Re: Transgender – a passing phase for many? April 27 column.
Though well written, Martin Hanson’s recent article did not utilise a critical lens when reviewing the Cass Review. The Cass review is a piece of research by Dr Hilary Cass that reviews transgender healthcare in the UK. The review has been labelled by many (conservative) outlets as an important step in the protection of children. Yet, looking at a companion document to the Cass Review — “Evidence review: Gender-affirming hormones for children and adolescents with gender dysphoria” — one can gain a greater understanding of the methodology utilised by Dr Cass.
The review examined a broad range of research, and it utilised a GRADE system based primarily on whether a study was blind and had a control group. The review ultimately found trans research to be of a “poor” grade. This has led to criticism of the Cass review, and rightly so, as having a biased and unsound methodology.
As a thesis student, I spent a lot of time constructing research methodology. The exclusion of research by the Cass review, or its downgrading, is placing lab grade expectations on research conducted in the real world. The primary argument that the review makes for this research is that it was not blind (that is, giving some children a placebo and others hormones) nor had a control group, a group of children left untreated. These two facts are ultimately antithetical to the ethics of medical practice; it would be unethical to not treat someone how they want to be treated, nor would it be ethical to make someone think they were taking hormones when, in reality, it was a piece of sugar.
Ultimately, the exclusion and downgrading of research that disagrees with the Cass review’s findings has generated a study lacking empirical research. Furthermore, research into Dr Cass and the review’s recommendations has revealed an ethically dubious argument that a service be set up for 17 to 25-year-olds, seeking to explain their gender incongruence by other means, such as eating disorders, neurodivergence, gender-related distress, or social acceptance.
This has all the hallmarks of conversion therapy, yet is conveniently not named as such — with trans people having the option to transition only after all other avenues are explored, which would take many years.
An added blow to the validity of the Cass review is that it also excluded research which demonstrates that people on hormones who have gender dysphoria experience lower risks of suicidal ideation and self-harm. The Cass review is a conservative piece of research, and in one instance, even uses “boy” and “girl” toys to identify gender, when a plethora of research exists within psychology exploring the social and parental influences of toy choice on children.
What I would say to Mr Hanson is that it is decidedly unwise to think that one review — one very flawed review — is capable of determining that gender dysphoria is a phase experienced by many.
Do medical institutions need to be given more funding and trans youth given more support? Absolutely. But this should not be at the detriment of their rights and freedoms.
One of the facets missing from the Cass review, at least in my reading, is the myriad of trans voices describing their positive experiences transitioning. The Cass review may also offer some unique insights into current practices in the UK on gender care.
Still, it is essential to note that Aotearoa New Zealand is not Britain. It may be helpful for comparative research, but it should not be transplanted into our considerations of trans healthcare unless proven true.
