Summary
A large group of health professionals and researchers, argue that the Cass Review's recommendations for severely restricting access to gender-affirming medical treatment (GAMT) for trans youth are unsubstantiated by evidence, methodologically flawed, and lead to harmful consequences.
The Cass Review Is Not Helping Trans Youth
The publication of the UK’s Independent Review of gender identity services for children and young people, widely known as the Cass Review, sent shockwaves through the trans community and gender healthcare professionals worldwide. Subsequently criticised by high-profile reports from Utah, Germany, Austria, and Switzerland, Australia has now joined the chorus, saying the Cass Review is deeply flawed. Published in the Medical Journal of Australia today, the report is highly critical of Cass.
Commissioned following increasing referrals to GIDS and legal cases like Bell v Tavistock, the Review’s final report is fundamentally flawed and fails to provide credible, evidence-based guidance for the care of transgender young people. Instead, its restrictive recommendations reflect a UK sociopolitical climate increasingly unsafe for trans people in the UK.
We must be clear: the Cass Review is a blueprint for withdrawing, not improving, person-centred care. Indeed, our own comprehensive report reflects the concerns raised by health professionals worldwide.
Recommendations Built on Restriction and Speculation
The Review’s central recommendations immediately raised concerns:
- Puberty Suppression Ban: The report recommended that puberty suppression using gonadotrophin-releasing hormone analogues (GnRHa) should only be accessible within a clinical trial. Following this, the UK Government prohibited the supply of GnRHa as Gender-Affirming Medical Treatment (GAMT) for minors, making this treatment unlawfully inaccessible for trans adolescents.
- Hormone Restriction: The Review recommended restricting oestrogen and testosterone for 16- and 17-year-olds, prescribing them only with “extreme caution” following approval by a “national multidisciplinary team”. This increased restriction is alarming, especially considering the Review’s own audit found that hormonal treatments were already restricted to a minority, with only 22% of assessed patients receiving GAMT.
- Pathologising Social Affirmation: Disturbingly, the Review conceptualised the social affirmation of trans children, such as using a chosen name or pronouns, as a potentially harmful intervention. This ignores strong observational evidence that supporting children to socially affirm their gender is associated with good mental health outcomes. Instead, the Review ignored the profound distress that occurs when a trans child’s identity is not respected.
Ignoring Evidence and Internal Contradictions
The Review is undermined by its striking internal contradictions and severe methodological weaknesses. While it acknowledged that some trans young people benefit from puberty suppression, its recommendations made it inaccessible to all. Furthermore, the Review found no evidence that psychological treatments improve gender dysphoria, yet still recommended expanding their use while withholding GAMT.
The Review achieved its restrictive goal by dismissing evidence of benefit from GAMT as “weak”. Yet, it imposed regulatory benchmarks almost unheard of in other areas of medicine. Crucially, the Review failed to evaluate the harms of withholding GAMT. It disregarded studies showing that adolescents who requested but were unable to access GAMT had poorer mental health outcomes compared to those who could access it. The underlying goal is to prevent regret at any cost, despite international data indicating that detransition and regret are relatively uncommon. Restriction only increases the predictable consequence of self-treatment without medical supervision.
The Review Ignored Its Own Commissioned Data
Perhaps the most damning indictment is that the Cass Review’s own commissioned systematic reviews contradicted its final recommendations. These reviews found:
- Moderate quality evidence of mental health benefits from masculinising and feminising GAMT.
- GnRHa and sex hormones are effective in achieving patients’ primary goals (suppressing puberty, inducing feminisation/masculinisation).
- No evidence of serious harm from GAMT or social transition sufficient to justify withholding care.
Despite this, the Review rejected the evidence, demonstrating a failure across the three pillars of evidence-based medicine: appraisal of research, real-world clinical expertise, and respect for individual patient values.
A Call for Person-Centred Care
The failures of the Cass Review stemmed partly from a team explicitly selected for their absence of experience in trans health care, with no trans people among the authors. This lack of lived and clinical expertise increased vulnerability to misinformation. Even after meeting with trans young people, reviewers failed to ask them if they found GAMT beneficial.
Trans youth deserve the high-quality care recognised elsewhere internationally as best practice – the gender-affirming model. This model is person- and family-centred, holistic, and supports trans young people in living authentically. It acknowledges that GAMT is essential, and potentially life-saving, for the minority who need and request it for relief from intolerable distress and to live more comfortably and safely.
In the face of these flawed recommendations, TransLucent stands firm: care must respect the voices, emerging autonomy, and dignity of young people. Better mental health for trans youth is associated with loving acceptance and timely access to GAMT where needed.
The Cass Review Is Not Helping Trans Youth
