Trans bans

It is not often that an almost 400-page report is greeted with such a reception, sparking colourful and widespread debate. But the Cass Review, an independent report into the UK's gender identity services for under-18s, has achieved just this.

Led by paediatricianA doctor who works with children. Dr Hilary Cass, the report alleges that young people are being "let down" by the lack of substantial evidence on medical interventions related to gender identity.

"The reality is we have no good evidence on the long-term outcomes of interventions to manage gender-related distress," Dr Cass writes, expressing concern that gender clinics have been too hasty in prescribing "treatments" which have not been assessed for their long-term safety.¹

Guidance in trans healthcare has changed dramatically in recent months and years. Just weeks before the publication of the Cass Review, NHS England announced that puberty blockers - hormonesChemicals created inside living creatures. They are used to send messages from one part of the body to another. which halt the progression of puberty temporarily - would no longer be routinely prescribed to children at gender identity clinics.

Meanwhile, from the age of 16, those who meet the clinical criteria for gender dysphoriaFeelings of discomfort or stress a person feels due to a mismatch between their gender identity and their sex assigned at birth.  may now be given gender-affirming hormones (testosteroneThe hormone that causes people to develop male sexual characteristics. Women also produce some testosterone. or oestrogenFemale sex hormones. After the menopause, these can increase the risk of cancer.).

There has been a spike in young people accessing gender identity services in recent years. In 2009, the gender identity development service of the NHS saw fewer than 50 children in a year. By 2021-2022, this had increased a hundredfold to more than 5,000.²

This has led to huge backlogsPlural of backlog, meaning an accumulation of unfinished work.. For trans people, the wait for a first appointment at a gender identity clinic can be five years or more, despite a target of 18 weeks.³

Young trans woman Ellie Gomersall says that the report's criticism of prescribing puberty blockers for trans youth fills her with "fear", as she recounts her experience of going through male puberty.

"Knowing I was a girl, the irreversible change of my body caused me much distress," she says.⁴

The UK has been at the centre of a raging debate over transgender issues, with some describing it as a "moral panic". This has been fuelled by vitriolicFilled with criticism or malice. political disagreements.

Recent surveys show that 94% of trans people are happier after medically transitioning.⁵ Some say that we should pay heed to these positive experiences, rather than letting political disagreements restrict trans people's access to potentially life-saving healthcare.

But others express concern that the polarisingTo cause people to divide into two opposing groups. debate means that some in the medical field are scared to express their doubts and concerns about gender-related treatments, for fear of condemnation.

Should politics stay out of medicine?

Yes: Policymakers should have nothing to do with medical decision-making. This should be done purely on evidence-based research, and the evidence shows that transitioning makes the vast majority of transgender people happier.

No: Politics has its place in medicine. It is where many people find representation of their concerns, and at present, trans healthcare is a central concern for many.

Or... Expressing concern about the rapid rise in gender-related treatments in the past decade is not "political". Nor is making reasonable statements about the fact that we are not aware of the long-term effects of some treatments.