A flood of false claims about England's Cass Review has coursed across social media and the press and among activists and academics. If only people who weighed in on the report had actually read it.
Thank you for all the incredible work you have been doing.....I just pledge to be a subscriber or whatever "pledging" means on substack. At the $80 level.
That's a link to NICE's current thought ("Further information: Established Procedure"). Do you have a link to something saying that they are *reconsidering* it please?
This is an excellent synopsis and thx for pointing out propaganda by bully activists. I think most people don’t realize physicians rarely read studies and the FP from Canada didn’t do his homework or bother reading the Cass Report bc media often publish opinions and mislead readers that their opinion pieces are fact based and fact checked.
Idk writing a report on trans health that excludes trans people, their families, and clinicians' voices seems analogous to a men-only committee writing a review on women's health. Doesn't sit right with me.
The advisory board. I'm talking about the advisory board. No cisgender person is neutral when it comes to transgender lives, and assuming that they are is deeply flawed.
Edit: also, I did read your article. I just don't agree with some of it and find your arguments miss the point. That's OK. My lunch break is over now so it's back to work for me.
I'm not saying giving kids these drugs is not bad.
Nor am I saying cutting off a young girl's breasts and boy's penises isn't wrong.
But it is the solitary fact that you and Cass has to even compile this level of research to substantiate and qualify the belief that doing those things is bad for kids shows how completely mad those medical providers are.
What part of giving cross sex hormones to children is wrong, doesn't the world not understand?
What part of surgically sterilizing boys and girls to fit into society is wrong, doesn't the world not understand?
These are not advanced Quantum String physics .
These are not planetary gravitational pull calculations.
What part of not trying to turn your little boy into a little girl, is beyond comprehension?
As I wrote in my book, Don't get on the plane why a sex change wilsl ruin your life.
, SEVEN FUCKING YEARS AGO, modern day transgender medical protocols are nothing more than Nazi medical experiments. And the doctors who perform them are guilt of war crimes.
So, Mr. Ryan, stop with all the pulling together facts, and studies and research.
I went through a sex change in 1990 and have spent the last 34 years tormented by the medical decisions and ramifications to my life that having SRS had.
What part of , you're dealing with Nazi doctors don't you understand?
Once you accept this,
You'll stop pulling together research,
and simply pull together a two man crew to hang the mother fuckers committing these crimes against your children.
I'm sorry you've had negative experiences with sex change. I know others who have had very positive experiences and I wish that could be everyone's story - I want everyone to respond to their own dysphoria freely (without stigma or hate) and with the most informed decision possible based on the individual's desires.
Let's look at Cass's summing up in the introduction ("Foreword from the Chair"). It is as you say "The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender related distress." But this phrase "no good evidence" in itself is a dismissal of the higher-quality studies discussed. It would be more accurate if she said "the reality is that we have some good evidence on the outcomes (but not a lot) plus a lot of lower-quality evidence...". You could then go on to add something about "...but nothing/less over longer periods of time" if you wanted.
In short, Cass turned a *relative* reality (the lower-quality studies are more in number than the higher-quality ones) into an *absolute* reality ("we have no good evidence")
Just because a study is high-quality doesn't mean that it answers the question as to whether "we have no good evidence on the long-term outcomes of interventions to manage gender related distress." It just means that it's good at supporting the conclusions that it does come to.
If a high-quality study will not satisfy you, then that raises the question: what will? What is the level a set of studies has to achieve to be accepted? The York researchers did the work (see the BMJ? papers) but it was Cass and her team that did the judging. Hence my point about her interpretation
You missed the point entirely. Just because a high-quality study relating to gender dysphoria answers questions A, B, and C doesn't mean that it answers questions D, E, and F.
A study can easily be high-quality without answering the questions that Cass is seeking to answer.
Which then begs the question as to why Cass and her team were looking at D,E and F instead of A,B, and C.
Which feeds into another thing: what was the function of the Cass report? Was it to review *all* the evidence, construct an argument based on *some* of the evidence, or promote a point by bringing in studies *other* than those in the York papers. She did go off-piste a couple of times, which makes me think it was the latter.
Your statement "Meanwhile, many claim that an RCT for gender-transition treatment would be unethical to conduct among children, because the preponderance of evidence indicates the treatment is safe and effective. (Others vigorously dispute that such a trial would be unethical and that such evidence is trustworthy—hence, they say, the need for an RCT.)" misses the point.
The point is not whether it would be UNETHICAL, it's whether a RCT is POSSIBLE. To randomise an individual they must first consent to be randomised. If they don't do that (and trans patients don't) then you can't do a RCT.
"The point is not whether it would be UNETHICAL, it's whether a RCT is POSSIBLE."
Funny thing, the author of the article agrees with you. He wrote, "Furthermore, it is not possible to blind such a study, because the effects of the drugs (ie: suppressed puberty or cross-sex puberty) are too obvious."
A double-blinded RCT is not feasible because it's obvious to anyone whether they're on blockers or hormones or not. But that does not mean that a non-blinded RCT is impossible. But it does raise the question of whether kids and their parents/guardians would be willing to enter a study in which they could be randomized to the control group. And if they were put in the control group, would they stay in the study and keep providing follow-up data? If there were other ways to get blockers and hormones, such as ordering from overseas, families might just ditch the control group and go that route.
Bear in mind that even in conventional RCTs (say a test designed to compare an improved surgical procedure to an existing one) only a small percentage will consent to be randomised. In contested cases like this, you won't get many.
You say in your tweet of April 15 that "Cass makes no mention of ROGD".
But in her paragraph 15.53 she says that "A self-identified sample of 100 detransitioners (Littman, 2021)..." The "Littman 2021" is a reference to this paper https://doi.org/10.1007/s10508-021-02163-w which was written by Lisa Littman to support her 2018 and other papers on Rapid Onset Gender Dysphoria (ROGD). Littman makes this clear in the text, eg "The data in this study strengthen, with first-hand accounts, the rapid-onset gender dysphoria (ROGD) hypotheses". You can't really cite Littman without supporting ROGD.
Cass's reference to Littman to support her paragraph is a use of ROGD. I think the fact that Cass left the word "rapid" out of her sentence "A range of issues were reported prior to onset of gender dysphoria" led you to miss this.
Aside from the matter that Einstein wrote papers on the photoelectric effect and Brownian motion, neither of which refer to relativity, one can make use of the data in a paper without endorsing every single conclusion of its author.
Thank you for all the incredible work you have been doing.....I just pledge to be a subscriber or whatever "pledging" means on substack. At the $80 level.
Ben you re a Jedi fighting all the spin and propaganda. So appreciated
Thank you for the deep dive.
One minor correction: it’s the Canadian Broadcasting Corporation, not Canadian Broadcasting Company :)
Many thanks, correcting this wild misinformation I peddled!
Truly wild! xD
NICE are also looking into developing recommendations about this procedure
https://www.nice.org.uk/guidance/topic-selection/gid-ipg10305
That's a link to NICE's current thought ("Further information: Established Procedure"). Do you have a link to something saying that they are *reconsidering* it please?
Thank you for this fabulous work. The activists are frothing at the mouth to discredit the Cass report, so your input is invaluable.
This is an excellent synopsis and thx for pointing out propaganda by bully activists. I think most people don’t realize physicians rarely read studies and the FP from Canada didn’t do his homework or bother reading the Cass Report bc media often publish opinions and mislead readers that their opinion pieces are fact based and fact checked.
Idk writing a report on trans health that excludes trans people, their families, and clinicians' voices seems analogous to a men-only committee writing a review on women's health. Doesn't sit right with me.
That claim is false. Cass interviewed families, doctors and kids who identify as transgender.
The advisory board. I'm talking about the advisory board. No cisgender person is neutral when it comes to transgender lives, and assuming that they are is deeply flawed.
Edit: also, I did read your article. I just don't agree with some of it and find your arguments miss the point. That's OK. My lunch break is over now so it's back to work for me.
It’s pretty long..almost 400 pages! And exactly like a novel, I would think. Where do you get it anyway?
Great work Mr. Ryan pulling all this together.
And to my mind not worth the time to do it.
I'm not saying giving kids these drugs is not bad.
Nor am I saying cutting off a young girl's breasts and boy's penises isn't wrong.
But it is the solitary fact that you and Cass has to even compile this level of research to substantiate and qualify the belief that doing those things is bad for kids shows how completely mad those medical providers are.
What part of giving cross sex hormones to children is wrong, doesn't the world not understand?
What part of surgically sterilizing boys and girls to fit into society is wrong, doesn't the world not understand?
These are not advanced Quantum String physics .
These are not planetary gravitational pull calculations.
What part of not trying to turn your little boy into a little girl, is beyond comprehension?
As I wrote in my book, Don't get on the plane why a sex change wilsl ruin your life.
, SEVEN FUCKING YEARS AGO, modern day transgender medical protocols are nothing more than Nazi medical experiments. And the doctors who perform them are guilt of war crimes.
So, Mr. Ryan, stop with all the pulling together facts, and studies and research.
I went through a sex change in 1990 and have spent the last 34 years tormented by the medical decisions and ramifications to my life that having SRS had.
What part of , you're dealing with Nazi doctors don't you understand?
Once you accept this,
You'll stop pulling together research,
and simply pull together a two man crew to hang the mother fuckers committing these crimes against your children.
Rene Jax .
I'm sorry you've had negative experiences with sex change. I know others who have had very positive experiences and I wish that could be everyone's story - I want everyone to respond to their own dysphoria freely (without stigma or hate) and with the most informed decision possible based on the individual's desires.
" I know others with positive experiences. "
What part of turning one's self into a Eunuch is positive?
What part of cutting away healthy tissue and organs is positive?
What part of filling one's body with foreign chemicals is good?
What part of surgically sterilizing yourself is positive?
What part of deciding to live on the fringe of society is positive?
The others you speak of are delusional, lying to themselves and or have no understanding of the consequences of what they've done.
That is the reality of gender medical treatments.
Let's look at Cass's summing up in the introduction ("Foreword from the Chair"). It is as you say "The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender related distress." But this phrase "no good evidence" in itself is a dismissal of the higher-quality studies discussed. It would be more accurate if she said "the reality is that we have some good evidence on the outcomes (but not a lot) plus a lot of lower-quality evidence...". You could then go on to add something about "...but nothing/less over longer periods of time" if you wanted.
In short, Cass turned a *relative* reality (the lower-quality studies are more in number than the higher-quality ones) into an *absolute* reality ("we have no good evidence")
Just because a study is high-quality doesn't mean that it answers the question as to whether "we have no good evidence on the long-term outcomes of interventions to manage gender related distress." It just means that it's good at supporting the conclusions that it does come to.
If a high-quality study will not satisfy you, then that raises the question: what will? What is the level a set of studies has to achieve to be accepted? The York researchers did the work (see the BMJ? papers) but it was Cass and her team that did the judging. Hence my point about her interpretation
You missed the point entirely. Just because a high-quality study relating to gender dysphoria answers questions A, B, and C doesn't mean that it answers questions D, E, and F.
A study can easily be high-quality without answering the questions that Cass is seeking to answer.
Which then begs the question as to why Cass and her team were looking at D,E and F instead of A,B, and C.
Which feeds into another thing: what was the function of the Cass report? Was it to review *all* the evidence, construct an argument based on *some* of the evidence, or promote a point by bringing in studies *other* than those in the York papers. She did go off-piste a couple of times, which makes me think it was the latter.
"Which then begs the question as to why Cass and her team were looking at D,E and F instead of A,B, and C."
Because a study looking at questions A, B, & C may be helpful for at least partly addressing D, E, or F even if it's not conclusive.
Your statement "Meanwhile, many claim that an RCT for gender-transition treatment would be unethical to conduct among children, because the preponderance of evidence indicates the treatment is safe and effective. (Others vigorously dispute that such a trial would be unethical and that such evidence is trustworthy—hence, they say, the need for an RCT.)" misses the point.
The point is not whether it would be UNETHICAL, it's whether a RCT is POSSIBLE. To randomise an individual they must first consent to be randomised. If they don't do that (and trans patients don't) then you can't do a RCT.
"The point is not whether it would be UNETHICAL, it's whether a RCT is POSSIBLE."
Funny thing, the author of the article agrees with you. He wrote, "Furthermore, it is not possible to blind such a study, because the effects of the drugs (ie: suppressed puberty or cross-sex puberty) are too obvious."
A double-blinded RCT is not feasible because it's obvious to anyone whether they're on blockers or hormones or not. But that does not mean that a non-blinded RCT is impossible. But it does raise the question of whether kids and their parents/guardians would be willing to enter a study in which they could be randomized to the control group. And if they were put in the control group, would they stay in the study and keep providing follow-up data? If there were other ways to get blockers and hormones, such as ordering from overseas, families might just ditch the control group and go that route.
Bear in mind that even in conventional RCTs (say a test designed to compare an improved surgical procedure to an existing one) only a small percentage will consent to be randomised. In contested cases like this, you won't get many.
Thank you, but I think you may have missed my point, which is that randomisation is dependent on the patient's willingness to be randomised. See BR's response at https://benryan.substack.com/p/the-cass-review-fact-check-its-clear/comment/54414188
You say in your tweet of April 15 that "Cass makes no mention of ROGD".
But in her paragraph 15.53 she says that "A self-identified sample of 100 detransitioners (Littman, 2021)..." The "Littman 2021" is a reference to this paper https://doi.org/10.1007/s10508-021-02163-w which was written by Lisa Littman to support her 2018 and other papers on Rapid Onset Gender Dysphoria (ROGD). Littman makes this clear in the text, eg "The data in this study strengthen, with first-hand accounts, the rapid-onset gender dysphoria (ROGD) hypotheses". You can't really cite Littman without supporting ROGD.
Cass's reference to Littman to support her paragraph is a use of ROGD. I think the fact that Cass left the word "rapid" out of her sentence "A range of issues were reported prior to onset of gender dysphoria" led you to miss this.
Aside from the matter that Einstein wrote papers on the photoelectric effect and Brownian motion, neither of which refer to relativity, one can make use of the data in a paper without endorsing every single conclusion of its author.
Fair point. I've removed the Einstein reference