Mick Hartley

The big gap in the Cass Report, as Janice Turner in the Times notes, is the lack of data from the gender clinics that refused to cooperate:

Imagine if 9,000 children who began treatment at the Tavistock Gids clinic (the NHS Gender Identity Development Service) were interviewed as adults. How did their lives pan out? What proportion are thriving as trans? How many now regret their youthful decisions? Has their mental health improved? Is their physical health affected by hormones? How many detransitioned, and why? A longitudinal study of this size would benefit not just NHS England but gender medicine worldwide.

Surely anyone who cares about these troubled adolescents, two thirds teenage girls, would leap to assist. The study’s key barrier, that a trans person acquires a new NHS number making it impossible to link a female child to an adult with a male gender marker, had been removed by special legislation for the purposes of the review.

So the flat refusal by six out of seven adult clinics to participate is the most revealing thing in Cass. The Nottingham clinic head, Dr Derek Glidden, wouldn’t comply despite being the NHS’s most senior adviser on trans health. Relations between the adult service and the University of York team grew so hostile, meetings were abandoned. And in this we see future problems for implementing Cass’s recommendations: that was just one skirmish; what lies ahead is a war.

Gender medicine is hugely suspicious of data. Clinics are noted for professional incuriosity and institutional sloppiness. I recall judges at the Keira Bell judicial review flabbergasted by Gids’s derelict record keeping. So no wonder they feared what Cass’s researchers might find. Even without the adult data, Cass coolly blew apart everything from suicide myths to the claimed benefit of social transition. With the data, what might she have found? Perhaps detransition rates far higher than the claimed 1 per cent, or that female misery is unalleviated by amputated breasts. Then the whole clinical edifice might crumble — which it still could, now adult services face their own independent review.

The broader truth is that child gender medicine is not fuelled by science but activism; not upon “does it work?” but “does the patient demand it?” Poor data is not a glitch but a feature.

It's not a science; it's a cult.

How do you create a new evidence-based service still staffed by clinicians who abhor evidence? The very Gids therapists and psychiatrists who oversaw a medical scandal, expediting children to blockers and hormones, still work in this field. They post on social media groups about how their work was misunderstood and that, as pariahs, they’re the real victims.

How can they fall in line with Cass when they disagree on first principles: ie does a “trans child” exist? Cass’s position tilts towards trans identity being socially constructed, peer-influenced or, in girls, spurred by a fleeing from womanhood precipitated by sexual abuse or porn. But gender ideologues believe an infant contains an innate gender identity that is apparent from early childhood, and the clinician’s job is to help manifest it, by bodily mutilations if required.

Yep, a cult. If you believe in innate gender identities no amount of evidence is going to sway you. Some transitioners were unhappy? Perhaps they weren't made of the right stuff. Perhaps a more radical approach was needed. Stronger drugs! Take off more bits! Whatever the problem, nothing is going to sway that belief. It's evidence-proof.