The New York Times, which has become notorious for its bad coverage of trans issues, has at least twice (6/9/23, 11/14/22) uncritically presented the speculative claim that puberty blockers “lock in” kids on a pathway toward subsequent treatment with cross-sex hormones. Both articles cited a portion of a report by Dr. Hillary Cass, commissioned by the English National Health Service to review its gender-identity services:
“The most difficult question is whether puberty blockers do indeed provide valuable time for children and young people to consider their options, or whether they effectively ‘lock in’ children and young people to a treatment pathway,” Dr. Hilary Cass, the pediatrician overseeing the independent review of the NHS gender service, wrote last year.
The Cass review provided no studies indicating that blockers “lock in” children toward a treatment pathway. Instead, it cited two small studies showing that nearly all participants who start blockers (96.5% and 98%) proceed to cross-sex hormones.
Hinkle’s ruling points out two problems with this claim that the Times doesn’t. First, this is correlation, not causation. Second, there’s a more plausible explanation, backed by research, that most kids proceed to cross-sex hormones because they had persistent transgender identities before starting blockers:
The defendants note that 98% or more of adolescents treated with GnRH agonists progress to cross-sex hormones. That is hardly an indictment of the treatment; it is instead consistent with the view that in 98% or more of the cases, the patient’s gender identity did not align with natal sex, this was accurately determined, and the patient was appropriately treated first with GnRH agonists and later with cross-sex hormones.
(Emphasis original.)
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seems to me that if 98% of people starting puberty blockers for gender dysphoria go on to gender affirming HRT they could just skip the $2000 a dose lupron shots and start the 20 cents a pill HRT, but cis people aren’t ready for that conversation yet because they see every trans person as a failed cis person who they could get back if they just tried hard enough to make them cis
Apologies for a rather rambling reply but this is good news and I was curious so I looked into some of the source material. I’m going to spoiler tag my comment as I imagine this could be a difficult topic to read about for some comrades.
spoiler
Adolescence is a confusing-enough time for most children. So I can see how there would be a few cases where a child wants puberty blockers to give themselves some time to work things out but then decides against further treatment.
But the judge’s finding makes sense. The decision to take puberty blockers must be difficult. There will likely be medical worries, not to mention the amount of stick that a child might expect to go through from their peers. It won’t be a decision taken lightly.
Just looking at the Cass Review. Something to be actually scared about on pp. 69–70: a subtle language of service privatisation. Hopefully the Review isn’t used to improve trans healthcare in with one hand only to undermine it with the other.
As quoted in the OP, the review does state (p. 38):
“The most difficult question is whether puberty blockers do indeed provide valuable time for children and young people to consider their options, or whether they effectively ‘lock in’ children and young people to a treatment pathway”
Immediately afterwards, the report adds:
The reasons for this need to be better understood.
Looks like the Times article also didn’t understand the concept of interim in ‘Interim Report’, that it will outline what work will be conducted before the final report. Then again, the Cass Review does include some contradictory statements. A few paragraphs later, it summarises Cass’s personal views (p. 39):
… the assessment process is inconsistent across the published literature. The outcome of hormone treatment is highly influenced by whether the assessment process accurately selects those children and young people most likely to benefit from medical treatment. This makes it difficult to draw conclusions from published studies.
Call me biased, but it seems to me that if >95% of children who take puberty blockers decide later to take feminising/masculinising hormones, the assessment process is just about as accurate as one might hope it to be. Unless Cass is saying that we have no way of knowing how many people who should have healthcare aren’t getting it. That would be a bit different.
There’s a relevant summary of the judgment of Bell v Tavistock, too:
Specifically, because most children put on puberty blockers go on to have feminising/ masculinising hormones, the judgment said a child would need to understand not only the full implications of puberty blocking drugs, but also the implications of the full pathway of medical and surgical transition.
It seems the judges in Bell missed the part about pausing puberty in order to be able to make a fully informed and more permanent decision later.
