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eddies-house · 11 months

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Cheese Dust

Bus Driver!Eddie x Teacher!Reader

8.2K Words

A/N - I saw this post and had to do something with it so here it is 🥴 also, somewhat proofread but not fully, lmk what y'all think

Masterlist

High pitched childish screams and laughter filled the hallways decorated in various school projects, some with copious amounts of glitter and others with feathers hanging on by a thread of dried hot glue. The beginning of the school year was always tiresome yet exciting, new groups of personalities filled your classroom abundantly. In the past few weeks you’d identified the students who would give you a difficult time, those who would participate willingly, and those who were shy and would take a minute to come out of their shell. Each one was welcome with open arms in your book, teaching was something you’d wanted to do for the sake of kids who didn’t have such great school experiences. Your mission was to turn that around and make school a place where your students would look forward to coming every day, a safe space where they would never have to fear being judged for not knowing as much as some of their peers. Not having the best luck with teachers and your academic life yourself, it was your priority to at least be the voice of the slightest bit of change. Even if you were the only one trying and every other teacher in the school saw you as weird.

Summer was ending and Fall was on the cusp of taking over, a slight breeze blew in through the metal doors into the building as students rushed out, hurrying home. Your dress would’ve gone up with the breeze had it not been for your hands tugging at the bottom in a quick move to save your dignity. Being known as the teacher that’s flashed everyone would be your nightmare especially since your coworkers already had some kind of disdain for you. Maybe it was because you were younger? All of them were over forty, the majority being older than fifty. Being in your twenties may leave them with a sour taste in their mouth, a side effect of being old and bitter towards the youth of America. The exact problem you were trying to combat as a teacher yourself since all you had experienced throughout school were old as hell teachers who had no patience for children or teens. Why they chose a profession working with them, you’ll never understand.

Keys clutched in between your fingers, you exited through the heavy door, the sudden wind taking your breath away momentarily before you basked in the lovely afternoon sun you had yet to become acquainted with all day, being lodged in your classroom for eight hours save for the fifteen minutes of recess. But even then you were condemned to the shade at the picnic tables near the building to finish grading a few assignments, not being able to enjoy the warmth of the sun against your skin. Eyes squinting at the brightness, you held a hand above your eyebrows to provide your retinas with some relief although your body thanked you for the vitamin D.

It was your first day of bus duty, the rotation was still being figured out the past few weeks but they seemed to have sorted it out which meant it was your turn. Strolling over to the bus loop, giant yellow school buses lined up around it, you stationed yourself toward the very end where no other teachers seemed to be. Three of them were chatting in the middle of the sidewalk, paying no mind to the students sprinting around them to get to their designated bus. Catching a glimpse of you at the end of the loop, they sneered, one of them, an older gentleman with a greasy brown combover peppered with gray, a mustache, and very beady blue eyes obviously gesturing toward you, not ashamed to let you see. Your gaze shifted toward a crack in the pavement, humiliation flushing through your body. You shouldn’t give him the satisfaction, you know, but there’s something so sinister about singling someone out and finding joy in making them feel so small.

Letting a puff of air out of your cheeks, you fumble with your keys in between your fingers, twirling them around while you shuffle your feet back and forth, avoiding the stares of your colleagues. “What the fuck is their problem?” a voice, smooth with a tinge of rasp, speaks. Tilting your head up ever so slightly toward the bus in which the voice originated from, a man with brunette curls, wild and a bit frizzy lazily walks down the bus steps and places himself next to you, eyeing the individuals in which he was referring to. His torso is adorned in some kind of a band shirt underneath a denim vest littered with patches and pins, the back displaying ‘DIO’ from what you can see as he stands beside you. He wears some ripped up black jeans with a chain dangling at his side, finished off with a handcuff belt buckle. In one of his back pockets is a bandana and in the other is what you can assume to be his neon vest that all bus drivers were supposed to be wearing. At his words you only shake your head, staring back at the ground. The mysterious guy points his finger, his hand showing off three chunky rings, pointing at your coworker who had humiliated you seconds ago. “He looks like a perv. He even allowed this close to the school?” The older teacher catches the guy pointing at him, snarling his way, his fellow bullies, two other middle aged women sporting the same disgust. At this you can’t suppress your laugh, your hand coming to cover your mouth to hide your joy.

Kids ignore every adult’s presence as they hurry onto the buses, some running past you at lightning speed, no doubt hoping to score the very back seat that everyone fights over. The man next to you has no shame in calling out the foul behavior of your coworkers. “What’re you lookin’ at porn stache?” he shouts through cupped hands. A playful shove is given by you and you catch a sparkle in his huge brown eyes, forcing you to linger your gaze on them a little longer as the molten chocolate buttons encompass you. You don’t even notice the way ‘porn stache’ clutches his chest in astonishment. “Stop!” you whisper, embarrassed but satisfied. A gentle smirk rests on his pink lips as he turns his attention to you. “What? I call it like I see it.” he crosses his arms over his chest, leaning against the bus and crossing his ankles. A student approaches the bus, her dress is blue and she sports a high ponytail in her dark hair, scrunchy matching, bangs ruffled from the school day. She looks too old to be in elementary school so you conclude that she must be a middle schooler as Hawkins Middle shared the bus loop with Hawkins Elementary. “Sinclair.” The bus driver’s dimples are on full display as he greets her. Her eyes roll while she begins stepping onto the bus. “I don’t know you at school, remember?” She scolds him. “Yes ma'am.” He puts on a southern drawl, snapping his fingers before pointing at her as she makes her way onto the bus.

You’re in awe of him, he’s so care free and different from everyone else. So effortlessly himself and you don’t even know him. “Listen, if that guy ever gives you a hard time, say the word and I’ll give him something to be embarrassed about.” His chin tilts toward the still chattering teachers. “Them too.” He points out the other two women. You’d never learned their names come to think of it, you were on your own island within the school. “Oh, that’s not necessary.” Waving him off, your fingers toy with a loose thread at the end of your dress. “I’m used to it.” You tell him truthfully. A nod is offered as he contemplates his next words, biting into his lip thoughtfully. “Shouldn’t have to be.” The words are simple yet reasonable. You dodge them anyway. “Sorry, what was your name?” Attempting to change the subject, you remember to pay attention to your surroundings as your sole job was bus duty which entailed making sure students got on the buses safely and no one was left behind. “Eddie” He answers as he checks his watch, the last thing he wanted was to be late. A single pissed off parent and he’d be written up. One write up for him actually meant getting fired due to his reputation.

Your posture straightens, a way to appear more professional and authoritative not just among the students but mainly the other teachers that thought less of you. A girl could try but ultimately your aura was more welcoming than intimidating which only gave them more ammo more often than not. “Are you not going to give me yours?” Eddie asks with a raised brow. Now you were distracted between talking to this random bus driver and trying to prove that your colleagues didn’t get to you. Glancing across the bus loop at them, you give him your name although you’re only halfway involved in the conversation now. “Why do you give them the time of day?” His sudden inquiry catches you off guard, your focus darting to the metal head leaning his weight against the bus, eyes squinting in the sun. Who was this guy? You weren’t sure how to process him, his edgy looks and his attitude were something you’d never been faced with before, coming from another small town yourself.

Hawkins became your new home when the district transferred you a year ago for a higher salary to replace one of their teachers who had retired. You couldn’t refuse since you were basically being paid crumbs at that point. In the past year, you’d never come across him despite the population being so small, it only made you more curious. “Excuse me?” You answer, a hint of offense laced in your tone. This so-called Eddie guy pushes his weight off of the bus and straightens out, lengthy legs stepping closer to you. “I’m just saying, if you stop caring what they think you’ll be untouchable. It’s kinda my thing.” His hand motions in front of him as if presenting himself to you. Opting to ignore his advice, you continue involuntarily keeping your peripherals on the snobby teachers. “Not really an option.” You mumble, pulling at a hangnail anxiously. A scoff escapes Eddie, his tattooed arms coming to cross over his chest again as he stands in your view of the other teachers, forcing you to look into his large coffee colored eyes. “It’s the only option. Otherwise you’ll go insane. Trust me, I would know.” There’s a detection of sympathy within his features, eyebrows slightly knitting together and a barely there frown.

The hint of confusion on your face indicates to him that you have no idea who he is or what his status among the Hawkins social ladder is. And he doesn’t have the faintest concept of yours either though if he were to gauge it off of your physical appearance he would conclude that you had a doting husband at home, were more than likely settled in Loch Nora with a nice two story home and a pristine lawn, belonged to the local country club, and all in all, were too good to even be talking to him. In fact, he couldn’t comprehend why you hadn’t told him off yet until your features communicated to him that you were oblivious to the hierarchy that plagued Hawkins. Before you can provide a response he’s piping up again. “How long have you been in Hawkins? If you don’t mind me asking.” He asks the question as if he’s trying to put a puzzle together. Looking him up and down, you decide that you don’t want to give up the information seeing as you’d just met the guy and there was no way to know of his intentions. “I’m sorry, why is that any of your business?” Your tone is standoffish. Buses began to let off that puff of air you hear when you know they’re about to leave, Eddie glancing around as he steps closer to his bus. Shaking his head, curls dancing along with the motion, he apologizes. “No-I-I didn’t. I’m sorry, it's just—I’ve never seen you before and you don’t seem to know–who I am?” He ends his sentence with a sigh, eyes closing in defeat. Now he just sounds like an asshole, berating you because you don’t know him but the truth behind it is the exact opposite of what it looks like and what you think. Eyes widening at him as if to say how dare you?, you begin taking a few steps back. “Oh, did I miss the memo or something? I’m sorry, I must have skipped over you on the brochure.” You sarcastically chide. He’s frantically waving his hands in front of him, face burning bright red as he tries to undo the interaction. “No, no, no. That’s not what I mean!” Eyes bulging out of his skull, he glances behind him into the bus then to his watch. “Fuck!” He whispers under his breath. “Okay–I really need to get these kids home but–” Looking less than impressed, you cut him off mid sentence. “Uh huh. You don’t need to make an excuse, just go.” You offer through clenched teeth. With one last groan, he rushes up the bus steps, boots stomping behind him as he quickly shuts the door. Through the open bus windows you hear him shout “Alright, sit the hell down or you might end up in the windshield!” If you had any friends, there was no way to rationally explain what just occurred to them.

–

Your work life and home life remained the same, bland. It was hard to make friends in your twenties as a teacher in a town that was densely populated with older folks. When you did attempt to go out and meet people your age, they really paid you no mind, already set in their ways with no incentive for a change. Lonely was the best way to describe how you felt. Neglected by those around you who you’d attempted to at least mingle with but no one would bite. It was a tedious game of trying to appear more confident than you were at work and appearing nonchalant outside of work in hopes to attract some friends. A hopeless back and forth that left you starving for attention, the kind of attention that was gratifying and that went both ways.

Your students were of course the light of your life and each one of them brought an undeniable warmth into the shadows of your existence. There was only so much that could provide to you though, they were all eleven and it probably wasn’t healthy to have the only positive attention in your life come from kids. Kids that weren’t even yours nonetheless. They loved you, absolutely loved you. Each morning a majority of them would squeeze you in a hug or at least ask for a high five. It was fulfilling to know that at least your mission in making the school system the tiniest bit better was playing out. The class was always excited to come in and learn, something that should automatically just be a given but unfortunately wasn’t in the grand scheme of things since the entire system was broken. At least you could sleep peacefully with the knowledge that your students appreciated you the same way you appreciate them.

As the next week came to an end, you were elected for bus duty again, clutching your keys in your palm as always and leisurely making your way out to the front of the school. The kids were extra excited since you’d begun a unit on plants and organisms. They each got to take home a clay pot with a seed they planted and watered in class. Over the weekend they were instructed to leave it in sunlight and talk to it about anything under the sun so that it would have encouragement to grow. You’d let them know that plants that had a friend to talk to were more likely to grow bigger and stronger than plants that had no one at all. When little Samantha asked if she could decorate her pot, you were elated and urged the rest of your class to also do something creative and told them that you would all do a little showcase on Monday. Now each of your students were quickly but carefully making their way out of the front of the school while carrying their soon to be plants, huge grins plastered on their faces.

Heading toward your selected spot for bus duty, away from the rest of the grumpy teachers, you stood alone and took in each child that passed. Each had an insane amount of energy, a buzz from the idea of the weekend just starting. You’d come to learn that the older teacher just across the way from you, ‘porn stache’ was actually named Mr. Wilson at a recent staff meeting. His reputation among students was less than satisfactory, they even go as far as saying he’s the worst teacher in the entire school. The other two women you were still unsure of but you figured you’d get an impression sooner than later. You would think that since you’ve worked at the school since last year, you would have been enlightened, however you remember how hostile the environment is and it makes sense.

Bus number eighty six pulls up in front of you, the exhaust letting out air as it breaks. A couple of students waiting nearby eagerly now stand in front of the bus door before it opens. Once it does, they’re racing to the back of the bus, screeching at each other and shoving one another playfully. Down the steps, clunky black combat boots step one at a time before big doe eyes meet your gaze. You’d forgotten that his bus would probably occupy the same parking space next to the curb so really it was your fault that you were met with him again. As his eyes land on you, he’s retreating back into the bus and slumping into his driver seat once again. Avoidance. Who were you to care though? The guy had some kind of an ego, saying you didn’t know who he was. Who did he even think he was? Some kind of king of Hawkins? You’d never even heard of him a day in your life and he was a bus driver for crying out loud. Not that there was anything wrong with the job but there was no need for him to be on his high horse.

The sudden chirp of one of your students, Jill, caught your attention as she ran up to you with a few of her friends, one being from your class, a boy named Harry and the other kids you didn’t recognize which meant they were from another class. She explained to you how excited she was for the new unit on plants, her own pot held in between her small hands. Jill goes on and on telling you about how no other teacher has ever done something like this, at least in all the years leading up to fifth grade. Harry chimes in to say that he can’t wait to come into class on Monday to see how everyone decorates their own pots. Your heart feels gooey, the fact that your students are comfortable with telling you that they’re actually looking forward to coming back to school is the biggest reward in your eyes. The way they banter and joke with you has the other teachers scowling your way, Mr. Wilson included. Instead of paying any mind to them, you continue to focus all of your energy on your students as they so deserve. You learn about Jill’s new puppy her dad surprised her with and you request that she brings in a picture as soon as she’s able to, enthusiasm dripping from your voice. Another student that isn’t in your class speaks up saying “I wish you were my teacher!” with a whine. At this you offer a small smile. “Well, I’m sure your teacher is just amazing!” You respond graciously. They all grumble in disagreement.

From his driver’s seat, taking in the scene of you on the sidewalk with your students, Eddie can’t fight the slightest upturn of his lips while you interact with them so sweetly. At the moment he only wishes he had someone like you when he was that age. Instead he was always met with harsh threats of being kicked out and sent to juvie for things that weren’t even worth that kind of punishment. His teachers couldn’t give less of a shit about him, he even believed they would hold him back just to cause him embarrassment and not cause he failed his classes. If that were the case, summer school should’ve been offered to him to up his grades but it never was. When his Uncle asked about summer school being an option for him back in middle school, the school administration simply told him they were full.

Eddie hated teachers with every fiber of his being and he had reason to, each one he ever had was always ready to set him up for failure and kick him to the curb. He was only a kid and the adults who were in charge of teaching him and helping him only caused more mental abuse in addition to the physical and emotional abuse he experienced at home before moving in with his Uncle. But he got over it and it made him hopeful that you seemed to treat the kids well and indulge in their child-like behaviors rather than disciplining them every time they raised their voice a bit higher than necessary. You seemed genuine in your facial expressions and the way you would make sure each child received equal attention from you as they put their two cents into the conversation.

Your smile faded as a fed up Mr. Wilson approached you and the students, his face feigning irritability as he cleared his throat, breaking up the fun you were having. The way you shrunk down on yourself had Eddie leaning forward in his seat to catch every detail of the dispute he knew was about to happen. Mr. Wilson addressed you by your name sternly before completing his thought. “You must know that our students need to get home in a timely manner, we can’t have you holding them up with all the chit chat.” The condescending voice of an older out of touch man has you internally cringing. He talked to you as if you were stupid, as if you were some little girl he didn’t deem worthy of his time and that he could simply get rid of with a snap of his fingers. Your students scurry off, frightened and you scold yourself for stuttering in your response. “M-Mr. Wilson we have plenty of time still. Bus duty doesn’t end until everyone is on the buses and as you can see, we still have a lot of kids left.” You point out the groups of students still littering the front of the school. “And it’s Friday. They’re just excited and I think it’s my job as their teacher to let them express that!” You defend yourself, voice still somewhat shaky which you could just kick yourself for but nonetheless you are standing your ground. A scoff is earned from the old man before he begins reprimanding you again. “I think it’d be wise for you to listen to those with more experience than you. As a man, I think it's my job to keep our ladies in line.” He spits, the words hitting you in the face. Eddie, still watching from his spot, determines whether he should step in or not. On one hand he could tell the guy off however he feels that would go against the whole point since he would also be a man stepping in. On another hand, gender doesn’t even matter, he’s always had it out for that motherfucker from the day he confronted him about not wearing his neon vest and expressed his distaste for his tattoos while also bringing up that he was living up to that Munson name. He should’ve punched him right there but thought better of it seeing as it would only add to the things people could say about him.

Formulating a reply in your mind, you attempt to physically appear unbothered even though emotionally you could never understand the thought process of a man under the influence of a power trip. “I think it's none of your business what I do, personally, Mr. Wilson. Have a great weekend.” You dismiss him as he would you, turning to face the buses in front of you and pretending he no longer existed. An attempt is made by him to pursue the argument however you ignore him and start slowly pacing around as if on patrol while waving to a few students. He gives up, staring at you like you had just murdered his family and then eventually making his way back to his clique of older teachers.

For a brief second you glance over to ensure he’s gone when a smirk appears on your face at your small victory. That’s when a familiar voice graces your ears. “That was metal as fuck.” Eddie. He’s no longer afraid to step out of his bus, maneuvering around a student he nearly ran over accidentally before moving aside and bowing as he gestures to the door dramatically for them to enter. Standing in front of you, he has a grin on his face. You shrug at his praise, offering no words. “No, seriously. Next time you shouldn’t hold back, just fully let ‘em have it.” A slight joke to lighten the mood as he punches the air with his fist but he means it. You breathe out a laugh as you stare at the weeds growing in the cracks of the sidewalk. “If I don’t hold back he could probably get me fired. I bet he’s even trying to find a way to have me fired for what I just said to him but it won’t really hold up since I was nice.” A frown makes its way across his soft features, his boot crunching a pebble beneath it as he thinks. “Welp. I’m in your corner. Don’t know how much good that’ll do you but I’ve hated that motherfucker since the day I met him.” He flashes you a smile while blinking his dark lashes at you. You hum in appreciation. “Even though I don’t know who you are?” You mock his words from last week, trying to hide the smile that's tugging at your lips. A look of sadness emerges on his face before being buried again by his charisma. “Sweetheart…” The word rolls off his tongue so effortlessly and before you can even protest the nickname he’s further explaining his stance. “I didn’t ask if you knew who I was because I’m some cocky asshole with a god complex. It’s quite the opposite actually.” He lets the anticipation build while you raise a brow for him to continue, him pacing around the sidewalk in a joking manner, almost like he had to go to the bathroom. “I’m the town satanist, didn’t you hear?” Now flashing jazz hands at you, his composure somewhat gives away a weakness. Amusement paints your expression and a laugh escapes your lungs, he couldn’t be serious. And he wasn’t as he began to go into a few details to aid in your confusion. “At least, that’s what they’re all so sure of.” His bitter tone gives you some insight on the situation as he shrugs. “I’m not. But because I look like me, talk like me, y’know…they just assume shit. Cause I play DND, they think I’m a cult leader.” Eddie fidgets with his rings but keeps his tone lighter as if this didn’t bother him. Shock takes over as you listen to him, your jaw drops. “And I probably just scared you, so I’ll just be on my bus.” He uses his thumb to point behind him while sticking his other hand in his back pocket that was stuffed with his neon vest. “No!” You’re surprised at your involuntary reaction but he stops short of the bus door and waits, arm braced on the frame. “I-I’m not scared. I just…wow. Those are the stupidest reasons to start a rumor like that.” You offer a sympathetic smile and he gladly takes it. “Honestly, I just use it to my advantage. People don’t mess with you if they’re scared of you. Has its perks.” An optimistic viewpoint on such a fucked up situation but it only draws you to him more. The last students saunter up to the bus and Eddie checks the time as he backs up onto the first step. “I gotta go.” Voice now soft, maybe even timid? His face reflects a tenderness and his irises hold some kind of promise in them. Nodding, you wave gently and with that he’s off with a final wave and a genuine smile that you hadn’t seen on him yet. It was enchanting.

–

Eddie the bus driver tampered with your mind all weekend and suddenly you were more than happy to take over bus duty if any of the other teachers requested. His gentle nature packaged in a rugged demeanor lured you in, the thoughts about him just kept manifesting in your mind–his deep dimpled grin, crazy curls, tattoos that now that you think about it made him that much more attractive, and of course those eyes–ugh those eyes would be the death of you if you ever had to look into them again. Which you were planning to do of course which meant you were plotting your own demise. Deep molasses pools that warmed you from the inside out, they were as addicting as the soda fountain at the gas station down the street from your house that you stopped at every day after work. They even replicated the syrupy cola color and you felt as though you could become hooked if you weren’t careful. So chocolatey almost like brownie batter that you couldn’t resist dipping your finger into, so sweet and so fulfilling. Even in the sun they were this deep, rich, cocoa brown that you’d never had the pleasure of seeing before you met him.

The scraping of a metal chair against the tiled floor of the teacher’s lounge snapped you out of your visions. Suddenly you were faced with the reality of your now cold leftover pasta staining your tupperware container as it sat atop the wooden table, a few teachers chattering while some headed off to catch up on some grading. What you would give to just continue drowning in those eyes rather than sitting in a room with a bunch of older adults.

Around two weeks later you still hadn’t ended up with bus duty, much to your disappointment. You were growing impatient, the only thing you were looking forward to was those big brown eyes and the charming man who possessed them. On the bright side, your students’ plants had just begun to sprout which left them overjoyed. Each individualized pot held in it a tiny sprout, a new little life that they were responsible for. It only pushed them to want to learn more and the way you taught it definitely helped ease a lot of the more boring aspects of the lesson.

A week later, you were finally approached with taking over bus duty for one of the other teachers who needed to take off early to pick up their own child who had gotten sick. Although you wouldn’t wish sickness upon anyone, you were ecstatic to hear that you’d been assigned to take over, trying to hide the upturn of your lips.

Once 3:15PM rolled around and the bell rang, your students threw their backpacks over their shoulders and bolted out the door, shouting a goodbye to you as you yelled back at them to walk while laughing at their antics. Giddiness fills your bloodstream on the way to the bus loop and your hands get shaky with anticipation. He shouldn’t have this much power over you however you feel that he’s probably the only guy in Hawkins you’d met that you would allow that power to. Something about your previous interaction with him had you yearning.

Reaching your selected spot, you wait patiently for bus eighty six to pull up. And when it does, the muffled riff of some metal song is blasting, growing even louder once the door opens. The music stills as he saunters off the bus in his typical uniform of a band shirt, denim vest, and ripped up black jeans. As his eyes meet yours while he steps onto the sidewalk, a little grin adorns his face, dimples on full display for you. “Hey, you haven’t been around for a while.” he mentions, fighting to get the door all the way open as it was beginning to close on its own halfway, slamming his bodyweight into it which seems to do the trick. “I’ve got my own things to do.” You banter with him, a hand on your hip. He fakes offense as he brings a hand up to his chest with a gasp. “Things other than babysitting the bus drivers?” His eyes crinkle at the corner in the cutest way. “I’m shocked.” He says in monotone before you both erupt in a fit of giggles. “I see you got the radio on full volume today.” You tease, referring to the booming music from earlier. “Oh yeah, I had to tinker with it but I finally figured it out. Really sick setup, it’s a pair of pliers holding the wires together.” He shoves both hands in his back pockets, something you’re starting to pick up on as a nervous habit. “Don’t tell anyone.” He whispers playfully with a hand covering one side of his mouth to shield from the other teachers. You laugh while staring at him in wonder. Stepping closer to you, just inches away, he raises his eyebrows while lowering his voice. “No seriously, I could probably get into a lot of trouble if you rat me out. They’ll be too stupid to figure out exactly what I did but y’know as a satanist and all…they’ll pin somethin’ on me.” You can’t help the cackle that escapes you, the ugliest sound you could’ve let out. It only makes him put on bigger dimples for you. “I’m sorry, I know you’re serious. It’s just so ridiculous.” You tell him through breathy laughs. He nods his head in agreement and chuckles along. This is the closest he’s ever stood to you and you’re now noticing the spice of his cologne and the scent of tobacco which strangely comforts you. “I am serious, but it is funny. I’ll know if you rat me out though.” He warns, his face adorably stern. “What? The teacher that no one talks to is gonna rat out the only person that actually will?” You give him a blank stare as he clicks his tongue. “Okay, that’s fair.” He decides. The two of you are still going back and forth, deep smiles embedded into your features as if no one else existed when the party comes to an end.

Mr. Wilson abruptly ends the conversation you and Eddie had been engaged in by clearing his throat in that annoying way he does. “Munson, I see you’re not wearing your vest again.” He talks down to him. Eddie’s eyes roll into the back of his skull, not at all hiding it from the man. “I can assure you, it’s right here.” He slightly turns and points to his back pocket where the bright vest is hanging. “Well I would think you’d be wearing it where everyone could see that you’re in fact a bus driver and definitely not some predator.” Mr. Wilson’s words are laced with venom, you can pick up on the vendetta he has against Eddie–he certainly doesn’t care about the vest, he’s just using it to pick a fight. “Listen, man–” Before Eddie can continue, you step in. “--Mr. Wilson I don’t know if I would be talking when you’re the one dress coding all these girls every single day. Are you purposely looking?” Eddie is taken back by your forwardness but also he can’t help the smirk as he takes in Mr. Wilson’s reaction. His mouth opens and closes like a goldfish, stunned. You await an answer patiently but nothing comes as Mr. Wilson scurries away like a frightened cat. It seemed he wasn’t able to handle when others would throw his own flaws back in his face. “Well, fuck.” Eddie sounds impressed, watching the man hurry into the building.

–

Over the course of a month you and Eddie continued to have harmless conversations that would sometimes leave you flustered, he was just so handsome and he was by far the funniest guy you’d met. You clicked with him, something you’d never experienced before, there was an undeniable chemistry. Even some of your students would make kissy faces behind Eddie as you talked with him, causing a rush of blood to heat your face.

On a Tuesday in late October, you had been filling in your grade book after school, working at your desk in the front corner of the classroom with most of the lights off to ease your eyes. The room was starting to fill out nicely with many projects you and your students had done throughout the last few months. Their plants had grown significantly and sprouted some leaves. Each one made its home on the shelf toward the back window of the room and every weekend students were free to take theirs home. They even had names, a piece of masking tape stuck to the front of every pot with them written in everyone’s handwriting.

Your train of thought was interrupted while you jotted down some notes to assist a student with a subject they were struggling in. A figure at the door had you glancing up only to be met with disappointment as you realized it was one of the teachers that would always gossip about you. You’d never heard what they said but you were smart enough to understand that looking in your direction and pointing every so often definitely meant you were the main subject. Her blonde hair was cut in a bob and she wore red rimmed glasses, perched at the edge of her nose. The dress she wore was covered in these ugly flowers that looked like puke. She had to be around sixty. You didn’t even know her name but you had the slightest inclination that she was going to tell you. Sure enough as she greeted you, she introduced herself as Mrs. Perry, another standard name. Making the air uncomfortable, she sat herself on top of the corner of your desk like she owned it. “I wanted to talk to you about something that myself and the other teachers have noticed.” She announces. All you wanted to do was roll your eyes but you refrained. This was about to turn into some kind of lecture about how you did your job wrong in their eyes. This conversation had happened before only with another teacher named Mrs. Dennis, who seemed fairly friendly at first but really just proved that she was like everyone else by letting you know that your ways of teaching were too progressive for their school.

You acknowledged Mrs. Perry with a hum for her to continue, signaling that you were listening to whatever nonsense she was about to bless you with. Her lipstick was way too bright for her complexion, that you could see even in the dim lighting of the room. “We were all worried…” she trails off vaguely. “Worried about what?” You ask, now a smidge curious. They were never worried, they were always at most concerned. Usually with your teaching techniques. “Well you see, we’ve noticed that Munson boy has been bothering you at bus duty. Now I know you probably were too afraid to say anything but—"”—Excuse me?” You cut in, a tone containing bitterness. “Dear, we all know who he is, what he’s done. You know he’s a cult leader, don’t you?” She looks at you with sympathy, as if to tell you that’s okay, little girl, you didn’t know any better. It made you want to absolutely vomit. You’re unable to grasp onto any words, a heavy and shaky sigh leaving you. “He listens to all that satanic music too, god what awful noise. It must’ve been terrifying having to face him all this time, you need to be careful. He might try to exploit you, if you understand what I’m trying to say…” “Okay, enough! You know what I don’t understand? I don’t understand how you people get to go off and judge anyone who is even the slightest bit different than you! You do it to him and you do it to me! And you wanna know something? Eddie is a hundred times the man than all the lowlife ones that work in this very school! Do you know that every one of them cheats on their wife or has some kind of a creepy problem with staring?” Your rant temporarily ends and she begins chiming in again. “I’m assuming you don’t know about his criminal background. How he’s an accomplice to his dad’s life of crime? He’s just like him and you’re going to end up like his mother if you don’t get out now.” Her voice is full of malice, trying to shred any sliver of purity you saw in Eddie.

You have no knowledge of Eddie’s past but based on your experience with the people of Hawkins, you had no intention of listening to any of the things they said about him. “I’m sorry, I can’t listen to any more of this. You people really don’t know how to mind your own business. Have you personally ever talked with Eddie?” You ask with a fire in your eyes. The woman is rendered speechless for a moment and then speaks back up. “No, but—“ “—No, nothing.” You finish, slamming your grade book shut and shoving it into your bag, heading for the door and gesturing for Mrs. Perry to exit your classroom so you can lock up. She attempts to reason with you some more but you won’t have it, holding a hand up in front of you to stop her as you storm down the hallway. Eddie Munson was the sweetest man you’d ever come across and you’d be damned if you were going to let everyone talk so lowly of him solely because of rumors and a bunch of hearsay.

—

The next time you have bus duty it comes up in conversation that Mrs. Perry tried to sway you away from him and advised that you get out while you can. “No fucking way.” Eddie has an amused smile plastered on his face as he munches on a bag of chips you’d grabbed from the vending machine. Nacho Cheese Doritos, his favorite. “Yeah, she just kept saying things. Was calling you a criminal, and even if it’s true it’s none of her business!” He can’t help but feel his heart swell three times the size his chest is capable of holding. Even if he were a criminal, you would still talk to him. That’s what he heard. While the rest of the population avoided him like the plague, you flocked to him willingly even if you weren’t sure whether it was true or not. You were giving him a fighting chance and that’s all he could ever ask of anyone ever, a luxury he never really was granted. “And then she said I’m gonna end up like your mom and that your dad—“ Immediately you stop talking as his breath hitches, his Doritos falling to the ground and his eyes void of emotion while he seems to be in another realm.

You're left without a clue as to what to do as he completely checks out of reality. “Eddie?” You softly whisper. “Eddie? Did I—I’m sorry if I said something I shouldn’t have, I was just going on and on and—“ “Don’t be.” Suddenly he’s back with you, grabbing his chips from the ground and crumpling the remaining snack in his hands, the foil bag crinkling loudly. “People uh, people like to—bring up my mom. My dad. They like to compare me to him.” His composure wavers for a second as he squeezes the noisy bag in his fist. He regains it and straightens himself out, looking directly into your eyes intently. “I don’t wanna get into it but, I’m not like him. Never will be. If you wanna stop talking I get it.” Your heart shatters as he lets a slice of vulnerability shine through. How could he think that because of one thing a woman said to you that she didn’t even have the slightest idea about, that it would send you running? Maybe other people had done so before you? If that was the case you wanted to personally ruin their lives and avenge whatever broken parts of Eddie’s soul they left behind in pieces. “Eddie, why would I want that?” You question sincerely.

You catch a panicked shift in his eyes as they move from left to right, he’s unsure of where to go from here. “If I like you I’m not going to stop talking to you because these people can’t handle anything other than their set in stone suburban lifestyle.” Your voice is gentle and you even venture to step closer to him, just barely grazing your fingertips against his only to realize his fingers were still dusted with nacho cheese. “Your fingers are still dusty.” You joke in a voice quiet enough only the two of you can hear. At this he cracks a smile, pulling one of his curls over his face in a bashful manner. “You like me?” He asks with rosy cheeks however his tone is teasing. “Mhm.” You hum back with a bite to your lip and a nod. “How much are we talkin’? Cause if I ask you out right now and make a complete dick of myself I’ll never recover.” He’s still twisting one of his curls around his finger, his opposite arm tucked under his bicep in a shy stance. A step closer to him and you’re breathing in each other's air. The kids around the bus loop are all too occupied in getting home to notice the flirtation happening among them which you were thankful for. “If you don’t ask me out, I may never recover either.” You eye his entire face, taking in the way his lashes dust over his cheeks while he gazes down at you, the hint of stubble threatening to break through his skin, and his pillowy pink lips that you’d hope to taste one day soon. “Are you busy Friday night?” He asks, bringing the hand that wasn’t layered in cheese dust to brush against your knuckles. Or so he thought. “Eddie!” You scoff, cringing at the gritty texture against your skin. “Sorry, sorry. Let me try again.” He holds his contaminated hand behind his back while allowing his other to brush his thumb over yours. “Will you go out with me Friday night? No Doritos, I promise.” He crosses his fingers in front of his face with a boyish smile. “Although you’re the one who gave them to me—“ “Eddie!” “Sorry, moment ruined again. Let’s go from the top.” He takes a deep breath but before he knows it, you press a kiss to his heated cheek, smiling up at him with a shy grin and your hands clasped in front of you, swaying from side to side as if this were a movie. He was really starting to think he was, there’s no way you were real. “Pick me up at seven?” You bat your lashes at him and he swears he could die happy then and there. “Yeah.” He whispers like it’s a secret among the two of you. “Wanna kiss you so bad right now.” He says hushed, bouncing on the balls of his feet. “I think they’d tack on a sex offender charge though if I tried since we're in front of a school so you’ll have to wait.” He smirks jokingly, you laughing with him. A series of woops and yells are heard from Eddie’s bus, a few of your students and some others not in your class cheering you both on, leaving you a flustered mess as Eddie just waves at them, nacho dust still coating his fingertips.

Quickly before he has to leave, you pull out a pen from your pocket where you’d always kept one just in case during school hours, jotting your number on his inner arm. “Call me.” You tell him with a close mouthed smile, attempting to contain all of your happiness. “You know I will, sweetness.” He purrs, offering you a scrunched up nose with a grin.

~end~

Masterlist

#eddie munson #eddie munson x reader #eddie munson fluff #eddie x reader #eddie munson fic #eddie munson smut #eddie munson x fem reader #eddie munson x female reader #bus driver!eddie #teacher!reader

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screamingfromuz · 7 months

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Recap- morning of day 6 12/10/2023 correct as 10:00

official numbers

Israel

1300 dead

3300 injured

100-200 held by various groups. Hamas claims for a 100, the Jihad claims for 30

340000 displaced Israelis

Gaza

1200 dead

5700 injured

190000 displaced (Amnesty)

1500 dead Hamas operatives (according to the IDF this is the body count that was found withing Israeli borders)

Major events and important facts

several hundreds of tons of explosive have been dropped on Gaza- there is no official new number, but from my calculation, over 2000 targets were hit. There is nonstop bombing of Gaza. Anyone in the command chain of Hamas is targeted

Israeli authorities have publicly told Gazians to flee to Egypt for their safety. there are reports that Hamas is ordering citizens to stay around places that are known to be marked to be bombed. Egypt shown displeasure with the idea that they will have to take the fleeing Gazians in, and told Israel off for telling the Gazians to flee to Egypt. The Rafah Border Crossing is being opened and closed periodically due to Egypt and Israeli actions.

Gazians are struggling to get people out of the rubble- therefore numbers are probably bigger.

still no official number of captured Hamas operatives.

Estimations of missing people due to the Saturday attacks are around 250.

Israeli counts (including kidnapped) include foreign citizens and Palestinians that are Israeli residence/citizens. unknown at the moment about foreign casualties inside of Gaza. there are foreign citizens in Gaza.

Israel shut both electricity and water to Gaza, Egypt is being talked with in order to arrange humanitarian aid. There are talks of airdropped supplies. The UN took a stand against the siege and are pressuring Israel to tone down the attacks and allow humanitarian aid.

Hamas reported that at least 4 prisoners were killed as a result of the bombing- I don’t have confirmation of more.

Hamas issued Monday night a warning that if Israel will not stop attacking, they will start killing captives- no new information in the matter. Hamas posted a video where they claim to have released an Israeli woman and her 2 children. I am working to verify it.

Northen Israel situation is messy. The Jihad and Hezbollah on one side and the IDF on the other are attacking each other with gunfire and missile fire were exchanged. A missile launcher that was directed toward Israel was found and dismantled by Lebanon’s army. Yesterday there were warnings of a few unmanned drones that crossed the border into Israel. There are definite tension there.

Syria is apparently trying to stay out of it.

there are still regular attempts to enter Israel by Hamas operatives, most are killed immediately. Unconfirmed reports from social media claim that Gazians that try to flee are presumed as Hamas operatives and are shot. No official confirmation by any side.

The west bank is getting more and more tense. Settlers are using the opportunity to attack Palestinian civilians; Hamas supporters are encouraging Palestinian youth to preform attacks; there confrontations between the IDF and Palestinians in the Palestinian and mixed cities.

In the past Few days Israeli and Palestinian groups have been arranging a community peacekeeping groups to help protect each other from extremists.

Yesterday evening Israel has declared a unified war cabinet with several opposition members. Israeli coalition members were met with anger and disdain by the Israeli public, blaming them for the situation.

Ben Gvir tries to incite a civil war.

The hostages are treated as bargaining chips by both sides.

#israel #palestine #ישראל #iron swords #al aqsa storm #donate #gaza #Hamas #Islamic Jihad #i/p #the israeli palestinian conflict #hezbollah #12/10/2023

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thehopefuljournalist · 9 months

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Am I a little bit late for some of you? I might be. But anyways. Here's what went right around the world this past week :)

Youth climate activists won a huge climate lawsuit

Sixteens youths (aged five to 22) from Montana, US, have emerged victorious after suing state officials for violating their right to a clean environment.

In their lawsuit, they argued that Montana's fossil fuel policies contributed to climate change, which harms their physical and mental health. Montana is a major coal producer, with large oil and gas reserves. The state has rebuffed these claims, saying that their emissions were insignificant on a global scale.

Judge Kathy Seely, in a 103-page ruling, set a legal precedent for young people’s rights to a safe climate by finding in their favour. “Every additional tonne of GHG [greenhouse gas] emissions exacerbates plaintiffs’ injuries and risks locking in irreversible climate injuries".

This win marks the very first time a US court has ruled against a government for a violation of constitutional rights based on climate change. It will now be up to Montana lawmakers to bring state policies in line.

“As fires rage in the west, fueled by fossil fuel pollution, today’s ruling in Montana is a gamechanger that marks a turning point in this generation’s efforts to save the planet from the devastating effects of human-caused climate chaos.” - Julia Olson, executive director of nonprofit law firm, Our Children’s Trust, which represented the youths in this case.

Number of Mexicans living in poverty fell by millions

Thanks to a new minimum wage boost and increases to pensions, the number of Mexicans living in poverty fell by 8.9 million between 2020-2022, according to new data published by the country’s social development agency, Coneval.

Coneval’s statistics suggest that the number of people living in extreme poverty also fell – from 10.8 million in 2020 to 9.1 million last year – although that figure is still up from a pre-Covid 8.7 million recorded in 2018.

There is still a long way to go, and some critics do claim that during the current president, López Obrador's presidency has been characterized by austerity.

An organised crime group trafficking endangered species has been jailed

The Wildlife Justice Commission (WJC), a small European wildlife charity, is apparently busting kingpins behind as much as half of the world's illegal trade in pangolin scales. The traffickers began six-year jail sentences a few weeks ago.

The wildlife charity went undercover to expose three Vietnamese and one Guinean national, members of an organised crime group trafficking body parts of endangered species including rhinos.

They were arrested in May 2022, following a four-year investigation by the WJC, and were accused of trafficking 7.1 tonnes of pangolin scales, as well as 850kg of ivory. Last month they pleaded guilty to smuggling and were jailed for six years.

All eight species of pangolin are listed as threatened animals, four critically endangered - they are protected by international law.

“There has not been a reported seizure of pangolin scales in Asia originating from Africa in more than 550 days,” said Steve Carmody, WJC’s director of programmes. “There is no clearer example of the importance of disrupting organised crime networks.”

AI gave conservationists a breakthrough

The use of AI-controlled microphones and cameras seems set to revolutionise

biodiversity monitoring in the UK following groundbreaking work by researchers at the Zoological Society of London (ZSL). They used the tech to record and analyse 3,000 hours of wildlife audio captured by monitors located near London railway lines.

The computers detected dozens of bird species, foxes, deer, bats and hedgehogs, and mapped their locations.

It’s hoped the innovation will help improve conservation and habitat management on Network Rail land.

This year is best ever for UK renewable energy installations

This years looks to be the best year so far for UK renewable energy installations, with record numbers of households fitting solar panels and heat pumps.

2023 marks the first time solar panel installations have topped an average of 20,000 a month, as homeowners look to harvest energy from the sun amid rising utility bills.

Read the full story here.

The UK’s Tree of the Year shortlist was revealed

The Woodland Trust has announced the shortlist for its annual celebration of some of the UK’s most treasured ancient trees, and for 2023 the spotlight is on the urban landscape.

“Ancient trees in towns and cities are vital for the health of nature, people and planet,” said the charity’s lead campaigner Naomi Tilley. “They give thousands of urban wildlife species essential life support, boost the UK’s biodiversity and bring countless health and wellbeing benefits to communities.”

Article published August 17, 2023

Thank you so much for reading! Let me know what interested you, and if there's any specific topic you'd like me to dig into, my DM's are always open :)

Much love!

#climate change #climate #hope #good news #more to come #climate emergency #news #climate justice #hopeful #positive news

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olreid · 1 year

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ok was anyone gonna tell me that in twilight mirage episode 38 the team gets essentially a distress call from a group of concerned parents who say that their children have been brainwashed by a cult and then they go to investigate and it turns out its like. a youth liberation effort by a bunch of teens who ran away from their parents and are trying to build a sustainable community on their own. and so the whole episode is just one long discussion about whether and under what conditions children should be allowed to emancipate themselves. and it becomes clear immediately that even people who were raised in this utopian fleet have not had to contend with children as political actors in any major way until now. podcasts for me

#i definitely didnt get this far the last time i tried this season. i would have Remembered #twilight mirage #a long wish to be elsewhere

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religion-is-a-mental-illness · 2 months

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By: Gerald Posner

Published: Mar 4, 2024

Newly leaked files from the world’s leading transgender health-care organization reveal it is pushing hormonal and surgical transitions for minors, including stomach-wrenching experimental procedures designed to create sexless bodies that resemble department-store mannequins.

The World Professional Association for Transgender Health documents demonstrate it’s controlled by gender ideologues who push aside concerns about whether children and adolescents can consent to medical treatments that WPATH members privately acknowledge often have devastating and permanent side effects.

Yet the US government, American doctors and prominent organizations nonetheless rely on WPATH guidelines for advice on treating our youth.

The files — jaw-dropping conversations from a WPATH internal messaging board and a video of an Identity Evolution Workshop panel — were provided to journalist Michael Shellenberger, who shared the documents with me.

Shellenberger’s nonprofit Environmental Progress will release a scathing summary report, comparing the WPATH promotion of “the pseudoscientific surgical destruction of healthy genitals in vulnerable people” to the mid-20th-century use of lobotomies, “the pseudoscientific surgical destruction of healthy brains.”

‘Arbitrary’ age limits

The comparison to one of history’s greatest medical scandals is not hyperbole.

It is particularly true, as the files show repeatedly, when it involves WPATH’s radical approach to minors.

When the organization adopted in 2022 its current Standards of Care — relied on by the National Institutes of Health, the World Health Organization and every major American medical and psychiatric association — it scrapped a draft chapter about ethics and removed minimum-age requirements for children starting puberty blockers or undergoing sexual-modification surgeries.

It had previously recommended 16 to start hormones and 17 for surgery.

Not surprisingly, age comes up frequently in the WPATH files, from concerns about whether a developmentally delayed 13-year-old can start on puberty blockers to whether the growth of a 10-year-old girl will be stunted by hormones.

During one conversation, a member asked for advice about a 14-year-old patient, a boy who identified as a girl and had begun transitioning at 4.

The child insisted on a vaginoplasty, a surgery that removes the penis, testicles and scrotum and repositions tissue to create a nonfunctioning pseudo-vagina. It requires a lifetime of dilation. Was he too young at 14?

Marci Bowers, WPATH’s president and a California-based pelvic and gynecologic surgeon who is herself transgender, said she considered any age limit “arbitrary.”

But she would not do it. Why?

“The tissue is too immature, dilation routine too critical.”

In lay terms, that means boys who are too young do not have enough penal tissue for the surgery and the surgeon must harvest intestinal lining to build the faux vagina. Even Bowers admits that can lead to “problematic surgical outcomes.”

She would know since she has performed more than 2,000 vaginoplasties. Her highest-profile patient is 17-year-old Jazz Jennings, the transgender star of reality TV show “I Am Jazz.”

Three corrective surgeries were required to fix problems from the original vaginoplasty.

“She had a very difficult surgical course,” Bowers admitted in a 2022 appearance on the show. “We knew it would be tough — it turned out tougher than any of us imagined.”

Still, Bowers told her colleagues in the internal discussion forum of the best age for an adolescent to undergo surgery: “sometime before the end of high school does make some sense in that they are under the watch of parents in the home they grew up in.”

Christine McGinn, a Pennsylvania plastic surgeon and herself transgender, agreed. McGinn has performed “about 20 vaginoplasties in patients under 18” and thinks the “ideal time in the U.S. is surgery the summer before the last year of high school. I have heard many other surgeons echo this.”

Waiting until teens are older than 18 and in college is problematic, she said: “there are too many stressors in college that limit patients’ ability to dilate.”

Dangers downplayed

WPATH assures patients that surgical and hormonal interventions are tested and safe. It is a different matter in private.

President Bowers, for instance, said publicly in 2022 that puberty blockers are “completely reversible,” although in the internal forum she conceded it is “in its infancy.”

What about children who are infertile for life since they started hormone blockers before they reached puberty?

Bowers told her colleagues the “fertility question has no research.”

At other stages, members talk frankly about the complications for the transition surgery for girls, a phalloplasty in which a nonfunctioning pseudo-penis is fashioned from either forearm or thigh tissue.

It requires a full hysterectomy and surgical removal of the vagina. They also discuss other serious consequences, including pelvic inflammatory disease, vaginal atrophy, abnormal pap tests and incontinence.

A 16-year-old girl who had been on puberty blockers for several years before she was put on testosterone for a year had developed two liver tumors that an oncologist concluded the hormones had caused. Another member described “a young patient on testosterone for 3 years” who had developed “vaginal/pelvic pain/spotting . . . [and] atrophy with the persistent yellow discharge.”

Several colleagues described patients with similar conditions, some with debilitating bowel problems or bleeding and excruciating pain during sex (“feeling like broken glass”).

Vaginal estrogen creams and moisturizers as well as hyaluronic acid suppositories “can be helpful.”

One WPATH member seemed surprised: “The transgender people under my surveillance do not complain about this matter. However, I confess that I have never asked them about it.”

Rise of ‘de-gender’ surgery

The litany of transition surgery’s side effects did not stop WPATH from endorsing far more radical “nullification” surgeries for patients who do not feel either male or female and identify only as nonbinary.

Several dozen so-called “de-gendering” surgeries are designed to create a sexless, smooth cosmetic appearance that is unknown in nature. There is even an experimental “bi-genital” surgery that attempts to construct a second set of genitals.

In 2017, when tabloids reported a 22-year-old man had spent $50,000 to surgically remove his sex organs so he could “transform into a genderless extra-terrestrial,” it seemed a one-off oddity.

But WPATH has enshrined that concept in its Standard of Care — the same document in which the group endorsed for the time first time chemical or surgical castration for patients who identify as eunuchs. (WPATH even linked to the Eunuch Archives, where men anonymously share castration fetishes.)

These science-fiction-like surgeries are not only reserved for adults.

“How do we come up with appropriate standards for non-binary patients?” asked Thomas Satterwhite, a San Francisco-based plastic surgeon who has operated on dozens of patients younger than 18 since 2014. “I’ve found more and more patients recently requesting ‘non-standard’ procedures.”

What are nonstandard procedures? They include “non-binary top surgery,” a mastectomy without nipples. There are brutal procedures for girls that eliminate all or part of the vagina and for boys that amputate the penis, scrotum and testicles.

The goal, as one San Francisco surgical clinic proclaims on its website, “is a smooth, neutral body that is cosmetically free of sexual identification.” On TikTok the trend is called a “flat front.”

‘Too young to understand‘

A particularly intense subject of discussion was whether minors could understand the lifelong consequences of their gender treatments. Minors are presumed by law to be incapable of making an informed decision about having a vasectomy or tubal ligation.

Gender surgeries are an exception, however.

WPATH’s Standard of Care allows all procedures so long as the minor “demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.”

In a May 2022 internal workshop, “Identity Evolution,” WPATH members conceded that was all but impossible.

Daniel Metzger, the British Columbia endocrinologist who cowrote the Canadian Pediatric Society’s position paper on health care for trans minors, said, “I think the thing you have to remember about kids is that we’re often explaining these sorts of things to people who haven’t even had biology in high school yet.”

Metzger noted adolescents are incapable of appreciating the lifelong consequence of infertility. “It’s always a good theory that you talk about fertility preservation with a 14-year-old,” he said, “but I know I’m talking to a blank wall. They’d be like, ‘ew, kids, babies, gross.’ Or, the usual answer is, ‘I’m just going to adopt.’ And then you ask them, ‘Well, what does that involve? Like, how much does it cost?’ ‘Oh, I thought you just like went to the orphanage, and they gave you a baby.’ . . . I think now that I follow a lot of kids into their mid-twenties, I’m always like, ‘Oh, the dog isn’t doing it for you, right?’”

There is extensive research showing adolescent brains are wired to have little control over rash behavior and are not capable of grasping the magnitude of decisions with lifelong consequences. It is why society doesn’t allow teens to get tattoos or buy guns. Car-rental agencies set 25 as the minimum age for renting a car, and Sweden sets the same limit for deciding on sterilization.

Detransitioners ignored, shunned

Although many WPATH members privately doubt that adolescents can give truly informed consent to life-altering procedures, they must affirm whatever children say about their gender.

Unless, the WPATH files disclose, the patient wants to reverse course and become a so-called detransitioner.

WPATH members mostly dismiss those cases as insignificant or overblown by the media and question whether minors who want to revert to their birth sex really understand what they are doing.

It’s a question that would never be asked for minors who declared themselves to be gender dysphoric.

One case involved a 17-year-old boy, just graduated from high school, who had been on testosterone for two years. He was reported to be “very distraught and angry. He reports he feels he was brainwashed and is upset by the permanent changes to his body.”

A self-described “queer therapist” did not believe any young person could be brainwashed. “In my experience, those stories come from people who have an active agenda against the rights of trans people.”

WPATH President Bowers said that “I do see talk of the phenomenon [detransitioners] as distracting from the many challenges we face.”

‘Frankenstein files’

The leaked files put a spotlight on the danger of mixing ideological activism with medicine and science. They should serve as an urgent wakeup call for the medical associations and government agencies that rely on WPATH guidance for transgender health.

The files might even prompt investigations into how those with distorted personal agendas seized control of the organization at the expense of science and patients.

Investigating what has gone wrong at WPATH might prove uncomfortable for some gender progressives in the Biden administration, none more so than Adm. Rachel Levine, the assistant secretary for health. Levine, the first transgender four-star military officer, is a WPATH member and has lavished praise on the organization.

She says it “assesses the full state of the science and provides substantive, rigorously analyzed, peer-reviewed recommendations to the medical community on how best to care for patients who are transgender or gender non-binary. It is free of any agenda other than to ensure that medical decisions are informed by science.”

Either Levine is unaware of the hormonal and surgical experimentation the group promotes or refuses to acknowledge it.

“The Frankenstein files.”

That is how a pediatrician described the leaked documents after I shared them with her.

Unfortunately, this is no horror novel.

It is a medical travesty playing out in real time, and the casualties are our children.

#Gerald Posner #Michael Shellenberger #WPATH #World Professional Association for Transgender Health #Mia Hughes #WPATH Files #The WPATH Files #medical corruption #medical malpractice #medical scandal #unethical #gender ideology #gender identity ideology #queer theory #first do no harm #religion is a mental illness

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the-garbanzo-annex-jr · 14 days

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by Ohad Merlin

Mutasher claimed that approximately 12 million citizens from different sects, religions and ethnic groups live in the historical Arabistan region, adding that there are also 6 million additional Persian Iranians in the area, whom he deems “settlers.” “The Iranian occupation, after it occupied the country, carried out a process of demographic change, so that masses of Ahwazis were transferred by force to the Persian interior to cities like Yazd and Kerman, while the Persian ‘settlers’ were transferred to Ahwazi cities. An example is the city of Izeh, which used to be a large Arab center in the area, but today is purely Persian.”

According to Mutasher, part of the Iranian interest in the area lies in its abundant natural resources. “The terrorist acts led by Iran which we witness today are caused with funding looted and plundered from its rightful Ahwazi owners to support international terrorist actors such as Hamas and the Islamic Jihad.

Indeed, the overwhelming majority of the Islamic Republic’s main gas and oil fields are located within the historical area of Arabistan, with some of the main ones situated in the modern Khuzestan province itself. Mutasher added that the gold and agricultural industries in the Ahwaz area are also significantly developed. “Al-Ahwaz, if liberated, can potentially be the one of the richest countries in the world; but unfortunately, the terrorist regime of Tehran today loots and plunders all these riches to support their terrorist agendas,” he commented.

Nowadays Arab citizens in Khuzestan point a critical finger at the central government in Tehran for what they describe as discriminatory policies against the Arab minority in the country. “Following the military occupation, the phase of the ‘soft occupation’ began, with examples being changing the names of cities. For example, the city of Al-Muhammara became Khorramshahr and Al-Khafajiya became Susangerd, and more,” he said.

In this context, Mutasher added that Iranian authorities refuse to register some Arabic names for children, such as Omar for boys and Aisha for girls, forcing the usage of Persian names instead. Other prohibitions mentioned by Mutasher include wearing the traditional Arab Ahwazi attire, which resembles that of the other peoples of the Gulf. “Regardless of this oppression, during the last two years we were able to break this line and we began to see our youth unite and revive their cultural history despite the obstacles,” he said.

#iran #hamid mutasher #iranian regime

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internationalyouthday · 28 days

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(Part 2) ECOSOC Youth Forum 2024.

"Reinforcing the 2030 Agenda and eradicating poverty in times of multiple crises: the effective delivery of sustainable, resilient and innovative solutions".

Watch (Part 2) ECOSOC Youth Forum 2024

United Nations Economic and Social Council, United Nations Youth, Office of the Secretary-General's Envoy on Youth, UNFPA, United Nations Development Programme - UNDP, Major Group for Children and Youth, United Nations Alliance of Civilizations (UNAOC); UN Web TV

#United Nations Economic and Social Council #United Nations Youth #Office of the Secretary-General's Envoy on Youth #UNFPA #United Nations Development Programme - UNDP #Major Group for Children and Youth #United Nations Alliance of Civilizations (UNAOC)

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ukrfeminism · 2 years

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5 minute read

The first red flag was the “dick pic”. Katie had no idea her 14-year-old son was communicating with strangers in secret on the Mermaids website, until she found several sexually explicit images on his phone.

Her autistic son, who had been teased at school for possibly being gay, had visited the school nurse, who in turn did what so many schools, local authorities and child mental health services across the country now do when presented with a gender-non-conforming child in distress: referred him to Mermaids.

The charity is the country’s best known transgender youth charity. It has basked in the support of celebrities such as Emma Watson and Prince Harry, and won generous grants from the National Lottery and the government.

Unbeknown to Katie, her son had joined the charity’s youth forum, a private online community for 12-19 year-olds who are struggling with gender issues. Parents and carers are not allowed. No proof of ID or age is required, only an email address.

Once signed up, he entered an online world where vulnerable children seeking support with others in similar pain, share their personal details, including phone numbers, email addresses and social media handles, under the apparently approving supervision of Mermaids moderators.

Screenshots seen by The Times also show users openly arranging to move their conversations about experimental drug treatments and medical transition on to even less supervised platforms, such as Discord, with the tacit approval of Mermaids moderators.

It was on Discord, an instant messaging social media platform that was started by gamers and now boasts about 350 million subscribers, that Katie’s son met the strangers who started sending sexual images and asking him to send them photos of himself in sexualised poses in his bedroom in return, which were then found by his mother.

“He felt they were his friends,” said Katie, a teacher. “It was after that I found all the Mermaids emails in his inbox, with the links to all these discussions [on the Mermaids youth forum.]”

The youth forum is promoted on Mermaids’ website as “a wonderful place to find community and allay fears”.

However, critics say it is an “irresponsible ‘Wild West’ free for all’ which allegedly fails the most basic online safety standards.

“Essentially, it is providing a space for children where it’s the blind leading the blind,” said Stephanie Davies-Arai, founder of campaign group Transgender Trend. “These children are not qualified to help other children with emotional and psychological issues. It’s hugely irresponsible.”

Mermaids promotes itself as a leading authority on LGBTQ issues, and is paid to train teachers, police forces, NHS staff and social services on dealing with transgender issues.

This week the Charity Commission confirmed it would be investigating Mermaids’ safeguarding practices, after receiving a number of complaints from parents.

One major red flag was its binder scheme. It emerged in an investigation by The Daily Telegraph earlier this week that the charity is sending potentially dangerous chest binders to children as young as 13 and 14, behind their parents’ backs. These are used by some women and young girls with gender dysphoria to flatten their breasts in a bid to appear more masculine but they carry serious health risks, potentially causing breathing difficulties and damage to healthy breast tissue, ribs and the spine.

Another cause for concern was the youth forum.

Confidential safe spaces can be vital lifelines for children to access support in the charity sector. Childline, for example, allows children to communicate anonymously with each other on message boards, subject to strict controls.

There is a time delay before a child’s post goes live, allowing moderators to screen the content. The house rules set clear parameters for discussion, forbidding any posts that talk, for example about self-harm as a coping method, or suggest that running away might be the right choice. Medical advice is forbidden — “even if something is safe for one person, it might not always be safe for other people” — and no posts are allowed about target-driven goals to change body shape as “it can make people feel competitive and encourage people to diet in unhealthy ways”. Children are not allowed to share any other ways to contact each other off the boards, and, crucially, the message boards are public.

Mermaids conducts its forum very differently.

On its website, Mermaids explains that “we sometimes suggest a young person uses an email address their primary carers have no access to” because some LGBTQ children live in “hostile environments” in which being outed may risk harm or even homelessness.

The charity insists it does not give medical advice. However, much of the discussion revolves around the idea of medical transition as a solution to various problems.

On the forum, which has around 700 members, children share their excitement at the prospect of starting hormone treatment. Introducing themselves, one child said: “I’m 15 and I’ve socially transitioned and I believe I’m getting my first blocker shot on Wednesday. (Fingers crossed!!!)

Mermaids continue to promote puberty blockers as a safe and reversible treatment, despite medical consensus that the long term impact on teenage development remains unknown.

In another post, under the subject heading “Forearm or thigh skin graphs [sic] Phalloplasty”, a young woman who identifies as male asks which part of the body is used to surgically create a penis.

“So I was wondering if anyone knew the difference between taking a skin graph [sic] from your forearm or thigh for phalloplasty? They had heard arm skin was preferred “but since I have permanent self harm scars I don’t think I’ll be able to.”

She is advised by another person in the group: “I really don’t think it will make a difference particularly because it will be 5 - 10 years before you get phallo. (I assume you want T [testosterone] and top surgery before),” adds the respondent, who then recommends some “really good videos on phallo” by a YouTuber.

When an unhappy youngster shares their mobile phone number, Snapchat and Instagram handles, it is left to another user — rather than a moderator — to warn them: “Are you sure it’s a good idea to post your phone number on here? There are over 700 people on this forum.”

In another post, under the topic “lonely”, one young girl posts her full email address and mobile phone number.

Once children sign up to the forum, they receive daily emails, highlighting the discussions taking place under headings such as “advice on unsupportive parents”.

Stephanie Davies-Arai, of the campaign group, Transgender Trend, said: “It’s a bit Lord Of The Flies, isn’t it? You’re letting children create their own little society, where they all support each other in a belief they probably learned online. They don’t have the maturity to recognise the harms of those internet forums.”

Parents expressed particular concern over the moderators’ alleged failure to intervene when users arranged to continue their relationships on other platforms.

In a post dated Jan 2020, a moderator using the name “Izzi J” interjected to advise the youngsters not to draw attention to the Mermaids connection, when they moved their conversation on to the unregulated chat rooms of Discord.

Izzi J wrote: “Great idea for you to have a Discord server together! I have to be a bit of a buzzkill here, you can’t call it Mermaids because it isn’t our server, run by us or affiliated with us. Give it a different name and you’re golden. Have fun :)”

In other posts, the same moderator talks about “the anti trans brigade”.

“Most people I know had no idea about trans issues until I came out and then the good people among them learned and changed how they viewed things. Some people are too lazy and bitter to change and that’s unfortunate.”

Having complained to the Charity Commission in 2020, Katie, not her real name, welcomed the watchdog’s decision to investigate further.

“I am cautiously optimistic that this time the Charity Commission will recognise unequivocally the harm being done to very vulnerable children,” she said.

Another parent, whose child was also referred to Mermaids, said: “Mermaids sees itself as the ‘hero’ or ‘rescuer’ of children, from ‘unaccepting’ parents. Anything that sidelines parents is a red flag.”

He said he was horrified to see the moderator’s response to Discord: “Discord is absolutely full of really grim self-harming and eating disorder servers [chat rooms], so just having vulnerable kids with body issues on discord is potentially a major risk.

“In contrast, Mermaids basically said, ‘what a great idea, off you go into this internet wild west, just you can’t use our name’. There was no concern for these young people’s welfare, they actually endorsed the idea of setting up a private server whose membership and rules would be completely hidden.”

The Times asked Mermaids to clarify the ages, training and background of the moderators who are responsible for supervising the forum, but the charity refused to respond.

In a statement, Mermaids said it was the victim of a “smear campaign.”

It said: “We’re in the midst of a targeted, cynical attack. Security of our platforms and safeguarding of young people is of the utmost importance to us and we continue to regularly review our processes and procedures to make sure our forums remain safe and secure. There are several layers of moderation checks before anyone can gain access to the forum, and anyone found to have fraudulently gained access to our platforms will be reported to the police immediately as a safeguarding concern.

“All of our moderators receive comprehensive training, including safeguarding training, and everyone using the forum has to comply with a strict code of conduct, which prohibits the sharing of personal information, including online identities.”

Mermaids emerged as a support group for young people receiving treatment at the NHS gender identity clinic based at the Tavistock and Portman NHS Foundation. Trust, which has since been disbanded on the recommendation of an independent review.

Whistleblowers said they were alarmed by the charity’s alleged influence over the clinic’s leadership team, with some clinicians concerned that Mermaids was schooling young people on what to say in the consultation room, in order to access hormone therapies quicker.

Mermaids insists it does not encourage one particular treatment over another.

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legallybrunettedotcom · 2 months

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what is your major ?

it's called social pedagogy. i got my bachelors and currently getting my masters. it's an interdisciplinary field that works with people who have behavioural problems, which includes a variety of problems and areas. it's sort of country specific. here it includes prevention, detection, evaluation, early interventions and treatment, processing and subsequent care for children, youth, and adults at risk of behavioural disorders or with manifested behavioural disorders, and their social environment, in the function of education, socialization, rehabilitation, and social integration. in practice it means rehabilitation of people who commit crimes, prevention in communities, individual and group counseling, creating programmes and projects etc. you can work with everyone from a kid with adhd to a person who has killed someone.

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workersolidarity · 2 months

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[ 📹 A Palestinian youth is stunned and horrified, speechless after Israeli occupation air forces bombed his friend's family home in the Gaza Strip in the early morning hours of Saturday, March 16th, 2024.

"I pulled out one of them, but two were left," the youth tells reporters. Asked what his message would be to the world, the youth responds by saying, "we are alive, and not dead. I don't know what to say..." before he is overcome by emotion at his loss.

Another man searches the rubble for his two children, his father, mother, brothers and sisters and their children, all missing in the debris of the ruined building.]

🇮🇱⚔️🇵🇸 🚀🚀🚀🏘️💥🚑 🚨

SCORES OF CIVILIANS KILLED IN ISRAELI BOMBING AND SHELLING ON THE 162ND DAY OF ISRAEL'S GENOCIDE IN GAZA

On the 162nd day of Israel's ongoing war of genocide in the Gaza Strip, the Israeli occupation forces (IOF) committed a total of 7 new massacres of Palestinian families, resulting in the deaths of at least 63 Palestinian civilians, mostly women and children, and wounding another 112 others over the previous 24-hours, according to Gaza's Ministry of Health.

The Israeli occupation continued its bombing and shelling across the north, central and southern Gaza Strip, killing at least 80 Palestinians and wounding scores of others as part of an unprecedented bombing campaign well on its way to causing 150'000 casualties since the beginning of the current round of Israeli occupation aggression.

While bombing and shelling intensified in the Gaza Strip, Zionist occupation Prime Minister Benjamin Netanyahu announced on Friday that the Israeli occupation army has approved a plan for ground operations in the city of Rafah, in the southern Gaza Strip, which the Hebrew media described as a "stick Jerusalem continues to hold over the terror group in efforts to reach a hostage release."

Netanyahu currently claims that four battalions of Hamas Mujahideen fighters remain in Rafah as the last major stronghold in the Gaza Strip under Hamas control.

The Netenyahu government has previously said that a ground offensive into the southern Gazan city is "necessary" to achieve the war's goals, adding that it wasn't a question of "if" but "when" the Zionist entity would have to enter the city.

Meanwhile, in a new horrific war crime, Zionist air forces bombed a 7-story residential building filled with displaced Palestinian families, not far from Al-Shifa Hospital in Gaza City, killing dozens of civilians and wounding many others.

Similarly, occupation warplanes bombarded a civilian residence in the Al-Tuffah neighborhood, north of Gaza City, resulting in the deaths of at least five civilians and wounding dozens of others.

Meanwhile, Israeli fighter jets bombed another residential home, this one on Al-Jalaa Street in Gaza City, martyring and wounding dozens of Palestinians, while another strike targeting a civilian home in the Al-Nasr neighborhood of Gaza City also resulted in several casualties.

Occupation Forces also shelled the area near the Al-Kuwaiti roundabout, at the intersection of Steet 10 and Salah al-Din Street in Gaza City, where starving Palestinian families wait for food aid trucks to arrive. The Israeli shelling killed at least one civilian and wounded a number of others.

Local Civil Defense teams also announced recovery efforts to rescue several killed and missing Palestinians after IOF fighter jets bombed a residential building on Al-Lababidi Street in Gaza City.

Elsewhere, Zionist artillery forces shelled two residential homes, west of the Nuseirat Camp, including a residential home belonging to the Tabatabi family, in the central Gaza Strip, slaughtering at least 36 civilians and wounding a number of others, while intense Israeli shelling also targeted the Al-Shati Refugee Camp, west of Gaza City.

Earlier, occupation warplanes bombed a number of civilian residences the Nuseirat Camp, which resulted in the martyredom of seven Palestinians and the wounding of several others, while an additional airstrike targeting the Abu Dawabeh family home in the village of Al-Masdar killed at least one civilian and wounded multiple others.

Heavy bombing and shelling also concentrated on several areas of Beit Hanoun, in the northeastern Gaza Strip, while simultaneously, Israeli occupation forces fired banned phosphorus shells into the town, lighting up the sky during operations there.

Zionist occupation forces didn't spare the southern Gaza Strip with its intense bombing and artillery shelling campaign, which turned its ugly attention towards Rafah where Israeli forces shelled an inhabited civilian home, resulting in a number of casualties.

In another tragic atrocity committed by the Zionist army, three civilians with the Dhahir family were martyred after IOF artillery shelling targeted them on their way to the local mosque in the Al-Adas neighborhood of Rafah city.

As a result of Israel's ongoing war of genocide in the Gaza Strip, the infinitely rising death toll now exceeds 31'553 Palestinians martyred, more than 25'000 of which being women and children according to the United States Pentagon, with an additional 73'546 civilians wounded since the beginning of the current round of Israeli aggression beginning on October 7th, 2023.

#source1

#source2

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#videosource

@WorkerSolidarityNews

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reignof-fyre · 1 year

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Colonizers impose their own cultural values, religions, and laws, making policies that do not favour the Indigenous Peoples. They seize land and control the access to resources and trade. As a result, the Indigenous people become dependent on colonizers.

Settler colonialization either rules as a minority group through oppression and assimilation of the indigenous peoples or by establishing themself as the demographic majority through driving away, disadvantaging, or outright killing the indigenous people.

Oh, I see...

The First Men came with bronze swords and great leathern shields, riding horses. As the men settled in the new land, carving out holdfasts and farms, they chopped down and burned the carved weirwoods that were sacred to the gods of the children of the forest. This provoked wars between the children and the First Men. Though the children fought with their greenseers, magic, and wood dancers, the First Men were larger, stronger, and more technologically advanced. The First Men cut down weirwoods as they believed that the greenseers could see through the eyes of the trees.

Brandon of the Bloody Blade is a legendary son of Garth Greenhand. He is credited with driving giants away from the Reach and warring against children of the forest, slaying so many at Blue Lake that it became known as Red Lake. In some tales, he is mentioned as the ancestor or father of Bran the Builder, making him a possible ancestor of House Stark.

Oh...

Andals first landed in the Fingers and attacked the First Men living in the Vale. They burnt out the weirwood groves, hacked down the faces, and slaughtered the children of the forest that they came across. Everywhere, they proclaimed the triumph of the Seven over the old gods. A hill, now known to the Westerosi as High Heart, was sacred to the children of the forest. There, the Andal king Erreg the Kinslayer cut down the children’s grove of thirty-one weirwoods. It is said that the First Men killed half of the children of the forest with bronze blades, and the Andals finished the job with iron

Interesting....

The Westeros of Aegon's youth was divided into seven quarrelsome kingdoms, and there was hardly a time when two or three of these kingdoms were not at war with one another. [Fire & Blood]

Aegon the Conqueror brought fire and blood to Westeros, but afterward, he gave them peace, prosperity, and justice

Aegon's first established law was the King's Peace, which forbid conflict in the realm without the leave of the Iron Throne. Aegon treated the defeated lords with respect and allowed each region to retain its own laws and customs and for the lords to retain both the right of pit and gallows and the first night. Aegon often travelled the realm with six maesters who educated him on each region's local customs and history.

...Aegon ignored the suggestions of making the ironborn vassals to the Tullys of Riverrun or the Lannisters of Casterly Rock, as well as the suggestion to exterminate the ironborn by dragonflame. Instead, Aegon allowed the ironborn to name their own lord paramount, for which the ironborn chose Vickon Greyjoy as Lord of the Iron Islands.

The remaining twenty-four years of Aegon's reign were peaceful, so much that the last two decades of his reign were later called the Dragon's Peace by the maesters of the Citadel. He spent much of his time consolidating his power by travelling throughout the Seven Kingdoms and building his capital at King's Landing.

Oh, really.

If the Valyrian's truly were the colonisers many in the fandom claim they are, Westeros would be extremely different.

For one, the predominant faith would be the Old Gods of Valyria, and the Faith of the Seven and the old gods of the north & children wouldn't exist. People would be forced to intermarry siblings/relatives and perhaps even keep slaves according to pre-Doom Valyria (even though the Targaryens stopped slavery once they left Valyria) or forced to marry Valyrian people to dilute their First Men or Andal blood so, eventually, most great houses were mostly Valyrian.

Temples dedicated to the Fourteen Flames would be built, dozens of dragons hatched and left to roam freely and hunt as they please, blood magic and sorcerers aplenty.

The Valyrians didn't do any of that. Aegon I ensured that the separate Kingdoms kept their culture and traditions and respected the Faith. It even says that many Targaryens gave up their faith in the Old Valyrian Gods (or so they say) to worship the Faith of the Seven or Old Gods of Westeros.

Tl;dr; the first men and andals colonized westeros to suit them, slaughtering the natives (children of the forest and giants) and the Targaryens (Valyrians) indeed conquered westeros but respected the land and people and only brought their ways of dragon riding and incestuous marriages who hurt no one :)

And also all the Targaryen's since Daenys's children's era were born on Westetosi soil, Dragonstone/Kings Landing, and thus were in actual fact westerosi but culturally and ethnically Valyrian.

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religion-is-a-mental-illness · 28 days

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By: SEGM

Published: Apr 15, 2024

The Cass Review of England’s gender services for children and young people, initiated four years ago, culminated earlier this week in the publication of the final 388-page report. The report was accompanied by 9 systematic reviews of evidence supporting the recommendations. Within hours, NHS England responded, thanking Dr. Hilary Cass and her team for “stepping up to lead such a complex review.” NHS England committed to following through on Dr. Cass’ recommendations, and acknowledged the national and international significance of this seminal work: “Your final report will not just shape the future of healthcare in this country for children and young people experiencing gender distress but will be of major international importance and significance.”

A wide range of stakeholders–from patients and clinicians to bioethicists, legal scholars and healthcare historians–will undoubtedly be studying the hundreds of pages of the Cass report and the accompanying studies for weeks and probably years to come. However, there is also considerable urgency to understand its key take-aways and the likely implications.

Balancing two conflicting priorities–the need for an unrushed, thorough and accurate analysis, as well as our commitment to the members of the healthcare community to inform them of key developments in the field–SEGM has decided to release our preliminary analysis. We chose to focus only on the most salient aspects of the Cass Report that will likely lead to a change in clinical practice.

What we present below is SEGM’s interpretation of the key messages in the report. We do not doubt that every person who reads the report will find a new “angle” and perhaps have a different interpretation. As always, we welcome disagreement and debate. The “many eyes of science” are needed now more than ever.

Summary

The Cass Review marks the end in England of the era of a highly medicalized approach to the treatment of young people with gender-related distress, which has come to be known as “gender-affirming care.” While the treatment protocol for youth comprising of puberty blockers, cross-sex hormones, and surgery, known as the “Dutch Protocol,” was invented in the Netherlands in the 1990’s, the report points out the concept of “gender-affirming care”–the notion that the doctors must accept children’s declarations of identity at face value and must assist them in gender change as early as possible–actually originated in the United States, and only then spread internationally.

The Cass Review provides a scathing assessment of the gender-affirming approach in general, and the gender-clinic model of care, which operationalized this approach of on-demand provision of gender-reassignment interventions, in particular. Going forward, England will treat gender dysphoric youth <18 using standard psychological and psychotherapeutic approaches, with very few young people receiving endocrine gender reassignment interventions (gender-transition surgeries for <18s have never been allowed in England). Further, the review noted that the group of young adults 18-25 is subject to many of the same concerns as the <18s, and recommended that the new regional “hubs” being set up to help gender dysphoric youth be expanded to include patients up to 25 years old.

NHS England (NHSE) welcomed the Cass Review’s recommendations and expressed a firm commitment to implement the recommended changes. However, NHSE went one major step further, announcing that they will be initiating a Cass-style review into the adult gender dysphoria clinics (GDCs) in England. NHSE had already decided to bring forward to 2024 its periodic review of the adult “service specifications,” which set out what clinical services adult clinics provide; as a consequence of Cass’ recommendations, they are additionally launching a much broader review of the entire adult gender clinic system. This was in part due to the concerns raised by the Cass Review that a vulnerable group of 17-25-year-olds represents fundamentally the same group of youth as the <18s, and needs similar protections from non-evidence-based practices. Further, whistleblower complaints from adult clinics corroborated concerns that vulnerable adults were not receiving proper evidence-based care. The refusal by all but one adult gender clinic to cooperate in the outcome analysis for the 9000 patients as part of the Cass Review likely contributed to NHSE’s determination to investigate the adult service. Adult gender dysphoria clinics see patients aged 17 and upwards, and NHSE has written to require them to halt appointments with 17-year-olds.

In summary, the care for <18s in England will no longer be based on the “gender-affirming” model of care but instead will treat youth with gender distress similarly to how it treats youth with other developmental struggles. Further, with the announcement of the adult gender clinic review, England starts a new chapter in the history of gender medicine, with a new focus on vulnerable gender-dysphoric young adults.

Many more developments are expected from England in the coming months. To what extent the UK changes will impact the West’s approach to helping young gender-dysphoric individuals remains to be seen. In SEGM’s view, the impact will likely be significant, even if delayed, as other countries contend with England’s findings and their implications for evidence-based clinical practice.

Detail Regarding Social Transition, Puberty Blockers, Cross-Sex Hormones, Surgery, and Overall Care Delivery Model

Social Gender Transition

The Cass Review positions social transition as an active healthcare intervention “because it may have significant effects on the child or young person in terms of their psychological functioning and longer-term outcomes.” (UK and other countries’ clinicians increasingly use “social prescribing” interventions in order to impact health outcomes).

For young children, the review strongly discourages social transition, noting that “sex of rearing” may profoundly alter a child’s developmental trajectory, with long-ranging consequences. Should parents insist on it, the review recommended that a healthcare professional be involved in helping parents understand the risk-benefit ratio of such a profound and likely life-altering decision.

For older teens, the review recognizes the autonomy of young people’s self-expression but strongly recommends that parents be involved in the decision, noting that secret transitions cause a rift between teens and their families, destabilizing the very support networks that are essential for young people’s long-term well-being.

More generally, should social transitions be undertaken, the review recommended only a partial, rather than complete, social transition, especially for younger children, noting how many children currently live in fear of being “found out.” The discontinuation of the use of puberty blockers (discussed next) will make that fear a certainty. Thus, it would be highly unwise for a parent to create a situation where a young child is living in “stealth.”

These recommendations were supported by interviews with patients and families, and by a systematic review of evidence of social transition published in a peer-reviewed BMJ journal. The review found a dearth of evidence and concluded, “professionals working in the area of gender identity and those seeking support should be aware of the absence of robust evidence of the benefits or harms of social transition for children and adolescents.”

The recognition of not only the potential benefits, but also the potential harms, and the unknown benefit-harm ratio of social gender transition is noteworthy.

Puberty Blockers

The use of puberty blockers to stop normally-timed puberty will no longer be offered as part of England’s publicly funded healthcare system. This is not a “new development” as the problems with using puberty blockers for gender dysphoria were already part of the Cass Review’s interim report, and NHSE had updated its puberty blocker policy a month before the issuing of the final Cass Review.

The rationale for withdrawing puberty blockers from medical practice is manifold. It ranges from unclear treatment aims (besides altering a child’s body), a lack of credible evidence that stopping normally-timed puberty leads to improvements in mental health, safety concerns (e.g., bone health), and profound unknowns across a range of health domains, especially brain development. The fact that nearly 100 percent of puberty-blocked youth proceeded with cross-sex hormones was treated as a negative signal that puberty blockers may be setting children on an irreversible path of gender transition.

As we noted in our earlier analysis, the NHS guidance regarding discontinuing the use of puberty blockers for stopping normally-timed puberty affects only the NHS clinics. Private clinics (including the single non-NHS youth clinic operating in the UK, as well as online clinics based abroad but serving UK citizens) are not subject to the NHS policies. This created a loophole that could be exploited to circumvent NHS actions to safeguard England’s youth from harmful medical interventions. In response to these concerns, Health Minister Victoria Atkins made clear the government’s intention to limit private gender care for under 18s and to eradicate the online trade in hormones, following Cass’ recommendations.

As we noted earlier, the NHS intends to conduct research into puberty blockers, and there has been much speculation about research design in general, and the eligibility for research in particular. The quote below from the final Cass Review suggests that eligibility may be limited only to natal males with early-onset and long-lasting gender dysphoria. It appears to suggest that natal females may not be eligible, as they can successfully undergo convincing masculinization with the help of testosterone at virtually any age:

14.56 Transgender males masculinise well on testosterone, so there is no obvious benefit of puberty blockers in helping them to “pass” in later life, particularly if the use of puberty blockers does not lead to an increase in adult Height. 14.57 For transgender females, there is benefit in stopping irreversible changes such as lower voice and facial hair. This has to be balanced against adequacy of penile growth for vaginoplasty, leaving a small window of time tо achieve both these aims. 14.58 In summary, there seems to be а very narrow indication for the use of puberty blockers in birth-registered males as the start of a medical transition pathway in order to stop irreversible pubertal changes. Other indications remain unproven at this time.

As we noted earlier, the NSHE made it clear in its puberty blocker update policy that there are no guarantees that such research will obtain the necessary ethical approval.

Like other recommendations in the Cass Review, the puberty blockers recommendation was based on extensive stakeholder consultation, and supported by a systematic review of evidence, which showed no credible psychological benefits of puberty suppression in the treatment of gender dysphoric youth. As we explained earlier, the original 2020 NICE systematic evidence review was updated in 2023, but newly-identified studies did not change its conclusions.

Cross-Sex Hormones

Shortly before the publication of the final Cass Review, NHSE issued an updated policy about the cross-sex hormones. As we noted at the time in our earlier analysis, the policy was only a minor update, necessitated by the launch of the new gender services, and it represented only minor changes. Cross-sex hormones for those around their 16th birthday were still allowed, although a new centralized team not directly involved in care of the young person would need to approve the medical necessity. At the time, SEGM posited that following the final Cass Review, the NHS will commit to a more thorough review of the cross-sex hormones policy, and further updates. This indeed has occurred.

According to NHS England’s response to the final Cass Report:

NHS England will review the use of gender affirming hormones through a process of updated evidence review and public consultation, similar to the rigorous process that was followed to review the use of puberty suppressing hormones.

NHS England has made clear that there will be a single cross-sex hormones policy “which will cover all people over the age of 16,” with further details to follow.

NHSE acknowledged Dr. Cass’s recommendation that “the new providers should be ‘extremely cautious’ when considering whether to refer young people under 18 years for consideration of hormone intervention.” To support this recommendation while the new cross-sex hormones policy is being developed, NHSE has “established a national multi-disciplinary team (MDT) that will review and need to agree all recommendations for hormone intervention.” Further, NHSE noted that the “first meeting of this new national MDT will take place later this month” chaired initially by Professor Judith Ellis, former CEO of the Royal College of Paediatric and Child Health.

The original NICE systematic review of evidence for the effects of cross-sex hormones was conducted in 2020, and it found similar problems in the evidence base as the puberty blockers review (unreliable evidence base), but with a signal that there may be some small short-term improvements in mental health following cross-sex hormones administration. The new systematic review of cross-sex hormones confirmed these findings.

The final Cass Review expressed concern over how small these changes were, considering the fact that the introduction of the long-awaited cross-sex hormones and desired physical changes is expected to lead to short-term improvements in mood. This suggests that the Cass Review is concerned not only with the low certainty of the reported benefits due to poor study designs, but also with the possibility that the small improvements may be short-lived and due to the potential placebo effect:

15.27 When a young person has been on puberty blockers, a short-term boost in mental wellbeing is to be expected when sex hormones are introduced. Testosterone is faster to produce physical changes than oestrogen, and birth-registered girls can expect to start seeing body changes in line with their identified gender within a few months. The start of long anticipated physical changes would be expected to improve mood, at least in the short term, and it is perhaps surprising that there is not a greater effect size. However, much longer term follow-up is needed to understand the full psychological impact of medical transition.

The NHSE’s announcement made it clear that the final cross-sex hormones policy will be based on the updated systematic review of evidence.

Surgery

Surgeries have never been available to under 18’s in England, so no systematic reviews of surgeries has been conducted, and no additional changes to the policy for youth under 18 are needed. However, NHSE’s announcement of the Cass-style review into the adult gender clinics raises questions about whether surgical interventions for young adults will now come under scrutiny as well.

Change in the Delivery Care Model Overall

In addition to making specific recommendations overall about social transition and endocrine interventions, the review challenged the concept that gender dysphoria/gender incongruence in youth as an exceptional condition that needs exceptional treatments delivered via exceptional models of care exemplified by gender clinics.

The healthcare delivery system for gender dysphoric youth will be restructured to provide a fundamentally different model of care, and realign it with the way care is typically organized in England. Every gender-dysphoric child or young person will have a dedicated primary care provider (a pediatrician or a GP) overseeing their care and well-being. Children and young people with mental health conditions, or those whose gender incongruence is causing distress, will receive psychotherapeutic and psychological services from the second level of care at the Child and Adolescent Mental Health Services (CAMHS).

Very few young people will be referred to super-specialized tertiary services, which will carefully examine the medical necessity of cross-sex hormones. The referring clinicians will need to demonstrate why cross-sex hormones delivered to under-18’s are medically indicated and preferred over allowing the young person to reach maturity, and a centralized team not directly involved in the care of the young person will need to agree with this assessment. It is expected that in the end, very few young people will be treated with interventions to alter their bodies.

Other notable aspects of the final report

The final Cass Review made a number of other highly consequential statements and observations. It is impossible to do a thorough overview of all of them given the short time since the report’s release, but we will highlight several that stood out to SEGM as particularly noteworthy.

Although chiefly forward-looking, the review described the alarming inadequacies of clinical practice at GIDS.

While the focus is on service improvement, the legal ramifications of the unsafe practice at GIDS in the longer term must be apparent to NHSE. GIDS refused to participate in the review’s research study, to compare clinical practice at a range of European pediatric gender clinics, therefore the report (at Appendix 9) of the Multi-Professional Review Group (MPRG) which oversaw GIDS’s referrals for puberty blockers is the major source of information about what went on there. The MPRG painted an extraordinary picture. It was not clear how thoroughly different treatment options had been discussed, and most children and parents were asking to obtain puberty blockers from their first appointment with GIDS, having “turned for information to the media and online resources, with many accessing LGBTQ+ and GD support groups which appear to be mainly affirmative in nature.”

Concerns of over treatment of neurodiverse and same-sex attracted youth.

Neurodiversity was suspected or diagnosed in a majority of children referred for puberty blockers and where sexuality was discussed “most cases are of same sex, opposite-gender attracted children.” The MPRG were “concerned about the lack of evidence of professional curiosity” about these children’s lives shown by GIDS clinicians. A recurrent concern was “the inadequacy and on occasion inaccuracy of answers given to children and their families by GIDS and their failure to correct child and parental misconceptions about puberty, puberty blockers and hormones.” Unsurprsingly, then, they note that the Care Quality Commission’s (CQC) observation that consent taking was judged to be “not in line with NHS and GMC requirements.” Records varied “from succinct to disorganised.”

A scathing assessment of poor quality and lack of independence for the guidelines by WPATH, The American Academy of Pediatrics (AAP), and the Endocrine Society (ES).

As part of the Cass Review, an independent team of research methodologists assessed all the current treatment guidelines and recommendations for quality in a systematic review, using the internationally recognized AGREE II methodology for evaluating guideline quality. The AAP 2018 treatment recommendations guidelines scored amongst those at the bottom of the 23 reviewed guidelines. The WPATH and the ES treatment recommendations did not fare much better. The review noted a marked lack of independence in guideline authorship, noting circular referencing: one non-evidence-based guideline was used to justify another non-evidence-based guideline’s recommendation. The significant overlap in authorship between the guidelines (especially between WPATH and ES) was noted as a significant cause for concern, as was WPATH’s refusal to acknowledge the results of their own systematic review in its adolescent section. The report points out that only the Swedish and Finnish treatment recommendations appear credible, but even they lack the specificity needed for the NHS to operationalize the treatment recommendations in the UK context. The concern over the proliferation of non-evidence-based guidelines, which at times do acknowledge the poor quality evidence but then issue strong recommendations to medically transition youth anyway, has been seconded in the BMJ article dedicated to this specific aspect of the Cass review findings.

Condemnation of the “toxic” nature of debate within which standard psychological therapies were rebranded "conversion practices."

The Cass Review drew attention to the difficulty of undertaking the review amid an “increasingly toxic, ideological and polarized public debate” that ill-served children. The report noted that it is essential to explore children’s complex needs and stated that it is “harmful to equate this approach to conversion therapy as it may prevent young people from getting the emotional support they deserve.” Furthermore, potential accusations of conversion practice “when following an approach that would be considered normal clinical practice” in other scenarios made clinicians wary of offering support to young people, leaving them without the help they deserve. The report highlighted the potential for legislation on conversion practices to complicate the situation and emphasized that “strong safeguards must be built into any potential legislation” to guard against the risk that clinical staff feel that discharging their duty of care would expose them to legal challenge.

Questioning the assumption of the gender identity theory.

While some have criticized the Cass Review for relying on constructs coming from the gender identity theory (e.g., referring to “gender identity” without critically assessing the origin and validity of this concept), the report did briefly address the outdated nature of the assumptions on which the “gender-affirming” care model is based. The report noted that the theory of gender identity development was set forth in 1966 by Kohlberg, who described a typical progression whereby by the age of 5-6, children develop gender identity constancy.

The report noted the obvious fact that the current patterns of both identifying as transgender for the first time at much older ages and also the growing phenomenon of detransition and re-identification with natal sex demonstrably contradict this theory.

The review considered a range of factors that may have contributed to the current phenomenon of a sharp rise of trans identification in youth. It noted that while biology likely plays a role, “since biological factors have not changed in the last 10 years it is necessary to look at other possible reasons for the increase in referrals and the disproportionate representation of birth-registered females.”

8.23 For children and young people with gender incongruence, ‘innate’ or biological factors may play a part in some individuals, in ways that are not yet understood, and in others psychosocial factors, including life experiences, societal and cultural influences, may be more important. Since biological factors have not changed in the last 10 years it is necessary to look at other possible reasons for the increase in referrals and the disproportionate representationof birth-registered females.

Recognition that the challenges in the mental health of Generation Z are likely at the root of the current phenomenon of trans identification in youth.

The report acknowledged the likely multi-factorial basis for the current explosion of gender-dysphoric youth, with a focus on “Gen Z” and the significant mental health crisis affecting this population more generally, as well as the role of social media.

7.21 The striking increase in young people presenting with gender incongruence/dysphoria needs to be considered within the context of poor mental health and emotional distress amongst the broader adolescent population, particularly given their high rates of co-existing mental health problems and neurodiversity. 7.22 Internationally, there have been increasing concerns about the mental health of Generation Z. The reasons for this are highly speculative, although there is ongoing debate about the contribution of excessive smartphone use and social media as discussed above.

Suggestion that the invention and the availability of the Dutch protocol likely contributed to the rapid rise in gender dysphoria in youth.

The report noted that the sharp rise in the numbers of gender dysphoric youth in the West also coincided with the introduction of puberty blockers into general medical practice. Of note, the Netherlands experienced a similar spike several years before the rest of the West–and incidentally, the Netherlands introduced the Dutch protocol/blockers into clinical use several years before the rest of the West. This lends further credibility to the theory that the very availability of the Dutch protocol treatment may have contributed to the growing numbers of youth seeing their developmental struggles through the “gender identity” lens and pursing medical interventions.

8.50 The dramatic increase in presentations to NHS gender clinics from 2014, as well as in several other countries, coincided with puberty blockers being made available off protocol and to a wider group of young people. The only country with an earlier acceleration in referrals is the Netherlands, where the Dutch protocol was developed.

Clear attribution of the “gender-affirming” model of care to the United States.

While it was the Dutch clinicians who came up with the “innovative clinical practice” to use puberty blockers in an off-label way to stop normally-timed puberty of gender-dysphoric youth, the report suggests that it was the Americans who propagated the approach of allowing the child to direct what medical interventions they need based on their self-declared identity.

Specifically, the review credits an American psychologist Diane Ehrensaft, who pioneered and promulgated this theory, which has become the core of the “gender-affirming” model of care. The report describes the model as a belief that “a child of any age may be cognizant of their authentic identity and will benefit from a social transition at any stage of development.”

2.13 In 2007 Norman Spack established a clinic in Boston, USA modelled on the Dutch protocol and began prescribing puberty blockers from early puberty (Tanner stage 2). 2.14 Practice in the USA began to diverge from the models of care in Canada and the Netherlands, following instead a gender affirmative model advocated by Diane Ehrensaft (Eherensaft, 2017). She described the three approaches as follows (Ehrensaft, 2017): “The first model, represented in the work of Drs Susan Bradley and Ken Zucker [Canada], assumes that young children have malleable gender brains, so to speak, and that treatment goals can include helping a young child accept the gender that matches the sex assigned to them at birth. The second model, represented in the work of practitioners in the Netherlands, allows that a child may have knowledge of their gender identity at a young age, but should wait until the advent of adolescence before engaging in any full transition from one gender to another. The third model, represented in the work of an international consortium of gender affirmative theoreticians and practitioners, allows that a child of any age may be cognizant of their authentic identity and will benefit from a social transition at any stage of development.” 2.15 The third model - the ‘affirmative model’ - has subsequently become dominant in many countries. As a result, some gender services have moved away from a more exploratory approach, and this is seen by some advocacy and support groups as a move to ‘gatekeeping’ model.

Incidentally, (a fact the the report does not mention), Ehrensaft was also a notable figure in promoting the now-defunct theory of repressed memory of satanic abuse, and published on the subject. This subject is outside the scope of this analysis, but notably, the epidemic stopped only after successful lawsuits demonstrating that some psychologists facilitated the patients’ “recovering” non-existing memories of abuse as an explanation of the patient's distress.

Clear acknowledgment of detransition as a growing phenomenon that can no longer be ignored.

There was a chapter dedicated to detransitioners, and the term “detransition” was mentioned in the report over 80 times, citing a number of studies from the UK and internationally. The report recognized that the rate of detransition and regret among the novel population of youth is unknown, but suggested it is no longer negligible, citing a UK study of double-digit detransition in a relatively short follow-up period. Of note, a recent US study found that among participants who were medically transitioning, almost 30 percent ceased medical transition based on a 4-year average followup, but the reasons for the cessation were not explored.

Suggestion of lack of data integrity in gender clinics.

The Cass Review revealed that in a truly unexpected turn of events, all but one adult gender clinic refused to cooperate in a data analysis project that would have allowed tracking of longer-term outcomes of 9,000 gender dysphoric young people, which included both those who underwent gender transitions as well as those who chose less invasive options. The responsibility for the research, which has obtained ethics permission, has now been handed over to NHSE, which will conduct the review without the gender clinics’s cooperation. The objection of the gender clinics and the responses to those objections (both contained in the appendices to the report) suggest that the reasons for the lack of cooperation may be ideological.

Further, there are indications through the report that there may be a lack of integrity in the gender clinic approach to data collection and reporting more generally. For example, the Cass team was advised by GIDS/Tavistock (the youth gender clinic) that only 27 percent of the referred cases were referred for endocrine interventions (puberty blockers and/or cross-sex hormones), creating the impression that only a minority of gender dysphoric youth are intervened with medically.

However, the context of the report signaled that this figure is open to misinterpretation (without directly calling it misleading). The report noted that the 27 percent only applies to the young people who were referred directly to the two adolescent endocrine centers. Among the 73 percent “non-referred” for endocrine interventions, 69 percent actually went on to adult gender clinics, where most likely received hormonal interventions.

The question of what percentage of youth referred to gender clinics end up transitioning is an open one. In the Netherlands, which claims a cautious approach, this number appears to be around 70-80 percent. It is reasonable to expect similar or even higher numbers among gender clinic staff who subscribe to the “gender-affirming” model of care.

Problems with applying the Dutch protocol to the “wrong” population.

The report clarifies that GIDS/Tavistock’s approach to validating the Dutch protocol failed on at least 3 accounts. As previously discussed, the clinic started scaling the treatment before they analyzed and published the results and they also changed the protocol where the minimum age of 12 for puberty blocked was dropped and replaced by pubertal tanner stage 2 stage–which can be as young as ages 8-9 in girls. However, the report highlights another important deviation, which may be responsible for the sheer scale of the current problem.

While the research study (aka “Early Intervention Study”) was only approved to include youth with the classic early childhood, the pre-pubertal onset of gender dysphoria that intensified in adolescence with no other significant mental health problems (to replicate the Dutch research), when the clinic chose to scale it widely, it expanded eligibility to all youth including those whose gender dysphoria emerged post-puberty and in the context of complex mental health problems (p. 73). The latter group currently represents the single biggest affected demographic.

The fact that the Dutch research is currently being applied to the very demographic which was originally contra-indicated for gender transition and that this problem is not confined to the UK but is a worldwide problem, has been highlighted in a number of recent publications and emphasized in the Cass report.

The current “suicide and suicidality narrative” surrounding gender-dysphoric youth is misleading.

The Cass Review noted that “balanced information, which is realistic and practical, and does not over-exaggerate or underestimate the risks, is essential to support everyone involved and identify young people in most urgent need of help.” The review commented on the thankfully low rates of completed suicides in the population of trans-identified youth, pointing out the latest evidence from Finland. However, the review appropriately recognized every suicide is a tragic event and the causes in each individual case must be clearly understood. The report noted a recent UK analysis of suicides using the National Child Mortality Database (NCMD). The analysis of 91 cases of youth suicides between April 2019 and March 2020 (1-year span) identified 108 total deaths across the entire population of the UK that were likely due to suicide. In examining the factors contributing to suicides, the Child Death Overview Panel concluded that Household functioning was found to be the most common contributing factor (69%), followed by mental health problems (55%), bullying (23%), and neurodevelopmental conditions (16%). Sexual orientation, sexual identity, and gender identity were assessed as a factor in 9 percent of total suicides. The Cass report did not provide an additional breakdown for sexual orientation vs gender identity. However, the report did note that systematic reviews failed to provide evidence that endocrine interventions reduce suicides.

The problem with the notion of the “diagnostic assessment.”

The report zooms in on a central argument leveled by gender-affirming clinicians that “gender-affirming” treatments are only provided following a diagnostic assessment, and therefore are medically necessary. The review aptly points out that neither the DSM-5 diagnosis of “gender dysphoria,” nor the “de-pathologized” ICD-11 diagnosis of “gender incongruence,” have a known predictive validity. In other words, a young person can meet the diagnostic criteria today, but nothing is known about how likely the young person is to continue to experience gender-incongruent feelings in the future.

16.8 A formal diagnosis of gender dysphoria is frequently cited as a prerequisite for accessing hormone treatment. However, it is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them. Depending on what has caused their distress or dysphoria, it may be resolved by medical treatment, but it may also be resolved in other ways.

The Cass Report notes, “The Review was unable to obtain clear criteria from the GIDS team on their criteria for referral for endocrine intervention.” The report also points out that if the causes for gender-related stress are “psychosocial,” “sociocultural” and/or “dynamic,” providing invasive and irreversible interventions to such young people presents a challenging ethical dilemma.

16.9 As discussed in Chapter 8, the nature and causes of gender dysphoria/incongruence are complex and poorly understood, and there is very limited understanding of the currently presenting population of predominantly birth registered adolescent females. Each individual will have a different mix of biopsychosocial factors, but if potentially dynamic psychosocial or sociocultural factors predominate in a significant proportion of people, one of the most challenging ethical questions is whether and/ or when medical intervention is the correct response.

Further, the report takes on the notion of the “diagnostic assessment” itself, noting that there is no formalized assessment process whereby one can determine how to conduct such an assessment, and how to arrive at predictable outcomes as to which young person is referred to the endocrine interventions and which one is not. The report notes:

10.17 There was also a general lack of understanding among service users participating in the lived experience focus groups about what the assessment was for and confusion about what was assessment and what was diagnosis. Thoughts on the purpose of the assessment included: • To support young people to explore their options and access the care that’s right for them. • To get validation of their trans identity and access to the medication pathway. • To make the person comfortable and focus on what they’re looking for from the service. • To ensure patients have an understanding of the healthcare options available.

The report concluded that, following a review of international clinical practice, “there was no approach to assessment that could be directly adopted for use in the NHS.” One needs to be developed to meet key goals (support identification of individual needs, allow outcomes to be measured more consistently and ensure children and young people have a similar experience of the service.)

The fundamentally new model will focus on assessment with the goal of “case formulation” followed by psychotherapy as the first line of treatment.

The new treatment framework will be comprised of the assessment, case formulation, diagnosis, care plan. Due to the problems described above (lack of specificity of what the goal of the “assessment” are), the report sets out a new and clear expectation of the role of the assessment. Rather than attempting to identify which young person should be referred to endocrine interventions, the goal is to “derive a multi-level formulation for a child or young person who presents to the NHS seeking help around their gender or experience of gender-related distress.”

The starting point of the assessment is to assess immediate risk and assess complex care needs. Assuming any immediate risks (if any) are addressed using standard psychotherapeutic approaches, the next goal is to come up with a “case formulation.” A case formulation is a standard psychotherapeutic process whereby clinicians synthesize the complexity of the young person’s situation to develop an individualized treatment plan.

The report makes it clear that if any interventions are indicated, standard psychotherapeutic interventions for mental health conditions, as well as more specific exploration of gender-related distress (if indicated), will be the primary treatment. Referrals to endocrine interventions will only be accepted from the Child and Adolescent Mental Health Services (CAMHS) with onus on the clinician making the referral to demonstrate to a centralized team that includes members not directly involved in the care the medical necessity of cross-sex hormones. As mentioned elsewhere, Cass recommended extreme caution in prescribing cross-ses hormones to youth, and the NHS has committed to updating its current cross-sex hormones policy to align it with the final report recommendations.

Recognition of the need to update the diagnostic categories to meet the changing clinical presentations of gender-related distress, and the phenomenon of detransition.

The Cass Review subtly but powerfully signals that the DSM-5 “gender dysphoria” diagnosis appears to be preferred by most clinicians, while the attempt to “de-pathologize” the condition in ICD-11 is less clinically useful.

At the same time, the report recognizes that neither of these diagnostic categories are adequate for the current complexity of the presentations. The diagnosis itself was criticized for relying on outdated notions of preferences for sexed stereotypes from “previous decades,” and the “DSM-5 diagnostic criteria for gender dysphoria has a low threshold based on overlapping criteria” leading to the risk of overdiagnosis and overtreatment. Further, the report indicated that the diagnosis is unhelpful in the care for the growing number of detransitioners as it does not have any specific categories for this growing patient population.

New focus on young adults.

The report recognized the new understanding of adolescent development and that adolescence does not stop at 18 but extends into mid-20s. Noting the disproportionate number of non-neurotypical individuals struggling with gender identity, the report noted that neurodiverse young people are particularly vulnerable “into their early 20s or longer because of their tendency to want black-and-white answers, and their difficulty in tolerating uncertainty.”

Consistent with that, the report recommends that the restructured approach to gender-dysphoric youth does not stop at 18, but subsumes the category of young adults. In addition, the report notes that while the provision of adult gender services fell outside of the review’s remit, several staff in adult gender clinics “contacted the Review in confidence with concerns about their experiences working in adult gender services.” Adult clinic “whistleblowers” shared that adult services experienced a similar influx of young adults, primarily females with complex mental health problems, presenting to adult gender clinics with an expectation of rapid provision of “gender-affirming” medical interventions, as well as growing numbers of detransitioners. The whistleblowers expressed deep concerns about the harm to the vulnerable population of young adults which seemed to represent the same demographic that began to be seen at the Tavistock a few years ago.

As a result, the review recommended a heightened focus on the adult services, and the NHS has responded by announcing an investigation into the adult NHS gender clinics.

Call for the development of new treatments and clear clinical targets.

The review recognizes the the evidence base for psychotherapeutic approaches to the management of gender dysphoria in youth is very low quality. At the same time, the report pointed out that standard therapeutic interventions for distress are the standard of care in medicine, and that no studies of the application of this approach to gender dysphoria have shown harm.

The review stated unambiguously that the “ultimate goal of any intervention is to help the child or young person to function and thrive, they need to be provided with tools and strategies to give them the best opportunity to do so.” The review called for the development of an “explicit clinical pathway for non-medical interventions, as well as a research strategy for evaluating their effectiveness.”

With this recommendation, the Cass report has redirected the clinical community towards the development and study of non-invasive clinical interventions with a focus on long-term outcomes, with the goal of helping young people achieve the best quality of life.

SEGM Take-Aways

The single most salient take-away is that the so-called “gender-affirming” model of care, which treats young people’s declarations of transgender identity as an indication that any physical body modification desired by the young person is medically necessary, is over in England. So is the era of the “gender-clinic model of care,” which exists to operationalize the highly medicalized “gender-affirming” care model.

We end our take-away by pointing the readers to a powerful editorial by the BMJ Editor in Chief. The entirety of this short editorial is worth reading, but we will highlight the more salient quotes below:

“Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions.”

“Without doubt, the advocacy and clinical practice for medical treatment of gender dysphoria had moved ahead of the evidence—a recipe for harm.”

“...Families, carers, advocates, and clinicians—acting in the best interests of children and adolescents—face a clear choice whether to allow the Cass review to deepen division or use it as a driver of better care.”

This analysis, published by the Editor-in-Chief of one of the most prestigious medical journals in the world, signals that the implications of the Cass Review will likely reverberate worldwide. It now appears inevitable that the arc of history has bent in the direction of reversal of gender-affirming care worldwide, although in some countries it will take considerably longer to change medical practice.

The Cass Review is a historic document the significance of which cannot be overstated. It is also multi-faceted, and no single analysis can do it justice. We have done our best to synthesize the most salient aspects of the review after a single reading. We have no doubt that we missed other important aspects and we trust that others will point them out.

#SEGM #Society for Evidence Based Gender Medicine #Cass report #Cass review #Dr. Hilary Cass #Hilary Cass #NHS England #National Health Service #gender affirming care #gender affirming healthcare #gender affirmation #medical scandal #medical malpractice #medical corruption #religion is a mental illness

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