Hillary Cass expresses concerns about gender medicine

Hillary Cass has spoken about her concerns and the response to the Cass Review released last month.

The Independent Review of Gender Identity Services for Children and Young People is a 388-page report that took almost four years to compile. The findings confirmed what most of us suspected – that affirmation-only pathways are harmful to minors.

Cass shared some insights and observations in a recent interview:

It was the stories of the young people she met that made the most impact. One, who started on hormones at the age of 15 through a private provider, had suffered a series of traumatising events: their father had died, they had an eating disorder, an autism diagnosis and were self-harming. “I felt that so much wasn’t taken account of in that situation,” Cass said. Another was treated without their parents’ approval when social services became involved. Cass was troubled by several conversations with one person now in their early twenties. Initially, they were “very determined that they wanted to get on to testosterone as quickly as possible. And a year later, absolutely didn’t want to.” At first, they hadn’t been interested in having children; 12 months later, they wanted a family.

Researchers found that putting children immediately onto puberty blockers or some on cross-sex hormones fails to address the underlying issues many face such as Autism, trauma, depression or eating disorders.

They conceded that while for a few medicalised pathways may be appropriate, it is not best practice as the consequences result in consequences that mean irreversible harm if a child later changes their mind. The lack of data and research in the area of gender medicine was very alarming.

For Cass, it was “fairly clear from the word go” that the evidence underpinning treatments was poor, as was the standard of research. But it was more than that: “I have still been surprised at the lack of curiosity among some professionals in this area to understand the change in the population, and the lack of adherence to normal clinical practice. I wasn’t expecting that.” 

“Preliminary results from the early intervention study in 2015-2016 did not demonstrate benefit… Despite this, from 2014 puberty blockers moved from a research-only protocol to being available in routine clinical practice and were given to a broader group of patients who would not have met the inclusion criteria of the original protocol.”

Had Cass ever seen anything like it in her career in medicine? “I can’t think of an example… And that’s why I think the single most generalisable message from the report is recommendation 32”, which stresses the importance of rules to prevent the creep into clinical practice of treatments that have no proven benefit, while also not stifling medical innovation. “If puberty blockers had been a new drug, they’d have gone through very strict controls before being prescribed. The weakness in this instance was that they were already licensed in children but for completely different use [the treatment of precocious or early puberty], for which they are totally safe… It should have been subject to greater scrutiny.”

The gender industry evolved so rapidly that medical practitioners were prescribing puberty blockers off label and without the proper authority to do so. This has resulted in too many young people being placed on a medicalised pathway without understanding the full implications.

Cass said she was worried about “young people commit[ting] to a medical pathway that does have potential costs: in terms of ability to have children, in terms of sexual function, in terms of osteoporosis, in terms of lifelong medication… when it ends up being the wrong thing, because then the cost-benefit ratio is the wrong way around. So, it’s not about being trans, it’s about the costs of medical intervention, and whether that’s the right thing for that individual.” 

It’s very easy to give people drugs and send them away and find that they’re still not able to get out of their bedroom… because you’ve not looked at the big picture.” 

“In precocious puberty… what the puberty blockers are doing is returning [abnormally high hormone levels] to normal.” But when puberty blockers are used to treat gender-related distress, doctors suppress the normal rise in sex hormones that takes place in adolescence. “It’s completely opposite.” What’s more, when used to treat gender-related distress, blockers are primarily given at a time when the brain is “developing quite complex decision-making abilities and your bones are also growing at pace. So, suppressing at that time is completely different from suppressing in younger children.”

Australian politicians and gender clinics have either ignored or downplayed the report. Despite the mounting evidence and the fact that the UK, Nordic Countries and several US states are halting the use of such drugs on minors, Australian clinics are steamrolling ahead without collecting data or conducting rigorous studies.

Our children deserve better. There needs to be an urgent inquiry into these practices now, before any more children are irreversibly and catastrophically harmed.

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