Re: Medical institutions must treat the Cass review as a significant event and act upon it
Dear Editor
GLADD remains concerned about the publication of pieces such as this in the BMJ which present one-sided and harmful narratives about trans people in the UK.
The author is correct that the final report of the Cass Review is a significant event. Its systematic reviews, narrative text, and recommendations will have significant implications for gender questioning and gender diverse youth for decades to come, regardless of one’s opinions of the review itself. Of course, it is true that medical institutions will need to learn from aspects of the review. There are recommendations that GLADD can support, which we will detail in due course after considered, cautious and careful work.
It remains essential that all published research must be critically appraised and carefully scrutinised; the Cass Review is no exception to this. Published just two months ago, critical analysis is ongoing. Some have already begun to dissect its methodology (a matter beyond GLADD’s scope and expertise), finding concerning flaws in its methodology and conclusions [1]. This should also not be taken as fact until due consideration and criticism of these critical appraisals is complete, but demonstrates that the review, like all other research, should be scrutinised carefully.
We note the author’s selective citing of aspects of the review, and wish to highlight the appalling experiences of gender questioning and gender diverse young people trying to navigate the care provided by the NHS [2]. Gender questioning and gender diverse young people in the UK are increasingly vulnerable in society (with transphobia-motivated hate crimes rising by 186% in the past five years in England and Wales) [3[, and require support from the services that care for them. We note with disappointment that the author has not elected to include this key matter in her piece. So-called ‘Gender Critical’ ideologies often place a blinkered focus on the evidence base without considering either the wealth of clinical experience available nor the voices of the trans people affected. Trans people’s voices and autonomy must be respected if we wish to understand how we can provide our best care for them.
We also highlight with alarm and concern the author’s comparison of gender-affirming care to gay conversion therapy in the 1950s. This is incorrect and deeply offensive to the LGBTQ+ community. The first aims to help an individual feel more comfortable in their gender identity, while the second forcefully and harmfully imposes a sexual orientation or gender identity onto a person. The author has wrongfully pathologised trans identities as an illness or undesirable, a disappointing misrepresentation of who people are. We advise all to consider the implications of such a comparison incredibly carefully. If people become forced to live under gender identities with which they do not identify, and healthcare to support autonomous decisions is banned, then that will most certainly be reminiscent of the conversion practices of the 1950s. That is a fair comparison which we advise all to reflect on sincerely - removing care to forcefully detransition a person (as has happened with temporary restrictions on GnRH analogues) is conversion therapy.
Dr Cass is right when she says that the toxicity of the debate is exceptional. Indeed, the weaponisation of the Cass Review against trans people has been startling, although not unexpected. Political parties and campaigners have used the review as a political football to perpetuate the culture war. The resulting effect is that trans people’s lives, rights and their very identities have become politicised like no others in society. It is our duty as medical professionals (and students) to fight against discrimination and bigotry whenever we see it, including from within our ranks.
Competing interests:
GLADD is a signatory organisation of the Memorandum of Understanding on Conversion Therapy in the UK (https://www.bacp.co.uk/media/14985/memorandum-of-understanding-on-conversion-therapy-in-the-uk-march-2022.pdf) and hosts the GLADD Medical Schools Charter on so-called LGBTQ+ 'Conversion Therapy' (https://gladd.co.uk/activism-conversion-therapy-charter/).
10 July 2024
Raphael Kohn
Co-Chair, GLADD - The Association of LGBTQ+ Doctors and Dentists
Kit Tigwell (Co-Chair, GLADD - The Association of LGBTQ+ Doctors and Dentists)
Rapid Response:
Re: Medical institutions must treat the Cass review as a significant event and act upon it
Dear Editor
GLADD remains concerned about the publication of pieces such as this in the BMJ which present one-sided and harmful narratives about trans people in the UK.
The author is correct that the final report of the Cass Review is a significant event. Its systematic reviews, narrative text, and recommendations will have significant implications for gender questioning and gender diverse youth for decades to come, regardless of one’s opinions of the review itself. Of course, it is true that medical institutions will need to learn from aspects of the review. There are recommendations that GLADD can support, which we will detail in due course after considered, cautious and careful work.
It remains essential that all published research must be critically appraised and carefully scrutinised; the Cass Review is no exception to this. Published just two months ago, critical analysis is ongoing. Some have already begun to dissect its methodology (a matter beyond GLADD’s scope and expertise), finding concerning flaws in its methodology and conclusions [1]. This should also not be taken as fact until due consideration and criticism of these critical appraisals is complete, but demonstrates that the review, like all other research, should be scrutinised carefully.
We note the author’s selective citing of aspects of the review, and wish to highlight the appalling experiences of gender questioning and gender diverse young people trying to navigate the care provided by the NHS [2]. Gender questioning and gender diverse young people in the UK are increasingly vulnerable in society (with transphobia-motivated hate crimes rising by 186% in the past five years in England and Wales) [3[, and require support from the services that care for them. We note with disappointment that the author has not elected to include this key matter in her piece. So-called ‘Gender Critical’ ideologies often place a blinkered focus on the evidence base without considering either the wealth of clinical experience available nor the voices of the trans people affected. Trans people’s voices and autonomy must be respected if we wish to understand how we can provide our best care for them.
We also highlight with alarm and concern the author’s comparison of gender-affirming care to gay conversion therapy in the 1950s. This is incorrect and deeply offensive to the LGBTQ+ community. The first aims to help an individual feel more comfortable in their gender identity, while the second forcefully and harmfully imposes a sexual orientation or gender identity onto a person. The author has wrongfully pathologised trans identities as an illness or undesirable, a disappointing misrepresentation of who people are. We advise all to consider the implications of such a comparison incredibly carefully. If people become forced to live under gender identities with which they do not identify, and healthcare to support autonomous decisions is banned, then that will most certainly be reminiscent of the conversion practices of the 1950s. That is a fair comparison which we advise all to reflect on sincerely - removing care to forcefully detransition a person (as has happened with temporary restrictions on GnRH analogues) is conversion therapy.
Dr Cass is right when she says that the toxicity of the debate is exceptional. Indeed, the weaponisation of the Cass Review against trans people has been startling, although not unexpected. Political parties and campaigners have used the review as a political football to perpetuate the culture war. The resulting effect is that trans people’s lives, rights and their very identities have become politicised like no others in society. It is our duty as medical professionals (and students) to fight against discrimination and bigotry whenever we see it, including from within our ranks.
References
1. Noone C, Southgate A, Ashman A et al. Critically Appraising the Cass Report: Methodological Flaws and Unsupported Claims [preprint]. 2024 [cited 2024 June 21]. Available from: https://doi.org/10.31219/osf.io/uhndk
2. LGBT Foundation. Transforming Outcomes: A review of the needs and assets of the Trans community. 2024. https://lgbt.foundation/wp-content/uploads/2024/01/TransformingOutcomesL...
3. Home Office. Hate crime, England and Wales, 2022 to 2023 second edition [internet]. London: Home Office, 2023. Available from: https://www.gov.uk/government/statistics/hate-crime-england-and-wales-20...
Competing interests: GLADD is a signatory organisation of the Memorandum of Understanding on Conversion Therapy in the UK (https://www.bacp.co.uk/media/14985/memorandum-of-understanding-on-conversion-therapy-in-the-uk-march-2022.pdf) and hosts the GLADD Medical Schools Charter on so-called LGBTQ+ 'Conversion Therapy' (https://gladd.co.uk/activism-conversion-therapy-charter/).