Talk:Cass Review

sources for consideration

• Vinter, Robyn (11 April 2024). "Trans children in England worse off now than four years ago, says psychologist". The Guardian.
• "The Guardian view on the Cass report: rising numbers of gender distressed young people need help". The Guardian. 11 April 2024.
• Barnes, Hannah (10 April 2024). "The Cass review into children's gender care should shame us all". New Statesman.
• "The Observer view on the Cass review: children were catastrophically failed by the medical profession". The Observer. 14 April 2024.
• "RCPCH responds to publication of the final report from the Cass Review". RCPCH.
• "Cass Review 'should mark a watershed moment' – charity chief". The Shropshire Star. 9 April 2024.
• Hansford, Amelia (10 April 2024). "Cass report urges 'caution' in prescribing puberty blockers to trans youth". PinkNews | Latest lesbian, gay, bi and trans news | LGBTQ+ news.
• Dyer, Clare (9 April 2024). "Guidelines on gender related treatment flouted standards and overlooked poor evidence, finds Cass review". BMJ: q820. doi:10.1136/bmj.q820.
• Abbasi, Kamran (11 April 2024). "The Cass review: an opportunity to unite behind evidence informed care in gender medicine". BMJ: q837. doi:10.1136/bmj.q837.
• Abbasi, Kamran (9 April 2024). ""Medication is binary, but gender expressions are often not"—the Hilary Cass interview". BMJ: q794. doi:10.1136/bmj.q794.
• Cass, Hilary (9 April 2024). "Gender medicine for children and young people is built on shaky foundations. Here is how we strengthen services". BMJ. 385: q814. doi:10.1136/bmj.q814. ISSN 1756-1833.
• "Evidence for puberty blockers and hormone treatment for gender transition wholly inadequate | BMJ". BMJ.
• Penna, Dominic (16 April 2024). "Chris Whitty: Debate around transgender issues 'too vitriolic'". The Telegraph.
• Reed, Erin. "Why Hilary Cass' NHS report is wrong about trans health care". The Advocate.
• "Gender care review: Children 'let down' by research amid 'exceptionally toxic' debate". ITV News.
• "Hilary Cass: Ideology on all sides directed gender care of children". ITV News.
• Horton, Cal (14 March 2024). "The Cass Review: Cis-supremacy in the UK's approach to healthcare for trans children". International Journal of Transgender Health: 1–25. doi:10.1080/26895269.2024.2328249.
• "Gender Identity Service Series". Archives of Disease in Childhood.
• Thornton, Jacqui (April 2024). "Cass Review calls for reformed gender identity services". The Lancet. 403 (10436): 1529. doi:10.1016/s0140-6736(24)00808-0.
• Ghorayshi, Azeen (2024-05-13). "Hilary Cass Says U.S. Doctors Are 'Out of Date' on Youth Gender Medicine". The New York Times. ISSN 0362-4331. Retrieved 2024-05-14.
• Grijseels, D. M. (8 June 2024). "Biological and psychosocial evidence in the Cass Review: a critical commentary". International Journal of Transgender Health. doi:10.1080/26895269.2024.2362304.
• Horton, Cal; Pearce, Ruth (7 August 2024). "The U.K.'s Cass Review Badly Fails Trans Children". Scientific American. Retrieved 13 August 2024.
• Polgreen, Lydia (13 August 2024). "The Strange Report Fueling the War on Trans Kids". New York Times. Retrieved 13 August 2024.
• Davie, Max; Hobbs, Lorna (8 August 2024). "Cass: the good, the bad, the critical". Retrieved 18 August 2024.
• Budge, Stephanie L.; Abreu, Roberto L.; Flinn, Ryan E.; Donahue, Kelly L.; Estevez, Rebekah; Olezeski, Christy L.; Bernacki, Jessica M.; Barr, Sebastian; Bettergarcia, Jay; Sprott, Richard A.; Allen, Brittany J. (28 September 2024). "Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth". Journal of Adolescent Health. doi:10.1016/j.jadohealth.2024.09.009. ISSN 1054-139X.

Downplaying facts

We seem to have a disagreement about whether the sentence that says:

• Children with comorbidities did not receive adequate psychological support, endocrinologists administering puberty blockers did not attend multidisciplinary meetings, and the frequency of those meetings did not increase when adolescents received puberty blockers, all of which the Dutch Approach recommends.

should be taken as a fact, or if we should use language like "The report claimed that..." to imply that NHS England is probably doing a good job, or at least an adequate job, of providing psychological support for kids with autism, anxiety, and depression, and it's really just the Cass Review's unimportant opinion that it's not good enough.

Here's some sources that say that children on the NHS are not receiving adequate psychological support, including trans kids.

• Evidence of UK’s child mental health crisis is stark and compelling (2022)
• GPs giving antidepressants to children against guidelines (2022) because of "Long-waiting times and high thresholds for treatment".
• Number of children needing help for serious mental health problems soars (2023)
• "In some areas of England and Wales, for example, Camhs won’t see young people with autism and there is often no statutory support at all in this area". [1] (2023)
• More children than ever need mental health care as figures show nearly half a million are awaiting treatment (2024)
• Over a quarter of a million children still waiting for mental health support (2024)
• ‘Jaw-dropping’ number of children in England with anxiety shocks even professionals (2024) – "NHS is not equipped to treat record numbers of cases" with "unacceptably long waiting lists".
• "children and young people who had an appointment for suspected autism had waited on average nine months (295 days) after their initial referral. This is despite the National Institute for Health and Care Excellence recommending that people with suspected autism should be diagnosed within three months of a referral". [2] (2024)
• "long waiting lists for mental health services or for autism/ADHD support... more than 40,000 children had been waiting over two years for treatment." [3] (2024)
• Children 'in limbo' over NHS autism waiting times (2024)
• NHS faces ‘avalanche’ of demand for autism and ADHD services, thinktank warns (2024)
• "of the respondents who were waiting for an NHS ADHD assessment, 24% had been waiting between one and two years and 10% had been waiting between two and three years". [4] (2024)

Content warning: Anyone who searches for this is going to find not only stories that sound like "We've been waiting two years for an autism assessment", but also stories that sound like "At the time of her suicide, she had been waiting two years for an autism assessment and two and a half years for her first appointment with NHS gender services". IMO that's not what stories of "adequate psychological support" sound like. Adding search terms like "children" seems to reduce the number of results focusing on suicide deaths, and I doubleplus-recommend doing that.

On the list of sources claiming that all's well and the kids are getting everything they need, I find: Nothing. Not even the Tories are claiming that the CAMHS is sitting around all day with nothing to do because kids are already so well supported, so we should urgently cut their budget and my taxes.

So with all of this in mind, could we please take out the WP:WEASELly language that's implying that "Children with comorbidities did not receive adequate psychological support" isn't a universally acecpted fact?

WhatamIdoing (talk) 02:57, 10 September 2024 (UTC)

I'm of a few views here that I'm not sure how to reconcile. On one hand, I think it's important when making claims that they are cited to their source if that source isn't "final". On the other hand, the Cass Review is such that it's a large scale review that, while some people dissent to it, should be able to have its findings taken without the attribution. Yet still, this statement in question is being cited to the interim report, which should be attributed if it's being discussed as something the interim report said (which it is here).

I'm not sure why this is only in background to begin with though - with barely any (if any) information in the actual discussion of the final Review. If there isn't going to be a section about the psychological support that is/should be provided in discussing the final results of the Review, then I'm not sure how it's relevant background information in the first place. If a section can be added discussing the findings of the final Review on this matter, then the background should continue to state that the interim report made that claim, since that's what the background paragraph in question is discussing. -bɜ:ʳkənhɪmez | me | talk to me! 03:11, 10 September 2024 (UTC)

I mean the Cass Review is not an undisputed report in the medical field by any stretch, and simply saying “According to the Cass Review, XYZ” goes a long way towards maintaining an NPOV on the topic. I think presenting the full report’s findings as undisputed fact without attribution, when we have countless medorgs across the globe including in the UK disputing it and accusing it of political machinations, misleads the reader at best and at worst is just pov. Snokalok (talk) 11:14, 10 September 2024 (UTC)

But we don't "have countless medorgs across the globe including in the UK disputing it". Where "it" means all of it. Nor are they "countless" vs "handful". The US ones have a common origin and united around a right-wing conservative domestic problem and are, sadly, playing at legal politics, not evidence based medicine.

There are two aspects to the review. One is the evidence both in terms of medical studies and the facts about the state of NHS England in this area. The other is in what should be done as a result. There is some criticism of the evidence, nearly all at an embarrassing level of competence by people with conflict of interest or no training at all in this field. Mostly that's about puberty blockers. And there's some criticism about what to do about it. Mostly that's about puberty blockers. And some of the criticism is of the puberty blocker ban, which isn't even recommended by the review.

But for the rest of it, as WAID points out, this is an NHS England commissioned report into the state of NHS England, which NHS England has accepted and vowed to fix. There isn't any need for any "According to the Cass Review" attribute any more than if National Highways published a report that said how long the A1 was and the condition of the road surface. None of these supposed "countless medorgs" dispute any of that. For our purposes, is the Cass Review a reliable source on the state of NHS England's trans healthcare? Absolutely. We can state these things as facts with a little numbered box after.

I've just finished reading Cass Review: Implications for Scotland. This is a 57-page NHS Scotland commissioned report written by a multidisciplinary team of experts and by the looks of it took weeks if not months to write. I wonder how many editors here have read it vs the Yale PDF or half-page BMA Council bullet-point statement.

The NHS Scotland report not only agrees with the Cass Review about the evidence and consequences, but goes through each of the 30+ recommendations working out how they apply to NHS Scotland. The differences, where they exist, are mostly because NHS Scotland is organised differently or has different programmes for improvement to occur within. They entirely accept Cass's analysis of the state of NHS England trans healthcare and agree NHS Scotland shares many of the same crises and solutions. What is interesting to me is that the NHS Scotland report will actually shape the future of trans healthcare in Scotland (much as the Cass Review will shape it for England). Unlike the other "publications" we have invested so much energy on, which will be forgotten about.

Snokalok, I really do encourage you to read the NHS Scotland report. Skim it at least. I know you won't agree with the puberty blocker bits but I think you will come away with a feeling that this is actually only a very very tiny part of the Cass Review. That most of it is about a health service that really is universally agreed as entirely failing its patients and for which radical change and investment is needed. I think you may also get a feeling that when the BMA council recommended to pause the implementation of the Cass Review and work to block it, why so many NHS doctors were aghast. -- Colin°^Talk 12:27, 10 September 2024 (UTC)

IMO if you can't state a fact from a source like the Cass Review without attribution, I have no idea what level of source you ever could. Void if removed (talk) 12:29, 10 September 2024 (UTC)

Wrt Snokalok's "misleads the reader at best and at worst is just pov", we actually do that when we attribute something that really is considered a fact and for which our source is reliable. It really is pov-pushing to stick weasel words around hard facts. As an editor with experience outside of this particular medical topic, I'm astonished at the degree to which mainstream first class evidence based medicine is being attacked on this topic, citing random lawschool PDFs and trade union councils, to try to discredit what is the largest, most thorough, independent and professionally conducted review of this field ever conducted.

It is a bit like we are writing about British Doctors Study and editors are filling this pages with stories about their gran living to 85 and smoking 40 a day, and linking to PDFs written by tobacco firms, and where Richard Doll reports he's scared to take public transport because of the abuse he gets. -- Colin°^Talk 13:15, 10 September 2024 (UTC)

My question is much narrower than this. We are saying that it's purely the POV of the Cass Review that "Children with comorbidities did not receive adequate psychological support".

@Snokalok, can you find any medorg that says that NHS England really has been providing trans kids with adequate psychological support? Just one medorg, anywhere in the world. If not, then this statement is not one that should have WP:INTEXT attribution. Probably lots of the others should, but I'm specifically talking about whether this exact claim should begin with that disclaimer-ish wording. WhatamIdoing (talk) 16:26, 10 September 2024 (UTC)

I think it’s important to ask what psychological support means here. In parlance on the topic in a UK context, it often means gender exploratory therapy and requiring the involvement of a mental health professional in perpetuity; which is of course, a highly controversial idea in the context of GAC, it’s considered conversion therapy to practice GET, etc. Thus, the statement requires attribution, because it makes the implication that they didn’t receive proper support *as the people doing the Cass Review considered it to be*. In other parts of the world meanwhile, it’s considered an intrusion to require continual therapy sessions in exchange for GAC - and we’ve even seen this opinion expressed several times by WPATH in a UK context. Thus, I’m not saying that the NHS or didn’t provide adequate support, I’m saying they didn’t provide adequate support as the Cass Review considered it, which is not necessarily a neutral position on the topic, and that’s why the attribution of “According to the Cass Review” is important. Snokalok (talk) 16:34, 10 September 2024 (UTC)

Here are two quotations about the absence of adequate support from the cited report (emphasis added):

• "Additionally, children and young people with gender-related distress have been inadvertently disadvantaged because local services have not felt adequately equipped to see them. It is essential that they can access the same level of psychological and social support as any other child or young person..."
• "The Dutch criteria for treating children with early puberty blockers were: (i) a presence of gender dysphoria from early childhood; (ii) an increase of the gender dysphoria after the first pubertal changes; (iii) an absence of psychiatric comorbidity that interferes with the diagnostic work-up or treatment; (iv) adequate psychological and social support during treatment; and (v) a demonstration of knowledge and understanding of the effects of gonadotropin-releasing hormones (puberty blockers), feminising/masculinising hormones, surgery, and the social consequences of sex reassignment"

Do you see anything in here that sounds like "Let's engage in conversion therapy"? I don't. I see "Local services are scared to provide ordinary treatment for autism in gender diverse kids because they worry that they might screw up" and "We actually need to support kids while they're on puberty blockers".

This sentence actually includes three claims:

• NHS England is not providing adequate psychological support for the subset of trans kids who have autism, anxiety, depression, eating disorders, etc. while they're on puberty blockers. Note: The claim isn't about all trans kids. It's specifically about trans kids with comorbidities.
• Endocrinologists administering puberty blockers did not attend multidisciplinary meetings.
• The frequency of those meetings did not increase when adolescents received puberty blockers.

I think that all three of these are uncontested claims of fact. Your reply above, for example, does not even attempt to claim that anyone in the NHS with autism and anxiety has been well-served by the current system. It looks to me like you've swerved right away from "Children with comorbidities need adequate psychological support" to "Everyone agrees that conversion therapy is evil". Fine: Let's just stipulate here that every editor on this page agrees that conversion therapy is evil. But it's also evil to have one branch of the NHS wash their hands of a kid's crippling anxiety by saying that GIDS will deal with the anxiety, and after an education- and life-destroying multi-year delay, GIDS saying that they only do gender and CAMHS will deal with the anxiety ...after another year-long delay. This is not a case of "continual therapy is the price for GAC"; this is a case of "patients are allowed to have more than one health problem, and being trans should not disqualify you from the ordinary treatment for autism". WhatamIdoing (talk) 17:04, 10 September 2024 (UTC)

@WhatamIdoing the first claim is cited to page 18 which says Within the Dutch Approach, children and young people with neurodiversity and/or complex mental health problems are routinely given therapeutic support in advance of, or when considered appropriate, instead of early hormone intervention. Whereas criteria to have accessed therapeutic support prior to starting hormone blocking treatment do not appear to be integral to the current NHS process.

p32, right after your second quote, says However, the Dutch Approach differs from the GIDS approach in having stricter requirements about provision of psychological interventions. For example, under the Dutch Approach, if young people have gender confusion, aversion towards their sexed body parts, psychiatric comorbidities or Autism Spectrum Disorder (ASD) related diagnostic difficulties, they may receive psychological interventions only, or before, or in combination with medical intervention

Your first quote applies to all trans kids, it never specified those with comorbidities - it's a critique of local clinics turning away trans kids saying "idk what to do with them"

The second is just a summary of the Dutch protocol.

The article currently states The report stated that children with comorbidities did not receive adequate psychological support ... which the Dutch Approach recommends

That doesn't appear to be cited properly, as the section it's citing is talking about how the Dutch approach mandated trans kids with comorbidities have those addressed before or instead of receiving trans healthcare.

What the cited source supports is The report stated children were not required to undergo therapy prior to puberty blockers ... which the Dutch approach recommends Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:15, 10 September 2024 (UTC)

YFNS, the Cass Review does not refer to the patient cohort as "trans kids". I'm reminded of the comment Cass made, linked a few sections above: "During the course of the Review, we observed a change in attitudes, from an initial narrative among many trans advocates that only a minority of the young people presenting would have a longstanding trans identity and would benefit from a medical pathway to a belief in some quarters that all the young people on the waiting list for services were ‘trans kids’."

It would be helpful if you would stop doing using that language for this group. As Cass indicates, this is a recent and fringe activist-language, not something accepted by reliable sources. It makes discussing the treatment of children referred to CAMHS or GIDS-equivalent centres difficult. Only a minority of child and adolescent patients in the UK were referred for hormone therapy and this has been true for many years. The Cass Review refers to the patient cohort as "gender-questioning children and young people" which is a neutral term that does not prejudge diagnosis. This is aligned with WPATH. WPATH states for adolescents: "Given the emerging nature of knowledge regarding adolescent gender identity development, an individualized approach to clinical care is considered both ethical and necessary" and "We recommend health care professionals working with gender diverse adolescents undertake a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns and seek medical/surgical transition-related care, and that this be accomplished in a collaborative and supportive manner" and "We recommend health care professionals assessing transgender and gender diverse adolescents only recommend gender-affirming medical or surgical treatments requested by the patient when:...The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed." and "Professionals working with adolescents should understand what is and is not known regarding adolescent gender identity development, and how this knowledge base differs from what applies to adults and prepubertal children." I could go on quoting. And as for children: "This chapter employs the term “gender diverse” given that gender trajectories in prepubescent children cannot be predicted and may evolve over time". This is not the page to dig deep into that stuff, but the gist is WPATH make no diagnostic assumptions about the referral cohort and neither should we in our language. It is a bit like calling anyone who goes to the doctor with a lump in their breast a "cancer patient".

There are two aspects to "psychological support". The first is that a large chunk of the current cohort have psychological and neurodevelopmental conditions that are not being addressed at all, never mind before any medical treatment starts as recommended by both WPATH and the Dutch Protocol. The second is support during such medical treatment.

It is already well documented that CAMHS thought a referral to GIDS meant they didn't have to deal with that child as they thought the experts there would, and GIDS thought they didn't have to deal with anything other than gender dysphoria as they assumed CAMHS would deal with that. Both services were and continue to be massively overloaded, understaffed and with huge waiting lists. Which is part of what led to perhaps wishful thinking that someone else was dealing with it. That's a UK health service issue that is uncontested. This is the feature of "holistic" treatment that Cass recommends and is being addressed by NHS England and Scotland.

I think the issue that although these children's comorbid conditions were being neglected by all services in the UK, and especially so if they were gender questioning with a GIDS referral, it is being combined by some with the current activist battle that is uncomfortable with the fact that all international guidelines for children and adolescents have a psychosocial/neurodevelopmental gatekeeping component in them. It would be easier to fight the US battle against affirmative care bans if there was no question that every single referral was a "trans kid" who needed puberty blockers cross sex hormones. And so we get the claim that this psychosocial gatekeeping and now even any holistic psychosocial therapy at all is "conversion therapy" despite the fact that WPATH's definition of such is in the same pages as their recommendations that one must deal with these other things in order to have, as they put it, "diagnostic clarity" or "standards of care"

So, could we please stick to the sources on this one. Cass is not talking about conversion therapy but about stuff that is even in the WPATH guideline and the Dutch Protocols. It is basic "standards of care", as the WPATH guideline calls itself, that the UK health services fell well well short of. -- Colin°^Talk 08:31, 11 September 2024 (UTC)

I introduced the language of trans kids into this discussion, and I will attempt to remember your advice in the future. WhatamIdoing (talk) 18:29, 11 September 2024 (UTC)

@Colin "trans kids" is not "recent and fringe activist language" - that is complete and utter nonsense at best, ridiculously insulting at worst, and I will not stop referring to trans kids as trans kids.

Cass referring to kids sure of their gender as "gender questioning" is in fact one of the peer reviewed criticisms of the report btw[5]

It is not a "neutral term that does not prejudge diagnosis" because being trans isn't a bloody diagnosis. And nobody has ever argued trans kids shouldn't get any mental healthcare or the NHS is doing a good job, that's a strawman, everyone agrees.

Besides which, I am sticking to what Cass said, that's why I quoted her specifically talking about how the NHS differed from the Dutch Approach. We already talk about diagnostic overshadowing earlier in the section, I am talking about a fragment of a sentence not supported by the cited source which could be changed to match the source. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:09, 11 September 2024 (UTC)

I'm sorry, are you seriously suggesting that colloquially referring to children as "kids" is fringe and activist language? --Licks-rocks (talk) 19:12, 11 September 2024 (UTC)

I believe the main point is that we shouldn't conflate "kids who have been referred to NHS gender services" with "kids who are sure they are trans".

YFNS cites a paper that says this:

"Trans children are instead reduced to definition as “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of trans children."

But it seems to me that an opposite and parallel statement would be equally true, viz.:

"When WhatamIdoing said 'trans kids' to refer to 'kids who have been referred to NHS gender services', she excluded “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of gender-questioning children."

I don't know what your experience is, and I don't want to bother looking it up, but I remember in the 1980s when the "Q" in LGBTQ was "questioning", and the definition seemed to be "I'm gay but I don't want to admit it". IMO Colin is correct that we shouldn't get in the habit of assuming that every single kid referred for gender services is actually trans. WhatamIdoing (talk) 20:07, 11 September 2024 (UTC)

@WhatamIdoing one term correctly refers to the majority of the cohort, the other incorrectly refers to them. If Cass said "youth seeking GAC" or something it would be another issue, but describing trans kids as "gender questioning" is not neutral. Imagine a report into LGB healthcare for youth which said "sexuality questioning youth" throughout and never once referred to "LGB youth" - it would be an immediate red flag. Per p 160 of the final report, the majority of kids turning up already socially transitioned.

I'd appreciate a response to my main point, which is what specifically did the Cass Review say about how the NHS differed from the Dutch protocol. I quoted 2 excerpts from the Cass review comparing the NHS and Dutch approach, which say the latter was stricter about mandating therapy as a prerequisite/corequisite/alternative to GAC. The paraphrase we have in the article misrepresents that. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:55, 12 September 2024 (UTC)

Imagine a report into LGB healthcare

The problem with analogies like this is they beg the question. Is that the same thing or not? Pick a different analogy and you can argue the reverse.

"Gender questioning" is the language of the review and I see no reason to avoid it.

In a clinical setting we're invariably talking about kids distressed at the development of secondary sex characteristics (prospective or actual), there's all kinds of reasons for that, strong opinions in different sources, and not much in the way of neutral language available. Void if removed (talk) 21:24, 12 September 2024 (UTC)

@Void if removed 1) this completely ignores the issue with the citation I'm discussing in favor of quibbling over language not in the article.

2) There is no situation on Wikipedia where somebody says "I am trans" and we refer to them as "gender questioning" just because somebody else did. MOS:GID and all that. Cass explicitly notes the majority of kids she's referring to as "gender questioning" have socially transitioned. Calling them all questioning is flatly inaccurate and not neutral at all. If you have a room full of 99 kids who say "I'm 100 sure I'm gay", and 1 person who says "I might be", saying you have a room full of "sexuality questioning kids" is nonsense. Insisting that some are questioning doesn't make it true for all people described. Colin and WAID have cited WPATH using terminology like "gender diverse" and "adolescents who present with gender identity related concerns" - those, unlike "gender questioning", accurately describe the cohort. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:08, 12 September 2024 (UTC)

Just to be clear, I'm not saying the term "trans kids" is activist language when used anywhere. And I'm aware of an anti-trans idea that there is no so such thing as a "trans kid", so I should have been clearer about that. There absolutely are trans kids. But I stand by the quote I made of Cass. WPATH above describe the referrals as "adolescents who present with gender identity-related concerns" and otherwise the shorthand "gender diverse" for both adolescents and children, repeatedly stating that each is an individual who's path is unknown. WPATH themselves recognise not all referrals will go down the path of gender-affirming medical treatments. WPATH themselves use the term "diagnostic clarity" to refer to a physician deciding to prescribe a medical treatment. I completely get the discomfort those words have wrt an identity but please take those concerns to WPATH and remember this is a medical treatment being prescribed.

YFNS cites [6] an activist complaining that Cass using neutral non-activist terminology is a problem. And yet YFNS doesn't describe this activist opinion piece as such, but as a "peer reviewed criticism", as though that elevates it to the truth. And as though the peer review process for such opinion pieces exists to elevate opinion to truth. As WAID notes, Horton's criticism is logically nonsense. This friends, is the problem we have here. Cal Horton's opinions are Cal Horton's opinions, not "peer reviewed criticism", as though some kind of science or fact-based research is going on here. -- Colin°^Talk 07:52, 12 September 2024 (UTC)

I appreciate the clarification in the first part. As for the second. Cal Horton's "opinion piece" has in fact gone through peer review and what's more it has not been published as a letter or opinion article, it has been published as a proper stand-alone article. So yes, "peer reviewed criticism" is a correct characterization. --Licks-rocks (talk) 08:30, 12 September 2024 (UTC)

I wish I knew the exact technical term for this piece of academic writing. I wonder how you'd view it if written by a gender critical activist criticising the WPATH standards of care. They'd have their own POV and conceptual framework around which to build their case. What do you think "peer review" exists for in this kind of work? Do you think it exists to agree that every single sentence in this polemic is The Truth? Or more that this isn't the work of a crazed individual divorced from all reality unable to make any kind of cohesive argument.

On the one hand we have a review that took four years to write and was explicitly asked to be independent and selected a most senior and respected doctor to perform. Such a review has to find a balance of terminology and careful wording that is likely to upset those on the extremes in either side. But the point of the review is not to appease activists by using the Correct Words (on either side) but to determine the correct healthcare for an area of NHS England.

On the other hand we have an activist who's body of research is in interviewing their social media circle and who has written this polemic to advance their opinion that the Cass Review is inherently transphobic and thus can be dismissed before its findings are even known. Which, you know, as a piece, is not any different to someone writing a polemic that socialised healthcare is the fairest system and advancing their arguments in support of that. Such an piece could be peer reviewed as a valid argument, but not as The Truth. Someone could equally write a piece that says the capitalist model of insurance and pay-as-you-go for healthcare is the fairest and best system and make their arguments in support of that. Both could be peer reviewed and published. But both can't be correct, and peer review does not exist to determine that for this kind of work.

So it is a problem, frankly, when the language used by both Cass and WPATH, both MEDRS sources, is being attacked by an article that is really just some activists opinion, and referred to in a way that suggest "peer reviewed criticism" is in any way special at discovering who is Right. -- Colin°^Talk 09:56, 12 September 2024 (UTC)

What do you think "peer review" exists for in this kind of work? Do you think it exists to agree that every single sentence in this polemic is The Truth? I will, for the umpteenth time, note that that is not what anybody in this discussion has ever argued, least of all me. Neither have I or YFNS ever suggested that the sentence you're quoting is the only, or even the best, example of what YFNS pointed out the paper criticized in that paper. The reason that paper got through peer revieuw, though, is because it seeks to describe patterns of behaviour within the cass revieuw and its underlying research. Looking through the paper more closely, I don't get the impression that either you or whatamidoing (but especially you!) have made any real attempt to understand those arguments or represent them here in earnest.

I wish I knew the exact technical term for this piece of academic writing It's called a peer reviewed literary analysis. --Licks-rocks (talk) 11:08, 12 September 2024 (UTC)

I was responding to YFNS, who referred to Cal Horton's opinion as "peer reviewed criticism". Their overall paper, of 25 pages and about 16 thousand words, was "peer reviewed" in as much as that is worth something for a "literary analysis". But their specific criticism of Cass's use of the term "gender questioning", was not "peer reviewed" in the sense that Horton's peers examined that criticism and all enthusiastically agreed with it. That's what calling it "peer reviewed criticism" implies. I've lost count of the number of times YFNS has cited Horton as though this was definitive and widely accepted evidence, rather than one person's opinion, containing numerous factual misunderstandings, of the interim report. It is frustrating when two NICE systematic reviews and seven York systematic reviews and a four year independent review are repeatedly dismissed by citing a "literary analysis" written by an activist with no clinical background or experience conducting or reviewing clinical research of this kind. Is is though the very top of the MEDRS source hierarchy pyramid is "activist criticism". -- Colin°^Talk 12:00, 12 September 2024 (UTC)

YFNS didn't quote that paper, she mentioned it. As far as I can tell, the quoting was done by whatamidoing. Just like YFNS didn't use the term Trans kids in any formal way, she used it as a colloquialism, with the actual text she suggested right next to it. just like whatamidoing did prior to her. Look, I already said this on AE, but I want you to stop taking the worst interpretation of what we are saying and running with it, because a lot of the time it isn't even what we said. --Licks-rocks (talk) 12:15, 12 September 2024 (UTC)

I don't understand your first sentence at all. Maybe read WAID's defence of the trans kids issue at AE, and consider if you are taking the worst interpretation of what I said. -- Colin°^Talk 13:14, 12 September 2024 (UTC)

my first sentence is pointing out that the quote you and whatif are agitating against was not placed on this talk page by YFNS or me, and is not representative for the argument being made in the paper. I think it is a strawman of the argument YFNS is actually making, which is that the language used in the cass review and its underlying literature has been criticised for being non-inclusive, and for casting doubt on kids' ability to have a well-developed gender identity. The cited quote is one of several examples given.

Actually, I think the sentence whatamidoing did not include is very telling here. Let me introduce a more complete quote, including the sentence whatamidoing's quote is referencing:,the interim report does not include even one reference to a trans child, adolescent or young person. Trans children are instead reduced to definition as “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of trans children. Yeah, if the report didn't make a single reference to gender questioning people, I would still consider that a problem, to paraphrase whatamidoing's argument above. I'm sorry, but this practice has a name, and it is called cherrypicking.

Also, before you get up in arms about this being about the interim report again: A, nobody said otherwise, B, YFNS did not introduce this quote as being about the main report, she didn't introduce this quote at all, and C: the same people that wrote the interim report also wrote the main one. and D. there are similar issues with the main review, as evidenced by several MEDRS having published statements about this by now.--Licks-rocks (talk) 14:15, 12 September 2024 (UTC)

I'm afraid you lost me at "quote". No idea what you are talking about. But to be honest, I've got bigger problems to deal with today, as you well know. -- Colin°^Talk 14:24, 12 September 2024 (UTC)

For my money, Attribution is not just for when you want to draw a source's claims into question, you can also use it when you are describing what a source is saying. To me, it makes sense to point out that the cass review is saying this, because we're trying to describe what the cass review is saying. How about we follow MOS:CLAIM here and change it to say "the Cass review stated that...". That's how we usually avoid making a value statement in attributing something, and I think that makes a lot of sense here. --Licks-rocks (talk) 19:22, 11 September 2024 (UTC)

From WP:INTEXT:

When using in-text attribution, make sure it doesn't lead to an inadvertent neutrality violation. For example, the following implies parity between the sources, without making clear that the position of Darwin is the majority view:

N Charles Darwin says that human beings evolved through natural selection, but John Smith writes that we arrived here in pods from Mars.

Y Humans evolved through natural selection, as first explained in Charles Darwin's The Descent of Man, and Selection in Relation to Sex.

Neutrality issues apart, there are other ways in-text attribution can mislead. The sentence below suggests The New York Times has alone made this important discovery:

N According to The New York Times, the sun will set in the west this evening.

Y The sun sets in the west each evening.

When we say that the Cass Review stated that the NHS is failing pediatric mental health patients, are we implying that others disagree? Or that Cass alone has made this important discovery?

We might want to specify that the Cass Review says that the NHS has failed the kids referred to gender services even worse than they've failed all the other kids (that is the meaning of "Additionally, children and young people with gender-related distress have been inadvertently disadvantaged..."), as that might be their own discovery, but I suspect that even this is not original to the Cass Review. There are probably sources from the so-called trans activists complaining about exactly this problem that predate the Cass Review. WhatamIdoing (talk) 20:40, 11 September 2024 (UTC)

We're saying the cass revieuw stated that this was the case, which it sure did. I guess you could read implications into that, but then, it's a single sentence. Unless the next sentence is that some other source disagreed with that part I personally simply wouldn't get that implication out of it. --Licks-rocks (talk) 21:12, 11 September 2024 (UTC)

But INTEXT says that other people might, so if we don't think there are any other sources disagreeing with it, then we shouldn't use INTEXT attribution. WhatamIdoing (talk) 21:19, 11 September 2024 (UTC)

INTEXT also says In-text attribution may need to be used with direct speech (a source's words between quotation marks or as a block quotation); indirect speech (a source's words modified without quotation marks); and close paraphrasing. It may also be used when loosely summarizing a source's position in your own words. Which in my opinion is what we're doing here. I'll notice that the Darwin example still includes attribution, so clearly it's not quite as black and white as that. --Licks-rocks (talk) 08:21, 12 September 2024 (UTC)

The responses here exemplify so many of the problems in this area. The Cass Review is a high quality source and we should be able to use it to source facts like "Children with comorbidities did not receive adequate psychological support" without attribution. We can.

Instead of this being a minor point on which everyone can simply agree because the answer is so obvious, we have a massive thread full of comments recycling arguments about how using the language of the review "erases the existence of trans children". That's one opinion, others are available.

Relitigating this wastes time and space and stalls meaningful progress. There is an unresolved conflict in MEDRS, which is that some cleave to the US-based affirmative model, and some want to stick to psychotherapy as a first line treatment, and the language you choose to discuss the patient group affects how you think about the appropriateness of either of those approaches, and we can't simply attribute every claim in the Cass Review because that's implicitly picking a "side".

So, returning to the original question, I think that it absolutely can be stated without attribution, and I've not seen a good reason it cannot, especially since it is talking about comorbidities. Void if removed (talk) 14:50, 12 September 2024 (UTC)

I am also trying to understand his "US-based affirmative model" that appears to disagree with the US-dominated WPATH guidelines I quote 08:31, 11 September, which have "a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns" as a first-line step, and explicitly state that "gender-affirming medical or surgical treatments" be only recommended after "The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed."

Which MEDRS guidelines "cleave to the US-based affirmative model" for children and adolescents? Or is this describing current widespread practice that has yet to be updated into WPATH SoC? -- Colin°^Talk 15:52, 12 September 2024 (UTC)

Well there's what WPATH say in SOC8 in September 2022, and there's what WPATH say about the Interim Cass Review in November 2022, and they don't exactly gel:

At several points in the document, there is an emphasis on “careful exploration” of a child or young person’s co-existing mental health, neuro-developmental and/or family or social complexities. There is also a suggestion that a “care plan should be tailored to the specific needs of the individual following careful therapeutic exploration…” WPATH, ASIAPATH, EPATH, PATHA, and USPATH are concerned that this appears to imply that young people who have coexisting autism, other developmental differences, or mental health problems may be disqualified, or have unnecessary delay, in their access to genderaffirming treatment. This would be inequitable, discriminatory, and misguided (Coleman et al., 2022). WPATH, ASIAPATH, EPATH, PATHA, and USPATH recommend that puberty suppression, where urgently indicated, can be commenced promptly, and proceed alongside and at the same time as any necessary diagnostic clarification of other conditions, or treatment of other conditions

I think the distinction really is: what do these different models mean by "assessment"?

The York review of the different standards says:

All guidelines recommend multidisciplinary assessment. Three types were identified: (1) comprehensive psychosocial assessment, (2) medical or ‘readiness’ assessment for adolescents seeking hormonal treatments and (3) diagnostic assessment for gender dysphoria/incongruence. Some guidelines integrate these, while others present them separately. In most guidelines, there is no distinct assessment section or recommendations. There is limited clarity about assessment purpose. Most cited reasons are to inform a care plan, or assess eligibility for hormone treatment. Although most guidelines describe different pathways for children and adolescents, only three provide separate guidance. Five recent guidelines propose that prepubertal children only require assessment if gender-related psychosocial care is needed but provide limited detail about this. Others propose all children be assessed. There is little consideration of how a psychosocial assessment might be different for children and adolescents.

Detailed guidance regarding assessment is lacking with no consensus about the aim or clinical approach, nor the necessity for assessment in prepubertal children. Although most guidance recommends assessing gender, mental health, psychosocial and family functioning, other domains vary. Few guidelines recommend exploring sexual orientation or assessing body image, despite these being identified as important factors. Few recommend specific assessment tools, and those suggested have not been developed and/or validated for this population.

Cass says that we need to understand why youth are distressed before any medical interventions because we might be misinterpreting comorbid conditions or other factors. I could be wrong, but my impression of the "affirmative" model is that the assessment does not really question "why". Void if removed (talk) 20:32, 12 September 2024 (UTC)

I think this from Turban, Thornton and Ehrensaft gives a flavour of the distinction. This is supposed to lay out general guidelines for the biopsychosocial assessments WPATH recommends. But there are a few notable areas where "exploration" is off-limits:

Discuss unvalidated theories of TGD identities being related to trauma or internalized misogyny, emphasizing that there are no data to establish these etiologies but wanting patients to be exposed to these ideas in a safe and supportive environment, given the likelihood of encountering them on social or legacy media.

Although no evidence exists that trauma or internalized misogyny are the etiological cause of one’s trans identity, adolescents may hear these ideas in the media; addressing these unvalidated theories can prevent psychological distress related to encountering these ideas for the first time after starting gender-affirming medical interventions and open the discussion with patients to understand how they may have been affected by previous trauma or misogyny.

So where open and undirected psychotherapy might uncover and address address underlying causal factors for an individual's gender distress, here affirmative clinicians are concerned with ensuring the individual is not unduly affected by media reports that trauma or internalised misogyny might be an underlying cause, framing them in advance as "unvalidated theories".

Similarly, when it comes to comorbid conditions, the assessment focuses not on whether such conditions may be in part contributing to "gender questioning", but rather how to ensure they are not a barrier to consent for medical transition:

Identify and address any co-existing mental health concerns, particularly as they may relate to ability to engage in appropriate medical monitoring and ability to provide informed assent.

It is also important to conduct a comprehensive mental health evaluation to determine whether any co-existing mental health conditions (eg, anxiety, depression, autism spectrum disorder, eating disorders, etc) require support and/or may have an impact on decision making capacity or unique needs.

While both exploratory and affirmative models may talk of "assessment", the exact nature and focus of that assessment is ultimately the key cause of conflict. Void if removed (talk) 08:28, 19 September 2024 (UTC)

Who stripped away the BMA content?

I went to grab a citation to put in the lede, and it was all gone Snokalok (talk) 14:02, 17 September 2024 (UTC)

Bon courage, someone's asking about you. Firefangledfeathers (talk / contribs) 14:06, 17 September 2024 (UTC)

Sorry I was out for a bike ride (nice to catch the autumn sunshine). I left an edit-summary didn't I? Quite why we had this bloated attention on the BMA was a puzzle! (Add: Oh I see it's snuck back in.[7] Seems undue to be; as if Wikipedia needs to surface the 'bad things' the BMA said. They're really not a reliable body for this stuff). Bon courage (talk) 14:19, 17 September 2024 (UTC)

While the section was a tad heavy for its weight, I don’t think we can really say what to me read as one sentence of ‘The BMA criticized the Cass Report,’ followed by two paragraphs of ‘but then everyone else told them that that was dumb because XYZ’ without including what those criticisms were Snokalok (talk) 14:37, 17 September 2024 (UTC)

I disagree, particularly since the BMA is only a trade union. I mean who cares, particularly when we have several more apt bodies making comments. More particularly this material should not be restored without consensus. Note WP:ONUS: "The responsibility for achieving consensus for inclusion is on those seeking to include disputed content" (my emphasis). By over-focussing on this body's pronouncements the article risks drifting into POV. Bon courage (talk) 14:48, 17 September 2024 (UTC)

I still stand by my earlier suggestion of expanding it as necessary over on BMA and summarize/link it here. The coverage since has been more about the resulting controversy within the BMA itself than the Cass Review, so it seems more DUE there than here. Void if removed (talk) 14:50, 17 September 2024 (UTC)

That sounds good; this is really more about the internal politics of the BMA than anything of real biomedical relevance to the Cass Review. Bon courage (talk) 14:52, 17 September 2024 (UTC)

Sorry, perhaps I’m misreading, but are you saying that the BMA’s specific criticisms of the Cass Review belong more on the BMA page than the Cass Review page? Snokalok (talk) 15:22, 17 September 2024 (UTC)

I'm saying that given the coverage in RS as the story has developed over time into one that centres on the BMA itself I think it is due for a fuller explanation over there, and a link and condensed summary with the most relevant parts here. Void if removed (talk) 16:40, 17 September 2024 (UTC)

Yes. For biomedical science, the BMA is not really a relevant body in the UK (we cite plenty that are). A sentence or two at most is due here. Otherwise it looks like Wikipedia is over-focussing on a bit-player in order to showcase the harsh words™ they put out. Bon courage (talk) 16:46, 17 September 2024 (UTC)

Right, and there was a longstanding consensus for inclusion before you changed it. Another relevant guideline is NPOV - because having two paragraphs on why critiquing the Cass review is dumb and all the people who are against doing so, needs to be balanced by what those critiques actually are. Otherwise it’s not neutral Snokalok (talk) 15:20, 17 September 2024 (UTC)

I don't think there was any consensus; you may of course try an establish it. After my edit the BMA content was:

The British Medical Association (BMA) has called for a pause on the review's implementation while it conducted a critique due to be completed by January 2025. The call has prompted some opposition from doctors, 1,400 of whom signed an open letter to the BMA characterising their planned critique as a "pointless exercise".

How is that "two paragraphs on why critiquing the Cass review is dumb"? Bon courage (talk) 16:10, 17 September 2024 (UTC)

You forgot the Academy of Royal Medical Colleges after that, but also look through the previous threads that even yet remain on this page - where several debates were had as to the content and where it was finally decided to keep it as it was before you changed it. That’s a consensus. A new editor coming in, while certainly welcome, does not break that consensus. Citing another guideline, we have BRD. You boldly shortened, I reverted as much as I could manually on mobile (hate the new html system, makes it impossible to manually revert things), and now we’re discussing. Snokalok (talk) 16:31, 17 September 2024 (UTC)

Nowhere was it "finally decided". Rather I see concerns about excessive quotation and smells of POV-pushing, and the section was tagged when I arrived here. BRD is not a "guideline", but an essay. WP:ONUS, on the other hand, is part of WP:V (i.e. core policy). Bon courage (talk) 16:36, 17 September 2024 (UTC)

Right, I forgot it was tagged.

Regardless, it was tagged as giving disproportionate weight to the criticisms of the BMA, not to the BMA’s original critiques. I’m not opposed to succinctness, but we can’t detail the counter-arguments of others if we’re not listing the original argument posed in the first place. Do you disagree? Snokalok (talk) 10:00, 18 September 2024 (UTC)

I agree with my own edit (i.e. we should have neither). The BMA is not a good source, especially compared to what we have, for biomedical science, and so their pronouncements are undue. Bon courage (talk) 10:56, 18 September 2024 (UTC)

They are a respected professional body though, representing a very significant number of doctors. If the spirit of your edit is to have neither criticism nor countercriticism, I don’t necessarily disagree, but I feel that your edit as you made it, read as being decidedly weighted in favor of the countercriticism. Reading through it from the perspective of the unknowing reader, my first thought was “What was said that provoked such documented backlash?” and inevitably a reader after asking that question, will fill in the blanks according to their own preconceptions.

Personally, I think that however little notability the BMA critique might have, the response to it holds decidedly less, and so I’m confused as to why you saw it as worth giving more space than the BMA themselves. Snokalok (talk) 12:48, 18 September 2024 (UTC)

Huh? what "countercriticism" are you referring to as being weighted? You you please show me which of my edits you are referring to with a diff. Bon courage (talk) 12:52, 18 September 2024 (UTC)

So I was looking at this diff,[8], and I realized that you didn’t actually edit in the AoMRC. Fair point to you there then.

Regardless, it does then become “here’s half a paragraph of the BMA saying they’re going to criticize” when they already criticized it, as the quotes I added show; followed by (with the AoMRC) 1.5 paragraphs including direct quotes of what I believe to be less notable backlash, on how such criticism is bad and the review will be implemented regardless.

Again, with direct quotes, the BMA Part balances these out in my view. Without direct quotes, it feels decidedly weighted in favor of those rebuffing either the criticism already given (per the quotes) or the idea of criticizing the Cass Review.

The current state of things, at this point is fine with me. BMA w/ quotes, half a paragraph about the letter, and then the AoMRC, that’s something that reads as relatively balanced to me. Snokalok (talk) 11:48, 19 September 2024 (UTC)

From this discussion it is apparent there is no consensus to give this much weight to the BMA so I have re-shrunk the section. Editors may try to establish a consensus for a more maximal treatment or pursue the option to hive the detail to the BMA article. Bon courage (talk) 12:00, 19 September 2024 (UTC)

Shrinking it to your original edit, while not my first choice, is acceptable on my end. Snokalok (talk) 12:32, 19 September 2024 (UTC)

The BMA story is obviously important and not mentioning it would be strange, but it's also the only UK medical organisation not to accept the review, despite being the least qualified and relevant to do so. It makes sense to keep coverage of it lean to ensure the article appropriately balances coverage against the unanimous acceptance by the organisations that actually oversee clinical practice. I think Void's right that it should be covered as a BMA topic rather than a Cass Review one. 212.36.63.7 (talk) 16:51, 17 September 2024 (UTC)

Yes, I think lean is the right approach. Others apparent want more. Let's see if they can be more persuasive about why Wikipedia needs to clear the WP:VNOT hurdle for extensive detail on this particular body alone. Bon courage (talk) 12:03, 19 September 2024 (UTC)

I also think that keeping this to a single paragraph is best. That treats the UK organizations equally and also respects the notion of an encyclopedia article (which should be a summary, not a detailed list of who said what). If the BMA says something useful or interesting (according to reliable sources) next year, then we can update it then. WhatamIdoing (talk) 01:22, 21 September 2024 (UTC)

Just to note, I have re-added the response from the AoMRC which was removed in the last edit, but without reference to the BMA. The AoMRC are a significant organisation, with responsibility for standards and training, whose response is at least as worthy of note as that of the BMA, of not more. Daff22 (talk) 12:27, 19 September 2024 (UTC)

The AoMRC’s response to the Cass Review would be worthy of such note. The AoMRC’s response to the BMA critique, an event already given incredibly little weight in this article, bears little to no weight by extension. Snokalok (talk) 12:34, 19 September 2024 (UTC)

Wait I didn’t see that you took out the BMA, okay fair Snokalok (talk) 12:37, 19 September 2024 (UTC)

International

The lead says: "However, it has been criticised by a number of international medical organisations and academic groups for its methodology and findings." I wonder whether "international" is the right word here.

First of all, does the word international apply to the academic groups, or only to the medical organizations? I'm not sure who the "academic groups" are. There the Integrity Project at Yale Law School, but I don't see any others (i.e., that aren't medical organizations).

Secondly, does the word international mean "organizations that actively/directly work in multiple countries" or is this meant to communicate "medical organizations outside the UK"? As an example, Médecins Sans Frontières is an international medical organization and PATHA of New Zealand is a non-international, non-UK national organization. WhatamIdoing (talk) 01:29, 21 September 2024 (UTC)

The answer is both, to both questions.

You have international global groups both medical, such as WPATH which is a global international medical organization, as well as groups such as Amnesty International as a global international non-medical human rights group or the Yale report group that was international, but not both medical and non medical.

As for the second question, it's both international in the "non-UK" (aka "foreign" (4) per wikt:en:international#Adjective) sense but of other national bodies, such as the Australian and New Zealand, American Association of Pediatrics, Canadian, as well as again, global (aka "of having to do with more than one nation" (1) per wikt:en:international#Adjective), such as WPATH and the Endocrine society or Amnesty.

What is missing is actually that beyond the international criticism, it has also received national criticism, such as from the BMA, which is now missing after a recent change by another user, so we should fix that in the lead and add "national and international" in that second sentence. I just made a follow up edit in the article to address this and also added the word "human rights organization" in recognition of Amnesty not falling in either a strictly medical, nor strictly academic group definition of the existing lead summary. Raladic (talk) 02:12, 21 September 2024 (UTC)

Do you know which "academic groups" are supposed to be included here? Amnesty International is neither medical nor academic. (Also, did they actually criticize the review, or did they instead criticize the media coverage and political weaponization of the review? I was under the impression that their response was exclusively the latter.)

At the moment, I'm wondering whether "However, it has been criticised by a number of organizations outside the UK..." would be more appropriate (e.g., includes international and non-international, medical and non-medical, academic and non-academic). WhatamIdoing (talk) 02:28, 21 September 2024 (UTC)

You can check out my change I made prompted by your initial question, I think especially the added wording of "human rights organizations" makes the question of which other academic groups beyond the Yale report group makes it moot, since we have Amnesty, as well as say Equality Australia, just to pull from the named organizations cited in the article for this. I don't think using the word "outside the UK" improves this and it is accurate to use the term international since there is a mix of global and non-global organizations (in use of the noun of international as I outlined above) that have levied criticism on it, so if we only added "outside the UK" it could be interpreted that it was just some small local other country organizations, so instead then we'd have to preface it with something like "it has been criticized by a number of global and non-global organizations outside the UK", which I think just makes it more convoluted. Raladic (talk) 02:55, 21 September 2024 (UTC)

I don't think that "widely welcomed by several UK medical organizations" is entirely idiomatic. If it's widely welcomed, then more than just several welcome it (though not all, as that would be universally welcomed).

I think we could shorten the second sentence to "it has been criticized by a number of organizations outside the UK". Then it wouldn't matter exactly how anyone chooses to classify the organizations. WhatamIdoing (talk) 03:23, 21 September 2024 (UTC)

The new phrasing is very awkward. I think we might just need more than one line to convey the full meaning here. Loki (talk) 03:28, 21 September 2024 (UTC)

I don't think a shortening of the sentence is needed and the lead should summarize the article. The lead as it stands is pretty short as-is and given that the reception section is almost half of the article as can be seen from the section sizes (I just added it to the headers of the talk page), if anything it should be expanded to accurately summarize the article and discuss core parts of it. The article presents a mix of medical and other organizations, so the lead calling it out is quite normal for someone who only has time to read the lead to get a picture of where criticism has come from instead of just having an abstract "organizations" without classifying what the array of them are. Raladic (talk) 03:30, 21 September 2024 (UTC)

The WP:LEADLENGTH (click that; it changed recently) as it stands is just over 250 words, which is a common length for FAs. For comparison, the old recommendation for an article of this length (just under 5K words) was two or three paragraphs (it's currently three) with 200 to 300 words (it's currently in the middle). WhatamIdoing (talk) 04:10, 21 September 2024 (UTC)

Right, but my point is that the lead is currently giving a lot more of its content to sections of the article that are much smaller, so it’s not quite summarizing the core contents of the article in appropriately similarly weighted amounts per MOS:LEADREL to summarize the entirety of the article as such. So if you want to trim the lead, then instead, we could for example remove the WP:FLUFF at the first sentence on the credentials of Cass, which are word puffery since this article is about the review, not the former credential of who led it. Raladic (talk) 04:19, 21 September 2024 (UTC)

The ==Reception== section contains 7 subsections about reception of the final report. I've lined up the sections with quotations from the lead. Let me know if you see anything else missing:

• political parties – and it was endorsed by both the Conservative and Labour parties
• NHS England and NHS Scotland – In September, the Scottish government accepted the findings of a multidisciplinary team that NHS Scotland had set up to consider how the Cass Review's recommendations could best apply there. [*]
• UK health bodies – The review's recommendations have been widely welcomed by UK medical organizations.
• other health bodies, trans medical groups, "assorted responses" – However, it has been criticised by a number of national and international medical organisations, academic groups and human rights organizations for its methodology and findings.
• and, finally, Cass's own response to the responses – ???

At a glance, the lead contains information about all of these sections except the last. I did notice that it omits all mention of support for the report by other health bodies and appears to categorize the non-judgmental response ("Dear Mass Media, Please note that disinformation is bad") from Amnesty International as being a criticism of the Cass Review.

[*] I'm not sure how to classify this part of the lead:

The review led to a UK ban on prescribing puberty blockers to those under 18 experiencing gender dysphoria (with the exception of existing patients or those in a clinical trial). The Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust closed in March 2024 and was replaced in April with two new services, which are intended to be the first of eight regional centres. In August, the pathway by which patients are referred to gender clinics was revised and a review of adult services commissioned. [...] In England a clinical trial into puberty blockers is planned for early 2025

On the one hand, this is a description of NHS England's reception of the report, namely a list of the changes it has made/is making as a result of the report. On the other hand, it's not presented in the form of "NHS England expressed support/opposition". That choice is probably appropriate (AIUI whether the agency agrees or disagrees is not very relevant, because they are going to have to implement most of the recommendations anyway) but it makes it difficult to decide whether these ~100 words should be 'counted' as representing the ==Recommendations==, ==Implementation==, or ==Reception== sections.  It's sort of all three at the same time. WhatamIdoing (talk) 17:52, 21 September 2024 (UTC)

If you'd like to do this 'by the numbers', then the ==Reception== section is around 40% of the article, and the quotations in the bullet points (i.e., excluding the part that I'm not sure how to classify) is around 30% of the lead. Since those two numbers are fairly close, that suggests that we're probably getting it approximately right. WhatamIdoing (talk) 17:55, 21 September 2024 (UTC)

I’m not in favor of this new phrasing, it unbalances it in favor of the UK medorgs.

It’d make it read like “The UK medical community welcomed it, but some other miscellaneous people didn’t like it.” Snokalok (talk) 09:50, 22 September 2024 (UTC)

Are you thinking that the UK political parties should also be mentioned in that sentence, too? It's inaccurate to say or even imply that only the UK medical community welcomed it.

We should probably remove "human rights organizations", because I only see two in the article, and neither of them criticize the report. Amnesty criticizes the misinformation about the report, and the British Equality and Human Rights Commission supports it. I'll go do that now. WhatamIdoing (talk) 17:29, 22 September 2024 (UTC)

Also, there aren't any non-international multinational groups mentioned in this article. "Multinational" does not mean "from outside the UK". It means "operating simultaneously in multiple countries". Facebook Inc is a multinational corporation. The Integrity Project at Yale isn't even a "national organization". (Technically, it's not even an organization at all; it's a project in a larger organization.) WhatamIdoing (talk) 17:33, 22 September 2024 (UTC)

I'm wrong; the Royal Australian and New Zealand College of Psychiatrists is multinational (or binational), since it operates in Australia and New Zealand. However, they don't seem to actually criticize the Cass Review, and they refer to a prior 2023 statement that says "There are methodological limitations in studies which assess the effectiveness of all models of treatment on the mental health of children and adolescents with Gender Dysphoria...There is limited high quality evidence to inform the provision or the withholding of medical interventions for gender affirmation of children and adolescents....The benefits and potential harms of both medical and psychosocial interventions for TGD children and young people have limited evidence" – which sounds pretty consistent with the Cass Review's complaints, as does their statement that standard recommendations include caution on the use of hormonal and surgical treatment, screening for potential coexisting conditions (e.g., ASD and ADHD), arranging appropriate service provision for these conditions, and offering psychosocial support to explore gender identity during the diagnostic assessment.

I really don't think we should name "multinational organizations" in the lead as opposing or disagreeing with the Cass Review; there's only one in the article, and it's not really opposed to anything in the Cass Review. The only thing they oppose is their own governments creating a copycat inquiry. WhatamIdoing (talk) 20:19, 22 September 2024 (UTC)

The Endocrine Society is multinational. Generally my intent was that international be used to mean, outside the UK, and multinational be used to mean operating in more than one country. Snokalok (talk) 20:35, 22 September 2024 (UTC)

Also WPATH is multinational Snokalok (talk) 20:38, 22 September 2024 (UTC)

Then the word you are looking for is foreign, not international. WhatamIdoing (talk) 21:27, 22 September 2024 (UTC)

“International employees”

”International collaborators”

”International students”

”International cultures”

“International films”

International is commonly used to replace the word foreign, because foreign carries with it a very specific connotation of ‘us vs the unknown and the strange’ which is not at all helpful. Snokalok (talk) 21:30, 22 September 2024 (UTC)

But also you didn’t answer my point about the endocrine society and WPATH Snokalok (talk) 21:30, 22 September 2024 (UTC)

Is there any question to be answered? You would like to downgrade WPATH and Endocrine Society from international (which implies they have something to say to everyone) to merely multinational (which implies that they are operating in specific countries and not in others). You would like to do this so that you can use the word international to mean "in a single country that isn't the UK". I think these are both bad ideas. WhatamIdoing (talk) 21:36, 22 September 2024 (UTC)

… You know what, that’s actually a fair point. Snokalok (talk) 21:39, 22 September 2024 (UTC)

When international is used that way (e.g., "international employees"), it is referring to groups of people/things from a wide variety of countries. The individuals are not themselves "international". For example, the Venice International Film Festival this year awarded its Golden Lion to The Room Next Door, which is a Spanish film, rather than an "international" one.

By contrast, an organization or an idea can actually be an international thing, e.g., the World Health Organization, the International Red Cross and Red Crescent Movement, or the International System of Units ("metric system"). WhatamIdoing (talk) 21:44, 22 September 2024 (UTC)

I have removed the word several from the sentence regarding UK medical organisations for two reasons. Firstly, it didn't make sense. Secondly, according to the article the only UK medical body to criticise the review is the BMA. That is not several, that is near universal approval. That fact should not be watered down in the lede. Daff22 (talk) 09:00, 21 September 2024 (UTC)

Please ignore the autocorrect typo in my edit summary on the article! Shouldn't edit on mobile. Daff22 (talk) 09:27, 21 September 2024 (UTC)

Here's my attempt at classifying the responses to the Cass Review's final report:

Groups reacting to the Cass Review

Org	Type	Where	Location	View	Notes
NHS England	Health	UK	National	Support	They don't have much choice.
NHS Scotland	Health	UK	National	Support
Conservative Party (UK)	Political	UK	National	Support
Labour Party (UK)	Political	UK	National	Support
Scottish Government	Political	UK	National	Support
British Psychological Society	Health	UK	National	Support
Royal College of Psychiatrists	Health	UK	National	Support
Royal College of Paediatrics and Child Health (RCPCH)	Health	UK	National	Support
Royal College of General Practitioners	Health	UK	National	Support
Academy of Medical Royal Colleges (AoMRC)	Health	UK	National	Support
British Medical Association (BMA)	Health	UK	National	Oppose
American Academy of Pediatrics	Health	USA	National	Oppose
Endocrine Society	Health	USA	International	Oppose
Canadian Pediatric Society	Health	Canada	National	Oppose?	They are not updating their recommendations right now. They think PBs are safe and can be appropriate.
Amsterdam University Medical Center	Health	Netherlands	National	Mixed	They think the evidence base for PBs is fine.
Royal Australian and New Zealand College of Psychiatrists	Health	Au + NZ	Multinational?	Mixed	They oppose politicians creating a similar government inquiry.
World Professional Association for Transgender Health	Health	USA	International	Oppose
Professional Association for Transgender Health Aotearoa (PATHA)	Health	New Zealand	National	Oppose
Equality Australia	Human rights	Australia	National	Oppose
Australian Professional Association for Trans Health (AusPATH)	Health	Australia	National	Oppose
Amnesty International	Human rights	UK	International	No opinion	Opposes misinformation about the report
Mermaids	Human rights	UK	National	Mixed
Stonewall	Human rights	UK	National	Mixed
Sex Matters	Political?	UK	National	Support
Genspect	Political?	UK	International	Support
British Equality and Human Rights Commission	Human rights	UK	National	Support
some unnamed individual academics	Academic	UK		Support
	Academic	UK		Oppose
	Academic	non-UK		Oppose
Integrity Project at Yale Law School	Academic	USA		Oppose

Overall, I'd say that the biggest difference between the content of the body and the lead is that the lead makes no mention of mixed responses. There seem to be several organizations that support parts of the report and oppose others, including only opposing very specific or narrow things (e.g., 99% of it is all good and/or none of our business, but we think the evidence base for puberty blockers is good enough). Another thing I've noticed is that the bigger and more UK-based the organization, the less likely they are to fully oppose it.

I've set the table to be sortable because I think that comparing similar groups might be interesting. The default order is the order in the ==Reception== section. If anyone thinks I've misclassified a group, please reply. WhatamIdoing (talk) 18:24, 22 September 2024 (UTC)

This is pretty great BUT I do have some quibbles:

The first one is that, while their HQs are both in the US, WPATH and the Endocrine Society are both international organizations with global membership.

The second one is that I'd split the political category into left and right or trans-supportive vs. trans-exclusionary. It's notable that Labour is supporting the Cass Review from the left(ish), for instance, and it's also not surprising where Sex Matters, Genspect, Mermaids, and Stonewall all fell out.

And the third is that there's a few cases, most notably WPATH/PATHA/AUSPATH but also the various Royal Colleges where we're including a parent organization and its independent child organizations, and I feel like we should note that. Loki (talk) 18:52, 22 September 2024 (UTC)

I changed Endocrine to list it as international. Amnesty is a UK-based international organization. International organizations have to have their legal existence somewhere. WhatamIdoing (talk) 19:04, 22 September 2024 (UTC)

That's fair! Loki (talk) 20:19, 22 September 2024 (UTC)

If you're using "international" to only mean "outside the UK" and "multinational" to mean it operates in globally, then Amnesty is multinational, as is the Endocrine society and WPATH. Though personally I think most people use "international" in place of global, rather than use multinational. Raladic (talk) 21:08, 22 September 2024 (UTC)

Also I'd say the Amnesty response is not entirely "no opinion", they strongly call out that "This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people. and “The negative rhetoric by the Government about the dangers of so-called gender ideology, healthcare for young trans people, as well as the push against LGBT-inclusive sex and relationship education is harmful and extremely damaging. It is no different from the ultra-conservative and evangelical groups pushing for discriminatory laws targeting trans people in the United States." - whether this critique is on the NHS/British Government or the report itself, it definitely reads as criticism. Raladic (talk) 21:21, 22 September 2024 (UTC)

Yes, they say that people who are not the Cass Review are behaving badly. Do you see anything that specifically sounds like they have "criticised [the Cass Review itself]...for its methodology and findings"? WhatamIdoing (talk) 21:26, 22 September 2024 (UTC)

The second quote of "The negative rhetoric by the Government" is criticism - the Cass Review was commissioned by the Government/NHS, and AI is criticizing it. The article is not just about the review, but also the resulting use by the British government of it (as the second paragraph of the lead summarizes with the resulting use of the review by the government, which means that the reception should also extend to it). So we can fix the reception sentence in the lead for this to expand it to something along the lines of "However, the review and its use by the British government has been criticised by a number of international and multinational medical organisations, academic groups and human rights organizations for its methodology and findings and the resulting restrictions on healthcare for transgender youth. Raladic (talk) 21:36, 22 September 2024 (UTC)

Your proposed sentence says that the review has been criticized for:

• its methodology,
• its findings, and
• the resulting restrictions on healthcare.

I do not see any words in the Amnesty International source that sound like criticizing any of those three things. Do you? If not, then we can't really put them down as having said that.

As for "The negative rhetoric by the Government" being criticism, I completely agree with you, but I believe that when they say "the Government" they specifically mean "the Conservative politicians who [then] currently make up the majority in Parliament" rather than "the 388-page-long report itself". WhatamIdoing (talk) 01:21, 23 September 2024 (UTC)

The sentence is a summary sentence that summarizes the core criticisms by the different organizations, it doesn't mean that every of the either 'medical organizations', 'academic groups' or 'human rights organizations' had the same of the summarized criticisms, just that collectively between those 3, those are some of the main criticisms levied. We can replace the word "restrictions" with "damage" or "harm" instead into "resulting damage on healthcare for transgender youth", which is the word used by AI. Raladic (talk) 01:30, 23 September 2024 (UTC)

It's fair to say that not every org has all of the criticisms, but as far as I can see, Amnesty International expresses none of those criticisms. They don't directly criticize the Cass Review at all. WhatamIdoing (talk) 01:43, 23 September 2024 (UTC)

They criticized the government's resulting use of the review affecting trans healthcare. Raladic (talk) 02:04, 23 September 2024 (UTC)

Which is not criticism of the review itself. WhatamIdoing (talk) 02:23, 23 September 2024 (UTC)

And as I already said, this article is also not just about the review, but also the resulting use of the government. Which in turn means criticism of the resulting use of the review it also relevant to this article here and I proposed the wording above to reflect that accurately. Raladic (talk) 02:29, 23 September 2024 (UTC)

Negative rhetoric from politicians isn't the "use by the British government" of the report. The British government used the report to justify a prohibition on prescribing puberty blockers; they did not use the report just to engage in "negative rhetoric" (which, after all, they were saying before, during, and after the report's creation and publication).

I think it would be fair and a straightforward reading of that source to say that Amnesty criticized the [then-]government's anti-trans rhetoric. WhatamIdoing (talk) 03:26, 23 September 2024 (UTC)

Phenomenal, thank you. Perhaps notable that the BMA response was a controversial one. Maybe also note which international medorgs the Cass Review was critical of (Endocrine Society, APA and WPATH) as I think the tit-for-tat nature of these criticisms is noteworthy. Void if removed (talk) 19:09, 22 September 2024 (UTC)

I think the UK/non-UK divide is looking pretty stark. In the UK, only the BMA Council and the unnamed individual academics have expressed total opposition; even Mermaids supports parts of it. Every group based in the US is reacted with polarized total opposition.

Are you thinking about adding a phrase along the lines of The World Professional Association for Transgender Health, whose guidelines were heavily criticized in the final report released an email statement saying that the report "is rooted in the false premise...? WhatamIdoing (talk) 19:12, 22 September 2024 (UTC)

If you want a rundown of all reception of the Cass Review, Dr. Ruth Pearce has collected most of the reception with commentary - What’s wrong with the Cass Review? A round-up of commentary and evidence – Dr Ruth Pearce including many academic responses that are not currently covered in the article. Organizationally in the UK, there is the British Association of Gender Identity Specialists (statement, national, UK) and the Feminist Gender Equality Network (statement, international, UK).

So I think beyond maybe adding those those organizations/academic groups to the current receptions, the other thing standing out is some of that other criticism being entirely missing . There has been broad opposition from some editors here about the inclusion of individual academic critiques, as you noted in your table in the "unnamed individual academics", so arguably given that looking at the quite long list that Dr. Pearce (herself a gender studies scholar) has compiled on the issue, I think it might warrant at least a sentence in our assorted reception list along the lines of a summary sentence like "Several academic experts have also raised individual criticism of the Cass Review in statements, published papers and magazine articles." instead of being entirely left out of the article.

One notable interesting recent article from Australia from 20 August 2024 in has some interesting commentary on the evidence used in Queensland which looked at similar things to the Cass Review, but with very different results as summarized in their recently published Queensland Children’s Gender Service report. Raladic (talk) 21:04, 22 September 2024 (UTC)

The blog post says: This post provides a round-up of links to written commentary and evidence regarding problems with the Cass Review... which suggests that it excludes sources that support the Cass Review. It therefore seems to me that it's not "a rundown of all reception of the Cass Review", but instead "a rundown of all the negative reception of the Cass Review". WhatamIdoing (talk) 21:53, 22 September 2024 (UTC)

I think the article already contains most/all the organizations that support the review, which as summarized is mainly localized to the UK, but it is missing several criticisms of it.

My point of linking to the list was to help you expand your table with the reception that is currently missing from the article. Raladic (talk) 22:02, 22 September 2024 (UTC)

I'm looking at the list with my WP:RS glasses on. Here's what I see:

• BMA – already in the article
• Integrity Project at Yale – already in the article
• A Google Doc written by two former gender care specialists – probably doesn't even count as WP:Published
• Press release from WPATH and USPATH – already in the article
• Press release from EPATH – already in the article
• British Association of Gender Identity Specialists (BAGIS) – press release that says they want to read the report "before offering a comprehensive response"
• PATHA – already in the article
• AusPATH – already in the article
• Therapists Against Conversion Therapy and Transphobia (TACTT) – another press release saying they'll get back to us after they've finished reading it
• Endocrine Society – already in the article
• American Academy of Pediatrics – already in the article
• The National – an article in a daily newspaper that is generally supportive, and out of which is highlighted a quotation from an unnamed expert who thinks that the government should have appointed some trans people to lead the inquiry instead of only cis people (fair enough, but doesn't tell us much about the results).
• The Medical Republic – self-described as a "paper" (rather than a newspaper) from "a group of like minded doctors, journos and ‘old world’ publishers who would like to jazz up communication more for doctors as we move into a mobile social universe"[9] that says that the Queensland review shows the Cass Review was basically right on the facts, and what's really wrong is the funding for gender healthcare. (I put "doctors paid by funding for healthcare think that there isn't enough funding for healthcare" in the "completely unsurprising" category.)
  The highlighted quote is the claim from an AusPATH member that "There have been multiple expert academic treatises written on what was wrong with the Cass Review". If those really do exist, then why aren't we citing them? A quick trip to PubMed with the usual MEDRS filters (review+systematic review+meta analysis) finds nothing from this calendar year. I suspect that the speaker's personal definition of "expert academic treatise" includes "someone put a PDF or Google doc on their university website".

That's the first section. Either we've already got it, or it doesn't meet WP:RS, or it says they'll get back to us later. WhatamIdoing (talk) 02:22, 23 September 2024 (UTC)

IIRC the Queensland report was published in February and the evidence cutoff was September 2023, so misses all the recent systematic reviews on blockers, eg. Zepf et al. Void if removed (talk) 22:50, 22 September 2024 (UTC)

Nope, this is a brand new independent report that was published in July 2024 (Independent report into Queensland Children's Gender Service finds no evidence patients were 'hurried' into decisions - ABC News) and looked at new data - It was conducted by a panel of professionals external to CHQ from across Australia with expertise and experience in child and adolescent health care and diverse gender experiences between December 2023 and June 2024. (page 5) - including referencing the final Cass review itself. Raladic (talk) 23:00, 22 September 2024 (UTC)

Ah right, I mixed it up with the Sax Institute report. Void if removed (talk) 06:17, 23 September 2024 (UTC)

Queensland Children's Gender Service report

Splitting this off from the above, since it's a separate topic, but worth bringing up as it references the Cass Review.

The Australians Queensland government recently published a new independent review report on gender services in Queensland. The Independent evaluation finds Queensland paediatric gender services safe and evidence-based (full report) was published in July 2024.

As this article - Why Queensland didn’t copy the UK approach to transgender care from the Australian Medical Republic highlights, the independent review looked at similar data as the Cass Review, and had some recommendations similar to Cass, but largely led to some very different outcomes than the Cass Review and the results of the Queensland report were adopted by their government and led to a doubling of the funding to expand services. Independent report into Queensland Children's Gender Service finds no evidence patients were 'hurried' into decisions - ABC News, Queensland gender service should be expanded, review finds.

One thing that was highlighted in the Medical Republic article on it was the statement from the past president from AusPATH calling out that the different outcomes likely are connected due to the Cass Review not including transgender experts (According to Brisbane GP Dr Fiona Bisshop, immediate past president of the Australian Professional Association for Trans Health, the Cass Review largely ignored doctors who were providing gender-affirming care. “There have been multiple expert academic treatises written on what was wrong with the Cass Review … they intentionally sidelined people who worked in the field. Practitioners who worked with trans patients and trans people themselves were excluded from that whole review, and that didn’t happen [in Queensland]. They talked to the right people who were using the service and they also included some people in the review panel who were experts.” she told The Medical Republic), which I know has been previously ignored on this talk page when it was brought up in The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children, but I think with yet another voice in a whole different continent drawing this same parallel I don't think we can just ignore it and it warrants inclusion in the article. Raladic (talk) 23:39, 22 September 2024 (UTC)

I think it’s worth noting that this is a source of significantly higher quality giving this criticism. The BMA also said that the “exclusion of trans affirming evidence” was a reason for their vote, so in light of these two sources I would support inclusion. Snokalok (talk) 00:55, 23 September 2024 (UTC)

Perhaps something like “Many in the medical field have accused the Cass Review of deliberately excluding evidence and people which favored gender affirming care as a mode of treatment.” Snokalok (talk) 00:57, 23 September 2024 (UTC)

Perhaps “some” instead of “many” would be more neutral Snokalok (talk) 01:00, 23 September 2024 (UTC)

What is your source for the incredibly strong claim of "deliberately excluding evidence"? Void if removed (talk) 09:39, 23 September 2024 (UTC)

I just looked for those "multiple expert academic treatises" in PubMed and didn't find them. Perhaps they're still stuck in the peer-review process? Or perhaps the speaker doesn't mean the same kind of source that I (and MEDRS) would mean with such a statement?

A handful of high-quality academic journal articles would be incredibly valuable. A soundbite from an AusPATH past president that asserts WP:SOURCESEXIST without identifying any of them is not so helpful. WhatamIdoing (talk) 02:28, 23 September 2024 (UTC)

I literally linked one of the peer-reviewed journal articles above that did point this out, so your search may have missed it, or overlooked it. Similarly, as much as people opposed to transgender care here tried to diminish the Yale Report because the academics (several of which are transgender studies experts) that authored it published it as a white paper, rather than a journal article, it also levied that relevant studies were excluded. Similar was levied in this pre-print paper. And as Snokalok pointed out, the point was also raised by the BMA as one of the reasons for them starting their own investigation of the Cass Review.

So again, this now has been levied by multiple fronts, they are not just making things up for the fun of it.

Criticism doesn't have to be exclusively published in academic journals to be relevant, the final Cass review itself is similarly self-published on its own website, not in an academic journal (only the underlying studies it is based on are in the BMJ). Raladic (talk) 02:44, 23 September 2024 (UTC)

That preprint claims evidence was excluded that wasn't. And the Yale report cited the preprint.

And the BMA Council just cited Yale and this preprint, they haven't done an "investigation". This isn't being levied on "multiple fronts". It's the same front. Void if removed (talk) 06:28, 23 September 2024 (UTC)

"A handful of high-quality academic journal articles would be incredibly valuable" ← this. Undercutting science with weak sources is a no-no. Bon courage (talk) 04:40, 23 September 2024 (UTC)

The QCGS report includes in its summary the conclusion that The process of making decisions about medical intervention is thoughtful, considered and evidence based. However, it does not cite the evidence on which that process is based.

The evaluation did not [...] set out to conduct an extensive literature review on the care and treatment of children and adolescents with diverse gender experiences as this was outside the Terms of Reference. (page 5)

The evaluation did not attempt to resolve public debates or subjective opinions on the ethical considerations of children and adolescents accessing gender services, nor was an extensive literature review undertaken. (page 19)

Possibly the conclusion of "evidence based" was based on this statement on page 28: Once consumers are accessing the QCGS, the community organisations reported the care is extremely comprehensive, considered, safe, and evidence based., which seems to be reporting the opinion of "community organisations (NGOs)", who seem to be neither doctors nor scientists.

I am not seeing any substantial scientific content in this report. Certainly nothing that would challenge the conclusions of the systematic reviews that underpin Cass.

The QCGS report says it was conducted by a panel of professionals external to CHQ from across Australia with expertise and experience in child and adolescent health care and diverse gender experiences. In other words, people who practice within this field. They investigated their field and found no wrongdoing. This is exactly why the Cass Review was done by independent experts. The claim that Cass intentionally sidelined people who worked in the field would actually be a reason for its strength - and therefore it would be inappropriate for this article to use non-independent non-scientific statements to undermine independent, scientific conclusions. Barnards.tar.gz (talk) 10:18, 23 September 2024 (UTC)

Whether including gender care specialists and/or trans people on the committee itself is overall a strength or weakness is really something for the reliable sources to determine, rather than for Wikipedia editors to opine about.

Given that the cis-controlled Cass Review and the trans-inclusive QCGS report came to nearly all the same conclusions (e.g., there are more kids accessing gender services than there used to be, the evidence base is less than ideal, etc.), it might be worth looking for a reliable source commenting on whether involving specialists/people with lived experience actually changes the answers. WhatamIdoing (talk) 16:59, 23 September 2024 (UTC)

I think it’s well within the remit of editors to assess the degree to which a source is independent of its subject matter. That’s why we have extensive guidance on how to do it: WP:INDEPENDENT. When writing about climate change, we would question the independence of a source written by people who make a living in the fossil fuel industry. The QCGS report doesn’t identify its authors (which is a separate issue) but does position them as professionals working in the field, whose livelihoods might be at risk if their paper delivered the “wrong” answer. Barnards.tar.gz (talk) 19:30, 23 September 2024 (UTC)

I mean, the Cass Review doesn't list its full author team either but we have had individuals associated with Genspect and SEGM claiming that they worked on it, soooo Snokalok (talk) 19:52, 23 September 2024 (UTC)

And so you think we should trust their self-serving, self-aggrandizing self-reports? Personally I'd need some evidence that they understand the difference between "worked on" and "submitted a public comment to". WhatamIdoing (talk) 00:14, 24 September 2024 (UTC)

@Barnards.tar.gz According to this source responding to the guidelines in "Australasian Psychiatry", two of the seven member panel are members of AusPATH. One is actually the president of AusPATH. Void if removed (talk) 08:51, 16 October 2024 (UTC)

BMA update

Just in case anyone's curious: The Lancet is available in Wikipedia:The Wikipedia Library, and this recent news article in it reports "more than 1500 doctors", says the campaign is called "Not In Our Name BMA", and links to the BMA's response on the petition's website.

It also says that the Council's motion passed with 21 votes in favor and 24 abstentions+votes against (assuming the most popular set of rules, that means there must have been at least four abstentions). One person present at the meeting indicated that the vote was skewed by age (younger members more likely to support it) and that a significant proportion had not read the report before voting. Another person said the people who created the motion have been subjected to harassment and abuse online.

I've updated the number of signatories in this article, but I don't think that this article needs any further detail. I post this because I know some of you were curious about some of the details, and in case it would be useful at the British Medical Association article. WhatamIdoing (talk) 02:37, 23 September 2024 (UTC)

Policy is debated and voted on openly by the Representative Body at the Annual Representative Meeting (ARM) every June. The Council can formulate policy between ARM events where none exists, but it is unheard of for it to do so on contentious topics.

This is a key point. What the council have done is quite extraordinary, and that (and the mounting opposition) has become the story, rather than any substantive criticism of the Cass Review, which is really just "we read the Yale white paper and that iffy preprint". Void if removed (talk) 08:30, 23 September 2024 (UTC)

But it's probably the key point for a different article. :-) WhatamIdoing (talk) 16:34, 23 September 2024 (UTC)

Japanese Society of Psychiatry and Neurology

This content was added here, but the wording suggests a secondary source is being invoked which hasn't (yet?) been cited, in particular for the text

While taking the Cass Review into consideration, the guidelines ultimately continued ...

Is that right? Or is this interesting bit of analysis WP:verified by the source? (I'll need some extra help with the Japanese to see for myself). More particularly, why is this relevant to the Cass Review? Bon courage (talk) 06:14, 29 September 2024 (UTC)

Seems to me relevant for Puberty blockers but not this page. Void if removed (talk) 08:02, 29 September 2024 (UTC)

After reading the entire section in the new Japanese Society of Psychiatry and Neurology guideline, it does appear relevant as it is a reception to the Cass Review as it specifically dedicates a section to discuss the Cass Review - Page 16 & 17. The document notes the unique situation of the UK healthcare system and Cass, The Cass Review was commissioned by the NHS in response to the unique situation in the UK, where gender care for children and adolescents was limited to two NHS-approved centres, with secondary sex suppression therapy being given to a large number of people annually in 2,000 cases without adequate psychological follow-up, under the pretext of a shortage of physicians and even access to general care. (translated from Japanese).

The review continues with critique of review due to the country specific context: In addition, the Cass Review has also raised concerns about the fact that there are cases in which children and young people who have progressed from secondary sex characteristic suppression therapy to physical treatment such as sex hormones and surgery later regret it, but this is also because the UK guidelines require a long time to adapt to hormone therapy, so secondary sex characteristic suppression therapy is extended to young people who are older than the age that is considered suitable for secondary sex suppression therapy. (translated from Japanese).

Which then leads them to their conclusion of On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed that the issues pointed out by Cass Review are old acquaintances, and that secondary sexual characteristic suppression therapy has been used for many years. It is a treatment that has been established for many years, and the efficacy and safety of secondary sex characteristic suppression therapy are well known. It is expressed that it is a judgment based on scientific knowledge. ....... In addition, it is medically self-evident that the undesirable physical characteristics of the sex will be irreversible if secondary sexual characteristic suppression therapy is not provided in necessary cases, and although it is difficult to conduct studies that provide high-quality evidence in such cases, there are concerns that it will have a negative impact on the subsequent mental state. (translated from Japanese).

So based on this reading, this result from this are very relevant to Cass as another international independent evaluation of the Cass Review, its findings and the resulting effects on puberty blockers being stopped in the UK. The Guidelines address Cass and puts it into context that the Cass Review guidelines were in the specific UK country context and are not otherwise necessarily applicable and also did come to its own conclusion that the administration of puberty blockers are warranted for use in Japan, given the scientific basis of them and the otherwise irreversible effects to transgender youth and the mental health effects. Raladic (talk) 17:00, 29 September 2024 (UTC)

Seems a bit coat-racky from that; their decision is about well, their decision - and doesn't really tell us anything about the Cass Review. Bon courage (talk) 17:34, 29 September 2024 (UTC)

How is it coat-racky? It directly addresses multiple points and conclusions of the Cass Review (and determines that they're wrong). Silverseren^C 17:42, 29 September 2024 (UTC)

"determines that they're wrong" ← where is that in the source? Bon courage (talk) 17:46, 29 September 2024 (UTC)

From the quotes Raladic gave above. They determine multiple conclusions of the Cass Review aren't based in scientific evidence, but because of how bad, long, and underfunded trans care is in the UK. The last bit then has them conclude that puberty blockers have been effective in multiple other countries, as noted by multiple other scientific organizations. And they note the negative mental effects of not giving blockers at the very end. Silverseren^C 17:54, 29 September 2024 (UTC)

That seems like a rather odd interpretation of what seems like rather a more nuanced response. There is nothing there about "aren't based in scientific evidence", and in any case we wouldn't be using weak sources to undercut strong ones if that means this document is questioning the systematic reviews underlying the review (which are, in Wikipedia terms, "science" of the utmost quality). I think if this is to be included we should limit it to what is said about the Cass Review itself directly, rather then trying to tease out implications, especially with WP:NOTED decorations. Bon courage (talk) 18:03, 29 September 2024 (UTC)

Please do explain the nuanced response in the quotes above. Especially since it concluded that the support of puberty blockers was what was based in scientific evidence. Oh, and is one of the major Japanese scientific organizations (journal and all) that explicitly deals with this sort of subject matter a "weak" source now? Funny, that. The quotes above are about the Cass Review and what it said and what the organization claims are incorrect. Which is why they specifically refer to the Cass Review in every single paragraph quoted. There is no "teasing" out implications. Unless they're just conclusions you don't like? Silverseren^C 18:18, 29 September 2024 (UTC)

Well, for example saying (and I'm leaning heavily on Google translate because of my poor Japanese):

[The Review] points out that there is a lack of evidence to reliably deny the possibility that secondary sexual characteristic suppression therapy may become an environmental factor that disrupts gender identity as a long-term effect, and that there is no evidence to reliably deny its adverse effects on mental and physical development. Following the publication of the Cass Review, discussions on secondary sexual characteristic suppression therapy have arisen not only in the UK but also internationally, and therefore the contents of the Cass Review and related discussions were considered when revising this guideline.

or their subsequent statement that they are strengthening reporting guidelines. The words "aren't based in scientific evidence" do not appear.

Your disappointing attempt to descend to ad hominem is noted; do it again and you will find yourself at WP:AE, as this is a WP:CTOP. Bon courage (talk) 18:26, 29 September 2024 (UTC)

The part you're quoting is not a section making any statement or conclusion by the Japanese organization, but summarizing one of the claims of the Cass Review. Unless you're claiming that Raladic's translation above is incorrect, it clearly directly addresses such claims, It is a treatment that has been established for many years, and the efficacy and safety of secondary sex characteristic suppression therapy are well known. It is expressed that it is a judgment based on scientific knowledge, among other things in the quotes above. Again, are those quotes accurate or not? Because those quotes are the actual conclusions of the guideline revisions, not the paragraph you quoted just now. Silverseren^C 18:30, 29 September 2024 (UTC)

The point is we should be relayed (if anything) what this group says about the Cass Review, not what they say about themselves. And what we say should be WP:Verified. Bon courage (talk) 18:44, 29 September 2024 (UTC)

The paragraphs Raladic quoted are what the group is saying about the Cass Review. Again, that's why they say "Cass Review" in every single paragraph. And Raladic included the link to the guidelines source, so it's already verified. Silverseren^C 18:49, 29 September 2024 (UTC)

But the 'medically self-evident' comment is not in paragraph about the Cass Review it it? The big elision in the quote above mask a paragraph break (at least in my rendition). Bon courage (talk) 19:02, 29 September 2024 (UTC)

The paragraph is prefaced with "In addition", building on the criticisms from international orgs noted in the preceding paragraph. It is followed by a paragraph summing up the debate and what they're choosing to do. The last part of the line is the most opposed to Cass, instead of "we don't have enough high quality evidence to prescribe PBs", they agree with most medical organizations that "it obviously blocks puberty, which is irreversible and not good for trans kids mental health, and it's difficult to conduct 'high-quality' research" Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:24, 29 September 2024 (UTC)

Seems like a lot of editorial interpretation there. Bon courage (talk) 19:41, 29 September 2024 (UTC)

Seems explicitly what the text says, with little to no interpretation required. Silverseren^C 19:47, 29 September 2024 (UTC)

Well no, because when text states "In addition" that is what is wikt:explicit (words have meaning), Interpeting that to mean "building on the criticisms from international orgs noted" is not explicit, although an editor might argue it is implicit, It might just mean "here is something else we considered in addition" and indeed that would be a plainer reading. I'd prefer it if Wikipedia just stuck to summarizing the plain meaning of the source rather than an intepretation of it. Bon courage (talk) 20:04, 29 September 2024 (UTC)

It’s in the Cass Review section, and is stated as their direct rationale for continuing blockers in spite of the review. Snokalok (talk) 03:38, 30 September 2024 (UTC)

Okay, so we're now clear it not in the same "paragraph". The Japanese organisation are it seems choosing to favour additional considerations to the Cass Review's findings in making their decision. But that tells us about their decision, it doesn't tell us about the Cass Review (except through "interpretation" or what you might call WP:SYNTH). Bon courage (talk) 03:50, 30 September 2024 (UTC)

The previous sentence talks extensively and explicitly about the reasons for trusting WPATH over the Cass Review, and then says “In addition” to preface its statement about permanent sexual characteristics. That’s not synth, that’s a direct reasoning in regards to the Cass Review from the source. Not every sentence needs to repeat the exact words “Cass Review” to be clearly part of its rationale and findings regarding the Cass Review, amazingly enough. Snokalok (talk) 04:07, 30 September 2024 (UTC)

That’s not synth, that’s a direct reasoning ← this is a contradiction. The "reasoning" of Wikipedia editors is not the basis for content. Although elided in the extract above, this paragraph shifts attention to other considerations "In addition, the AMAB states ...". How is this then about the Cass Review in any WP:Verifiable way? Bon courage (talk) 04:14, 30 September 2024 (UTC)

“On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed the view that the issues raised in the Cass Review are old knowledge, that secondary sexual characteristic suppression therapy is a treatment that has been established over many years, and that the efficacy and safety of secondary sexual characteristic suppression therapy should be judged based on scientific knowledge. The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) 8th Edition (2022)10) also describes the usefulness, limitations and side effects based on more systematic reviews than the Cass Review.

In addition, it is medically self-evident in AMAB cases that failure to perform secondary sexual characteristic suppression therapy in necessary cases will lead to irreversible physical characteristics of the undesired sex”

Because this is very clearly

their reasoning given for not going along with the Cass Review and instead continuing to adhere more closely to WPATH? Your points honestly just read as being a matter of WP:IDONTLIKEIT, this text is pretty indisputable. Snokalok (talk) 04:30, 30 September 2024 (UTC)

The goalposts keep moving, and now include an attempt to personalize the discussion with your mention of IDONTLIKEIT. Be aware this is a WP:CTOP so such tactics will result in you being reported to WP:AE. You seem to be correct that the Japanese are generally "not going along with the Cass Review and instead continuing to adhere more closely to WPATH". But this is the point, it tells us about the stances taken in their decision-making process and not about the Cass Review. That they choose to base decision on what is "medically self-evident" tells us nothing about the Cass Review except by the mechanism of WP:SYNTH. Bon courage (talk) 04:40, 30 September 2024 (UTC)

WPATH SOC7, not 8. Void if removed (talk) 06:41, 30 September 2024 (UTC)

“WPATH (The World Professional Association for Transgender Health)のStandards of Care (SOC) 第8版 (2022)10)でも、Cass Reviewよりも多くのsystematic reviewをもとに 有用性、限界や副作用について記述している”

You don’t need to know Japanese to be able to read that this clearly says SOC8, 2022 Snokalok (talk) 06:44, 30 September 2024 (UTC)

You're talking about the passing mentions in background/introduction. The actual updates to the 5th edition Japanese guidelines continued using the 7th edition of the SOC as a reference. Void if removed (talk) 06:50, 30 September 2024 (UTC)

No but what I mean is, in the translated quote above it said SOC 8, you corrected to say SOC 7, and now I’m posting the original Japanese to show that it indeed said SOC 8. Snokalok (talk) 06:52, 30 September 2024 (UTC)

What you said is instead continuing to adhere more closely to WPATH and it is relevant that that is SOC7. Void if removed (talk) 07:33, 30 September 2024 (UTC)

I can't see anything to support this claim in the text. Void if removed (talk) 20:00, 29 September 2024 (UTC)

I'm relying on google translate but from what I can tell the JSPN also said the WPATH SOC 8 "The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) 8th Edition (2022) 10) also describes the usefulness, limitations and side effects based on more systematic reviews than the Cass Review.", which could be mentioned in the article.

I would suggest we slightly alter the language to better capture the gist of the report: The Japanese Society of Psychiatry and Neurology published its updated guidelines in August 2024 on the treatment of gender dysphoria. While taking The guideline took the Cass Review into consideration, the guidelines ultimately continued to recommend puberty suppression in trans patients described it as specific to a UK context, noted it's criticisms by other international organizations, stated the WPATH SOC 8 considered more reviews, and noting that stated it "is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it". However, they did ask doctors administering such treatment to report more detailed information on it going forward. They stated they would continue to record prescriptions of puberty blockers to minors but expand to recording discontinuations and switches to hormone therapy.

Change explanatins (apart from minor style things)

• "the guidelines ultimately continued to recommend puberty suppression in trans patients" is covered by the last sentence
• "described it as specific to a UK context, noted it's criticisms by other international organizations, stated the WPATH SOC 8 considered more reviews" - I think this cuts to the heart of the criticisms better
• "However, they did ask doctors administering such treatment to report more detailed information on it going forward." - the however doesn't match the tone of the source, and I think it's good to note what they were already recording/pledged to start recording.

Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:08, 29 September 2024 (UTC)

Again, none of this is really due for this article. It isn't a "response". It is subsequent guidelines that considered Cass, WPATH, APA etc as background. It is due for Puberty blockers but coatracky here.

And the quotations on offer are highly selective. By my reading they seem to consider Cass not overly relevant because they currently have a large multidisciplinary team and psychological gatekeeping in place to manage individual cases that is far more in line with Cass' recommendations than GIDS practice (ie, the "UK context"). The "medically self-evident" quote is random and irrelevant. Selecting a few lines from a lengthy set of guidelines like this to create some sort of response to Cass is veering into WP:SYNTH. Void if removed (talk) 19:59, 29 September 2024 (UTC)

Of course it is due for the article. The paper spends two whole pages dissecting the Cass Review and which of the recommendations of the Cass Review it disagrees on the point of science, as I quoted above that secondary sexual characteristic suppression therapy has been used for many years. It is a treatment that has been established for many years, and the efficacy and safety of secondary sex characteristic suppression therapy are well known.

The other point of why it relevant for inclusion here is that it is one of the first more independent reviews of Cass that are not WPATH or other "involved" organizations that has put specific critique on the Cass Review to say that many of the recommendations from Cass should not be seen as universally applicable recommendations, but only in the context of the UK healthcare system that has been specfically lacking in transgender care.

The quotations above are not very selective, I copied several of the most relevant translated paragraphs of these two pages that discuss the Cass Review, this isn't a selecting picking of quotes. You are welcome to read the entirety of the two pages if you run them through Bing or Google translate, we just can't reproduce them in their entirety here due to copyright rules.

The fact that restriction of puberty blockers directly leads to negative mental outcomes as the above new critique called out, and more specifically to the death of transgender youth has also just a few days been backed by a newly published multi-year study published in Nature Magazine (NPR article), which found that laws restricting access to transgender care, such as restricting access to gender affirming puberty blockers directly led to an increase of 7-72% of suicide attempts of transgender youth. So here is hoping that the restrictions in the UK will be lifted, or else, the results of this study that followed similar such laws that were put in place in several states in the US over the past few years will sadly likely repeat itself in the UK, leading to unnecessary loss of life, given that the science on it now appears even more clear. The study has already been widely covered worldwide, but I haven't seen any mention of it in UK media yet, as it will probably ruffle some feathers in light of the UK government having recently enacted the ban. Raladic (talk) 22:35, 29 September 2024 (UTC)

The paper spends two whole pages dissecting the Cass Review

It spends a few sentences describing some parts of it as background, that's really not the same thing. Non-Japanese speakers are relying on auto translations of varying quality. Here's what I'm reading:

The Cass Review was commissioned by the NHS against the backdrop of a unique situation in the UK, where gender medicine for children and young people was limited to two NHS-approved institutions, and puberty blocker treatment was administered to as many as 2,000 individuals annually without adequate psychological follow-up, despite a shortage of doctors making general healthcare access difficult. The Cass Review also highlighted cases where children and young people who had progressed from puberty blockers to hormone treatment and surgery later regretted their decisions. However, the UK guidelines required a long period before eligibility for hormone therapy, meaning puberty blockers were applied to older youths than would typically be expected (the average starting age for puberty blockers in the UK is 15), with insufficient psychological assessment before moving on to hormone treatment and surgery. Following the Cass Review, the old specialist institutions in the UK were closed, new services were launched, and hormone therapy for young people continued within this new system. Puberty blocker treatment in the UK has been suspended in its previous medical form and is now continuing as part of clinical trials.

That's it. It is describing what happened, and why. There is no dissection, no critique. It goes on to add things about WPATH's response but that's not adding anything. This section then concludes:

In light of these points, the revision this time highlights cautionary points regarding puberty blocker treatment.

And:

In revising the guidelines to the 5th edition this time, as with the previous guidelines, the WPATH SOC 7th edition was used as a reference. Additionally, the guidelines of the Endocrine Society (2017) from the U.S. and the Amsterdam Free University Gender Clinic's guidelines were also referenced.

So this isn't a response or a critique, it is explaining the global backdrop against which they emphasise caution, and stick to SOC7, not SOC8. WP:NOTEVERYTHING that happens to mention Cass is due, and the way this is currently presented is selective.

Here's another way of describing this:

The Japanese Society of Psychiatry and Neurology referenced the Cass Review as part of the context for the creation of its 5th edition guidelines for the diagnosis and treatment of gender dysphoria. These guidelines continued to use WPATH SOC7 as a basis, and highlighted points of caution for the use of puberty blockers, while retaining requirements for multidisciplinary involvement and psychological assessment prior to any medical intervention.

All of which is I think a better summary of this document, and still none of it due for this page. Void if removed (talk) 11:59, 30 September 2024 (UTC)

@Raladic in this reversion you have claimed, again, that these guidelines spend an entire two pages dissecting and addressing the Cass Review. By my reading, that isn't the case. Merely describing the Cass Review is not two pages dissecting or addressing it.

The current wording creates a picture of a critical "response" from guidelines that are anything but, while eliding that Cass' recommendations are already not a million miles from the Japanese standards (multidisciplinary panels, psychotherapy as a first line treatment, assessment and gatekeeping, concerns with diagnostic issues with comorbid issues like autism, and with intervening too early on children who may not persist after adolescence).

I would sum this up as: we don't think Cass is that relevant to us since we're already taking great care in the way recommended, but in light of increased concerns we're going to reiterate the uncertainties and make sure we track desistance and discontinuation too.

As I said below, it may be due for a section on, say, "impact on international guidelines" or something. But this is not a "response", in the way the other content of this section is. Void if removed (talk) 10:26, 1 October 2024 (UTC)

Thanks for the suggestions @YFNS - I just used them to amend the paragraph with a few more wording changes for ease of reading and used the quote from the paper as-is on the effect of not administering puberty blockers, please take a look at the new change. Raladic (talk) 23:02, 29 September 2024 (UTC)

Taking this one sentence at a time:

The Japanese Society of Psychiatry and Neurology published its updated guidelines in August 2024 on the treatment of gender dysphoria.

So not immediately obvious how this is WP:DUE - it isn't stated up front or announced as a response to the Cass Review.

The guideline took the Cass Review into consideration and described that the Cass Review was specific to the unique situation in the UK, where gender care for children and adolescents was limited to two NHS-approved centres.

This makes a tenuous connection to the Cass Review, which is noted as part of the background picture. This is not a response, or an assessment, or a dissection or anything. It also gives a selective interpretation of what is said, which goes beyond the number of centres and into the lack of adequate psychotherapeutic assessment prior to physical intervention. They are largely noting that the criticism of GIDS that Cass produced are not applicable to Japan, where multidisciplinary assessment teams and psychotherapeutic gatekeeping are still the norm.

The paper noted criticism of the Cass Review by other international organizations, and stated the WPATH SOC 8 considered more reviews.

This is irrelevant, because the Cass Review is a specific review of services for children and young people, while SOC covers a far wider range of subjects. Also, WRT children and young people, I don't believe it is actually true. All this section is doing is noting such disagreement, not endorsing it, so this adds nothing.

The paper further stated that "it is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it".

This is an irrelevant quote that has no bearing on Cass, and doesn't contradict anything in the York reviews which were clear that - on a physical level - blockers certainly work to prevent physical development of secondary sex characteristics. The whole point is that the reasons for doing so were inconsistent, and the evidence of improved mental health was poor.

They stated they would continue to record prescriptions of puberty blockers in Japan to minors but expand to recording discontinuations and switches to hormone therapy.

Again, not relevant, and an incomplete picture since the Japanese guidelines are to involve a multidisciplinary team for assessment and gatekeeping that is far more in line with the direction of travel in the NHS. These guidelines are based on 2012's SOC7, which is again not mentioned.

Frankly, this feels like taking something that has no bearing on Cass, taking some isolated sentences, and turning it into a "rebuttal". This is all WP:DUE for other articles but tenuous here and any attempt to present a full and accurate picture would take up enormous space. Void if removed (talk) 09:09, 30 September 2024 (UTC)

@Void if removed - Is it necessary for the source to exclusively be about their thoughts on the Cass Review? Otherwise the source seems plenty DUE as it is directly commenting on the subject & explains what they find potentially lacking/non-applicable to them. Their inclusion would help establish a more diverse range of perspectives in regards to the review's findings & what their potential value may be in a global setting. Butterscotch Beluga (talk) 01:35, 1 October 2024 (UTC)

This section is "responses" - and if you compare the other entries, that's what they are, direct responses, press releases etc.

This is more like "updated international guidelines that happen to mention the Cass Review" - it isn't really a response so much as a description, and the way it's been framed in text (and described in this discussion, as if it's an analysis or critique) seems wrong to me.

Perhaps this would work in a different section on impact on guidelines internationally, but I think it's too soon to really justify that, and I don't think this merits a section of its own. Void if removed (talk) 08:26, 1 October 2024 (UTC)

The Cass Review was published, Japan’s response was to take it into consideration for their guidelines and determine to continue prescribing puberty blockers. That’s a response. Snokalok (talk) 12:06, 1 October 2024 (UTC)

This is a response to the Cass Review.

So is this.

These are the sorts of direct responses to the Cass Review currently outlined in that section.

Which is why I say an argument could be made for a new section, eg. "Impact on guidelines", and if that were the case, a better job would have to be done actually summarising how and why the guidelines were or weren't updated as a result of Cass, because right now this is a lot of selective interpretation of a WP:PRIMARY source.

The announcement of the 5th edition doesn't mention Cass as a reason, but says things like (by my translation):

Since that revision, the number of young patients has continued to increase, and there has been growing momentum to also address not only physical interventions but also psychosocial support.

And the summary of the key revisions:

Key Revisions in the 5th Edition:

* Updates in response to revised diagnostic criteria (DSM-5, ICD-11)

* Evaluation and treatment of discomfort with assigned gender during childhood

* Revisions related to psychiatric care involvement

* Additions regarding medications, dosages, and administration methods for hormone therapy and puberty suppression therapy

* Revisions regarding puberty suppression therapy

Reports:

* When starting puberty suppression therapy or hormone therapy for individuals aged 15 to under 18.

* When discontinuing puberty suppression therapy.

Have you compared these to the 4th edition guidelines? By my reading the 4th edition doesn't mention any concerns about infertility or confounding factors like autism, but these are present in the 5th edition - is this a result of the Cass Review highlighting these issues? We can't possibly know, and the document doesn't tell us. Does any of this come across in the text currently in use? No, because the sort of selective interpretation on display at the moment is not a good or comprehensive summary of the changes, turning some disconnected sentences into a "response to the Cass Review". But this source offers absolutely no comment of its own on the Cass Review, nor does it give any indication of the specific ways the guidelines were influenced by it.

The current paragraph gives the impression "we looked at the Cass Review and ignored it and WPATH criticised it, so we're carrying on with blockers". From actually reading, it seems far deeper than that, with significantly more caution on display, highlighting concerns of comorbidities, diagnostic overshadowing and desistance that weren't present before. I think this is the sort of thing that requires a HQ secondary source specifically analysing the impact of Cass on such guidelines, and until then this is just assembling fragments which create entirely the wrong impression, and all in a part of this article where I don't think it belongs. Void if removed (talk) 14:03, 1 October 2024 (UTC)

The announcement is a summary of their updated guidelines, the full document however, as @Raladic pointed out earlier, directly refers to the Cass Review. I'm not quite sure why you are quoting the summary as, by its very nature, it is meant to briefly describe their results, interpretations, & changes, not give in-depth explanations on how they came to those conclusions, hence them linking the document in full as well. I think you are applying too strict an interpretation of what constitutes a "response", as by all means, this directly responds to the Cass Review's findings. Butterscotch Beluga (talk) 14:24, 1 October 2024 (UTC)

"refers to the Cass Review" is not what Raladic described as "dissecting and discussing". Nor is it "criticism" as described in this edit.

What is their response to the Cass Review? I can't find one in the text. Or do you think that their response to the Cass Review is to produce the updated guidelines, despite this not being explicitly stated in the source? If so, what part of the guidelines is a response? The text doesn't make this clear, the announcement doesn't make this clear, and what's there now is selecting machine-translated lines from a primary source somewhat arbitrarily, without actually referencing the parts that the announcement says have been updated. Void if removed (talk) 08:48, 2 October 2024 (UTC)

@Snokalok this IP editor added a quotation here with no citation.

It was replaced with a machine translation by Raladic here.

Which you reverted arguing that this was, to you, more readable.

The wording supplied seems to come verbatim from this activist website, which is not a WP:RS, is not cited here, and we have no way to WP:VERIFY the translation which is currently presented as a direct quote.

This quote is now being used verbatim across multiple pages, with no indication that this is the true source.

IMO this quote adds nothing meaningful anyway, and should be removed. Void if removed (talk) 09:23, 4 October 2024 (UTC)

IMO the information in the quote is necessary to include. I don’t know if it’s an exact translation, but several translators have said virtually the same thing just in slightly different wording. Maybe we could replace the quote with something that’s not a direct quote such as: The paper noted that if AMAB individuals do not receive puberty suppression when necessary, it can result in irreversible characteristics of the undesired sex which could then negatively impact their mental state. Usr Trj (talk) 01:21, 5 October 2024 (UTC)

The paper noted that if AMAB individuals do not receive puberty suppression when necessary, it can result in irreversible characteristics of the undesired sex which could then negatively impact their mental state.

What does this have to do with the Cass Review? Void if removed (talk) 07:54, 5 October 2024 (UTC)

I think it’s a good example of how the new guidelines differ from the Cass Review and ultimately came to some different conclusions despite taking it into consideration. The Cass Review didn’t think puberty suppression was necessary and didn’t think not receiving it could negatively impact mental health. I think it’s important to include contrasting opinions and examples of medical organizations that considered the Cass Review but ultimately disagreed with it on some points. Usr Trj (talk) 22:59, 5 October 2024 (UTC)

Well known

Can someone help me out here? The (translated) source is quoted as saying the efficacy and safety...are well known. Does it actually say anything else? I'm asking this because the efficacy and safety of Black salve "are well known", too. Specifically, it's known to have one-tenth the efficacy of a sharp knife and to be far less safe. The fact that it's "well known" doesn't mean that it's good.

In this context, I suspect that "efficacy is well known" means "known to stop progression of puberty", but we seem to have a desire to imply that it means "known to prevent suicides" or "known to improve quality of life 10+ years later" or even "improves the quality of life in the short term, for Autistics who have already reached Tanner 5". While all of that's hoped for, I haven't seen anything that suggests any of that's actually proven. I'm sure the Cass Review never said that puberty blockers aren't effective for temporarily blocking puberty, either, so that would fall into the "not news" category. WhatamIdoing (talk) 23:13, 4 October 2024 (UTC)

I don't think that part is referring to suicides or anything like that. It says "efficacy and safety", so it's referring to the known effectiveness and safety for the use of puberty blockers, ie stating that the science is that there aren't meaningful health risks like the Cass Review is claiming. The part commenting on mental health effects is at the end of that section. Silverseren^C 23:17, 4 October 2024 (UTC)

"Efficacy" has nothing to do with health risks. WhatamIdoing (talk) 01:35, 5 October 2024 (UTC)

Whilst Cass did not dispute the efficacy of puberty blockers of blocking puberty, it did dispute the safety of puberty blockers for gender affirming care. In fact this statement of health risks led to the restriction of puberty blockers in the UK (one of very few actual actions so far). A different country saying it is well known these health risks aren't meaningful seem notable (at the very least in the context of the restriction on puberty blockers). LunaHasArrived (talk) 13:22, 5 October 2024 (UTC)

They didn't say they aren't meaningful, they said well-known. Void if removed (talk) 13:34, 5 October 2024 (UTC)

They said their safety is well known. I was taking Silver Seren's comment "there aren't meaningful health risks like the Cass review claims", at face value. LunaHasArrived (talk) 13:40, 5 October 2024 (UTC)

The passage is quoted in this comment here, which is based (I believe) on the following in the source:

一方、米国内分泌学会(Endocrine Society) を含む諸外国の複数の関連団体からは、Cass Reviewが指摘する事項は旧知のものであり、二次性徴抑制療法はこれまで長年に渡って築かれてきた治療法であるとともに、二次性徴抑制療法の効果や安全性については科学的知見に基づいて判断していくべきものであるという趣旨の見解が示されている。

But I can't reproduce this translation. When I translate it via multiple different methods, it a) reads like they're simply relaying the Endocrine Society's view, and b) don't actually state that the safety and efficacy is well known, rather that the concerns raised in the Cass Review are well known.

If we can't WP:VERIFY what a source says, we shouldn't be using it. Per WP:NONENG Editors should not rely upon machine translations of non-English sources in contentious articles. Void if removed (talk) 13:58, 5 October 2024 (UTC)

I have begged a favor from a friend (a native speaker of Japanese) and received translations for these three sentences:

• ja: 今回、ガイドラインを再改訂し第 5 版とするにあたって、これまでのガイドライン同様に、WPATHのSOC 第 7 版 11) を参考としている。また、前述の米国内分泌学会 (Endocrine Society 2017) のガイドライン8) 、アムステルダム自由大学ジェンダークリニックのガイドライン 9) も参考とした。
• en: As we revise the Guidelines to the 5th edition, just like we have done with the past editions, we take into consideration the 7th edition of the WPATH SOC 11). In addition, the Guidelines provided in the Endocrine Society 2017 8) as well as the Gender Clinic Guidelines at the Vrije Universiteit Amsterdam (Amsterdam Free University) 9) were also referred to.

and

• ja: 一方、米国内分泌学会(Endocrine Society) を含む諸外国の複数の関連団体からは、Cass Reviewが指摘する事項は旧知のものであり、二次性徴抑制療法はこれまで長年に渡って築かれてきた治療法であるとともに、二次性徴抑制療法の効果や安全性については科学的知見に基づいて判断していくべきものであるという趣旨の見解が示されている。
• en: On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed the view that the issues raised in the Cass Review are old knowledge, that puberty suppression therapy is a treatment that has been established over many years, and that the effectiveness and safety of that puberty suppression therapy should be judged based on scientific knowledge.

and:

• ja: WPATH (The World Professional Association for Transgender Health)のStandards of Care (SOC) 第8版 (2022） 10)でも、Cass Reviewよりも多くのsystematic reviewをもとに有用性、限界や副作用について記述している。
• en: The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) 8th Edition (2022) 10) also describes the usefulness, limitations, and side effects based on more systematic reviews than the Cass Review.

The middle one is the one you quote above. In the first and last, I underlined the bits referring to specific footnotes; think of those as just being our little blue clicky numbers/not directly content. WhatamIdoing (talk) 23:40, 12 October 2024 (UTC)

@LunaHasArrived, my main concern about this point is that we seem to be interpreting "safety profile is well-known" as being the equivalent of "these are safe". The safety profile of substances like mercuric chloride and thalidomide are also "well-known", and their safety is very bad indeed. The opposite of "well-known" is "uncertain". If this text actually says that the safety profile is well-known, that doesn't mean the Japanese authors are saying "it is well known these health risks aren't meaningful"; they are only saying that whatever the health risks are (whether very significant or very minor or something in between), everyone knows what they are. WhatamIdoing (talk) 23:38, 5 October 2024 (UTC)

You can read the results of a new multi year study that was just published that I referenced above, which has now actually proven that the link - restriction on access to gender affirming care including restricting access to puberty blockers, has led to negative mental health outcomes and a rise in suicides.

So since this study just came out and is the first one that actually tracked it, it obviously wasn’t available to consider while the Cass Review was written, or more importantly, the UK government action to now restrict them following the Cass Review, which will sadly likely result in a rise of suicides of trans youth in the UK, unless the UK government reverses course in light of the new data.

But in any case, this is a discourse and isn’t specifically linked yet to the Cass Review, but more to reply to your question of While all of that's hoped for, I haven't seen anything that suggests any of that's actually proven. Raladic (talk) 23:38, 4 October 2024 (UTC)

Thanks for that. However, that doesn't prove that puberty blockers are effective at protecting mental health. It doesn't even show that dashing expectations about being able to receive puberty blockers has an effect. The paper mentions puberty blockers once, as an example of gender-affirming healthcare. The paper did "not differentiate the laws based on type or scope", so they handled the 7 states that restricted healthcare the same as the 12 states that enacted non-healthcare restrictions. If one state enacts restriction "A" only, and another enacts restrictions "A and B", and both see the same result, then that argues for the irrelevance of restriction "B". This paper does not analyze down to that level, so literally all we can say is their conclusion that enacting some anti-trans laws increases suicide attempts. We can't say that it has anything to do with access to puberty blockers.

I am hoping that the authors are taking the Least publishable unit approach, and that we will therefore some day see a paper that lists which states enacted restrictions in which of their five waves and which categories of restrictions produced the worst effect. In the meantime, this isn't proof that puberty blockers protect mental health, and they don't even try to claim that it is. WhatamIdoing (talk) 02:16, 5 October 2024 (UTC)

Please stop carelessly saying the Cass Review or the closure of GIDS or restriction of puberty blockers will sadly likely result in a rise of suicides of trans youth in the UK.

The UK's leading authority on suicide prevention (and one of the most respected figures in this area worldwide) specifically examined these claims and found them baseless and irresponsible.

There is a need to move away from the perception that puberty-blocking drugs are the main marker of non-judgemental acceptance in this area of health care.

This new paper based on US social media self-reporting adds nothing to this page. Void if removed (talk) 08:01, 5 October 2024 (UTC)

See the problem with this is that it believes that trans kids want puberty blockers because it’s a marker of being accepted and not, you know, so they don’t go through the wrong puberty and the permanent bodily changes that come with it. Any source that supposes the former, is flat out unreliable. Snokalok (talk) 08:22, 5 October 2024 (UTC)

You've misunderstood. He's not saying kids want them as a marker of acceptance - he is talking about the general sociopolitical demand for their provision being treated as the main marker of non-judgemental acceptance in this area of health care. Void if removed (talk) 08:29, 5 October 2024 (UTC)

This study wasn't tracking social media self-reporting, they said they recruited participants using social media and then had strict protocols that they've detailed on the tracking.

This study ran over several years and is newer than the examination you linked as it was just published, so the review you linked obviously didn't have this data that now unequivocally links advancing of restriction of gender affirming care to a rise in suicides.

The data available to science is always a point in time. The world was considered flat, until people found that it was actually spherical. So we now have new strong data that links them. Since the US study found that the rise was not linked merely to the announcement of such anti-trans laws, but only after the restrictions actually went into effect, if an effect may be observed in the UK, it wouldn't have been observable until the restrictions were passed now. Raladic (talk) 15:10, 5 October 2024 (UTC)

The study is based on self-reports, even though the self-reports aren't being posted on social media. Self-reports have advantages and disadvantages. Especially for mental health issues, selection bias can be significant. But: That's a problem for the peer reviewers.

What we've got is a WP:MEDPRIMARY source that says something very general about passing any anti-trans law, and that says nothing specific about passing healthcare-related laws, much less about passing laws specifically about puberty blockers. Keep in mind that 65% of the states that this paper says saw a rise in self-reported suicide attempts did not pass any restrictions on healthcare at all, so those kids have every bit as much access to puberty blockers and all other forms of gender-affirming healthcare as they did before.

I'm not saying this is bad research – not at all – but we've got to respect the research by not blowing it out of proportion. They've found that self-identified trans kids were more likely to self-report suicide attempts some time after any anti-trans laws went into effect in their area. That's it. They did not find that the common bathroom bills were better or worse or the same as anti-puberty blocker laws. They just found that anti-trans laws in general, taken as an indiscriminate whole, had an effect. WhatamIdoing (talk) 23:54, 5 October 2024 (UTC)

How you interpret that section depends on the translation, which is why I think the whole thing should be scrapped.

For example, this translation (GPT4) implies that the issues raised in the Cass Review aren't new, but are actually well-known:

On the other hand, several related organizations from various countries, including the Endocrine Society in the United States, have expressed the view that the issues raised by the Cass Review are already well-known. Puberty suppression therapy is a treatment method that has been developed over many years, and its effectiveness and safety should be judged based on scientific knowledge.

However, this translation (Google) implies something very different:

On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed the view that the issues pointed out in the Cass Review are old knowledge, secondary sexual characteristic suppression therapy is a treatment that has been established over many years, and the effectiveness and safety of secondary sexual characteristic suppression therapy should be judged based on scientific knowledge.

Here, the framing is plausibly not that Cass is old news, but outdated - and in that sense they are saying that WPATH and the Endocrine society are more up to date in saying its safe and effective.

And this one (Bing) is incoherent, while saying the safety is not known.

On the other hand, several related organizations in other countries, including the American Endocrine Society, Cass The points made by the review are old acquaintances, and secondary sex characteristic suppression therapy has been around for many years. In addition to the treatment that has been built, the effect and safety of secondary sex characteristic suppression therapy are not known.

I think there's too much contradictory cherry-picking possible without an official English translation, and none of this is WP:DUE. Void if removed (talk) 08:25, 5 October 2024 (UTC)

The first two say more or less the same thing. ‘The issues raised have been known for a long time, but puberty blockers have been around for a long time and their safety should be based on scientific knowledge.’ The Bing one doesn’t, but also Bing is probably the least reliable resource for, anything, in the history of the internet. Either way, AI hallucinates, and the response by the relevant Japanese org is as due as any other. Snokalok (talk) 08:35, 5 October 2024 (UTC)

Sorry, what do autistics who have already been through puberty have to do with any of this? Snokalok (talk) 08:27, 5 October 2024 (UTC)

In the prior UK system, trans teens who have already completed puberty were put on puberty blockers (i.e., even though there was no more pubertal development to block) because they needed a year of puberty blockers before cross-sex hormones could be accessed.

Post-pubescent Autistic teens were the group that was most likely to voluntarily discontinue the use of puberty blockers before that year of puberty blockers was completed. WhatamIdoing (talk) 23:43, 5 October 2024 (UTC)

I think the JSPN section on the Cass Review actually mentioned something to that effect, would you be at all opposed to including that as a useful piece of info (ie quote + context)? To date I don’t know of any article on the topic that has it. Snokalok (talk) 01:00, 6 October 2024 (UTC)

I don't know if the Japanese source says anything about autism. They do say that the Cass Review reported the average age for the initiation of puberty blockers was 15 in the UK ("これ も英国のガイドラインではホルモン療法の適応までに長い時間が必要とされたため、二次 性徴抑制療法に適するとされる年代よりも高めの年齢の若年者にまで二次性徴抑制療法が 適用され（英国における二次性徴抑制療法開始年齢の平均は15歳とされる）").

I think it would be appropriate for the article to provide factual information such as "GIDS was seeing a lot of Autistic kids" and "Most kids weren't starting PBs until at least age 15", but I don't know that we gain much from saying that "The Japanese group says that the Cass Review says that most kids who got puberty blockers didn't get them until they were at least 15 years old". This is AFAICT an undisputed fact; we should just present it as an undisputed fact, and we should not present it as merely something someone says. WhatamIdoing (talk) 21:51, 6 October 2024 (UTC)

That info can be sourced to the York Review on care pathways:

One study reported that six (8%) young people discontinued gonadotropin-releasing hormone analogues (GnRH-a) for puberty suppression following a median duration of 6months (range 6-18 months). Compared with those who continued with treatment, young people who discontinued had initiated treatment at an older age and included a higher proportion of those with mental health conditions and autism spectrum condition

Void if removed (talk) 11:51, 10 October 2024 (UTC)

Medically self-evident quote

As I pointed out over on another talk page, following on from this comment, the quote it is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it is not derived from any known machine translation, and the actual verbatim source is a self-published activist website. I tagged this quote as failed verification. Can someone please provide a decent source for this actual translation? Void if removed (talk) 12:24, 9 October 2024 (UTC)

Oh and I did not notice @Snokalok had removed it, I've added it again. The text is here:

また、AMABにおいては、必要な例に二次性徴抑制療法を実施しないことで望まない性 の身体の特徴が不可逆的になることは、医学的に自明であり、そのような例では、質の高 いエビデンスを示す研究をすることが困難なものの、その後の精神状態に悪影響を与える ことが懸念されている。

Can anyone supply an actual verified source (not a self-published activist website) that this translates as:

it is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it Void if removed (talk) 22:55, 12 October 2024 (UTC)

An alternative to fixating on this lengthy quote is to paraphrase. I think we can confirm that "self-evident" is part of the source. So eg. something like:

The guidelines note it is "self-evident" that, unless puberty is suppressed, development of sex characteristics are irreversible in AMAB individuals. Void if removed (talk) 23:00, 12 October 2024 (UTC)

I think that’s a good compromise suggestion for the sentence. Raladic (talk) 23:07, 12 October 2024 (UTC)

That would be fine. Or we could go with the summary I previously suggested: The paper noted that if AMAB individuals do not receive puberty suppression when necessary, it can result in irreversible characteristics of the undesired sex which could then negatively impact their mental state. Usr Trj (talk) 08:06, 14 October 2024 (UTC)

I still think we should just paraphrase the sentence since all the translations virtually say the same thing just in slightly different wording. That way we can stop debating over the exact word for word translation. Usr Trj (talk) 08:02, 14 October 2024 (UTC)

New assorted response: Gender Affirming Care Is Evidence Based

I've removed a section referencing this commentary, as this is turning into a WP:COATRACK. By my reading, the entirety of this response boils down to noting the existence of other responses (Horton's piece on the Interim Review, the Noone et al preprint, the Grisjeels commentary and the Yale white paper), which is hardly an improvement to this article. What, specifically, does this response add?

It makes, as far as I can tell, one actual criticism of its own:

she also minimizes the robust data and the potential negative impact of increasing barriers for an already disenfranchised group.

For which there is no citation, so this is the opinion of the authors, in an opinion piece. It is not a terribly weighty commentary, and the material on Cass is thin.

I can't see what chucking this in adds, so WP:NOTEVERYTHING. At best it could be an extra citation to the condensed individual responses. Void if removed (talk) 13:48, 7 October 2024 (UTC)

Science evolves and so does often the reception of a piece, so yes this is DUE as it appears very well that the worldwide reception of the Cass Review is being continued to be criticized (so far, pretty universally outside the UK), which by itself may show that the Cass Review may fall into the abyss of being disregarded by the scientific community.

That by itself makes the continued worldwide criticism levied notable and not a coatrack and may over time actually change the focus of the article to become one that highlights the shift of the original positive reception within the UK to the then almost universally negative reception of it worldwide with highlights of some of its shortcomings, or in some cases, the failings of the conclusion drawn by the UK government thereafter (such as the imposition of a ban on puberty blockers). With the original findings of the Cass Review itself becoming a secondary background to this, just as say the Myth of the flat Earth was originally about the world being flat, until it turned into the Myth of it. Writings evolve, and so does the coverage of topics.

The lack of citations for the quote you are claiming is uncited are a re-iterating of a paragraph they make earlier in the paper - Existing research demonstrates the effectiveness of medical GAC interventions through the alleviation of distress [[18], [19], [20], [21]] and improvement in well-being and quality of life. [20,[22], [23], [24]. So, they are well cited.

The whole paper then ties it into Cass with The above-mentioned critiques are not new but have been highlighted in a recent non–peer-reviewed, independently published report by Cass (2024) that has gained traction in the media. [44], so basically the paper, just as the title of it being Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth suggests is a response to the Cass Review claiming in part that there isn't evidence. So with this, this paper isn't an opinion piece as you claimed, as it very clearly links the cited evidence for gender affirming care and has been published by a group of scientists in a peer reviewed journal, citing the evidence that exists and why RCTs are not ethically feasible. So please refrain from claiming every piece of critique that comes up against the Cass Review is just an opinion piece as you have also done in the past. Raladic (talk) 16:42, 7 October 2024 (UTC)

It's "commentary". It's in the "commentary" section. It's RSOPINION. Can you please stop ignoring BRD. Void if removed (talk) 19:15, 7 October 2024 (UTC)

BRD is one content resolution strategy, but so is WP:IMPLIEDCONSENSUS, which is how the majority of consensus of content is formed on Wikipedia, which happened here prior to your unilateral removal, as 4 separate editors (@Your Friendly Neighborhood Sociologist, Usr Trj, and Daff22: and myself) collaboratively edited on the paragraph.

So instead, next time, you should start a discussion before you unilaterally remove content against implied consensus.

This is actually highlighted at BRD - Wikipedia:BOLD, revert, discuss cycle#General overview - the diagram on the side outlines how often there is subsequent changes to new consensus. In those cases we are at implicit consensus territory per the preferred WP:Bold-refine and it is typically advised if you disagree with it to start a discussion, but not revert, per WP:BRB. Raladic (talk) 19:29, 7 October 2024 (UTC)

You've now ignored my comments about the fact this is merely commentary, and expanded the paragraph on this commentary piece to be almost the same length as the paragraph in the source that actually references Cass, with lengthy quotes and WP:UNDUE fluff like general statements about GAC. The source only spends 150 words on Cass or thereabouts.

When I ask you to follow BRD, I mean actually meaningfully discuss content.

I say: this is a commentary piece that adds nothing novel. It is no different to other opinions from individual academics we have previously collapsed.

So: why does this one get expanded? Void if removed (talk) 09:07, 8 October 2024 (UTC)

Is this piece peer reviewed? It doesn't look like it. (Under "Article info", there's no date indicating when it was "received" or "accepted", which usually indicate peer review.)

It is labeled as "Articles in Press". Does that mean that it is currently a pre-print? WhatamIdoing (talk) 04:20, 9 October 2024 (UTC)

No it's not a pre-print. The journal has the concept of "Articles online first", which means the article has been fully accepted, reviewed and proofed and will appear exactly the same online a few weeks ahead - The online article is identical to the version subsequently published in the print journal and is citable by the digital object identifier (DOI) assigned at the time of online publication. Raladic (talk) 04:27, 9 October 2024 (UTC)

It is a "commentary" piece, which means it is opinion. I can't tell if its been peer-reviewed, they usually aren't, but it varies. Void if removed (talk) 08:14, 9 October 2024 (UTC)

Here is a letter to the editor in Paediatrics and Child Health.

In terms of source - is there any difference between this, and the commentary piece? I don't believe so - commentary and letters to the editor are supposed to present opinionated points of view for discussion. They are not authoritative statements.

This letter concludes:

The Cass Review, based on nine studies, eight of which were systematic reviews assessing the quality of evidence, as well as extensive stakeholder consultation is the most thorough review of gender-affirming treatments in young people conducted to date. It carefully considered the meteoric rise of young people presenting with gender distress, the dramatic reversal of the sex ratio in this population, the co-occurring mental health and neurodiverse conditions, the socio-cultural and developmental contexts that may contribute to trans-identification, as well as the literature on detransition, and made prudent recommendations. The Cass Review represents the new international standard of care. Given that the current Canadian model parallels the UK’s prior gender-affirming care model, the findings of the Cass Review are pivotal. Canadian youth deserve the same protection of evidence-based guidelines as children in Finland, Sweden, and the UK.

Void if removed (talk) 08:31, 10 October 2024 (UTC)

Response bloat

As time has moved on, what were "responses" to the Cass Review upon its publication are increasingly more broad effects and impacts. Citations to it in guidelines. Commentary in opinion pieces. This is getting unwieldy.

I think we need to start restructuring into immediate, direct responses, and subsequent impact (domestically and internationally) on guidelines like the Japanese ones which are more "contextual", and the Australian review of services.

I suggest citing this BMJ investigation from May (which for some reason we aren't) which very explicitly notes the difference in reception between the UK and the US, and this places into context the polarised responses.

So something like:

• Reception (containing some of what's there already, but only the actual immediate direct reception
• Subsequent impact (for eg. the creation of a review into adult services, the impact on services in Scotland etc) with an international section, which can contain the Japanese and Australian content, which aren't really "responses" but "things that happened after, in the context of the cass review's findings"
• Further commentary (noting the divisions between the US/UK per the BMJ piece, notable opinion pieces etc)

I think there's space for some of the more subjective commentary, but cramming it all into "responses" is not aiding the reader, or balancing it well. Void if removed (talk) 09:29, 8 October 2024 (UTC)

I didn't think it was that bloated or hard to read. However, it seems misleading to say the Cass Review had an impact on the Japanese guidelines and the Australian review of services. The Japanese guidelines continued to recommend puberty suppression and seemingly dismissed it's relevance to Japan by calling it "specific to the unique situation in the UK" and the review of Australian services was rejected and so nothing really changed. I think both of these fit better in the response section. Usr Trj (talk) 10:24, 8 October 2024 (UTC)

They aren't a "response to cass" is my point. They are things that happened after, taking cass into consideration. The more time passes and the more we try and cram into "responses" the worse it is going to get.

Many things in "responses" are very clear statements in response.

Others aren't, but could go in a different section just fine. Void if removed (talk) 10:33, 8 October 2024 (UTC)

Then maybe you should've called the section "Aftermath" or something else instead. Using the word "Impact" implies that the Cass Review had a notable influence on Australia and Japan and led to notable changes in those countries, which it hasn't. Usr Trj (talk) 10:54, 8 October 2024 (UTC)

I'm not sure I agree, the section being "impact" can also be used to highlight notable points of lack of impact IMO. Aftermath sounds a bit dramatic to me, what about just "influence"? Or "Subsequent events"? Void if removed (talk) 11:26, 8 October 2024 (UTC)

"Subsequent events" will probably be confusing. People might expect to find (e.g.,) information about when new programs were opened, or if there was a follow-up report. WhatamIdoing (talk) 04:21, 9 October 2024 (UTC)

Sure - that was where I was originally hoping to put the material about adult services review etc. These aren't directly about the cass review, but are things that happened as a result. I'm trying to draw a line under the most significant direct responses and create somewhere else in this article that can be expanded with relevant but less directly responsive material. I'm out of synonyms though. "Later developments"? "Outcomes"? Void if removed (talk) 08:27, 9 October 2024 (UTC)

Also, I think the interviews with Cass that you moved to "Further Commentary" fit much better under the "Hilary Cass's response" section as they were previously, since Cass was directly responding to criticism in them. Usr Trj (talk) 10:29, 8 October 2024 (UTC)

Hilary Cass published extensive reflections on the review a month ago. Right now, there is nowhere for these to go, but they are certainly due. I hope that by starting this section with some of her comments it can be expanded with this. Void if removed (talk) 10:35, 8 October 2024 (UTC)

I don’t think it’s helpful to the reader to separate the responses like this, it makes them read the reception section and think those are the only responses. Snokalok (talk) 12:24, 8 October 2024 (UTC)

The point is to separate immediate, direct, PR type reactions like RCGPs and WPATH's from longer term, more contextual outcomes and influences like the adult services review. How about "initial reception" instead of "reception"? Void if removed (talk) 12:45, 8 October 2024 (UTC)

I’m not opposed to considering the idea but where do you draw the line? Snokalok (talk) 12:48, 8 October 2024 (UTC)

I draw the line at, basically, the direct responses we currently have from major orgs (or anything simliar to that which happens to come along, though it seems unlikely at this late stage).

I think the Japanese guidelines are too vaguely connected - nothing says they are a "response" to Cass (which is why I object to their inclusion at all in that current section). They don't describe it as such themselves, and it doesn't even really contain a response to Cass, merely describing it. However, it is clear they are a "response" to a changing context, with The Cass Review and WPATH butting heads making it reasonable to reissue service guidelines that make it clear what it all means for clinicians there. I think that is a sort of "second wave" wider impact sort of thing (as is the review of adult services, NHS Scotland etc).

IMO, if it is a press release explicitly stating "here's what we think of the Cass Review" its a response. Anything vaguer than that (rejected calls for a similar review in Australia) to me feel like a second order effect - and the advantage is that something structured like that can grow without cluttering up the more immediate responses. The more that gets added there, the harder it is a for a reader to grok the timeline, frankly. Every future international guideline that cites the Cass Review (whether endorsing or rejecting it) could be relevant in that sort of section. Void if removed (talk) 13:36, 8 October 2024 (UTC)

I’d be okay with sections labeled “Early reception” and “Later reception” Snokalok (talk) 14:21, 8 October 2024 (UTC)

Yes I think that's preferred rather than this completely separate section that's now below.

Also regarding the line @Void if removed is trying to draw - that's not how the medical community works - reception in medical papers is done through discussion and citing of them within a new separate paper - it is still inherently reception.

So I think with that, @Snokalok's suggestion to split it into early and later works better if you're concerned about timeline. Raladic (talk) 14:55, 8 October 2024 (UTC)

I think you'll want to reconsider your claim. If it's true that "reception in medical papers is done through discussion and citing of them within a new separate paper", then none of the self-published press releases we're citing should be considered True™ Responses, and perhaps they should all be removed.

(Sure, it's an Argument from consequences, but I suspect you won't like the consequences of your claim.) WhatamIdoing (talk) 04:24, 9 October 2024 (UTC)

Add the word "often" to the sentence ..reception in medical papers is often done through discussion and citing.. if we must quibble about words.

I think it was clear what I meant to say, which was only in response to VIR's point that if something doesn't explicitly says "here's what we think of the Cass Review" then it's not a response, which isn't how stuff is commonly addressed in published papers and I didn't say that only peer-reviewed responses are responses, just that a common way of mentioning something in citation and discussing it in papers and that such a mention still constitutes a response. Basically, the inverse of what you are implying, VIR was saying that papers that are not explicitly titled "response to Cass" are not a response, which is what I tried to refute. Raladic (talk) 04:47, 9 October 2024 (UTC)

@Raladic, I'm not sure exactly what kind of source you're talking about. Which of these two categories sounds closest to the mistake that we need to avoid?

• Cass Review gets published, and ____ puts out a press release to say that Cass got some facts wrong: Science by press release.
• Cass Review gets published, and ____ publishes a paper about trans teens that never mentions the Cass Review by name, but Wikipedia editors decide that this paper is a response to the Cass Review (because the subject matter overlaps, and the entire trans-healthcare profession, at least insofar as this can be determined from social media, is thinking of nothing else, so obviously any publication post hoc is indisputably ergo propter hoc): Wikipedia:No original research violation.

WhatamIdoing (talk) 18:34, 9 October 2024 (UTC)

So what counts as "early"? What counts as "later"?

The line I'm trying to draw is the difference between essentially breaking, reactive responses, and considered, down the line impacts/incorporation/rejection of actual findings.

That's more of a qualitative split, though it becomes somewhat temporal by necessity.

For example, the BMA's response is, IMO, is a "response" - but it isn't an early one because it took them months to actually state it. Void if removed (talk) 15:10, 8 October 2024 (UTC)

Actually I just took a look at what the responses are, and what we have is scientific responses, published by the scientific community, and we have some advocacy organization responses.

So I just took another stab to separate it like that, as well as to address the timeline issue, I actually found after reading the paragraphs that all that was needed was adding dates to some of the early in April one to make it clear those were immediately following the release and the new later responses already mostly had the dates and I added a few where I felt it was useful to readers without having to open the ref.

I also kept Cass's individul personal responses in her section, rather than having them split up across different sections, to make it clear that those are her individual personal opinions as a person, rather than in an official capacity of the review itself. Raladic (talk) 15:14, 8 October 2024 (UTC)

We went over that before - they aren't "scientific responses". Most of them are comments in popular journalistic sources, and the Yale white paper is not a scientific publication. Old section title was least bad consensus. Void if removed (talk) 15:21, 8 October 2024 (UTC)

They are scientific responses by medical and legal scholars, many of them published in peer reviewed journals, which is how the scientific community operates.

In any case, I renamed it into academic, which is irrefutably accurate. Raladic (talk) 15:26, 8 October 2024 (UTC)

I mean, you say "many of them published in peer reviewed journals", but only two in this section are published in journals, and at least one of those citations isn't peer-reviewed, and probably neither. So, in the first sentence:

The report was praised by some academics in the UK, who agreed with its findings stating a lack of evidence; while others both in the UK and internationally disagreed with the report's methodology and findings.

None of the citations here are peer-reviewed, even Abbasi's editorial in the BMJ, and aside from that one these are just comments in popular press so it doesn't justify this title. The Yale white paper isn't peer-reviewed either. This latest commentary probably isn't, it is hard to say for sure, I think it is at the editor's discretion at JAH?

(I really think that this latest commentary would be better under a "further commentary" section - it is commentary on the commentary as much as anything, noting the other responses. And that is the sort of section that can be expanded with other perspectives, illustrating the different points of view. There will be other academic works providing commentary and perspectives beyond simply a straightforward "response")

And the "advocacy organizations" title doesn't fit with the EHRC (who are not an advocacy org, but a regulator). Also, minor, but "organisations" please. TBH I would happily lose that entire section at this point, there's plenty of better material now, surely WP:NOTEVERYTHING... Void if removed (talk) 16:09, 8 October 2024 (UTC)

They are still academic responses. As I said, some are peer reviewed, but nonetheless, even others such as the Yale white paper were still drafted by academics with academic citing and all.

The same for the latest, which was published in a journal and it didn’t just reference the other responses, it also specifically cited the existing evidence that does exist and is the basis why gender affirming puberty blockers for transgender youth is still used in most of the world outside the U.K.

As for advocacy organizations as a title, I carefully considered it and actually checked the charter of the EHRc before I made that title and they are also that The Commission has responsibility for the promotion and enforcement of equality and non-discrimination laws in England, Scotland and Wales… Promotion is advocacy, so aside from also being tasked with enforcement, they are also tasked with promotion, which is advocacy, so as a banner it is appropriate. Raladic (talk) 16:24, 8 October 2024 (UTC)

No, this is wrong - advocacy groups seek to influence and bring about political change. The EHRC is an independent body set up by the UK government to reflect and enforce existing law and policy. There are quite significant differences between lobbying and pressure groups and a regulator like the EHRC, and this title misrepresents that. I disagree with your interpretation of "promotion" as making them the same thing, when they are not.

some are peer reviewed

I think by "some" it is "at most one, and possibly none". This sort of thing is why it was compromised to "assorted", so as not to mislead the reader into thinking these opinions had a more academic stamp than they actually do. Void if removed (talk) 17:00, 8 October 2024 (UTC)

I didn’t call the section advocacy groups, it was titled organization.

In any case, this easy to solve since we already had other UK government bodies further up from the NHS response, so I moved it up there and renamed it into UK government bodies to accurately group it. Raladic (talk) 19:24, 8 October 2024 (UTC)

It's not a government agency. It is an independent regulator.

Again, all these details are why we had "assorted", which was fine. Void if removed (talk) 19:29, 8 October 2024 (UTC)

It’s a Non-departmental public body, which is a very U.K. specific thing.

You have to remember that we write Wikipedia for a global audience, so I renamed the section to include the word public bodies now and specifically linked to the Non-departmental public body for the EHRC, which is helpful for readers who want to understand that they are a public body that is still accountable to parliament, but not directly part of the government as you pointed out. But they are still vested with their power through the county’s respective legal framework, just as most other National human rights institutions are to be able to actually enforce the charter they are tasked with. Raladic (talk) 19:45, 8 October 2024 (UTC)

Aside from the retitling - which is inaccurate and confusing still - there was a logic to the organisation of responses which this now breaks.

Previously, the responses flowed in decreasing order of importance.

1. Political responses. The immediate acceptance of the Cass Review across the political spectrum was hugely significant for an issue that is still deeply politically polarised in the US for example, and sits above the national health service, which the gov ultimately controls.

2. Health services. As the implementers of the review's recommendations, these responses were paramount.

3. UK medical bodies. As the bodies responsible for training and accrediting doctors, these responses again would affect how well-accepted the review was within the UK medical community.

4. International medical orgs. No direct influence on implementation, but a huge impact on how this was received by the broader medical community (will other countries follow suit, or will the UK be isolated?), and may have an impact over the long term

5. Others. Basically notable interesting but not directly impactful responses.

The EHRC fits into this latter category. Its opinion is interesting but utterly unimportant to the actual implementation of the review.

The way you've restructured it doesn't follow this flow, and also misrepresents the response of health services as government responses.

The previous title and order was absolutely fine, and EHRC being dumped under "assorted" was not a problem, so I don't know why you're insisting on retitling this section confusingly and cumbersomely in order to justify it. Void if removed (talk) 08:22, 9 October 2024 (UTC)

Substack content reposted on Lemkin Institute website

@Raladic the blogpost you've reinstated is atrocious, it doesn't belong under advocacy orgs, and is the sort of irrelevant musings of random activists that has no place here in any form, let alone a whole paragraph. Void if removed (talk) 17:59, 14 October 2024 (UTC)

I agree that it does appear pretty atrocious that public health officials are speakers at an openly anti-trans rights conference and that them being involved in the Cass Review does not help the optics of the neutrality of the Cass review. Since the Lemkin Institute for Genocide Prevention endorsed the report by republishing it and it doesn’t appear that the report is factually inaccurate, it links to the agenda of the conference and such for the facts summarized in the article by the paragraph that @Snokalok: added, it definitely appears due for inclusion as relevant context on the reception of the Cass Review. Raladic (talk) 18:44, 14 October 2024 (UTC)

My notifs still aren’t working, I saw this by checking the page history, but, how does everyone feel about splitting the difference with

“In 2024 the Lemkin Institute for Genocide Prevention published a piece by Erin Reed, stating that (blahblahblah)” That way the org is given its due, while still making clear to the reader that the piece itself is being written externally. Snokalok (talk) 20:26, 14 October 2024 (UTC)

Yes I think that is appropriate and what I tried to do with the attributed modified version I tried to re-instate.

The latest reversal did not cite relevant policy that warranted its removal (and itself bordering on WP:SQS without that editor having made any attempt at discussion here themself), so I think given the factual summary of facts from the as republished report with the the Lemkin institute endorsing it, you can go ahead and place your proposed amended version there @Snokalok. Raladic (talk) 20:36, 14 October 2024 (UTC)

I think that we've rolled up individual responses far more notable and reliable than this, and Reed is an unreliable source with a history of spreading outright falsehoods about the Cass Review, so definitely not reliable for anything on this page. Void if removed (talk) 20:40, 14 October 2024 (UTC)

Raladic as you well know, having reverted a number of my edits without discussion, the onus is on the editor wishing to add content to establish consensus on Talk.

As to this source: it is not correct to attribute authorship to the Lemkin Institute. As you can see here: https://www.lemkininstitute.com/world-news "We post articles from media outlets around the world that either cover ongoing cases of genocide and its aftermaths or that are tied to patterns and red flags of genocide." The Institute itself does not claim to have reviewed or published them. This particular repost is a self-published source which has been reposted by a member called "elsabis2014". I think anyone arguing for inclusion of this needs to establish how exactly the Lemkin Institute is "endorsing" this content, otherwise it is just a self-published source. FirstPrimeOfApophis (talk) 20:53, 14 October 2024 (UTC)

The policy I think is most relevant is WP:NEWSBLOG "Some newspapers, magazines, and other news organizations host online pages, columns or rolling text they call blogs. These may be acceptable sources if the writers are professionals, but use them with caution because blogs may not be subject to the news organization's normal fact-checking process." Erin Reed is not a reliable source by herself as VoidIfRemoved points out. And the Lemkin Institute does not claim to be subjecting these posts to any fact-checking process. FirstPrimeOfApophis (talk) 21:16, 14 October 2024 (UTC)

Erin Reed uses exclusively she/her pronouns, not they/them. I’m going to ask you to edit your response to use the correct pronouns. Snokalok (talk) 21:28, 14 October 2024 (UTC)

Absolutely. Thanks Snokalok, I wasn't aware. FirstPrimeOfApophis (talk) 21:32, 14 October 2024 (UTC)

It's a WP:SPS and Lemkin doesn't have any editorial oversight, but are an advocacy org reposting blog content on their website. Void if removed (talk) 21:56, 14 October 2024 (UTC)

Yes, I was looking for a policy specific to that use-case but WP:NEWSBLOG was the closest I could find. FirstPrimeOfApophis (talk) 22:06, 14 October 2024 (UTC)

UK puberty blocker restrictions

https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=1250787222&oldid=1250782373

Raladic has reverted some changes I have made with the edit summary "the changed terminology is not easier to understand by readers. Wikipedias purpose is to summarize a topic for the readers."

The current title "Legal ban preventing non-NHS medical providers from prescribing puberty blockers" does not accurately summarise what the sources say about this regulation. The regulation explicitly states that non-NHS prescribers may prescribe puberty blockers, to over-18s in the same way as previously and to under-18s in a more restricted way. Also "legal ban" is redundant.

The current text "The ban restricted their use to only those already taking them, or within a clinical trial" is also inaccurate. The regulation imposes no new restrictions on NHS prescriptions. As mentioned above, it doesn't restrict over-18 use at all. It also specifically allows for private prescriptions for reasons other than treating gender dysphoria.

Do you see why the current text needs to be changed?

As for the other changes:

"Instigated" is almost always a negative term in English, and implies the Good Law Project were doing something mischievous or immoral by bringing the challenge. See https://www.merriam-webster.com/dictionary/instigate. This is POV.

"Reception by advocacy organisation" is just poor English if you are talking about more than one organisation, which we are. FirstPrimeOfApophis (talk) 15:25, 12 October 2024 (UTC)

On Wikipedia we summarize what reliable sources say and they use the term "puberty blocker ban" as is linked from the cited sources of the paragraph and was previously discussed.

The reversion was about your change of the consensus language from this as it is counter to our policies. We tend to avoid WP:PRIMARY sources as you have linked and prefer to lean on WP:SECONDARY sources and summarizing what they say.

If you have new reliable secondary sources that use other language or supports the details you are talking about, then we can discuss this, but the current paragraph summarizes the case based on the common language used by multiple reliable sources and is a summary of them.

As for the other two things you mentioned of "instigated" and plural, yes those are fine separate improvements and already done. Raladic (talk) 15:58, 12 October 2024 (UTC)

Raladic citations to legislation are fine, there is even a WP template for it: https://en.wikipedia.org/wiki/Template:Cite_act (EDIT: as Raladic says, legislation is still a primary source). If you prefer, I can add these as well: https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers or https://mermaidsuk.org.uk/news/puberty-blocker-restrictions-explainer/.

But in fact it is the current text which is unsourced - where in the current sources does it say that non-NHS prescribers can no longer prescribe puberty blockers or "The ban restricted their use to only those already taking them, or within a clinical trial"? FirstPrimeOfApophis (talk) 17:10, 12 October 2024 (UTC)

Answering your questions: where in the current sources does it say that non-NHS prescribers can no longer prescribe puberty blockers - here in the Guardian article: The ban means that puberty blockers cannot be obtained from private prescribers and only from the NHS within a clinical trial, but Coppel said no trial had yet been established, despite Cass’s support for it.

And or "The ban restricted their use to only those already taking them, or within a clinical trial"? - is from this one in the cited BBC article - Puberty blockers are now only available to under-18s with gender dysphoria who are already taking the drugs. They can also be used in NHS clinical trials and in a few other circumstances.

The Mermaid source you just linked also summarizes the restriction as such here: Young people who did not receive a first prescription for this type of medication before 3 June 2024 and are accessing, or considering, private healthcare.

Again, as I said above, it doesn't mean we don't sometimes add a primary citation, but the existence of templates for it doesn't override our general policies to prefer reliable independent secondary sources and that we summarize the core points as so described, which appear well sourced and accurate. Raladic (talk) 17:30, 12 October 2024 (UTC)

Raladic I think you are misreading both the Guardian and BBC sources.

In any case, this is irrelevant, because we have a government-published secondary source answering these questions (https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers). It is not credible that the government would publish erroneous information about the details of their own regulations, so if (as you say) other sources conflict with it, we should go with the government source. FirstPrimeOfApophis (talk) 18:12, 12 October 2024 (UTC)

So that we are clear on what we are disagreeing about, I am saying that the most reliable source says the following:

The ban/regulation prohibits the sale or supply of GnRH analogues, except to:

1. anyone over the age of 18 ("The government has today introduced regulations to restrict the prescribing and supply of puberty-suppressing hormones, known as ‘puberty blockers’, to children and young people under 18 in England, Wales and Scotland.")
2. anyone under 18 with an NHS prescription (although other regulations may apply in this case) ("It will apply to prescriptions written by UK private prescribers and prescribers registered in the European Economic Area (EEA) or Switzerland. During this period no new patients under 18 will be prescribed these medicines for the purposes of puberty suppression in those experiencing gender dysphoria or incongruence under the care of these prescribers.")
3. anyone under 18 with a private prescription from a UK-based prescriber who started on a course of treatment before 3rd June 2024. ("Patients already established on these medicines by a UK prescriber for these purposes can continue to access them.")
4. anyone under 18 with a private prescription from a UK-based prescriber for a condition other than gender dysphoria ("They will also remain available for patients receiving the drugs for other uses, from a UK-registered prescriber.")

Raladic can you see why saying "non-NHS prescribers can no longer prescribe puberty blockers" and "The ban restricted their use to only those already taking them, or within a clinical trial" are both inaccurate, if UK-based private prescribers can still prescribe in cases 1, 3 and 4 above, and new patients can still be prescribed in cases 1, 2 and 4? FirstPrimeOfApophis (talk) 19:05, 12 October 2024 (UTC)

I would be interested in knowing how many people age 18 and older are on puberty blockers. I saw a news article from a non-binary person suing to stay on the drugs for the rest of their life, so I suppose the answer is at least one.

@Raladic, the sources are writing in the context of pediatric care. It would be appropriate for this article to be clear about that. Since someone has raised a concern over that, maybe we can find a way to be just a bit clearer that this only affects the under-18s. WhatamIdoing (talk) 20:09, 12 October 2024 (UTC)

Yes, which is why I made this edit earlier to add the words “for minors” just in case it wasn’t clear from context. Raladic (talk) 21:28, 12 October 2024 (UTC)

Regarding point 2 - the routine prescription even under NHS was further restricted to just under clinical trials. From your government source - The NHS stopped the routine prescription of puberty blocker treatments to under-18s following the Cass Review into gender identity services. In addition, the government has also introduced indefinite restrictions to the prescribing of these medicines within NHS primary care in England, in line with NHS guidelines. This is part of the second sentence, which further outlined that other than existing prescriptions, even within the NHS new prescriptions will only be issued for clinical trials (refer to the explainer letter sent by the NHS). I’ve corrected it now per the sources. Raladic (talk) 21:51, 12 October 2024 (UTC)

Raladic and I have reverted those changes due to POV language and inaccuracies you introduced. It is not for you to say whether the exceptions are "narrow" or not. And you have misunderstood the significance of the December 2023 date; if patients have been prescribed puberty blockers for gender dysphoria after that date, then it is treated as if they were already undergoing a course of treatment, even if they have not started to take medication ("In addition to those patients who have actually started treatment, patients are treated as having started treatment, whether or not they have actually taken a GnRH analogue, if they were prescribed with a GnRH analogue on or after 3 December 2023." page 2 of your explainer letter). FirstPrimeOfApophis (talk) 22:48, 12 October 2024 (UTC)

Raladic and why have you falsely accused me of "engaging in an edit war" here https://en.wikipedia.org/wiki/User_talk:FirstPrimeOfApophis#October_2024? FirstPrimeOfApophis (talk) 22:57, 12 October 2024 (UTC)

Please see below message from @Void if removed on the purpose of that section and how you changed the meaning of it and your reversion here was number 3 after number 2 here and your initial reversion of the content from the prior consensus, thus your last one is one too many and afoul of our WP:3RR rule. Raladic (talk) 23:03, 12 October 2024 (UTC)

This section is about the ban on non-NHS prescriptions. This was a separate, specific action. Talking about narrow exceptions or changing the title to remove the explicit reference to non-NHS prescriptions renders the section nonsensical. You are conflating multiple things here, and this is not an improvement. Void if removed (talk) 22:45, 12 October 2024 (UTC)

I think you’re replied to the wrong person. It was @FirstPrimeOfApophis who changed the title and expanded it to not only apply about non-NHS prescriptions.

As a response to that, there was no conflation as that expansion required those clarifications, since this then requires to make it clear that even on NHS, there are no more new prescriptions issued outside of clinical trials as announced by the NHS, and as the article already says further about about the stop of routine prescriptions.

@FirstPrimeOfApophisnow just reverted the content again, and for the 3rd time from the prior consensus version, thus now being afoul of WP:3RR - please self revert back to the previous consensus version prior to your change.

I agree with @Void if removed that this section was specifically about the new non-NHS restrictions, so those additions for the NHS parts are not helpful additions since they are already summarized further up in the parent paragraph - Puberty suppressing hormones are no longer routinely available in NHS youth gender services. Raladic (talk) 22:59, 12 October 2024 (UTC)

Yes, sorry that was directed above, I agree - the NHS parts are not relevant.

It is very important this be a separate section because it was a separate process, one which the NHS had no power to implement, which the government of the day enacted, and the subsequent Labour government retained and widened. Void if removed (talk) 23:09, 12 October 2024 (UTC)

OK, if that is consensus, I will revert to the original version. FirstPrimeOfApophis (talk) 23:20, 12 October 2024 (UTC)

Are we certain that "no longer routinely available" is the right understanding? Things can be "only in a clinical trial", but if the clinical trial itself is "routinely available" [or will be, because I understand they're still setting it up?], then that would still be "routinely available". WhatamIdoing (talk) 23:46, 12 October 2024 (UTC)

At the current moment, they are not routinely available, since they are just setting up the plans for a trial right now, so I think the current summary is accurate as of this current discussion.

If in the future such trials are available and do provide routine access we can change it, but right now we'd be in WP:CRYSTALBALL territory until that point. Raladic (talk) 23:52, 12 October 2024 (UTC)

If this section is only about non-NHS prescriptions, should we be mentioning "clinical trials" at all in this section? The sources seem to discuss this only in the context of NHS prescriptions. FirstPrimeOfApophis (talk) 14:46, 13 October 2024 (UTC)

New Source in the BMJ addresses Yale white paper and BMA

Recently published in the BMJ, is quite scathing about the Yale report. One to discuss.

https://adc.bmj.com/content/early/2024/10/13/archdischild-2024-327994

This sort of thing is why I wanted to move away from the current bloated "response" structure. It's getting complicated and the responses are evolving and generating their own responses. Void if removed (talk) 21:17, 14 October 2024 (UTC)

Void if removed how would you prefer to restructure it? FirstPrimeOfApophis (talk) 21:27, 14 October 2024 (UTC)

See here Void if removed (talk) 21:30, 14 October 2024 (UTC)

OK, I support it. FirstPrimeOfApophis (talk) 21:49, 14 October 2024 (UTC)

I think adding responses to the Cass Review is obviously necessary, but adding all these different responses to other responses to it like that article may be overdoing it. I think that everything that's currently in the article is fine, but do we really need to add every new article that is released criticizing or giving an opinion on another organization's response? Some may be an exception, but for the most part, I think we should just stick with organizations responding to the Cass Review instead of organizations responding to other organizations on it. That would help prevent the response section from becoming more "bloated" in the future. Usr Trj (talk) 03:54, 15 October 2024 (UTC)

This adds significant new perspective on some existing content (especially the Yale white paper). It is a high quality, peer-reviewed source, far better than some recent additions, and clearly WP:DUE. Aside from direct responses and additional context applicable to claims currently in this page, the paper also has lots of information that can be used as a high quality source to expand the background, implementation and general reception. For example:

The purpose of the Cass Review was to make recommendations to the National Health Service (NHS) in England (NHSE) on how to improve services for people under 18 experiencing issues with gender identity. It was underpinned by a robust research programme, engaged over 1000 stakeholders and took 4 years to complete. The results of the Review were embraced by the UK clinical community, as well as a number of other professional and third sector organisations and both main political parties. The editor-in-chief of the BMJ aptly observed, ‘The Cass Review is an opportunity to pause, recalibrate, and place evidence informed care at the heart of gender medicine. It is an opportunity not to be missed for the sake of the health of children and young people.’ NHSE accepted the Review’s recommendations in full and has initiated a 3-year implementation plan.

Void if removed (talk) 08:44, 15 October 2024 (UTC)

I am not in favor of responses to responses either Snokalok (talk) 12:02, 15 October 2024 (UTC)

If we have a low-quality initial response that is debunked by a high-quality further response (like here), it isn't acceptable for us to present only the initial source. This will lead to WP:FALSEBALANCE between responses and mislead readers. FirstPrimeOfApophis (talk) 16:34, 15 October 2024 (UTC)

Void if removed on second thoughts, separating immediate and further responses seems risky. For example, a reader will read our lengthy and uncritical presentation of the Integrity Project paper in "Initial Responses" and not be informed of its flaws unless they read the "Further Responses" section as well, where we present a summary of this peer-reviewed journal article. This risks amplifying misinformation.

As a compromise, I suggest where further responses address a specific initial response, the initial response and further response should be presented in the same place. Where further responses address a range of initial responses (e.g. this: https://www.bmj.com/content/385/bmj.q1141) they should go in a "Further Responses" section. FirstPrimeOfApophis (talk) 16:34, 15 October 2024 (UTC)

In an ideal world, what I would like to see is:

• Background
• Methodology
• Interim Review
• Final Review
  • Findings
  • Recommendations
  • Implementation
• Reception
  • UK Political (Labour, Conservative, SNP)
  • UK Medical (NHSE, RCPCH, RCGP, BPS, RCP, AoMRC, BMA)
  • International Medical (AAP, Endocrine Society, CPS, AUMC, WPATH, PATHA)
• Subsequent Events
  • Ban on private puberty blockers
  • Adult clinic review
  • Scottish gender clinics
• Wider Response
  • Cass Reflections on review
  • Yale team criticism (inc. response)
  • Scholarly reactions
  • Others etc...
  • Popular media

Keep reception to the best, most relevant, highest quality and immediate responses. Cull or rehome everything else in "Wider Response". Void if removed (talk) 17:00, 15 October 2024 (UTC)

Interesting. So Final Review > Implementation would only be what is currently in the NHS England section? FirstPrimeOfApophis (talk) 17:43, 15 October 2024 (UTC)

Yes - I think the other points are notable fallout of the Cass Review, but not actually to do with its implementation. Void if removed (talk) 19:07, 15 October 2024 (UTC)

I don't like the idea of separating reception and responses since many people see those things as one and the same. But IF that happens, the RANZCP and JSPN should be kept with the others in the "International Medical" section. What would "Scholarly reactions" be? I don't know what "Popular media" would entail. Usr Trj (talk) 12:11, 16 October 2024 (UTC)

There are quite a few red flags with this paper:

• 1) probably shocking almost nobody, one of the authors is the founder of SEGM (hardly independent from the Yale group)
• 2) The section "Medicine, law and The Integrity Project" paints a ridiculously incomplete picture of trans healthcare in the US
  • 1) It says WPATH, the endocrine society, and trans advocacy groups oppose such bans - ignoring that every major medical org in the US opposes those bans including places like the AAP and APA
  • 2) It neglects to note the states banning trans healthcare do so entirely due to conservative and anti-LGBT advocacy groups
• 3) "Criticism of the Cass Review process" is fairly weak
  • 1) Yale, and many others, have questioned putting somebody with no experience with trans kids in charge of their future across a country. The paper's response to that seems to be "nuh uh, we wanted somebody like that". That's a difference in values, not an error. Besides, they note that applied to the named systematic reviewers too, not just Cass.
  • 2) The statement this is critiquing, "many of the Review's author's identities are unknown", cites Following the completion of the "research programme" by the University of York, "A Clinical Expert Group (CEG) was established by the Review to help interpret the findings" (p 26), defined as "clinical experts on children and adolescents in relation to gender, development, physical and mental health, safeguarding and endocrinology" (p 62). There is no further information about the qualifications of the members of the CEG, nor how they were selected. This paper says Cass was the sole author and mixes up the Review's CEG with it's CPG, ignoring the critique that Cass had an anonymous group discuss how to transform reviews into policy recommendations, and then guffs about "polarization" justifying a secret panel helping develop the recommendations.
  • 3) Their critique of Yale is that "McNamara et al assert that the Review contravenes standard practice in scientific evaluations by not using GRADE in its recommendations" but they don't, they point out that CPGs are subject to greater scrutiny and scientific rigour than the Review was
• 4) It completes skips over the reports criticisms of Cass misrepresenting data and repeating false claims (ie, most kids desist)

There were many more issues in this paper, but I wanted to flag some obvious ones. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:44, 15 October 2024 (UTC)

Thank you for doing the work to actually interrogate this source. Snokalok (talk) 20:57, 15 October 2024 (UTC)

This looks like a peer-reviewed paper (I assume? I don't know) in a respectable journal, about the subject of the article, and hence quite reasonably eligible to be used as a source, unless there is some overriding reason that it should not be considered reliable. Disagreeing with the conclusions of the paper are not a reason for it not to be considered a reliable source. In short, I don't think your red flags are very red. In long:

1) Guilt by association fallacy based on one of the five authors (not the lead author).

2) It's not the job of this paper to present a complete account of trans healthcare in the US.

3.1) The Integrity Project paper says they would have preferred a review led by someone with industry experience. This paper says they think that would have compromised independence. On this matter, the two papers disagree. So yes, that's not an error.

3.2) What do you mean by "it's CPG"? The paper states that there were over 1000 individual contributors and that it wouldn't have been appropriate to name them. Maybe you would have preferred Cass name them. That's an opinion, not a red flag.

3.3) McNamara et al does make that assertion, on page 9: The Review introduces GRADE (p 55) but never evaluates the evidence using the GRADE framework.. This paper explains that (a) the NICE systematic reviews did use GRADE, and (b) GRADE is indeed (appropriately) absent from the Cass Review recommendations: but this is because GRADE is a tool for CPGs and not designed for Reviews

4) Maybe you think the paper should have covered more ground, but that's not a red flag.

Ultimately this paper is part of the ongoing back-and-forth conversation between increasingly disconnected groups of researchers, and our job here is to summarise that conversation with due weight, not to submit our own entries in the debate.

Barnards.tar.gz (talk) 23:12, 15 October 2024 (UTC)

1) SEGM's affiliation does raise issues of WP:DUE, WP:FRINGE, and WP:INDEPENDENT

2) It said it's job was to situate the Yale report in it. It failed and presented a both-sides-ism between anti-LGBT lobbying groups and every major medical org.

3.2) The Cass Review says The research programme, led by the University of York, comprised appraisal of the published evidence and guidelines, an international survey and quantitative and qualitative research. A Clinical Expert Group (CEG) was established by the Review to help interpret the findings. The cass review repeatedly mentions this group, separately from the workshops and broader polls (see page 62-63). The red flag here is the BMJ's strawman, Yale never called for all those contributors, just the CEG, and the paper is misrepresenting who Yale is talking about. If BMJ said "how dare you ask for the CEG", that'd be a difference of opinion, them saying "you're asking for thousands of names" is nonsense.

3.3) Here, we compare the Review’s approach with one of the most widely accepted frameworks for determining evidence quality: Grading of Recommendations Assessment, Development and Evaluation (GRADE).1 and Clinical practice guidelines throughout medicine consider all relevant factors, but the Review takes the unusual step of elevating its own assessment of evidence quality above the considerations that guideline developers value. and The Review fixates on evidence quality to the exclusion of many other factors that are rigorously considered by the developers of clinical practice guidelines - Simply put, the Cass Review made recommendations for how trans kids should be treated clinically. They did the work of a CPG without the rigor is Yale's critique, and the papers defense is "it isn't officially a CPG so the unrigorous recommendations are fine".

4) Yale noted multiple false statements in the Cass Review. A paper supposedly dissecting it and defending the Cass review ignoring those is noteworthy. At a minimum, it means any attempts to downplay the false statements noted by Yale can't be done using this as some gotcha.

our job here is to summarise that conversation with due weight - a flawed paper co-authored by the head of a pro conversion therapy group attacking strawmen hardly seems due to me. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:56, 15 October 2024 (UTC)

@Barnards.tar.gz, the metadata for the BMJ article gives the date of acceptance, which is usually a good indicator that it's peer reviewed.

This source ticks all the boxes for the WP:MEDRS ideal. BTW, it looks like this would be a good moment to mention WP:MEDASSESS:

Here, "assess evidence quality" essentially means editors should determine the appropriate type of source and quality of publication. Respect the levels of evidence: Do not reject a higher-level source (e.g., a meta-analysis) in favor of a lower one (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source. Editors should not perform detailed academic peer review.

Things like whether one of the authors has been cancelled for holding a reprehensible POV, or that we think they ought to have mentioned a longer list of organizations, are not actually valid criteria according to MEDRS.

@Void if removed, have you considered a structure that is more topical? Like:

• Multiple centers: Cass recommends, and nobody cared (except maybe some non-London-based parents who will spend less time schlepping their kids halfway across the country to these appointments).
• Future research: Cass recommends, but This Group has some concerns about privacy.
• Puberty blockers: Cass discourages, and was roundly condemned by a long list, who in turn were criticized by That Group.

In other words, instead of having separate ==Findings== and ==Responses== sections, let's have multiple ==Content with responses== (sub)sections. WhatamIdoing (talk) 01:28, 16 October 2024 (UTC)

I just want to make clear that the alleged reprehensible POV is being part of an organisation that maintains the importance of exploratory psychotherapy, which the Cass Review makes explicitly clear is not conversion therapy, stating that it is harmful to conflate the two - indeed, one of the systemic failings identified was that clinicians were fearful of being accused of "conversion therapy" if they engaged in bog-standard exploratory psychotherapy, and so dumped their patients straight onto GIDS, further overloading the service. That this (IMO highly pertinent) perspective is not mentioned in the article on the subject is of course a subject of much discussion over many months. IMO, Wikipedia is not a reliable source, and the BMJ is.

As for restructuring - I think it is important to have the findings together, as they are all of a whole, and that lets the reader understand the scope and intent of the review. I think interspersing that with criticism is going to make it exceptionally hard to read what the report actually covered, especially given the interdependence of some findings and the criticism thereof. Inevitably, anything on blockers would balloon, but it overlaps with findings on desistence, mental health, social transition, reliability of international standards etc etc.

Perhaps another approach would be to keep findings as-is, have the immediate reception from the major bodies, then move implementation after reception, and have coarser implementation measures (blockers etc), along with criticism of those measures? Void if removed (talk) 08:33, 16 October 2024 (UTC)

I just want to make clear that the alleged "reprehensible POV" is the plain facts SEGM opposed bans on conversion, is known for spreading pseudoscience, has attempted to ban public healthcare for trans healthcare for all ages, and works with the conversion therapy groups like the American College of Pediatricians. RS point out SEGM is inseperable from Genspect, which has done all the same, but also operates a discord for how to put kids through conversion therapy. These are ridiculously FRINGE and trying to paint that as "they just support psychotherapy" is nonsense.

Your Sandbox link misrepresents sources and puts actual peer reviewed work next to opinion pieces from SEGM leaders and their primary sources. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:11, 16 October 2024 (UTC)

This is completely irrelevant to discussion of how to incorporate the response in the BMJ into the article on the Cass review; further attempts to argue about SEGM should be removed per WP:NOTFORUM. 212.36.63.7 (talk) 18:24, 16 October 2024 (UTC)

It’s not irrelevant, it’s interrogating a source. Being from an RS doesn’t make a source necessary reliable, and vetting sources is a fully reasonable thing for an editor to do. Snokalok (talk) 22:57, 16 October 2024 (UTC)

Interrogating a source is reasonable. Dismissing a peer-reviewed source in a top-tier medical journal by claiming it is WP:FRINGE is not though. Do you have a reason not to cite this? It seems to me to be significant and relevant, and higher quality than several other sources used on this page. Void if removed (talk) 09:42, 17 October 2024 (UTC)

Yes, all the reasons YFNS said and also the fact that responses to responses is something that I and several other editors don’t agree with for this article. The Wakefield study was peer reviewed and published in a top tier journal too, by the logic you’ve presented here that should be sufficient for inclusion. Snokalok (talk) 10:42, 17 October 2024 (UTC)

I knew someone would try the 'but Wakefield' line. I have no idea why it doesn't apply to sources like the Integrity Project or Horton which have even less standing, but which support the POV you want to push. If the BMJ has fucked up to that extent then there'll be plenty of RS coverage and an eventual retraction which we can definitely put in this page; until then, let's stick with established MEDRS rules. None of the reasons YFNS gave are remotely relevant to whether the source is reliable and due: point 1 is just irrelevant guilt-by-association; and 2-4 are an attempted debunking of the contents of the article, of no bearing here because YFNS' arguments on this talk page are not a WP:MEDRS. 212.36.63.7 (talk) 12:02, 17 October 2024 (UTC)

Horton is a poor example: A peer reviewed study published in the leading journal of trans healthcare that isn't mentioned anywhere in the article despite being cited by nearly every source criticizing the Cass Review. It is 4 times as due as the BMJ piece, and the only apparent reason for not including it is it doesn't support the POV some editors want to push :) Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:16, 17 October 2024 (UTC)

This isn’t even a research paper though, it’s an opinion piece by a freelance journalist Snokalok (talk) 11:33, 16 October 2024 (UTC)

You might be thinking of earlier investigation by Jennifer Block, the source currently under discussion is a peer-reviewed paper with five co-authors. Void if removed (talk) 12:01, 16 October 2024 (UTC)

Oh I see, my mistake Snokalok (talk) 22:54, 16 October 2024 (UTC)

I like your idea on the structure. I think that is also somewhat in line with the spirit of WP:CRITS, providing balanced treatment of each topic, rather than repeating the Cass POV in one section and all the criticism (and the criticism of that criticism etc.) in another section. -- Maddy from Celeste (WAVEDASH) 15:43, 16 October 2024 (UTC)

I also think this structure is better. Loki (talk) 15:57, 16 October 2024 (UTC)

I can't see that being a terribly useful article to the reader.

• The Cass review found x relating to puberty blockers
  • WPATH condemned this and said it was bad
  • Yale published a white paper saying it was bad
  • Someone got a letter to the editor published saying they read how the Yale paper said it was bad
  • Japanese guidelines referred to the Cass review and carried on prescribing blockers
• The Cass review found x relating to social transition
  • WPATH condemned this and said it was bad too
  • Yale published a white paper saying it was bad too
  • Someone got a letter to the editor published saying they read how the Yale paper said it was bad as well

And so on...

You can't separate these things out like that when they are all interrelated.

This is a recipe for an unreadable mess. Void if removed (talk) 16:02, 16 October 2024 (UTC)

Agree with @Void if removed. That will make it impossible to follow the Cass Review or what any of the others are saying about it. Zeno27 (talk) 17:54, 16 October 2024 (UTC)

Also agree with @Void if removed. The actual findings and recommendations of the Review should be as clear as possible to the reader, and the best way to do that is keep them separate from other content. The ongoing political and scientific discussion of those findings and recommendations should be introduced separately, where all DUE and RS sources can be included. FirstPrimeOfApophis (talk) 19:28, 16 October 2024 (UTC)

I'm cautiously optimistic towards restructuring the article. Is there a ballpark estimate for the number of subsections required if we go with the content with responses-standard? Draken Bowser (talk) 18:14, 16 October 2024 (UTC)

SEGM's affiliation does raise issues of WP:DUE, WP:FRINGE, and WP:INDEPENDENT — Yes, it raises issues of how WP:FRINGE can possibly be applied to a peer-reviewed article in the BMJ because of affiliations of one of its authors. The policy simply cannot be applied here: peer-reviewed BMJ articles on gender medicine are part of mainstream gender medicine. If anything, SEGM's founder being published in this context is evidence against the organisation more broadly being treated as FRINGE. 212.36.63.7 (talk) 15:30, 16 October 2024 (UTC)

Snokalok can you clarify why you have reverted this change https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=1251696753&oldid=1251695385? "strong dispute" needs to be based on actual WP policies to be relevant, otherwise it is just WP:STONEWALLING. Please see Barnards.tar.gz and WhatamIdoing's detailed policy-based response to the supposed "red flags" above. FirstPrimeOfApophis (talk) 17:58, 17 October 2024 (UTC)

Omg my notifs are working again!

Anyway, the complaints are numerous and reasonable.

1. responses to responses are unnecessary and UNDUE (not capitalizing this to yell, just to highlight the policy) for the article.

2. The source is not INDEPENDENT and has affiliation with a FRINGE organization that pushes conversion therapy.

3. DUE weight is also called into question by the fact that we’ve already agreed to cut much more consequential papers on the Cass Review, such as Cal Horton, for reasonable reasons.

4. Whether MEDRS even applies to criticism here is tenuous, since this isn’t an article on puberty blockers, GAC, or anything else, it’s an article on a published document - and while the material of that document is biomedically-related, ultimately the subject of the article is the document itself. The Cass Review here is not being cited as a source on puberty blockers, it’s being cited as a source on the Cass Review. This is as much of a history article as it is anything else.

There is not a consensus that these issues are sufficiently mitigated, irrelevant, or overcome. I don’t even know if there’s a majority opinion, though that is certainly still a lower bar than a consensus. Thus, we shouldn’t be including it. We wouldn’t include the Wakefield study on a relevant article without consensus either. Snokalok (talk) 18:38, 17 October 2024 (UTC)

To clarify, what I meant by strong disputing is that like half the editors on this page are against its inclusion on valid grounds. Snokalok (talk) 18:41, 17 October 2024 (UTC)

A reminder that we're talking about a living person, that WP:BLP applies to talk pages, and that "pushes conversion therapy" is a strong claim.

Do you have a source for "pushes conversion therapy" that isn't self-published and doesn't boil down to claiming "exploratory therapy is conversion therapy"? Because - I repeat - the Cass Review says it isn't. Void if removed (talk) 21:51, 17 October 2024 (UTC)

The Cass Review is only one study, and the vast majority of sources say that SEGM pushes conversion therapy. Also, SEGM is an organization, not a person, living or otherwise. Loki (talk) 23:57, 17 October 2024 (UTC)

I’m going to go through this point by point because there’s so much to unpack here.

1. BLP doesn’t apply to organizations, and the individual’s connection itself to SEGM (which is the only thing BLP would apply to here) is yet undisputed.

2. Since the point you’re disputing is whether SEGM as an organization pushes conversion therapy, let’s look at SEGM.

Copy pasted from the SEGM page

“In May, 2021, SEGM called for an amendment to the Canadian criminal code C-6, which outlawed conversion therapy, falsely claiming that conversion therapy can only be applied to lesbian, gay, and bisexual people as opposed to transgender people as well. This position is not supported by any major medical organization, which define conversion therapy as including efforts to change sexual orientation or gender identity.” Cited to Science-Based Medicine[10]

So already, we have a clear example of them pushing for anti-trans conversion therapy, regardless of specific techniques employed, to remain legal.

3. I’m also glad you agree already that SEGM pushes the specific technique of gender exploratory therapy, good, because GET is widely considered conversion therapy. Here’s a collective statement I pulled from the GET section of the conversion therapy page, by six major MEDORGS all specializing in trans care saying that GET is conversion therapy (see section 9)[11]

4. I don’t recall the Cass Report, which as I recall is not peer reviewed, ever saying such a thing. The most it said about gender exploratory therapy was that there was an unhelpful lack of clear definition for the terms “affirmative” and “exploratory” in a treatment context. But please, if I’m wrong, show me. Snokalok (talk) 07:29, 18 October 2024 (UTC)

Snokalok thanks for this.

1. responses to responses are unnecessary and UNDUE for the article.

From WP:DUE "Neutrality requires that mainspace articles and pages fairly represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in those sources. (The relative prominence of each viewpoint among Wikipedia editors or the general public is irrelevant and should not be considered.)" (my emphasis)

Neutrality is not negotiable; it is not for editors to make arbitrary decisions like "we'll include early responses but not later responses which respond to those early responses".

2. The source is not INDEPENDENT and has affiliation with a FRINGE organization that pushes conversion therapy.

One of the five authors is co-founder and senior adviser to SEGM. Is this what you are referring to? She is not the lead author or the peer reviewer. One of the authors being involved in advocacy is not sufficient conflict of interest to discard a reputable source, otherwise we would have to discard the Integrity Report white paper.

Also see WP:ALLOWEDBIAS "A neutral point of view should be achieved by balancing the bias in sources based on the weight of the opinion in reliable sources and not by excluding sources that do not conform to the editor's point of view."

Considering how badly the white paper fails WP:INDEPENDENT adding this countervailing and more reliable source is the best way to achieve NPOV.

WP:FRINGE refers to theories, not people or organisations. There are no fringe theories articulated in this source. Whatever the authors believe (or not) outside this source is not relevant to determining the validity of this source.

3. DUE weight is also called into question by the fact that we’ve already agreed to cut much more consequential papers on the Cass Review, such as Cal Horton, for reasonable reasons.

This is an argument about other sources, not this one.

4. Whether MEDRS even applies to criticism here is tenuous, since this isn’t an article on puberty blockers, GAC, or anything else, it’s an article on a published document - and while the material of that document is biomedically-related, ultimately the subject of the article is the document itself. The Cass Review here is not being cited as a source on puberty blockers, it’s being cited as a source on the Cass Review. This is as much of a history article as it is anything else.

I don't really understand this. Are you saying it should be excluded because it meets MEDRS?

There is not a consensus that these issues are sufficiently mitigated, irrelevant, or overcome. I don’t even know if there’s a majority opinion, though that is certainly still a lower bar than a consensus. Thus, we shouldn’t be including it.

Opposition to changes is only valid if it is based on genuine Wikipedia policies. See WP:JUSTDONTLIKEIT.

FirstPrimeOfApophis (talk) 07:27, 18 October 2024 (UTC)

Restructuring

Can we continue the discussion on restructuring in this section? Currently the "New Source" section has become a bit confused. FirstPrimeOfApophis (talk) 18:09, 16 October 2024 (UTC)

OK, I've tried to implement the uncontroversial parts of VoidIfRemoved's proposed structure. I haven't changed the Reception sections at all, other than move the Interim Review reception to a new section and bring all Final Review reception sections up a heading-level. No content has been added or deleted. Let me know what you think. FirstPrimeOfApophis (talk) 19:00, 16 October 2024 (UTC)

I personally don't see the need to restructure. I think the article is fine as it currently is. But I strongly oppose creating different sections for "reception" and "responses" since those things are basically the same and could mislead readers who only read one section into think that's all there is. Usr Trj (talk) 19:28, 16 October 2024 (UTC)

I agree that reception and responses as separate sections isn’t helpful to the reader. I wouldn’t mind initial vs later reception though. Snokalok (talk) 22:56, 16 October 2024 (UTC)

Thanks - I've moved more material from "background" into those sections where I think it fits better. Void if removed (talk) 09:48, 17 October 2024 (UTC)

Cal Horton Again

I propose we add Cal Horton writing in the International Journal of Transgender Health argued that the Cass review publications between January 2020 and May 2023 indicated prejudice, cisnormative bias, pathologization; and inconsistent standards of evidence.[12] to the article. Not only is it a MEDRS, it is heavily cited in reference to the Cass Review:

sample of sources referencing Horton's critique of the Review

That being said, we also acknowledge the existence of concerns that some minors may face undue pressures to change their bodies, or may do so without being adequately informed about the scope or magnitude of the potential risks, many of which are the subject of ongoing research (e.g., Cass 2024; for critiques, see Grijseels 2024; Horton 2024; Noone et al. 2024;[13] [14] Although the current commentary focuses on the biological and psychosocial evidence pre sented in the Cass Review, other issues with the Review and its process have previously been raised (Horton, 2024). This article raises a number of similar concerns discussed here, in particular inconsistent standards of evidence. However, further concerns regarding prejudice and a cis-normative bias are also examined. Although science claims to be fully impartial, it never exists in a vacuum, and the confounding factors discussed by Horton should be considered carefully when interpreting the Review.[15] The above-mentioned critiques are not new but have been highlighted in a recent nonepeer-reviewed, independently published report by Cass (2024) that has gained traction in the media. [44] Other scholars have provided lengthy and nuanced rebuttals to the Cass report. [45-48] (45 being Horton)[16] The lack of consideration for how rigorous qualitative studies are designed, combined with the aforementioned exclusion of qualitative research from the systematic reviews, and the use of single (and sometimes misrepresented; see below) quotes from participants to support much broader conclusions demonstrates a misunderstanding of qualitative evidence in the Cass Report and the valuable insights about GAC that have been generated through qualitative research (see Horton, 2023[17] Although the current commentary focuses on the biological and psychosocial evidence presented in the Cass Review, other issues with the Review and its process have previously been raised (Horton, 2024). This article raises a number of similar concerns discussed here, in particular inconsistent standards of evidence. However, further concerns regarding prejudice and a cis-normative bias are also examined. Although science claims to be fully impartial, it never exists in a vacuum, and the confounding factors discussed by Horton should be considered carefully when interpreting the Review[18] Dr Cal Horton, a research fellow in Oxford Brookes’ Centre for Diversity Policy Research and Practice, wrote an academic paper raising concerns about preliminary documents published as part of the Cass Review. In the article ‘The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children’, published in The International Journal for Transgender Health, Horton argued that the interim recommendations promoted cis-normative standards and ideals.[19]

Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:59, 17 October 2024 (UTC)

It's in a medical journal, but WP:MEDASSESS states that low-level evidence should be avoided, and I'm pretty sure thematic analysis of documents counts as low-level evidence at best. Flounder fillet (talk) 16:58, 17 October 2024 (UTC)

WP:MEDASSESS is prefixed with When writing about any health effect (bolding present in original). This is not about the health effect, this is peer reviewed scholarship on how multiple publications by an organization describe and treat a minority group, which is comparing apples to oranges. These kinds of review are actually common in trans healthcare, such as this recent systematic review finding pathologizing language and cisgenderism to be fairly frequent across multiple sources.[20] WP:MEDRS explicitly carves out the exception News sources may be useful for non-biomedical content, such as information about "society and culture" – see WP:MEDPOP.) - if news sources can be used for such content, academic RS definitely can. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:21, 17 October 2024 (UTC)

It is perhaps worth noting that the health effect link at WP:MEDRS goes to WP:BMI, not health effect. Also this isn't an exception, "society and culture" is WP:NOTBMI, same with medical ethics. Flounder fillet (talk) 20:49, 17 October 2024 (UTC)

Your Friendly Neighborhood Sociologist ⚧ Ⓐ It doesn't seem unreasonable to me, if that is really the wording you are going to use and you aren't going to do something unusual (like put it in the lead). But wasn't this discussed previously here https://en.wikipedia.org/wiki/Talk:Cass_Review/Archive_3#Cal_Horton? What do you believe has changed since then? FirstPrimeOfApophis (talk) 17:37, 17 October 2024 (UTC)

I presume it's just been cited more since then in other RS. LunaHasArrived (talk) 18:36, 17 October 2024 (UTC)

I don't think anything's changed since then. It is a response to the interim review. It happens to have been cited a couple of times since then, by better sources which are already cited in this article because they are addressed at the Cass Review itself and are more pertinent, so I don't see what it adds. Void if removed (talk) 21:43, 17 October 2024 (UTC)