America should follow England’s lead on transgender care for kids

Calm discussionsBBC of are rare. “There are few other areas of health care where professionals are so afraid to openly discuss their views,” argues Hilary Cass, a British doctor. On , commissioned by England’s National Health Service, assessing the evidence for and against treatments for children who identify as transgender. Its conclusions will reverberate on both sides of the Atlantic, where standards of care differ wildly.The treatments at issue include puberty blockers, cross-sex hormones and (rarely) surgery. Puberty blockers are drugs that delay the onset of puberty. Cross-sex hormones stimulate the development of opposite-sex characteristics: oestrogen causes males to grow larger breasts, testosterone gives females bigger muscles and deeper voices, among other things. “There is not a reliable evidence base” to show that the benefits of offering such treatments to children outweigh the harms, says the Cass Review. Many studies have been published, but they are often of “poor quality”. Some draw conclusions from tiny samples. Some lack control groups, so that outcomes for patients receiving treatment are not compared with outcomes for those who do not. Far too little effort has been made to observe long-term effects. Some clinics even resisted attempts to gather such data. “It is unusual for us to give a potentially life-changing treatment to young people and not know what happens to them in adulthood,” Dr Cass told the .