BREAKING NEWS: UK’s final review of evidence on gender identity services for children
Psychiatrist Dr. Kris Kaliebe gives his initial response on the Cass Review
Dr. Kristopher Kaliebe is a board-certified General, Forensic, and Child and Adolescent Psychiatrist and professor in the Psychiatry Department at the University of South Florida. He has contributed his opinion on this topic in the past and graciously accepted our request to lend his expert opinion on this new development. We are grateful to have his voice advocating for children.
Yesterday the final report from England's National Health Service was published: The Cass Review, Independent review of gender identity services for children and young people.
Here are three core highlights taken directly from the overview:
• "Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity."
• "For most young people, a medical pathway will not be the best way to manage their gender-related distress."
• "There is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices."
Considering the facts above, it is applied common sense to conclude that it is imprudent to use puberty blockers, hormones, or surgeries in gender-distressed youth whose identity is still in the process of development.
Despite this, many activists still spin the tribal "anti-trans" narrative. Rather than engaging with the facts, they instead label those who advocate for cautious, evidence-based mental health or medical care as "anti-trans." This technique has been effective in silencing scholarly debate but is completely ineffective in helping gender-distressed youth get the proper mental health care they need.
In one respect, this "anti-trans" label is accurate. Because as Dr. Hilary Cass highlights, we are unable to know which youth will have an ongoing transgender identity.
Thus, thoughtful clinicians believe it is unwise to use the term "transgender" or "trans" when referring to a minor. Most youth gender-related distress will resolve; thus, labeling a child "trans" encourages the belief this is a stable identity rather than a temporary state. (see Rawee 2024, Singh 2021)
My other initial reflection is the continuation of terrible reporting on this subject. For example, the New York Times article published 4/9/2024 on the Cass Review, rather than reflecting on the harm activism has caused, preferred to quote a representative from Mermaids, which the NYT benignly labeled a "trans youth advocacy organization." The NYT did not note that Mermaids had a central role in pushing the "transgender child" narrative and pressured clinicians to medicalize youth gender distress.
These events have been thoroughly documented in Hannah Barnes’ excellent book Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children.
The NYT quoted the Mermaids’ representative without noting the irony, saying, "Extremist views have become much more normalized." They sure have!
It is not just the establishment press; a similar groupthink has occurred in professional medical associations such as the American Academy of Pediatrics (AAP) and the American Psychiatric Association (APA). I have witnessed this directly and have written on it before.
These organizations have behaved as if they were fighting a culture war rather than addressing clinical questions regarding youth gender medicine.
Yet, there is a glimmer of hope. I recently attended an American Psychiatric Association Webinar on advocacy. The webinar focused on standard and important psychiatric issues, such as improving access to substance abuse treatment. Gender-affirming care was not mentioned once. Congrats, APA.
Conversely, the American Academy of Pediatrics keeps signing onto Amicus briefs filled with ideology and misinformation. Some pediatricians may take the time to read the Cass Review and have the courage to start the reforms needed at AAP.
As noted in a recent article, children have a right to an "open future," that is, to grow into adults with a full range of life choices (Jorgenson 2024).
Having the final Cass Review allows us a high-quality road map forward.
"Mermaids don't have a leg to stand on"
Great article