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Notes -
Addressing the other parts of your post:
I agree it's "fine" from a CYOA point of view, as in, no one will be able to blame you for using a standard tool used across the industry. But from the perspective of trying to perform a Bayesian update based on the final report, I'm not sure I agree.
A lot of the scientific method in general is a heuristic crystallization of Bayesian approaches, and so I have no doubt that a lot of what is present in GRADE is justifiable across a wide swath of evidence, and comes to largely the same answer as a Bayesian approach would. But I think that if GRADE systematically downgrades some kinds of evidence from being "high quality", which in a proper Bayesian approach wouldn't require any serious adjustment, that can lead to certain evidence being ignored or de-emphasized compared to where it should.
I think absent any other evidence, just the existence of the Replication Crisis is enough to call a lot of medicine into doubt, and I see no reason why this wouldn't apply to trans healthcare. That the evidence is weaker than often claimed, is almost certainly true. (I'm not sure that that isn't the case for a wide variety of healthcare fields as well though - is trans healthcare uniquely bad, or is it just as bad as medicine as a whole, and do we need to adopt a whole swath of reforms to deal with things like p-hacking, the file drawer effect, small sample sizes, etc.)
I agree with Cass' conclusion, even if I question her methodologies, because I want to see higher quality medical evidence around trans issues, and especially trans kids. I want the medical research to be beyond reproach, whatever conclusions it comes to.
The basic problem with medicine, across the board, is that we're routinely doing barbaric things to be people, and the only justification we can have is that the evidence shows it will have a better outcome for the patient. Chemotherapy involves poisoning a patient with the hope that the poison will kill the cancer faster than it kills the patient. Amputating a limb might be a tough decision sometimes, but it is most justified if a patient would likely die if you didn't do it.
I want the evidence we use in all instances, especially trans healthcare to be airtight so that no one can say we're poisoning people or removing functional limbs or organs for no reason. It'll still be "barbaric", but if it can be justified as much as chemotherapy, then I think trans healthcare will be in a good place.
Well then I have 4 words for you: isolated demand for rigor. If you want to throw out all the published studies, and force the authors to do them right, I'm game. If we're supposed to apply the highest standards to Cass, and ignore the gaping holes in the literature published to date, I don't think you'll get a lot of people signing up for that.
As per my other comment, I've seen no indication that it does. The whole argument smells like a scramble to get some talking points out ASAP so the report doesn't get to circulate uncontested, even for just a few days.
There's a few major differences between cancer/chemotherapy and dyshporia/GAC. For one, the risks of cancer are pretty well measured. A doctor can tell you "you have an X% chance of living Y months/years" and be mostly right. By contrast a GAC doctor saying "would you rather have a happy daughter or dead son" is stoking fears that aren't justified by data at all. We are also open about the mechanism and effects of chemotherapy, every doctor will tell you it's basically poison, but the hope is it will kill your cancer before it kills you. By contrast puberty blockers are declared to be a magical pause button, safe, and fully reversible. That's just an outright lie. We also have good data about the chances of chemotherapy working, but not for puberty blockers improving outcomes for dysphoria. Finally, even if the decision to undergo treatment is the right one based on available data, we only do it with informed consent, which we tend to not have in case of GAC, by gender clinicians' own admission (see: WPATH Files).
You're right that there are issues in all of medicine, but we ensured there are some guardrails around it to minimize the barbarity. The guardrails were happily abolished for GAC at the insistence of trans activists, and the result is that "gender affirming care" is a lot more barbaric than other forms of medicine practiced today.
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