Not just to inform, but also to deprogram

might as well be addressing an archaic people who have just emerged blinking from a time capsule, still convinced that disease is God’s punishment for insufficient acts of propitiation.

In a sense, though, this is indeed very like one group to whom the report is addressed: those clinicians, parents and patients immersed in bubbles of identity affirmation, and cognitively isolated from any reasoning or evidence that would confound their worldview. Perhaps unusually for a medical review, it is clear from Cass’s overtly respectful tone and at times still-euphemistic language that her aim is not just to inform these readers but also to deprogram them.

The very first sentence of her report begins with a weary disavowal of Stonewall-endorsed paranoias (“This Review is not about… undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people’s rights to healthcare”). Somewhat nonsensically, references to “birth-registered females” are scattered throughout the text, as if the author were somehow only concerned with those with birth certificates — presumably an attempt to build bridges with child-like souls still convinced sex is something coercively assigned to neonates at random. Generally, there is a sense of gingerly addressing a group of emotionally labile people who are not quite ready to face the whole truth….

One could be forgiven for thinking that medical culture should easily be able to condemn bizarre physical interventions performed upon children in the name of religion, without having to undertake a four-year clinical review first. Indeed, lawmakers have previously criminalised practices such as FGM without requiring any such tests. But one instructive thing we can learn from the wreckage of gender medicine is that, with the right kind of institutional and rhetorical scaffolding, doctors can become unsure about what their goals are supposed to be. It’s no good telling them to first do no harm, when they can’t work out how to reliably detect it.