CCBI News: Gender Affirmation – Changing Approaches

January 15, 2025

Dear Friends of CCBI,

Changing Approaches to Gender Affirmation

A May 2024 article in CCBI NEWS, (CCBI News, May 22, 2024: The Cass Review, Final Report, April 2024) detailed the recommendations of the British National Health Service’s sponsored review of treatment of transgender people and gender dysphoria, in April 2024. I wrote that the Report noted “a lack of evidence for, and mounting evidence against, the use of puberty blockers,” which affect a young person’s hormonal development from the onset of puberty. I observed the Report was challenged and continues to be challenged by some health authorities, but increasing numbers of countries followed suit and stopped the prescription of blockers, at least until there is clear evidence of their safety or wisdom. This approach is not an ‘anti-trans’ objection, but a scientific argument concerning lack of evidence on which to base treatment that could endanger a young person’s health and fertility.

The Cass Report was conducted over four years with many independent contributing consultants, and Dr Cass noted the importance of seeing the phenomenon of gender dysphoria “… in the broader context of poor mental health and emotional distress affecting the broader adolescent population.” It was adopted in the UK and several European countries, but it is of interest that there is no sign of any alterations in Canada Health’s website about the treatment of young people seeking help to transition. The website simply states: “Everyone, regardless of their gender identity, has the right to be their authentic self, and should have access to the care and support they need to lead a happy and healthy life.”

The stance is ‘gender-affirmative,’ meaning it accepts a young person’s self-identification as a member of the opposite sex at face value and will help that person access treatment to achieve the desired transition through the use of puberty blockers and hormonal treatment. The website does not refer to changes made elsewhere or to any concerns, thus how Health Canada approaches these matters is an ethical question in itself. In the meantime, the statements on their website speak for themselves, and, presumably, Canadian hospitals take their cue from that.

Statistics

The same website publishes figures on gender diversity, since it has been possible since the 2021 census to report gender identity separately from ‘sex assigned at birth.’ The latter phrase is questionable: who exactly does this ‘assignment?’ Parents? Hospital staff? Siblings? It’s a meaningless phrase. Nobody ‘assigns’ sex or gender; its sex is inherent in the uniqueness of each new person and is known long before birth, thanks to ultrasound, genetic testing, etc. Even ‘gender-reveal’ parties recognize this long before the baby’s birth. Invitations read: ‘Good news! We’re having a son!’ or ‘We’re having a daughter!’

Now that the Cass Report and other European studies have demonstrated that many influential studies in this field are deeply flawed, it is reasonable to expect a discussion of this information in Canada in academic, medical, legal and political circles. Perhaps that is happening, but there is not much evidence of it in the public sphere. In fact, Canada is still following the approach of the World Professional Association for Transgender Health, which is supported by the American Academy of Pediatricians and Planned Parenthood. The Catholic Medical Association (US) takes a principled stance against medical interventions at puberty and the American Pediatric Association has a more nuanced approach, in light of evidence-based cessation of treatments in other countries. It is interesting that pediatric associations in the US are themselves divided on the issue.

Detransitioning

An article in Psychology Today relates how psychologist Deborah Littman described the phenomenon of ‘rapid transition gender dysphoria’ in light of a sudden surge of young teenage girls claiming to experience this condition. This was a marked shift from the usual pattern, where the young person begins to articulate gender discomfort at 4/5 years old. She suggested the root causes have not been fully investigated—a claim later made in the Cass Report. Littman theorized about ‘social contagion,’ i.e., young girls were being influenced by online information that led them to believe the root cause of their own troubles was gender dysphoria, leading to requests for treatment. Her findings were disparaged at the time, and she revised her work to say she was describing new social patterns of behaviour, not attempting to diagnose the cause of dysphoria.

In recent years, however, there has been an upsurge in requests for detransition, mainly from young women who sought to become men and who now seek counseling and medical assistance to ‘revert.’ In a subsequent article, Littman asked whether there might be a link between de-transitioning and rapid onset gender dysphoria. She surveyed one hundred people who ‘reverted,’ and the results showed that two-thirds of her respondents had been born female, reflecting the same gender distribution found by other studies. Littman’s survey revealed, among other points, that:

• 60 percent reported that they had become more comfortable identifying as their birth sex.
• 49 percent marked concerns about medical complications, particularly regarding hormone replacement therapy.
• 38 percent noted that transitioning had not resolved their psychological issues, so they had concluded that gender dysphoria was not the cause.
• 23 percent reported that experiences of discrimination had made living as a transperson untenable.
• Another 23 percent understood that they had in fact been struggling with sexual orientation issues rather than gender dysphoria.

Overall, about 75% stated that gender dysphoria was a misdiagnosis of their psychological disorder. In fact, the majority felt they had not been given an adequate evaluation from a medical or mental health professional before starting the transition procedure.

This, in turn, is acknowledged by the Cass Report, and de-transitioning is an area where health services in the UK and elsewhere are working to help those whose diagnoses have been wrongly made. Health Canada does not discuss this on its website and is difficult to find adequate information about it on the hospital websites I checked.

Speaking Out

A disturbing factor in Canada is that sometimes speaking about these matters in public has consequences, as I and some medical practitioners have found in terms of complaints made against them. The false accusation is sometimes made that to question gender affirmation is to support some form of ‘conversion therapy.’ This seems meant to discourage those who question or challenge certain procedures from speaking out, in clinics, schools, doctors’ offices, universities, etc. Yet hardly anyone uses that term. Rather, it is interesting that those who support early transition are themselves involved in an attempt to ‘convert,’ except the word ‘transition’ is used. That word and the actions that follow involve a shift or change, and a radical one at that, from male to female or vice-versa. The Cass Report made a strong request to make the debate less ‘toxic,’ and the Special Rapporteur on Violence against Women and Girls at the United Nations, commenting on the Report, noted:

…the tendency to equate inquiries into any underlying psychological or mental health issues with conversion therapy, preventing children from getting the comprehensive support they deserve. In my statement at the end of my visit to the United Kingdom in February 2024, I acknowledged the profile of girls seeking “gender affirming interventions” and underlined the need for any legislation on conversion therapy to ensure that it does “not prevent these young women being supported holistically…” and that it “should ensure transition does not become the only option that is acceptable to discuss with them.”

This is supportive of holistic treatment that is wider reaching than gender affirmation and more in line with the approach of those who counsel against taking steps leading to transitioning that may be irreversible or cause harm. The UN Rapporteur continued:

The Cass review findings and recommendations are seminal, and its implications go beyond the United Kingdom. While the Cass Review may not have framed its conclusions and findings explicitly in human rights language, it has – in my view – very clearly shown the devastating consequences that policies on gender treatments have had on human rights of children, including girls. These policies have breached fundamental principles, such as the need to uphold the best interest of the child in all decisions that affect their lives, and the right of children to the highest attainable standards of health. (emphasis added)

These are strong words that need to be heard in the highest circles of medical and legal administration. They are certainly in line with the social teaching of the Catholic Church and its emphasis on the dignity of the human person, ‘made in the image and likeness of God,’ the ultimate marker of our creaturely form, male or female.

Sources

Final Report – Cass Review
Why Some Transpersons Decide to Detransition | Psychology Today
UK: Implementation of ‘Cass report’ key to protecting girls from serious harm, says UN expert | OHCHR

Pope Francis’ Intentions for January

For the right to an education
Let us pray for migrants, refugees, and those affected by war, that their right to an education, which is necessary to build a better world, might always be respected.

Moira and Bambi