‘THIS is as insulting and ignorant an article as I have ever regretfully read. I am ashamed of The National for publishing this crap.”

That was the robustly expressed view of one reader four years ago, when I wrote about female detransitioners – young women who had attempted to become men via a process of medical transition, but later deeply regretted doing so.

That reader was very quick to declare the column “another attack on the rights of trans to be trans”, accusing me of spreading “absolutely undocumented and unproven rumours” by amplifying the testimonies of those who had shared the most painful experiences of their lives with a room full of strangers.

At that point, Keira Bell was still anonymous. I had heard her speak – quietly, hesitantly – the previous November at an event in Manchester called Detransition: The Elephant In The Room, but she went by a pseudonym and asked not to be filmed. I could never have imagined that before long her name would be synonymous with the topic about which I was writing.

With extraordinary bravery, she became the complainant in Bell v Tavistock, a case challenging the legality of prescribing puberty-blocking drugs to under-16s in England and Wales.

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It can no longer be claimed that cases like Keira’s – prescribed puberty blockers at 16, testosterone injections the following year, a double mastectomy at 20, then detransition from 21 – are undocumented, that the stories of their experience are mere “rumours”. Will my critic have shifted her position accordingly?

Somehow I doubt it.

Referring to another Manchester speaker who underwent removal not only of her breasts but also her womb and ovaries, I wrote: “Might writing about this young woman, and others like her, contribute to the spreading of fear about gender transition? Quite possibly, but perhaps it should.” I highlighted the absence of research on detransition and the alarming rise in referrals of girls with complex difficulties to gender identity services.

“Whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down,” wrote Dr Hilary Cass (below) in the final report of her long-awaited Review of Gender Identity Services for Children and Young People, commissioned by NHS England and published last week.

The National: Dr Hilary Cass has published her long-awaited report into gender services for children in the NHS (Yui Mok/PA)

“For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/retransition and/or experience regret. The NHS needs to care for all those seeking support.”

Working out how best to provide such care is a significant challenge, not least because of what Cass describes as the “surrounding noise and increasingly toxic, ideological and polarised public debate” about child transition.

Doubtless my critic from January 2020 would regard my work as part of that “noise”, that toxic and polarised debate. Perhaps she would regard Cass herself as contributing to it by noting that some children overcome their gender distress without permanently assuming a trans identity (is this, too, an “attack on the rights of trans to be trans”?).

The perceptive writer Victoria Smith has long warned that when politicians and journalists shift their positions on issues related to trans ideology, “they will blame ‘terfs’ – women who said what they are now saying, only earlier – for making it impossible to express themselves without sounding ‘hateful’.”

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For those who have been smeared, sacked and physically attacked, this will be infuriating. But personal vindication was never the primary goal of those raising the alarm about the unknown long-term effects of puberty-blocking drugs, cross-sex hormones and experimental surgeries on young bodies. The priority is protecting young people from harm.

The findings of the Cass review were unsurprising, given its interim reports led to the halting of prescription of puberty blockers to children in England outwith clinical trials. NHS Scotland has yet to follow suit, with the Scottish Government last week saying it would “take the time to consider the findings” of the final report. Let’s hope that doesn’t take too long.

Ministers will no doubt be nervous about asserting that healthcare in this area must be informed by evidence, not ideology. Citing the Cass report won’t be enough to stem the fury of those who wish to frame any note of caution as an attack on their identities and therefore a threat to their very existence.

Fortunately for Humza Yousaf and his new health secretary, Neil Gray, plenty of prominent figures from the campaign for “trans rights” are now performing shameless reverse ferrets to pretend they always supported the kind of holistic, evidence-based services Hilary Cass wants to see provided to young people.

An approach that mere weeks ago was tantamount to conversion therapy is now the thoughtful care that all right-thinking people should support.

If only the women urging compassion and caution earlier hadn’t done so in such an “insulting and ignorant” way, we would surely have arrived at this point sooner.