Cass on trial

Finnish study debunks the low-detransition claim; Texas Children's Hospital fires a whistleblower nurse; politicians wise up Down Under; the pseudo-Yale report savaged; a milestone for Spain's AMANDA

Photo by Joanes Andueza on Unsplash

GCN in brief

No ordinary treatment

United Kingdom | The UK Court of Appeal has agreed to take a case where the mother, Ms A, seeks to prevent her 16-year-old daughter, Q, who identifies as male, from accessing a private clinic, London’s Gender Plus, for cross-sex hormones. Ms A invokes England’s Cass report in arguing that a judge should override the normal medical autonomy of a 16 year old to protect her daughter from poorly evidenced and irreversible hormone treatment. In May, the High Court trial judge in the case, Mrs Justice Judd, declined to intervene in this way, but left open the possibility of such oversight where a child is “extremely vulnerable” or where a clinic, such as GenderGP, operates outside UK regulation. Q is living with her father and step-mother and is in a relationship with the stepmother’s daughter, who also identifies as a boy.

On August 13, the Court of Appeal agreed there is “a compelling reason” to hear Ms A’s appeal, and highlighted the question whether a judge should override the decision of an adolescent older than 16 with capacity to consent in circumstances where treatment “is being offered privately [in the UK], whilst not lifesaving or sustaining, is irreversible, highly controversial and could not be provided in accordance with some of the recommendations contained in the Cass review.”

Ms A’s legal arguments take issue with court decisions—predating April’s Cass report—which did not regard hormonal treatment of a gender-distressed minor as requiring more judicial oversight than any other medical treatment. Ms A’s lawyers point out that, following the Cass review, puberty blockers have been placed in a special category, being restricted to clinical trials. And in line with Dr Cass’s advice to use “extreme caution” in prescribing any cross-sex hormones for minors, England’s National Health Service (NHS) has imposed a pause on all under-18 appointments for this intervention.

Ms A argues that private providers such as Gender Plus operate with fewer safeguards than the post-Cass NHS. On her crowd-funder webpage Ms A says: “In the appeal I have argued that cross-sex hormones should not be provided in a private clinic or where there is a disagreement between parents, unless there has been authorisation by the court. This applies even if the child is 16 years old because of the lifelong risks of this controversial treatment, concerns about the clinical guidelines provided by [the World Professional Association for Transgender Health, WPATH] and the requirement in the NHS for an independent second opinion from a multi-disciplinary team.”

Lawyers for Ms A recommend the Australian approach set out in the 2020 re Imogen ruling of federal family law judge Garry Watts, presenting it as a doctor’s duty to check that both parents agree before any gender medical treatment of a child under 18 and, in the event of disagreement, for the court to decide what is in the best interests of the minor. The re Imogen decision has been criticised by state Supreme Court judges in Australia as gender clinicians seek to avoid this constraint imposed by federal family law.

More detrans, sooner

Finland | The rate of detransition has risen as more people undergo hormonal gender change, according to an unusually comprehensive study over three decades using Finland’s national registry data. The follow-up study of 1,359 patients, begun on cross-sex hormones from 1996 to 2019, found that 7.9 per cent of them had discontinued this treatment. Almost half of the sample started on hormones was younger than age 23; roughly two thirds were females given testosterone. Psychiatrist Professor Riittakerttu Kaltiala and her co-authors reported in BMC Psychiatry on August 19 that, “the risk of discontinuing hormonal [gender reassignment, GR] was almost threefold among those patients who had contacted the [centralised gender clinics] from 2013 to 2019 compared with those who had contacted the [clinics] from 1996 to 2005.”

The Finnish team say the proportion of patients who discontinued after short use of hormones also appears to have increased. “It is crucial to take seriously the desire to reverse medical GR and to ascertain its likelihood and predictors to target medical GR safely and provide appropriate services for those opting out of treatment that has resulted in irreversible changes in a healthy pretreatment body,” the authors say.

“It is already known that subjects currently seeking medical GR are, unlike earlier, predominantly birth-registered females, who are younger than before and present with more psychiatric co-morbidities than before. These observations may suggest that an increasing share of [gender dysphoria] patients actually do not present with achieved, consolidated identity … [M]edical transition early in terms of identity development may increase the risk of unbalanced treatment decisions, and this risk appears to have increased towards the present day, with detransitioning as the next step. Greater attention to gender identity issues and GR in the media and social media as well as assertive advocacy for medical GR may play a role in these developments.” In this context, the journal article from Finland cites the recent book The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness by social psychologist Jonathan Haidt.

The Finnish authors contrast their 7.9 per cent discontinuation rate with the very low regret rates claimed by today’s gender-affirming clinicians relying on dated, flawed or inapplicable studies from the 1960s-2010s. Professor Kaltiala’s team also note the much higher discontinuation rate reported by a recent, comparable US study, and suggest the lower rate of Finland may reflect the fact that patients there had to go through a comprehensive assessment in a nationally centralised clinic before getting hormones. One unexpected result of the Finnish study was that a patient’s need for specialist psychiatric care was not associated with a higher detransition rate.

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Video: Nurse Vanessa Sivadge says the assurances of Texas Children’s Hospital were “all a lie”

Furtively affirming

America | Vanessa Sivadge, a whistleblowing nurse who raised concerns that Texas Children’s Hospital was using Medicaid to fund puberty blockers and cross-sex hormones for minors contrary to state law, has been fired. On July 22, the hospital issued a statement that it had not yet “uncovered any evidence” of Medicaid fraud. A surgeon, Dr Eithan Haim, who with journalist Christopher Rufo exposed the hospital’s false claim that it had ceased paediatric gender medicine, has been appointed director of medical ethics and policy for Genspect USA. Texas state representative Shawn Thierry, a rare Democrat who voted to restrict medicalised gender change for minors, has been named as director of political strategy for Genspect USA.

Scandal Down Under

Australia | A link has been drawn between the US-based trans lobby WPATH and a children’s hospital gender clinic in the state of Western Australia (WA). A petition signed by 3,249 people and presented to the Upper House of the WA parliament cites the WPATH Files as proof that this lobby’s “published standards of care are not evidence-based and consistently violate medical ethics and informed consent.” The petition presented on August 13 by Dr Brian Walker—a family doctor turned Legalise Cannabis party member—highlights the fact that the treatment guideline used at the Perth Children’s Hospital gender clinic was based on WPATH standards. The petitioners seek a parliamentary inquiry into the care of gender-distressed youth.

Meanwhile, independent Upper House member Sophia Moermond has described the WA government’s proposed law allowing self-declared gender change as far reaching and frightening. “Although I realise that many people believe they are saving trans people, there is no scientific evidence that there is such a condition as trans. It does not exist. It is not real. Even gender dysphoria is now being disputed as a diagnosis, and that is because gender is nothing more than a set of culturally influenced sex-based stereotypes,” Ms Moermond said in the chamber on August 13.

“What we are looking at is a dangerous ideology that harms women, same-sex attracted people and children specifically. I realise that most people do not understand why gender ideology is homophobic. It is because sexual attraction is based on biological sex. This ideology denies that biological sex is real. Denying that biological sex is real is denying that same-sex attraction is real … Women and girls are also affected, as the [Tickle v Giggle] court case demonstrated. We are not even allowed our own apps as women because men want in. It actually demonstrates quite clearly how these amendments can lead to safeguarding issues for women and girls. Do not even get me started on the incredible misogyny displayed by the International Olympic Committee.

“As women, we have had centuries of training to recognise what men look like. In fact, we are much more discerning than men, because we have to be able to stay safe. Self-identifying in other places has led to predatory men accessing female-only spaces, with women in domestic violence and rape shelters having been attacked. We are seeing violent male sex offenders housed with women in female prisons. Female prisoners are a particularly vulnerable cohort, often with a history that includes male sexual violence against them. This [gender self-ID] bill will pave the way for those types of men to be housed with those women simply so they can continue to terrorise and rape them. When I had my briefing on this bill, I asked for the definitions of ‘sex’ and ‘gender.’ Those terms are repeatedly used in this bill. Do members know what was weird? There was no definition.”

Inexpert opinion

America | A gender-affirming critique of England’s Cass report—a critique often promoted as if it has the imprimatur of Yale University—is “an exceptionally misleading, confused, and fundamentally unprofessional document,” according to journalist Jesse Singal. The lead author, Dr Meredithe McNamara, is a physician-academic at Yale, but this “white paper” includes a belated disclaimer that its views are to be attributed to the authors as individuals, not to their institutions. Among the authors are Dr Johanna Olson-Kennedy of the gender clinic at Children’s Hospital Los Angeles, psychiatrist-advocate Dr Jack Turban and Australian gender clinician Dr Ken Pang. In a Substack post, Mr Singal remarks that, “Otherwise respected, well-credentialed experts have begun disseminating blatant misinformation about seemingly every facet of the Cass review and its findings.”

He says the McNamara et al white paper is the worst example of this. “The authors make objectively false claims about the content of the Cass review, badly misrepresent the present state of the evidence for youth gender medicine, and, just as alarmingly, exhibit a complete lack of familiarity with the basic precepts and purposes of evidence-based medicine. In some cases, the errors are so strange and disconnected from the Cass review that they can only, realistically speaking, be attributed to malice, a severe lack of curiosity and reading comprehension, or both.” Dr McNamara’s self-promotion as an expert in gender-affirming care has been sharply criticised by commentator Leor Sapir, who contrasts her public rhetoric with her sworn deposition in a court case over one of the many Republican state laws restricting paediatric gender medicine.

“As it turns out,” Dr Sapir writes, “McNamara admits that she does not perform or provide any of the ‘gender-affirming care’ that is implicated in these state laws. She admitted that she ‘generally’ does not perform diagnoses or assessments for gender dysphoria in minors and has never prescribed puberty blockers for this purpose (though she has prescribed them for other conditions). She has never been appointed as a member of any gender clinic.” The deposition reveals that Dr McNamara thought it too “expensive” to join the gender clinicians club WPATH.

Most come good

Spain | The Spanish parents’ group AMANDA—Agrupación de Madres de Adolescentes y Niñas con Disforia Acelerada—has marked the approach of its third anniversary with an opinion article in the newspaper ABC written by its president Marta Oliva. She tells the story of how eight mothers, each with a suddenly “trans” child, came together to form the group, did their research and began to apply the traditional “watchful waiting approach”.

“In these almost three years we have saved many girls, boys and adolescents. Of the more than 800 cases that have gone through AMANDA, a vast majority have desisted and resumed their lives happily and healthily, many of them as young lesbians and gay boys,” Oliva writes. “Unfortunately, we continue to receive new families every day. And, among all of them, there are about thirty whose lives will never be the same again: vulnerable young people, almost all of them autistic, some with serious additional disorders such as bipolar disease, psychosis, tumours ... who at the age of 18 have been medicalised, almost always at the first consultation, anywhere in Spain, despite the struggle of their mothers and fathers.

“The suffering of these families—who have to see how their son’s breasts grow, how their voice changes and their daughters grow beards, and, in the most dramatic cases, how they undergo surgery—is difficult to understand if it has not been experienced. Desperate mothers and fathers, who see their children’s bodies and lives forever damaged by a homophobic ideology, whose goal is to create lifelong customers for the medical and pharmaceutical industry.

“The reform of the Madrid [trans] law, in which we have been directly involved, asked for something as reasonable as that minors with previous psychiatric and psychological pathologies could be evaluated before starting irreversible hormone treatments, something that is included in all international medical protocols. However, this modification has been ruled unconstitutional by [Spain’s national] government, and before that by the Ombudsman. The collapse of the affirmative ideology is already a worldwide reality. Meanwhile, in Spain, this crisis has names and surnames of shattered lives: those of AMANDA’s children and their mothers and fathers.”

Slow down

Scotland | The Sandyford gender clinic in Glasgow will no longer take self-referrals, the National Health Service has announced. “However, the ban on self-referrals will not apply to more than 1,000 children and young people already on the waiting list,” The Daily Telegraph has reported. “A recent review found that nearly half of children and young people on waiting lists for the clinic were self-referrals (49 per cent), with only 30 per cent referred by their [family doctor]. The remainder came from other sources. NHS chiefs were under mounting pressure to remove self-referrals following the publication of the Cass review into gender identity services for children in England.”

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