The final report of the Cass Review – a major investigation of gender identity services for children and young people in the UK – has been released.
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The much-anticipated report outlines the findings and recommendations of Dr Hilary Cass through the Independent Review of Gender Identity Services for Children and Young People, commissioned by the National Health Service (NHS) England.
The Review was tasked with making recommendations on “how to improve NHS gender identity services, and ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria receive a high standard of care, that meets their needs, is safe, holistic and effective.”
Echoing the findings of the Review’s interim report, which posited there are “gaps in evidence” around treatment of trans youth, Dr Cass’ final report claims the “evidence is weak and clinicians have told us they are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.”
The report’s summary also acknowledges that the arena has “strong and widely divergent opinions” and that these opinions are “unsupported by adequate evidence”.
“The surrounding noise and increasingly toxic, ideological and polarised public debate has made the work of the Review significantly harder and does nothing to serve the children and young people who may already be subject to significant minority stress.”
The report makes 32 recommendations to the NHS to improve their services, ranging from increased support for managing associated distress for patients and their families/carers; defining gender incongruence as just one aspect of informing treatment pathways; to increase the available workforce; and the commissioning of a lead organisation to establish a consortium of relevant professional bodies.
“In conducting this Review I have had to make recommendations based on the currently available information,” Dr Cass says in her Chair’s foreword.
“I am very aware that this is a point in time and as new evidence is gathered different insights might emerge.
“I have recommended a service model that has inbuilt mechanisms to be able to evolve and adapt with the emerging research overseen by appropriate governance structures both within individual NHS organisations and at a national level.”
UK trans youth support service calls for clear, accurate information
Early responses from transgender support organisations and LGBTIQA+ advocates have raised concerns about the report and its findings, criticising both the report’s choice of language and cherry-picking of research sources.
Long-serving UK support service Mermaids released a statement acknowledging they are pleased the voices and experiences of trans young people “appear to have been heard and respected”, and welcome the Review’s calls for trans children, young people, and their families to be treated with compassion and respect.
Mermaids go on to identify their concerns with sharing “clear, accurate information when discussing this topic.”
“We are concerned that some of the language in the report is open to misinterpretation and could be used to justify additional barriers to accessing care for some trans young people in the same way the interim report has been.”
Mermaids are calling on NHS England and their counterparts across the UK to “resist pressures from those who seek to limit access to healthcare, listen to trans youth directly, and act urgently to provide gender services which are timely, supportive and holistic.”
AusPATH: Review out of line with medical consensus
Australian advocacy organisations, trans health practitioners and people with lived experience have railed against the report’s findings, warning the Review ignores the consensus of medical bodies and research around the world.
These groups share concerns that the Review downplays the risk of denying treatment to young people and limits their options by placing restrictions on care.
Dr Portia Predny, Vice President of The Australian Professional Association for Trans Health (AusPATH) says the recommendations are “at odds with the current evidence base, expert consensus and the majority of clinical guidelines around the world.”
“In Australia, our guidelines for gender affirming care for young people already prioritise holistic, individualised and person-centred care with the involvement of multidisciplinary teams of clinicians with all kinds of areas of expertise, to help and support young people to navigate their gender journey,” Dr Predny said.
Dr Predny also said applying the report’s findings to the Australian model is fundamentally flawed because it purely examines the NHS.
“The way that gender affirming care is accessed and provided in Australia is substantially different to the way that care is or has been provided in the NHS.”
Dr Predny identifies there are many areas of medicine where it is not feasible or ethical to conduct Randomised Control Trials (RCTs) to collect the highest quality of evidence. The Cass Review names RCTs as the “gold standard” for treatment study trials.
“One such area is gender affirming care but there are many others, including perinatal care, and a lot of paediatric care generally,” Dr Predny continued.
“Additionally, when you have multiple observational studies looking at a particular intervention and those studies are producing similar findings, the cumulative evidence becomes compelling.”
Advocates warn Review should not influence Australian model
Director of the Trans Justice Project, Jackie Turner, says that the Cass Review “can’t be allowed to shape trans healthcare in Australia.”
“Trans people, their clinicians, and families should always be involved in decisions and research about trans healthcare,” Turner said.
“The Cass Review has delivered a set of recommendations that will put the lives and wellbeing of trans youth at risk.”
Taking to social media, Turner also criticises the Review for ignoring research that contradicts its key claims.
“The interim report ignored ‘two decades of research’ on use of hormones and hormone blockers for gender-affirmation. It also failed to acknowledge the current international consensus on gender-affirming health care,” Turner wrote on Twitter/X ahead of the final report’s release.
“We have grave concerns that the final report of the Cass Review will open the door to subjecting trans young people to conversion practices due to the framing used in the interim report, the credibility of the academics cited, and those allegedly hired to work for the review.”
“Due to the alarmingly hostile actions of the UK government, we suspect that the Cass Review is being used as simply another avenue to attack trans people’s rights, lives, and access to health care.”
Research highlights low rate of treatment ‘regret’
A study published in the journal JAMA Pediatrics on 4 March 2024, examined data from Perth’s Pediatric Gender Clinic.
This study showed that 5.3% of young people reidentified with the birth-registered sex before or during assessment, and just 1% of patients who initiated medical treatment had detransitioned.
These results are in line with multiple studies conducted around the globe.
This is a developing story. Stay tuned to OUTinPerth for more.
