Hijacking the Cass report does us all a disservice – and doesn’t help trans kids

A major report into the way vulnerable children seeking gender care are being let down by the NHS highlights an ‘extraordinary toxicity’, writes Sean O’Grady – toxicity that is startlingly present in reaction to the report

In her long-awaited report into gender services for children in the NHS, Dr Hilary Cass found no good clinical evidence to support prescribing hormones to under-18s (PA Wire)

If you were an alien recently arrived on Earth, and had happened upon the multiple front pages this morning talking about the Cass review – the major new report looking at the way vulnerable children seeking gender care are being let down by the NHS – you would come to the conclusion that the discussion was binary: that it was a polarised, “pick one side or the other” debate.

Reading reactions to the findings of the fair, sensible and comprehensive review, you would likely assume you were being forced to pick a team, captained by those who shout loudest. On one side: those who are staunchly against trans rights; who use platforms like Twitter/X to profess their strident views. On the other, those who are pro trans rights, upset by the very suggestion that young people who are questioning their gender identity may benefit, in turn, from being questioned.

You would probably conclude, sadly, that there was little nuance to the discussion, depending on what you were reading (and, pertinently, who).

The findings of the review by distinguished paediatrician and former Royal College of Paediatrics and Child Health president Dr Hilary Cass may indeed warn that the “polarisation and stifling of debate” by adults has not only let children down, but hampered medical and scientific progress in the area, with healthcare professionals afraid to openly discuss their views. It may also outline what it calls the “extraordinary toxicity” of the rhetoric around trans rights – specifically, trans children. It may highlight the key point that vulnerable children seeking gender care are being badly let down by the NHS – and warn that teenagers are “falling off a cliff edge” in their care when they reach 17.

But the vital takeaways of the report itself risk becoming almost completely obscured by the very toxicity of which it speaks.

And so, you find yourself reading outbursts by columnists such as Allison Pearson in The Telegraph, who refers to the “trans brainwashing cult” and demonises those doctors who seek to help young people confused about their gender as “a cult that effectively brainwashes lonely, awkward or bewildered children, separating them from their loved ones and promising them they’ll be their ‘best self’ if only they cut off their breasts and grow a beard”. This helps no one.

You also see the extent of emotion expressed by trans commentators such as India Willoughby, who writes on Twitter/X: “Cass Review wanting no transition until 25. More Religious Right Anti-Abortion style rhetoric. They want trans people eradicated from society. Short of shooting us, the best they can do is ban transition and legitimise bullying. Make just being trans extremely intimidating.”

What we should be taking from this long-awaited and important review is a framework which is designed to help us all to do the best for trans children and others with gender dysphoria. Indeed, that is the duty that all of us have, because it is a societal issue. We will all at some point meet, know, work with or be related to people who find themselves in that situation – or something very similar.

The state and the law inevitably plays a central and necessary role. And the best way to create such an effective framework is not through tendentious, disrespectful and insulting arguments, articles and social media posts, but to place the task in the hands of someone who does know what they’re talking about. That is what the government, to its credit, has done by commissioning Cass to look at what’s been going on, review the situation, produce a report and make recommendations.

Hers is a balanced, sober, objective piece of work and rightly modest with it – in that it urges further research into the long-term effects of various treatments, and the option of not treating people. We should respect the experience and wisdom that shines through her words.

The central recommendation – that puberty-blocking drugs should not be used routinely, but rather in clinical trials – seems a sensible one. It will be controversial, because it does challenge what many consider to be a reasonable proposition: that delaying the onset of puberty buys teenagers and their families some time to assess life-changing courses of action.

Those of us who accepted the argument for puberty blockers need to listen with open ears to what Cass has to say: “The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.”

She is not rejecting puberty suppression, but calling for it to be researched further and backed by better evidence.

That essentially clinical approach is entirely appropriate and, as a matter of fact, entirely consistent with respecting trans rights and the sensitive handling of children in crisis. The fact that it challenges the settled view of some of us, in such a detailed, balanced and rational manner, compels us to endorse it.

Cass asks us to reflect on what has been happening. She argues that: “The toxicity of the debate is perpetuated by adults, and that itself is unfair to the children who are caught in the middle of it. The children are being used as a football and this is a group that we should be showing more compassion to.” Clinicians as a result are too frightened to treat children in need. She says that has to stop.

She is correct – and she’s done her bit to achieve that. But recent depressing experience suggests that trans rights will never be fully depoliticised and one where anything like a ceasefire will prevail, such is its salience in our never-ending, debilitating, divisive culture wars.

Politicians who should know better declare that “a man is a man, and a woman is a woman – it is just common sense”. Extremist activists on social media post that the modified trans rainbow “progress” banner is a “child-mutilation flag”. Writers and comedians allow themselves all too often to be used by quasi-political factions, or sink to ridiculing trans people in the most grotesque and inhumane – and unfunny – fashion. The implication is often that gender dysmorphia is simply there to be mocked, or isn’t real and just used by rapists to avoid men’s prisons, or is the creation of “a cult”, and the offence and hate is justified through the cause of “free speech”.

Well, perhaps it is – but it’s not free speech that’s very helpful in resolving the distress of individuals or the cohesion of society. As Cass implies, we should all exercise extreme caution in what we say about children, individually and collectively.

Trans rights, which affect a relatively small number of highly vulnerable people, have become a poisonous political issue, another arbitrary, science-free culture war, and kicked around like Brexit – and that’s transparently not a good thing.

Amplified on social media, sometimes by those in the outrage-for-profit game, or even foreign powers intent on creating societal discord, the interests of those involved, especially the children, are hijacked and abused by self-appointed guardians of their rights and welfare, as if they alone can occupy the moral high ground.

It is a dispiriting phenomenon, but history shows that the kind of work Dr Cass has done can slowly help guide society to a more consensual, fact-and data-driven approach. It was the case with Mary Warnock’s report on the tender issue of human embryo research in the 1980s, and with the landmark Wolfendon report into what are now called gay rights, published in the 1950s.

It will take time, but Cass has given us a path through the minefield – and, in reality, because we actually do have to have an agreed policy, it is a path we have no choice but to accept.