David Staples: Alberta can look to U.K. for advice on trans policy

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There’s one thing we can say with absolute certainty about the debate about the gender transitioning of children — it’s toxic.

Anyone who has entered into this debate will have noticed this poisonous atmosphere, most notably Dr. Hilary Cass.

But Cass, the former president of the Royal College of Paediatrics and Child Health in the United Kingdom, has produced a report that offers a way out of the anger and ugliness. She’s helping move the world towards a sensible, humane and evidence-based way of dealing with the trans issues, at least around the medical treatment of gender dysphoric or incongruent youth.

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Alberta can use such assistance just now. We’re about to be hit by a storm of trans controversy due to Premier Danielle Smith’s United Conservative government bringing forward a new law that will reshape the way we deal with various aspects of transgenderism.

Cass led a four-year independent review to find out why so many young people in the U.K., especially teen girls, were suddenly clamouring to transition and what evidence there was behind puberty blockers, hormones and surgery to treat them.

In April 2024, the final 388-page Cass Review came out. It was found to be so credible that it did the near impossible, uniting folks on all sides of the political U.K. spectrum, from Labour on the left to the Conservatives on the right, to accept Cass’ recommendations and promise to implement them.

Not that the Cass Review has been short on controversy. As Cass wrote in the report, “The toxicity of the debate is exceptional. There are few other areas of health care where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.”

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The Cass Review’s main finding? Just how little solid evidence exists on the medical transitioning of young people. Little is known about the medium and longer-term outcomes, the report stressed.

“This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”

The transitioning of youth was relatively rare in the U.K. as recently as 15 years ago. The U.K.’s Gender Identity Development Service saw fewer than 50 children per year, with fewer getting medical treatment. In 2011, however, came a single Dutch study and a protocol for puberty blockers as treatment, followed by an explosion of new patients in the U.K. to more than 1,700 per year by 2016.

Studies in the U.K. found no measurable benefit from this new treatment, the Review found, yet it expanded.

Cass heard from patients with varying views of the treatment. “Whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down. For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/retransition and/or experience regret.”

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Cass recommends more study, screening patients for other medical and psychological conditions, more and better trained medical care, clearer guidelines of what exactly is being treated and how the treatment is expected to work, and an overall focus on relieving distress in the patients. “For the majority of young people, a medical pathway may not be the best way to achieve this.”

The National Health Service England now recommends puberty blockers be used in young people only for research, based on Cass Review advice. “The review found that not enough is known about the longer-term impacts of puberty blockers for children and young people with gender incongruence to know whether they are safe or not, nor which children might benefit from their use.”

When it comes to the outcomes of masculinizing/feminizing hormones, the Cass Review recommends an “extremely cautious clinical approach and a strong clinical rationale for providing hormones before the age of 18,” with an option to provide them from the age of 16.

Alberta’s policy changes will deal with more than just medical treatment but, in the specific medical realm, the province’s new direction generally aligns with Cass Review recommendations. Alberta will ban hormone and puberty-blocking therapy for those under 16, and require parental, psychological and doctor approval for those 16 and 17.

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This approach will enrage some and distress others. But it looks to be a prudent path. When it comes to life-altering medical treatment of children and young people, where the outcomes are poorly understood, great caution is in order, correct?

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