Cass Review 2024 On Gender Identity Services In England
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The Cass Review of England’s gender services for children and young people, initiated four years ago, culminated earlier this week in the publication of the final 388-page report. The report was accompanied by 9 studies (8 of which were systematic reviews of evidence) supporting the recommendations. Within hours, NHS England responded, thanking Dr. Hilary Cass and her team for “stepping up to lead such a complex review.” NHS England committed to following through on Dr. Cass’ recommendations, and acknowledged the national and international significance of this seminal work: “Your final report will not just shape the future of healthcare in this country for children and young people experiencing gender distress but will be of major international importance and significance.”
For The Cass Review: Independent review of gender identity services for children and young people, please click HERE.
For The Final Cass Review and the NHS England Response, please click HERE.
Summary of the Cass Review, in italics, below:
For England, the Cass Report marks the end of the era of a highly medicalized approach to the treatment of young people with gender-related distress, which has come to be known as “gender-affirming care.” While the treatment protocol for youth comprising of puberty blockers, cross-sex hormones, and surgery, known as the “Dutch Protocol,” was invented in the Netherlands in the 1990’s, the report points out the concept of “gender-affirming care” – the notion that the doctors must accept children’s declarations of identity at face value and must assist them in gender change as early as possible– actually originated in the United States, and only then spread internationally.
The Cass Report provides a scathing assessment of the gender-affirming approach in general, and the gender-clinic model of care, which operationalized this approach of on-demand provision of gender-reassignment interventions, in particular. Going forward, England will treat gender dysphoric youth <18 using standard psychological and psychotherapeutic approaches, with very few young people receiving endocrine gender reassignment interventions (gender-transition surgeries for <18s have never been allowed in England). Further, the review noted that the group of young adults 18-25 is subject to many of the same concerns as the <18s, and recommended that the new regional “hubs” being set up to help gender dysphoric youth be expanded to include patients up to 25 years old.
The 2024 Cass Report on youth gender medicine provides a comprehensive review of the care and treatment of gender-diverse children and adolescents within the NHS. Here are the key findings and recommendations:
Key Findings:
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Increase in Referrals: The number of young people referred for gender identity support has increased significantly over the past decade. This surge includes a notable rise in birth-registered females during adolescence, who often have other co-occurring conditions such as autism or mental health challenges (Cass Independent Review).
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Quality of Evidence: The report highlights that the current evidence base for medical interventions like puberty blockers and cross-sex hormones is weak. Most studies are of poor quality, making it difficult to draw reliable conclusions about the long-term effects and benefits of these treatments (Cass Independent Review) (SEGM).
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Risks of Puberty Blockers: There is some moderate-quality evidence suggesting that puberty blockers can impact bone density and height. However, the overall benefits and long-term effects on mental health and development remain unclear (Medical News | MedPage Today).
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Cross-Sex Hormones: Similar to puberty blockers, the evidence supporting the use of cross-sex hormones in young people is also limited. The report calls for caution, particularly given the lack of long-term follow-up data (SEGM) (Medical News | MedPage Today).
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Holistic Care: The report emphasizes the importance of a holistic approach to care, integrating mental health and psychosocial support alongside any medical interventions. It suggests that for many young people, non-medical pathways may be more appropriate (Cass Independent Review).
Description of the video below, in italics, below:
“Medication is binary, but gender expressions are often not” Hilary Cass has chaired the Independent Review into Gender Identity Services for Children and Young People – The Cass review. Her recommendations will change how young trans people’s care in England is carried out. In this interview, Kamran Abbasi, editor in chief of The BMJ, asks Cass to explain the evidence, and thinking, behind her recommendations; and how those recommendations will change the care of young people. 2.06 – Why care needs to be hollistic, not siloed 7.20 – Improving psychological support and mental wellbeing 13.31 – The evidence for the use of puberty blockers 21.17 – Guideline issues 24.11 – The future of service delivery 28.43 – Overall thoughts on the care of young trans people Read Hilary Cass’s opinion article “Gender medicine for children and young people is built on shaky foundations” https://www.bmj.com/content/385/bmj.q814, in the video published on April 11, 2024, by The BMJ, as “Gender identity services in England – The Cass review“, below:
Description of the video below, in italics, below:
Helen Joyce talks to Rick Edwards on BBC 5 Live Breakfast about the Cass Review and the failings of the NHS’ Gender Identity Service, in the video published on April 10, 2024, by Sex Matters, as “Cass review- Helen Joyce BBC 5 Live Breakfast“, below:
Description of the video below, in italics, below:
Stephanie Davies-Arai, Dr Julie Maxwell and John Denning join Ciarán Kelly to discuss what the Cass Report means for children’s health and education. A medical and social experiment has been performed on children, they say. And while Cass is only the start of a return to evidence-based trans healthcare, it will give people confidence to resist the destructive gender-affirming ideology prevalent for so long. Recorded 9 May 2024, in the video published on June 5, 2024, by The Christian Institute, as “Cass Review|’Children have been lied to‘”, below:
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