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Latest comment: 2 months ago40 comments6 people in discussion
Did the British Medical Association ever publish the findings of their "neutral" investigation into the Cass Review? These 2025 sources report that it's more than six months overdue:
We should consider slapping an "As of June2025[update], they had still not published this" on the description (how many pages does that need to be updated on now?), and probably moving it out of the lead. An organization having an internal fight over the report and then doing and saying nothing at all about for the next almost two years now is not exactly the most important thing someone needs to know about the Cass Review. WhatamIdoing (talk) 00:12, 2 April 2026 (UTC)Reply
I’d be fine with doing both. I agree that, at least as of now, it’s probably not worth mentioning in the lead. But maybe once/if it comes out, it could be added back to the lead depending on how noteworthy it ends up being. Usr Trj (talk) 06:13, 3 April 2026 (UTC)Reply
That sounds appropriate, though of course, as you say, all the usual disclaimers (e.g., about needing to consider the sources) apply. Can you try to make some of those changes? WhatamIdoing (talk) 06:20, 3 April 2026 (UTC)Reply
All I could find was that Deborah Cohen, former Investigations Editor of the BMJ (which is owned by the BMA), tweeted in October 2025 that it's been delayed, though she didn't say for how long. InfernoHues (talk) 03:50, 2 April 2026 (UTC)Reply
Thanks. I see that the person who proposed the original (i.e., anti-Cass) resolution is now the head of the BMA. I would have thought that getting it published would be one of his goals. WhatamIdoing (talk) 19:53, 2 April 2026 (UTC)Reply
I have access to that news article (~850 words) through the Wikipedia:The Wikipedia Library. I have read it, and I think that it justifies a substantial rewrite to this article. Towards the end, the news piece quotes the BMA's science chair as saying: “The BMA fundamentally is here to look at the science behind these elements. We can now go back to those members who were very critical of the baroness and say, ‘She did the best with the information that we had at hand.’”
There was substantive disagreement between Task and Finish Group members on whether the restriction of access to puberty blockers represents a proportionate response to the evidence.
Otherwise, it appears that the BMA agrees with the Cass final report, and where the government actions differ from Cass report (e.g., fully banning all use of puberty blockers outside of trials, which was not the Cass recommendation), they agree with the Cass report and disagree with the government. WhatamIdoing (talk) 05:40, 8 May 2026 (UTC)Reply
I think this part is also relevant, given it validates some of the criticisms made by other groups.
Many of the statements in the Cass Review were supported by the cited literature, but a proportion were only partially substantiated or not substantiated. In several cases, there was a tendency for statements to simplify complex findings or to emphasise potential risks without equivalent contextualisation of potential benefits.
That first sentence is addressed in the news article. (Basically, the emphasis is on "cited", rather than on whether the material is true/accurate. For example, the Cass Review's own interviews with clinicians and other stakeholders are not in the literature, so those claims won't be supported by citations to literature.)
I think the second sentence is useful to us, as it is genuine secondary source material that analyzes the final report. It will be important to write that carefully: "In several cases" there was "a tendency" towards one problem or another. "Several" is usually less than "many" (certainly less than "most"). "A tendency" is not a strong claim, and the BMA report later explicitly rejects "bias". WhatamIdoing (talk) 18:08, 8 May 2026 (UTC)Reply
I might have missed it, but they only specifically reject bias in the studies selected for the review. They don't comment otherwise. InfernoHues (talk) 18:25, 8 May 2026 (UTC)Reply
They make this statement about the Cass final report (not the systematic reviews) in the Executive Summary: "There was some subjectivity to this process, albeit not definitive evidence of bias". WhatamIdoing (talk) 19:40, 8 May 2026 (UTC)Reply
No worries. It's a long report, and nobody expects any of us to have the whole thing memorized. You were correct that almost everything they said about bias was unrelated to this. Next time, it'll be your turn to show me something that I missed. WhatamIdoing (talk) 19:54, 8 May 2026 (UTC)Reply
In the category of ironies:
The Cass Review's final report was criticized for not being peer-reviewed, including by the BMA report, which is also not peer-reviewed.
The Cass Review (=the committee) was criticized for not disclosing the names of the people involved; they said the decision was made for security reasons. The BMA report did not disclose the names of the people involved; they said the decision was made for security reasons.
The BMA's report agreed that there wasn't much good research
There was misinformation on social media claiming that lots of good evidence exists but was ignored (Cass Review#Hilary Cass's response)
WPATH said that "the (research and consensus-based) evidence" ("consensus-based evidence" is usually considered an oxymoron, BTW) is good enough. (Cass Review#Global health bodies)
The New Zealand Ministry of Health said the research base isn't good enough. (Cass Review#New Zealand)
A Polish paper "the multifaceted downplaying of...the scientific knowledge base" (Cass Review#Poland)
"Some academics in the UK agreed with the Cass Review's findings stating a lack of evidence" but "Various scholars also criticised the emphasis on high and moderate quality evidence" (Cass Review#Reception by academics and researchers)
JAH published commentary claiming "robust data"
RAND "rated the existing evidence base as having low and very low certainty"
and so forth. Should all of this be in the same section, roughly as "The final report said there's not much good research. A, B, and C agreed with this, and D, E, and F disagreed with it"? WhatamIdoing (talk) 03:57, 11 May 2026 (UTC)Reply
No, because not all these sources deserve equal weight. In particular, WPATH as the main international WP:MEDORG in this topic area deserves hugely more weight than any other source you've listed. Conversely, the Senedd isn't even a reliable source at all. And you didn't even mention the Endocrine Society, which is also higher weight than almost all those sources.
I also think you're misrepresenting some of these sources. In particular:
After having actually read it myself, I wouldn't say the BMA report agreed with the Cass Review. Rather it said that the evidence is "limited" for both risks and benefits and said the Cass Review emphasized the weakness of the evidence for benefits but not for risks. It also, if you look at the details, thinks the evidence is stronger than the Cass Review thinks it is, though not by a lot.
I would not call what happened on social media "misinformation" if the two biggest MEDORGs in the topic area agree the evidence in the topic area is strong.
We go into detail about what happened in New Zealand in our section on it, and in what happened is that a government ministry under a right-wing government made an anti-trans decision and was criticized for it by basically every independent MEDORG in the country.
This is also to say that I don't think the BMA report justifies a substantial rewrite to this article, because I don't think it actually meaningfully agrees with the Cass Review. Rather, it's critical of the Cass Review but in a measured academic way. Loki (talk) 04:28, 11 May 2026 (UTC)Reply
Last I saw, ES and WPATH don't agree that the evidence base for pediatric gender care is "strong". They have said they think it is good enough and that it is comparable to what is seen in some other pediatric specialties.
The misinformation, has been described this way in this article for about two years now: "There were widespread misleading claims from critics of the report that it had dismissed 98% of the studies it collected and all studies which were not double-blind experiments. Cass described these claims as being "completely incorrect". Although only 2% of the papers collected were considered to be of high quality, 60% of the papers, including those considered to be of moderate quality, were considered in the report's evidence synthesis." Surely you don't think that ES and WPATH have promoted that misinformation. WhatamIdoing (talk) 04:37, 11 May 2026 (UTC)Reply
I don't but I would not say the misinformation was "lots of good evidence exists but was ignored", and would say that both WPATH and ES would endorse that. The misinformation was "it had dismissed 98% of the studies it collected and all studies which were not double-blind experiments". Loki (talk) 04:46, 11 May 2026 (UTC)Reply
I looked at the cited sources from WPATH. They say things like:
"emphasise the increasing evidence": in other words, "more than we used to have", but not "a lot".
"considers that the (research and consensus-based) evidence is such to recommend": in other words, "good enough", but not "a lot".
"ignoring more than three decades of clinical experience in this area as well as existing evidence showing the benefits": See also our article on clinical experience.
PATHA finds (and WPATH later endorsed) that "multiple observational studies" are "compelling". Unfortunately, reputable MEDORGS have said the same thing about many other treatments, and sometimes (e.g., arthroscopic knee surgery for osteoarthritis), they're proven wrong.
I think this indicates that they believe they have enough evidence to make a recommendation, but that's different from them saying that they have a lot of evidence. I don't see, e.g., anyone saying "Nope, no need to study pediatric gender care, so put those research funds to better use on something else" (and that does happen). WhatamIdoing (talk) 05:15, 11 May 2026 (UTC)Reply
In contrast to what the Cass Review recommends, WPATH and USPATH firmly stand by the Standards of Care for the Health of Transgender and Gender Diverse People – version 8, which was published in 2022—and based on far more systematic reviews tha[n] the Cass Review
---
The Cass Review appears to be an outlier, ignoring more than three decades of clinical experience in this area as well as existing evidence showing the benefits of hormonal interventions on the mental health and quality of life of gender diverse young people.
Loki, I usually find you to be so precise that I'm feeling disappointed and frustrated with this response. I'm not sure what the relevance of these quotations is meant to be.
Of course SOC-8 cites more reviews than the Cass Review. The Cass Review only has to concern itself with pediatrics, so it doesn't need reviews about, e.g., the health problems of older trans people. SOC-8, because it needs to cover pediatrics, young adults, and older adults, and it needs to cover details about various options, should have cited far more sources in total than the Cass Review did. SOC-8 needs to cover things like "Urethral complications after gender reassignment surgery" and "Sex Steroids and Cardiovascular Outcomes in Transgender Individuals" and "The worldwide burden of HIV in transgender individuals" (all systematic reviews cited in SOC-8). The Cass Review doesn't need to cover any of that, so it should be citing fewer sources, including fewer systematic reviews. I notice that they didn't point out any specific reviews that they believe should have been cited in the Cass Review. That's probably because there weren't any. The BMA report says that there weren't any obvious studies missed, and AFAICT from two years of discussions on this page, nobody else has found any missing ones, either.
The second quotation, about "existing evidence", says nothing about whether that's "a lot of evidence". Here's what it sounds like from where I'm sitting:
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....Our current understanding of the long-term health impacts of hormone interventions is limited...the research evidence around the long-term impacts of some treatments is limited....The gaps in the evidence base regarding all aspects of gender care for children and young people have been highlighted, from epidemiology through to assessment, diagnosis and intervention. It is troubling that so little is known about this cohort and their outcomes....the evidence base is currently weak....very limited research on the short-, medium- or longer-term impact of puberty blockers on neurocognitive development"
BMA report: "The evidence base for puberty suppression and gender affirming hormones is limited, predominantly observational, and characterised by substantial uncertainty."
WPATH: Yeah, well, but very limited evidence with gaps not actually the same thing as zero evidence, now, is it?! Some of that evidence is even existing evidence. You should be impressed the fact that some of the evidence is existing evidence. Existing evidence is much better than non-existing evidence.
Here's what I want: Either give up on trying to convince me that ES and WPATH say there's "a lot of" evidence, or show me a source in which they actually comment positively on the volume of evidence about pediatric gender care. Just so you know, my starting point is this:
Both the ES and WPATH believe that, when the scientific evidence is combined with their "decades of" non-evidence anecdata, they have enough information to make certain recommendations.
Mind the gap between "enough" and "a lot". We have "a lot of" evidence around what happens if you give kids antibiotics for ear infections (specifically, the number that develop drug side effects such as diarrhea is almost as big as the number who avoid a complication or recurrence of ear infection). We do not have "a lot of" evidence around what happens when pubescents at Tanner stage 2 with untreated and undiagnosed neurodivergence or mental disorders take puberty blockers for years, until they are finally old enough for GAH to be legal in their home country. ES and WPATH believe there is "enough" to make a recommendation, but they do not say that "enough" is "a lot".
Both the ES and WPATH would be grateful for any and all additions to the evidence base for pediatric gender care, precisely because they are not drowning in too much evidence.
It's normal in some fields to be working with limited evidence (e.g., almost all comorbidities), but it's not normal to have a limited evidence base and pretend that there's a lot of it. In fact, the opposite is normal: Further research is needed, especially for my lab in particular.
Here are some quotations that make me think that the ES and WPATH believe that there is not "a lot" of evidence in gender care medicine: "It is hoped that future research will explore the effectiveness". "Future research would shed more light on gender identity development if conducted over long periods of time with diverse cohort groups...While future research will help...there may always be some gaps." "In some cases, we recognize evidence is limited". "We hope future investigations will address this relative lack of data" "Future studies are recommended." "Future studies should focus on cardiovascular outcomes of interest, with a specific focus on individual predictors". "The number and quality of research studies evaluating pitch-lowering surgeries are currently insufficient". The "research on the long-term impact of GAHT on cancer risk is limited". "Contraceptive research gaps within this population are profound." They say that "to date there is insufficient research on the effectiveness of such interventions". It "still represents a critical gap in research", and "there has been little research on the sexuality of TGD adolescents". "Almost no research has been conducted".
If you think words like "evidence is limited" and "a critical gap in research" mean they believe there's "a lot of" evidence, then please provide a source in which they say that, in clear and unmistakable words, and not a source in which they say something different, such as that some research is "existing", or one in which they say that they cited more systematic reviews on all populations combined than Cass cited on pediatric populations alone. WhatamIdoing (talk) 02:21, 12 May 2026 (UTC)Reply
I have already given you plenty of sources where they comment positively on the volume of evidence in pediatric gender care. You have, in fact, yourself quoted them several times saying that, but every time you quote them it's with a sarcastic tone that makes me believe you don't realize this.
So I guess let me just go through the list again:
There is strong evidence demonstrating the benefits in quality of life and well-being of gender-affirming treatments, including endocrine and surgical procedures, properly indicated and performed as outlined by the Standards of Care (Version 8), in TGD people in need of these treatments. (direct quote from SOC8; admittedly this is not a pediatric-only statement but it does include pediatrics)
To conclude, although the existing samples reported on relatively small groups of youth (e.g., n 22-101 per study) and the time to follow-up varied across studies (6 months–7 years), this emerging evidence base indicates a general improvement in the lives of transgender adolescents who, following careful assessment, receive medically necessary gender-affirming medical treatment. Further, rates of reported regret during the study monitoring periods are low. Taken as a whole, the data show early medical intervention—as part of broader combined assessment and treatment approaches focused on gender dysphoria and general well-being—can be effective and helpful for many transgender adolescents seeking these treatments. (This is the conclusion of section 6 of SOC8, the section on adolescents, and is about as close as they ever get to saying the evidence is limited... but note that they don't.)
Additionally, this chapter also embraces the viewpoint, supported by the substantial psychological research cited above, that psychosocial gender-affirming care (Hidalgo et al., 2013) for prepubescent children offers a window of opportunity to promote a trajectory of well-being that will sustain them over time and during the transition to adolescence. This approach potentially can mitigate some of the common mental health risks faced by transgender and gender diverse (TGD) teens, as frequently described in literature (From the opening of section 7 of SOC8, the section on children. While I'm not going to quote the whole chapter, in general they clearly seem to think the evidence for social transition in kids is quite strong.)
In contrast to what the Cass Review recommends, WPATH and USPATH firmly stand by the Standards of Care for the Health of Transgender and Gender Diverse People – version 8, which was published in 2022—and based on far more systematic reviews that the Cass Review—in collaboration with The School of Evidence-based Practice Center at Johns Hopkins University and considers that the (research and consensus- based) evidence is such to recommend that providing medical treatment including puberty-blocking medication and hormone therapy is helpful and often life-saving for young TGD people
The Cass Review appears to be an outlier, ignoring more than three decades of clinical experience in this area as well as existing evidence showing the benefits of hormonal interventions on the mental health and quality of life of gender diverse young people (1-9).
The Cass Review relies on selective and inconsistent use of evidence, and its recommendations often do not follow from the data presented in the systematic reviews. (In context, WPATH criticizing the Cass Review for saying the evidence is weak is itself them saying the evidence is not weak.)
Amongst these is the supposition that gender incongruence is transient in pre-pubertal children. This document quotes selectively and ignores newer evidence about the persistence of gender incongruence in children (Olson et al., 2022).
This document discourages social transition in pre-pubertal children. This is despite recent evidence pointing to positive mental health and social well-being outcomes in children who are allowed to socially transition in supportive environments before puberty (Durwood et al., 2017; Gibson et al., 2021).
WPATH, ASIAPATH, EPATH, PATHA, and USPATH disagree with this approach, and emphasise the increasing evidence that access to reversible puberty blockers, and later gender-affirming hormone treatment if wished, is associated with positive mental health and social well- being in adolescents with gender incongruence, and that adolescents are satisfied with these treatments and perceive them as essential and lifesaving (Coleman et al., 2022). (Yes, "emphasize the increasing evidence" means they think there is a lot of evidence.)
We are deeply concerned that the NHS is taking inappropriate approaches to evaluating the established body of evidence and is therefore drawing erroneous conclusions underestimating the effectiveness of puberty suppression. (Again, saying the NHS is wrong to say the evidence is weak is saying the evidence is strong.)
It is ethically problematic to induce people to participate in a research project as the only way to access a type of care that is evidence based; evidence-based gender-affirming care; the best evidence-based and compassionate care (When they refer to their own standards they consistently call them "evidence-based".)
To be clear, I do not think WPATH (or ES, who consistently say similar things) thinks there is "too much" evidence because almost no specialty ever thinks there is "too much" research going on in their specialty. As the article you yourself link says, "further research is needed" is such a common phrase that it's a cliche. But I do think that they believe that the research evidence for their recommendations is not "limited" or "weak", nor is it just "enough" or only sufficient when supplemented by clinical practice. At its weakest they think there is a normal amount of evidence, and in many cases they describe the evidence (for their pediatric recommendations specifically) as strong or substantial or other words that mean "a lot". Loki (talk) 05:18, 12 May 2026 (UTC)Reply
This is good, but primarily about young adults.
"Emerging evidence base" is a euphemism for not having much evidence.
"substantial psychological research" is good.
Mostly irrelevant. "Consensus-based evidence" is a euphemism for non-evidence based recommendations. Arthroscopic knee surgery had consensus-based evidence behind it.
"existing evidence" could mean "very little evidence" "Clinical experience" means "not actually evidence-based".
Not a comment on how much evidence exists.
"newer evidence" could mean one paper.
"recent evidence" could mean one paper.
"increasing evidence" usually means that there used to be very little evidence indeed, and now there is slightly more. (Also, patients who had arthroscopic knee surgery were satisfied with their treatments and perceived the surgeries as essential. The surgeries didn't actually work any better than doing nothing, though.)
"the established body of evidence" is more hopeful; it doesn't say "large body of evidence", but that phrase is typically not used when there is significant uncertainty due to a lack of research.
Evidence-based, but with limited evidence.Of course they call their own work "evidence-based". Everyone does. The question isn't whether it's "evidence-based" to some extent or another; the question is how much evidence is it based upon, and how much is non-evidence-based "clinical experience"?
In regards to 8, it explicitly cites two papers, not one. But as less of a nitpick, couldn't the "recent evidence" be a reference to the "substantial psychological research" in 3. Yes, they're from two different documents, but the orgs are all under the greater WPATH umbrella. I don't think it makes sense to assume the worst possible scenario for each of the wording choices. InfernoHues (talk) 19:14, 12 May 2026 (UTC)Reply
Two papers can be one set of evidence (e.g., an original bit of research plus a review article that affirms it). Two papers can even be less than one full set of evidence, if the authors are pushed to produce the Least publishable unit. I assume that's not what's going on here, but I have not bothered to check.
I also don't think it makes sense to assume the worst for every single wording choice, and this list does have some of what I've been asking for. Many of these statements are the sort that will have been haggled over in meetings, so that they imply strong things without being vulnerable to factual challenges.
I think it's perfectly fine for a MEDORG to say "not much good evidence, but here's our best recommendation". IMO any MEDORG that doesn't make a recommendation because they don't have perfect evidence isn't doing it's job. One of the roles of a MEDORG is to fill the gap in between perfect evidence and the daily reality. But we, as Wikipedia editors, should not mistake phrases like "recent evidence" as meaning "a lot of evidence". They're making recommendations, and I assume (assume, because, as a Wikipedia editor, it's not my role to double-check) that those recommendations following professional standards and produce recommendations that are comparable in quality to, e.g., what American College of Obstetricians and Gynecologists produces for their members.
What I object to is Wikipedia editors misreading what they're saying, and trying to say that things like "decades of clinical experience" are the same as evidence-based medicine. "Decades of clinical experience" is what the world had in the centuries before it had (some) evidence-based medicine (the last estimate I saw was that about half of medicine was evidence-based now). WhatamIdoing (talk) 19:46, 12 May 2026 (UTC)Reply
Yeah that's all fair, and I agree completely. Getting back to the original point, I generally agree with Loki that the article shouldn't be restructured, but think some of what the BMA says should at least be mentioned, as well as the document that Loki's quoting from. InfernoHues (talk) 19:52, 12 May 2026 (UTC)Reply
The document Loki and I are (mostly) quoting from is SOC-8, which says nothing about the Cass final report because it predates the Cass final report by a couple of years.
I think the problem with the current structure is that if you want to know what the Cass Review recommended about (e.g.,) puberty blockers, then you have to look in multiple sections to get the whole story. WhatamIdoing (talk) 20:49, 12 May 2026 (UTC)Reply
I do agree that the structuring could be fixed, I just meant that it shouldn't be restructured based on what the BMA report said. Apologies if that isn't what you meant. InfernoHues (talk) 20:54, 12 May 2026 (UTC)Reply
In re they believe that the research evidence for their recommendations is not "limited" or "weak": And yet SOC-8 says that the evidence is "limited" and "weak" over and over again. The word limited alone appears 100 times in SOC-8, as they repeatedly say on approximately every other page that they're having to make recommendations without good evidence. (I bet they won't make the 'mistake' of calling out weakness in evidence in SOC-9, though.) WhatamIdoing (talk) 19:02, 12 May 2026 (UTC)Reply
I think it's important to contextualize the document's use of "limited" here as after some reading on my part, while true the word "limited" is used 101 times, your characterization that "they repeatedly say on approximately every other page that they're having to make recommendations without good evidence" seems rather inaccurate. I assume though that this reading is somewhat based on the repeated use of the below paragraph (specifically, said paragraph appears 15 times).
"All the statements in this chapter have been recommended based on a thorough review of evidence, an assessment of the benefits and harms, values and preferences of providers and patients, and resource use and feasibility. In some cases, we recognize evidence is limited and/or services may not be accessible or desirable." (Emphasis mine)
This is not an example of them "having to make recommendations without good evidence" though, but rather a boilerplate disclaimer for each section that, if there is limited evidence for a procedure, they will specifically state as such, then another 10 instances are from the phrase "not limited to".
Now regarding the instances that in some way refer to limited evidence (Apologies for the extremely long reply):
p33: Recommendations on how to handle patients who "are requesting less common treatments or treatments with limited research evidence".
p35: Limited empirical evidence (as in, that which is reliably reproducible) regarding adults due to both ethical concerns & the variation among individuals requiring treatments be considered on a case-by-case basis.
p39: Limited data associating cardiovascular & metabolic risks to hormone therapy in adults.
p42: Limited evidence that the approval of 2 separate health care professionals is necessary for adults seeking treatment.
p42: Limited research supporting a patient necessitating a minimum of 6 months of hormone therapy before undergoing surgery, when seeking a gonadectomy. They recommend the 6 months of hormone therapy anyway for potential ease of reversibility.
p43: Limited research in how to best handle adults seeking medical detransition.
p45: In reference to changes since the last SoC - "Until recently, there was limited information regarding the prevalence of gender diversity among adolescents."
p53: No studies on the long-term impact of medical treatment to youth who’ve received limited or no professional assessment.
p56: Limited studies on the risk/benefit of tucking in adults & none for youth.
p66: “A study on surgical outcomes of laparoscopic intestinal vaginoplasty (performed because of limited genital tissue after the use of puberty blockers) in transgender women “.
p67: Limited data on what age is best to begin treatment & the subsequent correlation with a positive outcome + “limited studies on youth who have initiated hormones prior to 14 years of age“.
p68: Again, “Data are limited on the optimal timing for initiating other gender-affirming surgical treatments in adolescents.“ + limited access to treatment depending on location. + “Limited data are available on the outcomes for youth undergoing vaginoplasty.”
p70: Limited empirical studies & no psychometrically sound way of ascertaining a prepubescent child’s gender identity & needs.
p77: Limited empirical research on evaluating the impact of professionals informing children & caregivers of potential gender-affirming medical interventions & related issues/solutions to fertility.
p78: Limited empirical data regarding the impact of caregivers & professionals supporting a child’s expressed gender identity.
p79: Limited & self-selected participant pool of a report on US detransition rate + limited ability to predict how a child’s gender identity may evolve, or whether/why they may detransition + Consider the potential impact of prejudice when deciding to transition, especially in places where acceptance may be limited.
p80: Limited research found some caregivers of socially transitioned children may discuss the option of new gender iterations & the children were comfortable with this.
p87: Limited social understanding of non-binary expression.
p98: Limited or no communication between professionals regarding intersexuality.
p101: Limited public awareness of intersexuality.
p103: An intersex child’s genitals may stress parents with research reporting a “correlation of surgery to create binary genitals with a limited amount of reduction in parental distress” & a minority of parents reporting regret.
p104: Limited long-term outcome studies on delaying the decision of intersex children receiving genital surgery until they’re of consenting age + Recommend surgical care be limited to intersex experts
p107: Referring to the “loss of or limited agency” of the incarcerated.
p116: Limited long-term data of prescribing GnRH to gender nonconforming adolescents compared to adolescents with precocious puberty.
p121: Limited data to guide treatment decisions relating to patients seeking feminizing treatment who have conditions sensitive to exogenous hormone treatment.
p123: Estradiol appears safer than CEE in limited studies + the quality of these “studies may be limited to prospective, cohort or cross-sectional study designs”
p132: “While gender-affirming facial surgery for AFAB individuals is an emerging field, current limited data points toward equal benefits in select patients. Future studies are recommended.“
p135: limited information about the long-term outcomes of non-standard surgeries + Potential complications resulting from metoidioplasty/phalloplasty include “limited to absent tactile and/or erogenous sensation”
p136: Most potential complications resulting from vaginoplasty “are self-limited”
p139: Gender nonconforming people who are a part of another marginalized group “experience discrimination and limited access to care at even greater rates”
p141: “Research on pitch-lowering surgeries is limited.“
p146: Primary care providers “are commonly called upon to provide care for a broad range of conditions and needs, including those with which they may have had limited or no prior experience” + “research on the long-term impact of GAHT on cancer risk is limited”
p148: A series of US studies on the prevalence of cardiovascular disease in trans individuals didn’t record hormone use & were “limited by the use of self-reported health histories” + Studies are limited on the impact of testosterone therapy on cardiovascular events or strokes in transgender men + “Current limited evidence suggests estrogen-based GAHT is associated with an increased risk of myocardial infarction and stroke“
p149: Evidence of both testosterone- and estrogen-based GAHT’s effect on lipid metabolism, is limited by the variety of hormone regimens.
p150: The difference of a slight elevation in “mean systolic blood pressure on long term follow-up of testosterone-based regimens”, was referred to as “of limited clinical relevance” + Due to the limited quality of studies, a systematic review concluded that “there is insufficient data to reach conclusions on the effects of gender-affirming hormone therapy on blood pressure” + “[L]imited data comparing the prevalence of diabetes mellitus between TGD and cisgender samples independent of hormone use.”
p151: Limited evidence suggests that PCPs can effectively discourage patients from smoking tobacco by describing its potential impact on treatment + The “literature on aging and transgender elders is limited” + Studies on gender nonconforming elder’s mental health is limited.
p153: “Limited retrospective data has not demonstrated increased risk for breast cancer among transgender men“
p154: “Direct study of antiretroviral/gender-affirming hormone therapy (ART/GAHT) interactions has been limited”
p157: “Because [laser hair removal] targets melanin, results may be limited for those with grey, blonde, or red hair“
p158: “American Society for Reproductive Medicine guidelines have lifted the experimental label on ovarian tissue cryopreservation, but evidence remains limited in prepubertal children“
p159 + p162: “We recommend health care professionals counsel pre- or early-pubertal transgender and gender diverse youth seeking gender-affirming therapy and their families that currently evidence-based/established fertility preservation options are limited”
p160: “Spermatogenesis might resume after discontinuation of prolonged treatment with anti-androgens and estrogens, but data are limited”
p163: “[T]here is limited information regarding health outcomes of infants born to transgender men” + Limited studies on lactation & chest/breast feeding of transgender men & those AFAB + Limited studies on lactation of transgender women & those AMAB.
p168: “Social and psychological barriers to sexual functioning and pleasure, including experiences of gender dysphoria, stigmatization, lack of sexual and relationship role models, and limited skills, can have negative impacts on overall sexual health”
p170: “Despite limited epidemiologic data, transmasculine persons who have sex with cisgender men frequently report HIV/STI risk related to receptive vaginal and/or anal sex”
p171: “[S]tudies demonstrating the effectiveness of event-driven PrEP with emtricitabine/ tenofovir disoproxil fumarate (TDF) have been limited to cisgender men”
Finally though, there are only 11 instances of "weak" used, 5 of which are related to voice training & those remaining that refer to evidence pertain to there being weak evidence correlating treatment with some symptoms, but they recommend providers check with their patients regardless. Butterscotch Beluga (talk) 02:30, 17 May 2026 (UTC)Reply
SOC-8 is a bit off-topic for a discussion about the BMA, but it's not just these two words. Consider, e.g.,:
"There is currently insufficient data on cardiovascular risk interventions across the lifespan in TGD persons with medical and surgical interventions" (p. 147)
"Although data are lacking, using the affirmed gender for transgender adults with a history of pubertal-age GAHT initiations is likely to be most appropriate." (p. 147)
"data are lacking on specific health issues facing transgender people who use GAHT later in life, individuals who began GAHT at a younger age, and those seeking to continue or begin GAHT in their sixth, seventh, eighth, or later decades. With an increasing proportion of transgender people beginning GAHT at younger ages, including some who begin at the time of puberty, studies to examine the impact of decades of such treatment on long-term health are ever more important." (p. 150)
Yes, as any big MEDORG's clinical guideline on their whole topic area would be. That doesn't mean they think the evidence for their recommendations is limited or weak any more than it does when the APA or the AGA says it. Loki (talk) 01:55, 18 May 2026 (UTC)Reply
Loki, they literally say that they're having to make these recommendations on the basis of limited evidence. Statement 5.6, for example, is a "weak recommendation" about which they say "While there was limited supportive research, this recommendation was considered to be good clinical practice". Or see Statement 6.6, "Limited studies are available on the specific risks and benefits of tucking in adults, and none have been carried out in youth." Most of chapter 10 (intersex) is weak recommendations that appear to be more common sense than evidence-based (e.g., "We suggest health care professionals educate and counsel families"). WhatamIdoing (talk) 02:33, 18 May 2026 (UTC)Reply
"This recommendation" in 5.6 is not their recommendation, it's the Endocrine Society clinical practice guidelines on which their recommendation is based. I will give you this is the closest thing you've found so far, though, since it's reasonably clear their evidence for this is a combination of secondhand evidence from the Endocrine Society plus common sense. I do note though that this is both not in any sense a pediatric recommendation, plus it's a recommendation where common sense is unusually strong evidence (5.6 is "avoid surgery before hormones").
--
"The specific risks and benefits of tucking" is not the recommendation in statement 6.6, that's We suggest health care professionals provide transgender and gender diverse adolescents with health education on chest binding and genital tucking, including review of the benefits and risks. Their evidence for recommending this is what they lay out in the paragraph after:
TGD youth may experience distress related to chest and genital anatomy. Practices such as chest binding, chest padding, genital tucking, and gen- ital packing are reversible, nonmedical interventions that may help alleviate this distress (Callen-Lorde, 2020a, 2020b; Deutsch, 2016a; Olson-Kennedy, Rosenthal et al., 2018; Transcare BC, 2020). It is important to assess the degree of distress related to physical development or anatomy, educate youth about potential nonmedical interventions to address this distress, and discuss the safe use of these interventions.
--
I'm not sure what you're talking about with Chapter 10, it seems as well cited as any other chapter. They're not hedging significantly either, and they go in detail into the research base for those recommendations same as always. Loki (talk) 03:02, 18 May 2026 (UTC)Reply
SOC-8 says in section 3.9. "Grading criteria for statements" (when they explain their modified GRADE approach) that any recommendation that was "We suggest" rather than "We recommend" is not supported by good evidence or necessarily even by most providers:
"Weak recommendations (“we suggest”) are for those interventions/therapy/strategies where:
there are weaknesses in the evidence base
there is a degree of doubt about the size of the effect that can be expected in practice
there is a need to balance the potential upsides and downsides of interventions/therapy/strategies
there are likely to be varying degrees of acceptance among providers and patients or those for whom the recommendation applies."
I missed that section, but also I don't see how that doesn't torpedo your argument, because right before that is:
Strong recommendations (“we recommend”) are for those interventions/therapy/strategies where: • the evidence is of high quality • estimates of the effect of an intervention/therapy/strategy (i.e., there is a high degree of certainty effects will be achieved in practice) • there are few downsides of therapy/intervention/strategy • there is a high degree of acceptance among providers and patients or those for whom the recommendation applies.
Remember, this whole argument is ultimately about your assertion that:
Last I saw, ES and WPATH don't agree that the evidence base for pediatric gender care is "strong". They have said they think it is good enough and that it is comparable to what is seen in some other pediatric specialties.
However, almost all the statements in section 6 (adolescents) and section 7 (children) are "we recommend" recommendations, meaning that WPATH says that "the evidence is of high quality" about all their pediatric recommendations except for 6.6 about binding and tucking and 7.15 about general (political) advocacy for trans children. Loki (talk) 15:37, 18 May 2026 (UTC)Reply
Thanks for checking that against the pediatric section in particular. It sounds like we could agree that they believe there is strong (enough) evidence for most but not all of their pediatric-specific recommendations. WhatamIdoing (talk) 03:53, 20 May 2026 (UTC)Reply
I'd agree with that if you cut the (enough). The definition of their recommendation includes "the evidence is of high quality". That's not "strong enough", that's just strong. Loki (talk) 04:53, 20 May 2026 (UTC)Reply
Thank for removing 203. The issue with 196 is that although it has the statement embedded into it, the page linked is speaks positively of the Cass review, this does not fit with the section in which the citation is used, which is to show the criticism of the review. A better citation would be one that is either direct, or does not hold a clear stance, or also criticises the review. Maddie | GeekOnALeash01 (talk) 02:00, 27 May 2026 (UTC)Reply
I don't think it's really that much of an issue, since the citation verifies the text, but I've replaced it with a direct link to the Endocrine Society's statement. InfernoHues (talk) 02:28, 27 May 2026 (UTC)Reply
Latest comment: 9 days ago7 comments4 people in discussion
In the lede's current state, paragraph 1 gives only background with no indication that the review is contested at all. Criticism only enters in paragraphs 3 (BAGIS, GLADD, international medical bodies) and 4 (LGBT+ Labour, the Green Party's withdrawn statement, LGBTQ+ advocacy groups). From WP:LEAD and WP:LEADFOLLOWSBODY, the lede should summarize the most important points from the article, including any notable controversies, and reflect the balance of coverage found in the body. By word count, a substantial share of the article's body (the reception/response sections covering UK health bodies, international medical organizations, academics, and LGBTQ organizations) is given to criticism of the review. WP:DUE would suggest that (assuming that's roughly proportionate to how the topic is covered in RSes) the lede's opening framing should at least mention the controversy.
I think we can either add a brief mention of the criticism into para one, rather than introducing it only after a lengthy background section, leave the structure as-is (on the reasoning that a lede should establish neutral facts first), or restructure the lede's paragraph order entirely.
What do y'all think? pauliesnug(message / contribs)02:30, 20 July 2026 (UTC)Reply
Originally paragraphs 2 and 3 were swapped. I changed the ordering because I thought it made more sense to explain what the review is about and then explain the criticism. It doesn't make much sense to say that it was controversial before saying what the report concluded in my opinion. That said, I'm not opposed to a mention in the first paragraph. InfernoHues (talk) 02:54, 20 July 2026 (UTC)Reply
That makes sense. I think a mention in the lede is best. Maybe:
... Its final report, published on 10 April 2024, made 32 recommendations across gender service provision. The review has been the subject of extensive criticism, including from the British Association of Gender Identity Specialists and the Association of LGBTQ+ Doctors and Dentists in the UK, and from medical organisations, clinical practice guidelines, LGBTQ+ advocacy groups, and academics internationally, who have challenged its methodology and conclusions. pauliesnug(message / contribs)03:49, 20 July 2026 (UTC)Reply
I've reverted this diff; the changes are IMO not an improvement. Most crucially, they are repetitive; both of the sentences added to the first paragraph are almost identical to sentences from the third paragraph.
In the lede's current state, paragraph 1 gives only background with no indication that the review is contested at all. This is correct per MOS:OPEN: The first paragraph should define or identify the topic with a neutral point of view, but without being too specific. The criticism of the review is not central to "defining or identifying" it (that would be things like its author, its contents, its release date), and arguably does not fulfill NPOV; neither does editorializing language like "extensive criticism". And mentioning individual organizations like BAGIS and GLADD, whose criticisms of certain parts of the review are not particularly noteworthy, runs afoul of "without being too specific".
From WP:LEAD and WP:LEADFOLLOWSBODY, the lede should summarize the most important points from the article, including any notable controversies, and reflect the balance of coverage found in the body. I'm not sure you understand what a lead is? It already does that; the lead is not just the first paragraph. Your edit summary says "add criticism to the lede", but the criticism was already in the lead's paragraph 3.
WP:DUE says: As in the body of the article itself, the emphasis given to material in the lead should roughly reflect its importance to the topic. Yes, the article devotes a great deal of space to criticisms of the review, but what consequence did these criticisms have? More important in the lead is to describe what the review actually contained (beyond the mention of "32 recommendations") and the review's real-world effects (namely, the ban on puberty blockers in the UK).
we can either add a brief mention of the criticism into para one The sentence you added about the criticism is 49 words long, which is far from "brief". At most in the opening paragraph, there could be a descriptor of a few words (i.e., calling the review "controversial") that is elaborated on later in the lead. Coverage of the response to an article subject should come after defining what that subject actually is; this is the standard style for any Wikipedia article about a piece of media, and especially when the lead is multiple paragraphs. Astaire (talk) 00:34, 21 July 2026 (UTC)Reply
WhatamIdoing (talk) 19:54, 8 May 2026 (UTC)
