A groundbreaking review out of the UK finds “poor” or “low quality” evidence for using puberty blockers and hormones to help gender-distressed young people. Dr. Hilary Cass, who led that review, gives her first U.S. broadcast interview to On Point.
Dr. Hilary Cass speaking about the publication of the Independent Review of Gender Identity Services for Children and Young People .
HILARY CASS: The quality was disappointingly poor. One of the significant reasons is that they just didn't follow up for long enough, particularly for young people who were taking masculinizing and feminizing hormones. Another problem is that many of the studies didn't take account of the fact that this is a really, what we call heterogeneous, so a mixed population of young people who were very different from each other.
CHAKRABARTI: Okay. So more specifically then, in the systematic review of studies relating to the use of puberty blockers. We should say that puberty blockers do have quite a well-established evidence base for use in some situations, right?CASS: Absolutely right, but it's really important to say that it's a very different thing to take a young person whose hormones are going through the normal increases that you expect to see in puberty. And pausing that.
CHAKRABARTI: To be clear, the report states, quote, that the University of York concluded, and that's the group that did the review.CHAKRABARTI: That there is insufficient or inconsistent evidence about the effects of puberty suppression on psychological or psychosocial health. CHAKRABARTI: This is a really important point that's been brought up by the Cass Review. About did the focus on trying to provide medical forms of therapy perhaps overshadow other forms of care., and they stated that, quote,"Research demonstrates that gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents," end quote.
There's also the question of, there have been competing claims about whether puberty blockers have negative impact on a young person's bone health.CHAKRABARTI: So, Dr. Cass, one thing that the review notes very clearly at the top is the rapid rise, and actually the exponential rise, in the number of young people, adolescents, in particular, seeking treatment for gender dysphoria.
And then often, by the next visit, the distress, the anxiety just ramps down. And the next time they see her, it's not that the dysphoria has gone away, but it's just slipped into the background. And then they can talk about whatever the other things are that are bothering them, which might be sexuality.
And that's where you find that the rates are fairly comparable. So we can't say that it is the gender questioning or the gender incongruence that's giving you additional suicide risk. And so the second part is, does the gender-affirming treatment pathway reduce that suicidality? But such data as we have shows that we can't detect a difference in the suicide rates before and after treatment.
And what we need to try and do is pick out young people who we think are at risk and say, what are all the things we need to get in place to support this young person's risk? It may be helping with their eating disorder. It may be that they are in difficult family circumstances. There's a whole raft of things that we may need to think about.
Therefore, a systematic review regarding outcomes of treatment in adolescence is not possible. Yet, is that not what the Cass Review did? A systematic review? CASS: Yes, so you have read this extremely carefully, probably better than most of the UK commentators. I think the problem is that there has been an echo chamber of guidelines. So one of the things that the York team did was they looked at where guidelines had followed each other, and they found that most of the guidelines, there was a circularity between the Endocrine Society, WPATH, and a series of other guidelines.
So this group of young people, if they are depressed, if they're anxious, if they need an autism diagnosis, all of those things should be put in place. We don't know which young people may benefit from medical care. And we have proposed that every young person who walks through the door should be included in some kind of proper research protocol so that we can follow them up and we can get those answers over time.
And they could see somebody who would really see them as a whole person, then I think they would get a much better deal. CHAKRABARTI: Dr. Hilary Cass, she led the team that recently published the independent review of gender identity services for children and young people. It's a massive report that was published at the behest of the National Health Services in England. Dr. Cass, thank you so much for joining us.CHAKRABARTI: We spoke with Dr. Cass late last week, and there's significantly more of that interview which you can hear in its.
EDWARDS-LEEPER: I think that the mental health concerns back when I started doing this work were really a result of being in the wrong body, the social stigma that surrounded trans people at that time. And once medical interventions were started, the mental health issues really did improve for the large majority of patients I worked with.
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