Time for some honest reflection? We can but hope...

Dr Hilary Cass is the Chair of the Independent Review of gender identity services for children and young people. The Review was commissioned by NHS England to see how gender identity services could be improved so that children and young people questioning their gender identity receive a high level of care that's safe, appropriate and holistic. The Final Report can be downloaded as a PDF from here. Below are the key findings and recommendations taken from this page here.

Overview of key findings

There is no simple explanation for the increase in the numbers of predominantly young people and young adults who have a trans or gender diverse identity, but there is broad agreement that it is a result of a complex interplay between biological, psychological and social factors. This balance of factors will be different in each individual.

There are conflicting views about the clinical approach, with expectations of care at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services.

An appraisal of international guidelines for care and treatment of children and young people with gender incongruence found that that no single guideline could be applied in its entirety to the NHS in England.

While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.

The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate.

The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services.

The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.

The use of masculinising / feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.

Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.

For most young people, a medical pathway will not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.

Innovation is important if medicine is to move forward, but there must be a proportionate level of monitoring, oversight and regulation that does not stifle progress, while preventing creep of unproven approaches into clinical practice. Innovation must draw from and contribute to the evidence base.

Overview of Recommendations

The recommendations set out a different approach to healthcare, more closely aligned with usual NHS clinical practice that considers the young person holistically and not solely in terms of their gender-related distress. The central aim of assessment should be to help young people to thrive and achieve their life goals.

Services must operate to the same standards as other services seeing children and young people with complex presentations and/or additional risk factors.

Expand capacity through a distributed service model, based in paediatric services and with stronger links between secondary and specialist services.

Children/ young people referred to NHS gender services must receive a holistic assessment of their needs to inform an individualised care plan. This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment.

Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress from gender incongruence and cooccurring conditions, including support for parents/carers and siblings as appropriate.

Services should establish a separate pathway for pre-pubertal children and their families. ensuring that they are prioritised for early discussion about how parents can best support their child in a balanced and non-judgemental way. When families/carers are making decisions about social transition of pre-pubertal children, services should ensure that they can be seen as early as possible by a clinical professional with relevant experience.

NHS England should ensure that each Regional Centre has a follow-through service for 17–25-year-olds; either by extending the range of the regional children and young people’s service or through linked services, to ensure continuity of care and support at a potentially vulnerable stage in their journey.  This will also allow clinical, and research follow up data to be collected.

There needs to be provision for people considering detransition, recognising that they may not wish to re-engage with the services whose care they were previously under.

A full programme of research should be established to look at the characteristics, interventions and outcomes of every young person presenting to the NHS gender services.

The puberty blocker trial previously announced by NHS England should be part of a programme of research which also evaluates outcomes of psychosocial interventions and masculinising/ feminising hormones.

The option to provide masculinising/feminising hormones from age 16 is available, but the Review recommends extreme caution. There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18. Every case considered for medical treatment should be discussed at a national Multi- Disciplinary Team (MDT).

Implications of private healthcare on any future requests to the NHS for treatment, monitoring and/or involvement in research, and the dispensing responsibilities of pharmacists of private prescriptions needs to be clearly communicated.

There's a lot to take in with this report and rightly so. It looks at what is a complex, sensitive and highly emotive issue. Looking at the above, it has arrived at findings and recommendations that will hopefully ensure children and young people do not embark on a pathway of irreversible surgery and a lifetime on medication if other alternatives are available. Basically, it's a step on the way to preventing the needless harm that will result from children and young going down a pathway that seems to be dictated more by ideological motivation than any sound medical rationale. Needless harm that comes from surgical procedures and medications that arguably, are experimental as opposed to proven and above all, safe.

Before we go any further, we like it to be noted that we have no issues with anyone wanting to question rigid gender roles and the expectations that come with them. We understand that for quite a few people, the expectations placed upon them by how other think they should conduct themselves based on gender stereotypes can cause considerable psychological distress. People should be free to live their lives how they want and not be constrained by the gender roles some would force upon them because of their biological sex. However, when some who should know better choose to play God by selling the illusion that surgical and pharmaceutical interventions are the answer to the anguish caused by the expectations resulting from rigid gender roles, it's time to ask questions and speak up.

That's asking some searching questions about who's really benefiting from this push towards surgery and a life long reliance on pharmaceuticals. Questions that are eloquently raised and answered in this piece: The Industry Of Artificial Sex Characteristics And The Dissolution Of Our Human Boundaries - Jennifer Bilek | The 11th Hour | 27.2.24:

The artificial sex characteristics of the gender industry are not real. They are products in a developing medical-tech market. They do not inherently alter the individuals who acquire them or endow them with any special human attributes. Instead, they primarily influence our perception of reality, serving the profit-driven agenda of the industry.

Although still in its infancy, the industry focused on self-actualized sex through commodification is experiencing rapid growth. It is imperative that we grasp the nature of this situation to avoid being drawn into the constructed virtual reality it seeks to impose upon us. We must question whether we want to inhabit a manufactured environment where individuals are reduced to commodities and reproduction is facilitated through medical technology, or as part of the natural world. How far is too far, in experimenting with the line between reality and technologically constructed humans?

Now, we'd like to think that the report from Dr Hilary Cass would prompt at least some people to pause, think about the positions they have taken on transitioning over the years, and start to reconsider them in light of the findings and recommendations. We'd also like to think that they would start to engage in some respectful debate on what is a complex issue. Our gut feeling is that some may well choose to go down this path. However, with the monitoring we do of a number of gender identity ideologues, it's clear they're doubling down. People doubling down on tenaciously held positions is not a pretty sight to behold - in fact, it's downright ugly!

For us, our introduction to how toxic the issue of gender identity was becoming came at the ill fated London Anarchist Bookfair which took place on Saturday 28 October, 2017. Toxic to the point of the event being disrupted by a number of zealous (and arguably, unrepresentative) trans rights activists who objected to the presence of gender critical and radical feminists at the event. This is a piece I wrote just over a year ago which in part, dealt with the difficulties we had in dealing with people who adopt an almost Maoist adherence to certain beliefs - Why do I do this to myself? 12.4.23:

I could have taken the easy path of not questioning gender identity politics and simply gone along with it. The thing is, if I had chosen that path, I would have been living a lie. I may still have had a few more 'friends' but I would have been getting sucked ever further into something my conscience and intellect could not go along with. At the end of my life, I want to look back and think that as far as was possible, I did the right thing, regardless of the cost. Although to be honest, losing 'friends' with an almost Maoist adherence to their beliefs wasn't exactly a loss! 'Friends' who often exhorted people to 'be kind' but who made no effort to practice that themselves.

As a bit of an aside, the zealous, unquestioning adherence to gender ideology was carried over by a fair number of anarchists who turned on anyone questioning the narrative we were being fed during the Covid 'crisis' in 2020 and 2021. It was the same tactics of smearing, insults, exclusion and a blank refusal to engage in any serious questioning about what was being done to us, let alone engage in a reasonable debate with anyone raising legitimate questions and concerns. This is what I wrote about this in this piece - Why do I do this to myself? 12.4.23:

The differences over the immediate impact of the lockdowns and restrictions were bad enough. It was when I started to look at how the Covid 'crisis' was being leveraged to accelerate the implementation of the Fourth Industrial Revolution (4IR) a.k.a. the 'great reset' that things started to get really weird. Weird in that I was left wondering what the f**k happened to what was supposed to be the questioning spirit of anarchism? Weird in that anyone writing anything about the way the crisis was being leveraged to bring about the 4IR was being labelled a 'conspiracy theorist'. Weird in that so many 'anarchists' fell into lockstep with a lot of the narrative that was being pedalled to keep people complying with the restrictions, the (anti)social distancing, the masking and dutifully getting a jab of a experimental mRNA. Weird in that not only did they buy into the narrative, the f**kers were actively enforcing it and shaming anyone who didn't comply. 'Anarchists'? Maoist zealots would be a lot closer to the truth with some of them.

Two different situations but with the same tactics being brought into play. It really does make you wonder what happened to the questioning spirit that used to be a part of anarchism in past decades. How a substantial part of a movement can be ideologically captured in this way raises a lot of questions that need to be answered. It's enough to make you a conspiracy theorist, isn't it?

As previously mentioned, the doubling down on entrenched positions on gender identity is already underway. Living just outside of Bristol, we're arguably too close for comfort to some of those engaging in the doubling down. So why are we courting possible trouble by publishing this piece? As we've made a conscious decision to avoid being at the same events as those engaging in the doubling down, we feel that we've got enough leeway to get away with posting this without any comeback. Sadly that's not the same for a lot of gender critical and radical feminists who have been subjected to some pretty vile abuse and threats.

Anyway, returning to the report by Dr Hilary Cass and whether it will prompt some honest reflection, we'd like to think that it would but, we're not going to be holding our breath waiting for it. Should any self identified anarchists raise their heads above the parapet and speak out in support of the findings and recommendations in the report, we will offer them our full solidarity.