Major medical associations have remained silent after the results of a four-year review commissioned by the National Health Service (NHS) England undermined their recommendations for giving puberty blockers to children with gender dysphoria
The Cass report, conducted by former Royal College of Pediatrics and Child Health Dr. Hilary Cass and released April 10, found that there is “weak evidence” for offering puberty blockers to children. It concluded that its findings “raise questions about the quality of currently available guidelines” offered by associations like the World Professional Association for Transgender Health (WPATH) and the Endocrine Society, yet neither organization has committed to reviewing their guidelines.
The review recommends against treating children with puberty blockers outside of a research setting. It also urged “extreme caution” for providing cross-sex hormones to minors under 18 and stressed the need for a “clear clinical rationale.”
The review further suggested a “full programme of research be established” to “look at the characteristics, interventions and outcomes of every young person presenting to the NHS gender services.”
“Although a diagnosis of gender dysphoria has been seen as necessary for initiating medical treatment, it is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them,” the report noted.
The American Medical Association, WPATH, American Academy of Pediatrics, American Academy of Child & Adolescent Psychiatry (AACAP) and Endocrine Society did not respond to multiple inquiries over the past week from the Daily Caller News Foundation asking whether they had concerns with the report’s findings or intended to conduct their own review. Aside from WPATH, these organizations have largely failed to even address the report publicly.
WPATH wrote in a statement that it “supports policies that increase access to high-quality ethical care for transgender youth,” claiming that the report’s foundation is rooted in a “false premise.”
The organization’s standards of care 8th version states that waiting several years to start a young adolescent on puberty blockers “is not always practical nor necessary given the premise of the treatment as a means to buy time while avoiding distress from irreversible pubertal changes,” though it acknowledges that establishing a “sustained experience of gender incongruence” can be important before starting.
“The foundation of the Cass report is rooted in the false premise that non-medical alternatives to care will result in less adolescent distress for most adolescents and is based on a lack of knowledge of and experience working with this patient population,” the organization said in a press release. “It is harmful to perpetuate this notion and does not acknowledge the very real fact that medical pathways are an important treatment option for many young people.”
The Endocrine Society characterizes puberty blockers as a “reversible pause to puberty” and “a first step in treatment to allow the adolescent to explore their gender identity and/or to provide relief from distress.” WPATH’s guidelines likewise recommend putting adolescents on “puberty suppressing hormones” to “alleviate gender dysphoria.”
WPATH physicians acknowledged puberty blockers can cause irreversible consequences in minors like infertility, bone loss and disruption of brain development in educational sessions from September 2022 previously obtained by the Daily Caller News Foundation.
Both the AMA and AACAP recommend WPATH’s guidance for handling gender dysphoria in children. The AMA often advocates against red state laws that ban sex-change procedures for minors, including puberty blockers.
The Cass report notes “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.”
The Cass report also questioned WPATH and the Endocrine Society on the “circularity” of their citations, which make support for their positions appear stronger than they are.
Early versions of the two organization’s guidelines influenced “nearly all” guidelines set by other organizations, the report notes. The two organization’s guidelines are also “closely interlinked” because WPATH provided input on the Endocrine Society recommendations, according to the report.
“The circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor,” the report stated.
