The Cass Review: Four Claims Trans Advocates Can't Afford to Make Anymore

The largest review to date of transgender health and gender dysphoria concludes that gender dysphoria in childhood does not predict lifelong experience. The review also concludes that puberty blockers don't merely 'buy time', but may change the trajectory of psychosexual and gender identity development, and that the evidence does not support the claim that they improve body image or dysphoria.

The review also finds that puberty blockers and cross-sex hormones are not 'life-saving' medicines, and that the exponential rise in trans identity in recent years is not explained by greater societal acceptance.


Transgender health and particularly the treatment of gender dysphoria in children and adolescents has become a major cultural, political, and ethical debate. The debate often takes place along lines of morality and ideology, with trans-identifying people on one side and those who question the fundamental assumptions of transgender ideology on the other.

This article will not focus on theological or pastoral reflection, important as such reflection undoubtedly is, nor will it mount a case against the foundations of transgender ideology - a case that is increasingly being made even by secular philosophers and public intellectuals. My aim is simply to show that the Cass review discredits four widely believed claims. This article will demonstrate: first, that adolescent gender dysphoria does not predict lifelong experience; second, that puberty blockers don't merely 'buy time' to think; third, that puberty blockers and cross-sex hormones are not 'life-saving' medicines; and fourth, that the exponential rise in trans identity in recent years is not explained by greater societal acceptance.

Finally, it will suggest how the Cass review might help us all have better conversations, especially with those with whom we deeply disagree on questions of trans identity.

Claim 1: Adolescent gender dysphoria does not predict lifelong experience

Trans identity is often presented as an innate reality, which must not be questioned. The claim is that children or adolescents who experience gender dysphoria simply are trans, and must therefore be allowed to make decisions on that basis.

But according to the Cass review, gender dysphoria in childhood "is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them" (29).

Indeed, far from gender dysphoria in minors reflecting an immutable reality, the large majority of people who experience it in childhood or adolescence will no longer do so in adulthood. As Cass reports, a review of studies "found persistence rates of 10–33% in cohorts who had met formal diagnostic criteria at initial assessment" (67). In other words, at least two-thirds of those who reported gender dysphoria as children no longer experienced it in adulthood. Most grew up to be same-sex attracted adults, who identified with their biological sex (67).

Claim 2: Puberty blockers don't merely 'buy time'

Puberty blockers are routinely prescribed to adolescents on the grounds that they just 'press pause' on sexual development and buy young people 'time to think'. This claim is made in middle school health classes across America today. But as the Cass review notes, "there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development" (32).

Strikingly, "the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinising/feminising hormones" (32). Furthermore, puberty-blockers may negatively affect important physical aspects such as cognitive development and fertility (32).

So, why are they so widely prescribed?

In 2011, a team of Dutch scientists published a study of 70 patients who had received early treatment with puberty blockers between 2000 and 2008. The minimum age for inclusion in the study was twelve, and kids had to have "suffered from life-long gender dysphoria that had increased around puberty, be psychologically stable without serious comorbid psychiatric disorders that might interfere with the diagnostic process, and have family support" (68).

Given the "poor mental

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