Keep calm but do not carry on: ethical issues with the recommendations made by the Cass Review–Giordano response to the commentaries

I thank all authors for their commentaries. I particularly appreciate the invitation to reflect on deeper commitments driving questions around evidence and medicine’s legitimate role. I share Carroll-Beight’s1 concern that sex/gender minorities are largely excluded from shaping clinical and research standards affecting them—a gap in my analysis. Wiesemann’s2 is insightful to note that, although commissioned as a review of services, the Cass Review offers clinical advice without adhering to the required international standards, and without ethical consideration (as Brierley and Larcher also note).3

I reply below to some substantive points.

‘It is […] uncontroversial that there is no good evidence that puberty blockers (PBs) are effective in alleviating GD (gender dysphoria) or co-occurring mental health problems’ (Gorin).

This is slightly misleading.4 PBs are not primarily intended to treat GD, which is best addressed with gender-affirming hormones (GAH) and surgery. They may procure other benefits:…

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