Thread by @JLCederblom

Thread of random thoughts from the Cass review.

For a decade trans activists have claimed that the science is settled. Over the last five years or so, this has been pushed back against with "the evidence is limited & weak". The discourse is now getting much closer to the reality that trans activism is anti-scientific.

(p. 25)

Tik tok tics, EDs - putting GD among these has been a forbidden thing, immediately getting you branded as a transphobe. But the non-binary child has cried wolf too many times.

Paraphrased, "we're in an era of medical social contagions". (p. 27)

There's a complex mesh of circularly referencing police statements and guideline summaries that all flow from SOC7 and ES 2009. It's effectively a shell game, smoke and mirrors to make the trans activist stance look considerably stronger than it actually is. (p. 28)

It expanded very rapidly, building upon nothing but managing to fill a void rapidly and became dominant in somewhat of a bloodless coup.

Finland and Sweden were the first to break free from this, taking an evidence-based approach, and the UK seems poised to follow.

The first recommendation seems entirely innocuous, and of course is purely a positive, unless you're a trans activist clinician who relies on being able to ignore all your medical responsibility in order to follow your beliefs. The buck has to stop somewhere - with you. (p. 28)

Recommendation 2, similarly, is entirely reasonable and seems very difficult to argue against from a trans activist stance. It features the "holy shit, why is the rate of autism >10x in this group" response, very mildly put as "should include screening".

Page 29 features a bizarre exchange where trans activists have complained and the Cass review have had to explain what the point of medicine is.

Acknowledgement that social transition is a major step, especially in pre-pubescents (p. 30). One of the main issues with this is "transhausen by proxy", when the transgender identity is, let's say, "heavily encouraged" by parents.

They should have caught the double period, though.

One thing trans activists do is insist on having it one way. A sane approach involves looking at all options, which is what the Cass review aims for. (p. 31)

SRs on social transition were obviously going to have this finding, but it's good to have it in writing. (p. 31)

How long until the "pause button" crowd backpedal? "We never meant..." - or are they too far gone? (p. 32)

I wonder how many "live-saving" comments the Cass review received. (p. 33)

I don't know if I agree on this one. Well, raw numbers, sure. But if there is an argument that the rates are increasing, I would argue that the rates have never been known, only claimed to be nearly non-existent, so any honest inquiry compared to that would look like an increase.

"That thing you should have done at least a decade ago? Yeah, do that." (p. 34)

There's a bit about Bell v Tavistock, and that trans activist ideas of "informed consent" appears to start and end with "intellectual and emotional ability to consent", and not requiring the person to be informed. (p. 34)

Doctors lying to patients is a big issue in this field.

Then there's a whole bunch of recommendations on page 35, with some solid quotable material in there. Long-standing incongruence being an "essential pre-requisite", and recommending "extreme caution" with regards to cross-sex hormones between 16 and 18.

What they've learned is that when a religious group captures a medical service, become entrenched, bully dissenters out, and establish a monopoly, it becomes extremely difficult to set it straight. (p. 36)

Because what GIDS provided was not medicine, you can't really provide a similar thing in a normal medical setting. And fully, truly, holding it to normal medical standards, while something the Cass review seems to do to a good extent, is still not entirely in reach.

I do like this, on page 37. It reads, roughly, "stop fucking about, get it done".

Gender clinicians lose perspective by isolating themselves. There's certainly self-indoctrination that comes to some people from it. (p. 37, 38)

If you read the material from things like the Appleby tribunal, you'll notice these clinics almost develop political commissars.

There also appears to be a typo/edit mistake on that bullet, as it goes 117, 120, 118. The other 120 (p. 38) brings up how medical professionals have previously just gone "it's complicated, let's send them to GIDS".

Gender services are generally hostile to investigation. This is not news, but it's good to have it in such high-profile writing. (p. 39)

Page 40 is just damning all around. Gender clinicians in the UK have had 15 years to get their act together, but have been too incompetent to perform the most fundamental parts of their job.

GIDS was essentially self-referred, which is of course ridiculous for such a specialized service in the first place, and even more so given the ideologically driven goal of some clinicians to transition as many kids as possible.

(p. 41)

"The current evidence base" is a bit generous here. It's not quite as weak as claims about the benefits of transition, but it wouldn't really fly in any other setting.

Given that medical transition is effectively a life-long treatment (in cases of gonadectomy inarguably so), it makes no sense at all to have yet another crack to fall through. Although if you're not really collecting data in the first place, perhaps start there. (p. 42)

Very concise bit on detransition care. "Some will be traumatized by the 'care' we gave them, so maybe don't send them to the same place again..." (p. 43)

"We see you, GenderGP." (p. 43)

"We'll have to clean up their mess, though. Oh, but pharmacists, don't forget that you're medical professionals too."

I've still not read up on NHS identifiers, but apparently they're sexed, and faking one causes follow-up issues. But since reality is transphobic, we can't quite say "stop it". (p. 44)

Not sure about the AI-looking art. If your hand looks like that, you might have been born without joints. (p. 46)

The start of the Approach chapter, the first real one, is a very accessible primer on what the point of medicine is. It's clearly written for an as wide as possible audience, so simple that even a politician could understand it.

Extremely so - it even explains what a drug or treatment is supposed to be, safe and effective. (p. 49)

I'm not sure if this is standard stuff for such a review, or if it's specifically designed to pre-empt the "but the science is settled, so says this Dutch paper where they ignored death and suffering and found everyone else was okay." (p. 50)

They've certainly done their due diligence in commissioning a wide range of inquiry. (p. 53).

I look forward to trans activist attempts to poke holes in them. And, in fairness, to my own and others attempts to poke holes in them. Because that's what you're supposed to do.

Page 55 has the usual pyramid of evidence we all know, but I think it's missing the point that the higher they go the harder they fall, e.g. something like . medium.com/@JLCederblom/a…

The next few pages are fairly detail-heavy and not that interesting other than to verify that they've done a decent job. They don't really hold their punches on page 64, though. Misrepresentation and exaggeration in the scientific literature. Not news - but very quotable.

Also on page 64, there's mention of the mismatch in expectations and what it's possible for the NHS to provide. A good amount of that is because the expectations aren't actually medicine.

The next chapter got regular a stock photo.

The start of the Context chapter, pages 67 through 74 are a decent (but far from perfect) description of the history of pediatric gender transition. Worth a read for most people, I think.

For example, they could probably point out that in the Dutch studies, they killed one of the kids, a fairly slow and painful death. This shook the research team to the core, prompting them to... unceremoniously drop him from the study.

de Vries et al. are not good faith actors.

Then there's the Early Intervention Study. The somewhat amusing reference at the end there (excellent work @totastuff for rehosting the video) is to

@totastuff The findings were... well, they failed to reproduce the Dutch results. Naturally, in the interest of scientific discourse and the progression of the best possible care, the gender clinicians decided to... try to kill the findings.

Carmichael et al. are not good faith actors.

@totastuff Also features a handy visual aid that should tell everyone how badly the two disagreed. (p. 71)

@totastuff Then there's the usual explosion chart from de Graaf et al., 2018. Note the legend telling us what AFAB and AMAB stand for, despite the chart actually using just F and M.

The Cass review decided to reproduce it in exact detail, including that error.

@totastuff Very quotable, page 73. Clinical practice appears to "have deviated" (passive voice), in a "departure from normal clinical practice".

@totastuff Paraphrased, "It's not our job to tell you how we got in this mess... but come on." (p. 74)

Very strong statement - clinical practice was disconnected from the clinical evidence base. No ands, ifs or buts. Disconnected.

The next few pages are mostly background, but touch on some interesting things. About the inarguable role of information in Bell v Tavistock, for example. Or the CQC finding that GIDS was a shitshow.

Page 85, with the post-covid bump.

A lot of females. And how fucked up do you have to be as a parent to take your 3-year-old to GIDS? (p. 86)

Useful statistics on page 88 - this is apparently from the one of the reviews that dropped at the same time.

I hadn't realized the Belgium was so ahead of time. Any Belgians around to tell me why?

On the sex ratio, they bring up Norway (p. 89). I would probably have brought up the most incredible outlier, which appears to be Finland (via ) at an incredible >8 females for every male. doi.org/10.1080/080394…

The next bit is fairly densely packed with interesting data, but I'm running out of available time today so I think I'll finish the chapter and finish the rest later.

There's a whole section on DSDs and (I would phrase it as...) untangling the "trans is just intersex of the mind" mess of an argument.

For example, the obvious statement that adolescence is adolescence. Windows of development where physical, mental and social development go hand in hand.

There's a recent video on this topic specifically with regards to gender which is worth a watch:

Actually, the paper that the video is about is referenced in the review itself. It's a good paper, as well.

The final bit of the chapter is... potentially going to be the subject of some trans activist rage.

After all, these should be fairly even if it's purely innate. (p. 107)

Social media and body image? I'm sure there couldn't possibly be a causal relationship there. (p. 110)

That couldn't possibly create a distorted relationship to your physical sex, could it?

"More likely than not".

That'll get you called transphobic in no time.

So, what the hell is going on?

"Who the hell knows?" (p. 114)

Things appear to be slipping a bit now. Many centuries? So the term "transgender people" includes historical transvestites and eunuchs, making it entirely useless.

They go on to discuss prenatal hormone levels, twin studies, brain research, but the whole segment is written quite differently from the previous ones, in that it appears to buy a lot more of the trans faith. Even when pointing out the nonsense in studies it uses loaded language.

Either way the conclusion is fairly clear. Biology may play a role, but it's not the cause of the explosion. (p. 117)

The psychosocial factors are at least fairly good, although saying "this factor is painful for people to discuss" is a bit of an empty gesture.

The societal acceptance is accurately described as insufficient, but I think it's somewhat of a mistake to separate it from the "peer and socio-cultural influence" category. These are two sides of the same coin.

The changing concepts brings up some of the usual interesting points, such as "why was Iran ahead of the curve with medical transition?", to which the answer is "because trans is not the progressive thing it self-identifies as".

With regards to broader mental health challenges (p. 119-120) this will no doubt get them branded as hardcore transphobes.

On the peer and socio-cultural influences, here in full, they go quite soft, but at least they say it.

I would be quite a lot harder. They could mention the misinformed patients, with scripted stories, canned answers. It would be controversial to trans activists, but I know they spoke with plenty of gender clinicians who reported this to them.

Clearly they're treading lightly.

The last, and weakest suggestion, is the availability of puberty blockers. If this was about the availability of medical transition as a whole, perhaps it would be slightly stronger. But realistically, that too would be primarily under social factors. (p. 120)

The conclusions are... well, about as milquetoast as you would expect. It's biopsychosocial. (p. 121)

This seems barely intelligible and profoundly unhelpful. (p. 121)

And then, for some reason, they actually just go out and say it in the conclusion to the conclusion. Most factors appear to be social mediation for another need or distress.

And that's it for this first thread. That was 123 pages out of 233 (and another 150 or so in appendices), so call it about halfway.

Hopefully there was something useful to someone who doesn't have the time to read it in there.

Wrapping with a hug from the Cass report. (p. 123)