OPINION | The Cass Review on gender-affirming care: SA's medical community now at a crossroads
The UK's Cass review recommends transitioning from medicalised gender-affirming care to evidence-based psychological approaches for children with gender dysphoria.
At the heart of the new review is a profound concern expressed by Dr Cass for the welfare of children and young people. An“A spiralling interventionist approach, in the context of an evidence void, amounted to over-medicalising care for vulnerable young people. A too narrow focus on gender dysphoria, says Cass, neglected other presenting features and failed to provide a holistic model of care. … In a broader sense, this failure is indicative of a societal failure in child and adolescent health.
The report recognises the need for proper exploration of children’s complex mental health concerns and acknowledges that many of those seeking treatment may simply end up as gay, lesbian, or bisexual adults without a transgender identity if allowed to develop naturally. The report’s main recommendation is that in the UK, care of youth with gender dysphoria who are less than 18 years old, should no longer be based on the gender-affirming model of care but instead should be similar to care for youth with other developmental struggles, and use standard psychological and psychotherapeutic approaches. Any use of hormones should be regarded as experimental and therefore need to be provided in the context of a carefully monitored clinical trial.
The National Department of Health has not produced any guidelines or policies recommending gender-affirming care, however, for the last few years, this approach has been actively promoted by individual clinicians, the Professional Association for Transgender Health South Africa, and somerecommending gender-affirming care and talks given at conferences, universities and online have done the same.
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