Hilary Cass Endorsed Youth Gender Transition in Some Cases and We Ignored It Because It Didn’t Fit Any of Our Narratives

But she continues to make sense

Built from a photo by Grant Faint.

Last month, British physician Hilary Cass achieved every doctor’s dream: She became a culture war lightning rod just for doing her job. After Dr. Cass released her review of youth gender medicine in the UK, which found that evidence for hormonal treatment of adolescents was “remarkably weak”, polemics in the US played their assigned roles. Left-wing hack Michael Hobbes denounced the review as “reactionary”, and The Majority Report’s Sam Seder immediately bought the inaccurate, left-wing spin of the report. Meanwhile on the right, a New York Post editorial used Cass’ findings to argue for a total ban on hormone treatments for minors, and groups who are pushing statewide bans trumpeted her work. So, the battle lines were made clear: If you’re on the left, Hilary Cass is ten times worse than Ted Bundy. If you’re on the right, Hilary Cass makes Honest Abe himself look like a sex offender. And if you’re an RFK Junior supporter, Hilary Cass is clearly a shapeshifting lizard person, wake the fuck up, sheeple.

This week, the New York Times ran an interview with Dr. Cass. Most reactions focused on the response to Dr. Cass’ report from professional organizations in the U.S., which has mostly been to put their fingers in their ears and run in the opposite direction. Meanwhile, this quote from Dr. Cass went almost completely unnoticed:

“There are young people who absolutely benefit from a medical pathway, and we need to make sure that those young people have access — under a research protocol, because we need to improve the research — but not assume that that’s the right pathway for everyone.”

We often don’t know how to react when someone does something against type. I’d be thrown if Jane Goodall started hawking Monster Energy Drink, or if Ken Burns wrote a book called Swagitude: Nine Simple Tricks To Bagging Hot Chicks. And I think that’s why the quote above mostly got ignored: Here was Hilary Cass, who had become the poster child for concern about youth gender medicine, saying that some young people would benefit from transitioning. Maybe it wasn’t quite as shocking as Ken Burns in leather pants instructing young nerds to “release their alpha tiger”, but I’m sure it confounded many people’s expectations.

I wouldn’t be doing my job if I didn’t mock this up.

Of course, people who have been following the issue closely might not have been surprised. After all: Though the Cass Report raised serious concerns about youth gender medicine, it did not recommend an outright ban on hormone treatments for minors. It recommended that the treatments be prescribed with “extreme caution”, and also called for puberty blockers to only be prescribed in clinical trials. This is similar to what Norway, Sweden, Finland, and Denmark did: They all restricted the use of hormones but didn’t ban them. These countries crafted policies based on the recognition that something might be appropriate in one context, but inappropriate in another, which everyone understands when it comes to things like sex, alcohol, and sending children dressed like monsters to strangers’ houses begging for candy. But for some reason, we struggle to apply this knowledge to youth gender medicine.

The extreme polarization of the youth gender medicine debate in the US has crowded out moderate positions. The activist left has demanded absolute adherence to its agenda on trans issues, including non-skepticism of the private health care industry and the objectively untrue belief that “the science is settled”. The right, meanwhile, has sought to ban the field altogether: 23 states have made it illegal to proscribe cross-gender hormones to minors. As often happens, the extremes have played off each other: Left-wing narratives focus on the bans and ignore evidence of unscientific practices, and right-wing narratives focus on detransition horror stories without acknowledging that transition sometimes leads to healthier, happier lives.

But two things can be true at the same time. It can be true that:

1. Social factors have caused some young people whose lives would not be improved by gender transition to seek guidance from gender clinics, only to receive hasty and one-size-fits-all treatment from hack clinicians who have convinced themselves that a few data points constitute a robust scientific consensus; and

2. Some people with gender dysphoria would have their lives improved by seeking gender transition before the age of 18.

It seems that Dr. Cass — who is either a righteous pro-science warrior or a hateful anti-trans bigot, depending on your perspective — believes that both of these things are true.¹ And so do I. In fact, I not only think that both of these things probably are true — I would absolutely stunned if they’re not both true. Trans people clearly exist, and some clinics seem about as tight-fisted with hormones as medical marijuana facilities in California were with weed in the 2000s, so both statement are almost certainly true.

The scandal exposed by the Cass Report was a failure by clinicians to separate young people who would benefit from gender transition from those who would not. Instead of doing probing assessments that consider multiple factors, clinicians clicked into Ally Mode the instant they heard the word “gender”. They prescribed treatments without being honest about what was and wasn’t known about those treatments. It was ideologically blinded medicine that ignored kids’ needs.

Total bans on youth gender medicine make the same mistakes. They fail to recognize that different kids will need different treatments, and impose one outcome on everyone. Instead of letting families make their own decisions on a highly personal issue, the government makes the call. The left failed kids by pushing everyone down the “transition” path, and the right is failing kids by blocking that path in every single case.

Normally, a statement by a doctor who is seen by some as an authoritative voice on a subject would get attention. And indeed: That’s how Cass’ words about American professional organizations’ response to her report were received. But her belief that transition is the right path for some young people has mostly been ignored. That’s probably because she said something that the people who previously agreed with her didn’t want to hear. At the same time, people who might have been receptive to her words just spent a month comparing her unfavorably to Hitler. If we could turn down the volume on the culture war for just a minute, we might be able to hear people like Dr. Cass, who seem to be focused on providing young people with the highest-quality care possible.

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1. Later in the interview, Dr. Cass says: “…multiple truths exist in this space — that there are children who are going to need medical treatment, and that there are other children who are going to resolve their distress in different ways.”