Why didn't the Cass Review cover all the types of gender dysphoria?
A Freedom of Information request to the Cass Review
In response to the large increase in children who are distressed regarding their sex, the Cass Review proposes commissioning a “network of regional services around the country”.1 However this is arguably treating the symptom of the problem and not the cause.
The problem is not that there are not enough “gender clinics”, but rather there are too many children, primarily girls, being encouraged to misdiagnose themselves with gender dysphoria, or having a “mismatched gender identity” by charities, schools, and non-governmental organisations.
The Cass Review is shown to omit research and “lived experiences” regarding what the DSM-5 calls “late-onset” gender dysphoria and autogynephilia.
If the Cass Review had covered the diagnostic descriptions and criteria of gender dysphoria in the DSM-5, including late-onset gender dysphoria and autogynephilia, then it would have become apparent that a recommendation of the Cass Review should have been that the teaching of the patently misleading “mismatched”, or now “incongruent”, “gender identity” narrative to children should be stopped.
Different types of gender dysphoria
There are two types of gender dysphoria described in the DSM-5: “early-onset” and “late-onset”.
In the case of early-onset gender dysphoria, this is defined as occurring before the onset of puberty, where a particularly feminine boy, or masculine girl, may identify persistently as the opposite sex. In most cases, the DSM-5 says this will desist at the onset of puberty, where they will have a high likelihood of being homosexual.2
There is another type of gender dysphoria, which the DSM-5 calls “late-onset” gender dysphoria, which is “much less common in natal females compared with natal males”,3 which in males “occurs around puberty or in later life”.4
Unlike the early-onset group, are otherwise heterosexual: “A substantial percentage of adult males with late-onset gender dysphoria cohabit with or are married to natal females. After gender transition, many self-identify as lesbian”.5 The DSM-5 says candidly that “Adolescents and adults with late-onset gender dysphoria frequently engage in transvestic behavior with sexual excitement.”6
The DSM-5 furthermore says that a phenomenon called autogynephilia, which it defines as the “[s]exual arousal of a natal male associated with the idea or image of being a woman”,7 increases the likelihood of of gender dysphoria in men with transvestitic disorder.8 Therefore many adolescent boys and men with late-onset gender dysphoria will also likely be autogynephilic.
Ray Blanchard, who served under the gender identity disorder subcommittee of the DSM-4, and his contemporary J. Michael Bailey, see autogynephilia as the most likely explanation, for typically masculine adolescent boys who suddenly identify as women:
From a parent’s perspective, autogynephilic gender dysphoria (which occurs only in natal males) often seems to come out of the blue. This is likely to be true whether the onset is during adolescence or adulthood. A teenage boy may suddenly announce that he is actually a woman trapped in a man’s body, or that he is transgender, or that he wants gender transition.9
These narratives can be observed in the media:
The Cass Review did not cover autogynephilia in its report under “Understanding the patient cohort”, which appears to have no justification, given that this is the phenomenon that causes gender dysphoria in adolescent boys.
Omitting research and “lived experiences”
I wanted to know why autogynephilia was omitted from the Cass Review, so I used a Freedom of Information request, asking for emails containing the word “autogynephilia” in the Cass Review’s mailbox.
The response from NHS England shows that the Review did receive emails from individuals with autogynephilia, marked “strictly confidentially”, “where relevant anonymously”, “not to be shared”.10
A question therefore arises, as to why the Cass Review did not cover the research regarding autogynephilia and these “lived experiences” and clearly differentiate all the types of gender dysphoria in its report.
This omission further appears unusual, given the Cass Review believes that some people are “non-binary”, which it mentions 31 times, despite the term not appearing at all in the DSM-5, connected to gender dysphoria or otherwise.
Furthermore, there are aspects of the Cass Review that do not make sense unless one provides the context of which type of gender dysphoria one is talking about.
For example, the Cass Review talks about the hypothesis that prenatal hormone exposure may cause cross-sex identification,11 but this has only ever been hypothesised regarding the early-onset homosexual cohort; this hypothesis does not apply to the late-onset, autogynephilic, cohort.
A different recommendation
If the Cass Review had covered the pathways to gender dysphoria as they appear in the DSM-5, then it would rapidly have become apparent that schools and charities teaching children that everyone has a “gender identity” that can become “mismatched”, is a misleading narrative, and recommended for it to be stopped completely.
Indeed, this was the conclusion of the UK’s Department for Education, which in its Draft RSE guidance, concluded that the “contested topic of gender identity should not be taught” to school children.12
The fraction of children and adolescents who are affected by this issue can still be cared for when they make themselves become known, on a case-by-case basis, as had always happened in the past.
DSM-5 p. 455
DSM-5 p. 456
DSM-5 p. 456
DSM-5 p. 456
DSM-5 p. 456
DSM-5 p. 818
DSM-5 p. 703-4
Cass Review p. 115