The Cass Review Fallout Demonstrates How Culture War Poisoned the UK and US have become
Good science cannot be done without shutting down the trans culture war first
Firstly, please forgive me for the tone of this post. At this point, I am very frustrated, and almost exhausted, at the state of the trans discourse in the English-speaking West. And what I’m going to discuss today has further heightened my sense of frustration.
Last week, the long awaited final report of the Cass Review into the treatment of trans-identifying minors in England was released. As expected, it recommended a more cautious approach, and the NHS has decided that puberty blockers will only be available in trials from now on. The review itself was a first attempt at a systematic scientific examination of the question. However, the fallout, from both extremes, was anything but scientific.
Firstly, we have the trans activists, across the English-speaking West, who fundamentally won’t accept a more cautious approach to the treatment of trans youth, no matter what. They have now sought to paint the report as a piece of transphobic work, and there are even suggestions that Dr Cass herself might be a TERF, despite the total lack of evidence for these claims. Some have even accused the report of trying to ban all trans treatment up to age 25, which is clearly not what the report said. As previously stated, it didn’t even recommend a total ban up to age 18, like many Republican-dominated states have done in America. In fact, if you read the report itself, you would find that it has taken a very respectful approach. Dr Cass has been nothing but kind and respectful to trans people, from what I see. Still, there is need to recognize that we can’t always treat kids as if they were fully grown adults! The activists’ ‘either with us or against us’ attitude only serves to polarize and inflame, and is certainly not good for objective science.
I do have to acknowledge that the concerns some people have raised about the Cass Review’s methodology are valid. After all, what we want is the best evidence, and only the best methodology will get us there. The Cass Review was a first attempt at being systematically scientific in this area, and as you might expect with first attempts, it isn’t likely to be perfect, and there likely needs to be more work done to get to a definitive answer on this issue. Those who have a working knowledge of medical systematic reviews would know that issues around the study inclusion criteria, which ultimately affects which studies are included or excluded, are of utmost importance, and can fundamentally alter the conclusions of the review. Therefore, if there are concerns in this area, they must be seriously addressed. Moreover, given that it is ultimately a review about health services, there is also the question of whether all relevant stakeholders have been consulted, as well as whether a representative sample of each kind of stakeholder has been included. However, the shame is that these valid questions have gotten lost in all the hysteria, and frankly conspiratorial thinking, on whether the report or its author might be ‘transphobic’.
And then, there was the issue of UK Labour Shadow Health Secretary Wes Streeting responding to the report. Apparently, he said that while a few years ago he might have said that ‘some people are trans, get over it, let’s move on’, now he realizes that ‘there are lots of complexities’. What’s wrong with that? There are indeed lots of complexities in the way society moves to accommodate trans people, and the quicker we face this reality and actually deal with those complexities rationally, the better for all of us. Anything else would just prolong the current stalemate and suffering.
On the other hand, as a reasonable trans person who wants society to get to the objective truth regarding this issue, and to get to sensible solutions for trans issues in general, I’ve found those on the other extreme of the debate to be even more disappointing. Rather than focusing on how to implement the findings of the report, or even just the need for a more cautious approach to the medical treatment of young people, those on the culture war right have sought to weaponize the review against the trans community, and the concept of gender identity, as a whole. They are reading things that are not there in the report (e.g. saying that the report discredits the concept of gender identity when it says no such thing at all). They are also conjuring up conspiracy theories about adult activists trying to ‘trans the kids’ when this is not the picture being presented at all. One of the main reasons why some young people were put on medical treatment without adequate assessment or evidence was that the NHS was simply falling apart. (If anything, I think one of the biggest takeaways from all this is that the NHS needs to be overhauled, and other countries should not look to copy that system.) There were long waiting times, and health care professionals were just trying to do what they can. Sometimes misguided decisions were made, but there is no evidence that activists are actively encouraging medical treatment within the system. Hopefully the new guidelines will rectify the practice going forward.
I can’t help but notice that a lot of the anti-trans rhetoric that latched onto the Cass Review’s report to dishonestly advance their own agenda has a connection to the broader anti-trans culture war being played out on the ‘New Right’ since about two years ago. These people have sought to paint anything trans-related as part of a ‘gender ideology’ conspiracy, with what constitutes ‘gender ideology’ deliberately ill-defined, similar to how some on the right deliberately use ‘woke’ in a vaguely defined way (and I’m saying this as an anti-woke liberal). They also keep conjuring up grand conspiracy theories about a cabal of activists trying to ‘trans the kids’ for financial gain or ideological purposes. There is simply no evidence for this. While I’ve long favored a more cautious approach when it comes to minors, I recognize that those of the opposite opinion are not evil. For example, I know some trans people who really want gender dysphoric teenagers to be able to access medical treatment, because this might help them ‘pass’ better, and have an easier life. They came to this view from the position of living life as a visibly trans person, and experiencing all the difficulties living like this in a sometimes unaccepting society. You have to remember that, due to social non-acceptance, ‘going stealth’ was the traditional goal of many trans people. To ‘go stealth’ you have to ‘pass’. In a way, those trans activists just want these kids to have the choice of ‘going stealth’ in adulthood, because life as a visibly trans person is not very nice, to put it mildly. Now, I don’t really agree with this line of thinking, because it ignores that there is also a risk to those who might regret later. All trans adults were once gender dysphoric young people, but not all gender dysphoric young people will persist to have gender dysphoria in adulthood. This is what some trans activists forget. But this does not come from a place of evil at all. And let’s face it: conspiracy-minded thinking took hold in parts of the right during the pandemic, sadly it has not gone away post-pandemic. Our cultural and political discourse is therefore effectively suffering from a case of long COVID. This really is a problem.
As a reasonable trans person, I am willing to take a rational look at the complexities in the way society accommodates trans people. I am willing to seriously consider the competing rights and concerns of different stakeholders, and not just pretend such conflicts don’t exist. I have even tried my best to take the trans activist establishment to task for failing to do this. However, the way the culture war right has behaved, particularly since the pandemic, is not helpful. I’m trying my best to build goodwill among trans people to get the necessary discussions going, but all the goodwill in the world can’t withstand a wave of culture warriorism hellbent on ‘eradicating transgenderism from public life’, as one prominent right-wing personality openly said at CPAC last year. (Indeed, if you can’t recognize that the desire to ‘eradicate transgenderism from public life’ is basically fascist, then you’re probably so deep down the culture war rabbit hole that you’re beyond saving.) A year ago I was certain that people like him were in the minority, even on the right, but with the way some people have behaved since the release of the Cass Review, I’m not so sure anymore.
In contrast to what has been happening in America and Britain, Scandinavia has taken a much more reasonable approach to this issue. Several countries there have also reviewed the evidence and recommended a more cautious approach towards the treatment of trans-identified young people. However, the scientifically-driven process was generally accepted across the board, and the outcomes have not been weaponized by either side to further their culture war agendas. People simply accepted the new advice, and moved on with it. The fact that Scandinavia can be this mature but America and Britain cannot, says a lot about the harmful effects the toxic culture wars around trans issues are having in the English-speaking world.
In conclusion, the Cass Review is a worthy first attempt, at least in the English-speaking world, to take a systematic scientific look at the question of medical treatment for trans-identifying minors. This alone should be welcomed. There remain some criticisms of the methodology of the review, and I think we should look into those seriously. Going forward, we should continue to gather evidence, as well as refine the methodology of reviewing the evidence. However, the fallout from the public release of the report, from people on both extremes of the trans culture war, demonstrates how difficult it is to do truly neutral and objective science in the context of a raging culture war. If one side keeps shouting that everything is ‘transphobic’, and the other side keeps shouting that everything is ‘gender ideology’, it would drown out all serious attempts at being fair and objective. This is why we need to shut down the culture wars ASAP. We need to call out the bad actors on both sides, as a matter of urgency.
Originally published at https://taraella.substack.com.
TaraElla is a singer-songwriter and author, who is the author of the Moral Libertarian Manifesto and the Moral Libertarian book series, which argue that liberalism is still the most moral and effective value system for the West.
She is also the author of The Trans Case Against Queer Theory and The TaraElla Story (her autobiography).
