Comment by gadders | Hacker News Reader

Comment by gadders | Hacker News Reader

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The Cass report in the UK was pretty clear that there isn't enough evidence to base decisions on https://cass.independent-review.uk/home/publications/final-r...

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While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.

The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate.

The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services.

The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.

The use of masculinising / feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.

The Cass report is pretty questionable quality wise - it was written with political goals pretty directly in mind and it rules out a lot of studies for not being double blind. (Which is necessarily a hard ask here, medical ethics boards aren't going to let you give hormones to the control group children or anything.)

And that criticism has come from medical boards in the UK and globally, I believe?

Anyway, that's also only for children, which feels politically like a wedge issue. The NHS is very slow at providing HRT and I rather doubt they're treating more than a hundred children for gender dysphoria in any way rn.

This is a common misconception about the review. It is true that none of the studies they looked at were double-blinded but they were still included if they were designed and conducted well enough. In a Q&A shortly after the review's release Cass demonstrates that she is well aware that exclusion based on this would be silly.

https://thekitetrust.org.uk/our-statement-in-response-to-the...

The amount of myths circulating about the review prompted the publishing of an FAQ page which deals with some of the more egregious examples (e.g. the claim that 98% of studies were rejected).

https://cass.independent-review.uk/home/publications/final-r...

I think it's naive to call a series of "myths" coming from the same camp as misconceptions.

There was a (successful) effort to push misinformation regarding the report.

What's the basis for the claim that the Cass Review was written with political goals directly in mind? Is this just based on the conclusion of the report, or is there actual substance for this statement?

Most of the criticism of the Cass Review comes from the US. Most of Europe has either stopped prescribing puberty blockers and cross sex hormones for minors or never did in the first place. The UK is joining the consensus among the majority of developed countries regarding treatment of gender dysphoric youth, now the US and Canada stand as the sole outliers.

> What's the basis for the claim that the Cass Review was written with political goals directly in mind? Is this just based on the conclusion of the report, or is there actual substance for this statement?

Cass meeting with DeSantis staffers [1], for one

[1] https://www.erininthemorning.com/p/cass-met-with-desantis-pi...

> Notably, Hilary Cass met with Patrick Hunter, a member of the anti-trans Catholic Medical Association who played a significant role in the development of the Florida Review and Standards of Care under Republican Governor Ron DeSantis.

This meeting was held after the Cass Review was published, so it's odd to try and use it to discredit the review itself. Furthermore, Hilary Cass met with hundreds of people to discuss the findings of the review. Is any researcher who ever speaks with Ron DeSantis simply disqualified in your view? Including research published before meeting him?

No, she met with Hunter before it was published:

> A followup email from Hunter indicates that he met with Cass on September 22, 2022 (ECF 184-1). Even as Paul Vazquez wanted to invite Cass to the Board of Medicine hearing as a subject matter expert, Hunter felt that would put her “in a difficult position”:

Why downplay this link in a discussion about the politicization of science?

The interim report - which had the same findings that gender affirming care in minors had scant evidence - was published in March 2022.

Also, that quote is not appearing anywhere in the linked article. Did you post the wrong link?

Again, is the mere fact that Cass - whose job is to advise governments on healthcare - met with someone in government supposed to disqualify the review as politically motivated? What, specifically, did this DeSantis staffer change in the Cass Review?

This is just straightforward attempts at guilt by association. Given that Cass' job is to advise government on healthcare, meeting with government staffers is hardly surprising.

> Also, that quote is not appearing anywhere in the linked article. Did you post the wrong link?

Linked in the article, about her meeting with Hunter

https://genderanalysis.net/2023/11/new-trial-exhibits-in-doe...

> This is just straightforward attempts at guilt by association.

Call him a "government staffer" all you like, let's call it what it is: her meeting with an explicitly religious interest group

Again, can you point out how the report was influenced. We have the interim report published before Cass met with this staffer. We have the final report published after this meeting. Can you elaborate on how it was changed at the behest of this staffer?

> and it rules out a lot of studies for not being double blind

Sorry but you're repeating disinformation that has already been refuted by the lead author, and is obviously incorrect if you read the Review itself.

http://archive.today/ea0Vi

> Dr Hilary Cass, 66, told The Times last week that one activist had begun posting falsehoods about her landmark review of the treatment of trans children before it was even published.

> She was referring to Alejandra Caraballo, an American attorney, transgender woman and instructor at Harvard Law School’s Cyberlaw Clinic.

> On April 9 — the day before the Cass review was published — Caraballo claimed it had “disregarded nearly all studies” because they were not double-blind controlled ones.

> Double-blind studies see patients randomly given either medicine or a placebo, with neither the patient or doctor knowing which.

> In a post on Twitter/X, Caraballo accused Cass and the review team of holding trans healthcare to an “impossible standard”. This was because, she said, transgender patients could not take hormones “blind”, as the effects of any hormones would fairly quickly become obvious.

> Her tweets were contradicted by the publication of the Cass review hours later.

> During a systematic review, researchers looking at studies on transgender healthcare found no blind control ones — so used another system altogether to determine study quality. Cass told The Times last week how difficult it would be to use blind control studies in relation to trans patients, for the same reasons identified by Caraballo.

> As for Caraballo’s claim that the review team “disregarded nearly all studies”, Cass pointed out that 60 out of 103 studies reviewed were used for the conclusions. They were studies deemed to be of moderate and high quality on the effects of puberty blockers and hormone treatment.

> Despite this, Caraballo’s post has been viewed 871,000 times and has not been deleted.

This is unfortunately quite a typical tactic of activists like Caraballo. They will deliberately lie to further their aims, relying on people who are unaware that their lies are lies to spread this disinformation.

The report basically said that there wasn't a lot of evidence that the treatments in question make people happy in the long run, which is an unusual standard to apply. Usually we look for evidence that medical treatments achieve their medical goals, and leave judgments about what will or won't make someone happy to doctors or patients. (For example, it's questionable whether certain cancer treatments that extend life by only a few months will be a net benefit for patients, but we generally let patients and doctors decide for themselves whether or not to go ahead with them.)

Given that the treatments are meant to address gender dysphoria which is unhappiness caused by a sense of misalignment with one's sexual characteristics I struggle to think of a better measure of success than long-term happiness.

It's a good measure of success, but if we applied the same standard consistently, then all kinds of treatments for all kinds of partially psychological conditions would have to be thrown out.

Also, it's taking a particular position to characterise gender dysphoria as merely a subjective feeling of unhappiness. I do not have any fixed position on what exactly gender dysphoria is, but I believe many trans people see it as far more than just that.

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