New Discoveries on Medical Care for Transgender Youth

By Tyler McKenzie

One truth that’s not up for debate is whether transgender people are beloved humans made in God’s image. They are. Gender dysphoria is real. To treat them with anything less than compassion is not Christian. What is up for debate is the efficacy of the current practices in transgender healthcare for youth. Recently, England released a scathing review that challenges the established gender affirming care model. Strangely, I haven’t heard many Christians discussing this. My goal here is to summarize these consequential findings so we can begin to process them. 

Hilary Cass is the leading pediatrician in England’s National Health Services. She recently completed what The Economist has deemed the most significant review “ever undertaken in the field of transgender health.” The Cass Review, an “Independent review of gender identity services for children and young people,” was published April 9th, 2024, by the Royal College of Pediatrics. The review was commissioned to determine the best medical approach for supporting trans youth. Here is Cass on their mission: 

“This review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people’s rights to health care. It is about what the health care approach should be, and how best to help the growing number of children and young people who are looking for support from the N.H.S. in relation to their gender identity.” 

Cass was not religiously or politically motivated. England is accepting of trans people. Their goal is to create a safer response for youth. That said, the big headline is shocking. They concluded the current gender affirming care model for youth (social transitioning followed by puberty blockers and cross sex hormones followed by surgical intervention) was accepted hastily without strong evidence. Cass reports that while doctors have always been cautious before implementing new interventions in emerging areas of medicine, “quite the reverse happened in the field of gender care for children.”  

Here are what two media outlets are saying. It’s important to note their willingness to challenge the culturally accepted approach. It shows the seriousness of the Cass Review: 

• The Atlantic (April 2024): In “Britain is Leaving the U.S. Gender Medicine Debate Behind,” Helen Lewis wrote, “[The Cass Review] has taken a political debate and returned it to the realm of provable facts. . . . The report drew on extensive interviews with doctors, parents, and young people, as well as on a series of new, systematic literature reviews. Its publication marks a decisive turn away from the affirmative model of treatment, in line with similar moves in other European countries.” 

• New York Times (April 18, 2024): In “The Courage to Follow the Evidence on Transgender Care,” David Books wrote, “Hilary Cass is the kind of hero the world needs today. . . . With incredible courage, she shows that careful scholarship can cut through debates that have been marked by vituperation and intimidation and possibly reset them on more rational grounds.” 
   

The 388-page manuscript and several summaries are available online. However, I have summarized the more relevant findings in the five points below. 

Puberty blockers, cross-sex hormones, and surgery are rarely necessary. The report says that exploration of identity is a natural process during childhood/adolescence that rarely requires clinical input or medical intervention. Gender dysphoria in childhood is not a reliable predictor for adult identification. Usually, gender dysphoria ceases and people embrace their biological sex. 

Most youth referred to gender clinics are dealing with other issues like autism, depression, anxiety, and eating or attention-deficit disorders. A study in Finland found that over 75% of referred adolescents needed psychiatric care for issues other than gender dysphoria. Another study found that trans-identifying people are up to six times more likely to have autism. Puberty blockers and cross-sex hormones can fail to treat (or even worsen) these other issues which may be the root cause of the dysphoria. 

There is no strong evidence that medical or social interventions improve mental health. Social transitioning techniques, like changing names or pronouns, do not provide strong evidence that they affect the mental health of youth (positively or negatively). Neither do medical interventions like puberty blockers and cross-sex hormones. Some European countries have already put restrictions on them. 

Social media and peer influence have played a substantial role in the exponential rise of trans identifications among teens, especially biological females. Transgender identifications have been growing rapidly since the 2010s. The popular explanation is that an environment of greater social acceptance has made it easier for people to be who they truly are. However, the report argues that we don’t know why identifications rose so quickly. The picture is complex and includes the power of social media and peer influence. The exponential nature of the growth is unlike other normal evolutions of acceptance for minority groups. 

This has become very politicized. The report suggests there was a rush to normalize gender-affirming care before the evidence was there. Many of the studies accepted as foundational were misrepresented, overstated, and of poor quality. Cass points out that there are few areas of healthcare where professionals are this afraid to openly share their perspectives because of online bullying and social shame. 

In conclusion, I hold orthodox Christian beliefs regarding sexuality and identity, but this isn’t a theological position paper. This is more like a news update. In our cultural moment, Christians must approach pressing issues with truth and love. If you use this information to bully and belittle, you are doing it wrong. If you use it to engage, minister, and love, thank you.