The Cass Review Is Published

On April 10, 2024, the final report of the Cass Review was published, an independent inquiry into gender care for children and young people in England. Paediatrician Hilary Cass conducted the inquiry at the request of NHS England. She began in 2020 and published an interim report in 2022.

The conclusions

For the inquiry, the University of York conducted a series of systematic literature reviews. The conclusion was that the evidence for puberty blockers and cross-sex hormones in minors is strikingly weak. Most studies were of low quality, and little is known about the long-term effects. Cass found that many young people seeking care also have other issues, such as autism, anxiety or depression, and that these had received too little attention.

The report contains 32 recommendations. The central message is that care should take a broader approach, with attention to the young person as a whole, and that medical treatment requires great caution and should be properly researched.

What the NHS changed

In March 2024, shortly before the final report, NHS England decided to stop routinely prescribing puberty blockers to minors with gender dysphoria. The Tavistock gender clinic in London closed and was replaced by regional centres. The British government subsequently also banned private providers from prescribing them; that ban was extended indefinitely in December 2024.

The background

NHS England commissioned the inquiry after the number of referrals to the gender clinic had risen sharply: from a few hundred a year around 2011 to approximately five thousand in 2021 and 2022. Waiting times grew to several years, and clinic staff had raised concerns about its practices both internally and publicly. The Bell v Tavistock case took place during the same period.

Who is Hilary Cass?

Hilary Cass is a paediatrician who chaired the UK’s professional association for paediatricians from 2012 to 2015. She had not previously worked in gender care, which was one of the reasons she was asked to lead the inquiry: she was considered independent of both sides of the debate. After the final report was published, she was appointed to the House of Lords.

Social transition and young adults

The report goes beyond medication. Cass writes that social transition, in which a child begins living with a different name and pronouns, is not a neutral step either. It may influence how their gender identity develops, and caution is therefore warranted in young children. The report also recommends that young people aged seventeen to twenty-five should not automatically move on to adult clinics, but should receive dedicated follow-up care. The brain and identity are still developing at that age.

The response

The British government and the opposition accepted the recommendations, as did the main UK medical professional associations. International reactions were divided. WPATH and US professional associations criticised the report, arguing among other things that it sets the bar for evidence too high. Health authorities in other European countries, by contrast, referred to it when reconsidering their own policies. NICE had already assessed the evidence; see the NICE reviews.

Significance

The Cass Review is the most comprehensive investigation into gender care for young people to date and is widely cited internationally, including in the Dutch debate. The methodology has also been criticised, including by professional associations that defend the existing model and in the so-called Yale report. Why the report is considered a turning point and what it means for the Netherlands is explained on transtijd.nl in the article about the Cass Review as a turning point in youth gender care. More information is available on the page about the Cass Review and in the archive.