Health

The French Society of Pediatric Endocrinology and Diabetology (SFEDP) recently commissioned its own version of the Cass Review, and this study reached almost the exact opposite conclusions of Cass […]

Upon reading both the Cass Review and the SFEDP Review, what immediately jumps out is the very different tone of each—Cass takes a tone that feels skeptical to the point of excess, offering mysteriously curt phrasing, statements rife with implications of harm or conspiracy by mainstream providers, and an overall sense of invalidation. By contrast, the SFEDP Review reads like a scientific paper—its language is straightforward and sterile, and there is none of the innuendo of Cass. Reading both side by side feels almost like traveling from a land of paranoia and conspiracy into levelheaded reality.

These basic differences in language imply very different approaches to working with trans minors—gender-affirming vs gender-critical.

[…]

Perhaps nowhere is the difference between the Cass Review and the SFEDP Review more clear than here: Cass bemoans the lack of good evidence and recommends generating it, whereas SFEDP declares that it is ready to follow the science by supporting minors in their transition. One cannot help but suspect that even if further research is conducted, in another 20 years another Cass will come along and demand another round of research into trans youth.

A typically incandescently brilliant barnstormer from Abigail.

There is a clash going on in Britain between two fundamentally irreconcilable ideologies.

The NHS, DHSC, and many other official institutions like courts view transition as a response to a medical problem they call ‘gender dysphoria’ or ‘gender incongruence.’ From this starting point it seems appropriate that trans people have to get permission to transition: transness is a medical matter with inherent risks that ought to be controlled by “specialists.” Sometimes those specialists delay or deny permission, but that’s just part of the job. It also makes sense to ask which treatments are “most effective at treating dysphoria” and explore alternative treatments through trials, reviews, consultations, etc. I call this view ‘Pathologization.’

According to Pathologization, past treatments like electric shocks simply failed to alleviate patients’ dysphoria. These days we have more effective methods, and one day we might discover a cheap way of treating it without transition- a silver bullet conversion therapy. Doctors and managers will determine when and whether adjustments to the system are needed. Ideally they’ll engage with trans people in “stakeholder groups” but if those groups don’t get what they want that’s not a dealbreaker. Patients who suffer or die waiting are unfortunate but hey, the NHS can’t save everyone.

On the other hand, the view of an increasing number- especially young people and trans people ourselves- is that transition is a bit like pregnancy. It’s a process that may require professional assistance to bring to the happiest possible conclusion (whether completion or termination), and for this reason it is appropriate and necessary that the NHS is involved. But whether, how, and when to do it should be up to you. From this starting point there should be as few obstacles as possible: the role of doctors and managers is to facilitate and advise but never delay or deny. Prompt, reliable access to transition is a civil rights matter.

[…]

It is vital to realise that organisations can embody an ideology even if nobody working in them believes it. I think sometimes when people hear “Organisation X is institutionally discriminatory” they interpret that as “The leaders of Organisation X are bad people.” For example;

“The Metropolitan police are institutionally racist.”

“I’ve met some police officers and they’re lovely!”

This is a mistake. To say that an organisation is institutionally discriminatory makes no comment on the character of its employees, merely the pattern of its outputs. Not everyone who controls trans healthcare is a frothing bigot; again, I have no animosity towards Colonel Korn or his colleagues. My issue is with the outputs of the system they manage.

We looked at the latest research from around the world to understand what knowledge was being used to inform the care of children and young people with gender dysphoria by looking for research published in the scientific literature between 2019 and 2023. This work builds on a previous report we provided to NSW Health summarising the research published between 2000 and 2019.

We found 82 research studies published since 2019. This represents a rapid growth in research in this field. Various methods of varying quality were used to gather information in these studies. While we found that there hasn’t been a significant increase in the use of gold-standard methods (such as, randomised controlled trials (RCTs)) in this emerging field of research, we were still able to draw out meaningful insights into the effectiveness and risks of gender dysphoria treatments. The research we found provides a good starting point for discussing critical issues with patients, caregivers, and healthcare providers, including deciding where to invest in future research.

NSW Health will use this review’s findings to guide various projects designed to gather more information from experts and people with lived experiences, with the aim of providing safe and effective psychological and medical treatment services for young people with gender dysphoria.

The Australian Financial Review reported that NIB’s CEO has said that the insurer needs an increase of around that mark because “ultimately, we have to cover claims inflation like any insurer because if you don’t eventually you go out of business.”

While this might seem obvious, it ignores the reality that the main reason private health insurers might go out of business is because people hate the product they offer, and even with all the carrots and sticks designed to force people to take out health insurance, a majority of Australians do not want it.

Over six years ago I pondered if private health insurance was a con. In the time since, during which we have experienced the greatest health crisis in a century, nothing has really changed the answer.

Not only does it remain untrue that private health insurance takes stress off the public system, it also remains a fib to call it private – it’s a public system merely carried out in an inefficient manner to deliver a product most people don’t want and haven’t ever wanted.

In the late 1990s, after 15 or so years of Medicare, fewer than a third of Australians held private health insurance. Then John Howard decided that the private sector needed help from the public sector.

He introduced a surcharge to penalise higher income earners who did not have private health insurance.

The stick was not enough. Howard then tried the carrot: providing a rebate on your private health insurance. These rebates are quite pricey – the government this year will spend about $7.5bn on them.

It did bugger all – you literally could not pay people to buy it.

One of the principles upon which provision of puberty blockers to young trans people was made was Gillick competence – the law that says that young people over the age of 12 can be individually assessed by medical professionals to determine whether or not they’re competent to make medical decisions for themselves. This was hard fought for by feminist campaigners back in the 1980s and it led to the passing of the Age Of Legal Capacity Act in Scotland in 1991. It’s a principle of particular importance when it comes to reproductive healthcare, as it helps young people to access the services they need even if, for instance, they feel unsafe discussing them with their parents. As such, it helps to protect them from abuse and to get used to the idea that they have ownership of their bodies, which is important as they grow up and negotiate boundaries in romantic and social relationships.

By overriding Gillick competence where trans people are concerned, Streeting has created a risk that it will be ignored in other cases too. Perhaps we shouldn’t be surprised. He seems shaky on the concept of medical consent more generally, as demonstrated by his suggestion that obese unemployed people should be given the weight loss drug Ozempic to improve their health and get them back into work. Although his initial comments on this, which provoked a public outcry, were quickly followed by assurances that it would not be compulsory, concern remains about the vulnerability of people who depend on the state for support, especially those who are disabled, who make up a significant part of the obese population. Like most drugs, Ozempic has side effects and is not appropriate for everyone.

Slimy git.

Streeting acknowledged that the decision would not be welcomed by everyone but sought to reassure young trans people. He had met many of them since taking up his post in July, he said, and listened to their concerns, fears and anxieties.

In a message directly to them, and referencing having come out as gay, he said: “I know it’s not easy being a trans kid in our country today, the trans community is at the wrong end of all of the statistics for mental ill health, self-harm and suicide.

“I can’t pretend to know what that’s like, but I do know what it’s like to feel you have to bury a secret about yourself, to be afraid of who you are, to be bullied for it and then to experience the liberating experience of coming out.

“I know it won’t feel like it based on the decisions I’m taking today, but I really do care about this and so does this government. I am determined to improve the quality of care and access to healthcare for all trans people.”

Decisions were being taken “based on the evidence and advice of clinicians, not politics or political pressure”, he added.

Some world-class hand-wringing going on in Washington. Take that, fascism! We are resolute in our misgivings about supporting you every step of the way!

The 2025 NDAA, which authorizes an astronomical military budget of $895 billion, contains numerous policy items including a 4.5% pay raise across the board, a more substantial 14.5% raise for junior service members, and over $600 million in military funding for Israel. It also includes multiple sections that would place new restrictions on gender-affirming medical care for military families on government TRICARE health plans, the military’s health insurance program for active duty members. Under Sections 708 and 709 of the bill, no Department of Defense funds or facilities may be used to “perform or facilitate sex change surgeries,” and TRICARE plans may not provide hormone therapy, puberty blockers, or “other medical interventions for the treatment of gender dysphoria that could result in sterilization” to anyone under 18. (Right-wing sources have increasingly pushed false and misleading claims that puberty blockers and hormones lead to sterilization.) Another section would prohibit the Department of Defense from establishing any new positions “relating to diversity, equity, and inclusion,” or from adding those responsibilities to existing DoD positions.

On Wednesday, members of the House approved the NDAA in a 281-140 vote, CBS reported. 81 Democrats voted in favor of the budget, while 16 Republicans voted against it. The bill will now be sent to the Senate for another vote.

Normally, party leaders “whip” members into voting one way or another based on their party’s collective goals — but House Minority Leader Hakeem Jeffries said he would not whip Democratic votes for or against the NDAA on Wednesday, even though the bill contains overtly anti-trans policy (for the second year in a row). “We’re not whipping on the National Defense Authorization Act. It’s a member-to-member, case-by-case analysis in terms of people making decisions as to what is the right thing to do,” Jeffries told reporters ahead of the vote, according to The Hill. Jeffries added that the bill contains “a lot of positive things” but “some troubling provisions in a few areas, as well.” The New York representative slammed Republican extremism in a press conference on Wednesday, but also told reporters that he and his party “are ready, willing and able to find bipartisan common ground with the incoming administration on any issue.” Jeffries was among the 81 Democrats who voted in favor of the NDAA on Wednesday.

[…] 

In a series of Bluesky posts on Wednesday, Virginia Rep. Bobby Scott called the gender-affirming care ban “reprehensible” and called on Republicans to “prioritize national security and servicemembers, not culture wars,” but voted in favor of the bill that day. As The Hill reporter Brooke Migdon observed, 50 other Democrats who signed a September letter denouncing the NDAA’s anti-LGBTQ+ provisions voted to advance it this week.

We mapped the extent to which researchers and advocates have been subject to intimidation tactics by tobacco, alcohol and ultra-processed food (UPF) companies and their associates. The tactics described include being descredited in public, legal threats, complaints, nefarious use of Freedom of Information legislation, surveillance, cyberattacks, bribery and even physical violence.

[…]

The scale of intimidation we have found is likely to be the tip of the iceberg. Many will be too scared to publicly reveal that they have been intimidated because of their work.

We found widespread intimidation across the three sectors, perpetrated by corporations themselves and their third parties. In the most serious forms of intimidation, the perpetrators remained unknown.

The World Professional Association for Transgender Health said the refusal or withdrawal of HRT for trans patients raised “ethical and clinical” concerns.

“Hormones should not be stopped for political reasons or in the absence of a recognised medical issue,” a spokesperson told TBIJ. “If GPs are withdrawing prescriptions despite recommendations, this could result in negative impacts on patients' mental and physical wellbeing.”

[…]

The issue appears to reflect a wider rollback of access to gender-affirming healthcare in the wake of April’s publication of the controversial Cass Review into health services for trans young people. This review claimed that the evidence base of using puberty blockers and gender-affirming hormones for young people was “weak”. Some of the same medicines are used in adult care.

The review did not recommend a ban on puberty blockers but resulted in one for young people experiencing gender dysphoria (they are still permitted for children experiencing early puberty). The ban was extended by the new Labour government in August. Adult gender services are now also under review.

The World Professional Association for Transgender Health said the refusal or withdrawal of HRT for trans patients raised “ethical and clinical” concerns.

“Hormones should not be stopped for political reasons or in the absence of a recognised medical issue,” a spokesperson told TBIJ. “If GPs are withdrawing prescriptions despite recommendations, this could result in negative impacts on patients' mental and physical wellbeing.”

Puberty blockers delay the onset of puberty, but don’t necessarily result in a measurable effect at the time they are taken. The main impact is seen when people are older. The physical effects of a puberty that does not match a person’s gender can have serious negative consequences for transgender adults.

In my role as a GP, I regularly hear from transgender adults (who have not had puberty blockers) struggling with distress related to bodily changes which occurred during puberty.

I have met people who don’t speak because their deep voice causes others to make incorrect assumptions about their gender. Some harm themselves or avoid leaving the house because of the distress caused by their breasts. Others seek costly surgical treatments.

This is when the benefits of maintaining equitable access to puberty blockers for those who need them become obvious. People are seeking hormones, surgery and mental health support for changes which could have been prevented by using puberty blockers when they were younger.

The ministry’s position statement recommends that puberty blockers are prescribed by health professionals who have expertise in this area, with input from interdisciplinary colleagues.

In my experience this describes how puberty blockers are currently being prescribed in New Zealand. Clinicians are already cautious in their prescribing. They work with multidisciplinary input to best support the young person and their family. They recognise the importance of mental health and family support for young people.