Australian Response To Cass Review Needed Now

The Cass Review – the largest-ever systematic review of evidence regarding pediatric gender medicine – released its Final Report this month. After a four-year-long examination of the evidence underpinning puberty blockers, cross-sex hormones, and other affirmative treatments in gender dysphoric children, the Cass Review concluded there is no clear evidentiary basis for medical gender-affirmation therapies in children. 

In other words, the use of puberty blockers and cross-sex hormones in children is experimental and in violation of core medical ethics principles.  

Despite the Cass Review’s findings, which have prompted the UK, Scotland, Ireland, and others to seriously restrict access to puberty blockers, the Australian Federal Government and State/Territory Governments are yet to do anything in response.  

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The Cass Review, commissioned by the UK’s National Health Service in 2020 in response to a dramatic increase in referrals to youth gender identity services, confirms that available research on puberty suppression and cross-sex hormone treatment is of such poor quality that no foundation exists for clinical decisions and informed consent. Importantly, it was found that gender-affirming care does not reduce suicide risk, contrary to the cruel but common transactivist trope, “would you prefer a trans kid or a dead kid?”, and there is no way of knowing whether gender dysphoria will persist into adulthood. 

Research already tells us puberty blockers and cross-sex hormones negatively impact cognitive development, irreversibly change a child’s body, and can cause sterility. 

The Review concludes, “For most young people, a medical pathway will not be the best way to manage their gender-related distress”. In direct contrast, Australian guidelines unanimously recommend an affirmation-approach as a default response to gender dysphoria, including in children, without empirical justification and without consideration of more holistic treatment pathways. 

This calls for an urgent suspension of the use of puberty blockers and cross-sex hormones in Australian children.  

Australian Health Minister, Mark Butler, has undermined the local relevance of the Cass Review’s findings, despite the publicly known fact that Australian gender clinics follow an affirmative approach. It is critical we write to our local MP and notify them of the urgency of this issue – calling for an inquiry into these treatments and a ban on puberty blockers before more children are harmed. 

Some key findings of the Cass Review include: 

  • Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity; 
  • The long-term impact of puberty suppression and cross-sex hormones on cognitive and psychosexual development is unknown; 
  • An unusual number of children who believe they are trans are neurodiverse, have psychiatric disorders or mental health issues; 
  • Initial research also indicates that children presenting at gender clinics have experienced higher-than-usual levels of maternal and paternal mental illness, exposure to domestic violence, emotional abuse and combined neglect or abuse. A review of the first 124 cases at the NHS Gender Identity Development Service found over 25% had spent some time in care, and nearly 50% were living with only one parent; 
  • 73% of patients discharged between April 2018 and December 2022 were natal sex female. 

One 15-year-long study of 2,700 children by the University of Groningen, published this year, found that most children with ‘gender discontentedness’ became content with their gender by age 25. 

Administering off-label medications to children to deter the natural process of puberty, without a proper understanding of the long-term physical, psychosexual and cognitive consequences and without another robust evidence-based rationale, is engaging in a medical scandal of the highest order.  

We must urge our MPs to immediately respond to the Cass Review’s findings by calling on Australia’s gender services to revise their approach before more children are harmed. Failure to do so could result in serious legal challenges against the Government and/or gender clinics for breaching their duty of care. 

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