Neasa Hourigan (Dublin Central, Green Party) | Oireachtas source

In 2020, the United Kingdom's National Health Service commissioned a report to optimise healthcare for transgender adolescents but it instead produced the Cass review. For some inexplicable reason, the HSE in Ireland is, by all accounts, undertaking its own review of this report. The report is highly politicised, junk science. It is driven by the UK's culture wars and should be allowed nowhere near policymaking in Ireland.

At a time when our health service is moving towards care that is rooted in the person and their rights, the Cass review actively undermines the legal competence of both children and adults to access choice-based medical treatment. It dismisses almost all existing clinical evidence on trans people's healthcare by applying evidence standards which, if applied to other medicines, would effectively invalidate more than three quarters of the existing treatments currently used in paediatric care.

The ways in which the report is flawed, bogus or methodologically compromised include but are not limited to the following: the Cass review does not follow established standards for evaluating evidence or evidence quality; the review casually discusses evidence quality but does not define it; it contravenes standard practice in scientific evaluations of medical research; and the review uses misleading and subjective terminology and misuses technical language regarding evidence quality. In any other field of medicine, this practice would be deemed unacceptable and harmful to patients.

An independent review of the evidence evaluation of the Cass report has described it as pseudo-scientific and subjective. It does not follow best practice or even standard practice in its fields. For example, the review conducted a series of focus groups with healthcare workers of varying backgrounds. It is not clear what expertise these individuals had but 34% of them admitted that their understanding of gender-questioning children came from the media.

The Cass review misinterprets and misrepresents its own data. There are too many instances to recount today but as an example, the review states without evidence that practitioners have abandoned normal clinical approaches to holistic assessment and that puberty pausing medications are available in routine clinical practice. However, the review's own data shows that only 178 young people in the UK with gender dysphoria, as the review describes it, currently receive medications that pause puberty under its definition. It is difficult to see how a medication is routine but also only applies to 0.0024% of the adolescent population.

The Cass review levies unsupported assertions about gender identity, gender dysphoria, standard practice and the safety of gender affirming medical treatments. It also repeats claims that have been disproved by sound evidence. This is where we truly see the political agenda laid bare in the Cass review. While the review places a high value on evidence quality and certainty, its recommendations frequently emanate from insufficiently supported assertions that have been disproven by scientific evidence. For example, the review continually highlights the concept of desistance - I hope I am saying that correctly - in a completely unproven way. Studies in the 1980s demonstrated that most gender non-conforming children would not meet the criteria for gender dysphoria after progression through puberty for a variety of reasons. This is not the same as a loss of transgender identity. Studies that claim high rates of desistance in children rely on data collected before there was a formal definition of gender dysphoria. At the time, children's behaviours were classified as non-gender conforming if they did not adhere to gender stereotypes, such as not wearing enough pink or not playing football.

More concerning is that despite stating opposition to so-called conversion therapy, the review favourably cites literature proposing methods which claim to suppress transgender identity in children and uses the desistance data from this literature unquestioningly. This is a terrifying vista for children, parents and families who are dealing with this - a health service that is willing to suppress you but not meet your needs.

The HSE has to uphold its good name and its commitment to evidence-based policy. It should not go anywhere near junk science or the Cass review.

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