By Veronica Esposito

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.

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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.

In their paper “Reducing the Joy Deficit in Sociology: A Study of Transgender Joy,” Shuster and Westbrook look to put a little more joy in the world, by researching not the pains and struggles that come with being trans but the reasons to celebrate who we are. This is much bigger than just trying to put a few glimmers in the way of an oppressed group. As they explain, the “joy deficit” “is particularly troubling, as joy is vital to human well-being. . . . As such, joy is sociologically relevant to fully understanding people’s lived experience.”

Shuster and Westbrook argue that because of this joy deficit, the narrative of the “transgender person in misery” has become unfairly centered as the “normal” narrative of trans existence. According to them, it’s become the dominant way that cisgender people view us, and also the dominant way that we see ourselves. Shuster and Westbrook argue that it’s not only unhelpful, but also just plain false, to paint trans people as fundamentally miserable beings.

Informed consent means that a trans person could access gender-affirming care without any need for mental health  treatment or a lengthy assessment process. This model is routine in the vast majority of all non-transgender medical care. Cisgender people routinely access similar hormonal medications as trans people without a mental health diagnosis for conditions like polycystic ovarian syndrome, precocious puberty, menopause, loss of virility with age, and birth control.

Many doctors worldwide use a gatekeeping approach to gender-affirming care, but the informed consent model for transgender hormone replacement therapy is also widespread in the United States—a map of IC providers created by activist and journalist Erin Reed lists nearly 1,000 such providers in this country. This has been the result of decades of advocacy by the trans community to have our healthcare approached similarly to other comparable treatments. 

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How do we know that informed consent works better? Well, to start, granting trans people significant levels of autonomy over their medical care is in line with the ethics of the medical profession, which directs doctors to engage in shared decision-making and uphold client autonomy whenever possible. As Bryan Murray puts it in a piece for the American Medical Association Journal of Ethics,  “Informed consent is at the heart of shared decision making—a recommended approach to medical treatment decision in which patients actively participate with their doctors.” Scholar Madeleine Lipshie-Williams points out that the gatekeeping mode for gender-affirming care is at odds with how the majority of medicine is practiced in the U.S.: “[the gatekeeping model], which requires medical professionals to provide official opinions on a trangender patient’s readiness to accept and undergo care, stands in contrast to the majority model of medical consent in the US.” Lipshie-Williams also argues that the informed consent framework is preferable because it is necessary for the normalization of trans identities: “there cannot be a depathologizing of transgender identity as long as transgender individuals are required to be seen by mental health specialists to confirm both the validity of their own self-proclaimed identity, as well as their mental fitness to consent to medical interventions that have been broadly accepted as necessary. There is an inherent contradiction in declaring medical care necessary whilst simultaneously maintaining that those for whom it is necessary continue to lack the capacity to consent to this care without assistance.”