Two months ago, the Cass Review was released in the United Kingdom. This review, guided and advised by individuals with ties to SPLC-designated hate groups and who met with Governor Ron DeSantis’ medical board—handpicked to ban care in Florida—has led to severe restrictions in the U.K., including criminalizing the possession of puberty blockers. The response outside the U.K. has been much more critical, with numerous medical organizations and doctors worldwide rejecting its recommendations. The latest major medical body to speak out is the Royal Australian and New Zealand College of Psychiatrists (RANZCP), the leading organization for training psychiatrists in both countries.
The Cass Review, a highly criticized evaluation of transgender care, was developed in the United Kingdom by Dr. Hillary Cass, a pediatrician without direct experience in transgender care. Although it was presented as an unbiased and neutral review, intentionally excluding transgender individuals from the decision-making process, it was later revealed that advisors with ties to the Society for Evidence-Based Gender Medicine, an SPLC-designated hate group, were involved. Dr. Cass has since controversially blamed being trans on pornography and labeled the American Academy of Pediatrics as a “left-leaning organization” due to its support for the medical care of transgender youth.
Last month, a handful of members of the RANZCP, some of which are notable figures in anti-trans activism in the country, wrote a letter to the organization stating that they had “serious concerns” about gender affirming care for transgender youth. They pointed to the Cass Review as justification for their concerns. The top signature on the letter is that of Jillian Spencer, who stated in an interview that she was fired for “being a danger to trans and gender-diverse children.” Now, the college has responded.
In a response posted to the RANZCP website, the college announced that the Cass Review is one of “a number of reviews,” and that it rejects the call for a “government inquiry” into trans care in the countries it represents. It further states that transgender care should be “patient centered” and individualized to a patient’s needs. Lastly, it expresses a full support for transgender youth and rejects claims that being transgender is a “mental health condition”:
“The College is committed to respectful, sensitive and appropriate mental health care being provided to individuals who identify as LGBTIQ+. Being Trans or Gender Diverse is not a mental health condition, and the RANZCP unequivocally supports the rights of trans and gender diverse people to have equal access to safe and effective mental health care that is underpinned by dignity, empathy and respect.
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The College emphasises that assessment and treatment should be patient centred, evidence-informed and responsive to and supportive of the child or young person’s needs and that psychiatrists have a responsibility to counter stigma and discrimination directed towards trans and gender diverse people.”
The statement from the Royal Australian and New Zealand College of Psychiatrists is the latest in a series of rejections of the Cass Review’s findings by medical organizations worldwide. Last month, the American Academy of Pediatrics responded to the review, disagreeing with many of its claims and asserting that the organization supports “individualized health care for each patient, in consultation with their family and health care team” when it comes to transgender youth. The Endocrine Society also dismissed the recommendations, stating, “Medical evidence, not politics, should inform treatment decisions.”
In Canada, the Canadian Pediatric Society rejected the Cass Review’s recommendations, announcing that “current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within a wider view of the patient’s mental and psychosocial health.” Children’s Healthcare Canada, which oversees the country’s children’s hospitals, concurred, stating, “Our position remains unchanged on the topic.”
Evidence continues to support the use of gender affirming care for transgender youth. A Cornell review of more than 51 studies found “gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.” Numerous studies show lower suicidality, with as much as a 73% reduction in suicidality for trans youth who are allowed care. In a recent article that was not considered by the Cass Review in the Journal of Adolescent Health, puberty blockers reduced depression and anxiety significantly. In Germany, a recent review by over 27 medical organizations has judged that “not providing treatment can do harm” to transgender youth. Due to strong evidence around transgender care, the American Psychological Association released a historic policy resolution condemning bans on gender affirming care. Notably, they are the largest psychological association in the world, with representatives elected to represent 157,000 members.
The lack of credibility given to the Cass Review outside the United Kingdom, especially in the United States, has frustrated its proponents. In a recent article published in The BMJ titled “Gender medicine in the US: how the Cass review failed to land,” anti-trans writer Jennifer Block laments that Erin Reed, the author of this article, highlighted the review’s anti-trans political ties with DeSantis’ picks, which hampered its acceptance. Although Block incorrectly claims that only a single meeting took place (Cass advisor Dr. Kaltiala attended several meetings and even advocated for the ban as a primary witness), she accurately demonstrates that the document’s political roots have been detrimental to its acceptance among credible scientific organizations. These political roots were recently confirmed when Conservative Women and Equalities Minister, Kemi Badenoch, admitted that “gender critical” individuals were placed in health roles to facilitate the Cass Review—a mechanism remarkably similar to how Florida’s review led to the banning of care in the state, borrowing from DeSantis’ strategy.
Despite its lack of acceptance abroad, the Cass Review continues to do tremendous damage in places predisposed to targeting transgender healthcare. It has already been cited in the United States to ban care in South Carolina, a Republican-controlled state. In the United Kingdom, it has led to the criminalization of possessing puberty blockers. As more medical organizations reject its findings, politicians will undoubtedly use its conclusions to push forward with bans on gender-affirming care for transgender youth, despite having little evidence to justify such decisions.
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