What I would have said, and what Dr Cass did say
Dr Hilary Cass went on Times Radio to talk about schools, trans children, and puberty blockers. Here is what I would have said if I had been asked those questions.
Dr Hilary Cass was recently interviewed on Times Radio1 about the draft schools guidance on gender identity and about the puberty blockers clinical trial. The interview was soft, unchallenging, and left some really important questions unanswered. So I decided to answer them myself.
In this video, I go through the Times Radio interview question by question, and for each one I explain what Dr Cass said, and then I share what I would have said if I had been the clinician in that chair. Below the video, I have summarised the key points for those who prefer to read.
Social transition does not lock children into anything
One of the first things Dr Cass says in the interview is that social transition at a young age risks locking children into a trajectory for life. This is a claim that gets repeated often, and it is worth examining carefully.
Social transition2 means allowing a child to express their gender in a way that feels right to them. That might involve a different name, different clothing, or different pronouns. None of these things are medical. None of them are irreversible. A child who tries a new name can go back to their old one. A child who wears different clothes can change again. The whole point of social transition is that it gives a child the space to explore and to understand themselves.
What we know from research3 is that children who are supported in their social transition tend to have mental health outcomes that are comparable to their cisgender peers. Children who are not supported tend to have significantly worse outcomes, including higher rates of anxiety, depression, and self-harm. If we are genuinely concerned about locking children into harmful trajectories, we should be far more worried about the long-term effects of rejection and denial than we are about letting a child try a different name.
The desistance narrative does not hold up to scrutiny
Dr Cass says in the interview that the vast majority of children who question their gender grow out of it. This is one of the most commonly repeated claims in the debate around trans children, and it is based on research that has been widely criticised.
The desistance studies that are usually cited included large numbers of children who were referred to clinics for general gender non-conformity, not because they were identifying as a different gender.4 Many of these children were referred because they had interests or behaviours that did not match the expectations for their sex. When those children later did not identify as trans, they were counted as having desisted.
When researchers look specifically at children who clearly, consistently, and persistently identify as a different gender, the picture changes significantly. Persistence rates among these children are high. These are not children who are confused or going through a phase. They are children who know who they are.
Continuing to repeat the desistance narrative without acknowledging these distinctions is misleading, and it has real consequences. It is used to justify delaying care, questioning children’s identities, and building policies that treat trans children as likely to change their minds.
Parental involvement matters, but so does understanding why some children do not tell their parents
Dr Cass describes a situation in the interview where children were being socially transitioned in schools without their parents’ knowledge. She links this to cases where the child had also experienced trauma, self-harm, and eating disorders, implying that the gender questioning was simply another expression of underlying distress.
I agree completely that parents should be involved in their child’s journey. The best outcomes in my clinical experience have always come when families are supportive and engaged. That is not the question.
The question is why some children did not feel safe to tell their parents.5 In most cases, it was not because a school conspired to keep it secret. It was because the child was afraid of rejection. When we know that family acceptance is the single most significant factor in the mental health outcomes of trans young people, the conversation needs to be about how we help parents become the safe people their children need, not about how we ensure children cannot access support without permission.
It is also important to challenge the idea that gender identity is caused by trauma. Some trans young people have experienced trauma. Some have not. Some have eating disorders. Many do not. Co-occurring conditions do not invalidate a person’s gender identity any more than they would invalidate any other aspect of who they are.
Telling children to get clinical advice when there is no clinical pathway
Throughout the Times Radio interview, Dr Cass repeatedly says that children and families need clinical advice. She says it about primary school children, about secondary school children, and about families navigating questions around gender identity. She is absolutely right that clinical support is important.
The difficulty is that the clinical pathway is now almost non-existent. NHS waiting times for gender identity services have been measured in years, not months. Since the Cass Review, puberty blockers have been removed from routine clinical use and restricted to a single clinical trial.6 The new regional centres that were supposed to replace the old model are not yet operational in any meaningful way. Many GPs are unsure what they are allowed to prescribe or recommend.
So when families are told to seek clinical advice, they are being directed towards a system that cannot help them. The result is that children wait, sometimes for years, without any support at all. Some families turn to private care or services abroad. Others simply go without. Telling people to seek help while simultaneously removing the routes to that help is not a sustainable or compassionate approach.
Neurodivergence does not undermine gender identity
Dr Cass notes in the interview that many young people who question their gender are neurodivergent. This is true, and it is an observation that has been made in the clinical literature for some time. Research does suggest a higher prevalence of gender diversity among neurodivergent people, and a higher prevalence of neurodivergence among gender diverse people.7
The question is what we do with that information. The way it is used in the interview, and in much of the wider discourse, suggests that neurodivergence is a complicating factor that makes a child’s gender identity less reliable. That if a young person is autistic and says they are trans, we should be more sceptical about their self-knowledge.
This is not supported by the evidence. Neurodivergent young people are perfectly capable of understanding and articulating their gender identity. If anything, many autistic people describe their relationship with gender in ways that are particularly clear and direct. Treating neurodivergence as a reason to doubt or delay is patronising and harmful, and it leaves neurodivergent trans young people waiting even longer for support that they need just as much as anyone else.
What do we actually do for trans children?
One of the most striking things about this interview is the question that the presenter keeps asking and that Dr Cass keeps not answering. Ayesha Hazarika asks, repeatedly and in different ways, what we actually do for children who are trans. For the ones that everybody agrees exist. What do schools do? What does the system do? How do we support them?
Each time the question is asked, Dr Cass redirects to caution, flexibility, clinical advice, and not getting locked in. She never gives a direct answer.
So let me give one. If a young person is trans, and they have had the time and space to explore and understand themselves, and their family is supportive, then what we do is we support them. We use their name. We use their pronouns. We let them dress in a way that feels right. We treat them with dignity and we trust them. For those who need medical support, we provide it carefully and thoughtfully, with informed consent and proper monitoring. That might mean puberty blockers. It might mean hormones. It is a clinical conversation, not a political one.
Trans children are not a policy problem to be managed. They are young people who deserve the same care, respect, and support as everyone else.8
The puberty blockers contradiction
The final section of the Times Radio interview covers the puberty blockers clinical trial. What is striking here is that Dr Cass says something that directly contradicts the position her review has created.
She says that young people were told for 15 years that puberty blockers were safe and essential. She says that if we simply ban them without trying to discover the truth, young people will seek them from unregulated sources abroad. She says we owe it to children to answer the question definitively.
I agree with all of that. The problem is that her review led directly to puberty blockers being removed from routine clinical practice and restricted to a single randomised controlled trial. That trial involves giving some young people a placebo, meaning they will believe they are receiving treatment but will not be. The number of places is extremely limited. Most children who need this treatment will not qualify.
So the very outcome Dr Cass says she wants to prevent, young people being driven to unregulated care because the NHS cannot help them, is exactly what is happening right now. That is the reality for families across the country. And until there is an honest conversation about that contradiction, the children at the centre of this debate will continue to pay the price.
If you found this useful, please share it with someone who needs to hear it. If you are a parent, a teacher, a clinician, or simply someone who cares about the wellbeing of trans young people, I would love to hear from you.
Great news from European Parliament.
https://greekcitytimes.com/2026/02/13/european-parliament-backs-non-binding-resolution-recognising-trans-women-in-eu-gender-equality-priorities/