The Vindication of Britain's Feminists
The Cass Review into the treatment of gender-questioning children is devastating. The truth was always there to be seen: many chose not to see it.
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Dr Hilary Cass’s review into the treatment of gender-questioning children by NHS England has finally been published. It is the most comprehensive official report of its kind ever conducted and its conclusions are damning: the unquestioning adoption of gender-affirming care for vulnerable and sometimes confused children has been a disaster. It is difficult to estimate the scale of the damage done by a medical approach which privileged ideological conviction and fashionable absurdity over evidence-based medicine and intuitive good sense.
Here, courtesy of Lucy Bannerman in The Times, is a single paragraph explanation of what happened:
From 2011 onwards, the NHS’s gender clinic for young people sent countless distressed patients to the endocrinology clinic for puberty blockers, even though the imagined benefits rested solely and precariously on a single Dutch study, whose own results were far from conclusive. Even the most optimistic interpretation of the Dutch results ignored that the original participants were screened to filter out young people who already had other conditions, such as autism. No such filter was applied to referrals from Gids, the NHS Gender Identity Development Service.
Worse still, those running the Gender Identity Service (Gids) at the Tavistock clinic in London (the chief centre for children’s gender services), knew there was little clinical evidence to support some clinicians’ enthusiasm for prescribing puberty blockers to young children. As Cass puts it:
This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.
[…]There continues to be a lack of high-quality evidence in this area and disappointingly, as will become clear in this report, attempts to improve the evidence base have been thwarted by a lack of cooperation from the adult gender services.
[…] The evidence is weak and clinicians have told us they are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.
[…] Preliminary results from the early intervention study in 2015-2016 did not demonstrate benefit. The results of the study were not formally published until 2020, at which time it showed there was a lack of any positive measurable outcomes. Despite this, from 2014 puberty blockers moved from a research-only protocol to being available in routine clinical practice and were given to a broader group of patients who would not have met the inclusion criteria of the original protocol.
As I have observed previously, this really is a scandal.
Dr Cass’s report is comprehensive. There is an awful lot in it which merits careful and time-consuming consideration. Far too much for some, in fact. Cass notes that the “toxicity” of this debate has been profoundly unhelpful and this, naturally, has given some people an out.
Here is James O’Brien, the radio host who enjoys being thought the “conscience of liberal Britain” (and about whom I have written before). He told his LBC listeners that Hilary Cass
“[…] has stressed - and many media commentators have elected to gloss over this bit of the report - she has stressed that her findings were not in any way intended to undermine the validity of trans identities or challenge people's right to transition. So there is the toxicity - that some people think transitioning is impossible, that there you cannot become a woman if you were born a biological male - and yet, Hillary Cass has given no support whatsoever to those people, despite some of them, perhaps predictably, already trying to claim some sort of vindication or victory.
When reports like this are published everyone claims vindication. Literally everybody will claim vindication and the more toxic a debate is, the more any intervention sees everybody claim vindication. The only people vindicated - and I would say this wouldn't I? - here today are the ones that have focused more on the toxicity perhaps than on anything else, because until you get rid of the toxicity, you're not going to help anyone.”
This, I suppose, is a “take”, albeit one of a familiar self-serving, pusillanimous style. People, most of them women, who have spent years wondering if it really is prudent to put gender-questioning children and adolescents on a medical pathway from which there is typically no exit actually are vindicated by the publication of a compellingly-detailed report which concludes, amongst many other things, that:
The central aim is to help young people to thrive and achieve their life goals. The immediate goal of the care and treatment plan must be to address distress, if this is part of the child/young person’s presentation, and any barriers to participation in everyday life (for example, school community or social activities).
For the majority of young people, a medical pathway may not be the best way to achieve this. 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 such as family breakdown, barriers to participation in school life or social activities, bullying and minority stress.
The people who most decidedly are not vindicated by the Cass Review are those who have spent recent years decrying a so-called “culture war” and, as a consequence, have pretended that the subject is so “toxic” it must be ignored.
Well, as I suggested a year ago, there is a “culture war” here but the people who most frequently complain about “culture wars” are often the people happiest fighting them (Nicola Sturgeon is a prime example of this). They, of course, are never “culture warriors” themselves. No, that label is reserved for their foes and it may easily, and popularly, be implied that these people are themselves allied with, or in some other vague sense connected to, nefarious dark forces made all the more disturbing by being, conservative or American or - even worse - both conservative and American. The accusation is sufficient to indicate that concerns must be fabricated or be being used as a “wedge issue” to undermine an impeccably progressive agenda that would otherwise be accepted as Obvious Truth by all good-thinking people. Your opponents’ arguments, you must understand, may never be made in good faith.
But I have spent years reading, and learning from many of these notorious women. They include, in no particular order, Helen Lewis, Kathleen Stock, Sonia Sodha, Susan Dalgety, JK Rowling, Julie Bindel, Victoria Smith, Helen Joyce, Janice Turner, Hadley Freeman, Jane Clare Jones, Hannah Barnes, Mandy Rhodes, Suzanne Moore, Lucy Bannerman and many others. (I am bound to have forgotten some, which is a little embarrassing). Politicians such as Joanna Cherry, Rosie Duffield, and Johann Lamont have more than pulled their weight too. In Scotland, the ladies at Murray Blackburn McKenzie have also been shining - and invaluable - points of sanity.
Many others, however, have been posted missing. And that’s fine. There is no requirement for anyone to be interested in, or take a view on, every issue. That I consider something important imposes no obligation on you to do so too.
But lads - for it is mainly lads - do not, for heaven’s sake, venture down from the hills now the battle is (largely) over and tell those that did the fighting that of course you would have joined in if only the whole affair had not been so distressingly “toxic”. Really, nothing could have given you more pleasure but being a Very Sensible Fellow you knew the whole thing was really, when considered properly, simply much more trouble than it could ever possibly be worth.
Every woman who writes about these issues can count on receiving vastly more intemperate responses than any man making precisely the same points. I know from my own experience too that people - mainly men - will quietly say something like “Of course I agree with you but I admire your bravery for saying this publicly.
Well, I claim no medals, let alone any honour, for myself but having spent years following this controversy and some time writing about it, I feel confident in saying that the right-on caricature of the women who first drew attention to these issues a decade ago is so grotesque it slips into outright calumny. Far from being silly women easily manipulated by American evangelicals, most of them fall squarely in the mainstream of British liberal-left opinion.
That does not mean conservatives - and less respectable groups to the Tories’ right - have not hopped aboard the Gender Critical Express but they neither built the train nor drive it. Equally, it is plainly the case that Twitter-warriors may often go vastly further than mainstream gender critical feminism and that, as tends to be the case, the longer a controversy rages the more entrenched its combatants become. Extremism Creep is a constant danger too, for every new position and every fresh “take” must be more scalding than its predecessor.
Nevertheless, the mainstream position has always been both clear and generous. Gender dysphoria is a real condition but even where it is not necessarily present the lives of gender-questioning teenagers are often complicated and must be treated with great patience and sympathy. I know this for many reasons, not least because I have friends whose children are in precisely this situation.
For some - a few - a medical pathway may be in their best long-term interests but for the overwhelming majority, time and empathy and talking and listening is much more likely to produce better outcomes than prescribing puberty blockers as a precursor to cross-sex hormones and, eventually, major body-altering surgeries.
This is something to keep in mind when the hand-wringers bemoan the “toxicity” evident on “both sides”. Because, really, the hysterical claims of “trans genocide” and the emotional blackmail of “If you don’t let your kid take puberty-blockers they will kill themselves” only came from one side.
The other, meanwhile, maintained that while transgender people obviously exist - to deny this is to chump yourself - their rights may from time to time conflict with other people’s rights and that most often and most significantly these other people will be women. (Though there are plenty of others, a really obvious example of this comes in sport - which I wrote about here.)
But, please, let us recall some of the most extraordinary bullshit previously peddled on these issues. Stonewall, for instance, now “welcome” the Cass Review but Stonewall have been at the forefront of nonsense. To wit:
So, yes, some receipts should be kept. One side in this discussion spent years wanting to have a rational discussion; the other side spent that time screeching “NO DEBATE”. Given Cass’s findings this is understandable, for it turned out that one side had almost nothing sensible - and even less that was useful - to say. We always suspect that might be the case; now we know why.
Because, again:
Ninety percent of natal girls and 80 percent of boys referred in 2012 reported being same-sex attracted or bisexual. One clinician recalls families who said, “Thank god my child is trans and not gay or lesbian”. Some of the children agreed: “I had kids telling me, ‘When I hear the word lesbian, I cringe. I want to die’” one doctor tells Barnes. “Initially, some of them had identified as lesbian. And some of them had experienced a lots of homophobia and then started identifying as trans. It was almost like a stepping stone.” Another doctor concurs: “In my view, I think there were gay children who were being pushed down another path”.
People - mostly women - who objected to this were vilified and hounded in public, traduced as bigots or as simpletons wittingly or unwittingly being manipulated by dark forces.
If people now wish to pretend none of that happened then so be it. If they also wish to pretend there was never any indication any of this was happening then, again, they are welcome to the comfort of their own self-delusion. But it was there all along and many of those who did not see chose their blindness.
Complaints that, look, it was all so very toxic really will not do. Plenty of people really have been vindicated by Cass and they deserve better than to be traduced by Jimmy-Come-Latelys who could not bring themselves to look at the evidence and take a view based on reality rather than their own self-flattering desire to be seen as one of the kindly ones.
Those people vindicated include the whistleblowers and concerned clinicians at the Tavistock, a significant number of the clinic’s former patients, journalists and academics and feminist campaigners who have been crying for attention to be paid to these issues for years as well as many others, too numerous to list here. They spent a long time fighting to be heard. It might be time for some of those who spent all these years ignoring them to, better late than never, start listening now.
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This seems to me a masterful, if depressing, summary of the situation. Quite how so many (in particular of the 'liberal left') lost their sense of perspective on this is astonishing.
A stellar article, Alex, which as you rightfully need to point out, has had a gestation of a decade. During this period, which also includes the polarising factor of Brexit too, let's not forget, it seems to me and many others who stayed in your uplands, that listening to contrary opinions has been systematically exiled.
The other great yet subtle point I glean from your take of the report is whenever sentences begin "Research suggests" or "Research has been done/published" that what will follow is polemics dressed up as science.
My last thought is for those who were made irrecoverable from those clinics; ever-anonymous and no doubt still suffering.