How Right-Leaning U.S. Press Weaponizes the Anti-Trans ‘Cass Review’
Image; Front page of Cass Report
For years, the scientific consensus on puberty blockers for children has been relatively straightforward. They cause no significant harm, and most of their effects are easily reversible.
As recently as last month, a study presented at the American Physiological Society's annual American Physiology Summit found:
“…that the short-term developmental delay of the uterus and ovaries caused by the puberty-blocking treatment in young female rats was reversible. A majority of reproductive function also recovered immediately after puberty blocking withdrawal. This study can help inform adolescents and their families in the decision to take puberty-blocking medication.”
While more research is always welcomed in replicating this study (especially when confirming these results in humans), this is just one drop in decades of literature on this subject. The research on this topic seems to suggest that such care increases positive mental health and that the effects of puberty blockers are again reversible.
Additional concerns, such as a decrease in bone density and neurological changes, are still not well understood. The prior might be caused by things such as lack of exercise, not from the medication itself, and there is a reported “bone density catchup” when people start taking hormones, but again, more research is needed. These drawbacks don’t seem to outweigh the many benefits.
In the past, anti-trans advocates have cited single studies to counter this consensus, but for a long time, these have been easily dismissed by citing the statements by the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, the American Association of Clinical Endocrinology, and the many, many other medical organizations that recognize the overall positive impact a gender-affirming approach has on development for transgender adolescents.
However, one new review may challenge this viewpoint — not because its methodology is particularly robust — but because it has the backing of a nation’s health service (i.e., the NHS). We are talking about the Cass Review — a meta-study that claims that existing literature is “remarkably weak” despite ultimately not finding any evidence to conclude that puberty blockers create significant harm. The British press has uncritically shared this claim that the Cass Review has disrupted decades of medical knowledge, and that reaction has started to spread to American media as well.
We are seeing a troubling trend as those on the right use this review to dismiss decades of established research so that care for trans people can be chipped away.
This is bad science
From the outset, it should be noted that the Cass Review is flawed. The report applied a highly rigorous standard that did not fit the context of transgender pediatrics. One hundred of the studies it reviewed were labeled as having “low-quality evidence,” which is not a moral judgment, despite how the report may frame it, and means something different in science. The “gold standard” for a study has always been randomized controlled trials, but because of the nature of puberty, doing RCTs for blockers would be entirely unethical and, in some cases, pointless.
As Dr. Sam Wong, president of the pediatrics section of the Alberta Medical Association, told the CBC:
“Within a few months, it’s obvious to the person that they’re on puberty blockers or they’re not on puberty blockers. So … they have feelings and they have impressions of what they should be going through. So that’s going to influence the study itself.”
Additionally, because of the limitations of pesky things such as ethics and subjectivity, there are many situations — not just with endocrinology — where there is only “low-quality evidence” to support care routines. A physician, Dr. Jake Donaldson, continues in that CBC article:
“[Even something as routine as treating a kid’s ear infection with antibiotics or painkillers may not have robust evidence]. That doesn’t mean we just every time we see an ear infection we turn around and walk the other way. Sometimes, an ear infection needs to be treated, sometimes it doesn’t.”
A standard is being applied here that we do not apply to other areas of medicine — one that is transparently discriminatory.
One would think that pediatrician Hilary Cass, the head of the infamous Cass Review, would be aware of this, but it’s clear that her bias is shining through. For example, Cal Horton notes in The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children that the report had many biases, including a source bias, writing:
“…[it does not] cite or engage with an existing body of literature on anti-trans prejudice amongst healthcare professionals…Within Cass Review reports however, quotations from interviewed healthcare professionals do display indications of potential ignorance, bias or anti-trans prejudice. These include healthcare professional quotes that express concern about trans children being created by peer pressure or social media, or the dismissal and belittling of trans children’s identities. All healthcare professional views, including those demonstrating ignorance, dismissiveness or hostility to trans children are presented as valid and valuable inputs to the Cass Review, with no discussion of the potential for anti-trans prejudice or ignorance amongst healthcare professionals.”
This refusal to engage in the existing literature, as well as to screen professionals who hold anti-trans biases, has led to a skewed situation on the solutions recommended in the Cass Review. There is a significant emphasis on advocating for the language of “exploration,” something commonly associated with “Gender-Exploratory Therapy,” which has been likened to conversion therapy. The preferences and comfort of professionals, even ones who are actively discriminatory, are valued over the autonomy of the children in question. The report relies on the language of caution, which, according to Horton, ignores that “conversion therapy can be veiled under a banner of caution,” pathologizing transness as something that might be solved given enough time rather than an identity to be respected.
There is a huge double standard here where the affirmative model is depicted as ideological and aggressive, while non-affirmative models (i.e., conversion therapy) are considered objective. As Horton continues:
“Cass Review commentary positions non-affirmative approaches as ‘neutral,’ contrasting them to affirmative approaches that are framed as ‘ideological.’ There is no recognition of the ideology underpinning approaches that deny the existence or validity of trans children.”
The report is advancing an anti-trans bias while using the language of objectivity to launder those opinions. Dr. Cass has gone on record as being firmly against conversion therapy, so it’s difficult to tell the intent of this language. This may be merely unconscious bias seeping into the report's authors — although, given the apparent gaps we have mentioned, that feels almost too charitable. Her disavowal could also be political cover meant to discourage criticism. It might even be both. Most conversion therapy, after all, is not labeled as such due to the stigma currently attached to it, and that rhetorical distancing may have tricked some authors.
Regardless, this language, whether unconscious or not, is discriminatory and is currently being weaponized by the far-right press.
The response of traditional conservative media
Since the Cass Report is not framed hyperbolically, many believe it to be the height of scientific rigor. “Calm discussions of transgender medicine are rare,” writes The Economist. “With incredible courage,” goes David Brooks in The New York Times, “[Cass] shows that careful scholarship can cut through debates that have been marked by vituperation and intimidation and possibly reset them on more rational grounds.”
These reactions represent a disturbing trend in media, where journalists and other media writers conflate a position being pronounced unemotionally as said position being rational and correct. If something sounds reasonable, few assess whether it actually is.
The aesthetic of moderation is more important to many of these writers here than actual reporting.
However, the truth doesn’t change no matter how loudly and angrily someone says it. The Cass Review is willfully disregarding the science at play, and many trans people are angry about that because they understand how it will be used to take away their rights. If a journalist ignores the truth because it doesn’t always come at them nicely, well, that’s just bad journalism and indicates a profoundly reactionary bias.
Yet the narrative of many conservative opinion writers and journalists is that all the criticisms against the Cass Review are merely coming from over-sensitive activists (and their allies). “In a world without partisan politics,” quips Helen Lewis in The Atlantic, “the Cass report on youth gender medicine would prompt serious reflection from American trans-rights activists, their supporters in the media, and the doctors and institutions offering hormonal and surgical treatments to minors.”
Lewis is insinuating here that it’s the bias of the trans community and their allies that has warped the medical establishment. She is advocating for a conspiracy theory that has no solid basis in reality.
Columnists such as David Brooks and Helen Lewis like to think that they are separate from the conservative, anti-trans movement because they are “nice” about their unexamined bigotry. Brooks even calls Republican-led anti-trans laws “brutal,” but when he advances the same talking points and half-truths as the anti-trans movement, the separation is in aesthetics only. Brooks goes on in his article to promote the widely discredited idea that social contagion could be responsible for the increase in trans youth, writing, “[One theory] is that teenagers are being influenced by the popularity of searching and experimenting around identity.” He may not think he’s as harmful as the Republican legislatures passing anti-trans laws, but by advancing this misinformation, he is walking alongside them.
Someone kindly telling you your rights should be removed is no different than someone doing it cruelly.
In the meantime, while these journalists are laundering bad science because they like the vibes of this report (and left unsaid, they like how it validates their biases), the far-right media is taking that acceptance and running wild with it.
Right-wing people foaming at the mouth
This report had an immediate effect on the confidence of the right in pronouncing the supposed “dangers” of gender-affirming care. Mia Gingerich noted this in her report for Media Matters for America, writing: “Right-wing media were quick to use publication of the Cass Report to claim vindication for their pervasive and politicized anti-trans coverage and to push further extreme rhetoric.”
Gingerich, for example, discusses how Fox News co-host of The Five, Greg Gutfeld, said the report was proof that “people” had purposefully deceived parents and children. He concluded this was a sign of a “proactive attack on vulnerable humans” based on “nonscience.” This comment is a sort of fascistic dog whistle, telling viewers to be worried about the transgender “other” waging an alleged war on their children.
Anti-trans narratives use this misrepresentation to justify and encourage severe “backlash” against trans people and gender-affirming care providers.
With this information, we are seeing even more extreme pronouncements on what should be done next. For example, an article from the Deseret News, which the Church of Latter-Day Saints ultimately owns, said that the report justified the consideration of conversion therapy, writing:
“The concept of ‘conversion therapy’ also needs to be rethought, according to the Cass Review. Given the significantly higher rate of mental health comorbidities of gender dysphoric children compared to controls, it is important that mental health professionals be allowed to investigate whether a child’s gender dysphoria may be relieved through psychological interventions. Proposed bans on ‘conversion therapy’ might stifle such needed therapy.”
For any who doubts the end goal isn’t conversion therapy, here’s the quiet part being said out loud. We see the subtext of the report, which alluded to conversion therapy through indirect talk of Gender-Exploratory Therapy, being made transparent.
And make no mistake, the thing being challenged is the acceptance of transgender people in public life, regardless of what level of medicalization they pursue. “[The Cass Review] should embolden government officials and policymakers to put a halt to the pseudoscience of gender transition,” John Stonestreet and Jared Hayden write in Breakpoint, a publication for an evangelical think tank bent on spreading Christianity. “Not to mention allowing revolutionary gender ideology to influence things like the rewriting of Title IX.”
Far-right commentator Scott McKay goes even further in The American Spectator, comparing those who support gender-affirming care to a father sexually molesting his child. He claims a wife would be justified in murdering her husband for this and, left unsaid, that people would be justified in murdering supporters of gender-affirming care. “…how is ‘transing’ a kid, not an abuse worse than sexually molesting him or her? We’ll let that hang for a while.”
It’s a call to unalive people.
We are seeing this report used as a pipeline where “concerns” over transitioning, most of which are medically unfounded, get used as justification for further discrimination and violence.
A sobering conclusion
The Cass Review has already profoundly impacted trans people in the United Kingdom. Even before the full report was released, the interim one was used as a justification to “restrict” care for transgender people. A quasi-black market for hormones is now emerging, and unlike the exact dosage and regular blood screenings that come from legitimate prescriptions, this will undoubtedly lead to unforeseen medical complications and maybe even deaths.
The danger of the report for Americans is that this will lay the foundation for a counter-narrative for trans care. Republican state legislatures have needed very little evidence, much of it outright fabricated (all of it misconstrued), to begin stripping away trans rights. The perceived legitimacy of the Cass Report provides them even more ammunition.
After all, New York Times op-ed writers are not the only ones who value the aesthetic of moderation over the actual substance and information on an issue. Plenty of Americans pride themselves on being at the center of an issue, even if one of the poles they are moving closer to is an outright lie.
The Cass Review is one block in an emerging, fabricated consensus. Let us hope there is enough time to dismantle it before it ever bears fruit.