The Cass Report: The Good, The Bad, The Critical

 

Dr Max Davie and Dr Lorna Hobbs (photos above) have written a thorough and critical review of the British Cass report on transgender health care for youth. We are taking the liberty of republishing it here.

The original can be found here.

Dr Max Davie - Consultant Paediatrician and former Education Lead for the new child and adolescent gender services at Great Ormond Street Hospital (GOSH).

Dr Lorna Hobbs - Clinical Psychologist and former clinician at the Gender Identity Development Service (GIDS) / former Education Lead for the new child and adolescent gender services at Great Ormond Street Hospital (GOSH).

Note from Max Davie: I have co-authored this post with my colleague Dr Lorna Hobbs. We have been dismayed at the uncritical way in which the deeply flawed Cass report has been accepted both professionally and in the wider political conversation. We wanted an alternative view, from experienced clinicians, to be out there in the public conversation. We have chosen to publish this on a blog, rather than in a journal or other publication, so that we can publish in a timely way and maximise access for people who might find our writing helpful.

The Cass review - the most comprehensive review of gender-related care for children and adolescents to date^[1] - was published four months ago now, and its impact on the world of youth gender healthcare is becoming clearer,  with the review findings already being used to justify a legal ban on any new puberty-pausing prescriptions for gender diverse young people, under 18, in England, Scotland and Wales (outside of a research protocol); and further afield, in the US, it is being used in at least ten states to support legal bans on gender-affirming care for young people (McNamara et al., 2024^[2]). At the same time, a new UK government is taking office, with an opportunity to take their own perspective on the document.

What does transgender mean?

Transgender is an umbrella term that encompasses a wide variety of  gender variant people, i.e. people who in some way or the other do not follow the traditional and stereotypical norms of what it means to a man or a woman, given the gender they were assigned at birth. Indeed, some transgender people do not feel at home in terms like "male" or "female" at all.

We can identify several categories of transgender people.

1. Transgender as a mismatch between assigned and experienced gender.

Transgender may refer to individuals whose gender identity differs from the gender they were assigned at birth.

This means that a person's internal sense of being male, female, or another gender does not align with  the gender assigned to them when they were born. 

For example, a transgender woman is someone who was assigned male at birth but identifies as female. Conversely, a transgender man was assigned female at birth but identifies as male. 

2. Transgender as being outside the gender binary of male and female.

Some transgender people may not identify exclusively as male or female, instead falling under nonbinary or genderqueer identities.

A spotlight on transgender and queer issues from the Crossdream Life forum

Crossdream Life is a forum for discussion of gender variance where members can explore their own identities, discuss transgender and queer issues and in general take a look at whatever it is that interests them.

This sometimes leads to very interesting discussions that will also be of interest to others. Here are some topics from the last 12 months or so.

Should you be offended if someone calls you trans?
Brigitte Macron sues people who call her trans. Is that transphobia?

Sampling and Blanchardianism
Ray Blanchard and the followers of his "autogynephilia" theory do some wild statistical acrobatics in order to find the facts fit a misleading theory. See also: Bailey on autogynephilia and AGP as a zombie theory.

Strong American support for the LGBTQ-community, but trans people do not get as much love as the rest
A debate on the mixed signals from American surveys of attitudes towards trans people.

The Cass Review heralds how all trans medicine will die
The British Cass review on transgender health care is a mess. See also the thread Cass Says Transition Should Be Measured By “Employment," Not Satisfaction

On Anne Vitale's theory on testosterone-poisoning in MTF crossdreamers

Sidebar to the Crossdreamers.com blog post "Does the effects of hormones on transgender prove that crossdreaming has a biological component?"

Anne Vitale presents a theory aimed at explaining dysphoria
in MTF crossdressers and crossdreamers.
Illustration: Jupiterimages

One of the leading experts on crossdreamers  is Dr. Anne Vitale. She is herself a transsexual woman, and has helped a large number of transgender patients, from those who identify fully with their target sex and want to transition (transsexuals), to non-transsexual crossdressers.

She has written one of the best books on transgender conditions that also covers crossdressers and crossdreamers.

I must admit she sometimes appear a bit too essentialist for my taste. She writes, for instance, that the defeminization of the brain in perinatal males experience leaves them "incapable of female behavior and sensibility," (Perinatal refers to the period around childbirth).

I find no support for the idea of a unique "female behavior and sensibility", as no temperaments, interests, abilities  or behaviors are exclusive to one gender. The sense of feeling like a man or a woman cannot be reduced to a function of the way you behave. (More about this here!)

Still, her idea about crossdreamers and male to female transsexuals being poisoned by testosterone is interesting.

Anne Vitale (from her home page)

In her book The Gendered Self, Vitale suggests that the variation we seen between transsexual and non-transsexual male to female transgender is caused by variation in the prenatal androgenization/defeminization processes, leading to different degrees of feminization of the brain, including female like hormone receptors.

In a separate note on hormones she writes:

"It is beyond dispute that there are both androgen and estrogen receptors in the brain. Genetic males normally have more active androgen receptors than women and women have more active estrogen receptors than men. That this normal distribution of estrogen and androgen receptor cells can be different in some individuals appears to be a possibility. It therefore follows that androgenic and estrogenic compounds will result in a modified-to-counter expected behavior in affected individuals. For reasons beyond the scope of this Note and as counterintuitive as it may seem, it can only be assumed that testosterone plays a crucial role in forcing certain male individuals to crossdress and experience femininity to the maximum degree possibly."