Craig Young is concerned that a flawed UK investigation into trans health care may affect the New Zealand government’s own delayed review.
Recently, Associate Health Minister Matt Doocey, announced that the release of the New Zealand review of puberty blocker data had been delayed. Throughout 2023, New Zealand Ministry of Health experts wrote a report on the efficacy, safety, and physical and mental outcomes of puberty blocker treatment for trans adolescents. The water was muddied by the UK’s controversial Cass Report (study on puberty), which has attracted considerable critical scrutiny about its research method design and bias. According to news reports, the article was ready for publication by April 2024, but the Minister withheld it. Is politics interfering with its release? Doocey is a National cabinet minister but the coalition includes gender-critical views from New Zealand First. Consultation with Cass Report lead Dr Hilary Cass has apparently followed, but the question is whether balancing critical studies have been cited to offset the questionable impact of the Cass Report.
By July 2024, a number of research reviews had appeared criticising the Cass Report, which had already been used to deny gender-appropriate medical care to transgender adolescents in the UK. Prominent clinical paediatricians expressed their unease at the composition and design of the Cass Report and argued that the report misuses data, rests many of its suppositions on speculation, misinterpreted the available evidence and sites spurious and debunked claims about gender identity. Yet in the UK following the report’s release puberty blocker access to trans adolescents through the National Health Service (NHS) was cut off and in the US 25 states followed suit.
The Cass Report’s critics point to a troubling absence of transparency when it comes to the report’s ‘expert advisory team’, as well.
They argue that given these problems and others, the Cass Report does not constitute authoritative guidelines or standards of care, nor is it an accurate observation of the available medical evidence on the treatment of gender dysphoria and ignores positive research findings on successful transitioning for trans adolescents, ignoring actual qualitative feedback from transgender youth themselves.
New Zealand, Australia and other jurisdictions cannot rely on this seriously flawed, ideologically driven document to determine public policy on medical care for transgender youth. Unfortunately, we won’t know whether this is the case or not until the Associate Health Minister releases the aforementioned Ministry of Health advisory report completed in April.
Unfortunately, the UK High Court has once again blundered into this debate. As long-time followers of the anti-transgender lobby’s animus against adolescent access will recall, Keira Bell, a detransitioner argued that the Gillick competence threshold did not apply when it came to comprehension and consent to hormone treatment and surgical intervention in the context of the Bell v Tavistock case. Ironically enough, given anti-transgender pseudofeminists regarded this as an iconic case, it incensed the UK feminist abortion rights and reproductive health lobbies, who were deeply worried that this precedent could be abused to attack competent minors’ access to contraception and abortion. The concept of Gillick competence arose in the context of reproductive health, when it was used to facilitate competent minor consent to contraception and abortion. Fortunately, though, in September 2021, the UK Court of Appeal overturned the High Court verdict and ruled that Gillick’s competence did apply in the context of trans adolescent comprehension and consent when it came to hormone treatment and transitioning. The Cass Report was then set up and as numerous critiques have noted, the dice were then loaded against competent trans adolescent access to necessary medical treatment.
Predictably, once again, the High Court upheld the decision of the previous UK Conservative Health Secretary to launch a regulatory ban against minor and adolescent access to puberty blockers, also upheld by the incoming Labour Health Secretary, Wes Streeting. There will once more have to be a remedial case within the UK Court of Appeal to set matters right. Shortly after the High Court decision, however, further developments threw this hasty and precipitous court decision into sharp relief.
The British Medical Association has reassessed whether to provide approval for the Cass Report. This is a telling development, whatever its apologists might claim. The BMA’s Senior Council had some highly critical observations to make about the Cass Report, pointing to numerous objections from clinical experts in paediatrics and developmental psychology such as those above. On July 31, 2024, the British Medical Association firmly came down on the side of transgender adolescents. The BMA represents 190,000 British medical practitioners, stated that it was heavily critical of the existing research basis used to ban puberty blockers for trans children and adolescents and called for a more detailed and open investigation into the clinical research related to adolescent transitioning and hormone treatment.
Undeterred by this development, unfortunately, NHS England has announced that it will shortly invoke another inquiry into trans medical services for adults. The National Health Service’s Medical Director for Specialist Services, Professor James Palmer and its Director of Specialised Commissioning, Dr James Stewart, said that an investigation into such services would be coordinated by Dr David Levy. Lobby group TransActual immediately expressed concern that the resultant inquiry was not into priority issues for the sector such as waiting times to access consultation and consequent hormone treatment, which are formidable barriers, but instead, into the efficacy and legitimacy of hormonal treatment itself.
New Zealand should not follow the same trajectory and launch an unwanted and unnecessary hatchet job against trans medical care for adults. One hopes that Minister Doocey is aware of the controversy about the Cass Report and refrains from making precipitate and harmful choices in our context and that New Zealand First’s backwardness over transgender rights is not allowed to influence the outcome.
