Dr. Cass: The American Academy of Pediatrics Is 'Out of Date' on Gender Affirming Care

AP Photo/Rick Bowmer

Dr. Hillary Cass is the former head of the Royal College of Pediatrics and Child Health in the UK. She recently completed a four year-long review of the treatment of pediatric gender care which concluded the evidence for gender affirming care was weak. While her report (know as the Cass Revew) was immediately influential in the UK it has been largely ignored in the US. Today the NY Times published an interview with Dr. Cass about her report and why she believes it hasn't led to any second thoughts in America. Simply put, she thinks it comes down to political pressure.


I’ve reached out to major medical groups in the United States about your findings. The American Academy of Pediatrics declined to comment on your report, citing its own research review that is underway. It said that its guidance, which it reaffirmed last year, was “grounded in evidence and science.”

The Endocrine Society said “we stand firm in our support of gender-affirming care,” which is “needed and often lifesaving.”

I think for a lot of people, this is kind of dizzying. We have medical groups in the United States and Britain looking at the same facts, the same scientific literature, and coming to very different conclusions. What do you make of those responses?

When I was president of the Royal College of Pediatrics and Child Health, we did some great work with the A.A.P. They are an organization that I have enormous respect for. But I respectfully disagree with them on holding on to a position that is now demonstrated to be out of date by multiple systematic reviews.

It wouldn’t be too much of a problem if people were saying “This is clinical consensus and we’re not sure.” But what some organizations are doing is doubling down on saying the evidence is good. And I think that’s where you’re misleading the public. You need to be honest about the strength of the evidence and say what you’re going to do to improve it.

I suspect that the A.A.P., which is an organization that does massive good for children worldwide, and I see as a fairly left-leaning organization, is fearful of making any moves that might jeopardize trans health care right now. And I wonder whether, if they weren’t feeling under such political duress, they would be able to be more nuanced, to say that multiple truths exist in this space — that there are children who are going to need medical treatment, and that there are other children who are going to resolve their distress in different ways.


There's a note at the end of the story that the AAP has added Dr. Cass' report to their base of information but they disagree they are misleading anyone. 

Surprisingly, the Times reporter who interviewed Dr. Cass didn't disagree with her suggestion that political duress was a factor in the US silence on her report. On the contrary, moments later she suggested pediatricians across the US were under the same pressure.

Pediatricians in the United States are in an incredibly tough position because of the political situation here. It affects what doctors feel comfortable saying publicly. Your report is now part of that evidence that they may fear will be weaponized. What would you say to American pediatricians about how to move forward?

Do what you’ve been trained to do. So that means that you approach any one of these young people as you would any other adolescent, taking a proper history, doing a proper assessment and maintaining a curiosity about what’s driving their distress. It may be about diagnosing autism, it may be about treating depression, it might be about treating an eating disorder.

What really worries me is that people just think: This is somebody who is trans, and the medical pathway is the right thing for them. They get put on a medical pathway, and then the problems that they think were going to be solved just don’t go away. And it’s because there’s this overshadowing of all the other problems.

So, yes, you can put someone on a medical pathway, but if at the end of it they can’t get out of their bedroom, they don’t have relationships, they’re not in school or ultimately in work, you haven’t done the right thing by them. So it really is about treating them as a whole person, taking a holistic approach, managing all of those things and not assuming they’ve all come about as a result of the gender distress.


She might have simply said be a doctor, not an activist. But that's hard to do these days. Some good comments here starting with this one from a teacher in North Carolina who begs the AAP to listen to Dr. Cass:

15th year of high school teaching here, and I just want to say, PLEASE, AAP, wake up.  Every single student I have worked with who is trying to transition has other major comorbid mental health struggles.  All of those struggles were pre-existing to gender dysphoria.  How can anything mental that is diagnosed as "rapid onset" in the adolescent years not at least be critically studied for social contagion?  

Cass is so correct when she says that many of these amazing young people need treatment for depression, neurodiversity struggles, ADHD, or eating disorders.  As an educator who has worked with "clusters" of students experiencing "rapid onset" gender dysmorphia, so many teachers are horrified by what we are "throwing" at these kids without studying it. 

Two weeks ago, a student told me that their doctor had done the following at ONE appointment:  raised their Adderall dosage, raised their Zoloft dosage, and started them on Lupron, which is a puberty-blocker.  In ONE appointment.  This student is 15 years old, and a high school sophomore.  This student is not in regular therapy.

Who is studying the effects, countereffects, and ramifications of all these separate medications on developing brains and bodies?   Why are teachers and school counselors so often the ones asking these questions and NOT the doctors writing these prescriptions or even the pharmacist filling these scripts? 

I feel like we are all screaming into a void.  Listen to Cass, AAP.  Listen.


From Daniel in Los Angeles:

Physician who votes Democratic here.  Increasingly over the past 10-20 years, the distinction between advocacy and research has been lost.  Researchers on topics such as this skew heavily progressive and they often work backwards from desired conclusions to produce shoddy research which support them.  Same for many professional societies such as AAP and even, remarkably, the AMA.

A mom named Heather replied to his comment.

It is so difficult to be a Democrat and on the "wrong side" of the debate here. Having seen my own daughter battle rapid onset gender dysphoria I know that she would have come to great harm if allowed to alter her body with drugs or surgeries. I hope that other moms out there are standing firm and helping their daughters through a scary and difficult time.

It would be nice to think the AAP will come around given time but frankly I don't have much hope for any of these institutions which have been captured by left-wing activists. They rarely self-correct.

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David Strom 5:00 PM | May 23, 2024