The Pennsylvania Psychological Association Forbids Its Members To Mention the Cass Review

The PPA rejected the Cass Review while promoting scientifically flawed WPATH guidelines.

Reality’s Last Stand is a reader-supported publication. Please consider becoming a paying subscriber or making a one-time or recurring donation to show your support.

This article was originally published on Benjamin Ryan’s Substack.

About the Author

Benjamin Ryan is an independent journalist, specializing in science and health care coverage. He has contributed to The New York Times, The Guardian, NBC News and The New York Sun. Ryan has also written for the Washington Post, The Atlantic, The Nation, Thomson Reuters Foundation, New York, The Marshall Project, PBS, The Village Voice, The New York Observer, the New York Post, Money, Men’s Journal, City & State, Quartz, Out and The Advocate. 

Learn more about Ryan’s work on his website, follow him on X @benryanwriter, and subscribe to his Substack.

---

In a recent email to over 1,000 members of the Pennsylvania branch of the American Psychological Association, the PPA’s leadership denounced Britain’s Cass Review, which found that pediatric gender-transition treatment is based on “remarkably weak evidence,” as “failing to meet the professional standard” of the PPA’s adherence to “evidence-based practices.” Accordingly, the PPA forbade any further mention of the Cass Review on the listserv.

Published in April, the Cass Review was nearly four years in the making. The report was commissioned by England’s National Health Service (NHS) and at 388 pages, is the most thorough analysis of the controversial field of pediatric gender-transition treatment to date. It was based in part on seven systematic literature reviews—the gold standard of scientific evidence—by evidence-based medicine experts at the University of York.

The review has led to a major pivot in the United Kingdom, putting the nation’s policies about pediatric gender medicine in line with four Scandinavian nations. The NHS has forbidden its health care providers from prescribing minors puberty blockers to treat gender-related distress. And the outgoing Tories put in place an “emergency” three-month ban of private prescribing of such drugs, one that the new Labour health secretary Wes Streeting has indicated he wishes to make permanent.

The NHS is at least ostensibly following the Cass Review’s recommendation to plan a clinical trial of pediatric gender-transition treatment, which is meant to be the only way for gender-distressed minors to access blockers and hormones. Such a trial would need to pass muster with an ethics review board and is not expected to launch until the beginning of 2025 at the very earliest.

The Cass Review has been met with scorn by the World Professional Association for Transgender Health (WPATH), a largely U.S.-based activist-medical association that published updated treatment guidelines for caring for transgender people in 2022 called the Standards of Care 8.

The Pennsylvania Psychological Association, despite being adamant that it was being transparent with its members about the reason for forbidding discussion of the Cass Review, did not specify in its email why it believed that the review did not meet the group’s evidence-based standards. Instead, in explaining its new policy, the PPA said that members of the LGBTQIA+ community on the listserv and their allies felt “targeted, harmed, and hurt” by the sharing of the Cass Review.

As an alternative, the PPA recommended that members reference WPATH’s Standards of Care 8 and the APA’s policy statement on gender-affirming care. This came after the Cass Review found that the WPATH’s guidelines “lack developmental rigor” and that the document “overstates the strength of the evidence.”

The University of York systematic literature reviews (there were two parts) that concerned global guidelines on pediatric gender-transition treatment found that WPATH’s guidelines were flawed due to engaging in what Cass subsequently characterized as “circularity” in their citations with other guidelines. This practice is more pejoratively known as “citation washing,” in which the scientific buck essentially stops nowhere—there is no original study that solidly backs a particular claim.

The University of York team deemed that the APA’s 2015 policy statement on gender-affirming care for children (which has since been updated) had poor rigor of development.

This move by the PPA to forbid discussion of the Cass Review directly follows the unsealing of internal WPATH communications in an Alabama court case regarding the development of the Standards of Care 8 that showed that some of WPATH’s own members knew that their guidelines were based on weak evidence. One WPATH leader stated in an email to colleagues that “we are painfully aware of the gaps in the literature and the kinds of research that are needed to support our recommendations.”

Additionally, the unsealed communications revealed that WPATH suppressed systematic literature reviews it commissioned from evidence-based medicine experts at Johns Hopkins University about the treatment of gender dysphoria when the findings did not support WPATH’s goals. WPATH also capitulated to outside pressure to remove age restrictions on pediatric gender-transition treatment and surgeries from the Biden administration, the American Academy of Pediatrics and the Trevor Project.

The PPA email blast stated that the discourse on the listserv had been “disheartening, hurtful and unprofessional” and upbraided members it asserted had harmed others, stating: “We were all taught early on our professional training that when someone tells you that you are harming them that you need to stop. Then you need to seek consultation, supervision, or additional training to provide care, or refer to professional with necessary expertise.”

The email to PPA members was signed by Allyson L. Galloway, president, Meghan Prato, communications board chair, and Michelle Wonders, EMCC chair.

Below is the email in its entirety.

Follow Ben on Twitter: @benryanwriter
Visit Ben’s website: benryan.net

---

If you enjoyed this article, please consider upgrading to a paid subscription or making a recurring or one-time donation below. Your support is greatly appreciated.