Dr. Hillary Cass is the former president of the Royal College of Paediatrics who spent four years writing a 400-page review of gender-affirming care. As you've probably heard by now, her review was not kind to the clinics and doctors who've participated in this trade.

It was a given that Dr. Cass would become a target of opprobrium for trans activists and that is exactly what has happened. In an interview published last Friday, she revealed that she has received many threats and has consulted security professionals who advised her to stay off public transportation for her own safety.

Cass said she was pleased that, for the most part, both sides in the debate over the treatment of children with gender dysphoria had not “weaponised” her report. But she has still had to deal with a “pretty aggressive” response from some, particularly those in activist groups. She is also staying away from Twitter/X.

Cass said: “There are some pretty vile emails coming in at the moment. Most of which my team is protecting me from, so I’m not getting to see them.” Some of them contained “words I wouldn’t put in a newspaper”, she said.

She added: “What dismays me is just how childish the debate can become. If I don’t agree with somebody then I’m called transphobic or a Terf [trans-exclusionary radical feminist].”...

Asked if the abuse had taken a toll on her, she said: “No … it’s personal, but these people don’t know me...

She added: “I’m not going on public transport at the moment, following security advice, which is inconvenient.”

This is what happens when medical advice is being filtered through a cult of left-wing activists. This is something Dr. Cass has been experiencing for some time now. The Times of London reported 10 days ago that adult gender clinics had done their best to create problems for Dr. Cass's review.

Six NHS Trusts thwarted a landmark review published by Dr Hilary Cass this week by refusing to co-operate with research into the long-term impact of prescribing puberty blockers and sex hormones.

Cass had commissioned a team at the University of York to examine how thousands of trans children fared after being transferred to adult NHS services from the age of 16.

But the research had to be abandoned after six of the seven NHS adult clinics refused to participate, with some expressing unfounded concerns over “interference from government ministers”. Cass described their failure to share data as “co-ordinated” and “ideologically driven”...

A document, buried in Cass’s report, lays bare the alleged reasons for the clinics’ refusal to participate, including that the “study may not be fully independent”. It said the six clinics claimed the study “may suffer from interference by NHS England, the Cass review team and government ministers” whose interests “do not align” with theirs and those of the patients.

In other words, they knew Dr. Cass wasn't a fellow cultist and so they did their best to keep her out of their data. They did this knowing the request came from a credible doctor at the top of her field who had been asked by the government to carry out the review. Now that their refusal to cooperate has come to light, they are all promising to cooperate and hand over the data. So presumably there will be an addendum to the Cass Review available sometime next year.

The Cass Review has already had a big impact in the UK where it has been front page news for weeks. But the reaction from the US media has been very muted so far. As Jesse Singal points out, that may be because reporting on it would require a lot of backtracking for most US news outlets.

Cass’ findings led to significant new restrictions on puberty blockers and hormones for youth in the U.K. The changes follow similar decisions based on comparable (albeit less ambitious) reviews in countries like Finland, Sweden, and Norway. Other European nations seem poised to follow suit.

On the other hand, the vast majority of American media coverage has for years touted the safety and efficacy of these treatments. In some cases, writers and reporters denounced the foolishness (if not transphobia) of those who exhibit undue skepticism toward them. These articles are often festooned with quotes from psychologists, psychiatrists, and endocrinologists with extremely impressive credentials—the sorts of people we are told to trust—reinforcing the view that if these treatments have any risks or unknowns, they are small, easily swamped by their salutary effects. A certain message has been delivered with the repetition of a drumbeat: An informed, compassionate person should support access to youth gender medicine.

The consensus is so strong and so intense that CNN has a stock sentence that it has pasted into dozens of its articles on this subject: “Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender—the one the person was designated at birth—to their affirmed gender—the gender by which one wants to be known.” As far as I know, CNN is the only outlet to have gone the full “Say the line, Bart!” route, but countless outlets have produced exceptionally shoddy coverage of this subject that will not age well...

On the media side, we don’t appear to be off to a good start: CNN, NPR, CBS News, NBC News, Vox, and Scientific American have almost entirely ignored the Cass Review, hoping it’ll fade away.

It won’t.

The American left is so used to running roughshod over critics, especially when it comes to bio-ethical issues like abortion or gender-affirming care. For decades they were able to count on the media having their back. And really they still do have the media in their pocket most of the time, but the world is a smaller place than it was in 1973. The news about countries in Europe pulling back from giving puberty blockers and hormones to teens can cross the oceans immediately without being sifted by progressive journalists at US newspapers. 

I don't think the opponents of the Cass Review really know what to do about it. It would be so much easier to discredit Dr. Cass if she were American and had some links to religious or conservative views that could be exploited to discount her. But that playbook doesn't work very well in this case. She's too obviously credible. So all that's left to do is lie, make threats and send nasty messages on X. That and go silent. They can keep Dr. Cass off public transportation and they can keep her report out of US news outlets. So far that seems to be the extent of the strategy.