AN EXHAUSTIVE AND independent study evaluating clinical care for dysphoric youth was published in April 2024 in England. The 388 page Cass Report is critical of “gender affirming care” (GAC) the highly medicalized approach to treating minors who feel that their biological sex and gender identity do not match. It has been heralded as the most important study in the history of youth gender medicine in the last decade.
The report, commissioned by the British National Health Service, was led by the well regarded former president of the Royal College of Paediatrics and Child Health, Dr. Hilary Cass and took four years to complete. It relied on a comprehensive collection of sources, evaluation of research and clinical recommendations in developing its findings and found “remarkably weak evidence” supporting the standard use of puberty blockers or surgical interventions for children with dysphoria.
Although acknowledging that “gender dysphoria” or “gender discordance” can cause great feelings of distress and lead to serious mental health issues, including suicidal ideation, the Cass Report recommends that minors experiencing such feelings be treated the same way they are for other developmental struggles, instead of being prescribed puberty blockers or undergoing cross-sex hormone replacement therapy.
For most young people, a medical pathway may not be the best way to manage gender-related distress, the Cass Report concludes.
It further notes that having a trans or gender diverse identity is believed to be the result of a complex interplay between biological, psychological and social factors. But warns against a rush to treatment that ignores the uniqueness of each case especially in the absence of substantial evidence-based research supporting medical interventions like puberty blockers or surgery.
For those young people for whom a medical pathway is determined to be clinically viable, wider mental health and/or psychosocially challenging problems must be factored into the decision, the report stresses.
RIPPLE EFFECTS
Going forward, England will treat gender-dysphoric youth under 18 years of age using standard psychological and psychotherapeutic approaches, with very few young people receiving endocrine gender reassignment interventions.
And the Cass Report is expected to have ripple effects in how other countries treat minors experiencing gender dysphoria.
NHS England, NHS Scotland, Belgium and the Netherlands have already reversed direction on puberty blockers because of the Cass Report’s recommendations.
Its findings come as the U.S. medical establishment awaits the results of a systematic review currently underway by the American Academy of Pediatrics that are not expected to be published until the end of 2025.
EMPATHY AND COMPASSION
Katie Dawson, director of Parish Evangelization and Faith Formation for the Diocese of Orange, said Diocese leaders continue to pore over the Cass Report’s findings. Gender dysphoria, she noted, is an issue that requires an empathetic and compassionate approach to a distressed child and family.
She said, “The Cass Report lends weight to the Church’s concerns about the dangers of addressing dysphoria with permanent and irreversible treatments for minor children.”
FUNCTIONING AND THRIVING
The Cass Report said the current explosion of gender-dysphoric youth is the result of many factors, including the current mental health crisis affecting youth as well as the role of social media.
The report noted that a sharp rise in the number of gender dysphoric youth in the West has coincided with the introduction of puberty blockers into general medical practice.
And it determined that to achieve the ultimate goal of helping a child or young person to function and thrive, medical and mental health professionals need to provide them with tools and strategies to give them the best opportunity to do so.