In April, Dr Hilary Cass, a former president of Britain’s Royal College of Paediatrics and Child Health, published the most comprehensive scientific analysis of paediatric sex-trait modification procedures to date. These procedures, often described as components of “gender-affirming care” (GAC), serve to align a child’s physical features with his or her claimed “gender identity” through (typically irreversible) hormone regimes and surgeries, which often lead to sterility and other serious medical side effects. The Cass Review, as it is commonly known, reported that the evidence base supporting the use of such procedures was “remarkably weak.” Moreover, while it’s been widely claimed that hormone treatments reduce the elevated risk of death by suicide among trans-identified children, Dr Cass found that the available evidence “did not support this conclusion.”

The response to Dr Cass’s findings has been dramatic. England’s National Health Service, which commissioned the report, expressed gratitude to Dr Cass and committed to implementing her recommendations. These include prioritising psychotherapy for gender-distressed youth, and phasing out the use of puberty blockers as part of England’s publicly funded healthcare system. Following the publication of the Cass Review, Scotland and Wales joined numerous other European jurisdictions—many of which have conducted their own reviews, and reached similar conclusions—in restricting the use of puberty blockers and cross-sex hormones to treat minors. Several international bodies have also issued policy statements praising the Cass Review for its thoroughness and lack of bias.

However, while these international authorities are reforming their policies in accordance with the latest scientific evidence, medical organisations in North America have generally remained steadfast in their support of GAC. The American Academy of Pediatrics and the Endocrine Society, for instance, both recently issued statements defending their support of GAC practices as “grounded in evidence and science,” and “based on a thorough review of medical evidence, author expertise, rigorous scientific review, and a transparent process.”