Trans Health Groups Challenge “Harmful” Cass Review


Two of the world’s leading transgender health groups say that the controversial Cass Review, championed by the likes of JK Rowling, is selective, inconsistent and harmful to young transgender and gender diverse youth.

The Independent Review of Gender Identity Services for Children and Young People, led by Hilary Cass, a retired consultant paediatrician, was released in April to immense controversy.

Commissioned by England’s NHS (National Health Service) in 2020, it sought to review gender services for children and young people, including those with gender dysphoria and those identifying as transgender.

Review Weaponised by the Anti-LGBTIQ+ Movement

The review concluded that there was only some evidence to support the effectiveness of hormonal interventions for those under the age of 18 and not enough evidence available to assess the physical risks and benefits. It also asserted that the effects of puberty blockers on cognitive and psychosexual development were unclear.

The study was weaponised by critics of trans-affirming health care for young people as proof that these are dangerous and extreme interventions. Harry Potter author JK Rowling, who has become increasingly transphobic in her views, was a vocal proponent of the Cass Review on social media.

The review has also bolstered the growing anti-trans and broader anti-LGBTIQ movement in the UK, which has seen the government failing to pass a promised ban on conversion therapy. The government has also moved to limit discussions of gender identity in schools, proposed to treat trans hospital patients in separate rooms, and banned the use of rainbow lanyards by civil servants.

As a direct result of the report, the NHS will now no longer prescribe puberty blockers to young trans people outside of clinical trials.

Cass herself has voiced apprehension that her work is being used to define what trans means or to roll back health care.

“There are young people who absolutely benefit from a medical pathway, and we need to make sure that those young people have access — under a research protocol, because we need to improve the research — but not assume that that’s the right pathway for everyone,” she told the New York Times.

Trans Health Experts Excluded from the Cass Review

In a 17 May 2024 joint statement, the World Professional Association for Transgender Health (WPATH) and the US Professional Association for Transgender Health (USPATH) addressed the credibility of the Cass Review, expressing several reservations about the report.

This includes the appointment of Hilary Cass to lead the review, which the groups say was done “without any transparent or competitive process.” They noted that Cass has limited clinical experience and expertise in providing transgender healthcare for young people and “lacks significant research qualifications or research expertise in transgender health.”

The organisations also expressed concern that the review purposely avoided engaging with experts in trans and gender-diverse youth or transgender medicine and surgery in an effort to be seen as “independent”.

Furthermore, WPATH and USPATH asserted that the Cass Review’s recommendations are in conflict with other more comprehensive reviews and standards of care for trans people.

The groups accused Cass of “ignoring more than three decades of clinical experience in this area as well as existing evidence showing the benefits of hormonal interventions on the mental health and quality of life of gender-diverse young people.”

Causing Distress and Harm to Young Trans People

“Regardless of what Dr Cass’ intentions may or may not have been, the Cass Review process itself intentionally and explicitly excluded any oversight from patients and their families and trans healthcare experts, and its content is not supported by a robust methodology,” said WPATH and USPATH.

They argue that the study relies “on selective and inconsistent use of evidence”, and its recommendations often do not follow from the data presented in the systematic reviews.

“The Cass Review deprives young trans and gender-diverse people of the high-quality care they deserve and causes immense distress and harm to both young patients and their families,” concluded the organisations.


This article was made possible with the support of the Other Foundation. The views expressed herein do not necessarily represent those of the Other Foundation.

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