Commentary on Political Economy

Friday 12 April 2024


Helpful Transgender Lessons From Europe


(4 min)

A person walks on a pedestrian crossing decorated with the pattern of the transgender flag on a street, London, April 10. Photo: isabel infantes/Reuters

American progressives love to say the United States should be more like Europe, and for once we agree. European countries are making important progress in one of the most divisive culture-war issues of the day—sex and gender—in ways that are a model for America.

The latest example is the Cass Review published in the United Kingdom this week. The National Health Service commissioned prominent pediatrician Hilary Cass in 2020 to study the NHS’s treatment of young people experiencing discomfort with their biological sex. The final result is a rebuke to the gender-industrial complex.

Gender medicine is “an area of remarkably weak evidence,” the report says. Treatment guidelines developed by the World Professional Association of Transgender Healthcare have become highly influential but “lack developmental rigor,” according to a study Dr. Cass commissioned from the University of York. The Cass Review finds no evidence that puberty-blocking hormones offer young people “time to think” about their gender identity and finds these interventions may distort a young person’s developing gender identity.

The inquiry was prompted in part by scandals at the Tavistock clinic, which had been England’s main treatment center for young people reporting discomfort with their biological sex. Worried clinicians reported that children were prescribed drastic treatments such as puberty-blocking hormones after cursory examinations; that the clinic wasn’t tracking longer-term outcomes; and that it was transitioning young people who may have been uncomfortable identifying as gay or lesbian.

Dr. Cass’s interim report, released in 2022, led the NHS to shut down the clinic. The U.K. instead will direct gender-dysphoric young people to centers adopting a holistic approach to mental-health concerns—which, the Cass reports note, often include forms of autism, depression, complex emotional trauma and other challenges. Dr. Cass’s final report finds it hard to separate the startling increase in trans-identifying children in recent years from the rise of social media, online pornography and other factors that can weigh on young people’s mental health.

The Cass Review shifts the trans debate back to medicine and science. Most attention is focused on its restrictions on puberty-blocking hormones, which the NHS will offer only in the context of true medical studies. In this way the U.K. follows the lead of such European countries as Sweden and Norway that have scaled back the availability of these drugs and are insisting on more comprehensive research into their effects before they can be widely prescribed again—if they ever will be.

Some in the U.S. are contrasting Europe’s approach to conservative states that have imposed bans on unproven gender treatments. It’s more accurate to say the medical profession in Europe is demonstrating humility about what it knows about youth and gender, so politicians and voters can have greater faith that doctors won’t abuse the leeway new rules offer for research. Can one say the same about America’s highest-profile medical associations, which are dominated by political conformity?

Europe’s emerging détente in the gender wars is based on compassion for distressed children and families and genuine scientific rigor concerning how best to help them. Maybe one day the U.S. will achieve a similar armistice.


As protests erupted outside a Glendale, Calif., school board meeting discussing LGBTQ+ issues in the classroom on June 6, 2023, opponents highlighted their concerns about teachers discussing sexual orientation and gender identity with children. Images: The Orange County Register via AP/Zuma Press Composite: Mark Kelly

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