Gender Identity

Jesse Singal: Should Kids Medically Transition?

Jesse Singal questions the science of "gender-affirming care."


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Should kids medically transition between genders?

The number of kids diagnosed with gender dysphoria has surged in recent years. In America, diagnoses have almost tripled from about 15,000 to more than 42,000 from 2017 to 2021. In the United Kingdom, the number of minors referred to the national Gender Identity Development Service grew from 51 in 2009 to 1,766 by 2016, leading to yearslong waitlists for care within the government-run health system.

This surge caused England's National Health Service to commission an extensive study of youth gender treatment. That study is known as the Cass Review, and its results dropped on April 10. The review's author, former head of the Royal College of Paediatrics and Child Health Hilary Cass, concluded that modern youth gender dysphoria interventions are informed by "remarkably weak evidence" drawing on studies "exaggerated by people on all sides of the debate to support their viewpoint" and that "we have no good evidence on the long-term outcomes of interventions to manage gender-related distress." The science, it turns out, is not settled—or anywhere close to it.

NHS England opted to stop routine prescriptions of puberty blockers following the review's publication, as have NHS Scotland and the Welsh government. Major American medical groups such as the American Psychiatric Association, American Medical Association, and American Academy of Pediatrics, all of which endorse prescribing puberty blockers for gender-dysphoric kids, have yet to officially respond.

American media coverage of the Cass Review, which could throw the entire youth gender treatment paradigm in this country into question, has been remarkably muted. But today's guest is never muted. Jesse Singal has been covering this topic—and taken a lot of heat for it—for years in the pages of publications such as The Atlantic, The Dispatch, and on his Substack, Singal-Minded.

Watch the full conversation on Reason's YouTube channel or the Just Asking Questions podcast feed on AppleSpotify, or your preferred podcatcher.

Sources referenced in this conversation:

  1. The Cass Review
  2. "Putting numbers on the rise in children seeking gender care"
  3. "What Went Wrong at the Tavistock Clinic for Trans Teenagers?" | SEGM
  4. "Hilary Cass: I can't travel on public transport after gender report"
  5. "Mermaids' response to The Cass Review—In Depth"
  6. States with legislation to curb "gender-affirming care"
  7. M.P. Dawn Butler admits to misrepresenting the Cass Review

Sources referenced in Just Ask Us Questions:

  1. Reason TV: "A private libertarian city in Honduras"
  2. Reason TV: "Don't 'Abolish the Police.' Privatize Them."


  • 00:00 Introduction to the Show and Topic: Kids and Gender Transition
  • 02:14 Media Coverage and Jesse Singal's Insights
  • 04:50 The Impact of Social Media and Activism on Youth Gender Medicine
  • 09:36 Exploring the Tavistock Controversy and Its Implications
  • 12:38 The Debate on Informed Consent and Medical Ethics
  • 28:37 Social Contagion Theory and Its Effects on Gender Identity
  • 34:03 Scrutinizing the Science Behind Gender-Affirming Treatments
  • 42:32 Navigating the Complexities of Youth Gender Medicine
  • 43:03 The Role of Data and Evidence in Gender Transition Debates
  • 44:34 The Impact of Politics and Misinformation on Transgender Health Care
  • 47:34 Exploring the Cass Review's Recommendations on Gender Medicine
  • 49:24 Comparing Gender Medicine Practices: U.K. vs. USA
  • 51:25 The Influence of Activism and Politics on Medical Standards
  • 55:16 Addressing the Concerns Around Puberty Blockers and Hormone Treatments
  • 01:20:32 Just Ask Us Questions: A Discussion of Anarcho-Capitalist Security