More research has cast doubt on the research methods within the UK Cass Review, which has been used to holt gender-affirming medical care for transgender adolescents.
Authored by Irish, British, Canadian and European researchers in the fields of paediatrics, developmental psychology and endocrinology; experts have cast doubts on the Cass Review’s information-gathering processes.
The criteria that either permitted or disqualified relevant studies seems quite bizarre. Government papers, post-graduate dissertations and non-English research papers were all disqualified while anecdotes, quotations and attributions were all allowed.
As well as questions of identification and selection of studies, the authors objected to the inappropriate use of the Newcastle Ottawa Quality Assessment Scale in this context. The delegated Cass Review researchers provided no reason for their ascription of a particular single threshold and poor measurement of the risk of bias. The researchers in this context used another evaluative tool, ROBIS.
Using the Newcastle Ottawa Scale to filter out studies that did not meet the preconceived bias and ambiguous initial criteria within their research protocols, the Report therefore excluded more than half of the relevant papers on puberty blockers and over one-third of those on hormone treatment. Ironically enough, the Cass Review’s own cited studies show diminished gender dysphoria and decreases in depression and suicidal intent, and none of the cited studies indicated any concrete proof of harm.
The Cass Review’s delegated researchers were also sketchy in terms of conducting a transparent summary of the purpose of their reviews, the research methods involved and the findings. They did not disclose changes to the initial criteria that guided their projects, how they developed their evaluative strategies and neglected to ascertain how bias in publication and outcome reporting might have affected their cited studies. Moreover, the most recent research is excluded from the delegated studies.
There is no corroboration within the report for claims about ‘accelerated’ referral of children and adolescents to gender-appropriate care services, or about the ‘increase’ in ‘detransitioning.’ Inferential jumps are made from selective citations of individuals from qualitative studies of gender-appropriate care. The critics note that flawed data sets, poor counting of referral data items, personal communications and uncorroborated communications are used to ‘ground’ the Cass Review claims.
As noted beforehand, the overall bias of the Cass Review is paternalist and pathologising. The authors of this critical study compare it to reproductive healthcare, which is resolutely patient centred and assumes the competence of the woman/pregnant person involved.
Finally, the authors point to the prevalence of misrepresentation and disinformation in more conservative jurisdictions from individuals without amenable expertise in the relevant disciplines of paediatrics, developmental psychology and endocrinology.  While the same cannot be ascribed to the Cass Review authors without evidence, its poor provenance may well be abused by Christian Right anti-transgender pressure groups to make harmful interventions that are not borne out by the overwhelming ensemble of mainstream research and clinical practice.
Already, all of the United Kingdom’s constituent realms have introduced treatment bans based on this flawed study. It should not be relied upon in our own context, or related and ensuing harm to transgender youth will be severe.
Source: Chris Noone et al “Critically Appraising the Cass Report: Methodological Flaws and Unsupported Claims”:
Article | Craig Young.