A monumental report claims that the case for allowing children and young people to transition gender has “weak foundations,” and the NHS will assess all trans treatments.
On Wednesday, Dr. Hilary Cass, a pediatrician, released her long-awaited review into the assistance and treatment provided to young individuals who identify as trans, warning that caution should be exercised before anyone under the age of 25 undergoes transitioning.
It also calls for a halt to the administration of potent hormones to children under 18, cautions that individuals who transition may regret it, reveals that many have experienced trauma and abuse, and states there is “insufficient data” on the long-term effects of the treatments provided to children.
The review highlights the pressure on individuals, with parents feeling compelled to allow their children to transition amidst a “toxic” debate to avoid being labeled as transphobic.
According to Dr. Cass, “the foundation of gender treatments for children and young people is weak.”
She states, “We must acknowledge that we lack robust evidence on the long-term effects of interventions to manage gender-related distress.”
In response, the NHS will reassess all transgender services it provides, including adult services, and will immediately cease treating any new patients aged 16 and 17 seeking gender transition at adult clinics.
“Exercise Extreme Caution”
Rishi Sunak has welcomed the remarks, noting the significant increase in recent years in young individuals, particularly young females, questioning their identity.
“We simply do not know the long-term effects of medical or social transitioning on them,” he said, “and thus we should exercise extreme caution in endorsing Dr. Cass’s plea for all cases to be handled with ‘great care and compassion.'”
Amid growing concerns that children are freely transitioning in schools and under medical supervision, the 388-page report took four years to compile.
Dr. Cass, the former president of the Royal College of Paediatrics and Child Health, cautions against hasty decisions while the brains of young individuals are still developing, advocating for “unhurried, alternative medical support” for those aged 17 to 25.
She asserts that doctors cannot predict which children and young people will adopt a lasting trans identity.
The consultant pediatrician suggests that “life-changing” decisions should be carefully deliberated in adulthood, noting that brain development continues into the mid-20s.
She warns that individuals who are “vulnerable in their journey” still require assistance and recommends that all individuals in this age group seek support from one of the regional centers she has proposed in her interim report, which will offer mental health and other assistance to individuals seeking gender transition.
Dr. Cass maintains that it is impossible to determine the “sweet spot” when a person becomes comfortable with their identity but emphasizes that decisions should not be rushed before an individual becomes a mature adult.
The report finds that the younger the children were, the more likely they were to change their minds.
“Exceptional” Toxicity of Debate
Dr. Cass remarks that the “toxicity of the debate is extraordinary” and that she has been “criticized” by all sides as she released her report on NHS transgender services.
“There are no other areas of healthcare where professionals are so hesitant to openly discuss their opinions, where individuals are vilified on social media, and where name-calling resembles the worst forms of bullying,” the report states. “This must cease,” she urges.
Dr. Cass’s report has received widespread acclaim.
The Cass review, which took four years to complete, has been welcomed.
Mr. Sunak stated that the government had promptly responded to Dr. Cass’s earlier request to cease routine use of puberty blockers for individuals under 16 in response to Mr. Sunak’s announcement.
“We will continue to take the necessary steps to safeguard young people,” the Prime Minister stated. “The health and well-being of children must come first.”
“Watershed Moment”
Wes Streeting, Labour’s health spokesman, believes the report should mark a “watershed moment” for the NHS’s gender identity services.
He asserts that children’s healthcare should always be guided by evidence and children’s welfare, “free from culture wars.”
Helen Joyce, of the gender-critical group Sex Matters, remarked, “This is the end of pediatric gender medicine as we know it.”
Kate Barker, CEO of advocacy group LGB Alliance, said, “We have known for years that the overwhelming majority of individuals experiencing gender distress resolve it on their own and grow up to be happy and well-adjusted lesbians, gay men, or bisexuals.”
She praised the importance of “time for reflection” for young LGB individuals who are most vulnerable to extreme gender identity ideology.
Implementing a “Pause for Under 18s”
The NHS has informed Dr. Cass in a letter that it will conduct an external expert review of all its adult gender clinics and has instructed them in the interim to halt scheduling first appointments for individuals under 18.
The letter, written by John Stewart, national director of specialized commissioning for NHS England, indicated that the NHS would also “review the use of gender-affirming hormones through an updated evidence review and public consultation, similar to the rigorous process used to assess the use of puberty-suppressing hormones.”
Over the past decade, children’s clinics have been inundated with referrals, now receiving over 1,600 referrals annually, compared to 50 in 2009.
Children with gender dysphoria or incongruence feel that their gender identity differs from their birth sex.
Approximately 2,000 16-year-olds have been referred to adult services because they could not be seen by a children’s clinic due to wait times.
The Cass review states that the adult clinics, of which there are 12 in England, declined to cooperate with its research.
The Bayswater Support Group, which provides assistance to parents of children with transgender identities, expressed “great concern” about the provision of adult services, where 70% of referrals are in the 17 to 25 age group and face the same vulnerabilities highlighted in today’s report.
The spokesman for NHS England expressed deep appreciation for Dr. Cass and her team’s comprehensive review over the past four years.
The NHS has made significant strides toward establishing a fundamentally different gender service for children and young people, in line with earlier advice by Dr. Cass, by discontinuing the routine use of puberty suppressants and initiating the first of eight new regional centers offering a different care model.
The NHS is also advancing its systemic review of adult gender services and has written to local NHS leaders asking them to halt scheduling first appointments at adult gender clinics for individuals under 18 after carefully considering this final report and its recommendations. “We will outline a comprehensive implementation plan.”
