hrefna, 2 months ago (edited 2 months ago)

"Cis doctor who trained in the 1980s—with a specialization in unrelated fields—wants to institute additional barriers to access for #trans people."

Where have I heard that before.

#CassReview

hrefna, 2 months ago

Also if this particular analysis is true, and I have no reason to doubt it, then I have to also agree with this criticisms analysis.

This is an area where blinding is extraordinarily difficult, if not impossible, to do ethically. Blinding is rarely used in social science in part for exactly this reason.

You aren't working with small groups of inbred mice here.

https://transactual.org.uk/blog/2024/04/11/press-release-the-cass-review-is-bad-science-and-should-not-be-taken-seriously-by-policymakers/

hrefna, 2 months ago

Anyways, some responses.

Horton, C. (2024). The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children. International Journal of Transgender Health, 1–25. https://doi.org/10.1080/26895269.2024.2328249

hrefna, 2 months ago

Dr. Hane Maung, Response to the Cass Review, GenderGP. This also emphasizes the problem with focusing on blinded RCTs.

https://www.gendergp.com/response-to-the-cass-review/

hrefna, 2 months ago

Our initial response to the publication of the Cass Review 10.4.24, Scottish Trans

hrefna, 2 months ago

On the RCT comment: this appears to be a common concern. A user on reddit put together this.

https://www.reddit.com/r/skeptic/comments/1c1i6qa/englands_cass_report_rejected_all_evidence_on/

At least one of those highlighted as "high risk of bias" due to "lack of control group" and "no blinding" was probably this study…

Joseph et al. "The effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria: findings from a large national cohort" https://doi.org/10.1515/jpem-2019-0046

Which, uh. I question what would have passed muster here.

hrefna, 2 months ago

Freddy McConnell, Hilary Cass’s proposals are mostly common sense. She must reject anti-trans bias with the same clarity

https://www.theguardian.com/commentisfree/2024/apr/11/hilary-cass-trans-children-review

These views fundamentally undermine trans people’s identities and the legal basis on which our rights to things like dignity, privacy and medical care are also protected. Failing to identify such extreme opinions and push back on them in a review focused on improving care for gender-questioning children and young people is unforgivable. Giving Cass the benefit of the doubt, perhaps simply stating that trans children and adults exist seemed too basic – but in the clinical and cultural context we’re operating in, it remains vital.

hrefna, 2 months ago

Erin Reed (@ErinInTheMorn), Hilary Cass' NHS report is rife with debunked theories and falsehoods

https://www.advocate.com/health/hilary-cass-nhs-report-debunked

In those meetings, Cass apparently took interest in Florida’s anti-trans expert report, according to emails from trial exhibits uncovered by transgender researcher Zinnia Jones, such as this email confirming that a meeting took place:

hrefna, 2 months ago

Transphobic report by UK pediatrician Hilary Cass released, LA Blade

https://www.losangelesblade.com/2024/04/10/transphobic-report-by-uk-pediatrician-hilary-cass-released/

hrefna, 2 months ago

Cass Review out of step with high-quality care provided in Aotearoa, Professional Association for Transgender Health Aotearoa (PATHA)

https://patha.nz/News/13341582

hrefna, 2 months ago

Cass Review out-of-line with medical consensus and lacks relevance in Australian context, Equality Australia

https://equalityaustralia.org.au/cass-review-out-of-line-with-medical-consensus-and-lacks-relevance-in-australian-context/

hrefna, 2 months ago

Jennie Kermode, The Cass review: trans care or trans scare?, Yorkshire Bylines

https://yorkshirebylines.co.uk/politics/the-cass-review/

The methodology for the Cass review was established by a team from the University of York including Tilly Langdon, who has previously been involved in promoting Gender Exploratory Therapy – an approach which, despite its neutral-sounding name, discourages children from identifying as trans and has been likened to conversion therapy. Her approach included setting a very high bar for evidence to be considered in the review, ruling out 100 of the existing 103 studies into the use of puberty blockers and hormones to treat trans children. The reason given for excluding all these studies was that they did not incorporate a double blind approach – in other words, they did not involve giving puberty blockers to some patients and placebos to others. This might sound like a reasonable objection on the face of it – until one considers that puberty is a dramatic physical and psychological process, and people can easily tell when it’s happening to them, so a double blind simply wouldn’t work in practice.

hrefna, 2 months ago

TENI (Transgender Equality Network Ireland) Statement on Cass Review into Gender Identity Services for Children and Young People

https://teni.ie/teni-transgender-equality-network-ireland-statement-on-cass-review-into-gender-identity-services-for-children-and-young-people/

#CassReview

We remain concerned by the prevailing narrative in the UK, which often expresses scepticism and hostility towards granting medical professionals the authority to prescribe puberty blockers to young individuals, despite evidence suggesting their potential for positive health outcomes. This sceptical narrative within the report ignores the wealth of research, from over a dozen studies of at least 30,000 trans and non-binary young people, that gender affirming healthcare is both safe and effective at improving their mental health and wellbeing.

hrefna, 2 months ago

Samantha Riedel, Advocates Say a Controversial Report on Healthcare for Trans Kids Is “Fundamentally Flawed”, them

https://www.them.us/story/cass-review-nhs-trans-youth-healthcare-report

#CassReview

One famously sarcastic illustration of this point took the form of a 2018 study that professed to use a control group to determine whether parachutes would prevent injury or death when skydiving.) In the case of hormone therapy and puberty blockers, a double-blind study would also be logistically unfeasible, as any placebo groups would quickly realize they were not receiving actual medicine. Nevertheless, the Cass Review disregarded or downgraded the perceived quality of dozens of studies on the mental and physical effects of HRT and puberty blockers in youth, based on researchers’ assertions that those studies “lack[ed] blinding and [had] no control group.”

hrefna, 2 months ago

Trans Safety Network, TSN statement on Cass Review Final Report

https://transsafety.network/posts/tsn-statement-on-cass-final-report/

#CassReview

hrefna, 2 months ago

Riki Lane, Cass final report: a major setback, Workers Liberty

https://www.workersliberty.org/index.php/story/2024-04-14/cass-final-report-major-setback

#CassReview

hrefna, 2 months ago

Robyn Vinter talking to Aiden Kelly, Trans children in England worse off now than four years ago, says psychologist, The Guardian

https://www.theguardian.com/society/2024/apr/11/trans-children-in-england-worse-off-now-than-four-years-ago-says-psychologist

#CassReview

“The decision to get rid of [Gids] and start afresh with two services with no history, no expertise in the field, with hiring clinical teams who have never worked in gender before, [who would be seeing] a much greater and much longer list of referrals, doesn’t sound to me like a successful approach and it really seems like we’re going backwards instead of forwards.” He added: “You’re going to have people who’ve been waiting over four years to see a gender specialist; they’ll arrive at one of these new gender clinics and they may well know more about the field of gender than the clinician will and that’s not an exaggeration. That, to me, is incredibly worrying.”

hrefna, 2 months ago

Not specifically about the #CassReview, but Dr. Kelly highlighted this German report.

Neue S2k-Leitlinie zu Geschlechts­inkongruenz und -dysphorie im Kindes- und Jugendalter vorgestellt, Deutsches Ärzteblatt (translation by Google Translate)

https://www.aerzteblatt.de/nachrichten/150071/Neue-S2k-Leitlinie-zu-Geschlechtsinkongruenz-und-dysphorie-im-Kindes-und-Jugendalter-vorgestellt

“These people are in serious crisis situations,” emphasized Claudia Wiesemann, director of the Institute for Ethics and History of Medicine, Göttingen University Medical Center and author of the guideline. The puberty block gives them room for development to make a reflected decision about their own future. “To refuse this because of fear of side effects is medically and ethically inappropriate. “Compared to the crisis situation, the side effects of puberty blockage are generally insignificant for those affected,” Wiesemann is convinced. Nevertheless, Pauli emphasized: “There can be side effects that we have to explain.”

hrefna, 2 months ago

UK: Cass review on gender identity is being 'weaponised' by anti-trans groups, Amnesty International

https://www.amnesty.org.uk/press-releases/uk-cass-review-gender-identity-being-weaponised-anti-trans-groups

#CassReview

hrefna, 2 months ago

The Dyke Project

https://www.instagram.com/p/C5qFMuxoK3L/

#CassReview

hrefna, 2 months ago

Not in direct response to the review, but relevant and Serano refers back it multiple times in her analysis of the review.

Julia Serano, 2023, Gender-Affirming Care for Trans Youth Is Neither New nor Experimental: A Timeline and Compilation of Studies

https://juliaserano.medium.com/gender-affirming-care-for-trans-youth-is-neither-new-nor-experimental-a-timeline-and-compilation-b4bb8375d797

#CassReview

I’ve read countless trans-skeptical and “just asking questions” articles about the gender affirmative model, and they always have one glaring omission. Specifically, they focus solely on gender-affirming practices — social transition, puberty delay, hormone therapy, and surgeries — and portray them as “novel” and “active” interventions that require further scrutiny. This framing makes it seem as though the alternative approach (passively “doing nothing”) is an inherently neutral and less risky option. But “doing nothing” is not doing nothing! It involves actively disaffirming trans kids’ genders — and we have lots of research on the impacts of that approach.

hrefna, 2 months ago

Feminist Gender Equality Network, Letter from academics concerned about The Cass Review

https://feministgenderequality.network/letter-from-academics-concerned-about-the-cass-review/

#CassReview

We regard The Cass Review as methodologically unsound, biased in the extreme (despite its reasonable-sounding language), dangerous, and rights-stripping in its proposals. If implemented it will cause great harm to trans and non-binary young people. This report should be scrapped, trans children deserve so much better than this.

hrefna, 2 months ago

Not directly referencing, but related to the conclusions and the behavior of the NHS.

Gendered Intelligence, NHS England delays puberty suppressing treatments

https://genderedintelligence.co.uk/news/15-nhs-england-delays-puberty-suppressing-treatments

#CassReview

hrefna, 2 months ago

LGBT+ Liberal Democrats, Initial Statement on the Cass Review

https://lgbt.libdems.org.uk/news/article/initial-statement-on-the-cass-review

#CassReview

hrefna, 2 months ago

Lisa Johnson, What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth, CBC News

https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920

#CassReview

Dr. Tehseen Ladha, a pediatrician in Edmonton and assistant professor at the University of Alberta, says the review may be misleading and ignores the context of pediatric medicine — where there is often imperfect evidence.
"Many people would see low-quality evidence and think well, that means this could harm our children. But that's not what it means." Even something as routine as treating a kid's ear infection with antibiotics or painkillers may not have robust evidence, notes Donaldson. "That doesn't mean we just every time we see an ear infection we turn around and walk the other way. Sometimes, an ear infection needs to be treated, sometimes it doesn't."
Ladha wondered if the review was "coming from a place of bias." "I think the framing of it really made it feel as though it was trying to create fear around gender-affirming care," she said. Donaldson called the systematic review paper and the broader Cass Review "politically motivated."

hrefna, 2 months ago

Gemma Stone, Spare a Thought for Hilary Cass, Novara Media

#CassReview

Even those involved in the review have expressed dismay at how it was conducted. Cat Burton, chair of the Gender Identity Research & Education Society, one of the organisations consulted by the Cass review team, took to X/Twitter to say that “after three discussions it was obvious that the review had been written before we started. She [Hilary Cass] totally discounted evidence from trans people from the basis of knowledge or lived experience.”
Cass also suggests that the rate at which young people move from puberty blockers to subsequent hormone treatments may, as anti-trans groups have warned, prove puberty blockers help cement a trans identity in these youth. Her data for this is the fact that in two (2) studies, nearly all trans youth prescribed blockers went on to take hormones. Of course, this finding could just as easily suggest that puberty blockers are being prescribed very precisely – a possibility Hilary Cass does not entertain for even a second.
More worryingly still, many of Cass’s conclusions are based on evidence that does not corroborate, or in some cases, directly contradicts her findings. For example, her recommendation of an intermediate service is based on the idea that brains don’t reach maturity until 25 – a notion that Dean Burnett, a neuroscientist and the author of The Idiot Brain describes as “guff based on hearsay, misunderstanding of neuroscience or wilful ignorance”.

hrefna, 2 months ago

Therapists Against Conversion Therapy & Transphobia (TACTT), Our interim response to the Cass report

https://therapistsagainsttransphobia.org/2024/04/12/our-interim-response-to-the-cass-report/

#CassReview

We echo expressions of concern from expert individuals and organisations regarding methodological flaws of the report. We note that evidence supporting an anti-trans position was consistently held to a lower burden of proof or research standard than other material. We note that the Cass Review dismissed numerous research studies whose results strengthened the evidence base to support medical treatment for gender incongruence.

hrefna, 2 months ago

Nicole Lee, Activist groups raise concerns over “deeply flawed” Cass Review on transgender healthcare, gcn (gay community news)

https://gcn.ie/concerns-cass-review-transgender-healthcare/

#CassReview

hrefna, 2 months ago

Rowan, Milo, and Luci. The Cass Review Needs To Be Thrown Out Entirely, This Is Why. What The Trans.

https://whatthetrans.com/cass-review/

#CassReview

hrefna, 2 months ago

Trans Healthcare Action. We cannot allow the deeply-flawed Cass Review to dictate the future of trans healthcare in Ireland.

https://www.instagram.com/p/C5l_QGGvpSf/

#CassReview

hrefna, 1 month ago

Comic by @sophielabelle

https://www.instagram.com/p/C5vdq-fM7in/

#CassReview

hrefna, 1 month ago

Brynn Tannehill. The Cass Review heralds how all trans medicine will die. Los Angelas Blade.

https://www.losangelesblade.com/2024/04/15/the-cass-review-heralds-how-all-trans-medicine-will-die/

#CassReview

hrefna, 1 month ago

Gemma Stone. The 32 things The Cass Review recommends and why they are concerning. Trans Writes.

https://transwrites.world/the-cass-review-recommendations/

#CassReview

hrefna, 1 month ago

Jules Roscoe. Review Used By UK to Limit Gender Affirming Care Uses Images of AI-Generated Kids. 404 Media (@404mediaco ).

https://www.404media.co/uk-gender-affirming-care-ai-generated-children/

#CassReview

hrefna, 1 month ago

Eli Cugini, The Cass Review, autism, and reinventing Blanchard

https://eliacugini.medium.com/the-cass-review-autism-and-reinventing-blanchard-c6dd94e3365c

#CassReview

So, the Cass Review took a study full of glaring markers of sexual misconduct & conversion therapy being enacted on trans children, quoted a statement about the data that is obviously incorrect if you look at the data for five seconds, used it to make a point intended to discredit autistic youth / paint them as delusional heterosexuals, and ignored blatant evidence of a long and documented history of gay and bi trans people being blocked from necessary healthcare interventions.

hrefna, 1 month ago

Dylan Naylor and Willow Parker. Cass report: ‘Here’s why politicians should not treat it as gospel’. Labour List.

https://labourlist.org/2024/04/hilary-cass-trans-report-final-review-lgbt-labour-policy-manifesto/

#CassReview

hrefna, 1 month ago

Gillian Branstetter. Between Reproductive Past and Trans Future. The Autonomy.

https://autonomy.substack.com/p/between-past-and-future

#CassReview

hrefna, 1 month ago

Not about the Cass review, but talking about the standards of evidence.

Brik et al. Trajectories of Adolescents Treated with Gonadotropin‐Releasing Hormone Analogues for Gender Dysphoria. Archives of Sexual Behavior (which is… something). 2018.

Even the journal that Zucker used to be the editor in chief of, that has a history of anti-trans bias, has published things that say "this would answer questions but would be considered unethical."

#CassReview

hrefna, 1 month ago

Chris Noone and Karen Sugrue. Trans young people have nowhere to turn, and the Cass Report has made it worse. The Journal.

https://www.thejournal.ie/readme/tavistock-cass-report-6356143-Apr2024/

#CassReview

Two thirds of the country voted for bodily autonomy in 2018, and that is all that trans people are asking for. Consider another parallel with the stories we heard during the campaign to repeal the Eighth Amendment — it is not possible to stop people from transitioning, so what is happening now is that we are just denying people from accessing safe and effective healthcare.

hrefna, 1 month ago

Han Tiernan. Over 130 Irish academics sign open letter criticising Cass Review on transgender healthcare. gcn.

https://gcn.ie/irish-academics-letter-criticising-cass-review/

The open letter in question: https://sway.cloud.microsoft/pFNJFRo9BM6LChR0?ref=Link&loc=play

#CassReview

hrefna, 1 month ago

Cal Horton. Ten Dangerous Cass Review Recommendations. Growing Up Transgender.

https://growinguptransgender.com/2024/04/16/ten-dangerous-cass-review-recommendations/

#CassReview

hrefna, 1 month ago

Trans Learning Partnership. The Trans Learning Partnership has developed policy statements on a range of issues affecting the trans community.

https://www.the-tlp.org.uk/policy-statements/

#CassReview

hrefna, 1 month ago

In the Misc category:

• Ethel Weapon has been cataloging #CassFlaws over on bluesky: https://bsky.app/hashtag/CassFlaws?author=lousadzak.bsky.social

• Dr Ruth Peace has been doing a roundup of reports. It covers a lot of the same things as this thread, but has better organization https://ruthpearce.net/2024/04/16/whats-wrong-with-the-cass-review-a-round-up-of-commentary-and-evidence/

#CassReview

hrefna, 1 month ago

Kaylin Hamilton. The UK’s Cass Review Is Already Harming Transgender Young People. Prism & Pen.

https://medium.com/prismnpen/the-uks-cass-review-is-already-harming-transgender-young-people-0fb41b1aeaeb

#CassReview

hrefna, 1 month ago

Grijseels, D. (2024, April 26). Biological and psychosocial evidence in the Cass Review: A critical commentary. https://doi.org/10.31235/osf.io/wjafd

#CassReview

Overall, this section discussing possible factors which have influenced the patient profile shows several issues in providing evidence to substantiate its claims. Forseveral key assertion, single studies are cited when a wealth of contradictory studies are available, showing a lack of balanced consideration of the literature. This calls into question the robustness of the listed conclusions of this section (8.52-8.62), and any recommendations the Review makes based on these
One of the central recommendations of the Review is the discontinuation of puberty blockers as standard practice for trans children within the NHS. As this is in direct conflict with long-standing international standards of care (Taylor, Hall, Heathcote, et al., 2024), it would be expected this recommendation is supported by substantial question about its positive effects of puberty blockers, and/or overwhelming evidence of their adverse effects. Such evidence is not presented in the Cass Review. Similarly,the Review argues there is insufficient evidence of long-term positive effects of hormone treatment in adolescents, recommending against early treatments, again directly contradicting international standards, and the large number of studies used to develop these standards

hrefna, 1 month ago

Gideon, M-K. The Cass Review Into Gender Identity Services for Children - Part 1. Gideon M-K: Health Nerd. #CassReview

hrefna, 1 month ago

Carnell, Henry. The UK’s New Study on Gender Affirming Care Misses the Mark in So Many Ways. Mother Jones. 10 May 2024.

https://www.motherjones.com/politics/2024/05/cass-review-transgender-health-care-nhs-gender-affirming-care/

#CassReview

“It’s a bad faith claim that we don’t have enough evidence for pubertal suppressants or gender-affirming hormones,” says Keuroghlian, who has worked with over 2,000 trans and gender-diverse patients in their career. “Gender-affirming medical interventions have been used for adolescent gender dysphoria for decades, and we have a large body of evidence linking them to improved mental health outcomes,” says Turban.
Perhaps because of the loose use of terminology, the Cass report describes some gender-medicine research as “poor” even though those same studies were rated “moderate” or “high quality” by reviewers at the University of York. The studies downgraded by Cass all demonstrated the efficacy of gender-affirming medical interventions. On the other hand, other studies that didn’t come to such strong conclusions in favor of intervention were not similarly downgraded.
More broadly, Keuroghlian and McNamara both argue that Cass’ conclusions undermining the observational studies is itself a form of bias. “The review’s conclusions are discriminatory,” says Keuroghlian. “It’s an intentional misapplication of science to deny a minoritized group access to medically necessary evidence-based care.” “Any deviation from basic principles of evidence-based medicine suggests bias,” says McNamara.

hrefna, 1 month ago

Horton, Cal. Social Transition, Puberty Blockers, and the Cass Review (Podcast Transcript). What the Trans. 7 May 2024.

https://whatthetrans.com/social-transition-puberty-blockers-and-the-cass-review-podcast-transcript/

#CassReview

It found that trans children who were supported and able to socially transition in childhood, had positive levels of mental health, depression and anxiety, levels of mental health similar to their cis peers. This was in direct contrast to research at the same time from populations of trans children and adolescents who had not been supported to socially transition, where high levels of depression, anxiety, suicidal ideation or suicide attempts were common. This ground-breaking finding that supported trans children have good levels of mental health is reported by the York systematic review thus “The study found no significant difference in depressive symptoms compared with population averages”. Do you see how the study’s own findings have been distorted to make it sound as though the study result is inconclusive?
Bizarrely they adopt a definition of social transition that is in no way standard, including children who only change appearance or clothing, in order to justify inclusion of a 2013 study in which no youth actually socially transitioned according to today’s understanding of this term.
Being trans is seen as inherently a bad outcome. It doesn’t matter if you are a happy trans teenager, or a healthy trans adult. This is a worse outcome than being a cis adult. The Cass Review utilises HRT to justify this eugenicist bigotry. Trans people, the Cass Review argues, are more likely than cis people to require ongoing HRT – life-long medication. Therefore, the Cass Review argues, policies that can limit and reduce the number of trans people are medically speaking, morally justified.

hrefna, 1 month ago

Reed, Erin. Endocrine Society And American Academy Of Pediatrics Respond To Cass, Reject Bans. Erin in the Morning. 13 May 2024.

https://www.erininthemorning.com/p/endocrine-society-and-american-academy

#CassReview

Similar sentiments were shared by Dr. Ben Hoffman, president of the American Academy of Pediatrics, who responded to the Cass Review, “What we’re seeing more and more is that the politically infused public discourse is getting this wrong and it’s impacting the way that doctors care for their patients. Physicians must be able to practice medicine that is informed by their medical education, training, experience, and the available evidence, freely and without the threat of punishment. Instead, state legislatures have passed bills to ban and restrict gender-affirming care, which means that right now, for far too many families, their zip code determines their ability to seek the health care they need. Politicians have inserted themselves into the exam room, and this is dangerous for both physicians and for families.”

hrefna, 6 days ago

Grijseels, D. M. (2024). Biological and psychosocial evidence in the Cass Review: a critical commentary. International Journal of Transgender Health, 1–11. https://doi.org/10.1080/26895269.2024.2362304

#CassReview

Overall, this section discussing possible factors which have influenced the patient profile shows several issues in providing evidence to substantiate its claims. For several key assertion, single studies are cited when a wealth of contradictory studies are available, showing a lack of balanced consideration of the literature. This calls into question the robustness of the listed conclusions of this section (8.52-8.62), and any recommendations the Review makes based on these.
All in all, this commentary raises numerous concerns regarding the biological and psychosocial evidence in the Cass Review. These concerns include inferring trends and causality about demographic trends and comorbidities within statistical substantiation, misrepresenting results from the literature, varying thresholds for the inclusion of studies and using unbalanced evidence or references to make one-sided claims. Together, these concerns call into question whether the Review is able to provide sufficient evidence to substantiate its recommendations to deviate from WPATH’s international standard of care for trans children

hrefna, 6 days ago

WPATH. WPATH and USPATH Comment on the Cass Review. 17 May 2024.

https://www.wpath.org/media/cms/Documents/Public%20Policies/2024/17.05.24%20Response%20Cass%20Review%20FINAL%20with%20ed%20note.pdf

#CassReview

hrefna, 6 days ago

#CassReview

Overall, this section discussing possible factors which have influenced the patient profile shows several issues in providing evidence to substantiate its claims. For several key assertion, single studies are cited when a wealth of contradictory studies are available, showing a lack of balanced consideration of the literature. This calls into question the robustness of the listed conclusions of this section (8.52-8.62), and any recommendations the Review makes based on these.
All in all, this commentary raises numerous concerns regarding the biological and psychosocial evidence in the Cass Review. These concerns include inferring trends and causality about demographic trends and comorbidities within statistical substantiation, misrepresenting results from the literature, varying thresholds for the inclusion of studies and using unbalanced evidence or references to make one-sided claims. Together, these concerns call into question whether the Review is able to provide sufficient evidence to substantiate its recommendations to deviate from WPATH’s international standard of care for trans children