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Cass Report

Gender medicine in the US: how the Cass review failed to land

“The time has passed for yet another systematic review,” says Julia Mason, an Oregon paediatrician and member of SEGM who has submitted several resolutions, including the April 2024 one, to AAP for more evidence based guidance. “We now have a dozen high quality reviews (eight Cass, two NICE, one Swedish, one German) all pointing to significant issues with the purely affirmative model of care,” she says. “Parents and their children are being misled in clinics all over the country. There is no evidence that giving puberty blockers followed by hormones and surgery is lifesaving care, and there is mounting evidence that the harms might outweigh the advantages.” The AAP did not respond to The BMJ’s request for comment.​

https://www.bmj.com/content/385/bmj.q1141
 
d4m10n said:
Gender medicine in the US: how the Cass review failed to land

“The time has passed for yet another systematic review,” says Julia Mason, an Oregon paediatrician and member of SEGM who has submitted several resolutions, including the April 2024 one, to AAP for more evidence based guidance. “We now have a dozen high quality reviews (eight Cass, two NICE, one Swedish, one German) all pointing to significant issues with the purely affirmative model of care,” she says. “Parents and their children are being misled in clinics all over the country. There is no evidence that giving puberty blockers followed by hormones and surgery is lifesaving care, and there is mounting evidence that the harms might outweigh the advantages.” The AAP did not respond to The BMJ’s request for comment.​

https://www.bmj.com/content/385/bmj.q1141
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Yes, the WPATH and US medical organisations are doubling down.

In WPATH's statement they appeal to numbers by stating that more nations disagree than agree with the conclusions in the Cass report. However, none of the nations that disagree have conducted systematic evidence reviews. As the report itself found, their medical organisations use guidelines which are not evidence-based, transparent or independent (all cross-referencing each other). It doesn't matter how many medical organisations reach the same conclusion if they didn't reach it independently. In contrast, every country that has conducted independent systematic evidence reviews has reached similar conclusions to Cass.

WPATH itself did commission systematic evidence reviews from John Hopkins, but as the BMJ article states, they published only two of them, and in publishing their own guidelines they ignored conclusions of one of those that found weak evidence. Apparently there was email evidence released in a legal case just recently that showed they tried to suppress publication of their reviews.
 
Dr Cass discusses the WPATH guidelines in this interview on US radio: "WPATH commissioned a systematic review from John Hopkins, which is obviously one of the most credible organizations in the U.S., but then they didn’t refer to that in that part, in the youth part of their guidance. And that was one of the reasons that when our team rated the various guidelines, they rated the WPATH guidelines relatively poorly in terms of the rigor of their development process. Because there were points within the chapter on children and youth where the WPATH team suggested that there was strong evidence and there wasn’t.

So there was a disconnect between the systematic review that they commissioned, and the conclusions that they reached."

The 2022 WPATH guidelines were rated 3 out of 7 in the systematic review conducted at the University of York for the Cass review, where 1 is the lowest possible score (using standard scales for rating clinical guidelines). Guidelines were rated independently by three raters and all gave the same rating; two did not recommend the guidelines for use and one did but with modifications.
 
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d4m10n said:
Gender medicine in the US: how the Cass review failed to land

“The time has passed for yet another systematic review,” says Julia Mason, an Oregon paediatrician and member of SEGM who has submitted several resolutions, including the April 2024 one, to AAP for more evidence based guidance. “We now have a dozen high quality reviews (eight Cass, two NICE, one Swedish, one German) all pointing to significant issues with the purely affirmative model of care,” she says. “Parents and their children are being misled in clinics all over the country. There is no evidence that giving puberty blockers followed by hormones and surgery is lifesaving care, and there is mounting evidence that the harms might outweigh the advantages.” The AAP did not respond to The BMJ’s request for comment.​

https://www.bmj.com/content/385/bmj.q1141
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Considering how many people are upset about the Cass conclusions, I'm surprised there seem to be no rapid responses published to any of the systematic reviews or to the article you cited. BMJ rapid responses are moderated but not peer reviewed. You would think if anyone had clear evidence of methodological problems with the reviews, it would be a simple matter to use this facility to point them out and encourage discussion.
 
Matthew Best said:
Why do you link to a google search, instead of the thing itself? Is there some reason?
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Yeah, I think if it was to point out that there is only one mention of the Cass Report by the American Psychological Association and it’s to an article that is, let’s face it, written in the jargon of sociopolitical woo, then it would have been helpful to at least write that.
 
Matthew Best said:
Why do you link to a google search, instead of the thing itself? Is there some reason?
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It's the only way to show that there is only one document meeting the search criteria on that website.

angrysoba said:
Yeah, I think if it was to point out that there is only one mention of the Cass Report by the American Psychological Association and it’s to an article that is, let’s face it, written in the jargon of sociopolitical woo, then it would have been helpful to at least write that.
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Fair enough; I was trying to make it obvious without leading too much. In your case, at least, the point was clear enough.
 
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My overall impression of that episode was that it wasn't very good.

They state that it challenges points they have made on the podcast before, so it is nice of them to declare an interest.

But the impression I got from the episode was that they did a bit of cherry-picking and strawmanning, and introducing studies from advocates that would probably not be considered very good evidence.
 
angrysoba said:
My overall impression of that episode was that it wasn't very good.

They state that it challenges points they have made on the podcast before, so it is nice of them to declare an interest.

But the impression I got from the episode was that they did a bit of cherry-picking and strawmanning, and introducing studies from advocates that would probably not be considered very good evidence.
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I'm left uncertain. I do think it seems like they found the two studies that confirm their pre-exsitng bias but, I might be doing that too. I was not compelled but i'm not not compelled.

Its an issue where I thin almost everyone has staked a claim and I don't know who to trust.
 
angrysoba said:
Yeah, I think if it was to point out that there is only one mention of the Cass Report by the American Psychological Association and it’s to an article that is, let’s face it, written in the jargon of sociopolitical woo, then it would have been helpful to at least write that.
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d4m10n said:
It's the only way to show that there is only one document meeting the search criteria on that website.

Fair enough; I was trying to make it obvious without leading too much. In your case, at least, the point was clear enough.
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d4m10n said:
Maybe a dozen? It's the biggest systematic review of the most controversial set of issues in their wheelhouse.
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So, I decided to start reading the Cass Report. It's too long to completely read through, but what I have looked at seems interesting enough.

I still haven't listened to that Studies Show podcast episode, which might be more useful to give me an idea of the methodology and how much it conforms to standard practice. The Science Vs podcast didn't do any of that at all, so it gave the impression of cherry-picking data to pretend the whole review was somehow wrong.

But, I did have a look at one of Jesse Singal's articles on this, from not long after the Cass Report was published, and he points out that the American Academy of Pediatrics (AAP) - not to be confused with the American Psychological Association (APA) or the right-wing crazies of the American College of Pediatrics - have indeed commissioned a systematic review having until now put out statements categorically affirming the use of pretty much all gender transition medication for minors.

"The AAP is working on its own systematic review of these treatments, and it has no good outcomes available to it. The choice appears to be between a headache and a disaster: If the systematic review is competently conducted and concurs with all those other systematic reviews, GLAAD will be mad for a few days—maybe it will park a truck somewhere!—and that will be a headache. If the AAP’s findings break from the rest of the civilized medical world, that would be a disaster for the organization. In the long run, institutions and figures will be forced to follow the trail blazed by Europe, not out of any sense of moral duty toward trans and gender-nonconforming youth, which was abandoned long ago, but simply because of the sheer brute force of institutional and reputational incentives. The American era of youth gender medicine being “SETTLED SCIENCE!!!” has reached its sunset. "

Link
 
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