The Cass Report remains undefeated

There is still no good evidence for medically transitioning children.

This has been proven yet again by the latest critiques directed at the Cass Report, the United Kingdom’s thorough review of the subject. The British government responded to its findings by restricting medical transition for kids, and the report has also been widely cited in the United States as states move to ban childhood transition.

The Cass Report is therefore an existential threat to transgender ideology and the multi-billion-dollar industry that has developed around it. And so trans activists and their allies are desperate to discredit Dr. Cass’ conclusions. But their very tactics show that they cannot. After all, the obvious way to debunk the Cass Report’s central claim—that there is no good evidence for transitioning kids—is to present good evidence for transitioning kids. The activists and gender clinicians do not do this, because there is no such evidence. Rigorous studies showing that transitioning kids is great for them do not exist. Indeed, one prominent provider of pediatric “gender-affirming care” recently admitted to suppressing her own data because it does not vindicate her work.

Attacks on the Cass Report are therefore all about distraction and misdirection, as illustrated in a recent opinion piece in the New England Journal of Medicine. Rather than address the evidence (or lack of it) for transitioning kids, it complains that the Cass Report is part of a “history of leveraging medicine to police gender norms.” The authors whine that Dr. Cass’s work for the British government did not follow American regulations, and that it did not include gender doctors who make their livings transitioning children. How dare Dr. Cass follow her own country’s rules or exclude people who would have a massive conflict of interest!

None of the authors’ critique addresses the core issue, which is whether there is any sound evidence that transitioning children is good for them. Unless the transgender industry and its advocates can provide that, their attempted nitpicks of the Cass Report are just chaff meant to distract from their fundamental failure to support their case. Addressing peripheral points of “law and policy” may strengthen an already solid medical argument on other matters, but in this case it merely highlights the neglect of the main medical issue.

This NEJM article does illuminate how abnormal “gender-affirming care” is. For instance, the authors whine that “Cisgender girls sometimes seek hormone therapy for hirsutism; cisgender adolescents receive hormone-replacement therapy for delayed puberty; and young people experiencing precocious puberty can receive puberty blockers to enable them to reach a greater height—without the hurdles that the Review recommends be instituted for transgender young people.”

Well, yes, because in such cases doctors are treating medical conditions with objective diagnoses and clear physical benefits from treatment. In contrast, “gender-affirming care” offers no physical healing, only disruption. It claims to resolve psychological distress through radical, permanent body modifications. Diagnosis of a transgender identity is subjective—doctors cannot use an MRI or bloodwork to confirm that, yes, this child is really a boy born into a girl’s body.

Rather, the claim that a child can be “born in the wrong body” must be taken on faith. It is a metaphysical, not medical, claim, and its subjective nature means that the only evidence for it would consist of intense psychological distress that resolves after transition. But, as the Cass Report showed, there is no good data to support this claim.

Nonetheless, fired by faith, trans activists and gender clinicians are carrying on. They have captured much of the medical establishment; hospitals, medical schools, and medical organizations have given in to the radical activists in their ranks. Worse still, they are destroying medicine itself at a fundamental level.

Love is the essence of good medicine. Love consists of willing the good of the other. Medicine rightly wills the good of the patient and deploys its skill and knowledge to that end. But this requires a knowledge of what human good consists of, particularly for medicine’s specific domain of physical health. Good medicine therefore depends upon a normative anthropology—an understanding of what is good and healthy for human beings, and what is abnormal and unhealthy.

True medicine strives to understand and promote health and human well-being. In contrast, gender ideology’s disavowal of any normative anthropology means that it regards medicine as merely a set of expert techniques to fulfill patients’ desires for their bodies. Instead of the good of the patient based on a right understanding of human nature, it seeks wish-fulfillment for the patient, regardless of how unhealthy or disordered the wish may be.

“Gender -affirming care” is an abdication of both the medical duty to care for one’s patients and the moral obligation to love one’s neighbor. This is especially so when it comes to children, who need guidance toward the good. The push to keep transitioning children despite the lack of evidence is evidence of a lack of love.