Suppose a 5-year-old boy says he's a girl, or a 14-year-old girl says she's a boy? What should happen next? Transgender activists insist that we must "affirm" those kids' new gender identity and promptly transition them, and that anyone who disagrees or pushes back is a bigot and transphobe. Opponents (including me) say that a child or teenager who isn't old enough to get a tattoo without parental consent shouldn't be allowed to transition to the other sex without parental consent. Transgender activists cite studies and stories that support their side; opponents (including me) cite studies and stories that support our side. We are deadlocked.
Or perhaps I should say we were deadlocked. Four years ago, the National Health Service in England appointed Dr. Hilary Cass, former President of the Royal College of Paediatrics, to review all the research on transgender kids and to issue a report and recommendations. Dr. Cass has just published her report, and it's huge, in every way (388 pages!). Dr. Cass commissioned six comprehensive reviews of every study from every country worldwide, looking at every kind of intervention with regard to kids and gender identity. Dr. Cass and her team interviewed kids who transitioned and who believe that transitioning saved their lives; they also interviewed kids who transitioned and who regret the transition, who believe that transition ruined their lives.
Dr. Cass has found that the evidence does not support medical intervention for children under 18. She notes that the current practice of giving puberty blockers and cross-sex hormones to children under 18 is based largely on a deeply flawed Dutch study from the 1990s. She concludes: "For most young people, a medical pathway will not be the best way to manage their gender-related distress." No more hormones. No more puberty blockers.
The report is so comprehensive, and so respectful of individuals with gender dysphoria, that there has been very little pushback even from transgender activists within the UK. The National Health Service has already announced that it will promptly implement Dr. Cass's recommendations. No more puberty blockers, no more hormones for children under 18 unless the child is enrolled in an approved academic study with appropriate safeguards. England thus joins four other European countries which now enforce similar limits.
Before the Cass report, the transgender debate was stuck. As I mentioned above: advocates would cite their studies, opponents would cite their studies, and nobody agreed on anything. In 2018, the American Academy of Pediatrics (AAP) released their guidelines for kids with gender dysphoria, strongly supporting the medical model of "affirmation." If a 10-year-old boy says he's a girl, you should immediately change his name to Emily and change the birth certificate to female. Start puberty blockers to ensure that he doesn't begin the process of turning into a man. Any other action is transphobia and bigotry. At the time, I criticized the AAP guidelines as being based in ideology rather than evidence. The AAP has recently announced that they have commissioned a review of their 2018 guidelines. I think it will be hard for them to come up with anything better than the Cass report; but on the other hand, it's not easy to admit you're wrong, especially when admitting you're wrong could open you up to civil liability.
David Brooks has a thoughtful column in the New York Times yesterday in which he observes that in recent years, politics and ideology have come to overrule research on a wide range of topics: not just regarding transgender kids, but on diversity, equity, and inclusion; the use of SAT scores in college admissions; and others. He quotes an earlier writer who thought that if we lose the habit of testing our beliefs, then we must "sink back into savagery." He hopes that the Cass report will be a turning point on a wider range of issues. I share his hope.
I have linked below to the Cass report web site, from which you can download the full report (all 388 pages) at no charge as well as the six separate scholarly reviews of all the research.
