Medical Groups Are Censoring the Cass Review
They should be learning from it
The Cass Review’s 388-page Final Report, released last April, is the world’s most comprehensive document on youth gender medicine. Tasked by England’s National Health Service to investigate, renowned pediatrician Dr. Hilary Cass spent four years gathering evidence and interviewing stakeholders from all sides of the debate over how to treat gender dysphoric kids.
The conclusion she came to? “The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”
The NHS subsequently changed policy from affirmation to evaluation, and banned puberty blockers (despite warrantless objections from a small but vocal minority of British physicians). Several European countries came to similar conclusions after systematic evidence reviews, witnessing exponential growth in adolescent-onset gender dysphoria, and watching the number of detransitioners rise.
America, alas, did not follow suit. The Endocrine Society dismissed the Cass Review, saying it “does not contain any new research” to contradict its current pro-puberty blocker guidelines. The American Psychological Association kept mum. The activist-led advocacy group World Professional Association for Transgender Health (WPATH)? They called into question the Review’s ethics—despite themselves removing a chapter on ethics from their latest “standards of care.”
The one exception was the 11,000-member American Society for Plastic Surgeons. In August, the ASPS stated that “there is considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions for the treatment of adolescents with gender dysphoria, and the existing evidence base is viewed as low quality/low certainty.” Meaning: the outcomes might be quite different from whatever research unearthed.
Perhaps it’s not a surprise, then, that the president of the Plastic Surgery Foundation, ASPS’s research wing, invited Dr. Cass to present at ASPS’s annual meeting. She was to be part of a panel called “Translating Evidence into Best Practices: A Gender Medicine and Surgery Paradigm.”
What is surprising? She wasn’t allowed to speak.
Before the meeting at the end of September, a group of ASPS members, along with “Fellowship Directors, Leaders of Gender-Affirming Surgery Programs and many Past Presidents and Other Leaders in Plastic Surgery,” sent a letter to the ASPS leaders and the annual meeting’s committee, complaining about Cass’s presence—despite the fact that she would have been joined by a gender-affirming surgeon.
“The Cass Report, which does not evaluate surgical practices in transgender youth, has faced numerous critiques due to significant methodological flaws, including omission of key findings from the existing body of literature,” they wrote—a summary of activist talking points. It “has been widely used to justify such penalties and the criminalization of gender-affirming care, impacting minors and, in some cases, adult patients.”
Some of those doctors, including “Queer surgeon” Blair Peters, had planned to attend a meeting scheduled concomitantly in Lisbon, Portugal, of WPATH—the organization whose own “standards of care” the Cass Review found to “lack developmental rigour.” Peters and others demanded that the board “arrange for virtual attendance and Q+A participation for all ASPS members attending the WPATH meeting in Lisbon.” They added: “If these necessary changes are not met, then the session must be removed from the 2024 meeting.”
In fact, ASPS did meet those demands, arranging for virtual participation for the select few who would not be in attendance. And yet, the panel was removed. Every other gender-related session—transgender facial surgery, gender-affirming chest reconstruction, functional outcomes of vaginoplasty and phalloplasty—proceeded as planned. Just not the one about evidence and best practices? Kaput.
Plastic Surgery Foundation president Dr. Scot Glasberg—who had convened the panel—sent a missive that it had been “postponed.” He told me he hoped to revisit the subject later, but he won’t be president next year. None of the ASPS members grumbling about the cancelation would go on the record to rebuke Glasberg or ASPS for caving to activist demands; clearly their culture is just as censorious as the other medical and psychological associations when it comes to Cass.
Dr. Shlomit Gorin, a San Francisco-based clinical psychologist, posted information about the Review, as well as systematic reviews from other countries and content by and about detransitioners, on her professional listserv: the APA’s Division 39, the Society for Psychoanalysis and Psychoanalytic Psychology.
Respondents dismissed her offerings as written by TERFs, hate groups, and conversion therapists, as anti-trans and “murderous in fantasy.” Eventually, her posts on gender were blocked; the newly-installed listserv moderator said she violated APA guidelines and “ethical commitments” from the division’s 2020 “Letter of Apology to LGBTQ+ Communities,” which prohibits “speech that is injurious to LGBTQ+ members.”
“It's censorship, defamation, intimidation, bullying,” she said.
Clinical psychologist Ann Best was suspended from the Pennsylvania Psychology Association listserv for sharing similar content. Some listserv members said posts about detransition or systematic reviews were “othering and infuriating,” harming LGBTQ+ members and “inconsistent with PPA's mission valuing evidence-based and ethical practice”—even if the content was about evidence and ethics. The listserv later banned any discussion of the final Cass Review. Recently, they shut the entire listserv down.
APA’s director of Sexual Orientation and Gender Diversity Office, Clinton Anderson, told me the APA sees it as a human rights issue, not a scientific one. And yet, Cass herself wrote: “Although some think the clinical approach should be based on a social justice model, the NHS works in an evidence-based way.”
Privileging politics over science makes it harder for those who need treatment to be served in an evidence-based way. Gorin says therapists are the front line, the ones approving young people for interventions. They need to be properly informed. And the surgeons? They’re the ones manifesting irreversible interventions—how can they do that ethically when prevented from hearing evidence?
Meanwhile, the plastic surgeons insistent on barreling ahead with “gender-affirming” surgeries, despite Cass’s steady handed rebuke, have set up their own new organization, the Society of Gender Surgeons. Their members include those who signed the letter, successfully demanding the cancellation of the panel with Cass. Their slogan? “Bridging the Gap Between Best Evidence and Clinical Practice.”
Their slogan? “Bridging the Gap Between Best Evidence and Clinical Practice.”
More like "Burning the Bridge Between Best Evidence and Clinical Practice.”
Terrific article, and so important! Yet another that SHOULD have been an op-ed in The NY Times or WaPo. It boggles the mind how anyone can paint Hilary Cass as a demon. She is what my British spouse would call “dead ordinary” (her highest possible compliment for anyone); that is, someone who climbs Lake District peaks in pleated plaid skirts and “sensible shoes.” Not to mention she is the most caring, compassionate, and scientifically dispassionate person one can imagine (indeed, her refusal to go beyond where the evidence took her and her team is a frustration to many of us—but oh, the doors she has opened . . . except of course here in the US). My litmus test to determine who the fanatics really are (lookin’ at you, Blair Peters) is anyone who attempts to demonize Hilary Cass. I mean really, she had thought on her retirement she’d learn to play the saxophone. How dead ordinary can you get?