62-year-old Cisgender Man Declares Hilary Cass Empathetic
David Brooks is not qualified to judge this, or anything else, about transgender healthcare.
Opinion, by Evan Urquhart
Before we begin, it needs to be stipulated that David Brooks doesn’t know anything about transgender healthcare. Brooks began his Thursday Opinion column for the New York Times with the sentence, “Hilary Cass is the kind of hero the world needs today,” but he has never before written about transgender healthcare. The Cass Review that impressed Brooks so much took four years examining transgender youth healthcare in England, then threw up its hands claiming there just wasn’t enough evidence to say anything. This conclusion contradicted the long-held opinions of every major medical organization in the US, but rather than questioning whether that might bear looking into Brooks has blindly accepted Hilary Cass’ conclusions at face value.
It is hard to blame him. Brooks knows nothing about this subject, and the Cass Report screams authority. From its ever so careful language, to its sober conclusion that no conclusions could possibly be reached, from its four year time span to its having the imprimatur of England’s National Health Service (under a far-right Tory government), everything about the Cass Report telegraphs seriousness, care, and consideration. It is like the New York Times itself in this, with so many trappings of mainstream respectability that to question either of them is to become Don Quixote, mad, ridiculous, tilting at windmills.
I don’t want to imply that Brooks did not read the 388-page Cass Report, but I will gently suggest that he is a very busy and very important figure, and it is 388 pages. Those who do read it will recognize that, while sections advocating to limit access to gender-affirming healthcare are very concerned with making sure that the evidence is of the highest possibly quality, the Report makes a ton of unsourced claims and wild speculations. For example, it speculates wildly about the causes of transgender identity, the reasons more youth have presented at gender clinics, the possibility that non-standard treatments with no evidence base might be effective, and the likelihood that detransition is more common than the evidence warrants. For full readers of the Report it’s hard to escape the conclusion that extremely high standards for evidence applied just to one area of the Report, the part that advocated for limiting access to youth healthcare.
But Brooks doesn’t mention this. Brooks was convinced by the Report or, more likely, by the very serious tone and trappings of the Report’s rollout.
Having been impressed by the conclusions of Report, Brooks turns to praising its author for her empathy.
screenshot from the New York Times
According to a wealthy 62-year-old white man who has been a conservative commentator all his life, Hilary Cass’ great strength is the empathy she has for the children she’s recommended have greatly reduced access to treatment for their gender dysphoria. “She realizes that this conclusion will not please many of the young people she has come to know,” Brooks writes, “but this is where the evidence has taken her.”
In contrast, Brooks negatively describes “practitioners who refused to cooperate and thus denied her information that could have helped inform her report.” Here, he’s referencing the fact that adult gender clinics raised privacy concerns about the Cass Review’s request to turn over patients’ records without the patients’ permission. Cass’ supposed empathy was never extended to patients who might not want their data shared, and the possibility that the providers who protected their patients’ privacy might have more empathy than the person requesting they trample it is not one Brooks considers.
What’s going on, here? Brooks uses the word empathy, but it’s not empathy that he means, not really. What Brooks and all the davidbrooksian people in this discussion mean is that the Cass report used polite language for its transphobia. Cass did not openly say that trans youth were mentally ill, didn’t know what was good for them, and should be forcibly prevented from transitioning by any means necessary because the fewer trans people the better, she implied it. That’s not empathy. That’s empty decorum.
Even in the language of the report, empty as it is, Cass can’t truly be said to have shown empathy, but only decorum. The Report repeatedly misgenders trans youth, particularly trans boys and transmascs, by describing them as their birth-assigned sex and using “teenage girls” as their appropriate comparator. A Report on trans youth that had any empathy whatsoever wouldn’t do this. Cass’ empty show of concern, which is primarily a concern that some youth might transition when perhaps somehow they might have been convinced not to, bears no resemblance to true empathy.
True empathy requires the ability to put yourself in the position of another person. Neither Cass nor Brooks seek to put themselves in the position of a youth who has suffered with untreated gender dysphoria on a waiting list for five years, with the irreversible effects of puberty worsening their distress, only to be told that the treatment they’ve been waiting for has only moderate quality evidence, so it’s best just to forget about treatment.
The trick of the Cass Report has been to convince people that moderate evidence in favor of treating gender dysphoria somehow provides a rationale for withholding that treatment and just giving talk therapy. For any other condition, from a headache to a broken leg to anorexia nervosa, this would be laughable. The idea that patients whose treatments lack high quality evidence should be given treatments with no evidence base at all is completely unreasonable. In any normal situation it would be clear that the moderate evidence treatments should remain the mainstream approach while further evidence is gathered.
Transgender medical care is not treated as normal medicine because transgender people are a highly stigmatized minority. This allows the mainstream to treat something as common sense as the idea that a medical treatment with moderate evidence is better than leaving a condition untreated as preposterous without realizing they’ve done it. The Cass Report is the apotheosis of this impulse, a 388-page defense of the idea that the possibility that there might be some way to convert trans youth into cis adults should outweigh the evidence that hormone therapy improves trans youth’s mental wellbeing.
Brooks didn’t know this. How could he? He was completely ignorant of gender-affirming care and its evidence. All he knows is that, in an increasingly contentious debate over trans issues, the Cass Report has made him feel comfortable. As Brooks sinks into the comfortable fantasy of there being fewer trans people around to be angry at being denied treatment he reaches for a word to describe his biases having been catered to… and comes up with “empathy.”
Evan Urquhart is the founder of Assigned Media and an incoming member of the 2024-2025 Knight Science Journalism fellowship class at MIT.