The Cass Review has failed young trans people 

By Annie Gidney

Content warning: this article discusses LGBT+ discrimination, mental health issues, and suicide.

It is no secret that the U.K. has become an increasingly hostile environment for transgender people over the last decade. The latest addition to this hostility is the publication of the Cass Review, led by Dr Hilary Cass, which was commissioned by NHS England in order to better understand how to improve their gender identity services. Both the Conservative and Labour parties have pledged to implement changes to gender affirming care in the UK based on the results of this report. However, many have criticised the review’s findings, declaring it inaccurate, unethical, or grounded in transphobic prejudice. 

By far the most controversial aspect of the review is its criticism of the use of puberty blockers by transgender children. The review does acknowledge the benefits of puberty blockers on cosmetic factors such as a reduction in body hair and breast growth, as well as lessened gender dysphoria. However, the review dismisses the mental health benefits of puberty blockers as “very modest and inconsistent”. The report claims that there is “no obvious benefit” to the use of puberty blockers by those transitioning to male as they “masculinise well on testosterone”, yet fails to acknowledge the mental distress and gender dysphoria experienced by transmasculine people who are forced to undergo female puberty.

Many have criticised the review’s findings, declaring it inaccurate, unethical, or grounded in transphobic prejudice

Regarding those transitioning to female, the Cass Review identifies a “very narrow indication” that puberty blockers should be prescribed in order to prevent the dysphoria-inducing effects of male puberty, yet it supposedly “remain[s] unproven” that it benefits mental health. The review’s suggestion that there is “no evidence” for gender affirming care reducing suicide rates in young transgender people is an ignorant and false one; numerous studies have found that gender affirming care decreases anxiety and depression in young transgender people, including many which were dismissed by the Cass Review. A study by Dr Julia Sorbara et al. in 2020, for example, demonstrated that trans adults who were unable to access hormone replacement therapy until later in life suffered from higher rates of anxiety and depression than those who were lucky enough to access it as teenagers. 

Curiously, similar studies to the Cass Review have just been caried out in Germany, Sweden, and Austria, all of which came to the opposite conclusion to the Review on the use of puberty blockers. The review has come under fire for allegedly choosing to ignore data that suggests young trans people benefit from gender affirming care. Shockingly, it declares forty-nine of the fifty studies cited by the review to be of “low quality”, the vast majority of which were ones providing evidence of the benefits of gender affirming care for young people. Furthermore, no pro-trans organisations were allowed to contribute to the study due to “bias”, whereas the organisation Sex Matters, which is consistently hostile towards transgender people, was allowed to give input. 

This is unfortunately yet another example of cisgender people making decisions about trans people’s bodies for them

Amnesty International’s response to the review declares it to be blatantly politically motivated, calling it “harmful and extremely damaging” to the transgender community. Many critics have also pointed out Cass’ own biases as a possible influence on the review’s conclusions, given that she has no background in transgender medical care and follows well-known members of the gender critical movement on social media. While this review may seem worrying for young transgender people in the U.K., it acts as a recommendation rather than an instruction, and we can expect whatever Bill is introduced based on its findings to look somewhat different to the report’s conclusions. However, given the leaders of both Conservative and Labour’s recent scapegoating of trans people in an attempt to win votes, it is understandable that people are fearing the worst. 

The near-unanimous rejection of the Cass Review’s proposals by the transgender community online should be sufficient proof that the review is misguided; this is unfortunately yet another example of cisgender people making decisions about trans people’s bodies for them. The review’s publication has prompted a further review of adult gender affirming care services under the NHS; based on its results, this is cause for concern among trans adults, but many LGBTQIA+ organisations are hopeful that an investigation into adult care services will highlight the areas of the current system which need improving. Now more than ever it is vital that transgender people are given a platform and listened to, and treated not as political pawns but as human beings.

Image: DVSROSS via Wikimedia Commons 

One thought on “The Cass Review has failed young trans people 

  • It should be painfully obvious to even lay people now that this isn’t about evidence or the wellbeing of trans people; this is an ideologically motivated attack on care-avenues for trans people. Care avenues, with a view to everything else.


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