Nothing in Critically Appraising the Cass Report is surprising, but a lot of it exactly confirms what has been widely suspected and reported less formally up until this point.
They essentially looked at it and found it wanting and against best practices
Noone, C., Southgate, A., Ashman, A., Quinn, É., Comer, D., Shrewsbury, D., … McLamore, Q. (2024, June 11). CRITICALLY APPRAISING THE CASS REPORT: METHODOLOGICAL FLAWS AND UNSUPPORTED CLAIMS. https://doi.org/10.31219/osf.io/uhndk
The Cass Review has been widely noted to have almost no domain experts or even methodological experts in their headlines or working with them.
Compare and contrast with this, whose corresponding author is Dr. Chris Noone, a researcher in LGBTQ+ spaces at the University of Galway and chair of the Research Sub-Committee of the National LGBT Federation.
After that we have an assortment of essentially cosigners in the author line.
Those cosigners include some who have an interest by being trans researchers in other domains (such as software engineering, bioinformatics, or ENT surgery), others have a rich set of domain experience (e.g., people whose direct area of research is trans youth helathcare or clinicians for the same). They cover multiple continents and institutions.
Many (if not all) of those involved are themselves trans or at least LGBTQ. These are people with a stake in the game, so to speak.
In general I tend to be skeptical of research that has a large author list like this, but in this case it is pretty clear that you are looking at people with a direct stake who are cosigning because of how much of a splash the Cass Report has generated in ways that affect them, and many of them personally. Many if not most also have relevant domain expertise.
Rather than analyzing the Cass Review directly, this paper starts off by tackling something that is in the inference chain for the foundations of the Cass Review: the systematic reviews and research that went into it.
It claims methodological biases, breaks down each of the reviews in turn, and is a good overall answer to the "this is the best report ever, citation: the cass report" thing you 've seen a lot of.
I won't go into it more for now, but it's well worth your time.
So long as we are on the topic, in the same vein some other citations that are worth your time:
Horton, C. (2024). The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children. International Journal of Transgender Health, 1–25. https://doi.org/10.1080/26895269.2024.2328249
Grijseels, D. M. (2024). Biological and psychosocial evidence in the Cass Review: a critical commentary. International Journal of Transgender Health, 1–11. https://doi.org/10.1080/26895269.2024.2362304
I continue to circle back to something that seems glaringly obvious when you read the #CassReview and when we talk methodological criticisms.
The selection of studies for the review could be considered reasonable! The grading could be considered reasonable! There are reasons to dispute both of these, but we could even make an argument for that. In that sense they didn't "discard the evidence."
But then in their conclusions they definitely discarded it.
I was critical of the Cass Report earlier, talking about how discounting studies that weren't double blinded RCTs was bad form. Apparently Dr Cass has responded, saying that '"obviously" young people could not be blinded as to whether or not they were on puberty blockers or hormones because "it rapidly becomes obvious to them". But that of itself is not an issue because there are many other areas where that would apply"' https://www.bbc.co.uk/news/health-68863594
It is very telling to me how the NHS and the BMJ (and various others) are not doing any correction of the anti-trans crowd when they attribute things to the Cass review that it doesn't say.
They are pretty much exclusivley talking about it in terms of debunking criticisms. Not support that draws an incorrect inference.
Another problem that I have with the #CassReview: its attempt to draw a line between puberty blocking and GAHT.
One would not expect that puberty blocking would reduce dysphoria and, in fact, it would be kind of weird if it turned out that it did: that doesn't fit with how any of this works.
Puberty blocking is about giving time to make a choice.
If all of the kids who are going on puberty blockers are then going on GAHT, a clear alternate hypothesis would be they should just start GAHT.
They talk about "returning to normal best practices" but in a real way that would be more accepting and more progressive than the previous status quo.
Because ordinarily when you have a situation in pediatric care where there is nothing "on label" there should be a conversation between the kid, the parent, and the doctor.
This is done very commonly, because most drugs aren't authorized for the age group they get used with (like 70–80% of prescriptions?)
There's literally nothing here that ties into any of the fields that are relevant. Her specialization is all in developmental and mental disabilities in high-support-need younger children.
"Independent" evidently means "so far out of her lane that she can't see her lane on this side of the horizon."
Grijseels, D. M. (2024). Biological and psychosocial evidence in the Cass Review: a critical commentary. International Journal of Transgender Health, 1–11. https://doi.org/10.1080/26895269.2024.2362304