Cass Report

[Emily's Cat]

Doesn’t sound like something Singal would do. A lot of doctoral theses may indeed seem ridiculous and journal papers may seem “inarguably inane” according to a quick scan of the title, but that doesn’t always mean the research wasn’t well done and/or that the researcher hasn’t cut their teeth doing the research itself.

It's Colin Wright - found some of the references.

This is just "oh that sounds silly", these are things like "The earth is a big badass butch dyke in menopause" being published in the National Library of Medicine. If it were an op-ed in Pink, okay, maybe... but in an actual medical journal, this is just trash. It's not science at all, it's ideological projection wrapped in Butleresque obfuscatory jargon.

There are probably bigger problems when people do research that has more consequential outcomes but which turns out to be badly done.

There are, unfortunately, a lot of papers that make massive claims about how their drugs can treat Alzheimer’s or cancer which turn out to be fraudulent or overhyped. Or indeed, make astonishing claims about the value of puberty blockers or hormones that turn out to be badly done.

I agree that the focus should be on quality of research and unsubstantiated claims, etc. But when the journals are selecting "peer reviewed research" on "Glaciers, gender, and science: A feminist glaciology framework for global environmental change research" instead, and pretending that it's somehow "science"... that gets in the way of even being able to consider the shortfalls of actual research. It's nonsearch all around.

Re: Glacier BS, here's Wright's critique of the impact of crap like this getting published as if it were actual science.

 

[d4m10n]

Just realized that this post actually makes more sense here:

Post in thread 'Transwomen are not Women - Part 15'

Jul 16, 2025

In U.S. political news, we've swung from the advocacy of Adm Levine to FTC hearings on the dangers of gender affirming medicine.

The Dangers of “Gender-Affirming Care” for Minors

The official website of the Federal Trade Commission, protecting America’s consumers for over 100 years.

www.ftc.gov

• d4m10n

 

[Elaedith]

The 2018 AAP statement on gender affirming care for minors was rated low quality in the systematic review of international clinical guidelines conducted for Cass. This was no surprise to many of us as we had discussed issues with these guidelines some time before Cass.

In August 2023 the AAP announced that it would conduct a systematic review of evidence as part of the update of guidelines that typically happens around every five years. In the meantime, it announced an intention to stand by existing guidelines which are not based on systematic review (the highest form of evidence on the EBM hierarchy), but on expert consensus (the lowest form of evidence). This is despite the guidelines now contradicting findings of multiple systematic reviews from other countries.

As of now (two years after the systematic review was announced) there is no word on the AAP systematic review, and the 2018 clinical guidelines have not been updated. Moreover, it appears that there is no pre-registration for the systematic review. This suggests that if the AAP does produce a review in the near future it will be without pre-registration. Without this, there is no way of tracking progress or checking if any methods were altered to manipulate outcomes.

If the AAP produces a systematic review in favour of gender affirming care without any pre-registration at all, will all the activists who tried to attack Cass for departing from some details in the pre-registration (despite not being able to show that these affected the outcomes), completely dismiss the AAP review, I wonder? I suppose they will, the same way that they are all condemning WPATH for supressing publication of its systematic reviews altogether, right? /s

 

[angrysoba]

This might be the best place for this pair of articles by Jesse Singal, as they cover much of the same ground as the Cass Review.

This is one area where I think the words “ideologically captured” fits well, as it describes the stance of a researcher who thinks, on the one hand, that there is little evidence for the treatment of certain transgender interventions and yet who does not want to approve of systematic studies that show this because they are politically problematic….

The Disaster At McMaster, Part 1

Scholars are being “traumatized,” a long-running collaboration is being torched. . . what is going on?

open.substack.com

The Disaster At McMaster Part 2: My Interview With Gordon Guyatt

“They’re all *terrified*. They’re all *traumatized*.”

open.substack.com

Full disclosure, I have not had time to read in their entirety. The first is a summary of the background, the second is an interview with the researcher.

 

[angrysoba]

Specifically, they relate to this statement…

https://hei.healthsci.mcmaster.ca/systematic-reviews-related-to-gender-affirming-care/

Members and allies of 2SLGBTQIA+ communities have raised concerns about recent systematic reviews related to gender-affirming care. These concerns center on the funding source, and specifically on the potential for the research to be misused to harm trans youth and to deny gender-affirming care.

Prompted by these concerns, the authors of the systematic reviews have shared the following:
In contrast to the way findings and presentation of our systematic reviews have been misrepresented and misinterpreted, they in fact show that, like the majority of what we do as physicians, the outcomes of specific aspects of care for transgender patients remain uncertain. The appropriate response to such uncertainty is shared decision-making that fully respects the autonomy of the individuals involved. Therefore, we have prepared the following letter related to our SEGM-sponsored systematic reviews: ….

It continues.

There are five signatories including Gordon Guyatt, who Jesse Singal interviews (and it is surprising that he gave an interview to Singal.

 

[angrysoba]

A bizarre saga in which essentially the researcher , Guyatt, believes the work is of high standard and does not dispute the finding that there is low evidence of low quality for the GD interventions but nonetheless does not want to associate with the SEGM anymore because to do so risks being considered transphobic, and because the results are convenient for those who say that such GD interventions lack good quality evidence:

“
Singal: I get a biased sample of parents who have at least some skepticism. But, if you’ll pardon my French, it’s a ◊◊◊◊◊◊◊ disaster that you cannot necessarily trust the guidelines put out by the Endocrine Society, the AAP, WPATH. I can’t imagine a worse situation for parents to be in.
So the general arrangement you guys came to with SEGM, where SEGM will give you guys funding and will give you independence to do these systematic reviews, three of which you’ve published, that just strikes me as very important work. I mean, the example that just came out—
Guyatt: Oh, I agree. When I participated in this it was because I thought it was valuable work, for sure.
Singal: Sure. Right. So three of the five reviews have come out. There was just one that was published in Plastic and Reconstructive Surgery. This is a systematic review of double mastectomies performed on individuals under 26 to treat GD.
People debate how often it happens in the States. [But] kids as young as 13, according to published research, get double mastectomies to treat gender dysphoria. I think it’s disastrous that you guys. . . it took us until 2025 for anyone to actually look at the evidence. So, wouldn’t a defender of SEGM say, “This is a very important result for people to have access to”? Like, what’s the problem with you partnering with SEGM on something like this, if you have full independence?
Guyatt: Because we are discredited by our association with SEGM.
Singal: Because if — and SEGM denies this — but you’re saying if SEGM is against these treatments. . .
Guyatt: No, irrespective of anything else, we are discredited by the. . . I don’t know how much, by some, some people in the. . . our audience is the trans community!
Singal: Your audience is the trans community?
Guyatt: Sorry?
Singal: What do you mean by that? Isn’t your audience just anyone. . .
Guyatt: Who’s making the decisions? Our reviews are to inform shared decision-making.
Singal: Okay. Isn’t your audience anyone — I mean, the public, but also — sorry, go ahead.
Guyatt: I agree, we have multiple audiences. One of our key audiences is the individuals facing this decision who should know about the evidence. And to be discredited, to have our work potentially discredited by an association with SEGM in [the eyes of] the people who are faced with this decision is very problematic.
Singal: But what if you’re being discredited for inaccurate or unfair reasons?
Guyatt: Well, do they know that?
Singal: Does who know that?
Guyatt: When the people who are upset at us for associating with SEGM write in the newspaper, “These reviews are pseudoscience. . . ””

 

[d4m10n]

I don't think Dr. Guyatt (*snickers in Gen Z*) is being particularly unfair when he characterizes SEGM's position on gender medicine as essentially “Don’t make these procedures available.”

What's your take @angrysoba?

 

[angrysoba]

I don't think Dr. Guyatt (*snickers in Gen Z*) is being particularly unfair when he characterizes SEGM's position on gender medicine as essentially “Don’t make these procedures available.”

What's your take @angrysoba?

My take is that, from what I can gather, Guyatt, and the other McMaster researchers had full autonomy to produce their reviews. They did so, Guyatt then apparently discovered that SEGM had funded them, and so he no longer wanted the forthcoming reviews to bear his name.

I think he should stick to his original principle of “publish and be damned” as that will happen anyway regardless of the SEGM connection and regardless of the outcome of the reviews.

Which is a long-winded way of saying it doesn’t matter what SEGM’s editorial line is.

 

[Elaedith]

I don't think Dr. Guyatt (*snickers in Gen Z*) is being particularly unfair when he characterizes SEGM's position on gender medicine as essentially “Don’t make these procedures available.”

What's your take @angrysoba?

Did you read Singal's piece?

"I had difficulty getting a straight answer out of Guyatt about exactly what was wrong with SEGM. He kept saying that SEGM favored bans on youth gender medicine, which SEGM has consistently denied. He couldn’t provide evidence; the emails he forwarded to me did not support this claim."

 

[d4m10n]

Are we skeptical of SEGM's denials or are we credulous?

Seems to me they would need superlative self-control not to get polarized on these issues along with almost everyone else.

 

[d4m10n]

Which is a long-winded way of saying it doesn’t matter what SEGM’s editorial line is.

I think that's fair, and probably the best approach for someone who believes they already conducted a fair and impartial assessment.

That said, it's pretty normal for us to be much more skeptical of research whenever we believe it was funded by a group with a specific political agenda.

 

[d4m10n]

Did you read Singal's piece?

Only the second one so far.

 

[Elaedith]

Are we skeptical of SEGM's denials or are we credulous?

Seems to me they would need superlative self-control not to get polarized on these issues along with almost everyone else.

Are you sceptical of Guyatt's claims or are you credulous? Isn't somebody making a claim supposed to produce the evidence to first before we examine the rebuttal? Everyone I have seen in the interviews with Guyatt suggest he is more concerned with the perceptions about SEGM (as a result of smear campaigns) than about truth. That is disappointing and dangerous for the future of EBM as Singal pointed out. Appeasing activists who use smear campaigns to suppress scientific evidence that contradicts their political narrative emboldens them.

 

[d4m10n]

Are you sceptical of Guyatt's claims or are you credulous?

Fairly credulous, but then I'd already concluded that the SEGM folks are generally against gender medicine for minors and don't really mind treatment bans so long as they don't go after psychotherapy in particular.

Isn't somebody making a claim supposed to produce the evidence to first before we examine the rebuttal?

Fair enough. What sort of evidence would convince you that SEGM is in favor of the bans which cited their research as partial justification?

 

[Elaedith]

Fairly credulous, but then I'd already concluded that the SEGM folks are generally against gender medicine for minors and don't really mind treatment bans so long as they don't go after psychotherapy in particular.

I agree that SEGM generally favours scaling back on gender-affirming treatment because that is an evidence-led position based on current knowledge about potential benefits and harms. I think the majority would prefer that clinicians engaged in more evidence-based practice and self-regulation, thus not necessitating outright bans.

Fair enough. What sort of evidence would convince you that SEGM is in favor of the bans which cited their research as partial justification?

That they adopted a position of favouring bans rather than a neutral position.

That said, I don't think Guyatt's actions have anything to do with SEGM's position on this. He admitted in the interview that even if he is wrong about that he would still disassociate from SEGM because of the perception that the association creates.

"Guyatt: —is. . . let’s say SEGM is well-behaved EBM and I’m wrong. We still shouldn’t partner with them, because you get tarred and feathered in the same way by participating with SEGM. In a certain group in the community, who’s an important group, you get discredited."

 

[d4m10n]

That they adopted a position of favouring bans rather than a neutral position.

Been around activist groups often enough and long enough that I've been tempted to coin a term or phrase for when it's best to take an officially neutral position even though nearly all the core activists in the group take a strong stance. Church-state separationists, for example, may proclaim religious neutrality while being populated mostly by atheists and agnostics with only a smattering of people from progressive faiths to leaven the loaf. If you look at the core group publishing at SEGM you will find individuals who actually have strong opinions on whether psychotherapy should be the first line treatment for gender diverse youth (yes) and whether adopting the endocrine pathway was a regrettable mistake (also yes).

I don't think Guyatt's actions have anything to do with SEGM's position on this.

He seems to be saying that it is the general consensus around SEGM that matters in terms of how he is perceived within his professional community, and I'm not about to disagree with him on this. As an idealist, I'd rather he took the “publish and be damned” approach suggested by @angrysoba, but as someone who needs my career to outlast my mortgage, I understand how much reputation matters to symbolic capitalists in general and academics in particular.

 

[d4m10n]

Just to give a little more context here, consider how the highly reputable and well-credentialed folks at Yale Medicine characterize both WPATH and SEGM:

LGBTQ+ Youth

On February 18, 2022, Texas Attorney General Ken Paxton issued an interpretation of Texas state law (the “AG Opinion”), taking the position that certain medical

web.archive.org

I'm not saying the Yalies are beyond question (or even correct) but I am saying that academia runs on reputation and right now one of those groups is considered quite marginal while the other is taken to be issuing standard protocols.

 

[angrysoba]

He seems to be saying that it is the general consensus around SEGM that matters in terms of how he is perceived within his professional community, and I'm not about to disagree with him on this. As an idealist, I'd rather he took the “publish and be damned” approach suggested by @angrysoba,
but as someone who needs my career to outlast my mortgage, I understand how much reputation matters to symbolic capitalists in general and academics in particular.

Yet he claims that he is invulnerable and also worries about discrediting the university. To me it is a bigger discrediting that he refuses to put his name to his research and allow it to be published because he doesn’t like who funded it.

There could be time, and it could be during his career, when somebody unsatisfied with their GD treatment might be looking for someone to sue. If they discovered that some research they otherwise could have made us of was deliberately suppressed by a scientist at a university specifically tasked to look at the evidentiary basis of their treatment…. Well it won’t be the university’s credit.

 

[ahhell]

He's in a bit of a bad position. He might be right that association with SEGM would make him less credible and trusted in his field of work. Even if it it's based on total BS, that would put him in a bad spot.

To be clear, I have no idea if SEGM reputation as being for GAC bans is deserved. I'm just saying that whether or not it is deserved, that could be a problem for him in his career. It would be brave of him to go ahead take the heat if he believes his work is not actually biased by that affiliation but, I'm not going judge him too harshly.

 

[angrysoba]

He's in a bit of a bad position. He might be right that association with SEGM would make him less credible and trusted in his field of work. Even if it it's based on total BS, that would put him in a bad spot.

To be clear, I have no idea if SEGM reputation as being for GAC bans is deserved. I'm just saying that whether or not it is deserved, that could be a problem for him in his career. It would be brave of him to go ahead take the heat if he believes his work is not actually biased by that affiliation but, I'm not going judge him too harshly.

I wonder which trans rights activists are going to say “I was worried about Guyatt’s association with SEGM for a second, but I’m glad he cleared up what he thinks in an interview with…. *checks notes* … Jesse Singal.”