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Revision as of 23:22, 2 January 2025 editYour Friendly Neighborhood Sociologist (talk | contribs)Extended confirmed users3,973 edits →ILGA, Transgender Europe, and IGLYO Joint Statement: ReplyTag: Reply← Previous edit Revision as of 23:26, 2 January 2025 edit undoYour Friendly Neighborhood Sociologist (talk | contribs)Extended confirmed users3,973 edits →ILGA, Transgender Europe, and IGLYO Joint Statement: ReplyTag: ReplyNext edit →
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:Clearly due. The source is appropriate as per ] and ], since ILGA is a well-recognized expert group and because the statement concerns the source itself. :Clearly due. The source is appropriate as per ] and ], since ILGA is a well-recognized expert group and because the statement concerns the source itself.
:The revert was unwarranted and the content should be reintroduced. ] (]) 23:12, 2 January 2025 (UTC) :The revert was unwarranted and the content should be reintroduced. ] (]) 23:12, 2 January 2025 (UTC)
::@] I don't have the energy for this. Consensus is against you, you aren't convincing anybody, please self-revert so this can be dropped. Best, ] (]) 23:26, 2 January 2025 (UTC)

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Section sizes
Section size for Cass Review (37 sections)
Section name Byte
count		 Section
total
(Top) 8,091 8,091
Background 15,442 15,442
Methodology 14,671 14,671
Interim report 8,346 8,346
Final report 493 26,573
Findings 16 13,656
Lack of research 1,361 1,361
Increase in referrals 1,482 1,482
Social transition 2,307 2,307
Puberty blockers 1,743 1,743
Hormone therapy 1,507 1,507
Psychosocial intervention 721 721
Clinical pathways 1,575 1,575
International guidelines 908 908
Conflicting clinical views 2,036 2,036
Recommendations 5,625 5,625
Implementation 6,799 6,799
Reception 16 60,435
Response from UK political parties and public bodies 6,321 6,321
Response from devolved governments 7,661 7,661
Response from health bodies in the United Kingdom 10,659 10,659
Response from other health bodies globally 5,125 5,125
Response from transgender specialist medical bodies 4,869 4,869
Other academic responses 10,522 10,522
Reception by charities, unions and human rights organisations 5,215 5,215
Reception by gender-critical organisations 1,242 1,242
Hilary Cass's response 8,805 8,805
Subsequent government actions in the UK 45 15,729
Ban on private prescription of puberty blockers 5,834 5,834
Adult clinics 6,830 6,830
NHS Scotland 1,733 1,733
Department for Education 1,287 1,287
See also 335 335
References 29 940
Works cited 911 911
Endnotes 30 30
External links 557 557
Total 151,149 151,149

sources for consideration

See Also

@Snokalok and @Raladic You have added and reinstated a link to the page 21st-century anti-trans movement in the United Kingdom which you have been busily creating for the past few weeks.

That page has a somewhat inflammatory title to suggest an association with the Cass Review.

It also is justified by you because it contains the following:

In 2024, the publication of the controversial Cass Review of youth gender services led to a criminal ban on puberty blockers, and a general shift in NHS policy towards gender exploratory therapy, which many experts say is a form of conversion therapy. The review's recommendations were generally welcomed by the British medical community, however the international medical and academic communities generally criticised or rejected the review on grounds of both methodology and findings.

Which of course is not a reflection of the language on this page. I suggest this material is a WP:POVFORK and the relation to this page tenuous at best, especially the weasel-worded material on conversion therapy, which is itself flatly contradicted by the Cass Review. Void if removed (talk) 18:18, 4 December 2024 (UTC)

Please remember that Misplaced Pages is WP:NOTCENSORED and while you may take personal issue with the topic, it is a well sourced and neutral article that summarizes the anti-trans movement in the United Kingdom.
The article discusses the Cass Review in context, in fact it is mentioned 18 times in the article, so it is entirely appropriate as a related article link. Raladic (talk) 18:22, 4 December 2024 (UTC)
It’s a highly controversial government report that was used to justify a ban on puberty blockers and the mainstreaming of GET, which is widely recognized but everyone but the Cass Review as a form of conversion therapy. How is that not highly relevant to a major sociopolitical movement which has for a long time made both of those goals a centerpiece of itself? Snokalok (talk) 18:54, 4 December 2024 (UTC)
I don't think your repeated comments about GET are helpful.
In the final report, I find this:
"Terms such as ‘affirmative’ and ‘exploratory’ approaches have been weaponised to the extent that it is difficult to find any neutral terminology... 11.6 The intent of psychological intervention is not to change the person’s perception of who they are but to work with them to explore their concerns and experiences and help alleviate their distress, regardless of whether they pursue a medical pathway or not. It is harmful to equate this approach to conversion therapy as it may prevent young people from getting the emotional support they deserve."
It sounds like the twin goals are:
  • "not to change the person’s perception of who they are" – which means not conversion therapy – and also
  • "explore their concerns and experiences and help alleviate their distress".
Do you have a preferred term for this combination of not trying to change people's identities while still letting them have what one GIDS specialist calls "an open space for exploration of what this means to the individual, and what support they need in order to live a happy and fulfilled life"? The GIDS staff said they considered this to be compatible with the affirmative model, which they described in the report as "respecting the young person’s experience and sense of self whilst still exploring the meaning of that experience in a non-directive therapeutic relationship". Do you believe that this is a non-affirming approach? I could imagine someone (e.g., on social media) agreeing that this is actually an affirming approach, and agreeing that it is literally the approach recommended by the final report, but worrying that there will be a bait-and-switch scam: The Cass report might say not to change the clients' identities, but all of us smart people know that means exactly the opposite. WhatamIdoing (talk) 08:23, 5 December 2024 (UTC)
This goes back to the points I made here and the continual refusal to actually balance that material with the Cass Review over the past year. Unpicking this is hard, because it means an assessment of both the included and excluded sources over there. Which I did. But I am in a minority, and so this will keep spilling over onto this page.
Eg. Clayton et al (2024) says:
In contrast, Cass notes that alongside biological factors, psychosocial circumstances (such as trauma, homophobia, social influence) and mental health conditions might contribute to the development of youth GD/GI, rather than just being secondary or coincidental. Under the Cass model, the multidisciplinary assessment is geared towards identifying elements in these various domains relevant to the individual patient’s GD/GI. Cass notes the critical importance of a formulation to inform an individualized management approach which is developed by a collaborative process considering patient values, clinical expertise, and research evidence.4 In this model, GD/GI may well resolve with maturity, treatment of any co-existing psychiatric conditions, and/or supportive psychosocial care or psychotherapy – such as trauma-informed therapy or family therapy as indicated for each individual case. Importantly, this type of therapy does not aim to ‘change someone’s identity’ but validates a young person’s experience while opening space for self-reflection about their experiences and help with alleviating distress. This is not conversion therapy.
This could scarcely be clearer. However, since all three authors are associated with SEGM, and since editors have already decided SEGM are really espousing "conversion therapy" and are therefore fringe, the chances of my successfully citing this over such objections is nil, as with the arguments against the various BMJ sources that have been excluded from this page. Ie, it does not matter that this is a high quality peer-reviewed source, saying explicitly that it isn't conversion therapy, editors seem to already know it is (largely based on the current state of Gender exploratory therapy and SEGM), and that these authors can't be trusted, and thus it is excluded.
Likewise, Roberto D'Angelo, president of SEGM, writing in September:
Further, the current dominant understanding of trans identification in young people entails a very specific way of formulating (I would argue distorting) psychological distress, described in The Cass Review as “diagnostic overshadowing”. In effect, what this means is that any suffering, manifesting as anxiety, depression, eating disorders, etc, is subsumed under the diagnosis of gender dysphoria or “massive gender trauma”. This reconfiguration effectively trivialises and even erases these problems and their meaning, viewing them as secondary phenomena that will evaporate once gender transition has occurred. This clinical process reshapes psychic pain, which is difficult for both patient and analyst to bear, into a concrete problem with a concrete solution. Those who raise concerns about the quality of the evidence base for this concrete solution present a threat to this defensive phenomenon and are attacked with the same ferocity encountered when a patient becomes aware of dissociated material or “not-me” states. The net effect is that both analyst and patient can avoid and deny the psychic pain that is “humming” beneath the experience of gender dysphoria, maintaining a powerful prohibition on knowing.
Again, these are by my reading legitimate perspectives expressed in respectable, peer-reviewed journals. But if you start from the position that it is conversion therapy and cannot be legitimate (and is therefore fringe) then it creates a self-perpetuating cycle where no balancing sources are ever acceptable, because by saying the "wrong" thing they are fringe, something that has been applied even to sources as weighty as the Cass Review. It is WP:EXTRAORDINARY to claim the Cass Review espouses conversion therapy.
Do you have a preferred term
There is no preferred term. There cannot be one. The split is between the affirmative model, and anything else. If it isn't the affirmative model, then it is considered de facto conversion, and any labelling is mere obfuscation, is the reasoning. Exploratory therapy, gender exploratory model, psychotherapy, psychoanalysis, psychodynamic psychotherapy, ethical exploratory therapy, non-directed exploration - these have all been used and every single one has been collapsed into "conversion therapy". Cass drew attention to this as part of the reason GIDS was overwhelmed and failed - because clinicians didn't want to risk engaging in bog standard psychotherapy themselves and just dumped patients to GIDS. Void if removed (talk) 09:52, 5 December 2024 (UTC)
Diagnostic overshadowing could use some work. I wonder if the outrageous experience some trans people have reported, of having a provider ask to look at their genitals when they have a broken ankle, could be a case of this.
I suspect that it's mostly meant to cover cases of "He's screaming again so that's just his Level 3 Autism, not a sign of physical pain", but I haven't looked for sources that would show how narrow or wide it's usually understood. WhatamIdoing (talk) 17:29, 5 December 2024 (UTC)
Well quite, and in the context of the Cass Review the refusal of the adult clinics to provide follow-up information makes much of this unfortunately poorly understood. The outcome data is so poor it's hard to say with certainty. Void if removed (talk) 20:56, 5 December 2024 (UTC)
Ok, but regardless of what SEGM may or may not be saying on this particular subject, they are still a fringe group that hold scientifically unsupported positions, so they & those closely affiliated with them should not be cited as reliable sources for medical/scientific topics. Butterscotch Beluga (talk) 20:35, 5 December 2024 (UTC)
@Butterscotch Beluga, can you point me to the policy or guideline that says if someone holds a fringe position that nothing they write, and nothing written by anyone closely affiliated with them, can be cited as reliable sources for medical/scientific topics?
If you are looking for an example from another field, Linus Pauling won a Nobel for chemistry, and part of that work developed into proving that Sickle cell disease is genetic. He also advocated for fringe-y positions on Vitamin C megadosage. Now, according to what you've said, there's a policy or guideline that says Pauling can't be cited "for medical/scientific topics". Which policy or guideline is it, and what's the exact wording in it? WhatamIdoing (talk) 20:52, 5 December 2024 (UTC)
I feel that's a poor example.
Linus Pauling has some ideas that are very well accepted, and others which have been dismissed as quackery. Same with other semi-quacks such as John Ioannidis.
I think if multiple folks state that Linus Pauling's views on medical info post 1960 is inflammatory, his statements should be given attribution, alongside the appropriate criticism. If he is well respected in electrochemistry, and pre1960-ish, it would be undue not to include him.
We can include SEGM as long as we attribute to them, and if there is sufficient criticism, we provide the WP:DUE amount of context around them. Bluethricecreamman (talk) 21:06, 5 December 2024 (UTC)
That's not what Butterscotch Beluga was saying. WhatamIdoing (talk) 21:36, 5 December 2024 (UTC)
That actually was what I was saying. When I said "for medical/scientific topics", I did indeed mean in the context that they are considered fringe.
This I hope properly conveys why I don't think those who are members/have close relations with SEGM are reputable, nor should their positions related to SEGM's subjects of advocacy carry much weight. Butterscotch Beluga (talk) 22:00, 5 December 2024 (UTC)
I wonder occasionally if it would be worth setting up a section similar to the Talk:Donald Trump#Current consensus section (which, in general, I think is a terrible idea), in which we record some things that we all agree on, e.g., that citing something written by an SEGM-tainted person does not automatically violate any policy or guideline, or that the Integrity Project's paper is not peer-reviewed, or whatever little facts we've discussed more than once or twice.
Butterscotch Beluga, I don't really care why you/we/anyone consider them disreputable. What I care about is whether Misplaced Pages editors post non-existent, made-up rules, which are then read and sincerely believed to be The Truth™ by less experienced editors. If you write something like "The policy says SEGM can't be cited for medical/scientific topics", then even if most of us know that this is just a quick thing, to get the general gist across, someone is eventually going to read that and believe that there is an actual WP:Policy that actually says this. This is a consequence of our method of teaching Misplaced Pages's rules, which is basically the telephone game. That's not your fault, but it is something you can help with. So I ask: Please (everyone), be careful about what you describe as being required or prohibited by policies and guidelines. It'll save everyone a lot of hassle and drama in the end. WhatamIdoing (talk) 22:33, 5 December 2024 (UTC)
I didn't say "The policy says SEGM can't be cited for medical/scientific topics" & as such, I'm not sure why you're putting it in quotes.
I'm saying that if someone works with a group with controversial views on conversion therapy, we shouldn't cite them uncritically on what is/isn't conversion therapy. Butterscotch Beluga (talk) 00:30, 6 December 2024 (UTC)
Right. Your exact words above were they & those closely affiliated with them should not be cited as reliable sources for medical/scientific topics.
Quotation marks in English have multiple uses; marking exact quotations of prior speech is only one of the multiple uses. WhatamIdoing (talk) 00:44, 6 December 2024 (UTC)
Ok. Personally, I don't like using quotation marks if I'm not quoting someone/something specifically, as it may lead to miscommunication, but that's neither here nor there. Butterscotch Beluga (talk) 00:47, 6 December 2024 (UTC)
This is a non-independent source, engaged in legal action in the US in opposition to SEGM so should be taken with a pinch of salt, especially in light of this peer-reviewed critique of the Yale team in the BMJ.
Which has of course been discussed here previously, and been derailed - again - by one of the co-author's relation to SEGM, never mind that the others are not.
The problem here is that on the balance of sources, we have a difference of opinion.
But if you start from the position of SEGM are fringe, that balancing of sources never happens. Void if removed (talk) 22:33, 5 December 2024 (UTC)
This might seem like a tangential response, but I'm looking at the BMJ critique you linked & was wondering if you could help clarify something for me.
It says "Various versions of McNamara et al have already been introduced into evidence in at least two high-profile court cases", but despite the two citations they supply, I'm having issues finding any mention of McNamara in either case.
Citation 16's google scholar link only finds the original BMJ critique & citation 17 does link to a case (Specifically this), but I don't see where McNamara et al is being used as evidence.
I'm probably just misunderstanding how google scholar works/am missing something obvious, but I wanted to check if you knew what the issue I'm having is. Butterscotch Beluga (talk) 23:56, 5 December 2024 (UTC)
Google Scholar does not track documents in lawsuits. Try searching a specialist website like this one: https://www.courtlistener.com/docket/63252064/eknes-tucker-v-marshall/?page=4 Or just try your favorite web search engine.
The SCOTUS case documents are here: https://www.supremecourt.gov/search.aspx?filename=/docket/docketfiles/html/public/23-477.html WhatamIdoing (talk) 00:52, 6 December 2024 (UTC)
RE: the first, the Yale critique of the Cass Review was filed as an amicus brief in Boe vs Marshall the day it came out, you can read it here: https://storage.courtlistener.com/recap/gov.uscourts.almd.77755/gov.uscourts.almd.77755.629.7.pdf
From here:
https://www.courtlistener.com/docket/63252064/boe-v-marshall/?page=4 Void if removed (talk) 16:25, 6 December 2024 (UTC)
I don't think this statement actually shows that GET isn't conversion therapy. Having read the article in sandbox as well, I'm even more suspicious of this approach. All the talk of meaningmaking and finding a formulation suggests a process of looking to attribute transness to underlying psychological conditions. Once such "meanings"/conditions have been identified, the therapist is obliged to treat them per oath. Whether they intend to or not, this then becomes an attempt to treat transness itself – the transness becomes a medical problem to fix – and is thus conversion therapy.
The name is also a giveaway of intentions. Gender exploratory therapy isn't neutral, and isn't simply exploration and investigation; it means starting from the position of assuming a need to treat. The treatment begins before the rationale has even been developed, and you just make up the rationale (sorry, "find the formulation") as you go along. And this "psychological intervention" is also mandated before you can access anything else.
But all this aside (I know, I know, Misplaced Pages is WP:NOTAFORUM), most experts internationally do see GET as conversion therapy. As did many UK experts until recently. We aren't bound to enforce UK policy changes or new report findings, only the consensus among experts. And WP:SPOV trumps government reviews. If the UK and a couple of other countries are outliers, then they naturally represent a minority viewpoint and not the consensus, and should be presented as such. Lewisguile (talk) 10:26, 20 December 2024 (UTC)
SPOV is a {{failed proposal}}, and NPOV says that the views of Misplaced Pages editors – including whether Misplaced Pages editors deem a particular POV to be "scientific" – are irrelevant. WhatamIdoing (talk) 22:57, 20 December 2024 (UTC)
You ignored the bit about most international experts disagreeing with the UK view. The UK is therefore an outlier. Lewisguile (talk) 13:02, 21 December 2024 (UTC)
I responded only to your claim that And WP:SPOV trumps government reviews.
I wonder, though, whether it's really appropriate to talk about "international experts". WPATH claims to represent/serve the world, but much of the world (e.g., developing countries) is not especially interested in its views. We're kind of in a position of having UK+Norway+Sweden vs US+AU+NZ+some others vs a majority of countries that explicitly prohibit transition or have no legal provision for it. "The international consensus", if you determine this by population or the number of countries, is that trans people get no medical care and have no legal rights. Perhaps we should talk about "the scholarly consensus"? WhatamIdoing (talk) 19:40, 21 December 2024 (UTC)
We can call it that if you'd like. "International expert consensus" might be the best framing, but we're splitting hairs. Lewisguile (talk) 20:13, 21 December 2024 (UTC)
What's the difference between an "international expert" and an "Australian expert"? WhatamIdoing (talk) 22:44, 21 December 2024 (UTC)
I'm not sure this is a fruitful line of discussion, TBH. With all the good faith I can muster, I have still found most your responses a combination of pedantic, sometimes a little combative and often baffling. I'm often not sure what you're trying to say or why. I feel like there's no way to engage constructively with them at present but I don't want to ignore you completely, because it seems you are trying to say something useful. It's entirely possible I'm just not understanding your response style or what you're trying to convey, but that's as good a sign as any to leave this line of thought well enough alone. Thanks anyway. Lewisguile (talk) 08:57, 22 December 2024 (UTC)
I'm also finding some of this confusing, which is why I'm asking questions.
AFAICT the answer to my question is that if the source agrees with the True™ POV, then they're an international expert, but if the source disagrees with the True™ POV, then that's only a country-level expert (at best). So if an Australian expert writes something that aligns with their country's approach, then they're an "international" expert, but if a Norwegian or Swedish expert writes something that aligns with their country's approach, then they're not. Right?
If so, then maybe we should say "WPATH's SOC-8" instead of "international expert consensus". It would be more specific and more neutral, as well as preventing confusion about why the "international" consensus is rejected by a majority of countries. WhatamIdoing (talk) 06:50, 23 December 2024 (UTC)
The international consensus is the medical opinion of the big international organizations in this area of medicine, namely WPATH and the Endocrine Society. It's true that there are specific experts and even sometimes whole national health organizations that contradict them, but in order to be the international consensus, they would have to either get WPATH and the ES to agree with them, or make an organization that was as big and influential in the area as WPATH and the ES are. Loki (talk) 03:58, 25 December 2024 (UTC)
Which is to say that the "international consensus" is "the agreement of two US-based organizations". I think we should consider being more specific (e.g., "Cass rejected the treatment protocols from WPATH and Endocrine Society, which are the most widely used in the world").
"International" in medicine usually means a UN agency, especially the World Health Organization. When describing a protocol that is widely used around the world (e.g., the CHOP-R chemo protocol), nobody bothers to call it an "international" protocol; it would feel weird – like your science is so weak that you need to slap on some peacock words for marketing purposes. WhatamIdoing (talk) 17:41, 25 December 2024 (UTC)
The UN is also US-based, though. Its headquarters are in New York.
More to the point, it's true that the US has an outsize amount of influence in many international organizations. But that doesn't make them not international. WPATH and the Endocrine Society are both very clearly international organizations according to all sources on them and your attempts to argue against that sound frankly like WP:IDONTLIKEIT to me. Loki (talk) 03:48, 26 December 2024 (UTC)
The UN isn't US-based, though its main headquarters are there. The UN was founded by multiple countries working together.
The WPATH article, on the other hand, says "The founding committee was entirely American...", and it looks like most of the past presidents were from the US. WhatamIdoing (talk) 04:07, 26 December 2024 (UTC)
So? Again, it's true that the US has an outsize amount of influence in many international organizations, but that doesn't make them American organizations. NATO was established in America and has been very clearly dominated by the US throughout its history, and yet it's clearly an international organization. And WPATH isn't even nearly so American-dominated as that.
This whole argument feels like a clear no true Scotsman to me: no true highly respected international WP:MEDORG would take such a strong stance on one side, therefore WPATH must be fake or illegitimate for some reason. Loki (talk) 02:04, 27 December 2024 (UTC)
Both NATO and its predecessor were formed by a treaty, which means that NATO was inherently an international project from the beginning.
Highly respected international MEDORGs do (and IMO should) take strong stances. What feels "off" to me is that we have two US-dominated orgs that Misplaced Pages editors have repeatedly presented not as being "right" (or equivalents, e.g., "evidence-based"), but instead as "the international consensus", which is abnormal for a MEDORG. Compare some other, once-contentious claims:
  • Measles vaccines do not cause autism.
  • The CHOP-R chemotherapy regimen is widely used because it has the same survival rate but lower side effects than the alternatives.
  • Antibiotics do not cure viral infections.
  • Screening mammograms are inappropriate for women whose expected lifespan is short (<10 years).
  • Breast self-exams don't save lives.
  • HIV causes AIDS, but Undetectable = Untransmittable.
But:
  • There's an international consensus that (some) trans kids should be eligible for hormone treatment before the age of 18.
Which leads one to wonder: How many other consensuses are out there, and do all of them disagree?
In the other examples, we don't need to prepend "There's an international consensus that...", because it's just facts, and everyone (i.e., every expert) around the world knows and agrees with these facts. So why is that necessary here? From where I'm sitting, it certainly sounds like it's because the "international consensus" isn't as widely agreed-upon as these other things. WhatamIdoing (talk) 04:52, 27 December 2024 (UTC)
The York review on international guidelines says that the majority of such guidelines are based on those by WPATH and the Endocrine Society. It does describe differences on specifics, but it also says, Overall, guidelines describe a care pathway similar to the original Dutch protocol that involves psychosocial care for prepubertal children followed by hormonal interventions for adolescents who meet specific criteria, provided by a specialist multidisciplinary team. This approach continues to dominate clinical guidance despite lack of high-quality evidence regarding treatments, or exploring alternative care models. Earlier it says, All but one of these promote a model of gender-affirming healthcare, which seems quite clear to me.
Their own conclusion was Published guidance describes a similar care pathway; however, there is no current consensus about the purpose and process of assessment for children or adolescents with gender dysphoria/incongruence, or about when psychological or hormonal interventions should be offered and on what basis. So the lack of consensus, per York, is in regards to the assessment process and when and why to offer interventions, not in the interventions themselves (the overall "pathway" is described as being broadly similar several times). From this, we can derive the following:
  • Most GLs internationally are based on WPATH and/or the Endocrine Society
  • All but one of the GLs advocate a "gender-affirming" model
  • Most GLs describe the same or a similar pathway
  • GLs differ on the specifics of when and why interventions are given (which isn't the same as saying they differ on which interventions are given)
  • GLs differ on the specifics of why assessment is conducted
Therefore, it's fair to say there's a consensus for gender-affirming care based broadly on the Dutch model, but that variations and rationales differ in key areas. The Cass Review, also drawing on the e-survey on service delivery, concludes that Most national and regional guidelines have been influenced by the World Professional Association for Transgender Health and Endocrine Society guidelines which themselves lack developmental rigour and are linked through co-sponsorship. There is consensus across guidelines that those requiring specialist gender care should receive a multi-disciplinary assessment, although there is a lack of clarity about who should be involved in this and any differences in assessment for children and adolescents. Similarly, there is consensus that children and adolescents should be offered psychosocial support, but there is limited guidance about the process or approach for this and different recommendations about whether specialist gender clinics or mental health services should provide this. There are differing recommendations about when and on what basis psychological and hormone interventions should be offered, and limited guidance about pre-pubertal children or those with a non-binary gender identity. Cass isn't saying there isn't any agreement, but that there is divergence on key specifics, as per the York review; that the evidence base for them isn't robust enough; and that service delivery models are different in different places (unsurprisingly). WPATH, of course, disputes that its guidelines are unreliable (as do other orgs) as per the current "Responses" section. When we separate out the service delivery elements (which is driven by budget, politics, local need, etc, and isn't necessarily defined by treatment guidelines but rather by the operationalisation of them), Cass is simply reiterating the York review on international guidelines (as we'd expect). So my summary above stands here too. Lewisguile (talk) 07:45, 27 December 2024 (UTC)
The York review covers international, national, and regional guidelines. It cites a 2021 paper that defines "international guideline" as a guideline intended to apply across multiple nations (most commonly, the EU or globally). They found 12 such international guidelines (Table 1): the 2017 Endocrine Society guideline, WPATH's SOC-7, a speech/language guideline based on SOC-7, and nine others that weren't based on either of the two big US-based groups, several of which are only partially about gender care, but some of which are highly relevant for the subject of the Cass Review (e.g., "Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents"). Some of these criticize ES and WPATH (e.g., based on "limited" evidence or being out of date), though I haven't noticed any that fully reject either. WhatamIdoing (talk) 21:15, 27 December 2024 (UTC)
Let me rephrase. Void if removed referred to the York review as the "York review on international guidelines" and I was using the same language. We were both referring (I think) to the overall findings of the "York review on guidelines"; in my case, I used "international" to mean "not UK"/"beyond UK", rather than specifically "GLs intended to apply across multiple countries". Cass' synthesis/conclusions seem to draw from across these GLs, without distinction for whether they're regional, national, etc. She makes her conclusions based on broad similarities and specific differences across the entirety of all the GLs, so that's what I've done too. Lewisguile (talk) 08:09, 28 December 2024 (UTC)
The York review of international guidelines tells us there is no international consensus. Void if removed (talk) 21:30, 26 December 2024 (UTC)
Where in the York review on guidelines does it mention conversion therapies? I didn't spot that on my recent re-read, so a page reference would help. Re: guidelines, it finds lack of clarity in specifics but says most guidelines are based on the same two guidelines (WPATH and Endocrine Society). Consensus is therefore largely around following the WPATH and Endocrine Society GLs, but obviously there is greater divergence thereafter. It also says:
  • "Guidelines describe a similar care pathway starting with psychosocial care for prepubertal children, puberty suppressants followed by hormones for eligible adolescents and surgical interventions as these adolescents enter adulthood."
  • "In general, there is consensus that adolescents should receive a multidisciplinary assessment, although clear guidance about the purpose or approach is lacking. There are differing recommendations about when and on what basis psychological and medical interventions should be offered. There is limited guidance about what psychological care should be provided, about the management of prepubertal children or those with a non-binary gender identity, nor about pathways between specialist gender services and other providers."
  • "Two guidelines explicitly adopt the Dutch model (the earliest paediatric treatment protocol), and most guidelines reflect this pathway. One of these, however, recommends that medical interventions occur under a research framework and modifies the original criteria for treatment. Four guidelines propose an individualised approach to medical interventions, while still describing a phased approach"
  • "All but one of these promote a model of gender-affirming healthcare and indicate that those with 'a stable gender identity' and 'supportive family and school environment' may not require psychosocial care. This recommendation marks a departure from earlier guidelines which describe psychosocial care as the mainstay of treatment, and the recent Finnish and Swedish guidelines which describe it as first-line treatment for childhood gender dysphoria/incongruence."
  • "Overall, guidelines describe a care pathway similar to the original Dutch protocol that involves psychosocial care for prepubertal children followed by hormonal interventions for adolescents who meet specific criteria, provided by a specialist multidisciplinary team. This approach continues to dominate clinical guidance despite lack of high-quality evidence regarding treatments, or exploring alternative care models" (So this last part is what I would say the consensus is beyond Cass. Recognising divergence from consensus doesn't negate consensus, and in some regards, the differences can be seen as matters of clinical judgement or service priority.)
Lewisguile (talk) 21:53, 26 December 2024 (UTC)
What you're doing there is recounting the POV of those who say exploratory psychotherapy is conversion therapy. This is of course one POV, and one which needs to be fairly represented in relevant articles.
But it is not the only POV, nor is it the only POV present in MEDRS, which are much more equivocal on this, nor is it a POV that can be taken as definitive and used to judge the validity of different POVs in MEDRS. Indeed, the most definitive statement in a high quality source comes from the Cass Review, explicitly stating that it is not conversion therapy, and that it is harmful to suggest it is.
As Cass said in a recent interview:
There are individuals who are saying that therapists who just take that careful, exploratory approach with a young person are conversion therapists, and that’s why it becomes so difficult, because then those therapists working in that space who are getting attacked become fearful Void if removed (talk) 13:44, 21 December 2024 (UTC)
The way to deal with this is not to look at only one source (e.g., the Cass Review), but to look at the breadth of sources in English and what the consensus among them seems to be. On the matter of whether "exploratory psychotherapy" (which doesn't seem to be a clinically defined term, as far as I can tell) is conversion therapy or not, it would be useful to consult what experts on trans health and conversion therapy say, and if there's any consensus between them? If there isn't, then we try to portray the major disputes. We certainly shouldn't ignore any major differences of opinion to push only one side, whether that's solely the view of the Cass Review or solely the view of anyone else.
If exploratory psychotherapy isn't well defined, then we may run into a problem there, too. But we can deal with that bridge when we come to it. Lewisguile (talk) 09:02, 22 December 2024 (UTC)
Another way would be to conduct a systematic review of international guidelines to determine what the consensus was on the appropriate psychotherapeutic interventions, at what point, to what end, what outcomes are expected etc. Which of course the Cass Review did, and found there to be no international consensus.
I think you might be mistaking strongly-expressed positions for international consensus.
As an aside, it is worth reviewing the recent Italian National Bioethics Committee position (Italian, but machine translation is good). What is fascinating (to me at least) about this is that despite a near-unanimous statement in accordance with the findings of the Cass Review signed by numerous clinical experts, after a year of taking evidence, resulting in advice to restrict puberty blockers to a clinicial trial context, almost half of this publication (9 pages) is given over to the opinions of a single dissenter and a single abstainer.
In this thread you have very effectively put forward broadly the same position as the dissenting voice. That's fine, these are valid (and in some contexts majority) positions, and should be fairly represented. But they are not the only POV, and in some contexts they are outliers.
Navigating this neutrally is hard, when there is genuine dispute in MEDRS and widely varying expert opinion - and when the center of gravity for the strongest opinions is the US, and deeply enmeshed in US politics and legal struggles, that makes it even harder. But I'm afraid there simply is no international medical consensus that we can all straightforwardly defer to on any of these matters, the most comprehensive evidence-based independent review in this area is still the Cass Review, and the claims that the Cass Review espouses conversion therapy are WP:EXTRAORDINARY. Void if removed (talk) 12:15, 22 December 2024 (UTC)
The Cass Review is also just one source. Consensus is determined based on representing the balance of all major viewpoints, including those which dissent. So the Cass Review's conclusions are Cass' opinions based on systematic reviews, stakeholder consultation, grey literature, etc'.' The tools at her disposal may have been better than most (or even all) alternatives, but she still had to interpret that evidence to make her own conclusions from those tools. Which is why we still consider it one source among many. It can be appropriately weighted, but it isn't the be-all and end-all on the matter. It's about as useful and authoritative as a NICE guideline or Cochrane review, but unlike them, is significantly less transparent and vests decision-making in a single individual rather than a committee.Lewisguile (talk) 19:06, 22 December 2024 (UTC)
If this were an article about medical care for trans people in general, I would agree with you, but since this is an article about a document, then the due weight calculation is a bit different. It's not just "one source among many"; it is "the subject of the article". WhatamIdoing (talk) 06:52, 23 December 2024 (UTC)
If the article is indeed a WP:POVFORK of something you should propose merging or nominate it for deletion instead of removing links. Flounder fillet (talk) 18:16, 5 December 2024 (UTC)
I think it's unrelated, inflammatory, and adds nothing to this page. It shouldn't be in see also. I the idea that I cannot simply say the link shouldn't be there, but must instead be drawn into wider content arguments about a page I have no interest in and that has no bearing on this one. Void if removed (talk) 21:03, 5 December 2024 (UTC)
Bandying claims of POVFORK then saying it is entirely unrelated to this page are not compatible arguments. Bluethricecreamman (talk) 21:07, 5 December 2024 (UTC)
I disagree. The subject is nothing to do with this page. It also contains POV descriptions of the Cass Review. These are orthogonal concerns.
Not every page that mentions the Cass Review belongs in See Also, that's what "what links here" is for. The fact is the principal subject of that page has nothing to do with this one, and suggesting it does is inflammatory. Void if removed (talk) 21:27, 5 December 2024 (UTC)
No, the article discusses the Cass Review against the wider backdrop of the anti-trans movement in the UK and how it is being weaponized by anti-trans fringe groups, so this connection between the articles is very clear and the See Also is appropriate. This opposition appears to be a clear case of WP:IJUSTDONTLIKEIT. Raladic (talk) 21:46, 5 December 2024 (UTC)
According to MOS:SEEALSO articles linked should be related to the topic of the article or be in the same defining category.
21st-century anti-trans movement in the United Kingdom is unrelated to the topic of this article.
I can't find any decent independent sources making such a connection. There's this (which is not a reliable source), there's this (which is a garbage source that contains outright misinformation from the headline onwards) and there's this (which talks about the anti-trans movement in the US, not the UK).
The premise of your inclusion of the Cass Review in this article seems to be your own POV that it belongs there, and now you're reasoning backwards to say it is relevant, because your article says so. Void if removed (talk) 23:04, 5 December 2024 (UTC)
They both share several defining categories , most prominently Category:LGBTQ-related controversies in the United Kingdom and Category:Transgender topics in the United Kingdom and Hillary Cass's own statement in the article In an interview with The New York Times in May 2024, Hilary Cass expressed concern that her review was being weaponized to suggest that trans people do not exist... - this is the weaponization of the Cass Review that anti-trans groups are doing that she's referring to.
Again, the other article has several citations and links to the Cass Review, there is a clear link of the topics, so this see also link is entirely reasonable. Raladic (talk) 23:12, 5 December 2024 (UTC)
The Cass Review has been a corner stone of anti-trans advocacy since its release, and has been cited as the primary motivator for anti-trans policies such as Victoria Atkins puberty blocker ban. The link between the Cass review and the anti-trans movement is evident, and there is no scarcity of references which can be cited. Here is one example, which cites a government barrister saying that "Atkins “acted on the basis of her personal views about the conclusions of the Cass Review” : https://www.independent.co.uk/news/uk/crime/victoria-atkins-nhs-high-court-secretary-of-state-london-b2578759.html HenrikHolen (talk) 01:53, 6 December 2024 (UTC)
A page having POV issues is not equivalent to it being a WP:POVFORK. Flounder fillet (talk) 01:22, 6 December 2024 (UTC)
This comment feels like it falls into the category of WP: I Just Don't Like It.
The Cass review has motivated significant rollbacks of transgender rights in the UK. It is undeniably pertinent.
HenrikHolen (talk) 22:04, 5 December 2024 (UTC)
@Partofthemachine This is the discussion about the "See also". Please feel free to add your thoughts also, as people are still contributing (albeit more slowly than at first). Lewisguile (talk) 08:15, 28 December 2024 (UTC)

Enforced BRD

Just so nobody misses this: There's a thing called 'enforced BRD', and it now applies to this page. That means that the rules used to be:

  • Make your edit
  • Get reverted
  • Maybe restore your edit (but never to the point of edit warring)

and they are now:

  • Make your edit
  • Get reverted
  • Start a discussion on the talk page (or just decide to never restore your edit)
  • At least 24 hours after starting that discussion, you can maybe restore your edit (but never to the point of edit warring, nor if the discussion on the talk page has active opposition. Silence is not active opposition).

See User:Awilley/Enforced BRD FAQ and User:Awilley/Consensus Required vs Enforced BRD for more information.

WhatamIdoing (talk) 04:04, 11 December 2024 (UTC)

Glad to see this - is it wrong that I think this should be mandatory on GENSEX? Void if removed (talk) 18:06, 11 December 2024 (UTC)
I think you would be surprised how cumbersome it can be, especially for problems like subtle vandalism. WhatamIdoing (talk) 18:29, 11 December 2024 (UTC)

EBM as motivation

Hi @Snokalok, hope you're doing well.

I've seen you've undone my edit explicitly saying that enabling EBM was a motivation for the systematic reviews and Cass Review as a whole. Fundamentally, this is what the systematic reviews were for: to see the extent to which different types of transgender healthcare are supported by scientific evidence. Furthermore, it's supported by both the sources used for the sentence I changed.

Thornton said: "Fundamentally, Cass says that children with gender incongruence should receive the same standards of high-quality, evidence-based care expected elsewhere in the NHS. “They deserve very much better”, she wrote. Cass commissioned four systematic reviews of the evidence on key issues, including puberty blockers, hormones, and clinical guidelines."

The Cass Review itself said (amongst other quotes): "Although some think the clinical approach should be based on a social justice model, the NHS works in an evidence-based way. Whilst navigating a way through the surrounding ‘culture war’, the Review has been acutely and increasingly aware of the need for evidence to support its thinking and ultimately the final recommendations made in this report."

Please let me know what you think when you have time. Thanks! 13tez (talk) 20:17, 17 December 2024 (UTC)

So, there are a couple points I’d raise.
First, I feel that given the contested nature of the review among the medical and academic communities, statements like “we’re choosing EVIDENCE over SOCIAL JUSTICE” are something that at best need to be attributed and not simply repeated in wikivoice. Beyond that though, it is contested that Cass’ conclusions are the only evidence based ones, as seen in the response from countless MEDORGS below saying that the evidence does indeed support GAC and directly contradict the report’s conclusions. It’s a point that’s been rehashed countless times on this page as well, the basic “Only 13% of medical treatments have high quality evidence, citation cochrane” and the “why did the report say that psychotherapy had the same quality of evidence as HRT but recommended psychotherapy over HRT?”
I think that we can’t neutrally say that the Cass Review was doing this for EBM when we have countless MEDORGS contesting that in the article, as well as the BLUESKY on double standards of evidence here. Saying the Cass Review was done for EBM is at best a POV statement that we can perhaps place with attribution, but I’d argue not without the social justice part of the quote, and not without careful NPOV balancing that we’d have to work out on here beforehand. Additionally, regarding the systematic reviews commissioned, while they themselves are by all accounts fine reviews, the Cass Review itself is not a systematic review, it’s government recommendations made separately in response to those reviews and without any peer appraisal process.
I’m sort of rambling here, the point is, the EBM over social justice thing is in no way a neutral, scientifically vetted, or MEDORG uncontested statement and we shouldn’t be repeating it as though it is one. If you feel that it’s something still worth including based on notability (which I’ve not given strong consideration to yet), I’d like to hear that case more in depth. Snokalok (talk) 20:52, 17 December 2024 (UTC)
This comment (we can’t neutrally say that the Cass Review was doing this for EBM when we have countless MEDORGS contesting that) treats intention and result as the same thing. The review could be done "for the purpose of" evidence-based medicine but "actually result in" something else, just like a review of this type hypothetically could have been done "for the purpose of making sure the right political party won the next election" or "for the purpose of reducing healthcare costs" or "for the purpose of giving every child a lollipop", even if none of that is what actually happened.
If you want to contest a claim that the purpose/motivation was evidence-based medicine, then you need a source that says the intended purpose (i.e., not the actual outcome) was something else. WhatamIdoing (talk) 00:35, 19 December 2024 (UTC)
But the quotes you've given don't actually say "our intention is to reinforce EBM" or similar. You seem to be confusing intent with outcome. They have said the treatments weren't evidence based and they would like more EBM, but that was a finding. Lewisguile (talk) 07:56, 19 December 2024 (UTC)
Since I've given no quotes, you must be referring to a comment from someone else, but I can't figure out which comment you're referring to. WhatamIdoing (talk) 21:06, 19 December 2024 (UTC)
You're right! Sorry about that. I think I was replying to someone else and got lost in the branching replies. I've been ill on and off with COVID for the last two weeks, so I've had a bit of brain fog. Ignore me for now and if I figure out where this comment goes, I'll move it to the correct place. Lewisguile (talk) 14:56, 20 December 2024 (UTC)
I’m not saying that we should say it wasn’t for the sake of EBM, just that we can’t reliably or neutrally say it was given everything above. Snokalok (talk) 14:19, 19 December 2024 (UTC)
If we have sources saying that it was for the sake of EBM, then we can reliably say that; if we have no sources directly saying that it wasn't for the sake of EBM, it would even be neutral.
Note that one source saying "It was all motivated by a love for EBM, folks" is not contradicted by another source that says "But the result is a disaster!" We'd need a source that says something closer to "This was not motivated by EBM; this was entirely motivated by his political aspirations". WhatamIdoing (talk) 21:09, 19 December 2024 (UTC)
Such as the one medorg down below (PATHA) saying “This was a hit job by the people who pushed GAC bans in the US”? Snokalok (talk) 02:00, 20 December 2024 (UTC)
As I said, if you want to contest a statement that says that the motivation was EBM, then you need a statement that says it was not motivated by EBM. "This was a hit job" is not the same as "They were not motivated by EBM". WhatamIdoing (talk) 03:22, 20 December 2024 (UTC)
On that, I would respectfully disagree for two reasons:
1. Motivated by EBM implies a good faith dedication to science that a hit piece would not. Even if you disagree on this point, the fact remains that saying it was motivated by EBM carries a connotation of good faith and professionalism that is disputed by the latter statement, and thus we wouldn’t be presenting a neutral view.
2. The original quote above made a very strong point of saying ‘EBM over social justice’ which, besides lending credence to the hit piece idea, makes it inherently a politically aligned statement rather than a scientific one, and as such we can’t present it without neutral balancing or, at the very least, the full sentiment w/ the social justice part Snokalok (talk) 14:47, 20 December 2024 (UTC)
Hey, thanks for getting back to me. I hope you're having a nice day.
First, I feel that given the contested nature of the review among the medical and academic communities, statements like “we’re choosing EVIDENCE over SOCIAL JUSTICE” are something that at best need to be attributed and not simply repeated in wikivoice.
I don't think that framing accurately represents the point Cass was making. I think that she was explaining in good faith, to anyone who didn't already know, ⁣that while some people would advocate for other approaches, the NHS (and modern medicine in general) operates based upon EBM. NICE was created in 1999 to disseminate evidence and clinical guidance, based upon that evidence, to the NHS.
What she's saying is true, and she says that the transgender culture war is harmful. I can see why using the phrase "social justice" could, on first impression, make someone believe otherwise, since it is sometimes used in anti-trans and other reactionary rhetoric. However, she's making an explanation for transparency, to aid understanding, and in good faith here, rather than deriding anyone.
it is contested that Cass’ conclusions are the only evidence based ones, as seen in the response from countless MEDORGS below saying that the evidence does indeed support GAC and directly contradict the report’s conclusions
I don't think it's accurate or balanced to say that "countless" medical organisations either support the review or its findings or oppose it/them. Medical organisations in the UK, including the NHS and the RCP, generally support the review (the BMJ, amid controversy, is pending). WPATH and its regional branches, which some view as MEDORGs, have criticised it. Some international medical organisations, such as the American Academy of Pediatrics, have criticised the review and/or contradicted some of its findings. Regardless, the Cass Review's findings are based upon the systematic reviews, which are the highest level of evidence in medical research and were commissioned by the NHS, one of the few "reputable major medical and scientific bodies" explicitly listed as a suitable source for medical information at WP:MEDORG. It is based upon an extremely high-quality body of evidence.
“Only 13% of medical treatments have high quality evidence, citation cochrane” and the “why did the report say that psychotherapy had the same quality of evidence as HRT but recommended psychotherapy over HRT?”
Making arguments like these ourselves isn't really helpful, since what we write has to be referenced from (and based upon the contents of) MEDRS sources anyway (without WP:SYNTH), regardless of our own personal beliefs and analysis.
we can’t neutrally say that the Cass Review was doing this for EBM
To be clear, I don't think that the review was commissioned solely or primarily to enable EBM or that this specific motivation (like, I believe, any other) existed in a vacuum. My sincere impression, at present, is that the Cass Review was commissioned in light of concerns raised (e.g. extensive waiting lists, a huge rise in referrals, and reports of inappropriate practice, including that not based upon evidence) in the GIDS. I believe it was intended to examine these reported issues and the existing evidence and then to make recommendations, based upon what they found and in accordance with evidence-based medicine, on how to improve the care given to TGGNC children and young people.
Per WP:VOICE, we shouldn't state a fact as an opinion. Therefore, if we can substantiate that the Cass Review was created to enable EBM as a fact with suitable references (even if it is one of multiple motivations), we should state it as a fact rather than as an opinion. To this end, I believe the following MEDRS sources substantiate it as a fact. Some refer more to the lack of evidence underlying existing clinical practice in GIDS or elsewhere, and some mention that this led to the Cass Review more explicitly.
  • pages 20 and 75-77 of the final report of the Cass Review
  • Cheung, C Ronny; Abbruzzese, Evgenia; Lockhart, Elaine; Maconochie, Ian K; Kingdon, Camilla C (14 October 2024). "Gender medicine and the Cass Review: why medicine and the law make poor bedfellows". Archives of Disease in Childhood: 2. doi:10.1136/archdischild-2024-327994.
  • Barnes, Hannah (8 March 2023). "Gender identity services in the UK are on pause as evidence comes under scrutiny". BMJ. 380: 509. doi:10.1136/bmj.p509.
  • McCartney, Margaret (30 May 2024). "Medical institutions must treat the Cass review as a significant event and act upon it". BMJ: 1. doi:10.1136/bmj.q1189. I know many senior medics who were concerned about the lack of evidence for interventions...
  • Evans, Marcus (October 2021). "Freedom to think: the need for thorough assessment and treatment of gender dysphoric children". BJPsych Bulletin. 45 (5): 286. doi:10.1192/bjb.2020.72.
  • Thompson, Lucy; Sarovic, Darko; Wilson, Philip; Irwin, Louis; Visnitchi, Dana; Sämfjord, Angela; Gillberg, Christopher (8 August 2023). "A PRISMA systematic review of adolescent gender dysphoria literature: 3) treatment". PLOS Global Public Health. 3 (8): 3. doi:10.1371/journal.pgph.0001478.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  • D'Angelo, Roberto (18 November 2023). "Supporting autonomy in young people with gender dysphoria: psychotherapy is not conversion therapy". Journal of Medical Ethics: 1. doi:10.1136/jme-2023-109282.
Please get back to me and let me know what you think when you have time. Thanks! 13tez (talk) 15:46, 20 December 2024 (UTC)
  • The Cass Review is not an impartial source on itself
  • Cheung et al. is written by multiple people who are members of conversion therapy orgs or famous for pushing conversion therapy
  • Barnes did not say it was evidence based
  • McCartney is an opinion piece
  • Evans is a member of conversion therapy orgs, and unsurprisingly spends a few paragraphs in that article attacking the Memorandum of Understanding on Conversion Therapy (fringe to say the least)
  • Thomspon et al does not say Cass was motivated by EBM
  • D'Angelo is the head of a conversion therapy org, and that's a primary piece where he defends it, and where he doesn't say the Cass Review was motivated by EBM
Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:14, 20 December 2024 (UTC)
Hey, thanks for your thoughts!
The Cass Review is not an impartial source on itself
Earlier consensus here was that the final report itself does qualify as WP:MEDRS and that it's suitable to use as a reference in this article, including on itself.
Cheung et al. is written by multiple people who are members of conversion therapy orgs or famous for pushing conversion therapy
Regardless of any (potentially valid) reservations about an author, it was published in Archives of Disease in Childhood by the BMJ Group, so it is a valid MEDRS source.
Barnes did not say it was evidence based
I'm not providing sources to say the Cass Review was evidence-based, because that has already been established. These sources are intended to show that there was concern that current practice before the Cass Review wasn't sufficiently based on evidence, and, therefore, that the Cass Review was, in part, motivated by a desire to enable EBM for this patient cohort.
Barnes highlighted the concerns on insufficient evidence, among other issues, that led to the Cass Review: "Some GIDS staff began to worry. The service, they believed, did not adequately consider that the evidence base underpinning the medical treatment of young people—the so called Dutch protocol—not only was limited in and of itself but applied to a different group of young people from those largely seeking the help of GIDS."
McCartney is an opinion piece
I checked, and it wasn't externally peer-reviewed, so I take that point.
Evans is a member of conversion therapy orgs, and unsurprisingly spends a few paragraphs in that article attacking the Memorandum of Understanding on Conversion Therapy (fringe to say the least)
Regardless of any (potentially valid) reservations about an author, it was published in BJPsych Bulletin by Cambridge University Press, so it is a valid MEDRS source.
Thomspon et al does not say Cass was motivated by EBM
From page 3, as cited: "...illustrating the acknowledged lack of good quality evidence regarding treatment comorbidities and outcomes to inform service design. Concern in the UK led to the commissioning of the Cass review..."
D'Angelo is the head of a conversion therapy org, and that's a primary piece where he defends it, and where he doesn't say the Cass Review was motivated by EBM
Regardless of any (potentially valid) reservations about an author, it was published in the Journal of Medical Ethics by the BMJ Group, so it is a valid MEDRS source.
From page 1, as cited: "Opinion is divided about the certainty of the evidence base for gender-affirming medical interventions in youth...critics claim the poor-quality evidence base warrants extreme caution...The Royal Australian and New Zealand College of Psychiatrists (RANZCP) articulates the central controversy in Position Statement 103, namely that ‘evidence and professional opinion is divided as to whether an affirmative approach should be taken in relation to treatment of transgender children or whether other approaches are more appropriate’. The recent Cass Review 2 and subsequent National Health Service (NHS) Interim Service Specification highlight the uncertainty about whether gender- affirming medical interventions or psychosocial and mental health interventions (including exploratory psychotherapy) are most helpful and safe for young people experiencing gender dysphoria."
Please let me know if you have any other thoughts. Thank you! 13tez (talk) 18:48, 20 December 2024 (UTC)
These quotes cannot possibly support the statement that the York reviews were commissioned to enable EBM, as the York reviews are not mentioned in them at all. Flounder fillet (talk) 11:51, 19 December 2024 (UTC)
From Thornton: "Cass commissioned four systematic reviews of the evidence on key issues, including puberty blockers, hormones, and clinical guidelines."
From the Cass Review's final report: "This lack of evidence placed limitations on the advice that could be given by the Review. An independent research programme was commissioned with the aim of providing the Review with the best available collation of published evidence, as well as qualitative and quantitative research to fill knowledge gaps. 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. This final report provides full details of the research approach and methodology used by the research team and a synthesis of the findings alongside interpretation of what they mean for the Review. The peer reviewed systematic reviews have been published alongside this report." 13tez (talk) 13:27, 19 December 2024 (UTC)
This in turn doesn't mention EBM. Flounder fillet (talk) 17:33, 19 December 2024 (UTC)
You said: "These quotes cannot possibly support the statement that the York reviews were commissioned to enable EBM, as the York reviews are not mentioned in them at all."
I was just showing you that this isn't true. The references from which the quotes are taken explicitly discuss the York systematic reviews. You can see this in the two new quotes from them I provided in my last reply to you.
Neither of the two pairs of quotes I have provided in this thread are the entirety of either of the two references from which they're taken. After all, one is the final report of the review itself. You are opining on whether the references discuss the reviews or EBM while assuming the quotes I am taking from them are the references in their entirety. This is not the case. 13tez (talk) 19:14, 19 December 2024 (UTC)
I wrote quotes, not citations. I was at no point "opining on whether the references discuss the reviews or EBM" - I was stating that the quotes you have chosen to include in your original post, the ones in quotation marks, are irrelevant to the statement you added to the page. Flounder fillet (talk) 19:39, 19 December 2024 (UTC)
You are correct in saying that the individual quotes I've provided in this thread don't discuss both EBM and the systematic reviews. However, the references from which they're taken contain more than just those quotes, and this isn't what I was arguing to begin with. 13tez (talk) 20:35, 19 December 2024 (UTC)
Well I've seen you added it to the motivating factors section now instead. Lewisguile (talk) 20:40, 19 December 2024 (UTC)
For clarity, I didn't add the enabling of EBM to the Motivating issues section. I only paraphrased those that are directly listed in page 77 of the review itself. I also qualified these factors by saying they're what the review listed as the key motivating issues. I don't think it would be appropriate to add enabling EBM there because it isn't included in this list from the review. 13tez (talk) 20:46, 19 December 2024 (UTC)
You probably shouldn't add so much text to an article while these issues are still being discussed. You've made a lot of changes, some of which are WP:POINTY and others which simply aren't well written. Because the edits are all done in small edits, I can't revert them partially to only remove the bad. I will have to revert them all, and you'll have to make your case for what you want to include here per WP:ONUS and WP:BRD. You can read about the enforced BRD process on this page here. Lewisguile (talk) 09:20, 20 December 2024 (UTC)

International reaction

Both the article lede, and the "Response from other health bodies globally" section, seem to give the impression that most health bodies outside the UK opposed the report's findings. But I would note that a number of medical authorities in various European countries, including Sweden, had already made changes to severely limit medical and surgical gender transitioning for minors in the years prior to this review's release. I did a quick search now, but haven't yet found any official reaction to the Cass Review from those countries' medical authorities. But it would be reasonable to surmise that bodies which disagree with the report would be more motivated to issue an official reaction, registering that disagreement, than those in agreement with it, so this could skew the sampling. In any case, I think it would be worth noting in the article that countries like Norway, Sweden, and Finland had already implemented most of the Cass Report's recommendations before it was published. -2003:CA:8728:D5C2:F3ED:8883:9187:C5E5 (talk) 21:10, 17 December 2024 (UTC)

I think it would be difficult to put in anything which isn’t explicitly related to the Cass Review. Those countries might well agree with many or most of the recommendations, but if they implemented them before the review was published, then they are probably not a significant fact about the review. This article shouldn’t become an index of everybody that agreed or disagreed with the report, and it especially shouldn’t become an index of everybody who merely acted concordantly with the report. Barnards.tar.gz (talk) 21:20, 17 December 2024 (UTC)
Re: "difficult to put in anything which isn’t explicitly related to the Cass Review"
The NYT article, which I've quoted an except of in another reply below, actually explicitly links the changes other European countries have made in recent years to Cass.
-2003:CA:8728:D5C2:F3ED:8883:9187:C5E5 (talk) 22:46, 17 December 2024 (UTC)
So I read this article you linked, and I think it’s worth noting that it also makes a very strong point of connecting it to the larger right wing political shift, and that any sentence which mentions the trend citing this source, needs to include that as well for NPOV Snokalok (talk) 23:02, 18 December 2024 (UTC)
This is a proposal to hang a WP:COAT. These are different changes that were made for different reasons in different times and different places. See https://www.politico.com/news/2023/10/06/us-europe-transgender-care-00119106 for more information about the exact changes in Norway and Sweden. Flounder fillet (talk) 21:53, 17 December 2024 (UTC)
I would disagree with your WP:COAT argument, as it's normal to give some background and context when discussing a new report. This gives readers important information as to whether a given report and its recommendations are an isolated aberration, or part of a larger trend. Obviously trends in other European countries shouldn't be the main focus of the article, which would be in line with "COAT," but they can be mentioned to contextualize. Regarding the Politico article you linked, in particular, this article, while not specifically labeled as an op-ed or opinion piece, is clearly opinion-driven, spinning and arguing that the recent policy changes in many European countries aren't actually so significant....And of course there's nothing wrong with arguing that position, but Wiki's coverage should be more balanced. -2003:CA:8728:D5C2:F3ED:8883:9187:C5E5 (talk) 22:33, 17 December 2024 (UTC)
As a followup, I did a quick search now, and found several good articles which balance out the Politico article's spin: , , , and . The last of those articles, from the NYT was actually published after the Cass Report came out, and explicitly links Cass with the larger trend, thus alleviating any possible "SYNTH" concerns:
"England’s move is part of a broader shift in northern Europe, where health officials have been concerned by soaring demand for adolescent gender treatments in recent years. Many patients also have mental health conditions that make it difficult to pinpoint the root cause of their distress, known as dysphoria.
In 2020, Finland’s health agency restricted the care by recommending psychotherapy as the primary treatment for adolescents with gender dysphoria. Two years later, Sweden restricted hormone treatments to “exceptional cases.”
In December, regional health authorities in Norway designated youth gender medicine as a “treatment under trial,” meaning hormones will be prescribed only to adolescents in clinical trials. And in Denmark, new guidelines being finalized this year will limit hormone treatments to transgender adolescents who have experienced dysphoria since early childhood."
-2003:CA:8728:D5C2:F3ED:8883:9187:C5E5 (talk) 22:43, 17 December 2024 (UTC)
No objection to something along the lines of "has been described as part of a trend of ". Flounder fillet (talk) 00:09, 18 December 2024 (UTC)
Same. Something neutral along those lines is fine. Lewisguile (talk) 15:59, 18 December 2024 (UTC)
Did this get added in? Lewisguile (talk) 16:21, 21 December 2024 (UTC)
no Flounder fillet (talk) 22:37, 22 December 2024 (UTC)
I think that this section will look better and be more encyclopedic a few years from now. We eventually want (and expect) to reach a point in which the article says something like "The recommendations around puberty blockers were supported by nearly all UK medical organizations and most northern European gender care organizations, as well as religious organizations and right-wing politicians. It was strongly opposed by multiple American-led gender care groups, who were concerned that a greater diversity in standards for gender care management in developed countries would lead to additionally politically motivated restrictions on gender care in the US. The recommendations about how many separate locations in England should offer gener care were a yawning bore that almost nobody in the UK actually cared about, and absolutely nobody outside the UK." We're just don't have the sources for that kind of general summary yet, and we probably won't until someone writes a book about it. WhatamIdoing (talk) 00:44, 19 December 2024 (UTC)
But that's extrapolating a lot from the sources so far provided. As for whether it's boring or not, Misplaced Pages is not WP:NOTAFORUM. Lewisguile (talk) 07:53, 19 December 2024 (UTC)
That's not even extrapolating from sources. I was making up hypothetical future article text based on hypothetical future sources. One of these days, probably years from now, I believe we'll be able to write a decent encyclopedic summary of the reaction. Earlier this year, we started with laundry lists and proselines about who said what when. We've progressed to thoughtfully curated laundry lists. But we are hampered by the non-existence of sources that take a high-level overview. WhatamIdoing (talk) 17:25, 19 December 2024 (UTC)
Fair enough. Such is the problem with covering "rolling news" (not quite rolling anymore, but you know what I mean). Lewisguile (talk) 20:39, 19 December 2024 (UTC)
Indeed. WhatamIdoing (talk) 03:23, 20 December 2024 (UTC)

Revert per enforced BRD

I've just reverted a series of edits by @13tez per the enforced WP:BRD on this page described here. I responded in the ongoing EBM thread to let the editor know, but am also adding it here so it's easier to find/see this for others.

Some of the edits are issues undergoing discussion at present, some make the article harder to read, and some seem a little pointed (e.g., the constant references to how systematic reviews are the best), so 13tez will need to get consensus for the changes here. Some may be fine; others may require more discussion.

13tez, it might be a good idea to start a new topic for each key area you want to make changes in, with suggested wording. That way, it won't get as bogged down. Thanks in advance! Lewisguile (talk) 09:28, 20 December 2024 (UTC)

Hi, thanks for letting me know.
Please can you tell me which portions of content I added you thought should (and should not) be removed before your revert and why?
Thanks! 13tez (talk) 09:47, 20 December 2024 (UTC)
As per WP:ONUS and WP:BRD, you should justify why the text is needed in the first place. There were a series of edits, so I don't have time to go through them all, but off the top of my head, there were a few typos, the language became slacker in certain areas, and the framing seemed non-neutral/editorialising. E.g., you mentioned "huge increases" ("huge" always seems emotive to me), gave a lot of space and added an image to stress the idea that systematic reviews are the best (this isn't needed beyond maybe a few extra words, since readers can click on the relevant article to find more), added tangential sources to support the same, added a new section which hasn't been discussed or received consensus, etc. I didn't go very far back, so it seemed this would revert the fewest number of overall edits and this makes it easier for me to self-revert if others think there's a consensus for the additions/changes. Lewisguile (talk) 10:51, 20 December 2024 (UTC)
Thanks for getting back to me. I'll try to discuss each of your concerns in order; please let me know if I've missed any of your points or if you still have any.
From what you've said, you don't seem to be opposed to how I edited RCPH for consistency or the paragraph beginning "The Royal Australian and New Zealand College of Psychiatrists rejected calls for...". Please can you tell me if I'm right in thinking you're not opposed to these changes?
per WP:ONUS and WP:BRD, you should justify why the text is needed in the first place
I think that the Motivating issues section is an important addition to the Background section because, without it, readers will not know which key issues resulted in the decision to commission the review. This would prevent them from fully understanding the background or context that led to the review being made. Describing this background and context to readers is the purpose of the Background section of the article.
I added an illustrative diagram of the hierarchy of evidence, showing systematic reviews, to give readers a visual understanding that each level of evidence in medical research feeds up into the one above it and that systematic reviews are considered the highest of these levels. Since the systematic reviews it commissioned are the foundation of the Cass Review, this helps readers understand the make-up and quality of the evidence that informed it. I added the information on the journal in which the systematic reviews were published and that they formed some (really most) of the evidence that informed the report and its findings. Again, this helps inform readers on the nature of the evidence and how it was used to develop the conclusions of the Cass Review. This information is relevant to the Methodology section of the article.
There were a series of edits, so I don't have time to go through them all
Per WP:BRD-NOT, if you're unable or unwilling to explain the substantive reasons for reverting edits, you cannot do so.
there were a few typos, the language became slacker in certain areas
I'd have been happy for you to have tightened up the language or fixed typos, or I'd be happy to do so now myself if you pointed out the issues. Notwithstanding other reservations, these small issues could have been addressed with a fix, and wouldn't necessitate the revert, per WP:BRDR. How do you think we should fix the copyedit issues?
the framing seemed non-neutral/editorialising. E.g., you mentioned "huge increases" ("huge" always seems emotive to me)
I'd be happy to discuss any issues in regarding editorialising because I wouldn't want to do so, but nobody's perfect. I think "huge" is an objectively true way to describe an increase of 3442.86%, and the review used the word "exponential" itself. However, if you'd prefer a less emotive adjective, I take that point and am open to suggestions. Maybe we could cite an exact figure to get away from adjectives altogether?
the constant references to how systematic reviews are the best...gave a lot of space and added an image to stress the idea that systematic reviews are the best
I don't think two references to the position of systematic reviews as the highest level of evidence in medical research can be accurately described as "constant". As I tried to describe in the summary of the edit where I implemented it, I made one in-text reference to this fact to host the references and the nuance of some hierarchies (there are multiple) also including meta-analyses in the top tier of evidence there. This allowed the caption of the image showing the pyramid illustrating the hierarchy of evidence to be simplified and and not need references. It also benefited text-only readers who might not read an image caption. Can you think of a better, alternative approach here?
I think the image helps readers understand the role of systematic reviews, and, in turn, the methodology of the Cass Review. I think it's a useful illustrative aid in this regard. The only space is this one image and another single sentence, so I don't think it's a disproportionately large amount of coverage considering it's within the Methodology section of the article and the importance of the systematic reviews to the Cass Review's methodology. Do you think that the use of the image falls within MOS:IMAGES?
added tangential sources to support the same
What makes you think the sources are tangential? One was the Cass Review itself; one was published in Hospital Pediatrics, a journal of the American Academy of Pediatrics; and one was published in Evidence-Based Medicine, a journal of the BMJ. They were all relevant to the specific point, saying:
  • "The highest form of evidence is that generated by a systematic review"
  • "The quality of evidence from medical research is partially deemed by the hierarchy of study designs. On the lowest level, the hierarchy of study designs begins with animal and translational studies and expert opinion, and then ascends to descriptive case reports or case series, followed by analytic observational designs such as cohort studies, then randomized controlled trials, and finally systematic reviews and meta-analyses as the highest quality evidence."
  • "A pyramid has expressed the idea of hierarchy of medical evidence for so long, that not all evidence is the same. Systematic reviews and meta-analyses have been placed at the top of this pyramid for several good reasons."
added a new section which hasn't been discussed or received consensus
Per WP:BOLD and WP:BRD, you don't need permission to make new edits. If something is under discussion or disputed, you can't unilaterally add it, but I never added what was being discussed: whether enabling EBM was a motivation for holding the Cass Review.
Please get back to me when you have time. Thanks! 13tez (talk) 13:07, 20 December 2024 (UTC)
Thanks for your quick reply! I'm ill with COVID, so bear with me if I don't check here immediately. I also appreciate your edits are in good faith, so I just want to get that out of the way.
Per WP:BRD-NOT, if you're unable or unwilling to explain the substantive reasons for reverting edits, you cannot do so. I did try to explain the main issues, re: NPOV (editorialising, pointiness) and lack of consensus, though in brief. I also explained that as you made multiple smaller edits, I couldn't just revert some parts without doing it manually for each one. But I'll go into a bit more detail below.
Even if material is verifiable, it doesn't necessarily mean it's notable or that it should be included. We have to make sure that what's included is WP:DUE and has consensus for inclusion. Neutrality can be affected by what is put into an article and what is left out, which means that using lots of detail in particular areas can reinforce the idea that this area is being emphasised. We should also keep it easy to read and stick to what's relevant.
In regards to the "systematic reviews" part, besides the issues I had mentioned already, you rearranged the paragraph to put that statement first, which seemed to emphasize that part. You also expanded the section on the York reviews to say where they were published, who the publisher was, its official affiliations and that it was peer-reviewed (which read, at least to me, like appeals to authority). Most of this isn't needed, as people can see who the reviewers are by following the references and clicking the relevant blue links. They can see who the publisher is. Describing all of this stuff at length can feel like the prose is trying to convince us of something, whether intended or not.
The motivating issues section also repeats much of the same information as the Methodology section, albeit in different wording and framing. It's largely redundant on that basis, and again, in the context of all the above, it reads as WP:POINTY.
All of this could've been trimmed for overegging the pudding anyway, and for adding extraneous detail, but the series of edits with these changes, plus the image, caption and repetition of the caption in the article body, do not appear to be WP:NPOV. In fact, the cumulative effect is like the article is trying to tell us a particular viewpoint. (I appreciate that it's easy to get swept up in detail that's interesting to us as editors without realising how it can make things seem lopsided.)
Of course, all of this is subjective, which is why I think we need to get more eyes on this. If others agree to keep the edits, I am always happy to self-revert if someone pings me. I'm also happy to workshop the text, although I may need to leave the detailed stuff till tomorrow since my attention is currently all over the place. Lewisguile (talk) 14:09, 20 December 2024 (UTC)
Tossing in my agreement with everything you said. Snokalok (talk) 14:47, 20 December 2024 (UTC)
It's possible that both of you need to read WP:POINTY again, since it is about Malicious compliance and Work-to-rule efforts, in which an editor disagrees with a rule and wants to screw up articles or processes by proving that following the rule can have unwanted effects. Don't rely on the name of the WP:UPPERCASE. A pointed statement (one that sharply emphasizes a point) is not a WP:POINTY edit. WhatamIdoing (talk) 21:16, 20 December 2024 (UTC)
Totally my fault! Sorry about that! Lewisguile (talk) 12:58, 21 December 2024 (UTC)
(An aside: the page you mean is probably WP:TENDENTIOUS, which covers editing that is argumentative or biased.) Loki (talk) 20:52, 21 December 2024 (UTC)
I think the pyramid image is helpful. This kind of pyramid diagram is included in the report itself (p55), and it really speaks to the heart of the matter. Barnards.tar.gz (talk) 15:00, 20 December 2024 (UTC)
Thanks for getting back to me again, and sorry to hear you have covid; I hope you get better soon.
To know where we now stand on your previous concerns after trying to allay them, please can you tell me:
  • If you understand the rationale for the edits I made to "RCPH" through the article for consistency and the paragraph beginning "The Royal Australian and New Zealand College of Psychiatrists rejected calls for...", and if you agree that they are suitable?
  • If you understand my rationale for including the pyramid hierarchy of evidence image and if you think it is useful for readers and falls within MOS:IMAGES?
  • If you still view the references substantiating that systematic reviews are the highest level of evidence in medical research as being tangential?
I also appreciate your edits are in good faith, so I just want to get that out of the way.
Thank you, I feel the same.
Even if material is verifiable, it doesn't necessarily mean it's notable or that it should be included.
I explained why I think my additions were due when justifying their additions in my last reply. Did you disagree with what I had to say?
you rearranged the paragraph to put that statement first, which seemed to emphasize that part
In all honesty, the reason why I made the paragraph breaks is simply because the single paragraph was getting too long. I think (?) you're saying that one of the new paragraphs started with the information that systematic reviews are the highest level of evidence to highlight it. However, that sentence came at the end of the first paragraph.
You also expanded the section on the York reviews to say where they were published, who the publisher was, its official affiliations and that it was peer-reviewed (which read, at least to me, like appeals to authority)...Describing all of this stuff at length can feel like the prose is trying to convince us of something, whether intended or not.
I don't see how it could be an appeal to authority when it isn't making an argument. If it went on to argue something based on an appeal to the authority of those who made the systematic reviews, it would be, but it doesn't. To some extent, MEDRS in a way works by appealing to authority anyway. Regardless, again, I think this information is due in the Methodology section, which exists to outline the methodology underlying the Cass Review, which was largely based upon the systematic reviews.
Do you think rephrasing this information somehow or even siloing it in a subsection, which people could skip if they're not interested in the particulars of the systematic reviews, could help this issue that it feels like an argument to you? How do you think we should resolve the issue of you feeling like my text is editorialising generally? Should we re-write it, e.g. with "huge" as we discussed before?
Most of this isn't needed, as people can see who the reviewers are by following the references and clicking the relevant blue links. They can see who the publisher is.
We could equally argue readers could go and read the references to see how the systematic reviews worked, what they discussed, etc. By this logic, lots of the content within the Methodology section (and the article as a whole) would be removed. The result would be that readers would be less informed. Can you understand why I don't see this as a good way to decide which content to include?
The motivating issues section also repeats much of the same information as the Methodology section...It's largely redundant on that basis
I really wouldn't have thought you'd think so. To be clear, do you mean the list of the "topics covered by the systematic reviews" in the Methodology section was too similar to the Motivating issues?
To me, the Motivating issues are the concerns which led to the review being commissioned, e.g. huge increases in referrals, intolerable waiting lists, unexplained drastic changes in the patient cohort, etc. To be neutral, I gave the caveat that the list was from and per the final report of the review. Conversely, the topics covered in the systematic reviews examine clinical practice caring for those patients, looking at things like puberty blockers, gender-affirming hormone therapy, psychosocial support, etc.
In short, I think the Motivating issues were concerns that caused the report to be created vs topics related to different areas of clinical practice assessed by the systematic reviews. I think the two are distinct enough to not be redundant. Do you still think including both is redundant?
I'm also happy to workshop the text
I'm very happy for my changes to be included while being rewritten more elegantly and simply, and I'm happy for copyedit issues to be fixed with or without me. How do you think this should be done?
I hope you feel better soon; please let me know what your thoughts are when you can! 13tez (talk) 18:13, 20 December 2024 (UTC)
About people can see who the reviewers are by following the references and clicking the relevant blue links:
Research indicates that most readers/non-editors will follow one reference about 1 out of 300 page views, and they will click on one or two links on desktop (either to get to this article, or to leave it for another), and zero or one link on mobile (about 65% of all readers) in an entire session. The Misplaced Pages rabbit hole behavior is uncommon.
For this article in particular, looking at last month's numbers, only 15% of readers click on a link to read another Misplaced Pages articles. So we should be writing the article, to use the wording from Misplaced Pages:The perfect article, to be "self-contained", because 85% of readers are not clicking through to any other articles, and >99% of readers are not clicking through to any refs.
In case you are curious, about 65% of readers last month came from Google/outside of Misplaced Pages. 8% last month came from our article on Kemi Badenoch (it was 1.5% the month before, so something must have happened in the news), 3% from Hilary Cass (5% the month before), and around 2.5% from Political views of J. K. Rowling.
85% of readers here stop after this article. Less than 5% of page views result in someone going to Hilary Cass, which is about 30% of the (small number of) readers who click on anything. Around 1% go to Bell v Tavistock and Time to Think (book), and everything else is tiny (less than 1% of page views/less than three readers per day). WhatamIdoing (talk) 22:08, 20 December 2024 (UTC)
Thanks for your patience, @13tez. I'm feeling a fair bit better at the moment — nighttimes are the killer because it's hard to breathe. I've gone ahead and reincorporated some of your edits with tweaks to make them, I feel, more balanced. There's one or two I haven't made yet, as I wanted tour input. I'll go through these in detail below:
  • The Royal Australian and New Zealand College of Psychiatrists rejected calls for an inquiry into trans healthcare following the release of the Cass Review, characterising it as one review among several in the field. They emphasised that, "assessment and treatment should be patient centred, evidence-informed and responsive to and supportive of the child or young person's needs and that psychiatrists have a responsibility to counter stigma and discrimination directed towards trans and gender diverse people." This wording seems fine to me. I restored it as it was.
  • Linking the RCPCH and adding the abbreviation afterwards is also fine. I have gone ahead and made that specific change for you.
  • The refs to systematic reviews being the highest quality of evidence were as follows:
Neither of these seem relevant to the Cass Review, unless I'm missing something, so I feel like we're possibly veering into WP:COATRACK territory. This isn't an article about the use of systematic reviews. What's important is what the use of systematic reviews means for the Cass Review, not what they mean in general. Though I suppose we can use these refs if we end up adding an endnote for this (see further down).
  • The image of the pyramid shouldn't be considered on its own but in conjunction with the other material added about systematic reviews. Whether people are likely to click through to a systematic review article or not is irrelevant; that's their choice. One reason for not clicking through might be that they already know what something is, for instance. But either way, a standalone article needs to introduce the concepts in sufficient detail to make them clear in the context of this subject, but no more, because those concepts aren't the main focus of this article. On that basis, I don't think the image is WP:DUE, because it's taking up space and word count for one detail. That detail can be added in other ways so it's less of a tangent. See below.
  • This wording is clunky and is trying to do too much in general (even before your additions): The Cass Review commissioned several peer-reviewed, independent systematic reviews into different areas of healthcare for children and young people with gender identity issues, including gender dysphoria. Systematic reviews, sometimes along with meta-analyses, are generally considered the highest level of evidence in medical research.
  • I think this is a better compromise: The Cass Review commissioned several independent systematic reviews into different areas of healthcare for children and young people accessing gender identity services in the UK. Would you be happy if we made this change? "Independent" isn't strictly needed, since we say in the next bit that the reviews were done by the University of York, but it's not a hill I'm willing to die on, so I've left it in.
  • I would leave "peer reviewed" with the publication info, like so: The systematic reviews were published in Archives of Disease in Childhood, the peer-reviewed medical journal of the Royal College of Paediatrics and Child Health. Otherwise, you have "peer-reviewed, independent systematic reviews", which is really clunky. This way, we avoid repeating the same information in multiple places, and the same wording in the same sentence. This also avoids repeating that the reviews were used to inform the Cass Report, since this is also stated in the line beginning The systematic reviews performed meta-analyses... (Though this line was also clunky, so I rejigged it.)
  • If anything else needs to go in here, I'd suggest an endnote, such as: This is where we could use your refs about the value of systematic reviews.
  • I don't see how it could be an appeal to authority when it isn't making an argument. I think the wording, as it was, did read like it was making an argument, for all the reasons I outlined above (emphasis, etc). Besides, per WP:INCITE, there's very rarely a need to include detailed attribution in this way; a specific reason stated for that policy is that people can click on the reference to find out more (regardless of whether they actually do or not). The wording I've suggested here, I think, is hopefully a fairer compromise and more concise.
  • To be clear, do you mean the list of the "topics covered by the systematic reviews" in the Methodology section was too similar to the Motivating issues? I do, in that the topics covered necessarily imply they were things being looked for, if that makes sense? However, I've suggested alternate wording that doesn't require another short sections within a short section: Key concerns which led to the creation of the review included increasing waiting lists due to larger numbers of children and young people requesting gender-affirming care from the NHS (over two years per patient), proportionally fewer patients who were assigned male at birth (AMAB) and an increasing number who were assigned female at birth (AFAB), a reported trend towards earlier medical interventions in this cohort, and concerns around the quality of evidence for treatment in this area.
What do you think of these suggestions in general? I think we've kept the main thrust of what you wanted to add, while keeping it all proportionate to what else is in there. If there's anything I've still missed (darn brain fog!), please let me know. Lewisguile (talk) 12:50, 21 December 2024 (UTC)
@Snokalok, what do you think about the above? Lewisguile (talk) 13:23, 21 December 2024 (UTC)
I’d change the “key concerns” bit, since as it’s currently worded it imo gives too much validity to some of the stated concerns. I’d reframe it as “stated concerns” instead. I believe it should change“medical interventions” to “medical treatment”. More neutral.
Past that, I think if we emphasize that the York reviews are peer reviewed systematic reviews, we need to make clear that the Cass Review *isn’t* any of those things, it’s just the opinion resulting from someone having read those reviews.
Those are my two main things. The first is a minor tweak that I’m going to BEBOLD on, the second we might need to workshop more thoroughly. Snokalok (talk) 16:04, 21 December 2024 (UTC)
Thanks. I support both those wording changes for neutrality. Good catch.
I also support your other suggestions, re: peer review, for the reasons you state. At the moment, the language might lead readers to assume the Cass Review itself is peer-reviewed. Though, I think that since the Methodology section now clearly states "peer-reviewed" in relation to the publication of the systematic reviews, I think it's definitely better than it was. I have also stated where another journal was peer reviewed for balance. Lewisguile (talk) 16:15, 21 December 2024 (UTC)
Hi @Snokalok, please can you undo your revert of my recent edit? Your stated reason was: "Removing excess info about publication, since per talk it was only agreed upon as being relevant if contrasted with the fact that the Cass Review is not peer-reviewed, as to avoid an appeal to authority"
However, my edit did not add any information. It only removed information, adjusted language, and rearranged text, for the reasons I explained in the edit summary. Thanks! 13tez (talk) 19:50, 21 December 2024 (UTC)
Ah! Yes, easy confusion. The text discussing the journal it was published in and that journal’s pedigree was boldly added earlier (which I personally disagree with doing but whatever) before consensus was obtained, and then solidified with the agreement above that it was only worth keeping if we contrasted it with the fact that the Cass Review is not peer reviewed and instead only built itself off other pubs, which I thought was made obvious in the report itself. However given that we can’t agree yet on the latter it seems, we shouldn’t have the former either - otherwise it creates the earlier issue stated by Lewis of reading as an appeal to authority. Snokalok (talk) 19:59, 21 December 2024 (UTC)
My bad! I thought my text wouldn't be controversial. Snokalok, what if we added the peer review clarification as an endnote? Would you settle for that? It might seem less objectionable to others if it's done like that instead? Lewisguile (talk) 20:27, 21 December 2024 (UTC)
I think that that’s giving it too much weight one way. If we had both the archives of disease in childhood AND the not peer reviewed thing in endnotes then fine, but otherwise it feels like we’re just trotting out a list of titles the Cass Review doesn’t actually hold, like medals given to North Korean generals. It gives the implication that the Cass Review was peer reviewed by the archives of disease in childhood, which it wasn’t. Snokalok (talk) 20:39, 21 December 2024 (UTC)
Sorry, @Snokalok, I didn't read my replies in order. It's a valid point. Hmmm. I'm not sure. On principle, I'm not opposed to saying where the reviews were published, but it's definitely not essential information and it's about as important as clarifying whether the Cass Review itself was peer reviewed. I think the RS for saying the Cass Review wasn't peer reviewed itself is the Cass Review? Nowhere does it state her recommendations and conclusions were peer reviewed – indeed, she says the opposite: that it was independent, and wasn't seen in advance by the NHS and Government. She details her process. If she didn't say the final report was peer reviewed, then it wasn't.Lewisguile (talk) 19:20, 22 December 2024 (UTC)
Hey @Snokalok, thanks for getting back to me! Sorry for my mistake - I originally thought your edit was just a revert of my edit, but it actually removed information Lewisguile added in an attempt to form a compromise.
I removed the information that the Cass Review was not peer-reviewed primarily because it was not referenced. The references placed at the end of that sentence were actually references for the previous sentence - that AODIC is the journal of the RCPCH. Their presence there was erroneous. However, that single sentence by itself, at the end of a paragraph otherwise discussing the systematic reviews, doesn't seem especially relevant.
I understand you think that if we say the systematic reviews were peer-reviewed, we need to say the Cass Review itself wasn't for balance. However, the latter was not referenced; this situation was already the status quo even before my originally contested edits; both Lewisguile and I were fine with it: this was the case in the changes they made and I agreed to; and the fact that the systematic reviews underwent a peer-review process is relevant to the methodology section because they were the foundation of the evidence upon which the Cass Review made its conclusions.
It gives the implication that the Cass Review was peer reviewed by the archives of disease in childhood, which it wasn’t.
How so? It's saying the systematic reviews commissioned by the Cass Review were peer-reviewed and published there, not the Cass Review itself.
Thanks! 13tez (talk) 21:03, 21 December 2024 (UTC)
So regarding citation, a small error on my part - I’d made the assumption that one of the citations was a direct Cass Report citation since, they’re everywhere, but it wasn’t and that was a mistake on my end.
Past that, as you can see above Lewis agreed with my take on the matter that there needed to be balancing via saying Cass is not peer reviewed.
As for your question, because the reader is very severely liable to see the words “Cass Review” and that it commissioned several systematic reviews, and come to the conclusion of the Cass Review just being the culmination of those and thus warranting the same prestige and pedigree as the peer reviewed pubs when in reality, the Cass Review is not that - it’s a non-peer reviewed government report that makes significant leaps in logic and conclusions not supported by the underlying systematic reviews (such as transness being caused by porn), and if we don’t make the distance between the two clear, a reader is very easily liable to mistake the statements of the Cass Review for the conclusions of the York Review, hence why we need to emphasize the difference or else not risk misattributing the authority. Snokalok (talk) 23:26, 21 December 2024 (UTC)
Once again, it's not a government report. Void if removed (talk) 23:48, 21 December 2024 (UTC)
The NHS is a government entity. An NHS report without peer review is therefore nothing more than a government report Snokalok (talk) 04:07, 22 December 2024 (UTC)
Hi @Snokalok, thanks for getting back to me again!
as you can see above Lewis agreed with my take on the matter that there needed to be balancing via saying Cass is not peer reviewed
However, they edited to the contrary, notwithstanding my other reasons for retaining the longstanding situation of the systematic reviews being described as peer-reviewed (which you alone have overridden) described previously and the views of other editors.
a reader is very easily liable to mistake the statements of the Cass Review for the conclusions of the York Review
Even though the latter did inform and lead to the former, I think we might find common ground here. I was thinking of adding a table summarising the results of the different systematic reviews, for example with the following columns:
  • intervention (e.g. puberty blockers)
  • number of relevant studies found
  • number of low quality studies
  • number of moderate quality studies
  • number of high quality studies
  • the strength of evidence overall (e.g. very low, low... very high)
  • the ability to make conclusions on the merits and effects of the intervention (e.g. very low, low... very high)
Please can you tell me what you'd think of adding something like this to the article?
Thanks! 13tez (talk) 00:18, 22 December 2024 (UTC)
So let me start by answering your first point regarding Lewis:
Thanks. I support both those wording changes for neutrality. Good catch.
I also support your other suggestions, re: peer review, for the reasons you state. At the moment, the language might lead readers to assume the Cass Review itself is peer-reviewed. Answered by Lewis in regards to me adding that Cass is not peer reviewed. Diff provided.
With that out of the way, yes the York Reviews informed them but they didn’t lead to the Cass Review, merely fed it. Again repeating my example, nowhere in the York Reviews did they say transness was caused by pornography, and yet the Cass Review did. Thus, we have to keep them separate, because the Cass Review draws conclusions not drawn in nor supported by the York Reviews, and to treat them as synonymous or as direct representations of each other would be facile.
As for your proposed table, I personally like the bar graph image you already added, I think that does a better job of conveying the info you want. Snokalok (talk) 04:13, 22 December 2024 (UTC)
Hey @Snokalok, thanks for getting back to me again!
So let me start by answering...Diff provided.
Again though: they edited to the contrary; the sentence saying the Cass Review was not peer-reviewed was not referenced; the status quo even before my originally contested edits was saying the SRs were peer-reviewed without saying the Cass Review wasn't, and one or even two editors cannot override that, especially while it's contentious; both Lewisguile and I were fine with it: this was the case in what they suggested and the changes they made and I agreed to; the fact that the systematic reviews underwent a peer-review process is relevant to the methodology section because they were the foundation of the evidence upon which the Cass Review made its conclusions; and the views of other editors weren't considered when you removed the fact that the systematic reviews were peer-reviewed.
yes the York Reviews informed them but they didn’t lead to the Cass Review, merely fed it
What do you mean by "lead" - leading to the creation of the review itself or leading to its findings? If you read the Cass Review, they definitely did lead to its findings.
the Cass Review draws conclusions not drawn in nor supported by the York Reviews
This isn't true. Apart from already being able to reference it from MEDRS sources, you can see in the final report for yourself how the findings of the systematic reviews are referenced, discussed, and used to create the findings and recommendations of the report. For example:
nowhere in the York Reviews did they say transness was caused by pornography, and yet the Cass Review did
How did you come to that understanding? Did it come from you reading the final report yourself? Did it come from you reading a discussion of it from a third party?
If you read the Cass Review, it discusses the effect of pornography on children on page 110. All it really says on the matter is:
  • more children are exposed to pornography from a young age
  • "Several longitudinal studies have found that adolescent pornography consumption is associated with subsequent increased sexual, relational and body dissatisfaction (Hanson,2020)"
  • "Research commentators recommend more investigation into consumption of online pornography and gender dysphoria is needed. Some researchers (Nadrowski, 2023) suggest that exploration with gender-questioning youth should include consideration of their engagement with pornographic content."
What it says is objectively true. It doesn't make any claims or assertions on the effects of pornography on TGGNC young people, let alone the one you're claiming it made: "transness was caused by pornography". It recommends more research to understand any potential effects of pornography on gender-questioning youth, which doesn't necessarily mean a causal relationship whatsoever.
I personally like the bar graph image you already added
OK, glad we can agree on that.
Please let me know what you think when you can! 13tez (talk) 13:08, 22 December 2024 (UTC)
Both LewisGuile and I were fine with it Yes and then when I stated my reasons to Lewis, he changed his mind, as the diff I provided above shows. He is no longer in agreement with you.
Regarding pornography, the report still suggests it as a cause of transness, and however you wish to characterize its claims, it still makes them without the York reviews doing anything of the sort. Thus, it’s a statement made entirely separately, and thus we can’t treat Cass and York as the same. Snokalok (talk) 13:23, 22 December 2024 (UTC)
Thanks for getting back to me again!
Yes and then when I stated my reasons to Lewis, he changed his mind, as the diff I provided above shows. He is no longer in agreement with you.
Again, firstly, that's not addressing any of my other reasons not to overturn the status quo of saying the SRs were peer-reviewed without saying the Cass Review wasn't. Secondly, we can just discuss it with them, let them speak for themselves, and form a compromise, like we've been trying to do.
Regarding pornography, the report still suggests it as a cause of transness
No it doesn't. Which quote from the final report, in your view, substantiates that claim? I showed you the direct quotes from the page in the report that discusses the effects of pornography. It doesn't make any claims or assertions on the effects of pornography on TGGNC young people, let alone the one you're claiming it made: "transness was caused by pornography". How did you come to that understanding? Did it come from you reading the final report yourself? Did it come from you reading a discussion of it from a third party?
we can’t treat Cass and York as the same
I'm not seeking this. I just wanted to say the systematic reviews were peer-reviewed and where they were published, and that they formed the bulk of the evidence which informed the final report of the Cass Review and its findings, because this information is relevant in the methodology section and all of these points are objectively true.
Thanks again! 13tez (talk) 13:38, 22 December 2024 (UTC)
Thanks for getting back to me again, @Lewisguile!
I'm feeling a fair bit better at the moment — nighttimes are the killer because it's hard to breathe.
I hope you continue to get better! Having had covid myself, I know exactly what you mean.
The Royal Australian...This wording seems fine to me. I restored it as it was....Linking the RCPCH and adding the abbreviation afterwards is also fine
Thanks!
I think this is a better compromise: "The Cass Review commissioned several independent systematic reviews into different areas of healthcare for children and young people accessing gender identity services in the UK." Would you be happy if we made this change?...I would leave "peer reviewed" with the publication info, like so: "The systematic reviews were published in Archives of Disease in Childhood, the peer-reviewed medical journal of the Royal College of Paediatrics and Child Health."
Yeah, I'm happy with that. I can live without the sentence on them being the highest level of research. I don't mind the omission of peer-reviewed in the first sentence, so long as we include that they were published in aodic and that it is peer-reviewed later on.
If anything else needs to go in here, I'd suggest an endnote, such as: This is where we could use your refs about the value of systematic reviews.
Yeah, that's actually a good idea. Would you be ok with having the information on systematic reviews being the highest level of evidence in an endnote like that? It could be a couple of sentences to inform the reader as to what a systematic review is, why they're good evidence/were used, etc?
I do, in that the topics covered necessarily imply they were things being looked for, if that makes sense?
Fair enough, I honestly see the two as distinct, so I didn't anticipate it as a potential issue at all.
I've suggested alternate wording that doesn't require another short sections within a short section: Key concerns which led to the creation of the review included
Thanks for compromising! I would say I think it was more readable as a bulleted list and I did qualify it by saying those were the key issues the report listed (albeit on a single page which can't go too in-depth) as the key motivating issues. Even though the rise in referrals and other concerns have been documented and are objectively true, I feel like it's also useful to say they're what the report itself says were the key issues.
What do you think of these suggestions in general?
Comparing my originally reverted edit to the current one, I'd make the following points:
On the Background section:
  • I'd say that the "stated concerns" were sourced from the review
  • I'd move "over two years per patient" to immediately after "waiting lists" to make the link more clear
  • We can omit the point re the change from mostly AMAB to mostly AFAB since it's shown in the graph and hard to explain in short form
  • I wouldn't say it was a "reported trend" since it objectively did happen and "trend" seems a bit deriding and unobjective (I know it was my original wording, but it was something I was planning on changing anyway)
On the Methodology section:
  • I (and Barnards.tar.gz) thought the pyramid image was helpful to understand the point of the systematic reviews. How would you feel about including the image with a similar caption, so long as we don't discuss it in the text as well?
  • The information on where the systematic reviews were published (the journal and the fact it's peer-reviewed) has now been removed. I feel like this is useful for the methodology section and removes the way in which we compromised on the matter. There is now no reference to the systematic reviews being peer-reviewed, even though this detail was already present even before my reverted edits and its definite relevance in the methodology section.
  • We are now excluding the information that the systematic reviews formed some (re MEDRS "the foundation") of the evidence for the findings of the Cass Review. Given its relevance in the methodology section, please can we restore this information?
  • Can we frame the last paragraph as objective truth? We're saying "the report says it did x" regarding other types of evidence it gathered. However, the consensus here was already that the final report itself is a MEDRS source, including on itself, and, realistically, we will also be able to find other MEDRS sources to substantiate these facts anyway. Per WP:VOICE, we should "avoid stating opinions as facts."
Miscellaneous:
  • Can we restore the external link to the GIDS series? I feel like it was useful.
Thanks again, hope you keep getting better! 13tez (talk) 20:39, 21 December 2024 (UTC)
Sorry for the late reply. I've been sleeping in an upright position this time to make breathing easier, and that's been working for me. I'm not so foggy-headed now.
Let me mull over your suggestions today and see if I can come up with some ideas that will also work for the others. I was quite happy with where things were yesterday, but I know a few people had issues with some of the wording since and we have, as a result, lost some of the wording I'd added as a compromise (as you noted).
I think we should be careful to avoid suggesting that the Cass Review was itself peer reviewed, rather than that it drew on peer reviewed sources (the systematic reviews). I think the picture gives the impression that the Cass Review itself is equivalent to the systematic reviews. I think a better image would be one which shows the relationship of the Cass Review to the published literature, grey literature, original research, and public engagement workshops. Does such an image exist? I'll re-read the reports today to see if I can find anything.
I think we can get to a consensus soon, but it is probably worth us tagging everyone currently active on the page, so we can make sure someone doesn't come along and undo any edits we've agreed upon here? Maybe I can start new threads for the Background and Methodology sections, so we can discuss the wording on them in their entirety in one dedicated place each? Individual tweaks that rely on other edits get lost when people start reverting or editing part of the text on isolation. Lewisguile (talk) 08:44, 22 December 2024 (UTC)
Hey @Lewisguile,
Sorry for the late reply. I've been sleeping in an upright position this time to make breathing easier, and that's been working for me. I'm not so foggy-headed now.
No problem! Take your time to get better!
we have...lost some of the wording I'd added as a compromise (as you noted).I think we should be careful to avoid suggesting that the Cass Review was itself peer reviewed, rather than that it drew on peer reviewed sources (the systematic reviews)
I'm yet to see a MEDRS source which can substantiate that the Cass Review itself wasn't peer-reviewed, so we still can't include it in the article. We could combine two of the sentences I made previously which might add the balance you want, something like: "The systematic reviews, which made up much of the evidence that informed the findings and conclusions of the Cass Review, were published in Archives of Disease in Childhood, a peer-reviewed medical journal..." This is more clearly saying that the systematic reviews were published in a peer-review journal and that they were some (per MEDRS "the foundation") of the evidence that informed the Cass Review, without suggesting the Cass Review itself was peer-reviewed. What do you think of that approach?
a better image would be one which shows the relationship of the Cass Review to the published literature, grey literature, original research, and public engagement workshops. Does such an image exist?
An illustrative image of the evidence base of the Cass Review can be found on pages 23 and 52 of the final report. I was thinking of making something similar and adding it to the methodology section myself to illustrate how the review gathered evidence then used it to inform its findings.
Maybe I can start new threads for the Background and Methodology sections, so we can discuss the wording on them in their entirety in one dedicated place each?
That's probably a good idea. I think we're almost there with the background section, so it doesn't make sense to conflate it with the discussions on the methodology section.
I think we can get to a consensus soon, but it is probably worth us tagging everyone currently active on the page, so we can make sure someone doesn't come along and undo any edits we've agreed upon here?
Yeah, that might be a good idea as well.
Hope you feel better soon! 13tez (talk) 13:20, 22 December 2024 (UTC)
Apologies again for the delay. I was feeling better, but then I took a heavy dip after lunch. I'm so sorry, because I feel like I've opened a can of worms and now can't deal with it as promptly as I normally would. Usually, I'm pretty good at getting back to people and offering suggestions. (Look at the November 2024 Amsterdam riots for an example – I'm obviously drawn to contentious topics!)
I want to dive into editing the Methodology and Background sections with you and @Snokalok, but I just don't think I can do it today.
Re: the image on p.24, I think that one's suitable (or obviously one like it which we can use).
I'll quickly offer my thoughts on this: The systematic reviews, which made up much of the evidence that informed the findings and conclusions of the Cass Review, were published in Archives of Disease in Childhood, a peer-reviewed medical journal...
Bearing in mind that Snokalok wants all this as an endnote, including the bit about the Cass Review not being peer reviewed, how about this tweaked version: The systematic reviews were used alongside to inform the conclusions of the Cass Review. I don't want to say made up much of the evidence if Cass doesn't say that. From her intro and pages before and after the image on p.24, she states that she made her decisions based on the evidence she had available at the time, which doesn't specify any ratio or which evidence was given priority. She also says she drew her own conclusions based on that evidence, so she's interpreting things as she sees appropriate. She refers to the systematic reviews throughout, but she also refers to other forms of evidence. My experience of being involved in similar processes is that the systematic reviews inform a process of discussion and decision-making, but the committee (in this case, it may just be Cass on her own; I admit I don't know as much as some others here do) can decide whatever they think is justified, using all the available sources to explain it. Sometimes you lean more or less on the reviews, and clinical judgment and committed decision can count for a lot.
Is there any consensus among other experts on the ratio? Either way, for endnotes, I usually use {{efn|Text here.<ref name="x" /><ref name="y" />}}, which would look like this: (using two random citations from the article). ETA: Adjusted this based on Snokalok's reply upthread which I missed.
  1. Cite error: The named reference TheChair was invoked but never defined (see the help page).
  2. Cite error: The named reference NHSCommissioning was invoked but never defined (see the help page).

Lewisguile (talk) 18:58, 22 December 2024 (UTC)

Methodology

@Lewisguile I have reverted the following edit.

This is the part for describing the report's methodology, neutrally, based on the best sources. Void if removed (talk) 13:50, 21 December 2024 (UTC)

Thanks, I saw that. I do think criticism of the processes is valid for the methodology section, and hiving it off only to the Responses section ends up risking non-neutrality. However, I am happy to add it to the Responses section for now and if anyone else feels strongly that it should also go in Methodology, we can return to that then.
As you specifically mentioned the complaints about trans non-inclusion/the governance group, I assumed you didn't have any problems with the wording changes re the description of meta-analysis? The wording there was awkward and didn't appear to be sourced on the page listed of the Cass Review (p. 4 is the title page), so I have replaced it with (a paraphrase of) the description used in the glossary on page 243, and changed the page in the reference too. If I've missed something there, let me know. Lewisguile (talk) 14:03, 21 December 2024 (UTC)
The Horton response has been discussed to death here and was excluded as an individual response in a compromise. It's also a response to the Interim review and not appropriate for the responses to the review itself. Void if removed (talk) 15:23, 21 December 2024 (UTC)
Do you have a link to the prior discussion showing consensus? I'm happy to self-revert if needed. Lewisguile (talk) 15:28, 21 December 2024 (UTC)
Never mind. Think I've found the discussion re: TOR. I'll go back in and remove it. Lewisguile (talk) 15:47, 21 December 2024 (UTC)
Hi @Lewisguile, I hope you've had a good Christmas and that you're feeling better now!
Re: the image on p.24, I think that one's suitable (or obviously one like it which we can use).
Yeah, I agree. I think we should make our own version of it since SVG is preferred and going to be higher resolution, plus for licensing reasons.
The systematic reviews were used alongside to inform the conclusions of the Cass Review.
That's super diluted, even compared to the version of the article in place before my originally contested edits, which talked about the systematic reviews separately, including saying that they were peer-reviewed (which is relevant to the methodology underlying the Cass Review) without also saying the Cass Review wasn't itself peer-reviewed. Compared to my edits which were originally being contested, it's also missing the illustrative pyramid image and journal where the SRs were published, which would both also contribute to readers understanding the methodology behind the review.
Is there any consensus among other experts on the ratio?
Plenty of MEDRS sources substantiate the fact that the systematic reviews contributed most of the evidence used to make the findings and recommendations of the review, including the review itself.
Either way, for endnotes...
I don't mind compromising and putting some information into an endnote, but the article currently has less information on the Review's methodology than even before my original edits, and it reads as if the focus groups and qualitative research had as much input into the review's findings, which is simply not the case.
Thanks again! 13tez (talk) 23:03, 30 December 2024 (UTC)
Hi @13tez,
I had a good Christmas. I hope you did, too.
I actually think the article is currently looking quite good. If anything, I think we need a sentence or two more on each of the other forms of evidence collected, rather than adding more about the SRs. That section is already heavily slanted towards the SRs, which aren't the topic of the article. The picture from p. 24 will also help in this regard.
As Cass makes clear, the SRs are just one part of the review and Cass often uses them alongside other forms of evidence to arrive at her own conclusions and recommendations. The evidence she draws on is often quite disparate – such as evidence of gender identity among intersex people.
I think the endnotes are the way to go to add a little bit more context, if needed. Someone else suggested adding where it was published, in the body, without any ceremony (i.e., without adding that it's a peer reviewed journal or is affiliated with the Royal College), and I think that's probably fine instead of endnotes, but it should probably only be one or the other. More than that isn't necessary, because the article is about the Cass Review and not the SRs. Anyone who wants to know more about systematic reviews or the journal in question can click through the blue links to get that info.
Similarly, I disagree the statement I suggested was diluted, since Cass herself often refers to the evidence "informing" her work, rather than being "based on" it or anything stronger. E.g.:
  • The report includes findings from the systematic reviews commissioned to inform the work. (p. 15)
  • She commonly describes what an SR "showed", "found", "documented", etc, and makes clear that SRs are the highest level of scientific evidence, but then mentions other sources and makes her conclusions based on all of those sources.
  • She's very clear this is her report, using first person. It's not the University of York's report: In my interim report I provided advice, My interim report highlighted the gaps in the evidence base, already highlighted in my interim report, my final report (at least twice), my recommendations, etc.
I think the text on SRs has to be proportionate to everything else and doesn't need to explain in detail what an SR is, since we don't also do the same for other sources of evidence (quite rightly in my opinion). Otherwise, the article becomes a WP:COATRACK.Lewisguile (talk) 08:41, 31 December 2024 (UTC)
I've added some of your additions (and others) as endnotes to the Background section, along with the "See also" link. I've taken a stab at including some of the content from prior edits into the Methodology section here: https://en.wikipedia.org/Talk:Cass_Review#c-Lewisguile-20241231174000-Methodology_2 Let me know your thoughts. Lewisguile (talk) 17:57, 31 December 2024 (UTC)

Interventions

@Snokalok you have changed "interventions" to "treatments" WRT the systematic reviews, tagged as a minor change. These reviews all say "interventions". This change is not warranted, and not minor. Treatment implies a positive act of care, intervention is neutral, and this wording is both preferable and accurate as relates to the sources. Void if removed (talk) 18:28, 21 December 2024 (UTC)

I disagree entirely. Yes, the sources say interventions, but intervention is not a neutral word, treatment is. Think:
”NSAID intervention” severe, foreboding
”NSAID treatment” neutral, ambiguous
”electroshock intervention” severe (and rightly so)
“Electroshock treatment” still appropriately severe but only because of the word electroshock, the word treatment is doing no lifting there.
”intervention” is a word with a negative connotation. Treatment is neutral, it doesn’t convey a positive connotation (as seen by electroshock) Snokalok (talk) 19:30, 21 December 2024 (UTC)
It's standard terminology. It's also what the sources use. Void if removed (talk) 20:02, 21 December 2024 (UTC)
Treatment is standard terminology, and the source is not neutral. We have an entire section of medorgs being very loud about that fact. And as wiki editors, it’s our duty when a source is not neutral to state its relevant info in neutral terms. Treatment is better than intervention Snokalok (talk) 20:04, 21 December 2024 (UTC)
I'm sorry, I just want to be clear: are you calling the systematic reviews "not neutral"? Void if removed (talk) 20:59, 21 December 2024 (UTC)
Treatment is probably not a POV word. A treatment doesn't have to work, or be appropriate. Intervention can be neutral in med-sci circles but for the general reader it can be particularly negative because of its associations with "having an intervention". Maybe it's worth asking over at the relevant MOS article? There may be a policy somewhere that's appropriate to guide us. Lewisguile (talk) 20:23, 21 December 2024 (UTC)
It has the same connotation as “medicalize”. While technically not an inapt description, it has the connotation of invasion. See also “military intervention”, “admin intervention”. Snokalok (talk) 20:26, 21 December 2024 (UTC)
Intervention has no such connotation. This is completely standard neutral terminology in a medical research context and adding your own subjective interpretation in order to justify deviating from the language used by the sources is completely unnecessary. The section you changed lists the titles of the reviews which are neutral and self-explanatory. Trying to justify it because you think these MEDRS aren't neutral is way off. Void if removed (talk) 21:14, 21 December 2024 (UTC)
There's nothing in MOS, but our WP article on Medical treatment (actually a redirect to Therapy; Treatment is a disambiguation page) says "care" is the broadest term, "intervention" is the narrowest (meaning an individual use of a treatment, such as taking your morning tablet), and "treatment" sits in the middle. So does this fit with how Cass uses the terms?
Looking at the Cass Review itself, it uses "intervention" 289 times and "treatment" 464. That includes referencing, which suggests the consensus among experts other than Cass herself also rests on using "treatment". She also seems to use "medical treatment(s)" and "medical intervention(s)" interchangeably, as she does with "hormone treatment(s)" and "hormone intervention(s)".
It's worth bearing in mind that everyday language is always useful for an encyclopaedia, since we aren't a medical science journal and our readers aren't (just) scientists or medics. When you look at another (also controversial) medical topic, Myalgic encephalomyelitis/chronic fatigue syndrome, that also avoids using some of the scientific and medical jargon for natural language. This is despite consensus for particular terms existing in the literature.
On balance, I think "treatment" wins out based on common usage, Cass' specific usage, its clarity, and its balance of breadth versus narrowness (it covers both general treatment approaches and individual instances of those approaches being applied, which I think is congruent with what Cass means when she says "intervention (s)"). However, I accept Void if removed's assertion that "intervention" is specifically used in that particular part of the Cass Review. A happy compromise might be to use "intervention" in direct quotes, so we're attributing it to Cass, and "treatment" when using Wikivoice. How do we all feel about that? It may involve some rewording, but it seems fair. Lewisguile (talk) 09:39, 22 December 2024 (UTC)

Was the Cass Review peer reviewed?

Nothing in the article seems to address this question unless I'm overlooking it. Nosferattus (talk) 19:43, 22 December 2024 (UTC)

We are currently discussing this. Per Cass' own description of the process, she only mentions the systematic reviews being peer reviewed. The whole point of the independent review is that she gets to make her own conclusions based on that evidence. Because she hasn't documented that the review was peer reviewed, I think it's pretty clear that it isn't (and she doesn't pretend that it is). But I'm sure there are people who feel very strongly that we can't include that in the article unless it's explicitly written somewhere. I'm not sure that follows (she included the protocols, process, etc; if it's not in those, it didn't happen), but, well, it's still an ongoing discussion. Lewisguile (talk) 19:55, 22 December 2024 (UTC)
WP:V will say that we can't include that in the article unless we have a reliable source that WP:Directly supports such a statement. And if none exist, then one has to wonder whether such a statement would be WP:DUE anyway.
About the above comments on the "peer-reviewed journal": Although that is a common phrase, it is somewhat more accurate to describe individual articles as being peer reviewed, because not everything in a peer-reviewed journal always undergoes (external) peer review. WhatamIdoing (talk) 07:06, 23 December 2024 (UTC)
I think you've got things reversed here. We can't describe the report itself as peer-reviewed if we can't verify that it was. What it appears to be is an administrative summary of peer-reviewed research. We should avoid using terms that imply that the report itself is peer-reviewed, as well: specifically, we should be very clear about what was in the reviews versus what was in the report summarizing those reviews. Loki (talk) 04:04, 25 December 2024 (UTC)
I agree. We can neither describe the final report as a peer-reviewed report, nor describe it as non-peer-reviewed report, unless we have sources.
My preference is to describe the systematic reviews as being peer-reviewed articles, and to describe nothing else (not the reports issued by Cass, not the journal in which the reviews appeared) in that language. WhatamIdoing (talk) 17:28, 25 December 2024 (UTC)
I'm fine with all of the above. I think we're in agreement. Lewisguile (talk) 17:43, 26 December 2024 (UTC)
The "non peer reviewed" is inappropriate. Cass is an independent review, it isn't an academic publication. We don't call the Independent Medicines and Medical Devices Safety Review "non peer reviewed" or any other wiki page about an independent review, because they are independent reviews, not academic papers. The source being used to make the claim this is a "narrative review" (which is quite wrong) is one line in a table in a non-peer reviewed document from a thinktank. This is inadequate. Void if removed (talk) 14:30, 1 January 2025 (UTC)
@Lewisguile you've reverted this saying If peer-reviewed systematic reviews are gold standard, they are gold standard here too- please point to me where the RAND document is peer-reviewed? It is not published in any academic journal. Here are their standards for their self-published reports: https://www.rand.org/about/standards.html
Please self-revert. And using this one source to falsely call an independent review a "narrative review" is a stretch. Void if removed (talk) 15:00, 1 January 2025 (UTC)
Here is the relevant bit:
This work was supported by Indiana University Bloomington and the Medical College of Wisconsin and conducted by the Access and Delivery Program in RAND Health Care and the Social and Behavioral Policy Program in RAND Social and Economic Well-Being. This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.
Source: https://www.rand.org/pubs/research_reports/RRA3223-1.html
So it is peer-reviewed. Lewisguile (talk) 15:15, 1 January 2025 (UTC)
That line (thank you for finding and posting it) would be more reassuring if they specified external peer review. "Internal" peer review is a thing, and "rigorous", like beauty, can be in the eye of the beholder. WhatamIdoing (talk) 00:34, 2 January 2025 (UTC)
VIR found something elsewhere on their website which said they have at least two reviewers, with one in-house and at least one other/independent, IIRC. I currently find anything on this page as it's now a wall of text. Sorry about that. Lewisguile (talk) 18:17, 2 January 2025 (UTC)
@13tez why did you add a citation needed tag? The source explicitly says it's a narrative review and not peer reviewed on p 10, table 2.1 Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:34, 30 December 2024 (UTC)
Ah, that's just because I'm not familiar with that source - hence why I put the CR and SRs into different sentences, so they can be referenced separately to avoid just this type of confusion. 13tez (talk) 23:40, 30 December 2024 (UTC)
@Lewisguile Just wanted to give you a heads up I think you slightly over-reverted here. I agree with the main removal of the bloated background, but want to check if you meant to also revert the additions to methodology clarifying the review was a non-peer reviewed narrative review and expanding on its methods - I'm assuming that was accidental collateral lol. Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:06, 31 December 2024 (UTC)
I thought about it, but I think if we add that in, then we also need to add in that the systematic reviews were peer reviewed. And the problem is, small additions can result in a bunch of other things being added too, so every small change is potentially a big one. This is the draft I have been working on:

Methodology

The Cass Review was an independent narrative review which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS. It was not peer-reviewed but it commissioned a series of systematic reviews which were. In addition to the systematic reviews, the review also commissioned qualitative and quantitative research into young people with gender dysphoria and their health outcomes, conducted listening sessions and focus groups with service users and parents, held meetings with advocacy groups, and gathered existing evidence and grey literature on the lived experiences of patients. The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity, which were carried out by the University of York's Centre for Reviews and Dissemination and published in Archives of Disease in Childhood. The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. The reviews covered:

  • Characteristics of children and adolescents referred to specialist gender services
  • Impact of social transition in relation to gender for children and adolescents
  • Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence
  • Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers)
  • Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy)
  • Care pathways of children and adolescents referred to specialist gender services
  • Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence

The systematic reviews assessed the quality of the studies available and used meta-analysis to combine the results of multiple studies. The results informed Cass' conclusions and recommendations, along with the results of the other forms of evidence collected. Lewisguile (talk) 17:40, 31 December 2024 (UTC)

@Snokalok @13tez @Your Friendly Neighborhood Sociologist @Bluethricecreamman What do you think of this draft? Lewisguile (talk) 17:51, 31 December 2024 (UTC)
Looks overall good to me! I only have the minor quibble that 2/3 sentences seem a little redundant,
  • The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity could probably be merged into It was not peer-reviewed but it commissioned a series of systematic reviews which were or even removed considering the bullets.
  • The systematic reviews assessed the quality of the studies available and used meta-analysis to combine the results of multiple studies. The results informed Cass' conclusions and recommendations, along with the results of the other forms of evidence collected feels very redundant, explaining what systematic reviews are, and we already note Cass commissioned all these things
Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:58, 31 December 2024 (UTC)
I'll drop the first redundant line. For the second, I will drop both sentences. Lewisguile (talk) 08:40, 1 January 2025 (UTC)
All done. Check out the latest version. I think it's much more balanced now. I also added the RAND systematic review to the "other academics" section for lack of a better home. That seems appropriate since it's also a systematic review, mentions Cass, and details some of the similarities/differences in their approaches and conclusions. Lewisguile (talk) 09:52, 1 January 2025 (UTC)
Hey @Lewisguile,
The Background and Methodology sections were separate sections, which I think made sense. Why is the Methodology section (describing how the review was carried out) now a subsection of the Background section (describing why the review was carried out)?
The new version of the Methodology section is still diluted compared to the version in place before my originally contested edits. Before them, the article said that the SRs were peer-reviewed and independent without having to state the CR itself wasn't peer-reviewed, which some people want to, citing WP:BALANCE. However, balance is not just weighing all viewpoints or sides of an argument equally, or even equally based on how much each are voiced, it's weighing their coverage in the article in proportion to their coverage in suitable/reliable sources.
We've now removed all mention of the SRs' independence, while adding that the CR wasn't itself peer-reviewed and criticism of the SRs from RAND Corporation ("The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes.").
To me, this seems WP:UNDUE because there's consensus the (externally peer-reviewed and independent) SRs were fine, even among people who criticise the CR; I've seen no MEDRS source that criticises them; the SRs commissioned by the CR concurred with others, e.g. the Swedish and Finnish SRs; and the SRs commissioned by the CR are of higher quality than RAND's SR because they were commissioned for the NHS, carried out by the Centre for Reviews and Dissemination, independent, and externally peer-reviewed by published in Archives of Disease in Childhood, a high-quality and peer-reviewed medical journal associated with the RCPCH, while the RAND SR was created by and for a think tank and research organisation. Furthermore, I don't think the RAND review is a WP:MEDRS source because it wasn't published in a medical journal or created by a major medical or scientific organisation.
We've also relegated the explanation of what the Centre for Reviews and Dissemination is to an endnote. While I'm okay with that change in and of itself, it's another dilution from the version in place before my original edits. Editors trying to maintain balance have pushed the ship back further the other way than my changes swayed it to begin with, and out of proportion with coverage in reliable and MEDRS sources. Therefore, there is now a WP:BALANCE issue.
The types of evidence other than the SRs ("In addition to the systematic reviews, the review also commissioned...") should be put at the end of the section because the SRs made up most of the evidence base for the review (per the CR other pieces of evidence "supplemented" them) and it makes sense logically for readers to group information on the SRs together.
Thanks! 13tez (talk) 12:28, 1 January 2025 (UTC)
The RAND corporation stuff is definitely UNDUE, this is a primary source from a policy thinktank, not any sort of MEDRS. Void if removed (talk) 14:43, 1 January 2025 (UTC)
It is a peer-reviewed systematic review, so definitely not a primary source. See here: https://www.rand.org/pubs/research_reports/RRA3223-1.html Download the report and read it for yourself. Lewisguile (talk) 15:17, 1 January 2025 (UTC)
@13tez Methodology was supposed to be a main header. I posted some text for workshopping upthread and had made the header there a subheader so it didn't start a new topic, but when I copied it over, I forgot to fix that.
RAND is due, as it's another peer reviewed systematic review. They worked with two universities on the report. I have no problem with the SRs, and I don't think stating what they excluded is non-neutral in itself. It's true they only looked at people up to 18, whereas RAND also looked at those up to 25. That was an intentional decision and all of those things, except the bit about confidence of evidence ratings, are also said within the Cass Review itself, so it can have two sources backing it up if you'd like?
@Void if removed's edits have conflicted with mine, so the changes I made to methodology have been reverted, adding "non-peer reviewed" back in and a few other things. I had suggested the following wording for Methodology, which I think was a fair compromise:
Methodology
The Cass Review was an independent narrative review which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS. According to Cass, "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians."
The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity, were carried out by the University of York's Centre for Reviews and Dissemination, and were published in Archives of Disease in Childhood. The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. The reviews covered:
  • Characteristics of children and adolescents referred to specialist gender services
  • Impact of social transition in relation to gender for children and adolescents
  • Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence
  • Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers)
  • Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy)
  • Care pathways of children and adolescents referred to specialist gender services
  • Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence
The review also commissioned qualitative and quantitative research into young people with gender dysphoria and their health outcomes, conducted listening sessions and focus groups with service users and parents, met with advocacy groups, and gathered existing evidence and grey literature on the lived experiences of patients. Lewisguile (talk) 15:26, 1 January 2025 (UTC)
Re: "supplemented", I did find this in the final report, but in this context The Review has therefore had to base its recommendations on the currently available evidence, supplemented by its own extensive programme of engagement (p. 20). This means the engagement activities were supplements, but the qualitative and quantitative research that the Cass Review also commissioned can't reasonably be slotted into the "engagement" category over the "available evidence" category. The quantitative research, certainly, wouldn't fit that criteria. Specifically, she also refers to the SRs on the international GLs as "supplementing" the evidence (p. 53: an appraisal of an international guidelines and international survey were undertaken to supplement this information). In the box underneath, the appraisal of int'l GLs is the two papers: Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1) and Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2), so I'm not sure we should draw a specific conclusion re: proportionality from the word supplement alone. Was it used more specifically anywhere else that you've found? Lewisguile (talk) 15:54, 1 January 2025 (UTC)
Hey @Lewisguile, thanks for getting back to me.
RAND is due, as it's another peer reviewed systematic review. They worked with two universities on the report. I have no problem with the SRs, and I don't think stating what they excluded is non-neutral in itself. It's true they only looked at people up to 18, whereas RAND also looked at those up to 25. That was an intentional decision and all of those things, except the bit about confidence of evidence ratings, are also said within the Cass Review itself, so it can have two sources backing it up if you'd like?
I don't necessarily doubt that it was peer-reviewed or that they worked with two univertisites to make it. However, it wasn't published by a major medical organisation or in a reputable medical journal. Therefore, I don't think we can count it as a MEDRS source, and I certainly don't think so to the extent that its criticism of the CR's SRs (which I view as higher quality sources for the reasons I gave before) should be afforded weight (especially when the quote comes from a paragraph explaining these were minor changes and the SRs mostly worked the same anyway). If you can find some other sources to back it up, that'd be better, both to have sources we all view as MEDRS/suitable stating these criticisms and to ensure there's enough coverage of them in MEDRS/suitable sources to warrant their inclusion (even if we view the RAND review as MEDRS, if these criticisms aren't made in other MEDRS sources, they won't have enough coverage to be included per weight).
Re: "supplemented", I did....I'm not sure we should draw a specific conclusion re: proportionality from the word supplement alone. Was it used more specifically anywhere else that you've found?
I think there are one or other two sources I don't have to hand saying the SRs were the foundation of the evidence and the CR's findings. From page 47 of the final report though: "The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews on a range of issues from epidemiology through to treatment approaches, and international models of current practice." You've also seen: "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians." I think the "as well as" puts emphasis more on the SRs being the "bedrock" of the CR. In all, I think it's reasonable to say the SRs were the core of the evidence the CR used; what do you think now, with this all in mind?
Regarding the draft version of the Methodology section (and comparing to the section before my originally contested edits and after them as well):
  • "According to Cass..." We should try to write the text ourselves, rather than quoting, especially given how contentious this article is: people will see "according to Cass" and immediately overwrite it because they "disagree with the review".
  • I appreciate you putting the non-SR stuff at the end, I think it works much better that way
  • I'm fine with the explanation of the role of the Centre for Reviews and Dissemination moving to an endnote if it helps get a compromise
  • Why did you remove the paragraph including the Mixed Methods Appraisal Tool and Newcastle–Ottawa scale? They were key to how the SRs worked and help the reader better understand the CR's overall methodology.
  • We've still swayed further towards criticisms of the SRs than even before my edits. For example, the section used to say the SRs were independent and peer-reviewed. Now, it doesn't, and instead we have some (minor in context) criticism of them. The boat has still been pushed back further than it swayed to begin with.
I might make a revision of the methodology section based upon the version present before my originally contested edits, with some tweaks - maybe adding extra details people want as endnotes and adding more references. What would you think about that?
Thanks again! 13tez (talk) 17:20, 1 January 2025 (UTC)
Hi @13tez,
"The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews on a range of issues from epidemiology through to treatment approaches, and international models of current practice." You've also seen: "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians." I think the "as well as" puts emphasis more on the SRs being the "bedrock" of the CR. In all, I think it's reasonable to say the SRs were the core of the evidence the CR used; what do you think now, with this all in mind? I really don't see it that way. In fact, with the "to support this" part in there, that shows me that there's no consistency in how she uses phrases like "support", "supplement", etc. How can the SRs be the most important thing if they only support the other evidence looked at? She's using these terms loosely throughout, and the only logical meaning, from my POV, is that the only consistent statement we can make is that she's using all this information to support her findings/recommendations, not that some evidence is prioritised and the rest is secondary. Anything more than that is WP:OR. Given the ambiguity, I think we either have to include her direct quotation or remove the claim of SR centrality altogether.
However, it wasn't published by a major medical organisation or in a reputable medical journal. Therefore, I don't think we can count it as a MEDRS source, and I certainly don't think so to the extent that its criticism of the CR's SRs (which I view as higher quality sources for the reasons I gave before) should be afforded weight (especially when the quote comes from a paragraph explaining these were minor changes and the SRs mostly worked the same anyway). If you can find some other sources to back it up, that'd be better, both to have sources we all view as MEDRS/suitable stating these criticisms and to ensure there's enough coverage of them in MEDRS/suitable sources to warrant their inclusion (even if we view the RAND review as MEDRS, if these criticisms aren't made in other MEDRS sources, they won't have enough coverage to be included per weight). As I said upthread, the Cass Review and its SRs already state what the remit of the review was, and therefore its limitations. So this is equally sourced by the Cass Review/SRs. The only part that isn't is the part about confidence ratings, and I'm happy for that particular part to be removed (although, the Cass Review doesn't include confidence ratings, so it's also not untrue). Besides which, we don't necessarily exclude RSes just because some sources are better. Only if the better source conflicts. But there isn't a conflict here, since Cass isn't contradicting RAND. Furthermore, RAND is peer reviewed (Cass isn't) and RAND's health research arm is well regarded and influential, having provided evidence for the US government among others. The SRs being published in peer reviewed journals is one-nil to the Cass Review, but the fact the overall RAND report is peer reviewed and Cass isn't makes it one-all. So there's not much in it. And again, Cass supports RAND's statement about limitations because those limitations were largely intentional.
But I feel very strongly that we shouldn't exclude RAND just because some editors prefer Cass or think it's more reliable, since the fact Cass has been based on SRs has been repeatedly used to already exclude other sources that are critical of the review. We need to be consistent here. Moreover, we shouldn't be excluding all criticism here; at worst, we should be including stuff with caveats to reflect the uncertainty Cass herself says exists in the evidence base (and therefore in her own findings). The person who added RAND in the first place obviously agrees it's due and so do I. Minimising critique (or perceived critique, since I don't feel RAND is actually giving a critique rather than simply explaining limitations) introduces bias in itself.
"According to Cass..." We should try to write the text ourselves, rather than quoting, especially given how contentious this article is: people will see "according to Cass" and immediately overwrite it because they "disagree with the review". It's a direct quote. That's the whole point. The compromise is to include the direct quote so that others can make up their own mind. Going back to a statement in Wikivoice isn't a compromise, because one of us is going to disagree with how it's framed. The only Wikivoice statement I think is justified is something along the lines of "to draw her conclusions, Cass commissioned systematic reviews, qualitative and quantitative research, etc".
Why did you remove the paragraph including the Mixed Methods Appraisal Tool and Newcastle–Ottawa scale? They were key to how the SRs worked and help the reader better understand the CR's overall methodology. The final report section details the tools used for each outcome/finding, so it's redundant. Also, specific trumps the general here, so being able to say "this SR used x" is better than a generalised statement.
If you want to propose some new text, please add a draft here and ping me. Then we can discuss it and workshop it without any intervening edit conflicts or reversions. However, I did make several compromises already and they have been repeatedly undone afterwards (I know there have been lots of editors making changes), so the draft I've proposed is far closer to your preferred wording than mine. I also suspect it's still a bit quiet here after Christmas, and we might want to give others a chance to chime in too, since there seems to be only 3 or 4 of us engaging regularly at the moment. Lewisguile (talk) 18:24, 1 January 2025 (UTC)
Hey @Lewisguile, thanks for sharing your thoughts again.
How can the SRs be the most important thing if they only support the other evidence looked at?
She said: "The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews..." She's saying the SRs were commissioned to support the ability of the review to be "grounded in a thorough...". This ability ("to be grounded...") is the "this" in "support this", not the other types of evidence. After pointing that out, and considering the other references we've discussed so far ("supplemented" and "the bedrock"), is your mind changed at all?
As I said upthread, the Cass Review and its SRs already state what the remit of the review was, and therefore its limitations. So this is equally sourced by the Cass Review/SRs
I'd be happy to include the scope/remit/limitations of the SRs or CR if they can be sourced from the CR or SRs themselves and are due etc. Do you think we could include something like that instead of the RAND stuff altogether to move forwards on this?
So there's not much in it.
I don't want to debate the relative quality of the two sources much more, since it isn't really productive, but: the NHS is the type of medical organisation (and listed as an example) in WP:MEDORG and they commissioned the review (and the group who carried it out serve the NHS); and the SRs were published in a (highly) reputable medical journal. Neither of these points are true for the RAND review, so I consider it to be of lower quality and credibility.
Again, I'm not assuming it's wrong - it doesn't even seek to criticise or "debunk" the SRs/CR anyway - just that I don't think we can assess its quality to be high enough under MEDRS to warrant the inclusion of its content in the article which is currently being presented in a manner that undermines the credibility of the SRs/CR.
I don't feel RAND is actually giving a critique rather than simply explaining limitations
Yeah, I don't feel that way either. RAND never says "the Cass Review was wrong" and the limitations are discussed, in context, as small differences from their own approach and not as criticisms anyway. However, the whole basis of including some of their described limitations of the SRs seemed to be critical and included to form some kind of balance "against the systematic reviews".
It's a direct quote. That's the whole point. The compromise is to include the direct quote so that others can make up their own mind
I was trying to say we don't need to make up our own minds on whether the CR commissioned "a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians". All of this is currently in the quote from Cass. However, this is all objectively true, not being contended here, and supported by MEDRS sources other than Cass. We can move that the CR commissioned that stuff out of the quote. I think it'd be beneficial because we should use direct quotes sparingly and, given how contentious this article is, people will see "according to Cass" and immediately overwrite it or add other text afterwards to "debunk" it because they "disagree with the review". Do you see what I mean about moving what we can out of the direct quote?
The final report section details the tools used for each outcome/finding, so it's redundant. Also, specific trumps the general here, so being able to say "this SR used x" is better than a generalised statement.
Yeah, I take your point that the Newcastle–Ottawa scale is redundant when included in both the methodology and final report sections. I think it makes more sense to include in the methodology section than the final report sections. In other words, describe how the quality of research was assessed in the methodology section, then describe the outcome of these processes in the final report section. What would you think about that? Ditto for the Mixed Methods Appraisal Tool.
However, we're now missing the explanation of why these tools were used ("because no blinded controlled studies – those usually thought of as having the highest quality – were available") and that meta-analyses were used to combine the results of different research in the SRs. I think this is important information, in part because "the CR excluded non-blinded studies which was unfair" is a widely covered and shared claim, and, in part, to explain the methodology underpinning the SRs and CR. Do you agree with me here? How do you think we could restore this information? I genuinely thought that paragraph had been removed accidentally, because I hadn't seen anyone objecting to it before.
If you want to propose some new text, please add a draft here and ping me. Then we can discuss it and workshop it without any intervening edit conflicts or reversions.
Sure, thanks again for working in good faith to compromise. I might make one in my sandbox or something similar and ping you with it.
Thanks! 13tez (talk) 22:13, 1 January 2025 (UTC)
Again, though, "to support this" doesn't mean "we used the systematic reviews over everything else". There's no explicit statement to support "we used this more than anything else", so the rest is a matter of interpretation. If the meaning is as clear as you think it is, then it will be equally clear if we include an original, direct quote? We could remove According to Cass, since the statement is sourced, while still using the direct quote. That will avoid the impulse for someone to try to counter it. We can also add invisible text to advise others not to do that in future.
Re: RAND versus the Cass Review, R (it's still sourced)AND has existed since c.1948, was funded by NIH and others, and regularly contributed research to the CDC and other governmental departments in the U.S. While it wasn't published in a journal (it says all its publishing is "open publishing"), their review was written by multiple authors and peer reviewed. The only person who needed to be convinced in the Cass Review was Cass (a self-described non-expert), so she was free to interpret the evidence how she wanted to. Which is why, in places, she makes her own conclusions, and draws from disparate bits of evidence like sex-rearing in DSD.
My main concern at this stage is that if nothing is allowed in that isn't deemed to be equal to the Cass Review by a small group of editors, then we effectively minimise any critique, discussion or nuance. WP:MEDRS shouldn't be used to silence disagreement, especially when the medical consensus across multiple countries isn't as clear-cut. That's before we even get into the politics of this – Cass is a politician, and members of the last government were proud to announce their own support of the review, even after they had made non-neutral statements about this subject before. Indeed, similar claims have been made about Cass.
All of which is to say that no evidence is perfect, all sources are biased, and the Cass Review itself isn't perfect. The SRs are mostly fine, but the CR =/= the SRs alone. There's a significant amount of synthesis and interpretation occurring to create the conclusions and recommendations, and Cass herself doesn't deny that.
What I suggested to VIR elsewhere was that we could remove the part about certainty ratings and then cite the remainder to both RAND and the Cass Review.
As for the grading tools, some of those would have been used either way. That's what a systematic review does. RAND used GRADE, which is what NICE uses, whereas York used a mixed approach. It's different but not particularly unusual, and so not majorly notable. However, I have no problem with those more specific statements from the findings being replaced with a more generic statement – so long as you're aware that's what's happening. I also don't mind the statement about no blinded studies being in there. Though, blinded RCTs are usually the highest standard and there are particular circumstances that make blinded RCTs unlikely or difficult to obtain here – e.g., control will always be treatment x + treatment y versus treat ebt X or y alone, or treatment x versus treat ebt y. You'll never get treatment x versus placebo for blockers, for example, because it's obvious whether you're going through puberty or not (especially if you have dysphoria). So someone is likely to feel, at some point, that this clarification also needs to be made. Not mentioning the blinded part avoids that. We already explain most of the evidence was of insufficient quality, which does the same thing for those who are interested in knowing such details anyway.
If you post a draft in sandbox, I'll happily take a look. Thank you. I'm going to put a notice in the WikiProject so we can get more eyes on this anyway. There's a danger whatever we say here will get reverted again otherwise. Lewisguile (talk) 08:59, 2 January 2025 (UTC)
About this sentence, which is what I believe you're talking about: The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. This is a selective statement of differences between the RAND report and the Cass report. (It leaves out "used different risk-of-bias assessment tools, excluded studies meeting less than 50 percent of bias assessment criteria from syntheses in the hormonal intervention reviews".)
I don't think that the first even sounds like a "criticism" of Cass; it sounds like a simple, factual description. In order:
  • The Cass Review looked at studies of the relevant population. This is a good thing, right? (If the world never sees another study for children with cancer that relies on geriatric results, it will still be too soon.)
  • The Cass final report excluded weak evidence. The RAND report included weak evidence, and I guess that's their choice, but it's not actually bad to exclude weak evidence.
  • The Cass final report also excluded studies that were not published in the international language of science. Not only is this usual, but nobody has since reported even a single study in any other language that could be used to seriously challenge any of Cass' recommendations. The RAND report says they didn't exclude non-English sources and still only found one non-English study that met their inclusion criteria (in Spanish; I believe it was PMID 36705053). This is therefore an unimportant difference between the RAND and Cass reports.
So what's left is: It did not provide certainty-of-evidence ratings for outcomes.
My main concern is that this sentence will not be understood by some (probably most) readers. We have seen unfortunate misunderstandings happen before (e.g., in the "they rejected 98% of the scientific studies!" misinformation), and I would like us to do our part, small as our part may be in this instance, to avoid setting off another round of drama on antisocial media. If we dump this in the article, some people are going to believe that they have now, finally, after all these months, found the detail that proves the Cass Review is 100% bad, because they have no idea what this means, but it sounds all science-y and it must be some kind of stunning criticism, or else Misplaced Pages wouldn't have mentioned it.
What RAND's statement means is that they intend to spam (low certainty) and (very low certainty) at the end of certain sentences in their report, and they notice that the Cass final report did not do this. (With a quick search, RAND didn't label anything in their report as having a certainty rating higher than "low".) RAND writes, e.g., in their Summary (bottom of page V) that puberty blockers slow pubertal progression (low certainty), GAH is associated with cross-sex pubertal changes (low certainty), and both of these reduced gender dysphoria (very low certainty), where Cass would have said basically the same thing, except not spammed "(low certainty)" after the items.
Including this label is the standard form for GRADE approach#Certainty of evidence, but including or omitting that information doesn't actually change the recommendation/assessment, and both the interim and the final report already said that the evidence base sucks in general. See, e.g., this line in the Cass final report:
This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.
That pretty much tells you that the certainty of evidence for "outcomes" is low (except when it's very low, or non-existent).
Additionally, quite a lot of the Cass final report isn't something that would have this sort of statement anyway. You can't have a certainty-of-evidence rating about whether Further research is needed.
My bottom line is that if we're going to mention this – and there's no clear reason why we should – we need to be precise in what we're saying and explain what that means and why it (doesn't) matter in practice. It might help to stop thinking of this as a criticism. RAND isn't complaining about Cass's choice. Also, they did a review of the evidence in a somewhat different way (e.g., including case studies), and still ended up in the same place, namely that the existing evidence base sucks (or is entirely non-existent for two of their categories). WhatamIdoing (talk) 11:38, 2 January 2025 (UTC)
I don't see it as criticism of Cass. I see it as describing limitations, which is also pretty neutral in this context. I've said as much elsewhere. My feeling, however, was that people are unduly anxious that it is a critique, which is why they don't want it in the article at all. I disagree with that stance and believe RAND is suitable to use. RAND isn't/wasn't just used in the article to cite the sentence above – it was also used to cite the limitations in terms of other countries. I.e., this is a review for the NHS and isn't necessarily applicable to other countries' health services. Which again, is blindly obvious to us, but a lot of people have spread misinformation about that part, such as that US politician who has tried to ban certain treatments citing Cass. That is relevant for the same reasons you cite: avoiding misinformation. So, broadly speaking, if we're in agreement that RAND is fair to use in the article, I'm happy.
However, if we're also including lots of detail on the SRs, then mentioning the (intentional) limitations is also warranted. I wanted less explanation of the SRs in general, but as 13tez feels very strongly that we need more info on them, then we should balance that out by adequately setting expectations. Lewisguile (talk) 18:30, 2 January 2025 (UTC)
I don't feel like we're including "lots of detail on the SRs".
The text currently says:

:::::::::::::It commissioned a series of several peer-reviewed, independent systematic reviews that looked into different areas of healthcare for children and young people with distress related to gender identity, was carried out by the University of York's Centre for Reviews and Dissemination, and was published in Archives of Disease in Childhood. The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. The reviews covered:

  • Characteristics of children and adolescents referred to specialist gender services
  • Impact of social transition in relation to gender for children and adolescents
  • Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence
  • Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers)
  • Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy)
  • Care pathways of children and adolescents referred to specialist gender services
  • Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence
Which is to say, it provides basic information about who-what-where and the main subjects of the seven reviews.
The "restricted to studies focusing on minors" is redundant with "looked into different areas of healthcare for children and young people". Mentioning the "non-English studies" thing implies that this is a material restriction, which is known to be false. For that matter, "non-English studies" implies that there was more than one non-English study, which RAND says is false. I think we should remove both of those.
Also, that first sentence is 50 words long. Maybe that could be split. WhatamIdoing (talk) 22:40, 2 January 2025 (UTC)
None of this is DUE - the RAND report could maybe go on puberty blockers or gender-affirming healthcare but its not a response to or critique of Cass, nor is it an authoritative source on Cass' methodology. It doesn't encompass the same evidence, and it isn't published in any reputable journal. Void if removed (talk) 21:10, 1 January 2025 (UTC)
That's your opinion, and frankly this feels like WP:BLUDGEONING at this point. You've vigorously fought every single source which critiques Cass in even the lightest terms possible. It risks becoming WP:STATUSQUOSTONEWALLING. Lewisguile (talk) 08:37, 2 January 2025 (UTC)
I lean towards agreeing with Void's suggestion that RAND is more relevant to other articles. Also, I think you're wrong to interpret RAND as "critiquing" Cass at all. WhatamIdoing (talk) 11:39, 2 January 2025 (UTC)
See above. I don't think it's critiquing Cass. But the objection to it seems motivated by keeping out criticism, whether it actually is or not. Lewisguile (talk) 18:32, 2 January 2025 (UTC)

Extensive changes

@Lewisguile going through your recent series of changes, re: this edit https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1265397808&diffonly=1

This was accurate and not misleading. The issue is the citation referred to page 5, when it should be page 5 of Appendix 2 of the report. I ask you to reinstate the old text and fix the citation. Void if removed (talk) 21:14, 26 December 2024 (UTC)

Thanks for catching that re: the citation. I've just checked that page now (p. 273 in the Final Report), and it says: There is very little information about detail or type of psychological care received by children and/or adolescents under the care of a specialist gender service, and there is limited low quality evidence on the outcomes of psychosocial interventions for children and adolescents with gender dysphoria or incongruence. Most analyses of mental health, psychological and/or psychosocial outcomes showed either benefit or no change, with none indicating negative or adverse effects. Only three studies assessed interventions that were specifically designed for children and/or adolescents experiencing gender incongruence, but these interventions varied considerably in content and delivery. I think the reason Cass didn't include this in the main report is because they were low quality findings, and hence weren't up to scratch.
Instead, Cass says (p. 30): The systematic review of psychosocial interventions found that the low quality of the studies, the poor reporting of the intervention details, and the wide variation in the types of interventions investigated, meant it was not possible to determine how effective different interventions were for children and young people experiencing gender distress.
So that's the takeaway. She couldn't make any conclusions due to low quality evidence. Including details of the low-quality results is likely WP:UNDUE and suggests we should do the same for other low quality outcomes. In this case, after confirming the text is in the appendix, I still think it shouldn't be in there. Lewisguile (talk) 22:33, 26 December 2024 (UTC)

Updates and copyedits

I have gone through the article to make some general copyedits for length and repetition, and to add page refs to some of the citations (see diffs here – moving stuff up has made some edits look larger in markup). I have tried to keep the meaning the same. In a few instances, I have removed text that was either apparently unsourced or which didn't reflect the source material (see thread immediately above this one). Where I could, I simply reworded such text, and only removed it when it wasn't there at all in the sources or was unclear/misleading. I'm noting here a few of my own queries/things we might still want to consider:

  • There are conflicting views about the clinical approach, with expectation at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services. We previously said clinicians had expectations far from the norm based on this, but I think this is actually talking about the expectations of service users and their families. I.e., that the expectation among patients and their families that they will/should receive treatment x, and that clinicians who don't offer this worry they'll suffer sanctions or face a complaint. That was a strong theme in the York papers, and makes sense in the context. If I'm reading that wrong, I'm happy to restore that wording or an alternative, as needed.
  • In-keeping with the general consensus for orgs over individuals in the Responses section (which is still really long), I have trimmed or removed statements by, e.g., the president or chair of an organisation if their comments were substantively the same as those of their org. E.g., if the org says "Yes!" and they say "Yay!" I've left quotes that add extra/different info ("Yay, but..." or "No").
  • On responses in general, the length is partly to due with lots of direct quotes. We could probably round up some of the Responses (in the format of orgs x, y and z supported the review but x said "something else" as well). In the meantime, I have trimmed the direct quotes a bit, both for length and to avoid extensive reproduction of text from sources. I don't believe these have changed the meaning of any quotes, but please ping me if I've left something important out or misinterpreted anything.
  • I think the Methodology section spends too much time on the independent systematic reviews, rather than the Cass Review process itself. This may need some workshopping.
  • Do we need a terminology or "concepts" section? There are some concepts that are overlapping and the nuances may not immediately be clear to readers (e.g., gender dysphoria, gender incongruence, gender-related distress). We can outline how the systematic reviews and Cass Review use these terms, if there are differences.
  • I added one sentence to summary Cass' response at the end of the lede: Following high profile media coverage, Cass expressed concern that misinformation about the review had spread online and elsewhere, and that her review was being weaponised against trans people. It seems important to mention both of these things. This wording seems fairly neutral to me and hopefully conveys the points in broad strokes, without needing to go into too much detail here. Hopefully this isn't controversial, but as always, I am happy to self-revert if necessary.

Thoughts are always welcome. Lewisguile (talk) 10:44, 27 December 2024 (UTC)

I agree with your idea of summarizing responses, and suggest that it should be "orgs x, y and z supported the review, and x said "something else" as well". One risk is that the supporters may be easy to summarize, which could result in "A, B, C, D, E, F, G, H, I, J, K, L, M, O, N, P, Q, R, S, T, U, V, W, and X all supported the review, but Y said <multiple sentences of disagreement> and Z said <long paragraph of disagreement>", which would amount to providing UNDUE weight to a minority of organizations.
Right now, we have a long list of subsections, to which I have added a quick guess at the overall 'feel' of the contents:
  • Response from UK political parties and public bodies: 90% support
  • Response from devolved governments: 80% support
  • Response from health bodies in the United Kingdom: 90% support
  • Response from other health bodies globally: 10% support
  • Response from transgender specialist medical bodies: 0% support
  • Other academic responses: 20% support
  • Reception by charities and human rights organisations: 40% support
  • Reception by gender-critical organisations: 100% support
The thing about summarizing is that the high levels of support are fairly boring: A, B, C, D, etc., all basically support the review and its recommendations. The opponents, however, are all over the map: N disagrees about this specific thing. O disagrees about a different specific thing. P throws out an ad hominem attack on Cass herself. Q makes an (unsubstantiated?) claim that Bad People were involved. R thinks it's fine, as long as it doesn't get imported into R's country. And so forth. The net result for the reader is that a concise summary of (for example) 60% support could look like 90% opposition, merely because the opposition can't be summarized as simply. WhatamIdoing (talk) 21:39, 27 December 2024 (UTC)
I hear you. But one way around that is to cluster them by the groupings we currently have. So "political parties x, y and z said this", "medical groups a, b and c said that", and so on. If we workshop the text here we might be able to pare it down fairly while making sure it doesn't feel unbalanced? We did something similar for November 2024 Amsterdam riots and it worked quite well. That section was equally long and got pared right back. Lewisguile (talk) 07:56, 28 December 2024 (UTC)
I'll take a stab at a draft tomorrow and post it here. I think we can do it without unbalancing things. I think we can keep it balanced through the space we give to each side. Lewisguile (talk) 18:42, 28 December 2024 (UTC)
Catching up now on the many changes over Xmas. So the "weaponisation" is not representative of the source given, which is clear that she's talking about the fear of weaponisation. I've clarified the body and removed from the lede, as I don't think its a significant enough statement in context. Void if removed (talk) 13:56, 1 January 2025 (UTC)
I have put the entire sentence because I don't think your reading is clear either. She's saying that she didn't say that trans people don't exist, not that there isn't weaponisation of the report. She's saying that there is fear, yes, but that doesn't mean that the fear isn't due to weaponisation. Arguably, the fear is caused by the weaponisation and that's what she's saying. Lewisguile (talk) 14:15, 1 January 2025 (UTC)
No, it is not - she's concerned people are fearful. You had written that she was concerned it was being weaponised. These are different. If you have to put the full quote in to try and make sense of it, I think that's WP:OVERQUOTE for such a trivial detail, and as written it is nowhere near ledeworthy.
The quote is
I think there is an appreciation that we are not about closing down health care for children. But there is fearfulness — about health care being shut down, and also about the report being weaponized to suggest that trans people don’t exist. And that’s really disappointing to me that that happens, because that’s absolutely not what we’re saying.
The "disappointing" is ambiguous. Is it the fear or the weaponisation she's referencing? If it was the latter, and if it was significant, there'd be other sources, because she's been very vocal about attacking the misinformation about her review. This feels like making a lot out of a passing comment. There are other, better sources for Cass' reflections, including a whole peer-reviewed article by her. I'd focus on the totality of her reflections as a whole rather than taking a tiny ambiguous quote like this and making it the focus. Void if removed (talk) 14:26, 1 January 2025 (UTC)
She says it's disappointing that that happens, because that's absolutely not what we're saying. It doesn't make logical sense that she's saying "we're not saying that there is fearfulness", or "we're not saying that there's weaponisation", while also saying "fearfulness is happening". The only way that "happening" and "saying" makes sense is if she's saying "weaponisation is happening but we didn't say ". Moreover, you admit yourself it's ambiguous what "disappointing" is referring to, so a direct quote avoids having to make a definitive statement about something you say isn't clear.
Incidentally, I think there was an edit conflict, so 13tez had inadvertently restored my text. I have edited the text again to address 13tez's edit conflict. The quote now isn't a blockquote, and it's shorter. I didn't re-add it to the lede after you removed it, but including it in the body isn't undue. ::::@Snokalok @Your Friendly Neighborhood Sociologist @Bluethricecreamman @13tez what do you think Cass is trying to say here? Lewisguile (talk) 15:13, 1 January 2025 (UTC)
If you have to parse the statement this much to get the meaning you want, then I think you should look for a better source, and if there isn't one, it doesn't belong. She just says its disappointing "that happens". What is the that? The fearfulness? The weaponisation? The whole messy situation where some peoeple are afraid and others draw the wrong conclusions from her work? I get the sense of her throwing her hands up at the whole mess. This is a brief statement in an interview, and seizing on one interpretation of these words and highlighting them to imply she was concerned about people weaponizing the report when she didn't outright say that is not NPOV.
The best source for Cass' reflections on the review is this peer-reviewed editorial.
AFAICT, we still don't cite this, and I don't know why. I brought it up months ago, and it gives a lot of useful material about what Cass felt was the most important takeaways. Weaponisation isn't in there, but she does reiterate:
This Review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people's rights to healthcare
I would revisit this source and expand from there the points she actually made and felt worth making, at length, in her own considered words, rather than over-interpreting an NY Times interview. Void if removed (talk) 18:06, 1 January 2025 (UTC)
If you have to parse the statement this much to get the meaning you want, then I think you should look for a better source, and if there isn't one, it doesn't belong. That's your opinion, and my opinion is that your interpretation seems to be the unlikely one. I still don't see why you object so much to the direct quotation. If it does indeed mean what you think it does, what harm would it cause to include that wording, rather than making a claim in Wikivoice which one of us is going to dispute? It is a direct answer to someone asking her about the reaction to the report, which is relevant to the section it was in. I believe I am trying to compromise here. Lewisguile (talk) 19:16, 1 January 2025 (UTC)
you object so much to the direct quotation
I don't feel strongly about the direct quotation - I think its overlong but, if that's the compromise fine.
But ideally, I would like to go to her peer-reviewed editorial and build this section from that, rather than quotes in interviews. I think that's a much better source for her considered reflections. But that's for another discussion. Void if removed (talk) 10:46, 2 January 2025 (UTC)

Interim report issues

Some more concerns (hopefully addressed) in the "Interim report" section:

  • While GIDS initially followed the Dutch protocol Technically, the interim report says it was "based on" and "paralleled" the Dutch protocol. It seems to have been somewhat different from the beginning, so I've clarified this. The report also says most px don't get referred for endocrine tx, so we should clarify that for balance. However, it does so while also saying there was insufficient data when referrals were made. I've attempted to address all these things here: The report said that while most children referred to GIDS did not receive endocrine treatment, there was insufficient detail provided about their broader needs when they did. The report also said that the current NHS approach to hormone interventions had "significant differences" from the Dutch protocol on which it was initially based. For example, the report said there were no clear guidelines for when to provide psychological support before or instead of medical treatment, endocrinologists administering puberty blockers did not attend multidisciplinary meetings, and there was insufficient capacity to increase (or even maintain) appointments once adolescents received puberty blockers.. I also pushed this to a new paragraph for ease of reading, and began with "The report said..." to avoid opening with "While..." per MOS:EDITORIAL. You'll also note I tweaked the bit about psych comorbidities here, since the page referenced (p. 18) is actually talking about the lack of screening for psych issues before or instead of hormone tx (which is more directly related to the topic at hand). I've reworded on that basis.
  • Another quibble: the bit about GPs under pressure was combined with a later comment about diagnostic overshadowing from another point that wasn't directly connected. This gave the impression that the overshadowing was due to pressure to affirm, whereas the report itself doesn't make that connection. (In context, it seems to be saying things are missed because of the tertiary care model, which skips local services.) I've reworded this so they're clearly separate thoughts and the context is clearer.The interim report said GPs and other non-GIDS staff felt "under pressure to adopt an unquestioning affirmative approach" to children unsure of their gender. The report also said that diagnosis of gender-related distress sometimes led to "diagnostic overshadowing", where comorbidities such as poor mental health – which were usually managed by local services – were overlooked.
  • Immediately following this, I've added some of the reasons for why the report thinks this is happening: The report suggested that long wait times to access GIDS had resulted in increased distress for patients and their families, as well as less time for exploration – since patients arrived having already begun social transition and with expectations of a rapid assessment process.
  • This is immediately followed by the Tavistock response as before, but I added In response... to clarify.
  • Other than that, I added a couple of words for flow so it all hangs together.

Again, if I've missed anything, or if you think this has unbalanced things a bit, do let me know. This section was originally almost entirely negative, whereas Cass herself was more nuanced. Hopefully this shows that. Lewisguile (talk) 12:49, 28 December 2024 (UTC)

Following on from this, I think the order should be tweaked a little for this section. Such as:
  • Current intro (up to lack of data collection)
  • GPs felt... up to rapid assessment process. (Move Tavi response down.)
  • Endocrine tx and Dutch protocol para here. Move up "gaps in the evidence" bit here (add ref) and move down NICE/NHS bit.
  • NICE/NHS England response here (maybe its own paragraph)
  • Sajid Javid response, Tavistock response (change "In response..." to "In response to the interim report..."), WPATH and associates response.
What do you think? That seems more coherent to me and flows better. Lewisguile (talk) 13:04, 28 December 2024 (UTC)
It seems to have been somewhat different from the beginning
Do you have a source for this? That's not at all my understanding and p70 of the Cass Review says the opposite, ie that GIDS initial trial was in line with the Dutch Protocol.
It was the model endorsed by Spack in the US in 2007 that deviated, and the pressure from eg. parent groups to adopt this model in GIDS after the early intervention study has started that caused divergence. Void if removed (talk) 13:52, 28 December 2024 (UTC)
Also you're inappropriately indicating social transition was a result of long wait times.
This is not the case, and indeed if you look at the York reviews is a global trend independent of wait time. Void if removed (talk) 13:57, 28 December 2024 (UTC)
Are you reading the interim report? Re: the Dutch protocol, Cass says: Although GIDS initially reported its approach to early endocrine intervention as being based on the Dutch Approach, there are significant differences in the NHS approach. (p. 18, Interim Report) and: From 2011, early administration of puberty blockers was started in England under a research protocol, which partially paralleled the Dutch Approach (the Early Intervention Study). From 2014, this protocol was adopted by GIDS as routine clinical practice. (p. 31, Interim Report)
I take your point about the change in approach, so what about the following: The report said that while the initial GIDS approach to hormone interventions "partially paralleled" the Dutch protocol... That is a bit clunky, but more accurate. Instead of the direct quote, we could also just say partially based on.
Re: social transition, Cass says: From the point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations and the extent of social transition that has developed due to the delay in service provision (p. 17, Interim Report). So she specifically says the delay is a cause. Remember this is about the interim conclusions, not the final report. Lewisguile (talk) 14:46, 28 December 2024 (UTC)
That says the *extent* of social transition, not that social transition is a result of long waiting times. The point being made is that parents and children/young people enter the system with expectations that have cemented due to long wait times. This is quite different. It isn't a matter of long wait times leading to social transition, it is that long wait times exacerbate an existing situation. Void if removed (talk) 16:54, 28 December 2024 (UTC)
The current article text doesn't say social transition is due to a long waiting time (at least not intentionally). It currently says: The report suggested that long wait times to access GIDS had resulted in increased distress for patients and their families, as well as less time for exploration – since patients arrived having already begun social transition and with expectations of a rapid assessment process. I.e., they can't explore social transition when they reach the clinic because it's already well underway.
However, if you think that this suggests that social transition wouldn't have occurred at all if there weren't wait lists, then that certainly wasn't my intent, and we should change it. How would you reword it? Perhaps since patients arrived having already progressed with social transition? Or since patients were relatively far along with their social transitions? Maybe the latter is better? Lewisguile (talk) 17:43, 28 December 2024 (UTC)

References

  1. ^ R. Dopp, Alex; Peipert, Allison; Buss, John; De Jesús-Romero, Robinson; Palmer, Keyton; Lorenzo-Luaces, Lorenzo (November 26, 2024) . Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research - RAND_RRA3223-1.pdf (PDF) (Report). RAND Corporation. Retrieved 2024-12-28.
  2. ^ Thornton, Jacqui (April 2024). "Cass Review calls for reformed gender identity services". The Lancet (News). 403 (10436): 1529. doi:10.1016/S0140-6736(24)00808-0. PMID 38643770. Cass commissioned four systematic reviews of the evidence on key issues...
  3. ^ Cass review final report 2024, p. 28. sfn error: no target: CITEREFCass_review_final_report2024 (help)
  4. ^ Cass review final report 2024, pp. 52–53. sfn error: no target: CITEREFCass_review_final_report2024 (help)
  5. ^ Cass review final report 2024, p. 60. sfn error: no target: CITEREFCass_review_final_report2024 (help)
  6. ^ Cass review final report 2024, p. 56. sfn error: no target: CITEREFCass_review_final_report2024 (help)
  7. ^ Cass review final report 2024, p. 8, Appendix 2. sfn error: no target: CITEREFCass_review_final_report2024 (help)
  8. "Homepage | Archives of Disease in Childhood". Archives of Disease in Childhood. Archived from the original on 19 December 2024. Retrieved 19 December 2024.
  9. ^ Clayton, Alison; Amos, Andrew James; Spencer, Jillian; Clarke, Patrick (31 August 2024). "Implications of the Cass Review for health policy governing gender medicine for Australian minors". Australasian Psychiatry: 3. doi:10.1177/10398562241276335.
  10. ^ "Gender Identity Service Series". Archives of Disease in Childhood (Series of reviews commissioned to inform the Cass Review). Archived from the original on 10 April 2024. Retrieved 10 April 2024.
  11. ^ Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Characteristics of children and adolescents referred to specialist gender services: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s3 – s11. doi:10.1136/archdischild-2023-326681. ISSN 0003-9888. PMID 38594046. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
  12. ^ Hall, Ruth; Mitchell, Alex; Taylor, Jo; Heathcote, Claire; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Impact of social transition in relation to gender for children and adolescents: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s12 – s18. doi:10.1136/archdischild-2023-326112. PMID 38594055. Archived from the original on 22 April 2024. Retrieved 22 April 2024.
  13. ^ Heathcote, Claire; Mitchell, Alex; Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth; Jarvis, Stuart William (9 April 2024). "Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s19 – s32. doi:10.1136/archdischild-2023-326347. PMID 38594045. Archived from the original on 23 April 2024. Retrieved 23 April 2024.
  14. ^ Taylor, Jo; Mitchell, Alex; Hall, Ruth; Heathcote, Claire; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s33 – s47. doi:10.1136/archdischild-2023-326669. ISSN 0003-9888. PMID 38594047. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
  15. ^ Taylor, Jo; Mitchell, Alex; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s48 – s56. doi:10.1136/archdischild-2023-326670. ISSN 0003-9888. PMID 38594053. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
  16. ^ Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Care pathways of children and adolescents referred to specialist gender services: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s57 – s64. doi:10.1136/archdischild-2023-326760. PMID 38594052. Archived from the original on 28 April 2024. Retrieved 28 April 2024.
  17. ^ Taylor, J; Hall, R; Heathcote, C; Hewitt, CE; Langton, T; Fraser, L (9 April 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)". Archives of Disease in Childhood (Review). 109 (Suppl 2): s65 – s72. doi:10.1136/archdischild-2023-326499. PMID 38594049. Archived from the original on 2 August 2024. Retrieved 13 April 2024.
  18. ^ Taylor, J; Hall, R; Heathcote, C; Hewitt, CE; Langton, T; Fraser, L (9 April 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)". Archives of Disease in Childhood (Review). 109 (Suppl 2): s73 – s82. doi:10.1136/archdischild-2023-326500. PMID 38594048. Archived from the original on 29 June 2024. Retrieved 13 April 2024.
  19. Cass review final report 2024, p. 161. sfn error: no target: CITEREFCass_review_final_report2024 (help)
  20. Cass review final report 2024, pp. 2, 3, Appendix 2. sfn error: no target: CITEREFCass_review_final_report2024 (help)
  21. James, Beal (26 April 2024). "Cass author condemns 'misinformation' spread by trans lawyer". The Times (News). Archived from the original on 2024-04-22. Retrieved 26 April 2024. During a systematic review, researchers looking at studies on transgender healthcare found no blind control ones — so used another system altogether to determine study quality.
  22. Cass review final report 2024, p. 243. sfn error: no target: CITEREFCass_review_final_report2024 (help)
  23. ^ Cite error: The named reference bbc-cass-misinfo was invoked but never defined (see the help page).
  24. Cass, Hilary (2024-09-06). "Gender identity services for children and young people: navigating uncertainty through communication, collaboration and care". The British Journal of Psychiatry. 225 (2): 302–304. doi:10.1192/bjp.2024.162. ISSN 0007-1250.
  25. "Homepage | Archives of Disease in Childhood". Archives of Disease in Childhood. Archived from the original on 19 December 2024. Retrieved 19 December 2024.
  26. Cass review interim report 2022, p. 40. sfn error: no target: CITEREFCass_review_interim_report2022 (help)
  27. Cass review interim report 2022, p. 18, 31. sfn error: no target: CITEREFCass_review_interim_report2022 (help)
  28. Cass review interim report 2022, p. 18. sfn error: no target: CITEREFCass_review_interim_report2022 (help)
  29. Cass review interim report 2022, p. 17. sfn error: no target: CITEREFCass_review_interim_report2022 (help)
  30. Cass review interim report 2022, pp. 17, 19. sfn error: no target: CITEREFCass_review_interim_report2022 (help)

Background changes

Hi @Snokalok, hope you're doing well.

After I made an edit to expand the background section to give readers, you subsequently removed one of the paragraphs I added, citing WP:SYNTH. I reverted your edit removing my changes, explaining why I felt this paragraph didn't constitute SYNTH. Afterwards, you made another edit in which you removed this paragraph again and warned me not to WP:EDITWAR and that this article currently has a WP:1RR in place.

The 1RR rule states: "An editor must not perform more than one revert on a single page—whether involving the same or different material—within a 24-hour period. An edit or a series of consecutive edits that undoes or manually reverses other editors' actions—whether in whole or in part—counts as a revert."

As I've described, you have now made two edits which removed this paragraph I added, so you are actually in violation of this rule. Please could you explain why you think this paragraph constitutes SYNTH, regardless of the explanation I offered? Thank you. 13tez (talk) 22:48, 30 December 2024 (UTC)

Ah, yes, regarding the 1RR, this page is actually under enforced BRD, not 1RR. That was my mistake for getting them mixed up. Regardless, the fact is that you made an addition, it was partially reverted, and under enforced BRD, you’re not to add it back in without consensus.
As for synth, there’s no evidence that I saw in your citations that Sweden’s opinions had any bearing on the Cass Report. Otherwise we could just as easily add in all of the countries that said the opposite prior to the report’s publication. Snokalok (talk) 22:58, 30 December 2024 (UTC)
Hey, thanks for getting back to me.
As for synth, there’s no evidence that I saw in your citations that Sweden’s opinions had any bearing on the Cass Report
The paragraph in question did not state or imply that the findings of the SR commissioned by Sweden did influence the Cass Review. If you are curious about this point, the Swedish guidelines are explicitly discussed in the final report (e.g. page 132) and the SR discussing guidelines. It is, however, part of the background context behind the review being commissioned, namely the debate over the strength of evidence for care like that provided at GIDS.
SYNTH refers to using two referenced pieces of information being used to argue for a third, without that third piece of information itself being supported by references. It is not text being irrelevant.
Please remove "which are meant to buy time without undergoing any permanent bodily changes for patients to assess their options" as this point is argumentative, discussed elsewhere, unsupported by sources, and not relevant to the concerns of the GIDS staff members.
Thanks!13tez (talk) 23:09, 30 December 2024 (UTC)
Okay starting with the buying time point, it’s in the latter two BBC sources attached to that sentence and since this is the background section and the sources mentioned it, it’s relevant to mention for a full and balanced picture.
As for synth, adding the Sweden thing suggests that the Cass Review was influenced by Sweden’s decision, but no cited sources said that; if you have a citation in the Cass Review, by all means add it back in with citation and we’ll go from there. Snokalok (talk) 23:46, 30 December 2024 (UTC)
Okay starting with the buying time point, it’s in the latter two BBC sources attached to that sentence.
The closest thing I could see is: "These drugs stop a young person's body developing, with the aim of helping to relieve gender dysphoria - distress caused when a person's gender identity does not match their biological sex. The NHS now recognises, external that little is known about their long term side effects." Am I right in thinking this is the sentence you're basing it off?
since this is the background section and the sources mentioned it, it’s relevant to mention for a full and balanced picture
Do you think describing the aim of the use of puberty blockers is relevant in a subsection discussing criticism of GIDS? Why not describe puberty blockers elsewhere, where they're discussed in more detail, so this point would be more relevant?
As for synth, adding the Sweden thing suggests that the Cass Review was influenced by Sweden’s decision
Well, the paragraph you removed doesn't say there's any link between Sweden's decision and the Cass Review. It was meant to describe the ongoing debate over the extent to which evidence supported the types of treatments given at GIDS and how several countries were also examining them at the time. Do you think we should instead make this point more clearly by describing how several other European countries were examining these treatments because of this ongoing debate (and came to similar conclusions) so this is more explicit? After all, the CR was commissioned by NHSE back in 2020, so the Swedish review couldn't have influenced it being created.
Thanks! 13tez (talk) 00:04, 31 December 2024 (UTC)
the recent research part is definitely synth and adds bulk to a background section. And why exactly Sweden specifically for a review article? Bluethricecreamman (talk) 00:07, 31 December 2024 (UTC)
Maybe we should remake it to focus more on the debate over the extent to which evidence supported the types of treatments given at GIDS and how several countries were also examining them at the time. That was my intent - to illustrate that other countries were also undertaking similar investigations because of this debate.
We can cut out the unique findings of the Swedish systematic review. I just thought it should be included since it's significant in what it found and its impact - the changes in clinical practice in Sweden. 13tez (talk) 00:30, 31 December 2024 (UTC)
If other countries are also looking at this evidence, that's something for the Responses section. At best, it requires a sentence in the Background section, but I think it definitely veers into WP:COATRACK territory. What's important to know is that there were concerns about GIDS and evidence, and that's what the Cass Review looked at. That's all well described in the Background section as it was before these additions, and is also discussed in the relevant parts of the Interim report, Final report and Responses sections.
I have added some of the extra info you created over the last day or so as endnotes, but really, none of this is needed for the article at hand. It's already getting long. It may be that there's a changing attitude to things like the Dutch Protocol across Europe, and maybe even elsewhere, but that could be covered at the relevant article or could form a new article. I don't think it needs to be here. Lewisguile (talk) 12:26, 31 December 2024 (UTC)
I think we may have gotten a bit confused. There are four publications to consider:
  • the February 2022 guideline from the Swedish National Board of Health and Welfare (with a final update in December 2022; English summary)
  • the March 2022 Cass interim report,
  • the 2023 Swedish systematic review (, cited in this diff), and
  • the 2024 Cass final report.
The 2023 Swedish systematic review does not actually mention Cass's work. It mentions some of NICE's work (linking to the NICE's documents on the Cass Review's website). "Last, there have been studies in this field published after the date of our literature search (9 November 2021). These have not been added to this study in order to not depart from the systematic approach. We nevertheless wish to comment on some of the publications. First, the National Institute for Health and Care Excellence in England (NICE) conducted evidence reviews of GnRHa as well as CSHT for children with gender dysphoria, which were independent from our work. The conclusions generally align with our findings."
NICE's work was (according to the Cass website) one of the things that led to the creation of the Cass Review, but the Cass Review itself is not mentioned in the 2023 Swedish systematic review.
The Cass final report discusses the 2022 Swedish National Board of Health and Welfare guideline at some length (primarily pages 129–135). The Cass final report mentions the 2023 Swedish systematic review in a single sentence in 15.25, only as an example of other papers that agree with Cass's commissioned reviews: "This is in line with other systematic reviews published previously (Ludvigsson et al., 2023)."
My first conclusion is that the 2023 Swedish systematic review is certainly not "a response" to Cass, since it doesn't mention Cass at all. It could be considered background information.
My second conclusion is that the Cass Review was influenced by the 2022 Swedish National Board of Health and Welfare guideline, since it spends quite a lot of time talking about it and agreeing with it. WhatamIdoing (talk) 20:38, 31 December 2024 (UTC)
Hey @Lewisguile,
I agree with WhatAmIdoing, both here ("I think we may have gotten a bit confused. There are four publications..") and below ("As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies.").
I'm not talking about other countries reacting to the Cass Review with similar reviews of their own or debate over the evidence underpinning treatments given to TGGNC youth that took place after the CR. This happened before the CR, so is part of the situational context before and that led to it. Therefore, it belongs in the Background section, not the Responses section.
The controversy over GIDS, including the "whistleblowers", legal cases, etc, led, in part, to the review and has been given extensive coverage in the news and has some in the report too. Therefore, per WP:DUE, so the reader can understand what led to the CR, and so the reader can understand the background on GIDS without having to go and read its article, its discussion is warranted in this article, albeit in a neutral tone, WP:Summary style, etc. For example, the Mermaids controversy got a lot of coverage, but after an investigation, there were found to be no inappropriate links between Mermaids and GIDS. Therefore, if we felt it was within due weight and included it here, we'd do so while giving that proviso. 13tez (talk) 13:30, 1 January 2025 (UTC)
Hi @Lewisguile and @WhatamIdoing,
Per the discussion here, I've added a reduced and summarised version of the previous content I added to the background section. It doesn't go into the general history of GIDS and says explicitly what the issues and background were behind the CR. Please let me know what you think when you have time. Thanks! 13tez (talk) 14:37, 1 January 2025 (UTC)
As I said elsewhere, I had attempted to come to a compromise on the wording, but VIR's hasty edits have restored much of the objectionable text (for you and for me). Find a version I think is quite fair here: https://en.wikipedia.org/Special:Diff/1266638132/1266639348 Note that it still has the SRs first, but it uses Cass's direct wording (which could be read to mean "this is the bedrock, and these things are also the bedrock" as well as "this is the bedrock, and these are other things we did which aren't the bedrock"), which allows us to briefly mention the other things too. Then the part about the other bits of research are included at the end, but without "supplemented" (since we've used the "bedrock" quote instead). It removes "non-peer reviewed" and "peer-reviewed" but keeps in where it was published. I think that gives you most of what you feel should be included while also doing the same for what I think should be in there? Lewisguile (talk) 15:37, 1 January 2025 (UTC)
Hey @Lewisguile, thanks for trying to compromise again!
I just restored your version of the new paragraph (the only differences are: I added a sentence explaining what GIDS is since it hadn't yet been done, at least by that point in the article; I changed the see also link to point to the GIDS article, not its history subsection; I made the text "systematic reviews" link to their article; and I removed a parameter causing an error in a reference which wasn't needed anyway).
@Lewisguile @Void if removed Please can you let me know if we can agree to leave the Background section as it is now in order to create a compromise and prevent frequent article changes?
I'm personally against the changes made to the Background section in the new paragraph ("In the years leading up to the Cass Review, several GIDS staff...") because the references say "debate" rather than "concerns"; there were other (highly covered) legal cases apart from BvT; and the legal cases also examined the evidence base as well as the ability to gain informed consent. However, I'm happy to compromise on them to get the paragraph added because I think it leaves readers more informed, and it allows us to resolve at least that section.
Thanks! 13tez (talk) 16:13, 1 January 2025 (UTC)
Thank you. I do want to get this right. I know we're all reading things slightly differently here, and I find myself more frustrated than usual with the text of the report itself (which is often imprecise), but I think we're inching closer to getting this article to a good place.
I changed "debate" to "concerns" just because "debate" sounded like it was a formal debate, rather than an ongoing series of issues being raised. If anything, I think that would veer too much on the side of the negative side of the debate over the positive, but I think it is a fair reflection of where things were at.
What did you think of my Methodology wording linked above? I think it also addressed many of your issues while also addressing some of mine. Are you happy for that to be restored as well? Lewisguile (talk) 16:19, 1 January 2025 (UTC)
Thank you. I do want to get this right. I know we're all reading things slightly differently here, and I find myself more frustrated than usual with the text of the report itself (which is often imprecise), but I think we're inching closer to getting this article to a good place.
Thanks again for working in good faith! I agree. Like I said, I'm happy to agree to leave the Background section where it is now, but I wouldn't mind getting another version we all think is an improvement either.
I changed "debate" to "concerns" just because "debate" sounded like it was a formal debate, rather than an ongoing series of issues being raised. If anything, I think that would veer too much on the side of the negative side of the debate over the positive, but I think it is a fair reflection of where things were at.
"on the negative side" meaning the toxic culture war side of things? I see what you mean. We could quote the MEDRS source directly and say "professional disagreement"? You might prefer "disagreement" to "debate", and it focuses the debate/concerns/disagreement to those among medical scientists, rather than toxic discourse between pro-trans and anti-trans groups.
What did you think of my Methodology wording linked above?
I'll take a look and reply in the Methodology section here (of this talk page), just so everything stays separated.
Thanks again! 13tez (talk) 16:30, 1 January 2025 (UTC)
@Lewisguile I have no idea what you're talking about with hasty edits, please be specific, with diffs. Void if removed (talk) 17:36, 1 January 2025 (UTC)
I meant the number of overlapping edits made in a short period of time, which meant that edits made by me and 13tez were reverted accidentally. I had realised all three of us were editing at the same time and tried to restore some of 13tez's text, but that got undone too.
Those could have been intentional, of course, but since you specifically objected to my use of a direct quote over Wikivoice and felt the RAND sourcing was undue, it seemed unlikely. Lewisguile (talk) 18:30, 1 January 2025 (UTC)
Here you restored the "non-peer-reviewed"
Aha thank you! This is the problem edit on my part. Yes, that was only supposed to be a section header change, my bad, I blame visual editor/too many tabs etc.
Hopefully a one off, but please, if I do anything like that again, ping me with the diff at the outset. Void if removed (talk) 21:45, 1 January 2025 (UTC)
I still think some of it is WP:SYNTH because it's drawing connections that Cass hasn't. It would be best to stick to things Cass specifically mentions as influences on the report. Lewisguile (talk) 14:49, 1 January 2025 (UTC)
@Snokalok, it's not quite right to say under enforced BRD, you’re not to add it back in without consensus. That's the Misplaced Pages:Consensus required restriction. Under enforced BRD, you're not to add something back in until you've posted a comment about it on the talk page and waited 24 hours.
Of course, if, during those 24 hours, a significant amount of opposition appears, then you shouldn't add it back in until the discussion gets settled, but that's due to the ordinary WP:EPTALK policy, not the enforced BRD rules specifically. WhatamIdoing (talk) 20:41, 31 December 2024 (UTC)
The background section is significantly expanded by nearly 3x... is all of it necessary or could you just link to the GIDS article for a lot of this criticism? Bluethricecreamman (talk) 23:44, 30 December 2024 (UTC)
Well, I expanded the section to allow readers to understand the current situation and history of transgender healthcare for young people in the UK at the time of the review and the concerns and events which led to it. This is important context describing the situation in which the review was commissioned and made. It's given coverage in the report itself because it aids the reader's understanding of the review: how can you understand its recommendations if you don't understand the prior situation they were meant to change. 13tez (talk) 00:33, 31 December 2024 (UTC)
It's not at all necessary. This is a huge addition of text added without consensus. This should be a paragraph at most, since the article already lays out the complaints against GIDS well. I will revert and we can sort out a new paragraph. Lewisguile (talk) 08:58, 31 December 2024 (UTC)
I've posted what I think is a decent compromise on the Methodology section here: https://en.wikipedia.org/Talk:Cass_Review#c-Lewisguile-20241231174000-Methodology_2 As for the Background, I stuck in the "See also" link and added some of the extra detail as endnotes. I'm hoping this avoids bloat while retaining the details people wanted in there for those who want it. Lewisguile (talk) 17:55, 31 December 2024 (UTC)
As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies. WhatamIdoing (talk) 20:46, 31 December 2024 (UTC)
The article does not the reasons why the Cass Review was commissioned. We could certainly add a sentence or two more, but we don't need the entire history. Lewisguile (talk) 14:32, 1 January 2025 (UTC)
I've taken a stab at compressing what @13tez just added. It seems better now, although it was simpler before either edit. Lewisguile (talk) 14:46, 1 January 2025 (UTC)
TBH I'm not sure why any of this is here - we already "see also" to GIDS, which covers all this in more detail. Void if removed (talk) 15:51, 1 January 2025 (UTC)
I didn't think it was due anyway, but 13tez very clearly wanted more context there, which is why I trimmed the longer version to a shorter one as a compromise. Lewisguile (talk) 18:34, 1 January 2025 (UTC)
Hey @Void if removed, I gave my reasoning for including this stuff before as follows: "I expanded the section to allow readers to understand the current situation and history of transgender healthcare for young people in the UK at the time of the review and the concerns and events which led to it. This is important context describing the situation in which the review was commissioned and made. It's given coverage in the report itself because it aids the reader's understanding of the review: how can you understand its recommendations if you don't understand the prior situation they were meant to change."
I also agree with the broad strokes of what WhatamIdoing said was their reasoning for agreeing with the idea of including at least some of the information I added, at least in some form: "As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies." 13tez (talk) 21:27, 1 January 2025 (UTC)
Ok, I take the point of having something in some form. Void if removed (talk) 22:05, 1 January 2025 (UTC)
Thanks! Glad we can agree or at least compromise on it :) 13tez (talk) 22:17, 1 January 2025 (UTC)

"Narrative review"

The Cass Review is not a narrative review. A narrative review is an academic review of existing literature. The Cass Review is an independent service review with a wide remit, that commissioned new research and engaged with stakeholders. Relying on one primary source to falsely call it a "narrative review" is wrong, and actually speaks to the reliability of the original source. This was a new addition which I have taken out, but @Lewisguile has reverted with an edit comment that by my reading wrongly refers to a document from a think tank as "peer-reviewed". I ask this be self-reverted and this badly-sourced misrepresentation actually be discussed before adding. Void if removed (talk) 15:13, 1 January 2025 (UTC)

I've told you twice now: it is peer-reviewed. You are frantically editing the page and adding talk page comments, and it's becoming a chaotic mess. You've actually restored text I had taken out because I agreed with 13tez that those things may not be needed, meaning the text is now more objectionable to more people as a result. Please take a breather and read your replies. Lewisguile (talk) 15:33, 1 January 2025 (UTC)
Just so we're clear about that process: https://www.rand.org/pubs/periodicals/health-quarterly/peer-review.html
All RAND documents are peer reviewed by at least two qualified reviewers—usually a RAND staff member and an outside expert. Reviewers are chosen for technical expertise, policy experience, and ability to provide an objective review. Reviewers are selected by the senior staff member in each RAND division responsible for quality assurance.
So it is sort of peer reviewed, semi in-house, and selected in-house. Not really comparable to an academic journal. This isn't the "gold standard".
Can you please take out the "narrative review" description - it is false. Void if removed (talk) 15:41, 1 January 2025 (UTC)
The Cass Review didn't have a peer review at all and you've argued that trumps almost everything else? I don't think we should have double standards here. It's a peer reviewed systematic review. NICE also publishes its own systematic reviews, but that doesn't invalidate them.
Either way, I didn't add that description, and you reverted my prior edit of that section when you made all your edits recently. It's probably best to go back and figure out who added it and ask them. Lewisguile (talk) 16:41, 1 January 2025 (UTC)
You're not comparing like with like.
The Cass Review is an independent review, and the final report is a culmination of a four-year process encompassing dozens and dozens of contributors and stakeholders, and multiple specifically commissioned systematic reviews. It is not a policy document or a peer-reviewed paper, and iti definitely isn't a "narrative review" - it is a service review, commissioned by a national health body. On this page, the cass review is an authoritative source about itself.
Other independent reviews that aren't peer-reviewed are things like the LCP Care Pathway - these aren't peer-reviewed sources, they are a different thing entirely.
NICE also publishes its own systematic reviews
NICE is not a policy thinktank.
I didn't add that description
So why did you revert to re-add it? If you aren't defending it, take it out again.
Also, having now read it in more detail, that RAND source is even more questionable.
It describes the 2022 Cass Review (so the Interim Report) as a narrative review, so it isn't applicable anyway. It also places, at the same level, two blogposts on SBM, which are also described as "narrative reviews".
https://sciencebasedmedicine.org/gender-affirming-care-is-not-experimental/
https://sciencebasedmedicine.org/gender-affirming-care-is-not-experimental-part-ii/
Likewise the "what we know project" which is little more than a group blog. This mixing of high quality sources like Cass with self-published stuff is pretty poor frankly.
Also the literature cutoff of September 2023 manages to exclude all the major work like Zepf et al that came just after that date. This document is already out of date, frankly, and seeing as it doesn't actually reference the final Cass Review beyond noting it exists, is not terribly relevant for this page. Void if removed (talk) 17:30, 1 January 2025 (UTC)
Also the literature cutoff of September 2023 manages to exclude all the major work like Zepf et al that came just after that date. All research has limitations. Of course they had a cutoff, because that's common practice. This document is already out of date, frankly, and seeing as it doesn't actually reference the final Cass Review beyond noting it exists, is not terribly relevant for this page. But in this case, RAND specifically talks about the applicability of Cass to other contexts than the NHS, and talks about its limitations. So I disagree that it's not terribly relevant.
iti definitely isn't a "narrative review" - it is a service review, commissioned by a national health body One isn't exclusive of the other. A service review can be a narrative review as well. According to RAND, its own "research is sponsored by U.S. government agencies; U.S. state and local governments; allied non-U.S. governments, agencies, and ministries; international organizations; colleges and universities; foundations; professional associations; other nonprofit organizations; and industry".
In this case: "This work was supported by Indiana University Bloomington and the Medical College of Wisconsin. In addition, RAND provided funding to support publication production, quality assurance, and supplemental research analyses. The research was carried out within the Access and Delivery Program in RAND Health Care and the Social and Behavioral Policy Program in RAND Social and Economic Well-Being. In addition, Lorenzo-Luaces was funded by grant numbers KL2TR002530 and UL1TR002529 (A. Shekhar, principal investigator ) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award (NCATS); Peipert was funded by grant number TL1TR002531 (T. Hurley, PI) from NCATS; and Buss was funded by T32-MH103213-07 (W. Hetrick, PI) from the National Institutes of Mental Health. RAND Health Care oversaw the quality assurance process for completing and publishing this report; otherwise, funders did not influence the conduct or reporting of this research. The authors declare that they have no competing interests."
NICE is not a policy thinktank. But RAND is not just a policy thinktank either. It has conducted high profile research for the US government. You can see its prior commissioners here: https://www.rand.org/health-care.html. It uses open publication.
So why did you revert to re-add it? If you aren't defending it, take it out again. I reverted to the Methodology section that 13tez had edited and which I had re-edited afterwards. 13tez had left it in and I saw (and still see) no reason to take it out. It was about the entirety of that section, not one particular part, which you reverted, thereby reinstating the "non-peer-reviewed" text as well. (See the diffs I posted elsewhere on this page.)
I'm trying to engage in good faith here, but it feels like you're unwilling to compromise on anything. Your responses seem consistently aggressive and WP:BATTLEGROUND-like. Not to mention the mess made with edit conflicts (not only your fault, but I was trying to fix that when I got reverted again, which made me give up). That makes it very difficult to form a consensus, and the article will just end up being resolved by who can shout the longest. Can we call it a day and come back to this with cooler heads? I'm sure there's a consensus to be had, but it will require all of us to engage with the ongoing attempts to agree wording on this talk page so we don't all keep reverting each other (whether accidentally or not). Lewisguile (talk) 19:09, 1 January 2025 (UTC)
The edit I'm currently concerned with is here:
https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266632416
You undid this here along with other changes:
https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266634667
Since then you've made accusations on my part of hasty editing, called for cooler heads, and cast aspersions, with accusations of aggression, while I'm simply trying to get you to engage in good faith on this edit.
Ignore everything else about this source to save distractions and just on this one specific point: I removed a recently added and IMO redundant new sentence in this section that incorrectly calls it a "narrative review" based on a source that doesn't actually call the cass review a "narrative review", and would be wrong to do so if it did.
You've reverted my change amid a whole bunch of other issues, which AFAICT are nothing to do with this edit, and then when I asked you why, told me you don't actually want that text in but to to take it up with whoever added it. That isn't how mandatory BRD is supposed to work. If you don't want to defend "narrative review", take it out please. Void if removed (talk) 21:34, 1 January 2025 (UTC)
based on a source that doesn't actually call the cass review a "narrative review", and would be wrong to do so if it did. - p 10, table 2.1 of the RAND report does call it that...
You keep saying the Cass Review is a "service review" rather than a "narrative review", but those are not in any sense mutually exclusive. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:55, 1 January 2025 (UTC)
It refers to the interim report as that. It is incorrect to do so, and also wrong to apply it to the Cass Review as a whole, or the final report. Void if removed (talk) 10:08, 2 January 2025 (UTC)
@Void if removed, you realise you made reverts and edits after mine, right? You left that part in but restored text from RAND, including the "non-peer-reviewed" statement I had removed and RAND's description of limitations which @13tez and I were discussing. I was restoring the text 13tez and I were quibbling over but broadly in agreement on and we were still discussing the nuances when you reverted it. You then removed the GC responses section and the comments of a GP which were also, incidentally, in line with a statement made by the BMA (the same source says: Many GPs are not trained to provide the specialist care these patients need and therefore fear risking patient safety.) to insert a statement which was less supported in said source, and now you keep demanding that I revert something you yourself have subsequently edited and left in. I'm not being difficult, but I'm well aware of the WP:3RR, and unfortunately, some editors interpret it narrowly (i.e., including self-reverts as well). Also, if I removed the text I would be obligated to also re-edit the text you restored, since 13tez and I were working on getting it up to scratch and both disagreed with several parts of the restored text.
As for the "narrative review" versus "service review" dichotomy, per WP:MEDRS, which you're familiar with: Reviews may be narrative or systematic (and sometimes both). Narrative reviews provide a general summary of a topic based on a survey of the literature, which can be useful when outlining a topic. A general narrative review of a subject by an expert in the field can make a good secondary source covering various aspects of a subject within a Misplaced Pages article. Such reviews typically do not contain primary research but can make interpretations and draw conclusions from primary sources that no Misplaced Pages editor would be allowed to do. This fits the definition of Cass to a tee. The primary sources are the York papers and the secondary review is Cass. The York papers also indicate they use narrative methods in addition to systematic reviews in in multiple places. (See Taylor J, Hall R, Langton T, et al. Arch Dis Child 2024;109:s3–s11 (s3).)Lewisguile (talk) 09:54, 2 January 2025 (UTC)
The definition you are talking about applies to review articles. The Cass Review is not a review article - you're trying to apply terminology across different kinds of document, when "review" has multiple meanings, both broad and narrow. The Cass Review is an independent service review (in the broad sense) that, as part of its process, commissioned multiple systematic reviews (in the narrow sense) and produced an interim report and a final report. It isn't a "review article" published in an academic journal and isn't straightforwardly either a systematic or narrative review. Rather the "review" is a 4-year process, and its output was two reports giving a series of recommendations and guidelines to the NHS about how it structures its service, which the NHS then followed. Quite where the final report fits on the MEDRS pyramid isn't straightforward, but it is much more in line with something like, say, clinical practice guidelines than anything. Void if removed (talk) 10:20, 2 January 2025 (UTC)
In the interests of moving on - I apologise unreservedly for this edit, which mistakenly reinserted text, when the only intention was to change a section heading.
Until you pointed to that diff last night, I did not realise that's what happened, as I was looking only at this specific diff relating to "narrative review" and its reversion. Had I realised, I would have reverted it myself. I'm not trying to get you to 3RR, or make demands, I'm just trying in the best possible faith not to fall afoul of enforced BRD. Void if removed (talk) 10:41, 2 January 2025 (UTC)
To avoid problems with enforced BRD, worried editors may find it useful to make no more than one edit to the article per 24 hours. WhatamIdoing (talk) 11:55, 2 January 2025 (UTC)
Yes, I suspected you didn't mean to restore that text. That was what I was trying to say yesterday. I suspect all three of us were working on edits at the same time and merely pressed publish at different points. Which explains why stuff which was taken out got put back in again, and sometimes in unusual ways. I'm sorry if I implied bad faith on anyone's part – it's always hard to convey/read tone online. Lewisguile (talk) 17:46, 2 January 2025 (UTC)

Gender-Critical Responses

VIR, you've removed the entire section on gender-critical responses saying Remove the "gender critical" organisations response, this seems like passing and non-notable coverage, and hardly deserved its own section, we have plenty of better responses now WP:NOTEVERYTHING We have the guardian saying Parts of Cass’s review have been proclaimed as wholesale vindication by gender-critical feminists

We have Them and Mother Jones saying The Cass Review won’t have an immediate impact on how gender medicine is practiced in the United States, but both Europe’s “gender critical” movement and the anti-trans movement here in the US cited the report as a win, claiming it is the proof they need to limit medical care for trans youth globally. Notable anti-trans group the Society for Evidence Based Gender Medicine called the report “a historic document the significance of which cannot be overstated,” and argued that “it now appears indisputable that the arc of history has bent in the direction of reversal of gender-affirming care worldwide.”

Right now we talk about how LGBT orgs have recieved the report, but don't mention gender-critical orgs once. Considering it's a fairly BLUESKY statement that the gender-critical movement in the UK is large and broadly opposed to youth transition, why remove mention of the fact they broadly supported Cass's review? It seems unbalanced to reference only LGBT orgs without any mention of gender-critical ones.

I think the section should be put back in and expanded. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:11, 1 January 2025 (UTC)

Agreed. There is an issue with balance in the article overall, so this section should go back in. Lewisguile (talk) 09:11, 2 January 2025 (UTC)
What I would hope is that we can get away from the constant blow by blow responses, and start thinking about the wider context and aftermath and subsequent political flashpoints as more secondary and reflective pieces come out. One line in a guardian piece in april saying unnamed "feminists" claim "vindication" doesn't justify a whole section in "responses"
We have a wide variety of contemporaneous responses from major political parties and health bodies domestically and internationally that gives an accurate reflection of how it was received at the time. We have a ton of individual responses we've culled because frankly everyone and their dog has an opinion so we have to keep it to the most significant ones. It is already hard to prioritise.
But what would be really good is to start working on what I suggested last year, which would be another section to expand on the wider response over time and larger political context in the aftermath. I think we should keep the immediate responses as focused as possible and start fleshing out everything after about August or so in a new section.
What was the immediate response? Domestic political parties and health bodies almost unanimously endorsed it, with a couple of notable exceptions like the BMA. Internationally the picture varied from cautious agreement on some points to outright condemnation. That is a picture we can present in the "responses" based on the best possible and most notable opinions. What was the wider context and aftermath? Maybe we can build a more useful picture of that from other sources but I don't think it is a good to keep expanding this section like this with every minor note of celebration or protest gathered from passing mentions in rolling news coverage at the time. Void if removed (talk) 09:59, 2 January 2025 (UTC)
And just so we're clear, the sourcing of this section was one passing mention right at the end of an Economist article that just happened to have a quote from Stella O'Malley, and a self-published statement by Sex Matters. Neither of these are DUE. We have avoided individual responses, and if there was decent secondary coverage dedicated to either of these organisations as a whole then fine, but this is not notable coverage. Void if removed (talk) 10:06, 2 January 2025 (UTC)
Again, it's your opinion that it's not notable. Our view is different. There isn't consensus for your removal. Lewisguile (talk) 10:16, 2 January 2025 (UTC)
My opinion is based on the dearth of coverage. If there were more coverage (ie an article about sex matters' response in a RS, or an article about Genspect's response), I would agree, but as it is this section is poorly sourced to one quote from one individual, and a self-published statement that I don't think is enough to establish notability. We wouldn't have covered Stonewall's response had it not received press attention in its own right, and Stonewall are vastly more notable, and similarly we wouldn't have framed a quote from an individual connected to Stonewall as Stonewall's official response either. I don't see coverage of a response from either Genspect or Sex Matters and unless there actually is any I don't think this is WP:DUE. Void if removed (talk) 10:26, 2 January 2025 (UTC)
I don't think that it's necessary to expand this content, or to name any of those orgs. It's enough to say that gender-critical orgs praised it, citing Misplaced Pages:Independent sources for this fact. WhatamIdoing (talk) 11:58, 2 January 2025 (UTC)
To be fair, though, the same could be said of the various politicians whose views don't diverge from their party's. (I think I've said this before, so apologies if I'm a stuck record.) Until then, we have got a blow by blow, so it should be representative of the key parties. Lewisguile (talk) 17:39, 2 January 2025 (UTC)
Eventually, I think most of those soundbites will get removed.
The bit about the Green Party issuing and then retracting a statement, for example, is just unencyclopedic. Encyclopedias summarize, with a focus on facts that made a difference. The net effect of the response from the Green Party – one of the smallest political parties in the UK, holding 0.6% of seats in Parliament, by no means a "key party" – on the world, on the Cass Review, on the implementation, on anything except themselves was: nothing. IMO that whole paragraph should be removed. WhatamIdoing (talk) 23:08, 2 January 2025 (UTC)

Enforced BRD (again)

@Lewisguile you have undone my reverts here.

These are recent additions by @Your Friendly Neighborhood Sociologist, which I have reverted. My understanding of enforced BRD is that these should then be brought here for discussion and then consensus established before being re-added. Void if removed (talk) 10:59, 2 January 2025 (UTC)

Hmmm. You raise a good point/grey area. My understanding is that @Your Friendly Neighborhood Sociologist can't reinstate their own edit for 24 hours, not that nobody can. The examples refer to Editor A and Editor B, where Editor A can't restore until they've discussed with Editor B. But Editor C isn't mentioned at all.
Enforced BRD is also intended to have the advantage that Editor B can't use 1RR+"consensus needed" to stonewall new edits being added, and to prevent Editor A from reverting the revert of Editor B.
I think Editor C restoring text isn't falling afoul of enforced BRD, but I'm happy to self-revert if there's no consensus for this text. At the moment, the additions (with your restored correction of removing Badenoch) seems fair and balanced, since LGBTQ groups are relevant and have mostly been removed from this article. It's quite relevant that most LGBTQ+ and trans groups have criticised the review, for example, but that's somehow not in the lede and has been whittled to almost nothing in the Responses section. Lewisguile (talk) 11:19, 2 January 2025 (UTC)
I've started a discussion either way: https://en.wikipedia.org/Talk:Cass_Review#c-Lewisguile-20250102113700-Responses_section_(picking_up_per_BRD) I noticed there wasn't one previously. Lewisguile (talk) 11:38, 2 January 2025 (UTC)
I would disagree TBH, this was added because of a tendency for bold additions to be added, reverted, and then re-added without discussion, and attempts to discuss ignored. I would say that if it can by bypassed by essentially tag-teaming (not an accusation, merely saying that that would permit bypassing EBRD), then it is a worthless measure, and not really in the spirit of the restriction. Void if removed (talk) 11:41, 2 January 2025 (UTC)
Ok, so from the FAQ:
You can reinstate the edit without violating this sanction, but if your revert gets reverted you must then discuss and wait 24 hours before re-reverting. That said, unless the revert was really bad it's a better idea to go to the talkpage before reverting. And if you stumble upon an active edit war between multiple editors you should definitely try to find a compromise/consensus on the talk page before participating in any reverting.
So basically, you aren't technically violating it, but it does seem to be not in the spirit of things to revert without discussion first.
I'd ask you in future to at least open a discussion first, or slow down and wait to see if the original editor takes it to talk, there's no rush. Void if removed (talk) 11:54, 2 January 2025 (UTC)
Yes, this is unclear, too. I think whoever wrote the FAQ simply didn't consider that a third editor might come along and revert a revert, which is why it only talks about the second person reverting the revert of their revert. Hmmm. It seems @WhatamIdoing has pinged someone for clarity, so that may help.
In any case, BRD does require an attempt to engage in said discussion by the reverter as well, if it's to work. I didn't see a topic for those reversions, which is why I have created this one. I think, in general, I would agree to the "no reverts of reverts" principle for all parties so long as whoever makes the first revert also actually opens up said discussion first. Then it's clear when an enforced BRD process has begun for all parties and it means we can gauge whether there's consensus or not for the edits. Lewisguile (talk) 17:35, 2 January 2025 (UTC)
Pinging Awilley, who may be able to tell us whether tag-team reverting is technically okay, and/or get the rules fixed to be clear about it. WhatamIdoing (talk) 12:00, 2 January 2025 (UTC)

Responses section (picking up per BRD)

We have a discussion already about the GC responses in the Responses section. We don't currently have one for the additions of LGBTQ+ groups in that section – these were initially reverted by @Void if removed and then restored by me. Personally, I agreed with the original editor, @Your Friendly Neighborhood Sociologist, that these are WP:DUE, since the article otherwise includes very little of the LGBTQ+ response to the review (which has largely been mixed to critical, with some outright opposing it).

As it's not entirely clear to me whether enforced BRD also applies to third party editors, I figured I should start the discussion anyway and I can revert the text again if there's not a consensus to keep it. Lewisguile (talk) 11:37, 2 January 2025 (UTC)

Lots of people have opinions, as do lots of activist groups. The student officer for a minor affiliated group in the Labour Party is not an opinion that is as notable as, say, WPATH's. So, we give lots of space to WPATH, and don't waste space on trivia with no significant secondary coverage.
I have in the past said that the responses should be limited to the notable and immediate reaction and implementation, and that wider things (like what you're concerned about) should be used to flesh out a new section covering the wider sociopolitical response and aftermath. I'm fully prepared to believe such things could go in there, but I simply disagree that what a minor political activist thought about the review is of any consequence, compared to how the royal colleges responded straight away. I think this continual attempt to expand "responses" rather than accept a limit there and start expanding further down the article is to the detriment of the article as a whole. My impression of the discussion at the time was that editors perhaps didn't want to see criticism relegated to the bottom of the article, but that's not how I see it - I think there's plenty of space for all that, but it should be contextualised properly as something wider than simply "responses". The Cass Review fits into a large and complicated divide in opinion and perception and we can give that its due, but not by simply recounting responses one by one, and each attempt to bring something new in there simply brings about new conflict.
I think it would be more fruitful to discuss how to expand a new section with a broader remit than to continue to bloat the responses. Void if removed (talk) 11:43, 2 January 2025 (UTC)
To the extent that it's feasible, I think that most groups should be presented in summaries: Most UK politicians and doctors supported it, the gender-critical people danced in the streets, UK trans groups were appalled by the puberty blocker restrictions but liked the idea of having more than one clinic in the whole country, the parent groups distrusted anything that would require more funding, American trans groups were terrified that it would prompt even more restrictions in the US, etc.
I also think that, to the extent that it's feasible, we should be citing reliable sources that are both independent and secondary for these claims. This will probably get easier as time goes on (e.g., if we get a "one year ago today" kind of news story later this year). WhatamIdoing (talk) 12:06, 2 January 2025 (UTC)
A one paragraph intro to the "Reception" section encompassing that sort of high level summary is probably a good idea?
I still think a new "Further Commentary" section or similar would be a good place to expand with some of the other stuff. Void if removed (talk) 12:53, 2 January 2025 (UTC)
I certainly wouldn't object to an overview like that, either. I think it sorely needs it. I would also have a compressed version in the lede, since it more accurately reflects the pro/anti in broad strokes rather than the flat statement we have in the lede at present. But the former is probably a higher priority. One good outcome of that is that we may, in time, be able to remove or further condense these sections in Responses altogether. It's more important to show the broad support/opposition among groups rather than listing individual comments, but that applies to all support/opposition and needs to be done carefully. Lewisguile (talk) 17:18, 2 January 2025 (UTC)
I agree with Lewis and Friendly Sociologist. Trans people are the affected party, so we should include responses from groups established to protect their interests. HenrikHolen (talk) 14:07, 2 January 2025 (UTC)
Thanks, Henrik. Lewisguile (talk) 17:19, 2 January 2025 (UTC)

ILGA, Transgender Europe, and IGLYO Joint Statement

The largest and oldest international LGBT watchdog ILGA, one of the largest and oldest international trans watchdogs Transgender Europe, and the largest LGBT student group IGLYO released a joint statement criticizing UK government policy and said The “Keeping Children Safe in Education 2024” guidance uses the Cass Review as an evidentiary basis for this policy change, despite its poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts. As stated by healthcare activist and feminist researcher Dr Ruth Pearce in an article titled “What’s wrong with the Cass Review? A round-up of commentary and evidence” (2024), the Cass Review “has been extensively criticised by trans community organisations, medical practitioners, plus scholars working in fields including transgender medicine, epidemiology, neuroscience, psychology, women’s studies, feminist theory, and gender studies”.

@Void if removed removed it saying this is about a government action, and it happens to mention the Cass Review in passing. This is not due, and also citing a blog?

  1. This is about a government action explicitly justified by the Cass Review, which the statement spends a paragraph critiquing
  2. They explicitly reference the blog in their statement. We aren't citing it directly, we're providing a courtesy link to who ILGA et al cited.

Today alone, you removed the fact the UK's LGBT doctors org explicitly criticized it, that the labour party's LGBT chapter criticized it , and are now removing criticism from Europe's largest LGBT rights watchdog and trans rights watchdog by claiming, somehow, a paragraph criticizing the Cass review is not relevant to the section "Reception by charities and human rights organisations". That's today alone, there are dozens of diffs of you trying to remove criticism from LGBT rights orgs, hell you even tried to remove that PATHA criticized them for whitewashing a form of conversion therapy.

Please self-revert. This is painfully obviously due, and your continued removal of criticisms from LGBT orgs is getting tendentious to the extreme. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:54, 2 January 2025 (UTC)

ILGA are huge and influential. If ILGA release a statement about the Cass Review, and it gets coverage in a RS, it is arguably more due than the Stonewall and Mermaids statements.
This, OTOH, is a self-published statement about a completely different matter, 9 months after the release of the final report. that happens to mention the Cass Review. It isn't a response and doesn't belong in "reception".
Now, if we had a section for wider impacts, or further coverage about related sociopolitical events, there's a case for it there, but even so, I'd hope for a secondary source that directly links this statement to the Cass Review. For example, perhaps if we had coverage of the "Keeping Children Safe in Education 2024" guidance that RS explicitly linked to the Cass Review, and a section in "wider impacts" or something that mentioned it and explained what it was, then this response to that guidance would go there.
And citing a blog is terrible sourcing.
So I would say: if this statement gets reliable secondary coverage relating it to the guidance, and there's coverage of the guidance relating it to the cass review, and we build enough to make a section relating all three things together in some sort of "wider impacts" or "subsequent events" section of this article, then it would be due. Void if removed (talk) 21:56, 2 January 2025 (UTC)
I dont understand why we cannot use advocacy group statements in attributed voice on Misplaced Pages in a reception section, and you just admitted that they are a giant watchdog. I also do not understand, this is clearly a large portion of info about the Cass Review and its effect on government policy. It is like arguing that a report about lung cancer criticizing cigarettes as a cause for cancer in a single paragraph is not about cigarettes and cannot be used as evidence.
The statement isn't a blog either and is part of the IGLYO website. this seems like tendetious editing. Bluethricecreamman (talk) 22:13, 2 January 2025 (UTC)
I dont understand why we cannot use advocacy group statements in attributed voice on Misplaced Pages in a reception section
If it were ILGA's statement upon the release of the Cass Review you'd have a point. That's not what this is, it is a statement about a different thing, months down the line.
The problem here is the longstanding resistance to expanding this article and instead turning "reception" into a coatrack, because it seems everyone wants their favourite response to be in "reception".
I would like to expand this article. I think you could make a better case for this statement as part of an expansion in a different section. It isn't "reception" because this is months down the line and a response to a completely unrelated political matter.
I think a better approach rather than continuing to bloat "reception" with ever more tenuous things is: make the case that the political matter itself is due, explain what it is and why, and then include ILGA's response to that.
The Cass Review is significant. It has had a significant impact. Now lots of subsequent matters rely on it. I think it is well past time to try to move past "reception" and into broader matters, and I would like to see the subsequent critical to and fro in that light, where they can be properly presented.
The guidance in question is here and the sole reference to Cass is:
However, the Cass review identified that caution is necessary for children questioning their gender as there remain many unknowns about the impact of social transition and children may well have wider vulnerabilities, including having complex mental health and psychosocial needs, and in some cases additional diagnoses of autism spectrum disorder and/or attention deficit hyperactivity disorder
That's literally it, and it is hardly contentious. Now if there's secondary coverage of this guidance, that makes the point it is directly the result of the Cass Review, then there's a case to be made for creating a section in "subsequent government actions" for this, and then arguably ILGA's response would be due as a response to that. I couldn't find any but I didn't look hard so be my guest. The only ones I found on a cursory search making a big deal out of it is Sex Matters, but that's nowhere near enough, it needs secondary coverage to make it notable, not just advocacy orgs taking predictably polarised positions.
The statement isn't a blog either
The edit included a citation to a blog. Void if removed (talk) 22:31, 2 January 2025 (UTC)
To be clear: this is a blog, by someone very invested in collecting every bad thing anyone said about the Cass Review all in one place. This is not a reliable source for anything, and there's no reason to cite it. Trying to justify citing it by calling it a "courtesy link" is no policy I've ever come across. As it stood, the edit inappropriately inflated the opinion of this individual blog.
We have a longstanding consensus to avoid individual responses in the "reception" section because there are so very many of them, and if we start adding them, there are a dozen higher quality ones in the queue before this one. Trying to add one like this, attached to the ILGA statement, is reopening an old argument.
So aside from the fact ILGA aren't even responding to the Cass Review I also strongly object to trying to get this extensive opinionated quote in:
They also quoted healthcare activist and feminist Dr Ruth Pearce, who collated criticisms of the review and said it "has been extensively criticised by trans community organisations, medical practitioners, plus scholars working in fields including transgender medicine, epidemiology, neuroscience, psychology, women’s studies, feminist theory, and gender studies"
Attempting this simply because ILGA cite this blog is ridiculous when we've excluded far, far more weighty and significant contemporaneous individual responses from, say, the editor-in-chief of the BMJ and surely nobody wants to have the "individual response" argument all over again. Void if removed (talk) 22:57, 2 January 2025 (UTC)
Bruh, ILGA cited them and quoted them. It was not cited for the statement, ILGA was cited quoting them. It would be silly to not provide a courtesy link. It is common practice on Misplaced Pages, when a source quotes and references another, to link the original.
We have a longstanding consensus to avoid individual responses in the "reception" section - Once again, it was ILGA et als response being quoted. The fact you don't like what they quoted doesn't mean they didn't quote it. If we have a source that says "BMJ editor-in-cheif said so and so", that would be different, but we don't. Apples and oranges. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:09, 2 January 2025 (UTC)
that would be different
It is not - we have dozens of sources of individuals being quoted, and we took the decision not to include any of them because it was so contentious, and it was more important to focus on what, say, WPATH thought, than what, say, David Bell thought. Once we got past the immediate and significant political and medical figures directly responsible for policy and implementation, just adding endless quotes from Doctor X saying "I think its great" and Doctor Y saying "I think its terrible" wasn't adding a lot. Void if removed (talk) 23:16, 2 January 2025 (UTC)
And here we have ILGA saying according to this collection of criticism and commentary of the Cass Review, it is xyz. Those are individual responses, this is a collation of responses that ILGA thought important enough to name, quote, and reference. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:22, 2 January 2025 (UTC)
a response to a completely unrelated political matter. - How exactly is UK government policy explicitly justified by the Cass Review "Completely unrelated"?
We should expand on the anti-trans schools guidance, and note ILGA's criticisms, in the section on "Subsequent government actions in the UK". But also cover what they explicitly said about the Cass Review itself in the section on human rights orgs.
WRT That's literally it, and it is hardly contentious. - That is ridiculously contentious...
  • Almost every criticism of the Cass Review highlights the fearmongering about supposed dangers of social transition. It's a human right, not requiring any kind of "caution".
  • Almost every criticism of the Cass Review highlights referring to kids who explicitly identity as trans "gender questioning".
  • Right after the Cass quote, they recommend multiple things Cass called for, which were also heavily criticized such as 1) outing trans kids to their parents 2) telling parents to take their pre-pubertal (ie, in no need of any medical treatment) trans kids to a clinic
  • As ILGA noted, the guidance previously said trans kids should be affirmed. That was replaced with "LGB kids should be affirmed", followed immediately with However, the Cass review, which is then followed by saying Cass's recommendations about trans kids
The edit included a citation to a blog. which ILGA et al explicitly referenced and linked. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:00, 2 January 2025 (UTC)
How exactly is UK government policy explicitly justified by the Cass Review
Do you have some good secondary sourcing for that? If so, please, expand on this in "subsequent government actions", ideally under a heading like "Keeping children safe in education 2024 guidance" and add the ILGA response there.
which ILGA et al explicitly referenced and linked
So? Void if removed (talk) 23:06, 2 January 2025 (UTC)
I said How exactly is UK government policy explicitly justified by the Cass Review "Completely unrelated"?. You have no compelling arguments for why it isn't, we have a statement from multiple reliable watchdogs that it is. Also, the fact it's blindingly obvious and verifiable. The guidance changed from "affirm LGBT youth" to "affirm LGB youth, however the Cass Review said XYZ about trans kids, so do the things Cass said for trans kids",
Like I said, ILGA's response to the guidance can go into a section on education, but the response to the Cass Review should be in the normal place.
So? If we mention what ILGA said, we mention the quote they gave, and there's no good reason not to provide a link and plenty of reasons too. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:20, 2 January 2025 (UTC)
very clearly due and should be included. Bluethricecreamman (talk) 22:07, 2 January 2025 (UTC)
Clearly due. The source is appropriate as per WP:USESPS and WP:ABOUTSELF, since ILGA is a well-recognized expert group and because the statement concerns the source itself.
The revert was unwarranted and the content should be reintroduced. HenrikHolen (talk) 23:12, 2 January 2025 (UTC)
@Void if removed I don't have the energy for this. Consensus is against you, you aren't convincing anybody, please self-revert so this can be dropped. Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:26, 2 January 2025 (UTC)


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