Understanding the reports on health care for trans youth
Learn more about reports on trans health care.
If you've been paying attention to news about trans health care restrictions, you've likely heard of the Cass Review, as well as changing European standards of care for transgender youth. Justices referenced both in the oral arguments in the case U.S. v. Skrmetti at the Supreme Court this week.
Here are some resources to learn more about the recent reviews on this subject.
Despite common claims that the Cass Review debunks the efficacy of trans health care, the report's conclusions are more complex than that. The review does recommend that some common treatments, like hormone therapy, should be provided to minors only with "extreme caution."
But it also calls for investing in trans health care by "expanding capacity at all levels of the system" to enable decreased wait times and "more timely care," "an individualised, personal approach," and the collection of additional data on longer-term outcomes.
For further context on the review, read the Yale-led, evidence-based critique of its conclusions. It's also worth diving into the Cass Review's underlying data. According to the Yale critique, the review "misinterprets and misrepresents its own data."
The report has not been uncontroversial in Britain, either. The British Medical Association called for a pause on the review's implementation and voted to independently evaluate its findings. After some of its members criticized the decision, the association's leadership reaffirmed its intent to evaluate the review and pledged to do so "from a position of neutrality." Its leaders also noted concerns that England's National Health Service chose to implement the review's recommendations inconsistently.
These episodes underscore the TJA's perennial coverage guidance for considering research: As with datasets, you should treat studies, reviews, and research like any other source. Evaluate their expertise, their authority, and their point of view. It's important to know how to understand and contextualize research — and potential bias — for your audience.
It’s also important to distinguish between peer-reviewed studies, scientific literature reviews, and the findings of health authorities. The U.S. Food and Drug Administration, the U.K. National Health Service, and the Florida Department of Health, for example, are all government bodies. Like for any document you obtain from a government agency, ask questions and apply scrutiny; it may not have gone through the same evaluation process as something published in a journal. Research itself has a number of possible methodological biases, which the Association for Health Care Journalists offers helpful resources for understanding. Academic journals' internal safeguards and conflict of interest policies also vary widely.
Claims that the U.S. has less-regulated gender health care, or that Europe is uniformly urging increased caution in providing gender-related health care to trans youth, also oversimplify the landscape. Some countries, such as the U.K. and Sweden, have restricted eligibility for care; there are also wide variations in access to care. However, as of early 2024, no European country except Russia had outright banned care. Two dozen U.S. states now have laws or policies that ban this care, mostly for youth but increasingly also for adults.
Meanwhile, the French Society of Pediatric Endocrinology and Diabetology this week released "expert consensus" that comes to different conclusions than the Cass Review, writing that "a wait-and-see attitude" does not "reduce psychological distress" and "increases the risk of committing suicide." This review argues against the use of "strict age criteria" and instead advises that physicians consider individual medical history, psychological state, and maturity.
So, what exactly is the health care at the center of all this debate?
Generally, it might involve mental health evaluation, then puberty-delaying medication or hormone therapy. These medications are commonly prescribed to cisgender youth for managing conditions such as early puberty, hypogonadism, or severe acne. Despite claims that gender-affirming surgery is widespread in the U.S., it is in fact incredibly rare: Harvard researchers found "little to no utilization" of surgery for trans minors. (Instead, they found that 97% of breast-reduction surgeries among minors are performed on cisgender teenage boys with gynecomastia, for example.)
In fact, surgery is rare even for trans adults. Only about 1 in 6 trans Americans of any age have received gender-related surgery, according to data from KFF/The Washington Post Trans Survey.
For additional style and coverage guidance, see our style guide's health care subsection.
This resource was originally published as part of a newsletter on December 6, 2024.
