In Praise of Cass
And some light shed on her critics
“No one out there really cares about this transgender stuff”, the senior BBC News executive told me when I asked about the low level of coverage of the publication of the Cass Review. “According to all the metrics the audience is not engaged with this story. Despite the sound and fury they just don’t think it’s that important.” I’ve tidied up the language here - they’re a potty-mouthed bunch, news executives.
The problem with this formulation is that plenty of things that don’t engage the general public turn out to have significance. It is very doubtful that the average fourth century Bithynian peasant had much to say about whether Jesus was coeternal with God. All the same the schism that this question caused within the early Christian church, the virulence of the dispute about it and the way it was resolved (much excommunication and not a little exiling) echoes down the centuries and helped structure the modern Western world. Whatever the ratings at the time.
Anyway it seemed a rare event when on Tuesday morning Mishal Husain presenting the Today programme asked the Chief Medical Officer for England, Sir Chris Whitty about his response to the Review, pushing him on what it had said about how children presenting with gender dysphoria had been treated for over a decade. Whitty replied that he supported the review and welcomed the “opportunity to rethink” in the midst of a debate he described as “vitriolic”.
The link to the full 388 page review is here:
https://cass.independent-review.uk/home/publications/final-report/
And early on Hilary Cass and her team - given the job over three years ago of reviewing the operation of the youth gender identity service provided by NHS England – refer to how the tone of the discussion on the issue of transgenderism had affected their work, writing that:
One of the major challenges for the Review has been the difficulty in having open, honest debate as people with differing views can find it uncomfortable to sit together in the same room or on the same stage.
For me the Review’s measured tone and insistence on evidence rather than rhetoric and emotion comes as a massive relief. It may not occupy much head space for the viewers of the Ten O’clock News but the way in which the various arguments around gender have developed in the last decade has been one of the most poisonous and friendship-splitting phenomena of recent times. This has not been by any means a symmetrical process, but it has certainly radicalised many of those involved, whichever line they’ve taken on sex and gender.
The Cass Review does not tell you about gender self-identification, women’s prisons, changing rooms or women’s sports and how to reconcile the rights of transgender people and others (by whom I mean overwhelmingly women. For example transmen are unlikely to make any impact on men’s sports). Cass doesn’t resolve any questions of what has come to be called a “gender critical” stance versus “gender ideology”. But it does strip a lot of the clamour – the sheer noise - out of an aspect of the debate that affects vulnerable young people and points the way to how those other discussions might be handled.
I have read the full report but some parts with more attention and understanding than others. For example the discussion of the structuring of future services and the protocols that should govern them are well beyond my area of competence, but necessarily take up a lot of the text and form many of the recommendations. In particular I was interested in what the Review’s chosen partner, the University of York’s evidence review team had to say about the basis upon which up to 2000 young people had been referred by the Gender Identity Service (Gids) to endocrinologists for puberty blockers over a decade. (Incidentally a friend pointed out to me this week that there might be questions to be asked about what protocol these endocrinologists were observing.)
I have cherry-picked a number of connected aspects of the Review that stood out for me. The first concerned the data on the demographics of referrals to adult gender clinics. Though incomplete this showed that around 70% of referrals were for birth-registered females under 25. Strikingly:
Clinicians confirmed the changing demographic as demonstrated by the data above. They described how this changed over a 2-year period between 2017 and 2019, from a mixed age range group with a majority of birth-registered males to 70-80% birth-registered females under the age of 25.
Clearly something was going on here. The question was what? More on that in a moment.