The long, hard road to Cass


The long, hard road to Cass

How whistleblowers, detransitioners and gender-critical activists took on trans ideology – and won.

Jo Bartosch

Jo Bartosch

Topics Identity Politics Long-reads UK

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How did people emerge from the hysteria of the witch trials? What must it have felt like to live through the period when supposed witches were suddenly revealed to be ordinary women? What did the accusers say when it became clear that these supposed agents of Satan were simply adult human females? Did they feel guilt and try to make amends? Did they shirk their responsibility? Or did they double down?

The reactions to the publication of the Cass Review last week might give us some idea. The activists, medical professionals and celebrities who championed the trans cause have been confronted with the horror they helped create. Dr Hilary Cass’s report into the NHS’s treatment of gender-confused kids has radically transformed the trans debate, exposing ‘gender-affirming care’ as a dangerous experiment. Now, the disciples of trans ideology are scrambling to save face.

The most common reaction from cheerleaders of trans ideology has been to meekly plead ignorance. One such case is that of Dr Adam Rutherford, geneticist, science communicator and president of Humanists UK – an organisation that in recent years has made a hard turn away from science and rationality in favour of worshipping the cult of gender identity. Yet when he was invited to comment on the Cass Review by Sex Matters director Maya Forstater on X, Rutherford said: ‘It’s not something I know much about.’ Really? It’s somewhat difficult to believe that Rutherford has somehow missed seeing this bit of hugely significant medical news.

This is mirrored by the bleating entreaties for ‘nuance’ from television presenter Kirstie Allsopp. For the past few years, Allsopp has smeared gender-critical views as transphobic. Now she is attempting to rewrite history by claiming that it has always ‘been possible to debate these things and those saying there was no debate are wrong’. We all know this isn’t true. As JK Rowling correctly points out, ‘one of the gender ideologues’ favourite slogans is “no debate”’.

Perhaps the most egregious response of all has come from former Stonewall CEO Baroness Ruth Hunt. It was Hunt who oversaw the charity’s transformation from a gay-rights charity to an LGBT lobby group, with the emphasis firmly on the T. It was under her watch that Stonewall tried to silence warnings about the dangers of experimental puberty blockers. Yet last week, Hunt told The Times that she had simply ‘trusted the experts’ on puberty blockers and cross-sex hormones, so she couldn’t possibly be held accountable. Given that Stonewall itself was deferred to as an ‘expert’ organisation on the issue of gender-affirming care, it is hard to accept Hunt’s projection of innocence. She was hardly some misled ingénue.

Even more deranged and delusional are those who have dismissed the Cass Review as ‘unscientific’. Apparently, Cass’s four years of research and the reams of data she gathered are simply a pretext for promoting a ‘transphobic’ narrative. This rejection of reason is perhaps most eloquently demonstrated by the hyperbolic hashtag, #CassKillsKids, which has been tweeted out by the likes of broadcaster and trans activist India Willoughby. But this position is so patently untrue that only a small minority of the most committed zealots seem to be defending it.

The fact is, it is incredibly difficult for trans activists to obscure their roles in this scandal. Many of them must now be aware that they cheered on a gruesome, ideologically motivated experiment on children. After all, the facts are now indisputable.

A London Pride march from the Wellington Arch on 9 July 2022, London, UK.
A London Pride march from the Wellington Arch on 9 July 2022, London, UK.

In measured tones and meticulous detail, Cass’s report reveals what was really going on inside the NHS’s Gender Identity Development Service (GIDS). She concludes that the ‘gender affirming’ medical treatments it provided, like puberty blockers and cross-sex hormones, are based on ‘wholly inadequate’ evidence. Doctors are usually cautious when adopting new treatments, but Cass says ‘quite the reverse happened in the field of gender care for children’. Instead, thousands of children were put on an unproven medical pathway. Worse still, medical professionals seemed largely uninterested in uncovering the side effects and long-term risks of these drugs. Cass says that all but one adult gender clinic refused to share patient data that would allow her team to study how childhood transitioners fared as adults. This made it virtually impossible to research the potential longer-term consequences of transitioning.

The implications of the review are so grave that politicians have had no choice but to act. On Monday, health secretary Victoria Atkins gave an excoriating speech to parliament, laying out the changes in policy that have already been made and those still to come. She reiterated that NHS England would no longer be able to prescribe puberty blockers for children with gender dysphoria outside of clinical trials. She also promised a crackdown on private prescriptions, as well as an urgent review on clinical policy for prescribing cross-sex hormones. Vitally, she also announced that NHS trusts that initially refused to cooperate with the review will now share their data, hopefully opening the door for further research. These developments were all sorely needed.

Atkins also made a point of thanking the clinicians, academics, activists and journalists who raised the alarm. She acknowledged that they had ‘risked their careers’ to do so. She told her fellow politicians that it should trouble each of them that the NHS ‘was overtaken by a culture of secrecy and ideology that was allowed to trump evidence and safety’.

Finally, politicians are taking these concerns seriously. Until very recently, they did not want to know. Back in May 2019, I was one of a handful of people to attend the First Do No Harm meeting at the House of Lords. There, in a tiny cramped room, we listened to clinicians and campaigners who were desperately worried about the goings on in the GIDS Tavistock clinic in London.

First Do No Harm was organised by campaigner Venice Allan and Let Women Speak founder Kellie-Jay Keen (aka Posie Parker), with the aim of bringing together journalists, politicians and medical experts. It was chaired and sponsored by Labour peer Lord Lewis Moonie, who himself had a background in psychology and clinical pharmacological research. Among the attendees was psychoanalyst Marcus Evans. He had resigned from his post as a governor at the Tavistock clinic in February that year, citing concerns about the influence of lobby groups on clinical practice.

Despite this wealth of knowledge and expertise, First Do No Harm went largely ignored by politicians. Invitations were sent out to every member of parliament. But, aside from Moonie, the only politicians in attendance were Baroness Tanni Grey-Thompson and Conservative MP David Davies. As Evans explained at the time: ‘No one would basically attend, they’d be threatened that they would have the whip withdrawn if they attended… the silencing of opposition in this area is unbelievable.’

There was certainly a cost for Moonie. After over 40 years in the Labour Party, he was told by party general secretary Jenny Formby that his membership would be at risk if he proceeded with the event. So he resigned. Five years on, and the concerns of Moonie, a small band of whistleblowing clinicians and tenacious campaigners have finally been acknowledged.

While First Do No Harm was the first public meeting bringing concerned voices together, staff within GIDS had already been sounding the alarm for some time. It was all the way back in 2004 that Susan Evans, wife of Marcus, first spoke out about the ‘precipitous referral’ of gender-confused children on to a medical pathway. As a clinical nurse at the Tavistock, she tried to raise the possibility that there were alternatives to medically transitioning children. But she was advised that GIDS would be unable to attract patients without offering puberty blockers. Evans resigned in 2007.

Today, Evans tells me that, while she is relieved about the findings of the Cass Review, she is frustrated to see ‘what happened at GIDS described as a debate between two sides’:

‘I wanted to ensure that kids were receiving a thorough assessment and that as a team there would be a more holistic exploration… That’s not a toxic debate, that is clinical discussion and that’s what a responsible clinician ought to do. All I ever did was raise ordinary but important clinical and safeguarding concerns and questions. I was inquisitive.’

Thankfully, there were still some other inquisitive clinicians out there. In 2018, Dr David Bell, consultant psychiatrist and staff governor at the Tavistock, wrote an internal report that slammed GIDS for promoting a model of uncritical gender affirmation. He blamed trans lobby groups like Mermaids and Stonewall for infecting the organisation. He also explained that many of the young patients seeking to medically transition would otherwise grow up to be lesbian, gay or bisexual. For this, senior management at GIDS threatened Bell with disciplinary action, in an attempt to silence him.

Shortly afterwards, in 2019, clinical psychologist Kirsty Entwistle, who had previously worked at the GIDS satellite clinic in Leeds, penned an open letter, echoing similar concerns. She warned that patients were falsely being told that puberty blockers were ‘fully reversible’ and that accusations of transphobia were stifling important medical and safeguarding discussions.

GIDS was desperate to silence anyone who expressed doubts about how clinics were operating. One such whistleblower was Sonia Appleby, who was a social worker and safeguarding lead at the Tavistock. In 2016, Appleby began to raise concerns about the shambolic record-keeping and the potential over-prescription of puberty blockers. For this, she was bullied and monstered by management, and shunned by GIDS director Dr Polly Carmichael. Carmichael apparently told her team that Appleby had ‘an agenda’ and discouraged staff from sharing any safeguarding concerns with her. In a small act of justice, in 2021 Appleby was awarded £20,000 in damages for the appalling way she was treated at the Tavistock.

The NHS's Tavistock Centre, 23 June, 2023, London, England.
The NHS's Tavistock Centre, 23 June, 2023, London, England.

Many of the stories from those who spoke out chime with one another. They talk about being alarmed that children’s underlying issues were being systematically overlooked. GIDS was more interested in prescribing medical treatments than in helping children who were suffering from homophobic bullying, mental-health issues, sexual abuse or other traumas. When questions were asked about the safety of puberty blockers and hormones, staff faced an atmosphere where clinical curiosity was discouraged. In all, between 2016 and 2019, a total of 35 clinicians left the Tavistock, with many citing concerns about children being over-diagnosed. Meanwhile, management ignored all these concerns and children continued to be prescribed puberty blockers.

It was shortly after Carmichael’s appointment in 2011 that GIDS began its first trial of puberty blockers. Before the research had even concluded, these drugs, which have also been used to chemically castrate sex offenders, were made more widely available to children. In 2014, the minimum prescription age was dropped from 16 to 11. Some private clinics even started prescribing them to children as young as nine.

GIDS management, it seemed, was remarkably unbothered by the lack of evidence for puberty blockers. In 2016, Carmichael told a World Professional Association for Transgender Health conference in Amsterdam that they were crucial for trans-identified kids and ‘incredibly successful’. But in the same speech, she admitted that ‘actually, the Dutch are the only team really who have published long-term perspective studies about this. So there is very little data available.’ Indeed, as Carmichael admits, virtually the only bit of evidence ever referenced in support of puberty blockers is a piece of flawed research from the Netherlands. It was later revealed that the findings from GIDS’s own puberty-blocker trial were far from reliable.

It was left to those on the outside to bring public attention to what was happening at GIDS. Yet, just as with the silencing of clinicians, those outside the medical profession were also smeared as transphobic for questioning the new wisdom about so-called trans kids.

One of the earliest groups to demand an evidence-based approach was Transgender Trend, which was founded by Stephanie Davies-Arai in 2015. She and her organisation were almost instantly hounded and derided by trans extremists. A children’s book published by Transgender Trend was even compared to ‘terrorist propaganda’. But this smear campaign wouldn’t stop the truth from being revealed. Transgender Trend soon attracted the attention of Oxford professor Michael Biggs. In 2019, he published a report with the organisation, showing that the use of puberty blockers did not reduce the mental distress experienced by patients – a conclusion now backed up by Cass.

This reality became impossible to ignore, especially as ‘detransitioners’ began to speak out. The existence of people who regretted their decision to transition proved to be a thorn in the side of the trans movement and a powerful testimony against so-called trans healthcare. In November 2019, a women’s rights group called Make More Noise hosted the first panel discussion of detransitioners in the UK, giving them an opportunity to share their stories with journalists. With testosterone-cracked voices and mastectomy scars, these young women embody the harms of gender medicine. They were the ‘data’ that the clinicians at GIDS had overlooked.

Detransitioners fought to make themselves heard. In 2020, a high-profile legal challenge by detransitioner Keira Bell against the Tavistock prompted NHS England to commission the Cass Review. Leading paediatrician Dr Hilary Cass was then tasked with finding out what was really happening at GIDS.

Detransitioner Sinead Watson, who, as a young adult, took medical steps to present as male, is one of those who gave evidence to the Cass Review researchers. She tells me: ‘They asked about my story, how I was evaluated, how quickly, about the side effects of [testosterone] and about the surgery. They asked how I was helped to deal with the regret when I sought out support from the NHS, and seemed genuinely surprised I had received no help.’

It truly is a scandal that children and youngsters were put on a pathway to medicalisation and then promptly abandoned. There are now calls for a public inquiry, and it looks like adult services will also now face their own Cass-style review. But the problem with the trans ideology is that it extends far beyond medicine. It is a mind virus that has infected almost every British institution.

Certainly, there can never be true justice for detransitioners. They will continue to carry the mistakes of the medical establishment, and the failure of the government, on their bodies. It also seems unlikely that any of the whistleblowers who were vilified for raising the alarm will receive apologies or retractions. Trans cheerleaders will continue to deny any complicity. No doubt the GIDS management and healthcare professionals who tried to suppress the truth will be able to slink off to lucrative careers elsewhere.

Still, the Cass Review has revealed that the witches were right. Its publication ought to mark a historical turning point, and serve as a reminder that truth can win out. We must remember all this when the next hysterical mania sweeps over society.

Jo Bartosch is a journalist campaigning for the rights of women and girls.

Pictures by: Getty.

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Topics Identity Politics Long-reads UK


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