OPINION – Stuff
DAMIEN GRANT – 28 APRIL 2024 – STUFF
OPINION: The debate over gender identity has gained in prominence in recent years and, to what will be my enduring shame, I chose not to confront it.
When you distil the serious complaint by those against the current gender-fluidity of modern culture, it is that the medicalisation of children’s gender dysphoria is wrong.
That puberty blockers, hormone treatments and gender-affirming surgery are a mistake. That we are damaging and potentially sterilising children because of an ideology.
I heard that but did not directly engage with it. Although. When I read the news story of Keira Bell, a young English girl who underwent and subsequently regretted hormonal treatment and a double mastectomy, I did pay attention.
Puberty is an essential aspect of human development. At the time the local Ministry of Health addressed puberty blockers and confidently asserted they were safe, reversible, and gave young people time to consider their identity. I see that advice has changed.
Why did I place faith in the pronouncements of the Ministry of Health? Given my inherent distrust of the state I am left with the uncomfortable conclusion that it was cowardice.
Seeing how others who waded into this topic had their careers and reputations damaged, it was preferable to hide behind an official declaration that the experts knew what they were doing than look closer and risk having to speak up.
The Cass Report has ended the ability to seek refuge in this sophistry.
Let me elaborate. The National Health Service in England commissioned Dr Hilary Cass to look at the treatment of gender dysphoria. Cass reports that prior to 2009 the demand for what the English call Gender Identity Services was negligible – fifty a year – but has undergone exponential growth. We have experienced a similar trend.
Cass considers the reasons and one of the explanations put forward is a greater acceptance of trans identity.
She is polite, but determinative: “the exponential change in referrals over a particularly short five-year timeframe is very much faster than would be expected for normal evolution of acceptance of a minority group.”
Among the drivers, Cass writes, are mental health and cultural trends.
This raises the question, why are we reaching for puberty blockers and hormone treatments, and what is the effect of doing so?
According to Cass, “the long term health impacts of hormone interventions is limited and needs to be better understood”. “Young people become particularly vulnerable at the point of transfer to adult services.”
She acknowledges hormone treatment for adults is “not without costs…” but is “…dramatically outweighed by the long-term benefits.”
The story for those under 18, and especially under 16, is different. Children on blockers will cease development while their friends continue and “…there are no good studies on the psychological, psychosexual and developmental impact of this period of divergence from peers”.
Her report states: “Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.”
Cass does not necessarily declare that the treatments used for gender-affirming care are unsafe, as some reporting has insinuated. Rather, that there is an absence of evidence that they are safe and effective.
She writes: “This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender related distress.”
However, “Some clinicians feel under pressure to support a medical pathway based on widespread reporting that gender-affirming treatment reduces suicide risk. This conclusion was not supported by the above systematic review”.
There has been criticism, with the most potent that she has been selective in her use of analysis, rejecting 98% of the studies available. Cass has been forced to respond that she found only 2% of the studies to be high quality, but that she used the majority of them anyway to achieve a “synthesis”.
There will be other critiques but this report has reversed the burden of proof. If these treatments are safe and effective then the evidence needs to be presented and peer reviewed.
Until they are maybe we should not treating people below the age of consent with powerful and unproven treatments.
Mostly the report has been received well and in the wake of its publication England and Scotland have joined the four Nordic nations in banning puberty blockers being prescribed to minors, although some hormone therapies are available for those over 16.
In New Zealand the Ministry of Health is reviewing their use and its report, initially due last year, has been delayed again.
Given the Ministry initially claimed that puberty blockers gave children an opportunity to consider their future, the following quote from the Cass report may prove disturbing: “Moreover, given that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinising/feminising hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.”
It is possible that we are looking at a major medical misadventure with a cohort of children having their lives compromised.
And too many of us, those with the opportunity and a platform, stood by and said nothing. Because we were afraid of the consequences, because if we did we’d feel compelled to say something, and to say something would come at a cost.
So we said nothing. Shame on us. Shame on me.