Children receiving NHS transgender treatment have embarked on a path of irreversible change despite scant medical data, a report concludes.
NHS gender identity services for children and young people have been based on “remarkably weak evidence”, the independent review by leading pediatrician Dr Hilary Cass has warned.
Their study, commissioned almost four years ago, makes 32 recommendations to reform NHS trans services and improve the care children receive.
Prime Minister Rishi Sunak welcomed the report and called for “extreme caution” when dealing with young people in the future.
Former president of the Royal College of Paediatrics and Child Health appointed to lead review in 2020
Dr Cass, retired consultant paediatrician, talks about the publication of the Independent Review of Gender Identity Services for Children and Young People, 9 April.
Dr Cass recommended a “follow-up service” for 17- to 25-year-olds to protect teenagers who “fall off the edge” when they turn 17.
Activists hailed it as “a return to common sense decision-making.” In other developments:
■ Dr Cass said the “toxicity of the debate” over care for trans children was “exceptional” and revealed she herself had been the target of criticism during her work;
■ The report said there was a “lack of high-quality research” into the effects of giving hormones and puberty blockers to children, and recommended that NHS England set up its own research programme;
■ Long NHS waiting lists were said to have driven trans children into the arms of private clinics, with GPs ‘pressured to prescribe’;
■ Dr Cass laid the groundwork for schools to introduce clearer guidance when dealing with trans children, ending parental exclusion;
■ The report called for the creation of a separate service for those who want to “detransition”, where gender transition is stopped or reversed;
■ Dr. Cass recommended a “follow-up service” for 17- to 25-year-olds to protect teenagers who “fall off the edge” when they turn 17.
■ NHS England launched a similar review of adult gender services led by an independent expert.
Dr Cass warned that her review had been hampered by how polarized the debate over the care of trans children has become. She said medical professionals had been abandoned.[too] They are afraid to openly discuss their views.
Dr Cass said: “Despite the best intentions of all those concerned with this complex issue, the toxicity of the debate is exceptional.
‘I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and I have also been criticized for engaging with groups and individuals who urge greater caution.
‘This is an area where the evidence is notably weak, and yet study results are exaggerated or misrepresented by people on all sides of the debate.
‘There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media and where insults reflect the worst bullying behaviour. This must stop.
“Polarization and the suffocation of debate do nothing to help young people caught in the middle of a stormy social discourse and, in the long term, will also hamper the research that is essential to finding the best way to help them thrive.”
Dr Cass said: “Despite the best intentions of all those concerned with this complex issue, the toxicity of the debate is exceptional” (File image)
It warned that its review had been hampered by how polarized the debate over the care of trans children has become.
Puberty blockers, known medically as gonadotropin-releasing hormone analogs, stop the physical changes of puberty in adolescents who question their gender. An example of these medications, called Triptorelin, is shown in the photo.
Dr. Cass described coming into contact with some “very aggressive people” during meetings as part of her job. The report found that the evidence for the use of puberty blockers and hormone treatments was largely based on “shaky foundations” and guidelines not supported by science.
Dr. Cass addressed recent debates about “social transition,” such as changing names and pronouns.
The report found that those who socially transition at a younger age or before seeing a medical professional were “more likely to follow a medical path.”
He said “the importance of what happens at school cannot be overstated” and said parents should not be excluded from conversations about their children’s well-being.
Unregulated private clinics came under some of the harshest criticism from Dr Cass, who echoed GPs’ warnings about prescriptions issued by overseas-based services.
The review said GPs had “expressed concern about being pressured to prescribe hormones after private providers had initiated them”.
He said no GP should be expected to “enter into a shared care arrangement with a private provider”, especially one acting outside NHS guidelines. Sunak said the report emphasized the need for caution with treatment.
He said: ‘We simply don’t know the long-term impacts of medical treatment or social transition on children.
“The well-being and health of children must come first.”
Helen Joyce, of the charity Sex Matters, said: “Hilary Cass’s report demolishes the entire foundation of the current model of treating gender-challenged children.”
“It is a shameful day for England’s NHS, which for too long gave vulnerable children harmful treatments for which there was no evidence.”
“Cass’ review is a breath of fresh air, marking a return to common sense decision-making and evidence-based medical treatment.”
After the Cass interim review was published in 2022, the Tavistock transgender clinic announced it would close because it was deemed unsafe for children.
A spokesperson for Bayswater, a group that supports parents of trans children, said the Cass Report “represents a radical change in the treatment of trans-identified children and young people”.
The report was also welcomed by Labor. Shadow health secretary Wes Streeting described it as “a watershed moment for NHS gender identity services”.
The report comes weeks after NHS England confirmed it would no longer prescribe puberty blockers to children at its gender identity clinics, saying there is insufficient evidence to support their “safety or clinical efficacy”.
A spokesperson said: “NHS England is very grateful to Dr Cass and her team for their exhaustive work.”
READ MORE: Dr Hilary Cass: How the world-renowned pediatrician behind the damning review of NHS children’s gender care is no stranger to ‘toxic’ debates (and loves Snickers!)