EP-119 Scientific Approach Needed – Gender-Affirming Care
Highlighting the UK’s NHS Cass Review on gender-affirming care with a focus on the often cited “suicide ideation” propaganda in Washington State politics.
Beginning in 2020 the National Health Service (NHS) in England commissioned a comprehensive multi-year review of gender-affirming care for children and adolescents. The scientific review, published in 2024, was a complete rebuke of the prevailing approach to gender-affirming care in the UK.
As a result of the review, the UK medical establishment and policy makers changed their approach to treatment for gender dysphoria in youth. Despite the updated science, activists and policymakers in Washington State continue to use emotional propaganda and pseudoscience to guide their campaigns and legislation.
The science has been reviewed. We must change our ways.
“She blinded me with science!” – Thomas Dolby ‧ 1982
Information war
“Save the children” has been a manipulative political ploy for decades. Both major political parties have used it as a vehicle for inserting ideology into policy. It may seem trite from an experienced lens of political analysis, but the effectiveness proves its longevity as a tactic.
There is a pernicious use of junk science fueling political propaganda regarding “youth gender care” in our society. The “save the children” slogan has been tied into a gordian knot of misinformation. The claims of science are used to tighten this twisted knot weaving through our community. It’s often hard to know who to trust when information outlets contradict each other with claims of factual science: “Not that science, this science. Not this science, that science.”
How do parents and community members inform themselves when the information space is littered with manipulation and a constant barrage of conflicting data sets? How are they to participate when each extreme faction emotionally invokes the language of “save the children” at every turn?
In the end, the very object of manipulation must be the guiding light forging a path forward to truth and reason – science.
Pseudoscience, popularized through political propaganda, states that youth gender-affirming care is necessary to combat teen suicide rates. This basic emotional plea invokes the time-honored manipulation of the “save the children” mantra. But the NHS Review debunked the pseudoscience; and it presented a peer-reviewed scientific assessment of youth gender-affirming care and the holistic issue of gender dysphoria.
National Health Service Commissioned Cass Review
The Cass Review was an independent review of the UK’s NHS gender identity services for children and young people. The scientific endeavor culminated with a lengthy 388-page review led by Dr Hilary Cass.
The mission for the Cass Review as stated in the document: “The Review was commissioned by NHS England to make recommendations on how to improve NHS gender identity services, and ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria receive a high standard of care, that meets their needs, is safe, holistic and effective.”
Trust the Science!
Advocates for gender-affirming care often cite research to support their stance that such interventions, including puberty blockers and hormone treatments, are crucial in reducing suicide risk among transgender youth. The often-quoted study is titled “Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation.” This study suggested that transgender and gender non-conforming youth who received puberty blockers exhibited lower rates of suicidal ideation compared to those who did not.
However, the Cass Review highlights a significant methodological flaw in the study: The study did not adequately account for the underlying mental health conditions of the participants. This oversight could lead to a false correlation between the treatment and reduced suicide ideation. Other factors or concurrent treatments might be affecting the outcomes. The Cass Review notes that many studies, including this one, fail to control for these psychiatric comorbidities, which are known to influence suicide risk independently of gender dysphoria.
The Cass Review delves into the actual data concerning suicide risks among transgender youth, offering a more nuanced perspective. It points out that while there is a narrative suggesting an elevated suicide risk specifically due to gender dysphoria, the evidence does not support such a direct causation. Instead, the review finds that:
- “Suicide risk appears to be comparable to other young people with a similar range of mental health and psychosocial challenges.” (page 186). This suggests that the increased risk of suicide in transgender youth might be more aligned with the general profile of mental health issues rather than solely due to gender dysphoria.
- The review underscores that studies reporting reduced suicidality with gender-affirming treatments often had significant methodological limitations, such as small sample sizes, lack of long-term follow-up, and absence of controls for concurrent mental health treatments.
- Quality of Evidence: The review found that only 2% of the studies examined were of high quality, with the majority suffering from issues like selection bias, lack of control groups, and inadequate statistical analysis. This has led to an overemphasis on potentially misleading results.
- Longitudinal Data: There’s a stark absence of long-term follow-up data for those who have undergone gender-affirming treatments. This lack of data makes it impossible to assess the actual impact on mental health outcomes and suicide risk associated with gender-affirming medical treatments.
- Psychosocial Interventions: The review notes that while there’s a focus on medical interventions like puberty blockers, psychosocial interventions, which have a robust evidence base for treating mental health in general adolescent populations, are often overlooked or underutilized in this cohort.
Scientific Recommendations
Given the findings, the Cass Review offers several recommendations to address the care of transgender youth more holistically and scientifically:
- Evidence-Based Approach: There is a call for more robust, long-term studies that can accurately assess the benefits and risks of all types of interventions for gender dysphoria, including but not limited to medical treatments.
- Comprehensive Care: The review recommends a shift towards a model of care that includes broader mental health support, acknowledging that gender dysphoria often coexists with other mental health issues that require attention.
- Research and Monitoring: Establishing a research program to monitor outcomes of transgender care, ensuring that interventions are based on high-quality evidence rather than anecdotal or poorly supported claims.
- Professional Training: Enhancing the skills of professionals in this field to deal with the complexity of gender dysphoria within the context of adolescence and mental health.
Science Wins
Last year, the NHS in England did a complete about-face regarding gender-affirming care and the way children and adolescents are treated for gender dysphoria. The Cass Review discovered that established policies and guidelines were developed from pseudoscience that created fear bias based on child suicide ideation and ignored fundamental underlying factors associated with gender confusion.
By debunking flawed research and highlighting the lack of high-quality evidence, the Cass Review challenges the narrative that has driven much of the policy and public discourse on transgender youth care.
However, Washington State policymakers remain in a blindfolded bubble of ignorance regarding the science associated with gender dysphoria. While the Cass Review suggests a scientific, evidence-based approach, urging caution against rushing to medical interventions without considering the full spectrum of an individual’s mental health needs, Washington State political leaders have rushed to protect a mill of treatments and policies steeped in misinformation.
The scientific recommendations by the Cass Review not only promise better outcomes for transgender youth, but also align with ethical medical practices that prioritize long-term well-being over short-term relief or ideological pressures.
The UK has changed direction as a result of the scientific Cass Review. Washington State Democrat policymakers must adhere to their sloganeering to “trust the science.” A clear-eyed reassessment of the basic care for children and adolescents afflicted with gender dysphoria must be undertaken.
Yes. This all must occur in Washington State to …. “Save the Children.”
Outro Music Credit – Boomcrickets 2001 – Vancouver Washington