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The newly released Cass Review on transgender care for young people has been pivotal in the UK, where the prescription of puberty \u201cblocking\u201d drugs outside of research protocols has now ceased.<\/p>\n
But in the United States, where the treatment-intensive, \u201cgender affirming\u201d model of care is the norm, the impact of Cass\u2019s four-year investigation and final report has been largely ignored, finds journalist Jennifer Block in\u00a0The BMJ<\/strong><\/em>\u00a0today.<\/p>\n The review concluded that the evidence on use of puberty blockers and hormones for children and teens experiencing gender related distress is wholly inadequate and called for a more holistic approach to care.<\/p>\n It also found that links between the evidence and medical guidance are often unclear, and largely informed by the World Professional Association for Transgender Health and Endocrine Society guidelines, which themselves lack scientific rigour.<\/p>\n \u201cThis approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor,\u201d wrote Cass.<\/p>\n Yet the American Academy of Pediatrics (AAP) and Endocrine Society have stood by their guidelines, while the American Psychological Association, American Psychiatric Association, and American College of Obstetricians and Gynecologists have remained largely silent about Cass.<\/p>\n \u201cUnfortunately, Cass does not seem to be penetrating the public consciousness,\u201d says Zhenya Abbruzzese, cofounder of the Society for Evidence-Based Gender Medicine (SEGM), a group of researchers and clinicians that has pushed for systematic reviews and an evidence-based approach.<\/p>\n Oregon paediatrician and SEGM member, Julia Mason, adds: \u201cParents and their children are being misled in clinics all over the country. There is no evidence that giving puberty blockers followed by hormones and surgery is lifesaving care and there is mounting evidence that the harms outweigh the advantages.\u201d<\/p>\n Not everyone has joined the consensus, notes Block. Scot Glasberg, past president of the American Society of Plastic Surgeons, now president of the Plastic Surgery Foundation, told The BMJ that the organisation will issue \u201ctrustworthy, high quality\u201d guidelines, but \u201clike Dr Cass, we\u2019ve found that the literature is of low quality and low value to dictate surgical care .. We are trying to be very measured and not get into the difficulty that some of the other organisations have gotten into.\u201d<\/p>\n Similarly,\u00a0The Wall Street Journal<\/em>\u00a0editors said the review \u201cshows wisdom and humility on treatment of young people, in contrast to the ideological conformity in U.S. medical associations,\u201d while\u00a0The Washington Post\u00a0<\/em>and\u00a0Boston Globe<\/em>\u00a0ran opinions that amplified Cass to argue for a more precautionary path forward. But many outlets, including\u00a0STAT News,<\/em>\u00a0CNN<\/em>, and\u00a0Scientific American<\/em>, which have run many articles favourable to the affirmative model, have so far ignored Cass.<\/p>\n So far, outspoken thought leaders have not reconciled their statements with the growing list of systematic reviews that stand in contradiction, adds Block.\u00a0<\/p>\n Yale paediatrician Meredithe McNamara has called puberty blockers \u201cone of the most compassionate things that a parent can consent to for a transgender child,\u201d and in testimony to the US Congress, warned that when gender-affirming care \u201cis interrupted or restricted, suicide, depression, anxiety, disordered eating, and poor quality of life follow.\u201d<\/p>\n Alejandra Caraballo, a Harvard Law School instructor with more than 160,000 X followers, also tweeted in advance of the report\u2019s release last month that it had \u201cdisregarded nearly all studies,\u201d a claim that Cass called \u201cmisinformation.\u201d<\/p>\n But Erica Anderson, a clinical psychologist and former president of USPATH, says the Cass report is going to \u201cstand the test of time.\u201d \u201cI\u2019m already hearing from the boards of directors and trustees of some hospital systems who are starting to get nervous about what they\u2019ve permitted. So I think that\u2019s going to accelerate change within American healthcare.\u201d<\/p>\n In the face of criticism, Cass has been unwavering: \u201cIt wouldn\u2019t be too much of a problem if people were saying ‘This is clinical consensus and we\u2019re not sure.’ But what some organizations are doing is doubling down on saying the evidence is good,\u201d she told the\u00a0New York Times<\/em>. \u201cAnd I think that\u2019s where you\u2019re misleading the public.\u201d<\/p>\n [Ends]\u00a0<\/p>\n The BMJ<\/p>\n<\/p><\/div>\n 10.1136\/bmj.q1141 <\/i><\/a><\/p>\n<\/p><\/div>\n Investigation: Gender medicine in the US: how the Cass Review failed to land<\/p>\n<\/p><\/div>\n 23-May-2024<\/p>\n<\/p><\/div>\n Competing interests: The author declares having contributed a commentary to Scientific American in 2019 that was removed for unspecified reasons following a social media campaign. Helmuth, who became editor-in-chief in 2020, was not involved.<\/p>\n<\/p><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":" The newly released Cass Review on transgender care for young people has been pivotal in the UK, where the prescription of puberty \u201cblocking\u201d drugs outside of research protocols has now ceased. The newly released Cass Review on transgender care for young people has been pivotal in the UK, where the prescription of puberty \u201cblocking\u201d drugs […]<\/p>\n","protected":false},"author":1,"featured_media":8884,"comment_status":"","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"jnews-multi-image_gallery":[],"jnews_single_post":[],"jnews_primary_category":[],"jnews_social_meta":[],"jnews_override_counter":[],"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[2],"tags":[],"class_list":["post-8883","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/scienmag.com\/wp-content\/uploads\/2024\/05\/Cass-review-on-gender-medicine-largely-ignored-in-the-US.png","jetpack_likes_enabled":false,"_links":{"self":[{"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/posts\/8883","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/comments?post=8883"}],"version-history":[{"count":0,"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/posts\/8883\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/media\/8884"}],"wp:attachment":[{"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/media?parent=8883"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/categories?post=8883"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/scienmag.com\/wp-json\/wp\/v2\/tags?post=8883"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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