The Cass Report: Changes to Trans Care in England
Hello everyone. I hope you are enjoying the week. My husband and son went to visit my mother-in-law this week, which meant some quiet time to relax, catch up on work, and do one of my favorite activities: chocolate making.
This week I want to talk about the newly released Cass Report coming out of the UK. This 388 page report was commissioned by the National Health Services (NHS) to create guidelines for transgender care in the UK. To put it mildly, the report is incredibly problematic and will lead to awful care for trans individuals. Amnesty International has already condemned the report, and it has already been used as justification for conversion therapy for transgender children. Preliminary reports were also used to close the only gender clinic for transgender youth in the UK. This week, I would like to discuss two points which I find emphasize the anti-trans attitude of the Cass Report: disregarding the research & the approach to social transitioning.
Before we discuss the Cass Report, you can read my previous post on the World Professional Association of Transgender Health recommendations for transgender care here and my post on gender affirming care in youth here.
Disregarding the research:
Many of the recommendations from the Cass Report were based on 11 reviews of the literature which were taken up by researchers at the University of York. Many of these reviews rate the research which has been done on care for transgender people as “low quality” based on the Newcastle-Ottowa Scale (NOS). This scale has low intercoder reliability; in other words, the authors often disagree on their codings of articles. There is also limited proof that the NOS can identify bias in research. Since the Cass Report is used to determine treatment options for transgender children, the fact that some of the important studies within the Cass Report rely on the NOS is concerning and shows a complete disregard for the research and treatment options and supports available.
Some of the complaints of the research are unrealistic. For example, some of the complaints is that there is limited research which reaches what is often referred to as the “Gold Standard”, random controlled trials. This is a controversial perspective which does not take into account the purpose of the study. As Gertsman recently said:
Indeed, in research, what is important is having a research design that matches the research question you are asking in an ethical manner. When looking at transgender supports, double blind research random controlled trials are unrealistic for ethical and logistical reasons. On the other hand, there are many excellent studies looking at transgender services that use other methods, such as pre- and post-testing which provide important perspectives into transgender care.
The Approach to Social Transitioning
There is a lot of bad science in this report, such as the (unsupported) idea that boys prefer trucks because of… biology. But one part I want to focus on is the section on social transitioning. The section on social transitioning is based on a review of the literature which was published in conjunction with the report. They also interviewed transgender children and adults. The workgroup creating this report found that many people found solace in social transitioning:
The report goes on to say, on page 164, that:
This is categorically false. Indeed, there is a large amount of research which has shown the positive impacts of social transitioning in children. Many of these articles were either ignored or were deemed not high enough quality to be considered. What is upsetting is that Cass and colleagues wrote this even after meeting with transgender youth and their families and learning about the positive impacts of social transition. Due to this, recommendations around social transitioning use incomplete information and professionals will not support children and families who want to understand social transitioning.
Conclusion
Overall, this is a problematic and incomplete report which will, sadly, lead to transgender children and adolescents in the UK not getting the supports that they deserve. As the report recommends limiting transitioning for people under the age of 25, it will lead to awful care for many adult transgender individuals as well. Lastly, many anti-transgender politicians around the world will use this report as evidence to stop access to transgender care. I can spend a lot more time going over some of the other issues, like reporting high rates of detransitioning based on older studies while ignoring the data from the 2022 US Transgender Survey showing low rates of detransitioning, but I wanted to instead keep it simple by focusing on two specific issues. Over the next few months, I will keep you all updated as this report is used both in the UK and in other countries.