Sorry Dr Cass, trans healthcare is about more than just suppressing anxiety

Another day ending in ‘Y’, and another concerning Cass report development – this time, from the paediatric expert behind it, Dr Hilary Cass.

During a parliamentary committee session, Dr Hilary Cass, who headed the divisive review into trans youth healthcare in England, claimed conversion therapy bans could “frighten therapists,” expressed “deep concerns” over private healthcare, and claimed to have been told by trans people that their advice to their younger selves would be that they “don’t have to rush” into medical treatment (which, given near-indefinite waiting times, seems a moot point).

But what was most jarring was her claim that puberty blockers are an “almost totemic” obstacle in the way of alternative methods to mitigate patients’ anxiety and depression.

I am not here to question Dr Cass’ credentials or claim to have the same grasp on paediatric care she does. But what I do know – as someone who has had depression, anxiety and suicidal thoughts, and battled with gender dysphoria for my entire life – is that suggesting anti-anxiety medication are an ‘alternative’ to puberty blockers points to a fundamental lack of understanding of what it means to be trans.

That’s before pointing out, as many already have, that anti-anxiety medications like SSRIs usually aren’t recommended for under-18s because of potential harmful side effects which could trigger suicidal thoughts or affect brain development.

Conversely, there is plenty of evidence from internationally recognised bodies that shows puberty blockers are beneficial to those who need them – evidence that the Cass Report has seemingly brushed aside.

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Trans healthcare and puberty blockers are treatments for a very specific set of issues that a patient is facing. And while those patients may present with anxiety, depression or suicidal thoughts – as many young LGBTQ+ people do – treating those symptoms does not mean that their trans-specific healthcare needs shouldn’t be addressed.

The way Hilary Cass approaches the issue points to a misunderstanding of what puberty blockers are actual for, claiming that anti-anxiety medication can be “just as effective” for improving a young trans young person’s wellbeing.

Effective for what? Suppressing potentially unwanted and psychologically painful physical developments like breast growth? Blocking body-hair growth? Is putting trans kids on SSRIs going to stop them crying themselves to sleep over a body they wish they didn’t have, as I and many other trans people have experienced in the past?

The suggestion of anxiety medication as an alternative to puberty blockers or other medical interventions also appears to contradict the “holistic approach” the Cass report so strongly urges. If there are supposedly numerous pathways that may be right for young trans people, medical included, why is she advocating so strongly against one of them?

Trans youth cannot be treated in isolation from the strictly gendered and hostile society they are raised in, and treating their anxiety is vital – but that alone cannot be seen as the way to solve their underlying gender dysphoria.

Of course, a huge source of anxiety for trans people right now is the transphobic rhetoric spewed from institutions and political figures each and every day, without fail.

Whether you’re 18, 13, or 35 years old, that anxiety now builds more and more.

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