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sources for consideration

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Enforced BRD

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Just so nobody misses this: There's a thing called 'enforced BRD', and it now applies to this page. That means that the rules used to be:

  • Make your edit
  • Get reverted
  • Maybe restore your edit (but never to the point of edit warring)

and they are now:

  • Make your edit
  • Get reverted
  • Start a discussion on the talk page (or just decide to never restore your edit)
  • At least 24 hours after starting that discussion, you can maybe restore your edit (but never to the point of edit warring, nor if the discussion on the talk page has active opposition. Silence is not active opposition).

See User:Awilley/Enforced BRD FAQ and User:Awilley/Consensus Required vs Enforced BRD for more information.

WhatamIdoing (talk) 04:04, 11 December 2024 (UTC)[reply]

Glad to see this - is it wrong that I think this should be mandatory on GENSEX? Void if removed (talk) 18:06, 11 December 2024 (UTC)[reply]
I think you would be surprised how cumbersome it can be, especially for problems like subtle vandalism. WhatamIdoing (talk) 18:29, 11 December 2024 (UTC)[reply]

Was the Cass Review peer reviewed?

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Nothing in the article seems to address this question unless I'm overlooking it. Nosferattus (talk) 19:43, 22 December 2024 (UTC)[reply]

We are currently discussing this. Per Cass' own description of the process, she only mentions the systematic reviews being peer reviewed. The whole point of the independent review is that she gets to make her own conclusions based on that evidence. Because she hasn't documented that the review was peer reviewed, I think it's pretty clear that it isn't (and she doesn't pretend that it is). But I'm sure there are people who feel very strongly that we can't include that in the article unless it's explicitly written somewhere. I'm not sure that follows (she included the protocols, process, etc; if it's not in those, it didn't happen), but, well, it's still an ongoing discussion. Lewisguile (talk) 19:55, 22 December 2024 (UTC)[reply]
WP:V will say that we can't include that in the article unless we have a reliable source that WP:Directly supports such a statement. And if none exist, then one has to wonder whether such a statement would be WP:DUE anyway.
About the above comments on the "peer-reviewed journal": Although that is a common phrase, it is somewhat more accurate to describe individual articles as being peer reviewed, because not everything in a peer-reviewed journal always undergoes (external) peer review. WhatamIdoing (talk) 07:06, 23 December 2024 (UTC)[reply]
I think you've got things reversed here. We can't describe the report itself as peer-reviewed if we can't verify that it was. What it appears to be is an administrative summary of peer-reviewed research. We should avoid using terms that imply that the report itself is peer-reviewed, as well: specifically, we should be very clear about what was in the reviews versus what was in the report summarizing those reviews. Loki (talk) 04:04, 25 December 2024 (UTC)[reply]
I agree. We can neither describe the final report as a peer-reviewed report, nor describe it as non-peer-reviewed report, unless we have sources.
My preference is to describe the systematic reviews as being peer-reviewed articles, and to describe nothing else (not the reports issued by Cass, not the journal in which the reviews appeared) in that language. WhatamIdoing (talk) 17:28, 25 December 2024 (UTC)[reply]
I'm fine with all of the above. I think we're in agreement. Lewisguile (talk) 17:43, 26 December 2024 (UTC)[reply]
The "non peer reviewed" is inappropriate. Cass is an independent review, it isn't an academic publication. We don't call the Independent Medicines and Medical Devices Safety Review "non peer reviewed" or any other wiki page about an independent review, because they are independent reviews, not academic papers. The source being used to make the claim this is a "narrative review" (which is quite wrong) is one line in a table in a non-peer reviewed document from a thinktank. This is inadequate. Void if removed (talk) 14:30, 1 January 2025 (UTC)[reply]
@Lewisguile you've reverted this saying If peer-reviewed systematic reviews are gold standard, they are gold standard here too- please point to me where the RAND document is peer-reviewed? It is not published in any academic journal. Here are their standards for their self-published reports: https://www.rand.org/about/standards.html
Please self-revert. And using this one source to falsely call an independent review a "narrative review" is a stretch. Void if removed (talk) 15:00, 1 January 2025 (UTC)[reply]
Here is the relevant bit:
This work was supported by Indiana University Bloomington and the Medical College of Wisconsin and conducted by the Access and Delivery Program in RAND Health Care and the Social and Behavioral Policy Program in RAND Social and Economic Well-Being. This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.
Source: https://www.rand.org/pubs/research_reports/RRA3223-1.html
So it is peer-reviewed. Lewisguile (talk) 15:15, 1 January 2025 (UTC)[reply]
That line (thank you for finding and posting it) would be more reassuring if they specified external peer review. "Internal" peer review is a thing, and "rigorous", like beauty, can be in the eye of the beholder. WhatamIdoing (talk) 00:34, 2 January 2025 (UTC)[reply]
VIR found something elsewhere on their website which said they have at least two reviewers, with one in-house and at least one other/independent, IIRC. I currently find anything on this page as it's now a wall of text. Sorry about that. Lewisguile (talk) 18:17, 2 January 2025 (UTC)[reply]
@13tez why did you add a citation needed tag?[1] The source explicitly says it's a narrative review and not peer reviewed on p 10, table 2.1[2] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:34, 30 December 2024 (UTC)[reply]
Ah, that's just because I'm not familiar with that source - hence why I put the CR and SRs into different sentences, so they can be referenced separately to avoid just this type of confusion. 13tez (talk) 23:40, 30 December 2024 (UTC)[reply]
@Lewisguile Just wanted to give you a heads up I think you slightly over-reverted here[3]. I agree with the main removal of the bloated background, but want to check if you meant to also revert the additions to methodology[4] clarifying the review was a non-peer reviewed narrative review and expanding on its methods - I'm assuming that was accidental collateral lol. Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:06, 31 December 2024 (UTC)[reply]
I thought about it, but I think if we add that in, then we also need to add in that the systematic reviews were peer reviewed. And the problem is, small additions can result in a bunch of other things being added too, so every small change is potentially a big one. This is the draft I have been working on:

Methodology

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The Cass Review was an independent narrative review which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS. It was not peer-reviewed but it commissioned a series of systematic reviews which were.[a] In addition to the systematic reviews,[1][2][3] the review also commissioned qualitative and quantitative research into young people with gender dysphoria and their health outcomes,[4] conducted listening sessions and focus groups with service users and parents, held meetings with advocacy groups, and gathered existing evidence and grey literature on the lived experiences of patients.[5] The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity,[2][3] which were carried out by the University of York's Centre for Reviews and Dissemination [b] and published in Archives of Disease in Childhood.[7][8][9] The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes.[1] The reviews covered:[10]

  • Characteristics of children and adolescents referred to specialist gender services[11]
  • Impact of social transition in relation to gender for children and adolescents[12]
  • Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence[13]
  • Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers)[14]
  • Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy)[15]
  • Care pathways of children and adolescents referred to specialist gender services[16]
  • Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence[17][18]

The systematic reviews assessed the quality of the studies available[c] and used meta-analysis to combine the results of multiple studies. The results informed Cass' conclusions and recommendations, along with the results of the other forms of evidence collected.[22][23] Lewisguile (talk) 17:40, 31 December 2024 (UTC)[reply]

@Snokalok @13tez @Your Friendly Neighborhood Sociologist @Bluethricecreamman What do you think of this draft? Lewisguile (talk) 17:51, 31 December 2024 (UTC)[reply]
Looks overall good to me! I only have the minor quibble that 2/3 sentences seem a little redundant,
  • The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity could probably be merged into It was not peer-reviewed but it commissioned a series of systematic reviews which were or even removed considering the bullets.
  • The systematic reviews assessed the quality of the studies available and used meta-analysis to combine the results of multiple studies. The results informed Cass' conclusions and recommendations, along with the results of the other forms of evidence collected feels very redundant, explaining what systematic reviews are, and we already note Cass commissioned all these things
Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:58, 31 December 2024 (UTC)[reply]
I'll drop the first redundant line. For the second, I will drop both sentences. Lewisguile (talk) 08:40, 1 January 2025 (UTC)[reply]
All done. Check out the latest version. I think it's much more balanced now. I also added the RAND systematic review to the "other academics" section for lack of a better home. That seems appropriate since it's also a systematic review, mentions Cass, and details some of the similarities/differences in their approaches and conclusions. Lewisguile (talk) 09:52, 1 January 2025 (UTC)[reply]
Hey @Lewisguile,
The Background and Methodology sections were separate sections, which I think made sense. Why is the Methodology section (describing how the review was carried out) now a subsection of the Background section (describing why the review was carried out)?
The new version of the Methodology section is still diluted compared to the version in place before my originally contested edits. Before them, the article said that the SRs were peer-reviewed and independent without having to state the CR itself wasn't peer-reviewed, which some people want to, citing WP:BALANCE. However, balance is not just weighing all viewpoints or sides of an argument equally, or even equally based on how much each are voiced, it's weighing their coverage in the article in proportion to their coverage in suitable/reliable sources.
We've now removed all mention of the SRs' independence, while adding that the CR wasn't itself peer-reviewed and criticism of the SRs from RAND Corporation ("The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes.").
To me, this seems WP:UNDUE because there's consensus the (externally peer-reviewed and independent) SRs were fine, even among people who criticise the CR; I've seen no MEDRS source that criticises them; the SRs commissioned by the CR concurred with others, e.g. the Swedish and Finnish SRs; and the SRs commissioned by the CR are of higher quality than RAND's SR because they were commissioned for the NHS, carried out by the Centre for Reviews and Dissemination, independent, and externally peer-reviewed by published in Archives of Disease in Childhood, a high-quality and peer-reviewed medical journal associated with the RCPCH, while the RAND SR was created by and for a think tank and research organisation. Furthermore, I don't think the RAND review is a WP:MEDRS source because it wasn't published in a medical journal or created by a major medical or scientific organisation.
We've also relegated the explanation of what the Centre for Reviews and Dissemination is to an endnote. While I'm okay with that change in and of itself, it's another dilution from the version in place before my original edits. Editors trying to maintain balance have pushed the ship back further the other way than my changes swayed it to begin with, and out of proportion with coverage in reliable and MEDRS sources. Therefore, there is now a WP:BALANCE issue.
The types of evidence other than the SRs ("In addition to the systematic reviews, the review also commissioned...") should be put at the end of the section because the SRs made up most of the evidence base for the review (per the CR other pieces of evidence "supplemented" them) and it makes sense logically for readers to group information on the SRs together.
Thanks! 13tez (talk) 12:28, 1 January 2025 (UTC)[reply]
The RAND corporation stuff is definitely UNDUE, this is a primary source from a policy thinktank, not any sort of MEDRS. Void if removed (talk) 14:43, 1 January 2025 (UTC)[reply]
It is a peer-reviewed systematic review, so definitely not a primary source. See here: https://www.rand.org/pubs/research_reports/RRA3223-1.html Download the report and read it for yourself. Lewisguile (talk) 15:17, 1 January 2025 (UTC)[reply]
@13tez Methodology was supposed to be a main header. I posted some text for workshopping upthread and had made the header there a subheader so it didn't start a new topic, but when I copied it over, I forgot to fix that.
RAND is due, as it's another peer reviewed systematic review. They worked with two universities on the report. I have no problem with the SRs, and I don't think stating what they excluded is non-neutral in itself. It's true they only looked at people up to 18, whereas RAND also looked at those up to 25. That was an intentional decision and all of those things, except the bit about confidence of evidence ratings, are also said within the Cass Review itself, so it can have two sources backing it up if you'd like?
@Void if removed's edits have conflicted with mine, so the changes I made to methodology have been reverted, adding "non-peer reviewed" back in and a few other things. I had suggested the following wording for Methodology, which I think was a fair compromise:
Methodology
The Cass Review was an independent narrative review which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS.[d] According to Cass, "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians."[24]
The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity,[2][3] were carried out by the University of York's Centre for Reviews and Dissemination,[e] and were published in Archives of Disease in Childhood.[7][25][9] The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes.[1] The reviews covered:[10][23]
  • Characteristics of children and adolescents referred to specialist gender services[11]
  • Impact of social transition in relation to gender for children and adolescents[12]
  • Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence[13]
  • Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers)[14]
  • Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy)[15]
  • Care pathways of children and adolescents referred to specialist gender services[16]
  • Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence[17][18]
The review also commissioned qualitative and quantitative research into young people with gender dysphoria and their health outcomes,[4] conducted listening sessions and focus groups with service users and parents, met with advocacy groups, and gathered existing evidence and grey literature on the lived experiences of patients.[5] Lewisguile (talk) 15:26, 1 January 2025 (UTC)[reply]
Re: "supplemented", I did find this in the final report, but in this context The Review has therefore had to base its recommendations on the currently available evidence, supplemented by its own extensive programme of engagement (p. 20). This means the engagement activities were supplements, but the qualitative and quantitative research that the Cass Review also commissioned can't reasonably be slotted into the "engagement" category over the "available evidence" category. The quantitative research, certainly, wouldn't fit that criteria. Specifically, she also refers to the SRs on the international GLs as "supplementing" the evidence (p. 53: an appraisal of an international guidelines and international survey were undertaken to supplement this information). In the box underneath, the appraisal of int'l GLs is the two papers: Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1) and Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2), so I'm not sure we should draw a specific conclusion re: proportionality from the word supplement alone. Was it used more specifically anywhere else that you've found? Lewisguile (talk) 15:54, 1 January 2025 (UTC)[reply]
Hey @Lewisguile, thanks for getting back to me.
RAND is due, as it's another peer reviewed systematic review. They worked with two universities on the report. I have no problem with the SRs, and I don't think stating what they excluded is non-neutral in itself. It's true they only looked at people up to 18, whereas RAND also looked at those up to 25. That was an intentional decision and all of those things, except the bit about confidence of evidence ratings, are also said within the Cass Review itself, so it can have two sources backing it up if you'd like?
I don't necessarily doubt that it was peer-reviewed or that they worked with two univertisites to make it. However, it wasn't published by a major medical organisation or in a reputable medical journal. Therefore, I don't think we can count it as a MEDRS source, and I certainly don't think so to the extent that its criticism of the CR's SRs (which I view as higher quality sources for the reasons I gave before) should be afforded weight (especially when the quote comes from a paragraph explaining these were minor changes and the SRs mostly worked the same anyway). If you can find some other sources to back it up, that'd be better, both to have sources we all view as MEDRS/suitable stating these criticisms and to ensure there's enough coverage of them in MEDRS/suitable sources to warrant their inclusion (even if we view the RAND review as MEDRS, if these criticisms aren't made in other MEDRS sources, they won't have enough coverage to be included per weight).
Re: "supplemented", I did....I'm not sure we should draw a specific conclusion re: proportionality from the word supplement alone. Was it used more specifically anywhere else that you've found?
I think there are one or other two sources I don't have to hand saying the SRs were the foundation of the evidence and the CR's findings. From page 47 of the final report though: "The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews on a range of issues from epidemiology through to treatment approaches, and international models of current practice." You've also seen: "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians." I think the "as well as" puts emphasis more on the SRs being the "bedrock" of the CR. In all, I think it's reasonable to say the SRs were the core of the evidence the CR used; what do you think now, with this all in mind?
Regarding the draft version of the Methodology section (and comparing to the section before my originally contested edits and after them as well):
  • "According to Cass..." We should try to write the text ourselves, rather than quoting, especially given how contentious this article is: people will see "according to Cass" and immediately overwrite it because they "disagree with the review".
  • I appreciate you putting the non-SR stuff at the end, I think it works much better that way
  • I'm fine with the explanation of the role of the Centre for Reviews and Dissemination moving to an endnote if it helps get a compromise
  • Why did you remove the paragraph including the Mixed Methods Appraisal Tool and Newcastle–Ottawa scale? They were key to how the SRs worked and help the reader better understand the CR's overall methodology.
  • We've still swayed further towards criticisms of the SRs than even before my edits. For example, the section used to say the SRs were independent and peer-reviewed. Now, it doesn't, and instead we have some (minor in context) criticism of them. The boat has still been pushed back further than it swayed to begin with.
I might make a revision of the methodology section based upon the version present before my originally contested edits, with some tweaks - maybe adding extra details people want as endnotes and adding more references. What would you think about that?
Thanks again! 13tez (talk) 17:20, 1 January 2025 (UTC)[reply]
Hi @13tez,
"The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews on a range of issues from epidemiology through to treatment approaches, and international models of current practice." You've also seen: "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians." I think the "as well as" puts emphasis more on the SRs being the "bedrock" of the CR. In all, I think it's reasonable to say the SRs were the core of the evidence the CR used; what do you think now, with this all in mind? I really don't see it that way. In fact, with the "to support this" part in there, that shows me that there's no consistency in how she uses phrases like "support", "supplement", etc. How can the SRs be the most important thing if they only support the other evidence looked at? She's using these terms loosely throughout, and the only logical meaning, from my POV, is that the only consistent statement we can make is that she's using all this information to support her findings/recommendations, not that some evidence is prioritised and the rest is secondary. Anything more than that is WP:OR. Given the ambiguity, I think we either have to include her direct quotation or remove the claim of SR centrality altogether.
However, it wasn't published by a major medical organisation or in a reputable medical journal. Therefore, I don't think we can count it as a MEDRS source, and I certainly don't think so to the extent that its criticism of the CR's SRs (which I view as higher quality sources for the reasons I gave before) should be afforded weight (especially when the quote comes from a paragraph explaining these were minor changes and the SRs mostly worked the same anyway). If you can find some other sources to back it up, that'd be better, both to have sources we all view as MEDRS/suitable stating these criticisms and to ensure there's enough coverage of them in MEDRS/suitable sources to warrant their inclusion (even if we view the RAND review as MEDRS, if these criticisms aren't made in other MEDRS sources, they won't have enough coverage to be included per weight). As I said upthread, the Cass Review and its SRs already state what the remit of the review was, and therefore its limitations. So this is equally sourced by the Cass Review/SRs. The only part that isn't is the part about confidence ratings, and I'm happy for that particular part to be removed (although, the Cass Review doesn't include confidence ratings, so it's also not untrue). Besides which, we don't necessarily exclude RSes just because some sources are better. Only if the better source conflicts. But there isn't a conflict here, since Cass isn't contradicting RAND. Furthermore, RAND is peer reviewed (Cass isn't) and RAND's health research arm is well regarded and influential, having provided evidence for the US government among others. The SRs being published in peer reviewed journals is one-nil to the Cass Review, but the fact the overall RAND report is peer reviewed and Cass isn't makes it one-all. So there's not much in it. And again, Cass supports RAND's statement about limitations because those limitations were largely intentional.
But I feel very strongly that we shouldn't exclude RAND just because some editors prefer Cass or think it's more reliable, since the fact Cass has been based on SRs has been repeatedly used to already exclude other sources that are critical of the review. We need to be consistent here. Moreover, we shouldn't be excluding all criticism here; at worst, we should be including stuff with caveats to reflect the uncertainty Cass herself says exists in the evidence base (and therefore in her own findings). The person who added RAND in the first place obviously agrees it's due and so do I. Minimising critique (or perceived critique, since I don't feel RAND is actually giving a critique rather than simply explaining limitations) introduces bias in itself.
"According to Cass..." We should try to write the text ourselves, rather than quoting, especially given how contentious this article is: people will see "according to Cass" and immediately overwrite it because they "disagree with the review". It's a direct quote. That's the whole point. The compromise is to include the direct quote so that others can make up their own mind. Going back to a statement in Wikivoice isn't a compromise, because one of us is going to disagree with how it's framed. The only Wikivoice statement I think is justified is something along the lines of "to draw her conclusions, Cass commissioned systematic reviews, qualitative and quantitative research, etc".
Why did you remove the paragraph including the Mixed Methods Appraisal Tool and Newcastle–Ottawa scale? They were key to how the SRs worked and help the reader better understand the CR's overall methodology. The final report section details the tools used for each outcome/finding, so it's redundant. Also, specific trumps the general here, so being able to say "this SR used x" is better than a generalised statement.
If you want to propose some new text, please add a draft here and ping me. Then we can discuss it and workshop it without any intervening edit conflicts or reversions. However, I did make several compromises already and they have been repeatedly undone afterwards (I know there have been lots of editors making changes), so the draft I've proposed is far closer to your preferred wording than mine. I also suspect it's still a bit quiet here after Christmas, and we might want to give others a chance to chime in too, since there seems to be only 3 or 4 of us engaging regularly at the moment. Lewisguile (talk) 18:24, 1 January 2025 (UTC)[reply]
Hey @Lewisguile, thanks for sharing your thoughts again.
How can the SRs be the most important thing if they only support the other evidence looked at?
She said: "The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews..." She's saying the SRs were commissioned to support the ability of the review to be "grounded in a thorough...". This ability ("to be grounded...") is the "this" in "support this", not the other types of evidence. After pointing that out, and considering the other references we've discussed so far ("supplemented" and "the bedrock"), is your mind changed at all?
As I said upthread, the Cass Review and its SRs already state what the remit of the review was, and therefore its limitations. So this is equally sourced by the Cass Review/SRs
I'd be happy to include the scope/remit/limitations of the SRs or CR if they can be sourced from the CR or SRs themselves and are due etc. Do you think we could include something like that instead of the RAND stuff altogether to move forwards on this?
So there's not much in it.
I don't want to debate the relative quality of the two sources much more, since it isn't really productive, but: the NHS is the type of medical organisation (and listed as an example) in WP:MEDORG and they commissioned the review (and the group who carried it out serve the NHS); and the SRs were published in a (highly) reputable medical journal. Neither of these points are true for the RAND review, so I consider it to be of lower quality and credibility.
Again, I'm not assuming it's wrong - it doesn't even seek to criticise or "debunk" the SRs/CR anyway - just that I don't think we can assess its quality to be high enough under MEDRS to warrant the inclusion of its content in the article which is currently being presented in a manner that undermines the credibility of the SRs/CR.
I don't feel RAND is actually giving a critique rather than simply explaining limitations
Yeah, I don't feel that way either. RAND never says "the Cass Review was wrong" and the limitations are discussed, in context, as small differences from their own approach and not as criticisms anyway. However, the whole basis of including some of their described limitations of the SRs seemed to be critical and included to form some kind of balance "against the systematic reviews".
It's a direct quote. That's the whole point. The compromise is to include the direct quote so that others can make up their own mind
I was trying to say we don't need to make up our own minds on whether the CR commissioned "a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians". All of this is currently in the quote from Cass. However, this is all objectively true, not being contended here, and supported by MEDRS sources other than Cass. We can move that the CR commissioned that stuff out of the quote. I think it'd be beneficial because we should use direct quotes sparingly and, given how contentious this article is, people will see "according to Cass" and immediately overwrite it or add other text afterwards to "debunk" it because they "disagree with the review". Do you see what I mean about moving what we can out of the direct quote?
The final report section details the tools used for each outcome/finding, so it's redundant. Also, specific trumps the general here, so being able to say "this SR used x" is better than a generalised statement.
Yeah, I take your point that the Newcastle–Ottawa scale is redundant when included in both the methodology and final report sections. I think it makes more sense to include in the methodology section than the final report sections. In other words, describe how the quality of research was assessed in the methodology section, then describe the outcome of these processes in the final report section. What would you think about that? Ditto for the Mixed Methods Appraisal Tool.
However, we're now missing the explanation of why these tools were used ("because no blinded controlled studies – those usually thought of as having the highest quality – were available") and that meta-analyses were used to combine the results of different research in the SRs. I think this is important information, in part because "the CR excluded non-blinded studies which was unfair" is a widely covered and shared claim, and, in part, to explain the methodology underpinning the SRs and CR. Do you agree with me here? How do you think we could restore this information? I genuinely thought that paragraph had been removed accidentally, because I hadn't seen anyone objecting to it before.
If you want to propose some new text, please add a draft here and ping me. Then we can discuss it and workshop it without any intervening edit conflicts or reversions.
Sure, thanks again for working in good faith to compromise. I might make one in my sandbox or something similar and ping you with it.
Thanks! 13tez (talk) 22:13, 1 January 2025 (UTC)[reply]
Again, though, "to support this" doesn't mean "we used the systematic reviews over everything else". There's no explicit statement to support "we used this more than anything else", so the rest is a matter of interpretation. If the meaning is as clear as you think it is, then it will be equally clear if we include an original, direct quote? We could remove According to Cass, since the statement is sourced, while still using the direct quote. That will avoid the impulse for someone to try to counter it. We can also add invisible text to advise others not to do that in future.
Re: RAND versus the Cass Review, R (it's still sourced)AND has existed since c.1948, was funded by NIH and others, and regularly contributed research to the CDC and other governmental departments in the U.S. While it wasn't published in a journal (it says all its publishing is "open publishing"), their review was written by multiple authors and peer reviewed. The only person who needed to be convinced in the Cass Review was Cass (a self-described non-expert), so she was free to interpret the evidence how she wanted to. Which is why, in places, she makes her own conclusions, and draws from disparate bits of evidence like sex-rearing in DSD.
My main concern at this stage is that if nothing is allowed in that isn't deemed to be equal to the Cass Review by a small group of editors, then we effectively minimise any critique, discussion or nuance. WP:MEDRS shouldn't be used to silence disagreement, especially when the medical consensus across multiple countries isn't as clear-cut. That's before we even get into the politics of this – Cass is a politician, and members of the last government were proud to announce their own support of the review, even after they had made non-neutral statements about this subject before. Indeed, similar claims have been made about Cass.
All of which is to say that no evidence is perfect, all sources are biased, and the Cass Review itself isn't perfect. The SRs are mostly fine, but the CR =/= the SRs alone. There's a significant amount of synthesis and interpretation occurring to create the conclusions and recommendations, and Cass herself doesn't deny that.
What I suggested to VIR elsewhere was that we could remove the part about certainty ratings and then cite the remainder to both RAND and the Cass Review.
As for the grading tools, some of those would have been used either way. That's what a systematic review does. RAND used GRADE, which is what NICE uses, whereas York used a mixed approach. It's different but not particularly unusual, and so not majorly notable. However, I have no problem with those more specific statements from the findings being replaced with a more generic statement – so long as you're aware that's what's happening. I also don't mind the statement about no blinded studies being in there. Though, blinded RCTs are usually the highest standard and there are particular circumstances that make blinded RCTs unlikely or difficult to obtain here – e.g., control will always be treatment x + treatment y versus treat ebt X or y alone, or treatment x versus treat ebt y. You'll never get treatment x versus placebo for blockers, for example, because it's obvious whether you're going through puberty or not (especially if you have dysphoria). So someone is likely to feel, at some point, that this clarification also needs to be made. Not mentioning the blinded part avoids that. We already explain most of the evidence was of insufficient quality, which does the same thing for those who are interested in knowing such details anyway.
If you post a draft in sandbox, I'll happily take a look. Thank you. I'm going to put a notice in the WikiProject so we can get more eyes on this anyway. There's a danger whatever we say here will get reverted again otherwise. Lewisguile (talk) 08:59, 2 January 2025 (UTC)[reply]
About this sentence, which is what I believe you're talking about: The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. This is a selective statement of differences between the RAND report and the Cass report. (It leaves out "used different risk-of-bias assessment tools, excluded studies meeting less than 50 percent of bias assessment criteria from syntheses in the hormonal intervention reviews".)
I don't think that the first even sounds like a "criticism" of Cass; it sounds like a simple, factual description. In order:
  • The Cass Review looked at studies of the relevant population. This is a good thing, right? (If the world never sees another study for children with cancer that relies on geriatric results, it will still be too soon.)
  • The Cass final report excluded weak evidence. The RAND report included weak evidence, and I guess that's their choice, but it's not actually bad to exclude weak evidence.
  • The Cass final report also excluded studies that were not published in the international language of science. Not only is this usual, but nobody has since reported even a single study in any other language that could be used to seriously challenge any of Cass' recommendations. The RAND report says they didn't exclude non-English sources and still only found one non-English study that met their inclusion criteria (in Spanish; I believe it was PMID 36705053). This is therefore an unimportant difference between the RAND and Cass reports.
So what's left is: It did not provide certainty-of-evidence ratings for outcomes.
My main concern is that this sentence will not be understood by some (probably most) readers. We have seen unfortunate misunderstandings happen before (e.g., in the "they rejected 98% of the scientific studies!" misinformation), and I would like us to do our part, small as our part may be in this instance, to avoid setting off another round of drama on antisocial media. If we dump this in the article, some people are going to believe that they have now, finally, after all these months, found the detail that proves the Cass Review is 100% bad, because they have no idea what this means, but it sounds all science-y and it must be some kind of stunning criticism, or else Wikipedia wouldn't have mentioned it.
What RAND's statement means is that they intend to spam (low certainty) and (very low certainty) at the end of certain sentences in their report, and they notice that the Cass final report did not do this. (With a quick search, RAND didn't label anything in their report as having a certainty rating higher than "low".) RAND writes, e.g., in their Summary (bottom of page V) that puberty blockers slow pubertal progression (low certainty), GAH is associated with cross-sex pubertal changes (low certainty), and both of these reduced gender dysphoria (very low certainty), where Cass would have said basically the same thing, except not spammed "(low certainty)" after the items.
Including this label is the standard form for GRADE approach#Certainty of evidence, but including or omitting that information doesn't actually change the recommendation/assessment, and both the interim and the final report already said that the evidence base sucks in general. See, e.g., this line in the Cass final report:
This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.
That pretty much tells you that the certainty of evidence for "outcomes" is low (except when it's very low, or non-existent).
Additionally, quite a lot of the Cass final report isn't something that would have this sort of statement anyway. You can't have a certainty-of-evidence rating about whether Further research is needed.
My bottom line is that if we're going to mention this – and there's no clear reason why we should – we need to be precise in what we're saying and explain what that means and why it (doesn't) matter in practice. It might help to stop thinking of this as a criticism. RAND isn't complaining about Cass's choice. Also, they did a review of the evidence in a somewhat different way (e.g., including case studies), and still ended up in the same place, namely that the existing evidence base sucks (or is entirely non-existent for two of their categories). WhatamIdoing (talk) 11:38, 2 January 2025 (UTC)[reply]
I don't see it as criticism of Cass. I see it as describing limitations, which is also pretty neutral in this context. I've said as much elsewhere. My feeling, however, was that people are unduly anxious that it is a critique, which is why they don't want it in the article at all. I disagree with that stance and believe RAND is suitable to use. RAND isn't/wasn't just used in the article to cite the sentence above – it was also used to cite the limitations in terms of other countries. I.e., this is a review for the NHS and isn't necessarily applicable to other countries' health services. Which again, is blindly obvious to us, but a lot of people have spread misinformation about that part, such as that US politician who has tried to ban certain treatments citing Cass. That is relevant for the same reasons you cite: avoiding misinformation. So, broadly speaking, if we're in agreement that RAND is fair to use in the article, I'm happy.
However, if we're also including lots of detail on the SRs, then mentioning the (intentional) limitations is also warranted. I wanted less explanation of the SRs in general, but as 13tez feels very strongly that we need more info on them, then we should balance that out by adequately setting expectations. Lewisguile (talk) 18:30, 2 January 2025 (UTC)[reply]
I don't feel like we're including "lots of detail on the SRs".
The text currently says:

:::::::::::::It commissioned a series of several peer-reviewed, independent systematic reviews that looked into different areas of healthcare for children and young people with distress related to gender identity, was carried out by the University of York's Centre for Reviews and Dissemination, and was published in Archives of Disease in Childhood. The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. The reviews covered:

  • Characteristics of children and adolescents referred to specialist gender services
  • Impact of social transition in relation to gender for children and adolescents
  • Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence
  • Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers)
  • Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy)
  • Care pathways of children and adolescents referred to specialist gender services
  • Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence
Which is to say, it provides basic information about who-what-where and the main subjects of the seven reviews.
The "restricted to studies focusing on minors" is redundant with "looked into different areas of healthcare for children and young people". Mentioning the "non-English studies" thing implies that this is a material restriction, which is known to be false. For that matter, "non-English studies" implies that there was more than one non-English study, which RAND says is false. I think we should remove both of those.
Also, that first sentence is 50 words long. Maybe that could be split. WhatamIdoing (talk) 22:40, 2 January 2025 (UTC)[reply]
None of this is DUE - the RAND report could maybe go on puberty blockers or gender-affirming healthcare but its not a response to or critique of Cass, nor is it an authoritative source on Cass' methodology. It doesn't encompass the same evidence, and it isn't published in any reputable journal. Void if removed (talk) 21:10, 1 January 2025 (UTC)[reply]
That's your opinion, and frankly this feels like WP:BLUDGEONING at this point. You've vigorously fought every single source which critiques Cass in even the lightest terms possible. It risks becoming WP:STATUSQUOSTONEWALLING. Lewisguile (talk) 08:37, 2 January 2025 (UTC)[reply]
I lean towards agreeing with Void's suggestion that RAND is more relevant to other articles. Also, I think you're wrong to interpret RAND as "critiquing" Cass at all. WhatamIdoing (talk) 11:39, 2 January 2025 (UTC)[reply]
See above. I don't think it's critiquing Cass. But the objection to it seems motivated by keeping out criticism, whether it actually is or not. Lewisguile (talk) 18:32, 2 January 2025 (UTC)[reply]

Updates and copyedits

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I have gone through the article to make some general copyedits for length and repetition, and to add page refs to some of the citations (see diffs here – moving stuff up has made some edits look larger in markup). I have tried to keep the meaning the same. In a few instances, I have removed text that was either apparently unsourced or which didn't reflect the source material (see thread immediately above this one). Where I could, I simply reworded such text, and only removed it when it wasn't there at all in the sources or was unclear/misleading. I'm noting here a few of my own queries/things we might still want to consider:

  • There are conflicting views about the clinical approach, with expectation at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services. We previously said clinicians had expectations far from the norm based on this, but I think this is actually talking about the expectations of service users and their families. I.e., that the expectation among patients and their families that they will/should receive treatment x, and that clinicians who don't offer this worry they'll suffer sanctions or face a complaint. That was a strong theme in the York papers, and makes sense in the context. If I'm reading that wrong, I'm happy to restore that wording or an alternative, as needed.
  • In-keeping with the general consensus for orgs over individuals in the Responses section (which is still really long), I have trimmed or removed statements by, e.g., the president or chair of an organisation if their comments were substantively the same as those of their org. E.g., if the org says "Yes!" and they say "Yay!" I've left quotes that add extra/different info ("Yay, but..." or "No").
  • On responses in general, the length is partly to due with lots of direct quotes. We could probably round up some of the Responses (in the format of orgs x, y and z supported the review but x said "something else" as well). In the meantime, I have trimmed the direct quotes a bit, both for length and to avoid extensive reproduction of text from sources. I don't believe these have changed the meaning of any quotes, but please ping me if I've left something important out or misinterpreted anything.
  • I think the Methodology section spends too much time on the independent systematic reviews, rather than the Cass Review process itself. This may need some workshopping.
  • Do we need a terminology or "concepts" section? There are some concepts that are overlapping and the nuances may not immediately be clear to readers (e.g., gender dysphoria, gender incongruence, gender-related distress). We can outline how the systematic reviews and Cass Review use these terms, if there are differences.
  • I added one sentence to summary Cass' response at the end of the lede: Following high profile media coverage, Cass expressed concern that misinformation about the review had spread online and elsewhere, and that her review was being weaponised against trans people. It seems important to mention both of these things. This wording seems fairly neutral to me and hopefully conveys the points in broad strokes, without needing to go into too much detail here. Hopefully this isn't controversial, but as always, I am happy to self-revert if necessary.

Thoughts are always welcome. Lewisguile (talk) 10:44, 27 December 2024 (UTC)[reply]

I agree with your idea of summarizing responses, and suggest that it should be "orgs x, y and z supported the review, and x said "something else" as well". One risk is that the supporters may be easy to summarize, which could result in "A, B, C, D, E, F, G, H, I, J, K, L, M, O, N, P, Q, R, S, T, U, V, W, and X all supported the review, but Y said <multiple sentences of disagreement> and Z said <long paragraph of disagreement>", which would amount to providing UNDUE weight to a minority of organizations.
Right now, we have a long list of subsections, to which I have added a quick guess at the overall 'feel' of the contents:
  • Response from UK political parties and public bodies: 90% support
  • Response from devolved governments: 80% support
  • Response from health bodies in the United Kingdom: 90% support
  • Response from other health bodies globally: 10% support
  • Response from transgender specialist medical bodies: 0% support
  • Other academic responses: 20% support
  • Reception by charities and human rights organisations: 40% support
  • Reception by gender-critical organisations: 100% support
The thing about summarizing is that the high levels of support are fairly boring: A, B, C, D, etc., all basically support the review and its recommendations. The opponents, however, are all over the map: N disagrees about this specific thing. O disagrees about a different specific thing. P throws out an ad hominem attack on Cass herself. Q makes an (unsubstantiated?) claim that Bad People were involved. R thinks it's fine, as long as it doesn't get imported into R's country. And so forth. The net result for the reader is that a concise summary of (for example) 60% support could look like 90% opposition, merely because the opposition can't be summarized as simply. WhatamIdoing (talk) 21:39, 27 December 2024 (UTC)[reply]
I hear you. But one way around that is to cluster them by the groupings we currently have. So "political parties x, y and z said this", "medical groups a, b and c said that", and so on. If we workshop the text here we might be able to pare it down fairly while making sure it doesn't feel unbalanced? We did something similar for November 2024 Amsterdam riots and it worked quite well. That section was equally long and got pared right back. Lewisguile (talk) 07:56, 28 December 2024 (UTC)[reply]
I'll take a stab at a draft tomorrow and post it here. I think we can do it without unbalancing things. I think we can keep it balanced through the space we give to each side. Lewisguile (talk) 18:42, 28 December 2024 (UTC)[reply]
Catching up now on the many changes over Xmas. So the "weaponisation" is not representative of the source given, which is clear that she's talking about the fear of weaponisation. I've clarified the body and removed from the lede, as I don't think its a significant enough statement in context. Void if removed (talk) 13:56, 1 January 2025 (UTC)[reply]
I have put the entire sentence because I don't think your reading is clear either. She's saying that she didn't say that trans people don't exist, not that there isn't weaponisation of the report. She's saying that there is fear, yes, but that doesn't mean that the fear isn't due to weaponisation. Arguably, the fear is caused by the weaponisation and that's what she's saying. Lewisguile (talk) 14:15, 1 January 2025 (UTC)[reply]
No, it is not - she's concerned people are fearful. You had written that she was concerned it was being weaponised. These are different. If you have to put the full quote in to try and make sense of it, I think that's WP:OVERQUOTE for such a trivial detail, and as written it is nowhere near ledeworthy.
The quote is
I think there is an appreciation that we are not about closing down health care for children. But there is fearfulness — about health care being shut down, and also about the report being weaponized to suggest that trans people don’t exist. And that’s really disappointing to me that that happens, because that’s absolutely not what we’re saying.
The "disappointing" is ambiguous. Is it the fear or the weaponisation she's referencing? If it was the latter, and if it was significant, there'd be other sources, because she's been very vocal about attacking the misinformation about her review. This feels like making a lot out of a passing comment. There are other, better sources for Cass' reflections, including a whole peer-reviewed article by her. I'd focus on the totality of her reflections as a whole rather than taking a tiny ambiguous quote like this and making it the focus. Void if removed (talk) 14:26, 1 January 2025 (UTC)[reply]
She says it's disappointing that that happens, because that's absolutely not what we're saying. It doesn't make logical sense that she's saying "we're not saying that there is fearfulness", or "we're not saying that there's weaponisation", while also saying "fearfulness is happening". The only way that "happening" and "saying" makes sense is if she's saying "weaponisation is happening [to suggest trans people don't exist] but we didn't say [that trans people don't exist]". Moreover, you admit yourself it's ambiguous what "disappointing" is referring to, so a direct quote avoids having to make a definitive statement about something you say isn't clear.
Incidentally, I think there was an edit conflict, so 13tez had inadvertently restored my text. I have edited the text again to address 13tez's edit conflict. The quote now isn't a blockquote, and it's shorter. I didn't re-add it to the lede after you removed it, but including it in the body isn't undue. ::::@Snokalok @Your Friendly Neighborhood Sociologist @Bluethricecreamman @13tez what do you think Cass is trying to say here? Lewisguile (talk) 15:13, 1 January 2025 (UTC)[reply]
If you have to parse the statement this much to get the meaning you want, then I think you should look for a better source, and if there isn't one, it doesn't belong. She just says its disappointing "that happens". What is the that? The fearfulness? The weaponisation? The whole messy situation where some peoeple are afraid and others draw the wrong conclusions from her work? I get the sense of her throwing her hands up at the whole mess. This is a brief statement in an interview, and seizing on one interpretation of these words and highlighting them to imply she was concerned about people weaponizing the report when she didn't outright say that is not NPOV.
The best source for Cass' reflections on the review is this peer-reviewed editorial.
AFAICT, we still don't cite this, and I don't know why. I brought it up months ago, and it gives a lot of useful material about what Cass felt was the most important takeaways. Weaponisation isn't in there, but she does reiterate:
This Review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people's rights to healthcare
I would revisit this source and expand from there the points she actually made and felt worth making, at length, in her own considered words, rather than over-interpreting an NY Times interview. Void if removed (talk) 18:06, 1 January 2025 (UTC)[reply]
If you have to parse the statement this much to get the meaning you want, then I think you should look for a better source, and if there isn't one, it doesn't belong. That's your opinion, and my opinion is that your interpretation seems to be the unlikely one. I still don't see why you object so much to the direct quotation. If it does indeed mean what you think it does, what harm would it cause to include that wording, rather than making a claim in Wikivoice which one of us is going to dispute? It is a direct answer to someone asking her about the reaction to the report, which is relevant to the section it was in. I believe I am trying to compromise here. Lewisguile (talk) 19:16, 1 January 2025 (UTC)[reply]
you object so much to the direct quotation
I don't feel strongly about the direct quotation - I think its overlong but, if that's the compromise fine.
But ideally, I would like to go to her peer-reviewed editorial and build this section from that, rather than quotes in interviews. I think that's a much better source for her considered reflections. But that's for another discussion. Void if removed (talk) 10:46, 2 January 2025 (UTC)[reply]

Background changes

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Hi @Snokalok, hope you're doing well.

After I made an edit to expand the background section to give readers, you subsequently removed one of the paragraphs I added, citing WP:SYNTH. I reverted your edit removing my changes, explaining why I felt this paragraph didn't constitute SYNTH. Afterwards, you made another edit in which you removed this paragraph again and warned me not to WP:EDITWAR and that this article currently has a WP:1RR in place.

The 1RR rule states: "An editor must not perform more than one revert on a single page—whether involving the same or different material—within a 24-hour period. An edit or a series of consecutive edits that undoes or manually reverses other editors' actions—whether in whole or in part—counts as a revert."

As I've described, you have now made two edits which removed this paragraph I added, so you are actually in violation of this rule. Please could you explain why you think this paragraph constitutes SYNTH, regardless of the explanation I offered? Thank you. 13tez (talk) 22:48, 30 December 2024 (UTC)[reply]

Ah, yes, regarding the 1RR, this page is actually under enforced BRD, not 1RR. That was my mistake for getting them mixed up. Regardless, the fact is that you made an addition, it was partially reverted, and under enforced BRD, you’re not to add it back in without consensus.
As for synth, there’s no evidence that I saw in your citations that Sweden’s opinions had any bearing on the Cass Report. Otherwise we could just as easily add in all of the countries that said the opposite prior to the report’s publication. Snokalok (talk) 22:58, 30 December 2024 (UTC)[reply]
Hey, thanks for getting back to me.
As for synth, there’s no evidence that I saw in your citations that Sweden’s opinions had any bearing on the Cass Report
The paragraph in question did not state or imply that the findings of the SR commissioned by Sweden did influence the Cass Review. If you are curious about this point, the Swedish guidelines are explicitly discussed in the final report (e.g. page 132) and the SR discussing guidelines. It is, however, part of the background context behind the review being commissioned, namely the debate over the strength of evidence for care like that provided at GIDS.
SYNTH refers to using two referenced pieces of information being used to argue for a third, without that third piece of information itself being supported by references. It is not text being irrelevant.
Please remove "which are meant to buy time without undergoing any permanent bodily changes for patients to assess their options" as this point is argumentative, discussed elsewhere, unsupported by sources, and not relevant to the concerns of the GIDS staff members.
Thanks!13tez (talk) 23:09, 30 December 2024 (UTC)[reply]
Okay starting with the buying time point, it’s in the latter two BBC sources attached to that sentence and since this is the background section and the sources mentioned it, it’s relevant to mention for a full and balanced picture.
As for synth, adding the Sweden thing suggests that the Cass Review was influenced by Sweden’s decision, but no cited sources said that; if you have a citation in the Cass Review, by all means add it back in with citation and we’ll go from there. Snokalok (talk) 23:46, 30 December 2024 (UTC)[reply]
Okay starting with the buying time point, it’s in the latter two BBC sources attached to that sentence.
The closest thing I could see is: "These drugs stop a young person's body developing, with the aim of helping to relieve gender dysphoria - distress caused when a person's gender identity does not match their biological sex. The NHS now recognises, external that little is known about their long term side effects." Am I right in thinking this is the sentence you're basing it off?
since this is the background section and the sources mentioned it, it’s relevant to mention for a full and balanced picture
Do you think describing the aim of the use of puberty blockers is relevant in a subsection discussing criticism of GIDS? Why not describe puberty blockers elsewhere, where they're discussed in more detail, so this point would be more relevant?
As for synth, adding the Sweden thing suggests that the Cass Review was influenced by Sweden’s decision
Well, the paragraph you removed doesn't say there's any link between Sweden's decision and the Cass Review. It was meant to describe the ongoing debate over the extent to which evidence supported the types of treatments given at GIDS and how several countries were also examining them at the time. Do you think we should instead make this point more clearly by describing how several other European countries were examining these treatments because of this ongoing debate (and came to similar conclusions) so this is more explicit? After all, the CR was commissioned by NHSE back in 2020, so the Swedish review couldn't have influenced it being created.
Thanks! 13tez (talk) 00:04, 31 December 2024 (UTC)[reply]
the recent research part is definitely synth and adds bulk to a background section. And why exactly Sweden specifically for a review article? Bluethricecreamman (talk) 00:07, 31 December 2024 (UTC)[reply]
Maybe we should remake it to focus more on the debate over the extent to which evidence supported the types of treatments given at GIDS and how several countries were also examining them at the time. That was my intent - to illustrate that other countries were also undertaking similar investigations because of this debate.
We can cut out the unique findings of the Swedish systematic review. I just thought it should be included since it's significant in what it found and its impact - the changes in clinical practice in Sweden. 13tez (talk) 00:30, 31 December 2024 (UTC)[reply]
If other countries are also looking at this evidence, that's something for the Responses section. At best, it requires a sentence in the Background section, but I think it definitely veers into WP:COATRACK territory. What's important to know is that there were concerns about GIDS and evidence, and that's what the Cass Review looked at. That's all well described in the Background section as it was before these additions, and is also discussed in the relevant parts of the Interim report, Final report and Responses sections.
I have added some of the extra info you created over the last day or so as endnotes, but really, none of this is needed for the article at hand. It's already getting long. It may be that there's a changing attitude to things like the Dutch Protocol across Europe, and maybe even elsewhere, but that could be covered at the relevant article or could form a new article. I don't think it needs to be here. Lewisguile (talk) 12:26, 31 December 2024 (UTC)[reply]
I think we may have gotten a bit confused. There are four publications to consider:
  • the February 2022 guideline from the Swedish National Board of Health and Welfare [5] (with a final update in December 2022; English summary)
  • the March 2022 Cass interim report,
  • the 2023 Swedish systematic review ([6], cited in this diff), and
  • the 2024 Cass final report.
The 2023 Swedish systematic review does not actually mention Cass's work. It mentions some of NICE's work (linking to the NICE's documents on the Cass Review's website). "Last, there have been studies in this field published after the date of our literature search (9 November 2021). These have not been added to this study in order to not depart from the systematic approach. We nevertheless wish to comment on some of the publications. First, the National Institute for Health and Care Excellence in England (NICE) conducted evidence reviews of GnRHa40 as well as CSHT41 for children with gender dysphoria, which were independent from our work. The conclusions generally align with our findings."
NICE's work was (according to the Cass website) one of the things that led to the creation of the Cass Review, but the Cass Review itself is not mentioned in the 2023 Swedish systematic review.
The Cass final report discusses the 2022 Swedish National Board of Health and Welfare guideline at some length (primarily pages 129–135). The Cass final report mentions the 2023 Swedish systematic review in a single sentence in 15.25, only as an example of other papers that agree with Cass's commissioned reviews: "This is in line with other systematic reviews published previously (Ludvigsson et al., 2023)."
My first conclusion is that the 2023 Swedish systematic review is certainly not "a response" to Cass, since it doesn't mention Cass at all. It could be considered background information.
My second conclusion is that the Cass Review was influenced by the 2022 Swedish National Board of Health and Welfare guideline, since it spends quite a lot of time talking about it and agreeing with it. WhatamIdoing (talk) 20:38, 31 December 2024 (UTC)[reply]
Hey @Lewisguile,
I agree with WhatAmIdoing, both here ("I think we may have gotten a bit confused. There are four publications..") and below ("As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies.").
I'm not talking about other countries reacting to the Cass Review with similar reviews of their own or debate over the evidence underpinning treatments given to TGGNC youth that took place after the CR. This happened before the CR, so is part of the situational context before and that led to it. Therefore, it belongs in the Background section, not the Responses section.
The controversy over GIDS, including the "whistleblowers", legal cases, etc, led, in part, to the review and has been given extensive coverage in the news and has some in the report too. Therefore, per WP:DUE, so the reader can understand what led to the CR, and so the reader can understand the background on GIDS without having to go and read its article, its discussion is warranted in this article, albeit in a neutral tone, WP:Summary style, etc. For example, the Mermaids controversy got a lot of coverage, but after an investigation, there were found to be no inappropriate links between Mermaids and GIDS. Therefore, if we felt it was within due weight and included it here, we'd do so while giving that proviso. 13tez (talk) 13:30, 1 January 2025 (UTC)[reply]
Hi @Lewisguile and @WhatamIdoing,
Per the discussion here, I've added a reduced and summarised version of the previous content I added to the background section. It doesn't go into the general history of GIDS and says explicitly what the issues and background were behind the CR. Please let me know what you think when you have time. Thanks! 13tez (talk) 14:37, 1 January 2025 (UTC)[reply]
As I said elsewhere, I had attempted to come to a compromise on the wording, but VIR's hasty edits have restored much of the objectionable text (for you and for me). Find a version I think is quite fair here: https://en.wikipedia.org/wiki/Special:Diff/1266638132/1266639348 Note that it still has the SRs first, but it uses Cass's direct wording (which could be read to mean "this is the bedrock, and these things are also the bedrock" as well as "this is the bedrock, and these are other things we did which aren't the bedrock"), which allows us to briefly mention the other things too. Then the part about the other bits of research are included at the end, but without "supplemented" (since we've used the "bedrock" quote instead). It removes "non-peer reviewed" and "peer-reviewed" but keeps in where it was published. I think that gives you most of what you feel should be included while also doing the same for what I think should be in there? Lewisguile (talk) 15:37, 1 January 2025 (UTC)[reply]
Hey @Lewisguile, thanks for trying to compromise again!
I basically just restored your version of the new paragraph (the only differences are: I added a sentence explaining what GIDS is since it hadn't yet been done, at least by that point in the article; I changed the see also link to point to the GIDS article, not its history subsection; I made the text "systematic reviews" link to their article, since they hadn't yet been mentioned in this article; I removed a parameter causing an error in a reference which wasn't needed anyway; and I corrected "the NHS England Policy Working Group" to "an NHS England Policy Working Group").
@Lewisguile @Void if removed Please can you let me know if we can agree to leave the Background section as it is now in order to create a compromise and prevent frequent article changes?
I'm personally against the changes made to the Background section in the new paragraph ("In the years leading up to the Cass Review, several GIDS staff...") because the references say "debate" rather than "concerns"; there were other (highly covered) legal cases apart from BvT; and the legal cases also examined the evidence base as well as the ability to gain informed consent. However, I'm happy to compromise on them to get the paragraph added because I think it leaves readers more informed, and it allows us to resolve at least that section.
Thanks! 13tez (talk) 16:13, 1 January 2025 (UTC)[reply]
Thank you. I do want to get this right. I know we're all reading things slightly differently here, and I find myself more frustrated than usual with the text of the report itself (which is often imprecise), but I think we're inching closer to getting this article to a good place.
I changed "debate" to "concerns" just because "debate" sounded like it was a formal debate, rather than an ongoing series of issues being raised. If anything, I think that would veer too much on the side of the negative side of the debate over the positive, but I think it is a fair reflection of where things were at.
What did you think of my Methodology wording linked above? I think it also addressed many of your issues while also addressing some of mine. Are you happy for that to be restored as well? Lewisguile (talk) 16:19, 1 January 2025 (UTC)[reply]
Thank you. I do want to get this right. I know we're all reading things slightly differently here, and I find myself more frustrated than usual with the text of the report itself (which is often imprecise), but I think we're inching closer to getting this article to a good place.
Thanks again for working in good faith! I agree. Like I said, I'm happy to agree to leave the Background section where it is now, but I wouldn't mind getting another version we all think is an improvement either.
I changed "debate" to "concerns" just because "debate" sounded like it was a formal debate, rather than an ongoing series of issues being raised. If anything, I think that would veer too much on the side of the negative side of the debate over the positive, but I think it is a fair reflection of where things were at.
"on the negative side" meaning the toxic culture war side of things? I see what you mean. We could quote the MEDRS source directly and say "professional disagreement"? You might prefer "disagreement" to "debate", and it focuses the debate/concerns/disagreement to those among medical scientists, rather than toxic discourse between pro-trans and anti-trans groups.
What did you think of my Methodology wording linked above?
I'll take a look and reply in the Methodology section here (of this talk page), just so everything stays separated.
Thanks again! 13tez (talk) 16:30, 1 January 2025 (UTC)[reply]
@Lewisguile I have no idea what you're talking about with hasty edits, please be specific, with diffs. Void if removed (talk) 17:36, 1 January 2025 (UTC)[reply]
I meant the number of overlapping edits made in a short period of time, which meant that edits made by me and 13tez were reverted accidentally. I had realised all three of us were editing at the same time and tried to restore some of 13tez's text, but that got undone too.
Those could have been intentional, of course, but since you specifically objected to my use of a direct quote over Wikivoice and felt the RAND sourcing was undue, it seemed unlikely. Lewisguile (talk) 18:30, 1 January 2025 (UTC)[reply]
Here you restored the "non-peer-reviewed"
Aha thank you! This is the problem edit on my part. Yes, that was only supposed to be a section header change, my bad, I blame visual editor/too many tabs etc.
Hopefully a one off, but please, if I do anything like that again, ping me with the diff at the outset. Void if removed (talk) 21:45, 1 January 2025 (UTC)[reply]
I still think some of it is WP:SYNTH because it's drawing connections that Cass hasn't. It would be best to stick to things Cass specifically mentions as influences on the report. Lewisguile (talk) 14:49, 1 January 2025 (UTC)[reply]
@Snokalok, it's not quite right to say under enforced BRD, you’re not to add it back in without consensus. That's the Wikipedia:Consensus required restriction. Under enforced BRD, you're not to add something back in until you've posted a comment about it on the talk page and waited 24 hours.
Of course, if, during those 24 hours, a significant amount of opposition appears, then you shouldn't add it back in until the discussion gets settled, but that's due to the ordinary WP:EPTALK policy, not the enforced BRD rules specifically. WhatamIdoing (talk) 20:41, 31 December 2024 (UTC)[reply]
The background section is significantly expanded by nearly 3x... is all of it necessary or could you just link to the GIDS article for a lot of this criticism? Bluethricecreamman (talk) 23:44, 30 December 2024 (UTC)[reply]
Well, I expanded the section to allow readers to understand the current situation and history of transgender healthcare for young people in the UK at the time of the review and the concerns and events which led to it. This is important context describing the situation in which the review was commissioned and made. It's given coverage in the report itself because it aids the reader's understanding of the review: how can you understand its recommendations if you don't understand the prior situation they were meant to change. 13tez (talk) 00:33, 31 December 2024 (UTC)[reply]
It's not at all necessary. This is a huge addition of text added without consensus. This should be a paragraph at most, since the article already lays out the complaints against GIDS well. I will revert and we can sort out a new paragraph. Lewisguile (talk) 08:58, 31 December 2024 (UTC)[reply]
I've posted what I think is a decent compromise on the Methodology section here: https://en.wikipedia.org/wiki/Talk:Cass_Review#c-Lewisguile-20241231174000-Methodology_2 As for the Background, I stuck in the "See also" link and added some of the extra detail as endnotes. I'm hoping this avoids bloat while retaining the details people wanted in there for those who want it. Lewisguile (talk) 17:55, 31 December 2024 (UTC)[reply]
As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies. WhatamIdoing (talk) 20:46, 31 December 2024 (UTC)[reply]
The article does not the reasons why the Cass Review was commissioned. We could certainly add a sentence or two more, but we don't need the entire history. Lewisguile (talk) 14:32, 1 January 2025 (UTC)[reply]
I've taken a stab at compressing what @13tez just added. It seems better now, although it was simpler before either edit. Lewisguile (talk) 14:46, 1 January 2025 (UTC)[reply]
TBH I'm not sure why any of this is here - we already "see also" to GIDS, which covers all this in more detail. Void if removed (talk) 15:51, 1 January 2025 (UTC)[reply]
I didn't think it was due anyway, but 13tez very clearly wanted more context there, which is why I trimmed the longer version to a shorter one as a compromise. Lewisguile (talk) 18:34, 1 January 2025 (UTC)[reply]
Hey @Void if removed, I gave my reasoning for including this stuff before as follows: "I expanded the section to allow readers to understand the current situation and history of transgender healthcare for young people in the UK at the time of the review and the concerns and events which led to it. This is important context describing the situation in which the review was commissioned and made. It's given coverage in the report itself because it aids the reader's understanding of the review: how can you understand its recommendations if you don't understand the prior situation they were meant to change."
I also agree with the broad strokes of what WhatamIdoing said was their reasoning for agreeing with the idea of including at least some of the information I added, at least in some form: "As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies." 13tez (talk) 21:27, 1 January 2025 (UTC)[reply]
Ok, I take the point of having something in some form. Void if removed (talk) 22:05, 1 January 2025 (UTC)[reply]
Thanks! Glad we can agree or at least compromise on it :) 13tez (talk) 22:17, 1 January 2025 (UTC)[reply]

"Narrative review"

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The Cass Review is not a narrative review. A narrative review is an academic review of existing literature. The Cass Review is an independent service review with a wide remit, that commissioned new research and engaged with stakeholders. Relying on one primary source to falsely call it a "narrative review" is wrong, and actually speaks to the reliability of the original source. This was a new addition which I have taken out, but @Lewisguile has reverted with an edit comment that by my reading wrongly refers to a document from a think tank as "peer-reviewed". I ask this be self-reverted and this badly-sourced misrepresentation actually be discussed before adding. Void if removed (talk) 15:13, 1 January 2025 (UTC)[reply]

I've told you twice now: it is peer-reviewed. You are frantically editing the page and adding talk page comments, and it's becoming a chaotic mess. You've actually restored text I had taken out because I agreed with 13tez that those things may not be needed, meaning the text is now more objectionable to more people as a result. Please take a breather and read your replies. Lewisguile (talk) 15:33, 1 January 2025 (UTC)[reply]
Just so we're clear about that process: https://www.rand.org/pubs/periodicals/health-quarterly/peer-review.html
All RAND documents are peer reviewed by at least two qualified reviewers—usually a RAND staff member and an outside expert. Reviewers are chosen for technical expertise, policy experience, and ability to provide an objective review. Reviewers are selected by the senior staff member in each RAND division responsible for quality assurance.
So it is sort of peer reviewed, semi in-house, and selected in-house. Not really comparable to an academic journal. This isn't the "gold standard".
Can you please take out the "narrative review" description - it is false. Void if removed (talk) 15:41, 1 January 2025 (UTC)[reply]
The Cass Review didn't have a peer review at all and you've argued that trumps almost everything else? I don't think we should have double standards here. It's a peer reviewed systematic review. NICE also publishes its own systematic reviews, but that doesn't invalidate them.
Either way, I didn't add that description, and you reverted my prior edit of that section when you made all your edits recently. It's probably best to go back and figure out who added it and ask them. Lewisguile (talk) 16:41, 1 January 2025 (UTC)[reply]
You're not comparing like with like.
The Cass Review is an independent review, and the final report is a culmination of a four-year process encompassing dozens and dozens of contributors and stakeholders, and multiple specifically commissioned systematic reviews. It is not a policy document or a peer-reviewed paper, and iti definitely isn't a "narrative review" - it is a service review, commissioned by a national health body. On this page, the cass review is an authoritative source about itself.
Other independent reviews that aren't peer-reviewed are things like the LCP Care Pathway - these aren't peer-reviewed sources, they are a different thing entirely.
NICE also publishes its own systematic reviews
NICE is not a policy thinktank.
I didn't add that description
So why did you revert to re-add it? If you aren't defending it, take it out again.
Also, having now read it in more detail, that RAND source is even more questionable.
It describes the 2022 Cass Review (so the Interim Report) as a narrative review, so it isn't applicable anyway. It also places, at the same level, two blogposts on SBM, which are also described as "narrative reviews".
https://sciencebasedmedicine.org/gender-affirming-care-is-not-experimental/
https://sciencebasedmedicine.org/gender-affirming-care-is-not-experimental-part-ii/
Likewise the "what we know project" which is little more than a group blog. This mixing of high quality sources like Cass with self-published stuff is pretty poor frankly.
Also the literature cutoff of September 2023 manages to exclude all the major work like Zepf et al that came just after that date. This document is already out of date, frankly, and seeing as it doesn't actually reference the final Cass Review beyond noting it exists, is not terribly relevant for this page. Void if removed (talk) 17:30, 1 January 2025 (UTC)[reply]
Also the literature cutoff of September 2023 manages to exclude all the major work like Zepf et al that came just after that date. All research has limitations. Of course they had a cutoff, because that's common practice. This document is already out of date, frankly, and seeing as it doesn't actually reference the final Cass Review beyond noting it exists, is not terribly relevant for this page. But in this case, RAND specifically talks about the applicability of Cass to other contexts than the NHS, and talks about its limitations. So I disagree that it's not terribly relevant.
iti definitely isn't a "narrative review" - it is a service review, commissioned by a national health body One isn't exclusive of the other. A service review can be a narrative review as well. According to RAND, its own "research is sponsored by U.S. government agencies; U.S. state and local governments; allied non-U.S. governments, agencies, and ministries; international organizations; colleges and universities; foundations; professional associations; other nonprofit organizations; and industry".
In this case: "This work was supported by Indiana University Bloomington and the Medical College of Wisconsin. In addition, RAND provided funding to support publication production, quality assurance, and supplemental research analyses. The research was carried out within the Access and Delivery Program in RAND Health Care and the Social and Behavioral Policy Program in RAND Social and Economic Well-Being. In addition, Lorenzo-Luaces was funded by grant numbers KL2TR002530 and UL1TR002529 (A. Shekhar, principal investigator [PI]) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award (NCATS); Peipert was funded by grant number TL1TR002531 (T. Hurley, PI) from NCATS; and Buss was funded by T32-MH103213-07 (W. Hetrick, PI) from the National Institutes of Mental Health. RAND Health Care oversaw the quality assurance process for completing and publishing this report; otherwise, funders did not influence the conduct or reporting of this research. The authors declare that they have no competing interests."
NICE is not a policy thinktank. But RAND is not just a policy thinktank either. It has conducted high profile research for the US government. You can see its prior commissioners here: https://www.rand.org/health-care.html. It uses open publication.
So why did you revert to re-add it? If you aren't defending it, take it out again. I reverted to the Methodology section that 13tez had edited and which I had re-edited afterwards. 13tez had left it in and I saw (and still see) no reason to take it out. It was about the entirety of that section, not one particular part, which you reverted, thereby reinstating the "non-peer-reviewed" text as well. (See the diffs I posted elsewhere on this page.)
I'm trying to engage in good faith here, but it feels like you're unwilling to compromise on anything. Your responses seem consistently aggressive and WP:BATTLEGROUND-like. Not to mention the mess made with edit conflicts (not only your fault, but I was trying to fix that when I got reverted again, which made me give up). That makes it very difficult to form a consensus, and the article will just end up being resolved by who can shout the longest. Can we call it a day and come back to this with cooler heads? I'm sure there's a consensus to be had, but it will require all of us to engage with the ongoing attempts to agree wording on this talk page so we don't all keep reverting each other (whether accidentally or not). Lewisguile (talk) 19:09, 1 January 2025 (UTC)[reply]
The edit I'm currently concerned with is here:
https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=prev&oldid=1266632416
You undid this here along with other changes:
https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=prev&oldid=1266634667
Since then you've made accusations on my part of hasty editing, called for cooler heads, and cast aspersions, with accusations of aggression, while I'm simply trying to get you to engage in good faith on this edit.
Ignore everything else about this source to save distractions and just on this one specific point: I removed a recently added and IMO redundant new sentence in this section that incorrectly calls it a "narrative review" based on a source that doesn't actually call the cass review a "narrative review", and would be wrong to do so if it did.
You've reverted my change amid a whole bunch of other issues, which AFAICT are nothing to do with this edit, and then when I asked you why, told me you don't actually want that text in but to to take it up with whoever added it. That isn't how mandatory BRD is supposed to work. If you don't want to defend "narrative review", take it out please. Void if removed (talk) 21:34, 1 January 2025 (UTC)[reply]
based on a source that doesn't actually call the cass review a "narrative review", and would be wrong to do so if it did. - p 10, table 2.1 of the RAND report does call it that...
You keep saying the Cass Review is a "service review" rather than a "narrative review", but those are not in any sense mutually exclusive. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:55, 1 January 2025 (UTC)[reply]
It refers to the interim report as that. It is incorrect to do so, and also wrong to apply it to the Cass Review as a whole, or the final report. Void if removed (talk) 10:08, 2 January 2025 (UTC)[reply]
@Void if removed, you realise you made reverts and edits after mine, right? You left that part in but restored text from RAND, including the "non-peer-reviewed" statement I had removed and RAND's description of limitations which @13tez and I were discussing. I was restoring the text 13tez and I were quibbling over but broadly in agreement on and we were still discussing the nuances when you reverted it. You then removed the GC responses section and the comments of a GP which were also, incidentally, in line with a statement made by the BMA (the same source says: Many GPs are not trained to provide the specialist care these patients need and therefore fear risking patient safety.) to insert a statement which was less supported in said source, and now you keep demanding that I revert something you yourself have subsequently edited and left in. I'm not being difficult, but I'm well aware of the WP:3RR, and unfortunately, some editors interpret it narrowly (i.e., including self-reverts as well). Also, if I removed the text I would be obligated to also re-edit the text you restored, since 13tez and I were working on getting it up to scratch and both disagreed with several parts of the restored text.
As for the "narrative review" versus "service review" dichotomy, per WP:MEDRS, which you're familiar with: Reviews may be narrative or systematic (and sometimes both). Narrative reviews provide a general summary of a topic based on a survey of the literature, which can be useful when outlining a topic. A general narrative review of a subject by an expert in the field can make a good secondary source covering various aspects of a subject within a Wikipedia article. Such reviews typically do not contain primary research but can make interpretations and draw conclusions from primary sources that no Wikipedia editor would be allowed to do. This fits the definition of Cass to a tee. The primary sources are the York papers and the secondary review is Cass. The York papers also indicate they use narrative methods in addition to systematic reviews in in multiple places. (See Taylor J, Hall R, Langton T, et al. Arch Dis Child 2024;109:s3–s11 (s3).)Lewisguile (talk) 09:54, 2 January 2025 (UTC)[reply]
The definition you are talking about applies to review articles. The Cass Review is not a review article - you're trying to apply terminology across different kinds of document, when "review" has multiple meanings, both broad and narrow. The Cass Review is an independent service review (in the broad sense) that, as part of its process, commissioned multiple systematic reviews (in the narrow sense) and produced an interim report and a final report. It isn't a "review article" published in an academic journal and isn't straightforwardly either a systematic or narrative review. Rather the "review" is a 4-year process, and its output was two reports giving a series of recommendations and guidelines to the NHS about how it structures its service, which the NHS then followed. Quite where the final report fits on the MEDRS pyramid isn't straightforward, but it is much more in line with something like, say, clinical practice guidelines than anything. Void if removed (talk) 10:20, 2 January 2025 (UTC)[reply]
In the interests of moving on - I apologise unreservedly for this edit, which mistakenly reinserted text, when the only intention was to change a section heading.
Until you pointed to that diff last night, I did not realise that's what happened, as I was looking only at this specific diff relating to "narrative review" and its reversion. Had I realised, I would have reverted it myself. I'm not trying to get you to 3RR, or make demands, I'm just trying in the best possible faith not to fall afoul of enforced BRD. Void if removed (talk) 10:41, 2 January 2025 (UTC)[reply]
To avoid problems with enforced BRD, worried editors may find it useful to make no more than one edit to the article per 24 hours. WhatamIdoing (talk) 11:55, 2 January 2025 (UTC)[reply]
Yes, I suspected you didn't mean to restore that text. That was what I was trying to say yesterday. I suspect all three of us were working on edits at the same time and merely pressed publish at different points. Which explains why stuff which was taken out got put back in again, and sometimes in unusual ways. I'm sorry if I implied bad faith on anyone's part – it's always hard to convey/read tone online. Lewisguile (talk) 17:46, 2 January 2025 (UTC)[reply]

Gender-Critical Responses

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VIR, you've removed the entire section on gender-critical responses saying Remove the "gender critical" organisations response, this seems like passing and non-notable coverage, and hardly deserved its own section, we have plenty of better responses now WP:NOTEVERYTHING[7] We have the guardian saying Parts of Cass’s review have been proclaimed as wholesale vindication by gender-critical feminists[8]

We have Them and Mother Jones saying The Cass Review won’t have an immediate impact on how gender medicine is practiced in the United States, but both Europe’s “gender critical” movement and the anti-trans movement here in the US cited the report as a win, claiming it is the proof they need to limit medical care for trans youth globally. Notable anti-trans group the Society for Evidence Based Gender Medicine called the report “a historic document the significance of which cannot be overstated,” and argued that “it now appears indisputable that the arc of history has bent in the direction of reversal of gender-affirming care worldwide.”[9]

Right now we talk about how LGBT orgs have recieved the report, but don't mention gender-critical orgs once. Considering it's a fairly BLUESKY statement that the gender-critical movement in the UK is large and broadly opposed to youth transition, why remove mention of the fact they broadly supported Cass's review? It seems unbalanced to reference only LGBT orgs without any mention of gender-critical ones.

I think the section should be put back in and expanded. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:11, 1 January 2025 (UTC)[reply]

Agreed. There is an issue with balance in the article overall, so this section should go back in. Lewisguile (talk) 09:11, 2 January 2025 (UTC)[reply]
What I would hope is that we can get away from the constant blow by blow responses, and start thinking about the wider context and aftermath and subsequent political flashpoints as more secondary and reflective pieces come out. One line in a guardian piece in april saying unnamed "feminists" claim "vindication" doesn't justify a whole section in "responses"
We have a wide variety of contemporaneous responses from major political parties and health bodies domestically and internationally that gives an accurate reflection of how it was received at the time. We have a ton of individual responses we've culled because frankly everyone and their dog has an opinion so we have to keep it to the most significant ones. It is already hard to prioritise.
But what would be really good is to start working on what I suggested last year, which would be another section to expand on the wider response over time and larger political context in the aftermath. I think we should keep the immediate responses as focused as possible and start fleshing out everything after about August or so in a new section.
What was the immediate response? Domestic political parties and health bodies almost unanimously endorsed it, with a couple of notable exceptions like the BMA. Internationally the picture varied from cautious agreement on some points to outright condemnation. That is a picture we can present in the "responses" based on the best possible and most notable opinions. What was the wider context and aftermath? Maybe we can build a more useful picture of that from other sources but I don't think it is a good to keep expanding this section like this with every minor note of celebration or protest gathered from passing mentions in rolling news coverage at the time. Void if removed (talk) 09:59, 2 January 2025 (UTC)[reply]
And just so we're clear, the sourcing of this section was one passing mention right at the end of an Economist article that just happened to have a quote from Stella O'Malley, and a self-published statement by Sex Matters. Neither of these are DUE. We have avoided individual responses, and if there was decent secondary coverage dedicated to either of these organisations as a whole then fine, but this is not notable coverage. Void if removed (talk) 10:06, 2 January 2025 (UTC)[reply]
Again, it's your opinion that it's not notable. Our view is different. There isn't consensus for your removal. Lewisguile (talk) 10:16, 2 January 2025 (UTC)[reply]
My opinion is based on the dearth of coverage. If there were more coverage (ie an article about sex matters' response in a RS, or an article about Genspect's response), I would agree, but as it is this section is poorly sourced to one quote from one individual, and a self-published statement that I don't think is enough to establish notability. We wouldn't have covered Stonewall's response had it not received press attention in its own right, and Stonewall are vastly more notable, and similarly we wouldn't have framed a quote from an individual connected to Stonewall as Stonewall's official response either. I don't see coverage of a response from either Genspect or Sex Matters and unless there actually is any I don't think this is WP:DUE. Void if removed (talk) 10:26, 2 January 2025 (UTC)[reply]
I don't think that it's necessary to expand this content, or to name any of those orgs. It's enough to say that gender-critical orgs praised it, citing Wikipedia:Independent sources for this fact. WhatamIdoing (talk) 11:58, 2 January 2025 (UTC)[reply]
To be fair, though, the same could be said of the various politicians whose views don't diverge from their party's. (I think I've said this before, so apologies if I'm a stuck record.) Until then, we have got a blow by blow, so it should be representative of the key parties. Lewisguile (talk) 17:39, 2 January 2025 (UTC)[reply]
Eventually, I think most of those soundbites will get removed.
The bit about the Green Party issuing and then retracting a statement, for example, is just unencyclopedic. Encyclopedias summarize, with a focus on facts that made a difference. The net effect of the response from the Green Party – one of the smallest political parties in the UK, holding 0.6% of seats in Parliament, by no means a "key party" – on the world, on the Cass Review, on the implementation, on anything except themselves was: nothing. IMO that whole paragraph should be removed. WhatamIdoing (talk) 23:08, 2 January 2025 (UTC)[reply]
They probably will get removed but there isn't consensus for that just yet. We'll get there, though. Lewisguile (talk) 11:45, 3 January 2025 (UTC)[reply]

Enforced BRD (again)

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@Lewisguile you have undone my reverts here.

These are recent additions by @Your Friendly Neighborhood Sociologist, which I have reverted. My understanding of enforced BRD is that these should then be brought here for discussion and then consensus established before being re-added. Void if removed (talk) 10:59, 2 January 2025 (UTC)[reply]

Hmmm. You raise a good point/grey area. My understanding is that @Your Friendly Neighborhood Sociologist can't reinstate their own edit for 24 hours, not that nobody can. The examples refer to Editor A and Editor B, where Editor A can't restore until they've discussed with Editor B. But Editor C isn't mentioned at all.
Enforced BRD is also intended to have the advantage that Editor B can't use 1RR+"consensus needed" to stonewall new edits being added, and to prevent Editor A from reverting the revert of Editor B.
I think Editor C restoring text isn't falling afoul of enforced BRD, but I'm happy to self-revert if there's no consensus for this text. At the moment, the additions (with your restored correction of removing Badenoch) seems fair and balanced, since LGBTQ groups are relevant and have mostly been removed from this article. It's quite relevant that most LGBTQ+ and trans groups have criticised the review, for example, but that's somehow not in the lede and has been whittled to almost nothing in the Responses section. Lewisguile (talk) 11:19, 2 January 2025 (UTC)[reply]
I've started a discussion either way: https://en.wikipedia.org/wiki/Talk:Cass_Review#c-Lewisguile-20250102113700-Responses_section_(picking_up_per_BRD) I noticed there wasn't one previously. Lewisguile (talk) 11:38, 2 January 2025 (UTC)[reply]
I would disagree TBH, this was added because of a tendency for bold additions to be added, reverted, and then re-added without discussion, and attempts to discuss ignored. I would say that if it can by bypassed by essentially tag-teaming (not an accusation, merely saying that that would permit bypassing EBRD), then it is a worthless measure, and not really in the spirit of the restriction. Void if removed (talk) 11:41, 2 January 2025 (UTC)[reply]
Ok, so from the FAQ:
You can reinstate the edit without violating this sanction, but if your revert gets reverted you must then discuss and wait 24 hours before re-reverting. That said, unless the revert was really bad it's a better idea to go to the talkpage before reverting. And if you stumble upon an active edit war between multiple editors you should definitely try to find a compromise/consensus on the talk page before participating in any reverting.
So basically, you aren't technically violating it, but it does seem to be not in the spirit of things to revert without discussion first.
I'd ask you in future to at least open a discussion first, or slow down and wait to see if the original editor takes it to talk, there's no rush. Void if removed (talk) 11:54, 2 January 2025 (UTC)[reply]
Yes, this is unclear, too. I think whoever wrote the FAQ simply didn't consider that a third editor might come along and revert a revert, which is why it only talks about the second person reverting the revert of their revert. Hmmm. It seems @WhatamIdoing has pinged someone for clarity, so that may help.
In any case, BRD does require an attempt to engage in said discussion by the reverter as well, if it's to work. I didn't see a topic for those reversions, which is why I have created this one. I think, in general, I would agree to the "no reverts of reverts" principle for all parties so long as whoever makes the first revert also actually opens up said discussion first. Then it's clear when an enforced BRD process has begun for all parties and it means we can gauge whether there's consensus or not for the edits. Lewisguile (talk) 17:35, 2 January 2025 (UTC)[reply]
Pinging Awilley, who may be able to tell us whether tag-team reverting is technically okay, and/or get the rules fixed to be clear about it. WhatamIdoing (talk) 12:00, 2 January 2025 (UTC)[reply]

Responses section (picking up per BRD)

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We have a discussion already about the GC responses in the Responses section. We don't currently have one for the additions of LGBTQ+ groups in that section – these were initially reverted by @Void if removed and then restored by me. Personally, I agreed with the original editor, @Your Friendly Neighborhood Sociologist, that these are WP:DUE, since the article otherwise includes very little of the LGBTQ+ response to the review (which has largely been mixed to critical, with some outright opposing it).

As it's not entirely clear to me whether enforced BRD also applies to third party editors, I figured I should start the discussion anyway and I can revert the text again if there's not a consensus to keep it. Lewisguile (talk) 11:37, 2 January 2025 (UTC)[reply]

Lots of people have opinions, as do lots of activist groups. The student officer for a minor affiliated group in the Labour Party is not an opinion that is as notable as, say, WPATH's. So, we give lots of space to WPATH, and don't waste space on trivia with no significant secondary coverage.
I have in the past said that the responses should be limited to the notable and immediate reaction and implementation, and that wider things (like what you're concerned about) should be used to flesh out a new section covering the wider sociopolitical response and aftermath. I'm fully prepared to believe such things could go in there, but I simply disagree that what a minor political activist thought about the review is of any consequence, compared to how the royal colleges responded straight away. I think this continual attempt to expand "responses" rather than accept a limit there and start expanding further down the article is to the detriment of the article as a whole. My impression of the discussion at the time was that editors perhaps didn't want to see criticism relegated to the bottom of the article, but that's not how I see it - I think there's plenty of space for all that, but it should be contextualised properly as something wider than simply "responses". The Cass Review fits into a large and complicated divide in opinion and perception and we can give that its due, but not by simply recounting responses one by one, and each attempt to bring something new in there simply brings about new conflict.
I think it would be more fruitful to discuss how to expand a new section with a broader remit than to continue to bloat the responses. Void if removed (talk) 11:43, 2 January 2025 (UTC)[reply]
To the extent that it's feasible, I think that most groups should be presented in summaries: Most UK politicians and doctors supported it, the gender-critical people danced in the streets, UK trans groups were appalled by the puberty blocker restrictions but liked the idea of having more than one clinic in the whole country, the parent groups distrusted anything that would require more funding, American trans groups were terrified that it would prompt even more restrictions in the US, etc.
I also think that, to the extent that it's feasible, we should be citing reliable sources that are both independent and secondary for these claims. This will probably get easier as time goes on (e.g., if we get a "one year ago today" kind of news story later this year). WhatamIdoing (talk) 12:06, 2 January 2025 (UTC)[reply]
A one paragraph intro to the "Reception" section encompassing that sort of high level summary is probably a good idea?
I still think a new "Further Commentary" section or similar would be a good place to expand with some of the other stuff. Void if removed (talk) 12:53, 2 January 2025 (UTC)[reply]
I certainly wouldn't object to an overview like that, either. I think it sorely needs it. I would also have a compressed version in the lede, since it more accurately reflects the pro/anti in broad strokes rather than the flat statement we have in the lede at present. But the former is probably a higher priority. One good outcome of that is that we may, in time, be able to remove or further condense these sections in Responses altogether. It's more important to show the broad support/opposition among groups rather than listing individual comments, but that applies to all support/opposition and needs to be done carefully. Lewisguile (talk) 17:18, 2 January 2025 (UTC)[reply]
I agree with Lewis and Friendly Sociologist. Trans people are the affected party, so we should include responses from groups established to protect their interests. HenrikHolen (talk) 14:07, 2 January 2025 (UTC)[reply]
Thanks, Henrik. Lewisguile (talk) 17:19, 2 January 2025 (UTC)[reply]
The approach taken in Wikipedia policy is to ignore our (i.e., Wikipedia editors') beliefs about who "the affected party" is, and to rely on what the published reliable sources say, with special attention to sources that are WP:SECONDARY and WP:INDEPENDENT. If the independent, secondary reliable sources don't care what Organization A says, then editors should be cautious about assuming that this article should include information from groups that nobody else thought was worth discussing. WhatamIdoing (talk) 07:31, 3 January 2025 (UTC)[reply]
We don't need a source to say the sky is blue, but luckily, there are plenty of sources which discuss the Cass Review as affecting/pertaining to trans people or subsets of trans people (such as the review itself). I don't think anyone here needs to go over the basics of reliable sources, but thanks for offering your advice. Lewisguile (talk) 11:41, 3 January 2025 (UTC)[reply]
I don't think my earlier comment was clear. I believe that there are multiple affected parties, including, but not limited to:
  • Children and teens who would have been seen at GIDS, except that it's been closed;
  • Parents seeking gender care for their kids;
  • Healthcare providers, who have to learn new referral systems and standards;
  • Gender care providers, whose jobs have disappeared, been relocated, or changed;
  • People in the UK who would not have been seen at GIDS (e.g., because they're adults) but who are affected by subsequent decisions (e.g., schools that have to update their policies); and
  • Trans people outside the UK, especially in the US, who worry what the politicians will do.
But the fact that a Wikipedia editor holds these beliefs is not important. What's important is what the reliable sources say. And for better or worse, the reliable sources don't seem to care much about what some of the small or marginal groups are saying. Therefore, the Wikipedia articles shouldn't care much either.
I think this is a straightforward case of following the sources' lead. WhatamIdoing (talk) 02:55, 4 January 2025 (UTC)[reply]

ILGA, Transgender Europe, and IGLYO Joint Statement

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The largest and oldest international LGBT watchdog ILGA, one of the largest and oldest international trans watchdogs Transgender Europe, and the largest LGBT student group IGLYO released a joint statement criticizing UK government policy and said The “Keeping Children Safe in Education 2024” guidance uses the Cass Review as an evidentiary basis for this policy change, despite its poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts. As stated by healthcare activist and feminist researcher Dr Ruth Pearce in an article titled “What’s wrong with the Cass Review? A round-up of commentary and evidence” (2024), the Cass Review “has been extensively criticised by trans community organisations, medical practitioners, plus scholars working in fields including transgender medicine, epidemiology, neuroscience, psychology, women’s studies, feminist theory, and gender studies”.

@Void if removed removed it saying this is about a government action, and it happens to mention the Cass Review in passing. This is not due, and also citing a blog?

  1. This is about a government action explicitly justified by the Cass Review, which the statement spends a paragraph critiquing
  2. They explicitly reference the blog in their statement. We aren't citing it directly, we're providing a courtesy link to who ILGA et al cited.

Today alone, you removed the fact the UK's LGBT doctors org explicitly criticized it[10], that the labour party's LGBT chapter criticized it [11], and are now removing criticism from Europe's largest LGBT rights watchdog and trans rights watchdog by claiming, somehow, a paragraph criticizing the Cass review is not relevant to the section "Reception by charities and human rights organisations". That's today alone, there are dozens of diffs of you trying to remove criticism from LGBT rights orgs, hell you even tried to remove that PATHA criticized them for whitewashing a form of conversion therapy[12].

Please self-revert. This is painfully obviously due, and your continued removal of criticisms from LGBT orgs is getting tendentious to the extreme. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:54, 2 January 2025 (UTC)[reply]

ILGA are huge and influential. If ILGA release a statement about the Cass Review, and it gets coverage in a RS, it is arguably more due than the Stonewall and Mermaids statements.
This, OTOH, is a self-published statement about a completely different matter, 9 months after the release of the final report. that happens to mention the Cass Review. It isn't a response and doesn't belong in "reception".
Now, if we had a section for wider impacts, or further coverage about related sociopolitical events, there's a case for it there, but even so, I'd hope for a secondary source that directly links this statement to the Cass Review. For example, perhaps if we had coverage of the "Keeping Children Safe in Education 2024" guidance that RS explicitly linked to the Cass Review, and a section in "wider impacts" or something that mentioned it and explained what it was, then this response to that guidance would go there.
And citing a blog is terrible sourcing.
So I would say: if this statement gets reliable secondary coverage relating it to the guidance, and there's coverage of the guidance relating it to the cass review, and we build enough to make a section relating all three things together in some sort of "wider impacts" or "subsequent events" section of this article, then it would be due. Void if removed (talk) 21:56, 2 January 2025 (UTC)[reply]
I dont understand why we cannot use advocacy group statements in attributed voice on Wikipedia in a reception section, and you just admitted that they are a giant watchdog. I also do not understand, this is clearly a large portion of info about the Cass Review and its effect on government policy. It is like arguing that a report about lung cancer criticizing cigarettes as a cause for cancer in a single paragraph is not about cigarettes and cannot be used as evidence.
The statement isn't a blog either and is part of the IGLYO website. this seems like tendetious editing. Bluethricecreamman (talk) 22:13, 2 January 2025 (UTC)[reply]
I dont understand why we cannot use advocacy group statements in attributed voice on Wikipedia in a reception section
If it were ILGA's statement upon the release of the Cass Review you'd have a point. That's not what this is, it is a statement about a different thing, months down the line.
The problem here is the longstanding resistance to expanding this article and instead turning "reception" into a coatrack, because it seems everyone wants their favourite response to be in "reception".
I would like to expand this article. I think you could make a better case for this statement as part of an expansion in a different section. It isn't "reception" because this is months down the line and a response to a completely unrelated political matter.
I think a better approach rather than continuing to bloat "reception" with ever more tenuous things is: make the case that the political matter itself is due, explain what it is and why, and then include ILGA's response to that.
The Cass Review is significant. It has had a significant impact. Now lots of subsequent matters rely on it. I think it is well past time to try to move past "reception" and into broader matters, and I would like to see the subsequent critical to and fro in that light, where they can be properly presented.
The guidance in question is here and the sole reference to Cass is:
However, the Cass review identified that caution is necessary for children questioning their gender as there remain many unknowns about the impact of social transition and children may well have wider vulnerabilities, including having complex mental health and psychosocial needs, and in some cases additional diagnoses of autism spectrum disorder and/or attention deficit hyperactivity disorder
That's literally it, and it is hardly contentious. Now if there's secondary coverage of this guidance, that makes the point it is directly the result of the Cass Review, then there's a case to be made for creating a section in "subsequent government actions" for this, and then arguably ILGA's response would be due as a response to that. I couldn't find any but I didn't look hard so be my guest. The only ones I found on a cursory search making a big deal out of it is Sex Matters, but that's nowhere near enough, it needs secondary coverage to make it notable, not just advocacy orgs taking predictably polarised positions.
The statement isn't a blog either
The edit included a citation to a blog. Void if removed (talk) 22:31, 2 January 2025 (UTC)[reply]
To be clear: this is a blog, by someone very invested in collecting every bad thing anyone said about the Cass Review all in one place. This is not a reliable source for anything, and there's no reason to cite it. Trying to justify citing it by calling it a "courtesy link" is no policy I've ever come across. As it stood, the edit inappropriately inflated the opinion of this individual blog.
We have a longstanding consensus to avoid individual responses in the "reception" section because there are so very many of them, and if we start adding them, there are a dozen higher quality ones in the queue before this one. Trying to add one like this, attached to the ILGA statement, is reopening an old argument.
So aside from the fact ILGA aren't even responding to the Cass Review I also strongly object to trying to get this extensive opinionated quote in:
They also quoted healthcare activist and feminist Dr Ruth Pearce, who collated criticisms of the review and said it "has been extensively criticised by trans community organisations, medical practitioners, plus scholars working in fields including transgender medicine, epidemiology, neuroscience, psychology, women’s studies, feminist theory, and gender studies"
Attempting this simply because ILGA cite this blog is ridiculous when we've excluded far, far more weighty and significant contemporaneous individual responses from, say, the editor-in-chief of the BMJ and surely nobody wants to have the "individual response" argument all over again. Void if removed (talk) 22:57, 2 January 2025 (UTC)[reply]
Bruh, ILGA cited them and quoted them. It was not cited for the statement, ILGA was cited quoting them. It would be silly to not provide a courtesy link. It is common practice on Wikipedia, when a source quotes and references another, to link the original.
We have a longstanding consensus to avoid individual responses in the "reception" section - Once again, it was ILGA et als response being quoted. The fact you don't like what they quoted doesn't mean they didn't quote it. If we have a source that says "BMJ editor-in-cheif said so and so", that would be different, but we don't. Apples and oranges. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:09, 2 January 2025 (UTC)[reply]
that would be different
It is not - we have dozens of sources of individuals being quoted, and we took the decision not to include any of them because it was so contentious, and it was more important to focus on what, say, WPATH thought, than what, say, David Bell thought. Once we got past the immediate and significant political and medical figures directly responsible for policy and implementation, just adding endless quotes from Doctor X saying "I think its great" and Doctor Y saying "I think its terrible" wasn't adding a lot. Void if removed (talk) 23:16, 2 January 2025 (UTC)[reply]
And here we have ILGA saying according to this collection of criticism and commentary of the Cass Review, it is xyz. Those are individual responses, this is a collation of responses that ILGA thought important enough to name, quote, and reference. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:22, 2 January 2025 (UTC)[reply]
Well, let's get some outside opinions. Would you like me to ask at WT:CITE, since this seems to be a question closer to formatting than to whether her blog contains the quote? Or do you have a different policy/guideline/noticeboard that you think would be more relevant? WhatamIdoing (talk) 23:34, 2 January 2025 (UTC)[reply]
That might help actually! Though, I did just find MOS:QUOTE saying Per the verifiability policy, direct quotations must be accompanied an inline citation which seems straightforward. Formatting and policy wise, when have source A saying X and and as B said Y, it makes sense to cite it as A said X.[A] It cited B saying Y.[A][B]Somebody should make WP:RECURSIVEQUOTES for this lol Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:55, 2 January 2025 (UTC)[reply]
WP:V only requires a single source.
I've posted it at Wikipedia talk:Citing sources#Convenience links. It took a while to figure out how to explain the situation for people who know nothing about the subject matter, but I think it will be clear enough. We'll probably get at least one response in the next 24 hours. WhatamIdoing (talk) 04:37, 3 January 2025 (UTC)[reply]
Interested to see what other people say. WP:CONVENIENCE is about alternative hosting for the same source. So, eg, a formal citation to a book, and a convenience link to an archived public domain copy. I can't see how that justifies adding a direct citation to a blog mentioned in a source. Void if removed (talk) 09:36, 3 January 2025 (UTC)[reply]
a response to a completely unrelated political matter. - How exactly is UK government policy explicitly justified by the Cass Review "Completely unrelated"?
We should expand on the anti-trans schools guidance, and note ILGA's criticisms, in the section on "Subsequent government actions in the UK". But also cover what they explicitly said about the Cass Review itself in the section on human rights orgs.
WRT That's literally it, and it is hardly contentious. - That is ridiculously contentious...
  • Almost every criticism of the Cass Review highlights the fearmongering about supposed dangers of social transition. It's a human right, not requiring any kind of "caution".
  • Almost every criticism of the Cass Review highlights referring to kids who explicitly identity as trans "gender questioning".
  • Right after the Cass quote, they recommend multiple things Cass called for, which were also heavily criticized such as 1) outing trans kids to their parents 2) telling parents to take their pre-pubertal (ie, in no need of any medical treatment) trans kids to a clinic
  • As ILGA noted, the guidance previously said trans kids should be affirmed. That was replaced with "LGB kids should be affirmed", followed immediately with However, the Cass review, which is then followed by saying Cass's recommendations about trans kids
The edit included a citation to a blog. which ILGA et al explicitly referenced and linked. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:00, 2 January 2025 (UTC)[reply]
How exactly is UK government policy explicitly justified by the Cass Review
Do you have some good secondary sourcing for that? If so, please, expand on this in "subsequent government actions", ideally under a heading like "Keeping children safe in education 2024 guidance" and add the ILGA response there.
which ILGA et al explicitly referenced and linked
So? Void if removed (talk) 23:06, 2 January 2025 (UTC)[reply]
I said How exactly is UK government policy explicitly justified by the Cass Review "Completely unrelated"?. You have no compelling arguments for why it isn't, we have a statement from multiple reliable watchdogs that it is. Also, the fact it's blindingly obvious and verifiable. The guidance changed from "affirm LGBT youth" to "affirm LGB youth, however the Cass Review said XYZ about trans kids, so do the things Cass said for trans kids",
Like I said, ILGA's response to the guidance can go into a section on education, but the response to the Cass Review should be in the normal place.
So? If we mention what ILGA said, we mention the quote they gave, and there's no good reason not to provide a link and plenty of reasons too. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:20, 2 January 2025 (UTC)[reply]
You keep saying How exactly is UK government policy explicitly justified by the Cass Review.
I'm asking you to provide secondary coverage that would justify this statement.
If it is indeed explicitly justified by the Cass Review, I would very much like to see a dedicated section explaining how, and then the ILGA statement in response, because that is what ILGA are responding to and it demonstrates, for better or worse, the wide impact of Cass on policy, and the ongoing criticism of Cass by orgs like ILGA every time that policy comes up. This would benefit the article as a whole. Void if removed (talk) 23:29, 2 January 2025 (UTC)[reply]
very clearly due and should be included. Bluethricecreamman (talk) 22:07, 2 January 2025 (UTC)[reply]
Clearly due. The source is appropriate as per WP:USESPS and WP:ABOUTSELF, since ILGA is a well-recognized expert group and because the statement concerns the source itself.
The revert was unwarranted and the content should be reintroduced. HenrikHolen (talk) 23:12, 2 January 2025 (UTC)[reply]
@Void if removed I don't have the energy for this. Consensus is against you, you aren't convincing anybody, please self-revert so this can be dropped. Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:26, 2 January 2025 (UTC)[reply]
I've started wondering (not just due to this, but this is a fine example) if Wikipedia's whole notion of sourcing is rapidly becoming outdated.
Fifteen years ago, when our Official™ Rules started calcifying, we would have said that if ILGA/this joint statement was actually important, you would know that because someone other than the self-publishers would have picked up on it. There'd be a newspaper article, or a magazine story, or some independent source we could cite. If we were lucky (and we frequently were) that source would combine several, so that we had a single source telling us which of several press releases we needed to pay attention to.
But here we are, four months later, and it sounds like nobody's picked this up. Traditionally, we'd have said that was evidence that the joint statement was not important to get mentioned on Wikipedia, as it's too easy for editors to accidentally end up with NPOV failures if we get to cherry pick which sources we personally deem important.
That said, in this case (and some others), I wonder if the problem is that our old assumptions about journalism are now unrealistic. Why would the news media write a story about this statement, when the people who want to read about it have already heard all about it on social media? WhatamIdoing (talk) 04:52, 3 January 2025 (UTC)[reply]
Here's how I'd expect something like this to be covered:
In September 2024, the UK Government released new statutory guidance for schools and colleges, titled "Keeping children safe in education 2024". This provided guidance for safeguarding in education, covering a variety of topics from physical abuse to mental health, along with escalation pathways and statutory duties for educators. The guidance contained new measures explicitly justified by the Cass Review, regarding social transition within the education environment, cautioning that schools and college should be aware of the Review's findings and guidance in this area. IGLYO, ILGA-Europe and TGEU released a statement strongly condemning the new guidance, expressly criticising its reliance on the Cass Review as an evidentiary basis.
Or something similar, expand ILGA's effusive condemnation as appropriate etc. If that could be sourced I would support that at a minimum for starters, and as I suggested, it would fit nicely under "further government actions".
The problem is that everything up until the mention of the ILGA statement has absolutely zero coverage that I can find. This guidance has been roundly ignored by the press since it came out 4 months ago, nobody has made any connection to the Cass Review outside of activist groups, and the mention of Cass in the actual document boils down to a single paragraph in a 180-page document, making the "explicitly justified" overstating things somewhat. Without the underlying guidance being notable, and without it having some relation to the Cass Review as established in a RS, there's no real grounds for incorporating ILGA's statement on this page, as if it were a direct response to the Cass Review when it is - very explicitly, from the title on down - a response to new statutory guidance and a criticism of that guidance's reliance on the Cass Review.
So I would say you could make a case that ILGA etc are big and notable enough that their self-published statement doesn't need a secondary source to establish notability, but I think you need a secondary source to establish the notability of what they're actually responding to, and that connects that government guidance to the Cass Review, so you can hang the ILGA statement off it. Otherwise we're going to be mining every activist statement that responds to every policy downstream of the Cass Review, and chucking it in "reception" pretending they're responses to Cass, when they aren't - they're responses to further events the Cass Review precipitated, which individually should be included if they're notable. Void if removed (talk) 09:18, 3 January 2025 (UTC)[reply]
I thought the source itself was fine (subject matter experts talking about themselves and not about a BLP), and it is notable. But it's probably too long where it was. I would support it going under "further govt action" as per @Void if removed. I'd suggest the following:
In September 2024, the UK Government released new statutory safeguarding guidance for schools and colleges, titled "Keeping children safe in education 2024". Among the topics covered by the guidance, it contained new measures regarding social transition within the education environment, saying that schools and colleges should follow the Cass Review in this area. International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA), international LGBTQ student organization IGLYO, and Transgender Europe released a joint statement condemning the new guidance, and criticising its reliance on the Cass Review for its "poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts".[26] Lewisguile (talk) 11:19, 3 January 2025 (UTC)[reply]
Ok, now find a good secondary source for the first two sentences to establish notability and relevance of the topic to Cass so we're not just cobbling it together from WP:OR and primary sources and I'll agree.
The best I found was:
https://www.tes.com/magazine/analysis/general/keeping-children-safe-in-education-kcsie-safeguarding-guidance
Which describes it as "only minor changes in language", stressing how inconsequential the update is, and no reference at all to Cass or social transition. Absent a better source, this seems to not be WP:DUE. Void if removed (talk) 15:41, 3 January 2025 (UTC)[reply]
I think the statement should be mentioned in the article (as it is significant), but no more than a single sentence should be needed. Also, I agree with Void that the blog should not be cited, nor is it necessary to discuss the blog post specifically. Nosferattus (talk) 07:00, 4 January 2025 (UTC)[reply]

Methodology V3.0

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Hi @13tez,

I've taken a stab at a new consensus version of Methodology, using your comments and some feedback from others. This is a new topic to avoid getting lost in a wall of text. Changes and reasons as follows:

  • Restored assessment tools but removed the Times source for why these were used per WP:MEDPOP, as it was conflating two different things (it's standard practice to assess studies in meta-analyses; that's how you know how to weight stuff).
  • Per the discussion with @WhatamIdoing, I reworded the sentence about limitations/scope so it hopefully doesn't read as criticism (we all seemed agreed that it wasn't). Now it is more focused on what the review did do, not on what it didn't. E.g., it says it "examined English-language studies of minors" rather than "it excluded non-English studies", etc. I have added an endnote after "minors" to clarify that the systematic reviews looked at ages <=18, while the qualitative review included people up to 30 to speak about their prior experiences. This is important, I think, because there has been some confusion about whether the report covers people aged 19–25 and whether the evidence reviews can be extended to this age range or older. But as an endnote, it's out of sight. Another possibility would be to replace "minors" with "participants up to 18 years old" to be absolutely clear in the body text, but that felt too long.
  • I have merged the MMAT and NOS info into the bit about confidence ratings, so that we haven't removed @Your Friendly Neighborhood Socialist's additions but now they're more explicitly relevant. (An alternative would be to use some of the Yale comments about use of these tools instead, but that feels like a whole other can of worms.
  • For the evidence base, I used Cass and the BMJ as sources for "assist" and "supplemented", rearranging the order a bit as per those sources. Because the "engagement programme" is explicitly supplementary, I've put that at the end, as it was in my prior edit and yours. Because the qualitative/quantitative research is described as supplementary and part of the research programme in the BMJ overview, I have put that with the York stuff, but have marked it as supplementary in the text. As I understand it, York wasn't involved in the focus groups, etc, so this also clearly delineates the research programme from the engagement programme. (I can see the latter were performed by market research types.)
  • I have updated the BSN note to better reflect where that conversation left off, although I still think there was generally consensus that the source itself is high quality (regardless of whether one thinks it's exactly equal to Cass or not) and that the approach taken by Cass for her own conclusions and recommendations is a narrative one (a narrative review can use systematic reviews as well). Personally, I would remove that tag, but didn't want to without confirming you were satisfied first.
  • The agreed upon endnotes should all still be intact as well. @Snokalok, did I get yours in here too?

I think that should cover most of our concerns. I'm sure there are still bits we both think should/shouldn't be there, but I feel happy with this level of compromise. Is it okay with you?Lewisguile (talk) 10:52, 3 January 2025 (UTC)[reply]

I don't think this though certainty-of-evidence ratings were not provided for individual outcomes makes sense in isolation. What's happening here is that the RAND report took one approach, and the York reviews took another. The RAND report simply lists the differences in approach, so saying what the York reviews did not do in this way is misleading. It is like York cycled to work, Rand drove to work, and so we say in wikivoice "York did not drive to work". I think far too much is being made of this fleeting comparison. Also, again, that opening sentence - the Cass Review was a process, that ended up producing two reports, only the first of which this document describes as a "narrative review". Describing the process as a "narrative review" doesn't make sense, and in any event the only thing this source can plausibly be used to describe as a "narrative review" is the interim report, so this claim as presented is unsupported by the source. Void if removed (talk) 11:35, 3 January 2025 (UTC)[reply]
Re: process versus review: The problem is that we can cite a review but we can't cite an intangible "process". Even if that process is outlined in a document, it's the document we're referencing. However, we could change the wording to clarify that we're talking about the reports/conclusions and recommendations themselves, such as: The Cass Review's final conclusions and recommendations were published in a non-peer-reviewed narrative review, which synthesised evidence from multiple sources to make policy recommendations for services offered to transgender and gender-expansive youth in the NHS...? But that seems more complicated.
Re: certainty of outcomes: it's relevant to know that confidence ratings weren't published for individual outcomes. Confidence ratings aren't necessarily interchangeable with quality ratings, but also, if you want to know specific confidence ratings for particular/individual outcomes in different studies, rather than the quality rating of studies as a whole, these SRs won't provide that information. That is a significant difference from most systematic reviews conducted by NICE, the WHO, and others, and is a notable limitation (though that doesn't mean it's necessarily a criticism either). GRADE, which is the international standard for systematic reviews (rather than the MATT and NOS), does provide this data because confidence ratings can vary between different outcomes in a single study, as well as between studies. This then allows you to pool outcomes across different studies, while properly weighting it. The Cass Review doesn't do that, even though it's an international standard, so that should be noted. Lewisguile (talk) 12:30, 3 January 2025 (UTC)[reply]
Even if that process is outlined in a document, it's the document we're referencing.
No, the "methodology" section refers to the review as a whole. This is the process by which a series of systematic reviews were commissioned, stakeholder involvement took place, and two reports were produced.
This page is about The Cass Review, and the final report of The Cass Review has its own dedicated section within it. This is the wrong place for this information, even if were correct or due.
When you cite "The Cass Review", what you're citing is the final report of the Cass Review. See all the citations on the page to "Cass review final report 2024". Describing the process by which that final report was produced as a "narrative review" makes no sense whatsoever.
The Cass Review's final conclusions and recommendations were published in a non-peer-reviewed
We can't say that because it isn't true and it isn't sourced.
Put it another way - WPATH's SOC8 is not a "narrative review" - it is a set of guidelines and best practices. However, within it, Chapter 6 (Adolescents) contains a narrative review.
a systematic review regarding outcomes of treatment in adolescents is not possible. A short narrative review is provided instead.
If someone were to refer to the evidence on adolescent treatment in SOC8, they might accurately describe it as a narrative review but it would be an inaccurate description of SOC8 as a whole.
In the RAND document, they describe the interim report of the Cass Review on the topic of "Gender dysphoria treatments" as a "narrative review". That might be true. Therefore, with this source, you could say that the Interim report of the Cass Review contains a narrative review of gender dysphoria treatments.
But that is not everything contained in the interim report, and to describe the whole document as a "narrative review" is as wrong as calling the WPATH SOC8 a "narrative review", and neither of which are as wrong as calling a 4-year independent service review a "narrative review".
This is all a very unnecessary series of hoops to jump through to justify an inappropriate label. I simply don't understand why so much energy is spent on trying to wrongly describe an independent service review as a narrative review. Void if removed (talk) 15:16, 3 January 2025 (UTC)[reply]
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  2. ^ a b c Thornton, Jacqui (April 2024). "Cass Review calls for reformed gender identity services". The Lancet (News). 403 (10436): 1529. doi:10.1016/S0140-6736(24)00808-0. PMID 38643770. Cass commissioned four systematic reviews of the evidence on key issues...
  3. ^ a b c Cass review final report 2024, p. 28.
  4. ^ a b Cass review final report 2024, pp. 52–53.
  5. ^ a b Cass review final report 2024, p. 60.
  6. ^ a b Cass review final report 2024, p. 56.
  7. ^ a b Cass review final report 2024, p. 8, Appendix 2.
  8. ^ "Homepage | Archives of Disease in Childhood". Archives of Disease in Childhood. Archived from the original on 19 December 2024. Retrieved 19 December 2024.
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  13. ^ a b Heathcote, Claire; Mitchell, Alex; Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth; Jarvis, Stuart William (9 April 2024). "Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s19 – s32. doi:10.1136/archdischild-2023-326347. PMID 38594045. Archived from the original on 23 April 2024. Retrieved 23 April 2024.
  14. ^ a b Taylor, Jo; Mitchell, Alex; Hall, Ruth; Heathcote, Claire; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s33 – s47. doi:10.1136/archdischild-2023-326669. ISSN 0003-9888. PMID 38594047. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
  15. ^ a b Taylor, Jo; Mitchell, Alex; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s48 – s56. doi:10.1136/archdischild-2023-326670. ISSN 0003-9888. PMID 38594053. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
  16. ^ a b Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Care pathways of children and adolescents referred to specialist gender services: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s57 – s64. doi:10.1136/archdischild-2023-326760. PMID 38594052. Archived from the original on 28 April 2024. Retrieved 28 April 2024.
  17. ^ a b Taylor, J; Hall, R; Heathcote, C; Hewitt, CE; Langton, T; Fraser, L (9 April 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)". Archives of Disease in Childhood (Review). 109 (Suppl 2): s65 – s72. doi:10.1136/archdischild-2023-326499. PMID 38594049. Archived from the original on 2 August 2024. Retrieved 13 April 2024.
  18. ^ a b Taylor, J; Hall, R; Heathcote, C; Hewitt, CE; Langton, T; Fraser, L (9 April 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)". Archives of Disease in Childhood (Review). 109 (Suppl 2): s73 – s82. doi:10.1136/archdischild-2023-326500. PMID 38594048. Archived from the original on 29 June 2024. Retrieved 13 April 2024.
  19. ^ Cass review final report 2024, p. 161.
  20. ^ Cass review final report 2024, pp. 2, 3, Appendix 2.
  21. ^ James, Beal (26 April 2024). "Cass author condemns 'misinformation' spread by trans lawyer". The Times (News). Archived from the original on 2024-04-22. Retrieved 26 April 2024. During a systematic review, researchers looking at studies on transgender healthcare found no blind control ones — so used another system altogether to determine study quality.
  22. ^ Cass review final report 2024, p. 243.
  23. ^ a b Cite error: The named reference bbc-cass-misinfo was invoked but never defined (see the help page).
  24. ^ Cass, Hilary (2024-09-06). "Gender identity services for children and young people: navigating uncertainty through communication, collaboration and care". The British Journal of Psychiatry. 225 (2): 302–304. doi:10.1192/bjp.2024.162. ISSN 0007-1250.
  25. ^ "Homepage | Archives of Disease in Childhood". Archives of Disease in Childhood. Archived from the original on 19 December 2024. Retrieved 19 December 2024.
  26. ^ "Joint statement: Trans children and young people in schools deserve safety and understanding". ILGA Europe. September 2, 2024. Retrieved 2025-01-02.


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