Dr Hilary Cass’s long-awaited review into healthcare for transgender children and young people was released this week. Her verdict was damning, and was delivered with Swiftian understatement:

‘The adoption of a medical treatment with uncertain risks, based on an unpublished trial that did not demonstrate clear benefit, is a departure from normal clinical practice.’

But perhaps even more shocking was this quote:

‘There is minimal research evidence to inform questions regarding likely trajectories and outcomes particularly in the context of: a) physical treatments (e.g. hormone blockers to suppress the onset of puberty); b) social transition (where a child presents to other people as their experienced gender e.g. using preferred gender pronouns) and; c) co-occurring ASD [Autistic Spectrum Disorder].’

It is shocking because it was not in the Cass Review at all. Instead, it comes from a funding application submitted in 2019 by the Tavistock, the NHS trust at the centre of the scandal. Clearly the Tavistock knew as far back as 2019 that there was a dearth of evidence about the long-term effects of these treatments. But GIDS continued to prescribe hormone blockers.

The grant application was successful, and it was funded by the National Institute for Heath and Care Research in 2019. Also funded was a project at the University of Oxford which ‘[built] upon critical race scholarship’ to develop a theory of how ‘cis-ignorance’ manifests in trans healthcare. A third project examined gender identity services for adults. Although the project was completed in 2021, there are no resulting publications reported on the NIHR’s website. The total awarded to these projects was £3.3 million.

Concerns were first raised about the Tavistock by whistleblowing nurse Sue Evans in 2004. Yet, two decades later, the Cass Review found that benefits and harms of puberty blockers and cross-sex hormones for trans adolescents are still unknown, with a systematic literature review attributing this to ‘poor study design, inadequate follow-up periods and a lack of objectivity in reporting of results.’

Given the clear need for rigorous research on trans healthcare and the apparent availability of generous grant funding, why haven’t academics done this already? A central reason has been the erosion of academic freedom in our universities.

Any academic who dares to question gender-identity orthodoxy can expect obstacles at every stage of the research process. The ethics committee at Bath Spa University blocked research into detransitioning among young people because ‘Engaging in a potentially “politically incorrect” piece of research carries a risk to the University.’ The first study I’m aware of to raise the hypothesis that social contagion might be a factor in rising admissions to gender-identity clinics was denounced as ‘hate speech’, leading the journal to issue a grovelling apology and to insist on publishing a correction, although the results were unchanged. Academics have faced campaigns to defund their research (for using the term ‘biological males’), had papers rejected because it is deemed transphobic to talk about biological sex, and have been no-platformed even when invited to speak about entirely unrelated topics.

Every aspect of academic life is affected. Michele Moore, a disabilities academic, faced attempts to remove her from a journal editorship because of her concerns with the idea that anyone can be born in the wrong body. James Esses, a student psychotherapy student was thrown off his master’s course and had to sue the UK Council of Psychotherapy to get them to concede that the view that gender questioning children should receive counselling rather than being put on a medical pathway was a ‘valid’ professional opinion. For Kathleen Stock the vilification went far beyond her professional life: she was advised by police to stay away from campus and install CCTV at her home.

Academics have faced campaigns to defund their research, had papers rejected and been no-platformed, even when speaking about entirely unrelated topics

The freedom to criticise lies at the heart of science. The philosopher Karl Popper argued that scientific beliefs must be falsifiable: there must be some experiment you can perform that puts your beliefs to the test. A belief which cannot be criticised cannot be falsified, and so cannot be science. The silencing of critics is an anathema to science: a scientist must subject their ideas to the severest scrutiny and must welcome the scrutiny of others.

The reward is that the greatest discoveries in science arise when we admit that what we once believed is wrong. Galileo is a heroic figure in the history of science, not only for his genius, but also for his defiance. By promoting the theory of heliocentrism, he challenged both human intuition and the Inquisition. He was punished with a conviction for heresy and spent the rest of his life under house arrest. Nevertheless, Galileo incontrovertibly won the argument.

Fortunately, some academics have also had the courage to stand up for science in the face of gender ideology. One such academic is Michael Biggs, a sociologist at Oxford. It was Biggs in 2019 who first exposed the fact that GIDS had run a trial on the effectiveness of puberty blockers but had never published the unfavourable results. Biggs also exposed the poor evidence for claims that puberty blockers dramatically reduce the risk of suicide. This was of crucial importance: it showed parents that they did not need, as activists claimed, to choose between ‘a living son or a dead daughter’. Biggs’ paper on suicide was rejected by the Lancet, Archives of Suicide Research, Archives of Disease in Childhood, British Medical Journal and PLOS One. His research has received no funding. Going against the tide of fashionable ideology is a hard path for academics, who are judged according to their grant income and the volume of outputs in top journals.

With Cass’s report, the application of science to transgender healthcare has finally gone mainstream. Not everyone will like this. In Cass’s words: ‘Although some think the clinical approach should be based on a social justice model, the NHS works in an evidence-based way.’

But this does not mean the debate on transgender healthcare is over. Science is born from disputation. As the evidence from the planned studies comes in, there will be a great deal to dispute. What is important is that we engage with the evidence with an open mind and with a willingness to be proven wrong.