. Growing up in Letchworth, Hertfordshire, Bell had what she has called a “very rocky” childhood. Her parents split up when she was five. Flitting between them, she was never able to settle and always felt alienated from her peers. By the age of 14 she had started to look into the process of transitioning, using YouTube for research. Her GP referred her to local mentalhealth services, who in turn referred her to the Tavistock Clinic, which she first attended just after she turned 16, in early 2013. By the end of that year she was taking puberty blockers. “I definitely felt affirmed at the Tavistock,” she told The Telegraph in 2020. “When I spoke to these clinicians there was no exploration of why I felt like that, really. It was just accepted, and they were trying to deal with it [by putting] me on to the treatment path.” At 17 she was on testosterone injections. By 20 she’d had a double mastectomy. But a year after her surgery, she started to have regrets. She stopped the injections and helped bring a legal challenge against the Tavistock. The case initially won in the High Court before being defeated in the Court of Appeal. In the meantime Bell had become the face of the detransition cause, a thoughtful and articulate advocate who faced tremendous resistance online. While whistleblowing clinicians raised the alarm, Bell presented the human face of thousands of young people who felt they had been misled at a vulnerable moment in their lives. In the wake of the scandal, the Tavistock has closed, replaced by regional services. The NHS has all but banned puberty blockers and put much more stringent criteria on the prescribing of hormones. Treatment now takes a more rounded approach, prioritising a child’s psychological needs. But the changes and delays to the services mean thousands of distressed children and young people remain on waiting lists many years long. Echoing the review’s findings, Bell says she worries that the private sector is stepping in to fill the gap. “The private sector is now blindly taking onboard what was being shut down in regards to public services, which is very worrying, because it doesn’t seem to be about the care of people, and [is] more financially motivated,” she says. “[Staff ] have moved over to the private sector who were in the Tavistock Gids. Now they’re left to their own devices to descend into all that madness in the private sector, where there’s less regulation. They can run wild with it. It’s a massive concern. “It’s vindicating that the Tavistock Gids is closed and they’re not providing those treatments to minors anymore, but the fact it’s shifting to the private sector does worry me.” Dr Aidan Kelly, who previously worked at the Tavistock and is now director of a private clinic run by several former staff, insisted his centre “is already working in line with much of what is described in the Cass Review”, offering “a careful, multi-disciplinary team approach to our assessment and ongoing support of young people… Our hormone clinic sees only those 16 years or older for genderaffirming hormones. It does not prescribe puberty blockers.” Bell says that, for many young people in a similar position to her own, “Regret is really what we’re talking about, as opposed to detransition itself, which has an abstract sort of meaning, and people interpret it in different ways. There are people that are technically still transitioned, who have those regrets, and they wouldn’t dare mention it. So it’s a much bigger issue than people realise. It can be painful for people to turn back. And I don’t think a lot of people will. They’ll continue with it out of fear. People wouldn’t dare speak up because suddenly they’d be called transphobic and ousted from their friendship group.” She adds that it is not only trans rights campaigners who can cloud the conversation. “In an ideal world I would want political influence to be taken out of these services that are dealing with vulnerable people,” she says. “I worry about political influence on both sides. The trans rights side and the people that are more focused on women’s rights, which can sometimes get in the way of real care in this sort of area.” Today, Bell is now trying to spend some time out of the limelight. “I want to feel I’m in a bit more of a stable place. But I’m making moves. I don’t want a crazy life. My life has been so up and down, from a young age, so I’m just trying to find peace. It’s a work in progress.” If the reforms have come too late for Bell, she hopes that they will spare other young people what she has gone through. “I wouldn’t have done anything differently,” she says, of her involvement. “I’m just glad that it helped to bring awareness. It feels like it didn’t happen in vain, at least.” As for herself, she is learning to live with the anger and sense of betrayal she feels about her past. “I don’t feel as riled up as I did five years ago,” she says. “The anger is still there, but I’m able to manage it better. I’m hoping it will diminish over time. But it’s always going to be there because I have that reminder, every day I wake up and look in the mirror, or speak. It’s a forever thing.” Article Name:‘There was no exploration of why I felt the way I did’ Publication:The Daily Telegraph Start Page:2 End Page:2](https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F19c6138a-705a-4fc1-a19b-e8442a72f028_1208x745.png "‘There was no exploration of why I felt the way I did’ ‘Detransitioner’ Keira Bell sued the Tavistock over her treatment. She tells Ed Cumming that she feels vindicated by the Cass Review The Daily Telegraph11 Apr 2024 “I feel very vindicated,” says Keira Bell. “The Cass Review is another moment that adds to that feeling. But it’s just the tip of the iceberg.” Bell, 27, became the most prominent former patient of the Tavistock gender clinic as a result of her determination to expose the trauma she experienced at the centre as a teenager. She is speaking to The Telegraph as the conclusions of Dr Hilary Cass’s final review into gender identity services emerge after four years of painstaking work by one of the country’s top paediatricians. As widely expected, the report found that children had been badly let down by the NHS, particularly the Gender Identity Development Service (Gids) at the Tavistock, in London. Despite “remarkably weak” evidence, clinicians, responding to a surge in referrals, put thousands of children on irreversible courses of treatment, prescribing puberty blockers and hormones to help them change gender. “For people like me who have been involved as whistleblowers, this isn’t news, obviously,” Bell says. “There’s much more to be revealed. But the Cass Review is a start.” The review is the final stage of a process that began in late 2018, when parents of patients first wrote to the Tavistock’s trust to raise concerns about the speed of treatment. The Tavistock Gids closed last month. More than five years after that letter, thousands of young people, families and campaigners hope that the Cass Review will draw a line under a scandal that has shamed the NHS. None more so than Bell, who is perhaps the most prominent “detransitioner” in the UK, a young woman who has gone through hell at least twice, first in having changed her gender to male and regretted it, and then come forward to share her experience in public and fight a landmark legal case. There is no celebration in her voice, only perhaps a sense of relief that everything she has been through in recent years might not have been for nothing. Growing up in Letchworth, Hertfordshire, Bell had what she has called a “very rocky” childhood. Her parents split up when she was five. Flitting between them, she was never able to settle and always felt alienated from her peers. By the age of 14 she had started to look into the process of transitioning, using YouTube for research. Her GP referred her to local mentalhealth services, who in turn referred her to the Tavistock Clinic, which she first attended just after she turned 16, in early 2013. By the end of that year she was taking puberty blockers. “I definitely felt affirmed at the Tavistock,” she told The Telegraph in 2020. “When I spoke to these clinicians there was no exploration of why I felt like that, really. It was just accepted, and they were trying to deal with it [by putting] me on to the treatment path.” At 17 she was on testosterone injections. By 20 she’d had a double mastectomy. But a year after her surgery, she started to have regrets. She stopped the injections and helped bring a legal challenge against the Tavistock. The case initially won in the High Court before being defeated in the Court of Appeal. In the meantime Bell had become the face of the detransition cause, a thoughtful and articulate advocate who faced tremendous resistance online. While whistleblowing clinicians raised the alarm, Bell presented the human face of thousands of young people who felt they had been misled at a vulnerable moment in their lives. In the wake of the scandal, the Tavistock has closed, replaced by regional services. The NHS has all but banned puberty blockers and put much more stringent criteria on the prescribing of hormones. Treatment now takes a more rounded approach, prioritising a child’s psychological needs. But the changes and delays to the services mean thousands of distressed children and young people remain on waiting lists many years long. Echoing the review’s findings, Bell says she worries that the private sector is stepping in to fill the gap. “The private sector is now blindly taking onboard what was being shut down in regards to public services, which is very worrying, because it doesn’t seem to be about the care of people, and [is] more financially motivated,” she says. “[Staff ] have moved over to the private sector who were in the Tavistock Gids. Now they’re left to their own devices to descend into all that madness in the private sector, where there’s less regulation. They can run wild with it. It’s a massive concern. “It’s vindicating that the Tavistock Gids is closed and they’re not providing those treatments to minors anymore, but the fact it’s shifting to the private sector does worry me.” Dr Aidan Kelly, who previously worked at the Tavistock and is now director of a private clinic run by several former staff, insisted his centre “is already working in line with much of what is described in the Cass Review”, offering “a careful, multi-disciplinary team approach to our assessment and ongoing support of young people… Our hormone clinic sees only those 16 years or older for genderaffirming hormones. It does not prescribe puberty blockers.” Bell says that, for many young people in a similar position to her own, “Regret is really what we’re talking about, as opposed to detransition itself, which has an abstract sort of meaning, and people interpret it in different ways. There are people that are technically still transitioned, who have those regrets, and they wouldn’t dare mention it. So it’s a much bigger issue than people realise. It can be painful for people to turn back. And I don’t think a lot of people will. They’ll continue with it out of fear. People wouldn’t dare speak up because suddenly they’d be called transphobic and ousted from their friendship group.” She adds that it is not only trans rights campaigners who can cloud the conversation. “In an ideal world I would want political influence to be taken out of these services that are dealing with vulnerable people,” she says. “I worry about political influence on both sides. The trans rights side and the people that are more focused on women’s rights, which can sometimes get in the way of real care in this sort of area.” Today, Bell is now trying to spend some time out of the limelight. “I want to feel I’m in a bit more of a stable place. But I’m making moves. I don’t want a crazy life. My life has been so up and down, from a young age, so I’m just trying to find peace. It’s a work in progress.” If the reforms have come too late for Bell, she hopes that they will spare other young people what she has gone through. “I wouldn’t have done anything differently,” she says, of her involvement. “I’m just glad that it helped to bring awareness. It feels like it didn’t happen in vain, at least.” As for herself, she is learning to live with the anger and sense of betrayal she feels about her past. “I don’t feel as riled up as I did five years ago,” she says. “The anger is still there, but I’m able to manage it better. I’m hoping it will diminish over time. But it’s always going to be there because I have that reminder, every day I wake up and look in the mirror, or speak. It’s a forever thing.” Article Name:‘There was no exploration of why I felt the way I did’ Publication:The Daily Telegraph Start Page:2 End Page:2")
THIS WEEK IN PARLIAMENT
Parliament is in recess until April 15.
AROUND THE WORLD
Trans activists outraged over Hong Kong’s new policies for changing gender on IDs [LGBTQ Nation]
Hong Kong's trans activists are outraged by new, supposedly eased policies for changing gender markers on IDs that remain discriminatory and stringent. Despite a 2023 court ruling against mandatory gender-affirming surgery, trans individuals still face invasive requirements like surgery, legal declarations of gender dysphoria, hormone treatments for two years, and random blood tests.
Planet Fitness gyms receive bomb threats after Libs of TikTok’s anti-trans campaign [LGBTQ Nation]
Angry parent ruthlessly defends trans teen who was denied entry to prom for wearing a dress [LGBTQ nation]
In Alabama, a transgender teen was barred from her prom for wearing a dress, sparking outrage from Lesa Drake, a fiercely supportive parent. Despite no school policy violations, the principal enforced a discriminatory dress code.
Bar owner vows to “fight back” after drag story hour interrupted by bomb threat [LGBTQ Nation]
After a bomb threat disrupted a Drag Story Hour at Freddie's Beach Bar in Arlington, Virginia, owner Freddie Lutz vows to ‘fight back’, hoping for a larger turnout next time. The event, aimed at promoting inclusivity through drag performers reading to children, was temporarily evacuated but continued after police found no threat.
The North Face faces conservative boycott for sponsoring a queer summer camp [Advocate]
Another day, another company added to their ever-increasing list of brands they say they are boycotting but never do.
Joe Biden launches ‘Out for Biden-Harris’ campaign initiative to engage & woo LGBTQ+ voters [Advocate]
The Biden-Harris campaign has launched "Out for Biden-Harris," a strategic effort to engage the LGBTQ+ community for their re-election in 2024, emphasising the significant impact and mobilisation of LGBTQ+ voters in their previous electoral success. Campaign manager Julie Chavez Rodriguez highlighted the crucial support from nearly 11,000 LGBTQ+ volunteers in the 2020 election, aiming to further harness this community's organising power to secure re-election.
Elon Musk will sue Australia for ordering Twitter to remove a hateful post by an anti-trans activist [LGBTQ Nation]
Elon Musk is suing Australia for ordering his social media platform, Twitter [yes, I will continue to call it that until he respects trans people], to remove a hateful post by anti-trans activist Chris Elston, defending the move as a stance for "free speech." This, from the man who has the word ‘cis’ banned on Twitter as hateful speech. Australia's eSafety commissioner demanded the post's removal, deeming it offensive and harmful towards trans individuals, specifically targeting Australian trans activist Teddy Cook with derogatory language.
NAIA issues “unacceptable” blanket ban on trans women competing in women’s sports [LGBTQ Nation]
The National Association of Intercollegiate Athletics (NAIA) has approved a ban on transgender women participating in women’s sports
ANY OTHER BUSINESS
Lesbian News publisher Ella Matthes has died at 81 [Advocate]
Ella Matthes, publisher and editor of North America's longest-running lesbian publication, Lesbian News Magazine, passed away at 81 from a heart attack. Under her leadership since 1994, the magazine became a key voice for lesbians, featuring notable personalities and advocating for lesbian visibility and rights.
RECOMMENDED READING
What the Cass Review fails to tell us about growing up trans, by Robin Moira White.
Gender-Affirming care for trans youth is neither new nor experimental: A timeline and compilation of studies, by Julia Serano.
TRANSWRITES YOU MIGHT HAVE MISSED
NHS & puberty blockers: Former GIDS patients reflect on long wait times, invasive assessments, by Sasha Baker.
The Cass Review: A government-sanctioned attack on trans lives, by Lee Hurley.
Fanfiction was my gay-girl-to-gay-guy pipeline, and I’m proud of it, by Jesse Smith.
What does Liz Truss’s anti-trans bill actually say? By Lee Hurley.
Andrew Joseph White’s writing is exactly what autistic transgender people like me needed when we were younger, by Ayman Eckford.
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Thanks for this thorough work. I love that you still call Twitter by its original name.