'Extreme caution': Cass Review raises red flags on gender-affirming care for trans kids

One of the most contentious battles of our time is over what access transgender young people and their families should have to medical intervention.

A week ago, the U.S. Supreme Court jumped into the fray by allowing Idaho to start enforcing its ban on what has become known by LGBTQ+ proponents as “gender-affirming care” for minors.

The country is nearly split between Republican-led states that have acted to restrict puberty-blocking drugs, hormone treatments and surgeries – and Democratic-led ones that want few if any limits. 

The name-calling on both sides of the issue hasn’t helped. Conservatives wary of intrusive treatments are framed as not caring about transgender kids and making them feel unsafe; liberals are accused of mutilating and indoctrinating children. 

Maybe the right course of action lies somewhere in between these extremes. With more children experiencing gender dysphoria than ever before, some humility is demanded. 

There’s much that we simply don’t know about the long-term implications of giving minors these drugs and surgeries that can permanently change the trajectory of their lives.

That’s one of the findings of the widely anticipated Cass Review, released this month.   

The nearly 400-page report represents a years-long review by Dr. Hilary Cass, a pediatrician, of existing research as well as interviews with young people, families and clinicians. 

The review was commissioned by England’s National Health Service, which has already acted on some of Cass’ interim recommendations. The NHS has said that puberty-blocking drugs will be available only for minors who are in a clinical trial. This follows a trend of other northern European countries hitting pause on such treatments.  

Cass’ report is written in a clear and compassionate manner, and her findings deserve careful consideration in the United States, too.

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Evidence behind youth gender care 'remarkably weak'

Cass’ conclusions point to a need to slow down on drug treatments, and that the evidence supporting related gender care is “remarkably weak.” 

While Cass found that children deserve better, more comprehensive care related to their gender dysphoria, the report cautions strongly against the use of puberty blockers and hormones. 

Some of the key findings from the report: 

• "There is no simple explanation for the increase in the numbers of predominantly young people and young adults who have a trans or gender diverse identity, but there is broad agreement that it is a result of a complex interplay between biological, psychological and social factors."
• "The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate."
• "The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown."
• "The use of ... hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population." 
• "Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity."
• "For most young people, a medical pathway will not be the best way to manage their gender-related distress." 

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These last two findings track with a growing number of young people who are telling their stories of “detransitioning” and who regret that they weren’t offered more comprehensive help before hormones or surgery. 

Some professionals in the medical field are speaking out, too.

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Grace Powell, for instance, had believed she was transgender as a teen and had a double mastectomy and took cross-sex hormones before college. Powell, now in her early 20s, has detransitioned.

She told New York Times’ columnist Pamela Paul: “I wish there had been more open conversations. But I was told there is one cure and one thing to do if this is your problem, and this will help you.”

Others have similar stories. 

When dealing with children, the traditional medical pledge to “do no harm” carries extra weight. Young people and their families deserve the best and most reliable information before making any big decisions.

Cass’ report raises many red flags about how little is known about the long-term consequences of gender-affirming medical treatment in children. She urges “extreme caution” multiple times throughout her review. 

Transgender activists act as if the science on this complicated issue is settled. As Cass shows us, that’s far from the truth. 

Ingrid Jacques is a columnist at USA TODAY. Contact her at [email protected] or on X, formerly Twitter: @Ingrid_Jacques.