September 4, 2024

It has been more than four months since the publication of the Independent Review of gender identity services for children and young people, known as the Cass Report. There has been no mention of it by the National Association of Independent Schools (NAIS) or its member associations. There has also been no discussion on the NAIS membership Diversity listserv, which frequently addresses gender issues.

What is the Cass Report?

The Cass Report, an independent assessment commissioned by England’s National Health Service, evaluated the effectiveness of gender treatment for children and young people. It was a comprehensive review led by Dr. Hilary Cass, former president of the Royal College of Paediatrics and Child Health. It concluded that there is no definitive evidence supporting the benefits of “gender-affirming care” for children and young people.

This short video from Genspect outlines the (Lack of) Evidence Supporting Gender-Affirming Care

Dr. Cass’s review did not specifically address schools, but she emphasized their critical role, stating: “The importance of what happens in school cannot be under-estimated; this applies to all aspects of children’s health and wellbeing. Schools have been grappling with how they should respond when a pupil says that they want to socially transition in the school setting. For this reason, it is important that school guidance is able to utilise some of the principles and evidence from the Review.” (p. 158).

The evidence for supporting social transition in schools has been largely discredited: “The systematic review showed no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence. However, those who had socially transitioned at an earlier age and/or before to being seen in clinic were more likely to proceed to a medical pathway.” (p. 31). The review suggests that permitting non-conforming expression should not involve obscuring a child’s biological sex. The report is not specifically about schools but it has implications for schools and their policies.

Key Findings of the Cass Review:

• There is no clear evidence that affirming a child’s declared gender identity through social transition, puberty blockers, or cross-sex hormones resolves gender dysphoria
• There is no evidence suggesting that not transitioning children increases the likelihood of suicide
• There is no long-term, scientific evidence to support policies that immediately affirm a student in an adopted ‘gender identity’
• Holistic psychological care and psychosocial support should be the focus for young people experiencing gender-related distress
• The role of the school is to neutrally ‘hold space’ while children develop their identities
• There is no solid evidence of the long-term safety or efficacy of puberty blockers
• Gender reassignment and social transition should not be the default treatment until further research provides conclusive outcomes.

Clearly: 

• Schools should use relevant, up-to-date evidence to inform their policies.
• Schools should not facilitate ‘social transitioning’ as this is a powerful psychological intervention that teachers are not qualified to make.
• Social transitioning’ is not a best-practice policy. “…it is unclear whether [social transition] alters the trajectory of gender development, and what short- and longer-term impact this may have on mental health.” (Cass p. 163)

UK and World Response

In response to the report it commissioned, the UK government placed an emergency ban on puberty blockers for individuals under 18 in England. The Report, and this decision, have had a global impact, prompting medical organizations and governments to re-evaluate their policies. Some countries, such as Sweden, were already rethinking their treatment practices.

Reem Alsalem, the United Nations Special Rapporteur on violence against women and girls, noted that policies on gender treatments have “breached fundamental principles” of children’s human rights, resulting in “devastating consequences.” The Cass Report has very clearly shown the devastating consequences that policies on gender treatments have had on human rights of children, including girls…its implications go beyond the UK,”

Contrast with US Response

Federal agencies and professional associations in the US have largely ignored the Cass Review. The Department of Health and Human Services and the American Medical Association have not acknowledged it, while the Endocrine Society dismissed it. The American Academy of Pediatrics has remained silent, despite the Cass Review rating the research underlying their guidelines as among the least rigorous of 23 international guidelines on gender care.

The advocacy group the World Professional Association for Transgender Health (WPATH) claimed Dr. Cass was not qualified to judge as she had not practiced gender medicine herself. (Her expertise and neutrality were the reasons for her selection for the job.) This from an organization – (WPATH) – that was recently exposed by the WPATH Files as promoting “transgender medicine” leading to widespread medical malpractice on children and vulnerable adults. 

Andrew Doyle devoted an entire program to this expose. 

An article in the NY Times asked: Why Is the U.S. Still Pretending We Know Gender-Affirming Care Works?

Pamela Paul explained the political stakes this way:

“In Britain, both the Labour and the Tory parties quickly accepted the Cass Review’s findings. But in the United States, the issue is held hostage to each political party’s tendency to bend to its extremes. Republicans are beholden to religious and social conservatives. Democrats have bowed to transgender advocacy groups. The result is a struggle between those who believe they are trying to ‘save’ children from transgenderism and those trying to ‘protect’ children from transphobes.”

Putting politics and ideology ahead of science and the welfare of children helps no one. Is there a role for NAIS in helping schools find a way out of this intense and unhelpful ideological tangle?

Why the Silence from NAIS?

Despite global commentary on the Cass Review, NAIS has not said a word. I wonder whether any schools and regional associations have even heard of let alone read the Report and its recommendations. Did its publication register at NAIS?

NAIS is not in the healthcare business. However, it has offered guidance on gender-related issues for over a decade, including articles, blog posts, and workshops on topics like puberty blockers and social transition. 

Many NAIS schools routinely teach gender identity theory even to very young children. They have brought problematic social media influencers (Jeffrey Marsh, ​​Alok Vaid-Menon) in as diversity speakers, and included books, videos, and curricula created by advocacy and activist groups in their libraries and classrooms. NAIS and regional associations have highlighted controversial presenters (Diane Ehrensaft, Joel Baum) and suggested resources from activist organizations as resources for schools.  Gender issues are often included in accreditation manuals. 

Last summer, NAIS offered a multi-day workshop in partnership with the Gender Spectrum, an organization that supported administering puberty blockers to pre-adolescent children and cross-sex hormones to teenagers. This summer—post-Cass—it was business as usual with a four-day NAIS Inclusive Schools Network Institute (ISNI) in partnership with the Human Rights Campaign Welcoming Schools, a transgender advocacy group. The institute was organized to guide school leaders in using “a framework for creating gender-inclusive schools”.

The Role of Schools

Dr. Cass emphasizes the importance of schools in children’s health and well-being, stating that schools should use principles and evidence from the Cass Review to guide their policies. The review found no clear evidence that social transition in childhood has positive or negative mental health outcomes but noted that children who socially transitioned earlier were more likely to proceed to medical pathways.

Dr. Cass’s report confirmed what many clinicians and experts have been saying for years: children and young people who present at gender clinics often have other issues, such as trauma, abuse, autism, depression, anxiety, and internalized homophobia. These issues need to be addressed during a period of watchful waiting. Puberty often resolves the distress many children feel about their bodies, with the majority desisting by late teens or young adulthood. Despite these findings, NAIS schools continue to promote gender identity, teaching it to very young children and including advocacy materials in their curricula. Dr. Cass makes clear that these are powerful interventions that schools are not qualified to make.

The Need for Open Discussion

In a rational world, Dr. Cass’s report would transform the debate on how best to treat children in distress over their sexed bodies. However, the topic remains polarized, driven by ideologues and activists who shut down discussion and dissent.

An experienced NAIS school administrator told me that raising questions about this could be a “career-ender.” Why is that? Does NAIS have an explanation for such fear of free expression?

Many teachers and administrators in NAIS schools would welcome an open discussion about the best ways to help their students, and some question the promotion of gender ideology in the curriculum. Can they be heard without fear of ostracism and career repercussions?

Conclusion

Dr. Cass delivered her report and its 31 recommendations after considering all the quality global evidence and research available. She met with hundreds of patients and their families, clinicians, and experts. She strongly urged against overmedicalization and stated that the evidence for administering puberty blockers is weak. She also noted that social transition is a powerful intervention and schools should not take the lead in making those decisions. Since then, the British government, both Conservative and Labour, have maintained the ban on puberty blockers for gender-dysphoric young people. Health Secretary Wes Streeting said that he believed in science and child safeguarding and that the Government would follow the Cass recommendations. 

Where will NAIS be when the science (or rather if the dust) finally settles that the evidence for these treatments is not there and social transitioning is harmful? In the US, the resistance from medical trade groups and organizations leads to the question posed in the NY Times article Why Is the U.S. Still Pretending We Know Gender-Affirming Care Works?

The Cass Review should lead to wider discussion. The medical scandal of child transitioning did not happen in a vacuum. The media, social media, and schools have all played a part in placing vulnerable children on a medical pathway for life. Social transition in schools—names, pronouns, celebration, affirmation—is a prime example. Children who do not conform to sex stereotypes—often those who would grow up to be lesbian or gay—are particularly at risk. There is a strong case that “gender-affirming care” is anti-gay conversion therapy. 

Other children particularly at risk are those who have a variety of co-morbidities and social conditions such as autism, anxiety, depression, trauma, abuse, and neglect.

Schools that fail to discuss this issue and ignore the research are neglecting their duty to students. Teaching “gender identity” as fact is indoctrination into a contested belief system. 

Systematic reviews show no trustworthy evidence supporting the benefits of these interventions and mounting evidence of harm. Schools engaging in social transition are performing a powerful psychological intervention without proper training. 

The Cass Review serves as a wake-up call to clinicians, childcare professionals, and adults who supported this experiment without critical examination. Children and young people in distress have been ill-served by the medical treatment models. They deserve better.

It took years to get us into this muddle. 

Can NAIS respond and help schools get out of it? 

Or not? 

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You may also enjoy reading more articles written by Josie Holford for Intrepid Ed News.