Cass Review final report – our statement

The Cass Review final report has been published. We thank Dr Cass and her team for all their methodical and careful work to produce an extraordinary document that will have influence worldwide.

In its breadth and scope, Dr Cass has produced a world-leading guideline on the care of children and adolescents experiencing gender-related distress.

We hope that this government and all political parties will actively support NHS England to follow and implement the report’s critical, evidence-based findings.

Dr Cass and her team have reviewed and analysed global research evidence and guidelines in transgender health care to establish an evidence base for treatments within the NHS, along with research protocols to address the many gaps in the evidence.

Crucially she has considered children and adolescents holistically through a framework of childhood development and adolescent mental health, and within a cultural and social environment unique to this generation.

Not only that, Dr Cass has produced a detailed and comprehensive service model and practical recommendations for a treatment pathway that will bring the NHSE service into line with normal standards of paediatric healthcare.

The information and recommendations in the report de-mystify the condition of gender dysphoria as something that is uniquely specialised, and places it within the appropriate framework of child and adolescent mental health services. As part of a psychosocial treatment pathway it incorporates standard mental health treatments which have been shown to be effective in the treatment of adolescents with a range of difficulties and adverse life experiences.

We are pleased to see that the final report has addressed some of our biggest concerns:

  • The establishment of a follow-through service for 17–25-year-olds, in line with other mental health services. This is critical to ensure this age group receives the same standard of care as younger adolescents.
  • Acknowledgment of the lack of evidence for the benefits of cross-sex hormones, the need for caution and the importance of data collection and follow-up. NHS England must now follow the recommendation for a review of cross-sex hormones and include them in a broader research programme. We would like to see NHSE ending the routine prescription of cross-sex hormones, in line with the puberty blockers policy.
  • The recommendation for provision of specialised NHS services for detransitioners and those who regret their medical transition. This is an urgent requirement.
  • Insufficient research on social transition, inconclusive evidence of any benefits but clear risk of creating persistence of an identity that would in all likelihood have resolved by itself. We hope that the government will use this information to end the practice of social transition in schools carried out by untrained adults. The impact on other children of adults pretending a child has changed their sex is outside the terms of reference for this report, but it is something the government must address.
  • The need for support for siblings of children who identify as the opposite sex. This must be a priority. We would like this extended to the children of adult transitioners.
  • No formal science-based training in psychotherapy, psychology or psychiatry teaches or advocates ‘conversion therapy.’ Normal “exploration of complex psychosocial challenges and/or mental health problems an adolescent may be experiencing is essential to provide diagnosis, clinical support and appropriate intervention”, and it is harmful to equate this approach to ‘conversion therapy.’
  • Evidence of the disproportionate number of same-sex attracted and bisexual young people referred to the Tavistock GIDS.
  • The inclusion of autism assessment and acknowledgment that this often goes undiagnosed in girls.
  • An acknowledgment of social influences, including pornography, online and social media and peer pressure. The report points out that ‘social contagion’ is the most hotly contested explanation for the exponential rise in the number of children adopting a trans identity, but the examples included show the influences clearly.
  • Although no direct reference to Rapid Onset Gender Dysphoria, acknowledgment throughout the report that the majority of referrals are teenage girls who developed gender dysphoria at or after puberty and that this is a completely new cohort.

Throughout the report Dr Cass documents a lack of cooperation and in some cases obstruction from GIDS and some of the adult gender clinics. This meant that not all of the specially commissioned research into outcomes for gender healthcare could be completed. Although the NHS has promised to continue the research, this attitude shows the depth of opposition in some parts of the NHS to the Cass Review reforms.

In the Key points and recommendations the report points out just how much of an outlier the medical pathway established at the Tavistock GIDS actually was:

23. The adoption of a treatment with uncertain benefits without further scrutiny is a significant departure from established practice. This, in combination with the long delay in publication of the results of the study, has had significant consequences in terms of patient expectations of intended benefits and demand for treatment.

That this was allowed to happen, with so many children’s health put at risk, with irreversible and unknown outcomes, is a national scandal. What this report exposes is that obstruction to mending the service is ongoing. A crucial part of the development of an evidence-based service is gathering the data, but some efforts by the Review to collate the evidence of long-term outcomes have already been thwarted:

91. A strand of research commissioned by the Review was a quantitative data linkage study. The aim of this study was to fill some of the gaps in follow-up data for the approximately 9,000 young people who have been through GIDS. This would help to develop a stronger evidence base about the types of support and interventions received and longer-term outcomes. This required cooperation of GIDS and the NHS adult gender services.

92. In January 2024, the Review received a letter from NHS England stating that, despite efforts to encourage the participation of the NHS gender clinics, the necessary cooperation had not been forthcoming.

The report states:

2.34 However, there are clearly lessons to be learned by everyone in relation to how and why the care of these children and young people came to deviate from usual NHS practice, how clinical practice became disconnected from the clinical evidence base, and why warning signs that the service delivery model was struggling to meet demand were not acted on sooner.

We hope that this report will result in lessons learned more widely: that the medical scandal at the Tavistock GIDS did not happen in a vacuum. In terms of the care of children and young people of this generation, society more widely has some responsibility for the encouragement of children towards this medical pathway. Social transition in schools is one example:

12.12 The MPRG is concerned that some children living in stealth have a common, genuine fear of “being found out”, suffering rejection either due to not having taken friends into their confidence (withholding personal information regarding biological sex or specific sex-based experiences), or due to trans prejudice or transphobia. They observed that this fear of “being found out” is driving a sense of urgency to access puberty blockers, which may not allow consideration of other pros and cons of the treatment.

We must also look at the role of the internet, early access to smartphones and the kind of information children are accessing with no proper guidance from adults:

8.47 It is the norm that all experiences of health and illness are understood through the norms and beliefs of an individual’s trusted social group. Thus, it is more likely that bodily discomfort, mental distress or perceived differences from peers may be interpreted through this cultural lens.

8.48 More specifically, gender-questioning young people and their parents have spoken to the Review about online information that describes normal adolescent discomfort as a possible sign of being trans and that particular influencers have had a substantial impact on their child’s beliefs and understanding of their gender.

The report also references the failure in safeguarding within the clinical setting, which now must also be addressed in other settings. In schools, the same dynamic can be observed when as soon as the word ‘transgender’ is mentioned, all safeguarding responsibilities towards children seem to be forgotten:

10.43 As with all health care provision, when working with children and young people safeguarding must be a consideration. There are complex ways in which safeguarding issues may be present. Clinicians working with children and young people experiencing gender dysphoria have highlighted that safeguarding issues can be overshadowed or confused when there is focus on gender or in situations where there are high levels of gender-related distress.

Children have been utterly failed and The Cass Review final report is not just a wake-up call for NHS England, but for the media, for politicians, for childcare professionals and for all adults who have cheerleaded this experiment on children with no questions asked: it has been the failure of society as a whole to safeguard the health and welfare of our children.  

This Post Has 8 Comments

  1. F. Mac

    Thank you Transgender Trend for your tireless dedication in protecting minors from so-called ‘gender’ medical care and the adults who failed in their duty to do the same. This medical scandal happened because so-called medical professionals allowed it to happen by putting ideology ahead of evidence and good medical practice in treating the minors in their care. Those practitioners responsible failed in their duty of care to their patients and to their duty to their professional ethical standards; they have failed personally and have brought their respective professions into disrepute. My hope is that this report will influence the practice of ‘gender’ care across the Western World.

  2. Shirley Jane Connell

    Thank God – !

    Canadian Grandmother

  3. Ellie

    Thank goodness. Commonsense prevails! All of the photographs from way back in my childhood show me as a little girl who loved to dress as a princess or a fairy or to organise tea parties for teddy bears and dolls. Despite a loving and normal family life, as a child classed as highly intelligent, I think I always felt on the outside of things. Puberty hit at the same time as the first lockdown and my sense of alienation grew from mild discomfort to avid repulsion to what was happening to my body. My friendship groups changed and I found new friends amongst the outsiders – the obese, the nerds and those who classed themselves as transgender. I found myself attracted to that ideology and decided that my feelings of confusion were as a result of having been born in the wrong body.
    My parents are of a liberal mindset and accepted my decision to change my name and pronouns to reflect my new male persona. They were wise enough to discourage breast-binding or puberty blockers. We all felt that a visit to a doctor would have resulted in a fast track to a destination I didn’t feel ready for. My school accepted my request to be treated as a male and, initially, I felt liberated and happier. However, as time went on, I noticed that people were often wary of me. Despite the male clothing, I was still obviously a girl in appearance and personality. I was aware that one or two people stated to avoid me and those who engaged with me avoided the use of my new name or male pronouns.
    At the end of Year 12, I was starting to feel more unhappy than I previously had before my social transition. Relationships always failed and friendships lacked any permanence or closeness. When looking at universities, I started to consider those that would not be too much of a challenge, although my teachers all urged me to apply to one of the top universities. My confidence was at an all-time low and I felt that I had little worth. Photographs from that period say it all: slumped shoulders, ill-fitting clothes, hiding behind someone else and avoiding looking at the camera. A friend, sensing my growing despair, invited me to a theatre group he belonged to. With my low confidence, I volunteered for roles behind the scenes rather than on the stage. The group was run by a dynamic lady in her late thirties and although the plays they performed were traditional – classics or Shakespeare, she always found ways to give the production a modern twist. One day, I bumped into her in town and she asked if I had time for a cup of coffee because she wanted to ask me something out of hearing of the rest of the group. At first, I did not want this lady, who was probably the person I admired most in the world at that time, to think badly of me, but in the course of an hour, I had told her about my feelings and how unhappy I was. It turned out that she had wanted to talk to me about a part in the next production. She explained that in Shakespeare’s time, women were played by men and asked if I would I try out for the female lead in Romeo and Juliet. It was a turning point in my life. We became close friends and she became a role model. A strong, successful woman was what I knew I needed to be. She was brave enough to go and talk to my parents, who agreed not to make a big issue of my detransition.
    Looking back, I think that I never had a desire to be a boy: what I had was a fear of being a girl.
    What would have helped?
    1. Access to good mental health care that does not automatically assume that transitioning is the only outcome.
    2. Family and friends keeping the door open for detransitioning (e.g. ignore the pronouns and fake name)
    3. A strong role model who is willing to mentor, support and fight for you.

    I am glad I found my way back. I am about to start an undergraduate degree at a top university and although relationships are still not perfect, my mentor tells me that they never are.

    1. Colleen

      Ellie,
      I am a mom to a son who’s story is so similar to yours. I’m not even sure how I happened on this post, other than fate. I’m so happy you found that mentor. It’s not easy being a young person today

  4. Derek Jones

    Our Canadian Grandmother got there before me. So as a UK Grandfather all I can say is you’re absolutely right.
    At last there is some chance of getting out of the ‘rabbit hole’ we have all been led down. Sanity returns. 👏👏

  5. Wendy Milton

    I’ll be waiting patiently for my UNBC med school daughter to acknowledge any of this. At present she refuses to discuss the topic. I can only hope she sees reality (which has always been the case) and now can feel empowered to follow the saner world (she’s always loved the Brits…). I do feel for her being in a medical school environment that is still influenced by trans activists. But at the same time I’d like to be able to talk to her about it, and get her pov about what is going on there.

  6. James

    This has been a long time coming honestly with facts those following it had known for a very long time – it didn’t take a genius to work out for example that there is no long term data on puberty blocker use, particularly in children and yet members in our society propped up the lie that they wanted to believe in favour of getting what they wanted as opposed to the best health outcomes for vulnerable children. There needs to be some serious accountability and change in how seriously our government and media takes the advice of activists – particularly when it surrounds medical care.

  7. Tony Turner

    Congratulations to Dr Cass, for her thorough and thoughtful work. We now have to make sure that it is widely read and understood. It is time for us to take back control from the trans activists.

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