Hey Mark Butler, Why Don't You Give Dr. Cass a Call?

Written By Michael David

Two significant developments in the international debate on youth gender medicine three weeks ago went largely unreported in Australia.

Singapore's Ministry of Health issued its first national guidelines on youth gender dysphoria. Its circular, sent on 5 May to doctors and hospitals, states:

"Children and adolescents below 18 years old who are diagnosed with gender dysphoria should not be offered hormonal and surgical treatment."

Treatment must be sequential, starting with psychological support. The circular highlights the risks of irreversible medical interventions given to young people "who are still developing their sense of identity." Assessment may take 12 to 18 months.

The following day, the British Medical Association published the results of its two-year review of the Cass Report. The BMA had previously voted to oppose the Cass Review and declared its recommendations unsubstantiated. After two years of its own evidence-led process, it no longer opposes the Cass Review and does not fundamentally disagree with any of its 32 recommendations.

Professor David Strain, who led the review, told The Times that Dr Cass "has been vindicated in the way she approached the data." When asked to name a single recommendation he opposed he said: "I can't." Of her approach: "She approached an area of significant uncertainty with that prime rule of medicine, of 'first, do no harm.'"

The BMA continues to oppose a legislative ban on puberty blockers, arguing that prescribing decisions should rest with clinicians rather than politicians. That is a separate argument. On the evidence, and on the Cass methodology, it has conceded the ground.

To every clinician, academic or journalist who said the Cass Review was flawed: the BMA has now reviewed it over two years and could not identify a single recommendation to oppose.

Among the jurisdictions that have moved to restrict or review medical gender interventions for minors: Finland, Sweden, England, New Zealand and Singapore. Queensland has extended its pause on initiating puberty blockers and cross-sex hormones for new minor patients in the public health system until 2031, and the Northern Territory withdrew public health funding for new patients under 18 in December 2025.

Meanwhile in Australia...

In Australia, the institutions responsible for reviewing current practice are the same ones that have spent years defending it. We have documented elsewhere the regulatory consequences faced by Dr Andrew Amos and Dr Jillian Spencer for publicly questioning paediatric gender medicine. You can read that account in our April piece:

Read Here

Leor Sapir, a Senior Fellow at the key think tank Manhattan Institute, set out nine factors last week that help explain why paediatric gender doctors continue as they do. They are worth reading in full:

  • Lack of experience. Young clinicians have not watched children develop and have often not had children themselves.

  • Action bias. For adolescents, time typically resolves distress. But inaction feels like abandonment.

  • Stethoscopitis - his term for the hubris of the newly credentialled, eager to act before experience tempers the impulse.

  • Sunk cost. Once a doctor has publicly defended paediatric transition and cast critics as bad people, admitting error becomes almost impossible.

  • Overcompensation. Some gender clinicians cite their own difficult experiences growing up gay. The effect is to project personal history onto a clinically different situation.

  • Declining standards. Medical schools have relaxed entry requirements and diluted scientific curricula in the name of social justice.

  • Low barrier to entry. In his words, "'expert in gender identity' is hard to distinguish from 'clinician who agrees to defer to patients' self-description/diagnosis.'"

  • Professional satisfaction. No other area of medicine defines treatment success as making the patient happy in the moment. The incentive structure is inverted.

  • The near-complete absence of non-trans heterosexual men from the field. The gatekeeping specialties are female-dominated, and the stronger empathic aversion to saying no has, in this context, been misdirected.

Dr Cass wrote: "We do not know the 'sweet spot' when someone becomes settled in their sense of self, nor which people are most likely to benefit from medical transition. When making life-changing decisions, what is the correct balance between keeping options as flexible and open as possible as you move into adulthood, and responding to how you feel right now?"

Earlier studies found that the majority of children presenting with gender dysphoria did not persist to a transgender identity in adulthood, and a substantial proportion were same-sex attracted. Young gay and lesbian people are being medicalised. That alone should horrify everyone.

With the level of institutional capture in Australia, we remain sceptical that the NHMRC review will truly grapple with the strong international evidence. Mark Butler could pick up the phone.

Further Reading

Michael David
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