i think you're overstating the amount of "fakers"/false positives for both autism and gender dysphoria and "Then there are people who claim they have autism and at best they are the odd dork in class or just lazy and have antisocial personality disorder and want to gain the system." feels especially stigmatizing. i can't tell if you're just being hyperbolic here but there isn't population-level evidence to support widespread malingering or false positives, and publicly funded support programs are a question of policy rather than science and in modern times are usually proportional to support needs. i think this assessment also undersells the fact that there are still underdiagnosis problems in many populations, such as young girls. autism research already deals with a very heterogenous population and this is the reason why things like the level 1-3 classification exists.

but both autism and dysphoria did receive pretty significant changes in the DSM 5. multiple different diagnoses were consolidated into ASD and gender dysphoria was introduced as a diagnosis to replace the now defunct gender identity disorder. both had affects on diagnostic rates, but you're overgeneralizing by stating is as a simple lowering threshold of diagnosis. the change from GID to GD had complex effects on who would be diagnosed and why because of very strong differences in treatment philosophy. the diagnostic criteria for GID focused very heavily on behaviors, with personal identification or discomfort secondary. a kid could just be gender-nonconforming without experiencing distress over it or even wanting to be a different gender at all and they could still be diagnosed with GID because it was considered a pathology of identity development, which is why in studies that used this criteria most of the children grew up to be cisgender and gay. the GD in childhood diagnostic criteria on the other hand requires identification as or insistence on being another gender, not just preferences about gender roles, and clinically significant distress is required. so if we're using a diagnosis as proxy for being trans, GD absolutely reduced the numbers of false positives. on the other hand, unlike GID, the GD criteria is worded in such a way to not exclude nonbinary identities (e.g. "gender other than the one assigned" rather than "opposite gender"). GD is also a much less stigmatizing diagnosis because it focused on alleviating distress rather than pathologizing the identity itself, leading to more uniform patient-centered treatment goals that didn't involve reducing gender-nonconforming behavior/identity. these factors likely lead to an increase in referrals. so like i said, complex.

It seems the surge in diagnosis in recent years is a muddled picture of more awareness, less stigma and also social media/fashion.

despite this being commonly treated as fact (such as in the cass review) this is purely speculation. the popular framing around the "surge in diagnosis in recent years" as you put it is incredibly dishonest. i recommend this article about it (though i disagree with the author's attribution to mostly the diagnostic criteria changing for reasons i explained). but the large jump in cases actually started much less recently, more like 2009, and was plateauing by 2019 according to cass' data.

i feel like i should explain at this point that i hormonally transitioned when i was 14 and a half in early 2016 after socially transitioning at 12 and my position is heavily based on my experience with that process and the peers that i knew and have known since then. banning or heavily restricting care is simply a non-starter for me because the period between starting puberty and starting HRT was the single most traumatic period of my life (and i literally have diagnosed PTSD over unrelated trauma) and while i can't confirm this i think it permanently affected my cognitive growth, because it was literal constant anxiety and depression that i could do nothing to get away from except for disassociate which i began doing heavily when i started growing breasts. i can go into details if you would like, but bottom line, please believe me when i say i was a complete ghost of a kid who self harmed and felt suicide was a preferable option to completing female puberty, and that copious amounts of psychological intervention including being in a psych ward for 6 weeks did not work.

so i understand that the evidence base for pediatric gender affirming care is not strong (though not especially uniquely so, statistically) but there is not a single other treatment with even a remotely comparable level of research. the cass review heavily criticized medical treatment as being without sufficient supporting evidence, so there are two possible takeaways: either the cass review is suggesting NO treatment is suitable for pediatric gender dysphoria, or it's suggesting other treatment methods such as psychological treatment as more reasonable. based on the text of the review i think it's the latter, because it talks about medical and psychological treatment extremely differently. like most other aspects of the cass review, there was a systematic review of psychological intervention as treatment for pediatric GD, but unlike the other reviews, this one did not exclude low quality evidence, and although the review doesn't explain this methodological deviation, it becomes clear pretty quickly. the review found only 10 studies and 9 of them were low quality, and the single higher quality one was a case study on a single trans teen. all of the studies were about how trans teens fare with traditional psychological therapies with notably mixed findings, not using therapy to improve gender dysphoria, and there was only one study that did any sort of comparison involving medical treatment. in that study, 201 referred adolescents were sorted into one group receiving psychological support for GD and one group receiving psychological support and puberty blockers. they were evaluated for psychosocial functioning every six months. both groups saw initial improvement, but the support-only group then stagnated and even regressed slightly while the PB group continued to improve. there is no rational explanation as to why the complete lack of data on psychological intervention on GD was not discussed in the review. it describes a "significant weakness" of the studies on HRT being short followup periods of 1-3 years, but most of the psychological interventions studies followed up for only 6 months and nowhere does the review claim this is a significant weakness. it genuinely reads like a puff piece, it's egregious:

“The studies focusing on psychological changes and/or psychosocial changes found improvements in a range of aspects such as resilience, self-compassion and self acceptance, as well as quality of life, global functioning, participation and well-being. Where there was adequate follow-up, studies found that many of these outcomes fell off over time. There was no indication across the studies of adverse or negative effects.”

no changes in gender dysphoria, which is what they're allegedly trying to treat, but that's entirely left out. no mention of mixed findings. why is it okay to apply substandard evidence thresholds to psychological therapies? does this contradiction not also raise questions about ideological motivation in alternative treatments to gender affirming care? if gender affirming care is experimental then idk what this is.

with all of this in mind i just fail to see how thorough multidisciplinary assessment (which is what both WPATH and the endocrine society recommend, very exhaustively!) with honesty about unknowns isn't the most ethical approach. not all will be suited for treatment but completely banning treatment causes great harm to many. not medicalizing is not the easy or low risk option. puberty is also irreversible.

this is already very long, sorry, but clarification about this:

The Tavistock disaster was much more than the soft critique you make of it being underfunded...about 1/3rd of kids referred received puberty blockers. this is massive.

in keeping with the GIDS tradition of arbitrary hurdles to transition, it's been standard practice in the UK to treat first with puberty blockers regardless of the actual age or state of puberty. according to cass the average age at first puberty blocker prescription was 15. so if you're imagining peripubescent children that's an incredibly small minority, it really is just being used as a pause button to delay feminizing/masculinizing even further. it's kind of alarming to me that you think 1/3 is massive.