Most clinical transgender guidelines for minors not evidence-based and of ‘poor quality,’ says UK medical review

Most of the research behind so-called “gender-affirming care” is of “poor quality” and unable to provide a “reliable evidence base upon which to make clinical decisions.”

That is according to the British pediatrician who has led an independent review of studies and guidelines used to treat children and teens with gender dysphoria by the use of puberty blockers, cross-sex hormones and even surgeries. 

Rising numbers of young people under the care of England’s National Health Service (NHS) have presented with some form of expressed gender identity issues, says Dr. Hilary Cass, but the rationale for the treatments administered “remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health.” 

One of the primary problems with the previously published research, Cass notes, is the “lack of long-term follow-up data on those commencing treatment at an earlier age.” 

Cass led a team from the University of York in a systematic review of the studies and guidelines that have set the “gender-affirming care” treatment protocol for British children and teens.  

In her foreword to their final report, the pediatrician laments that while new treatments for young people traditionally go through a lengthy trial period during which doctors are cautious about recommending them, “quite the reverse happened in the field of gender care for children.” 

“The toxicity of the debate” is likely among the contributing factors to this apparently drastic “reversal,” she observes, adding, “The knowledge and expertise of experienced clinicians who have reached different conclusions about the best approach to care are sometimes dismissed and invalidated.” 

Cass took to task medical professionals who have attempted to bully, censor and otherwise stifle those who opposed their views. 

“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,” she writes.  
“This must stop.” 

The review team examined several areas of debate often found in media, including the value of so-called “social transition,” in which children who claim to have a gender identity unaligned with their biological sex change their appearance, and identify with a new name and “preferred pronouns” corresponding to their perception of themselves. 

“The systematic review showed no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence,” the report notes. “However, those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway.” 

Another common claim of transgender medicine activists is that administering puberty blockers is fairly harmless and buys time for a child and his or her parents to assess whether to continue with further drug or surgical treatment.  

The reviewers, however, found no support for this assertion: 

“[G]iven that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinising/feminising hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.” 

Studies pertaining to the use of puberty blockers for children also show evidence the drugs compromise bone density. However, “no changes in gender dysphoria or body satisfaction were demonstrated,” the report says. 

Gender activists also claim medicalized “gender-affirming care” is a form of suicide prevention based on the premise that young people who are not “affirmed” in their new gender identity have high rates of suicide. 

The York reviewers, however, found no evidence that supports this claim: 

“Tragically deaths by suicide in trans people of all ages continue to be above the national average, but there is no evidence that gender-affirmative treatments reduce this. Such evidence as is available suggests that these deaths are related to a range of other complex psychosocial factors and to mental illness.” 

That conclusion is supported in other research as well, particularly a recent study from Finland that found mental health disorders are the main predictor of suicide in adolescents with gender dysphoria. 

The primary predictor of death in gender-dysphoric young people is “psychiatric morbidity,” the researchers said. “Medical gender reassignment does not have an impact on suicide risk.” 

Overall, the evidence reviewed by the Cass team suggests “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.” 

That finding was also observed in a recent long-term study from the Netherlands, which concluded that the sense of discomfort with one’s gender is “relatively common” among young adolescents and decreases as children get older, with most growing out of it. 

Additionally, such “gender non-contentedness” was found to be tied to poor self-concept and mental health issues throughout development. 

Children and teens with gender dysphoria, therefore, should receive a “holistic assessment,” one that screens as well for “neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment,” the report concludes. 

“The central aim of assessment should be to help young people to thrive and achieve their life goals,” Cass says, rather than viewing them “solely in terms of their gender-related distress.” 

Cass also asserts the need for services for detransitioners, “recognising that they may not wish to re-engage with the services whose care they were previously under.”