Fri 12 Apr 2024 — 5 min

The Cass Review final report has been met with condemnation, both from trans experts and professional therapy groups in the UK and around the world. In the aftermath of its publication and inflammatory contents, despite concerns from experts, politicians are putting pressure on NHS clinicians to rush through recommendations and throw caution to the wind, as well as threatening to rush through laws banning standard healthcare practices in the private sector. This is a threat to the safety of young people accessing NHS health services. We urge politicians to stop grandstanding when childrens’ lives and wellbeing are at stake, and listen to the criticisms of the report.

Despite only being published 2 days ago, experts are already raising alarms about the methodological flaws in the research undertaken by the review. Trans Safety Network are still working on processing the review, but we believe there to be systemic biases in the ways that the review prioritises speculative and hearsay evidence to advance its own recommendations while using highly stringent evidence standards to exclude empirical and observational data on actual patients. This adds to the concerns we have previously had about Cass excluding trans people from the research oversight board - that Cass was set up from the start to impose a particular perspective without input from the patient cohort affected by the outcome.

The report at one point attempts to use the correlation of puberty blockers prescribed to young trans people with the fact that they grow up to transition later in life as proof that it was puberty blockers that made them trans, without considering that they were prescribed puberty blockers on the basis of an assessment by clinical professionals that they were trans. In reality, one would hope to minimise the number of unnecessary prescriptions to young people who come to the conclusion they’re not trans and these figures showing that most grow up to be trans would be seen as a good thing. Unfortunately, the Cass Review final report seems to assume, as an unspoken starting point, that growing up to be a trans person is a bad thing, and the rest of the conclusions follow from that assumption.

The report similarly reports an “increasing number” of detransitioners in relation to GIDS treatment, as reported anecdotally by “clinicians” while only identifying less than 10 in a patient cohort of over 3000. These discrepancies and use of hearsay that doesn’t match up with the hard data in a report that has taken 4 years of work to produce are deeply alarming. While Cass used the report to derisively contrast “Social justice” approaches against the “evidence based” approach the NHS is supposed to be based on, the human rights of the patients in question are a key concern in ensuring that evidence is used fairly and in a way that centres the specific needs of patients rather than political grandstanding, lobbyists, clinicians or anyone else’s agenda. Lobby groups which Cass has chosen to approvingly include contributions from in the report very openly advocate for expanding the target age range for preventing transition to 25 years old. This is a goal which Cass has effectively empowered through her recommendations.

Trans Safety Network are concerned that these discrepancies are not a matter of accident or error. We have previously identified a number of professionals involved in both the Cass Review and the NHS Gender Dysphoria Working Group which helped commission the review who are involved either in lobbying efforts against trans affirmative healthcare, or who have actively promoted conversion therapy. These include one of the authors on the Cass systematic reviews, Tilly Langton, who produced a training which promoted conversion therapist organisations to trainee psychiatrists working with children.

We caution that it will take a considerable amount of time for credible academic responses to process the 388pp of the final report as well as the several supplementary research papers published supporting it. Politicians need to step off the gas, listen to the early warnings being issued by both medical experts worldwide and by the trans community, and avoid rushing through political interference with existing clinical services.

We are especially concerned, in light of 4 inquests we are aware of initiated over the last year for young trans people who died by suicide while waiting for gender dysphoria healthcare. Those who are affected most by the decisions that are being made are being ignored and harmed by the ongoing violence of this effort to impose a health establishment order against trans people’s agency rather than in harmony with it. There is an extremely long history of medical violence which informed the disability rights slogan “Nothing About Us Without Us”.