Cass Review author says leading medical org only supports trans health care under “political duress”

In an interview with Azeen Ghorayshi of the New York Times published earlier today, Dr. Hilary Cass – lead author on the highly controversial Cass Review examining gender-affirming care for trans youth – took a “both sides” approach as to whether social acceptance or the widely discredited theory of ‘social contagion’ causes people to come out as trans.

“Social acceptance just doesn’t happen that way, so dramatically,” Cass told the Times. “So that doesn’t make sense as the full answer. But equally, those who say this is just social contagion are also not taking account of how complex and nuanced this is.”

Related: Anti-trans bills keep citing The New York Times

“By any objective measure, the paper seems clearly devoted to advocating against this care.”

She went on to say that “it only becomes a challenge if we’re medicalizing [gender], giving an irreversible treatment, for what might be just a normal range of gender expression.”

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The social contagion concept refers to the debunked concept of rapid-onset gender dysphoria (ROGD), a hypothesis originally promoted by Lisa Littman, who has since had her initial study on the topic retracted. 

There is no evidence for ROGD, and the only advocates for it are notable anti-trans activists.

Published last month, the Cass Review is a lengthy report that commissioned multiple systematic reviews of the quality of evidence surrounding pediatric gender-affirming care from England’s University of York. Cass spearheaded the review, which has been used to support bans on puberty blockers in England and has been widely criticized for being politically biased and inaccurate.

In the interview, Cass was also asked whether she has heard from “any other U.S. health bodies, like the Department of Health and Human Services,” to which she replied, “No.”

While Cass may not have been in contact with them following the report’s publication, she did meet with Floridian health officials as recently as September 2022 – something not mentioned in Ghorayshi’s piece. As reported on by Zinnia Jones of GenderAnalysis, Cass met and collaborated with members of the Florida Board of Medicine appointed by the state’s anti-LGBTQ+ Gov. Ron DeSantis (R).

In a recently revealed email chain between activist Alejandra Caraballo and Ghorayshi, Ghorayshi denied that this omission is misleading.

Cass also dismissed the position of expert organizations like the American Academy of Pediatrics (AAP), claiming that it is a “fairly left-leaning” organization and is politically motivated in what it chooses to support. The AAP is the leading medical organization for pediatricians in America, comprising over 67,000 doctors. It has previously advocated for mask mandates and vaccines and has argued for the safety of abortions.

Additionally, Cass claims in the interview that she kept 58% of the evidence and did not dismiss anything for not being a randomized control trial. While this is technically true, it ignores points made by journalists and experts alike, such as a recent Mother Jones piece highlighting how the scale used to evaluate these studies is very subjective and explaining that her approach to evaluating study quality showed favoritism for studies critical of transgender care. A Twitter thread by journalist Lexi Koren also made detailed critiques of the review’s process.

Cass also failed to mention in the interview that there are heavy restrictions for puberty blockers in England that were put in place in direct response to her work.

This interview is not the first time Cass has made misleading or problematic claims. In one released earlier this month with NPR, she claimed that transitioning success could be measured by factors like employment, making no mention of how anti-trans discrimination may bias the results.

Journalist Erin Reed wrote of this claim, “Should transgender people be judged on their ability to be ’employed’ or their willingness to ‘get out of the house,’ their own discrimination may then be used against their ability to access medication.”

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