Why the Cass Review Still Matters, And Why We Must Look Again
Re-examining the Evidence, Assumptions, and Impact Behind the NHS’s Most Controversial Review
The Cass Review is often spoken about as though it is finished, concluded, and safely filed away. In reality, it continues to shape policy, restrict care, and influence how transgender young people are seen and treated across the UK.
With Dr Hilary Cass back in the headlines following the announcement of a puberty blocker trial, now is exactly the time to revisit what the Review was built on, and what it left unexamined.
A Review With Lasting Consequences
In April 2024, Dr Cass sat down with Dr Kamran Abbasi, Editor-in-Chief of The BMJ, to explain the thinking behind her work.
It is worth reminding ourselves why her Review existed at all:
It was commissioned to guide how the NHS should support children and young people questioning their gender identity or experiencing gender incongruence. Its conclusions have shaped policy, restricted access to care, and shifted public perception nationwide.
When we revisit that interview, the foundations of the Review, what was examined, what was assumed, what was accepted, and what was dismissed, raise serious questions that have never been satisfactorily addressed.
This conversation deserves scrutiny.
Expertise Matters
In the interview, Dr Cass emphasised that her clinical background is in childhood disability, not gender identity.
In almost every other area of medicine, major national reviews of specialist services are led, or at least heavily guided, by experts in that field.
Yet here, the stakes were extraordinary. Care for trans young people was effectively paused and that pause has consequences.
What Counts as “Evidence”?
The Review repeatedly claims to be grounded in evidence but the conclusions it reached stand in stark contrast to every major international authority on transgender healthcare.
WPATH, the Endocrine Society, the American Academy of Pediatrics, and others have reviewed the same studies and reached a different position:
Puberty blockers and hormones, when used appropriately, can be life-changing and beneficial.
If two expert bodies review the same evidence and reach opposite conclusions, we must ask:
Where is the difference coming from?
Concerns That Were Never Resolved
Several issues stand out:
International experts report they were not consulted.
There was no clear method for resolving differing clinical perspectives.
Psychological therapy was framed as an “alternative” to medical care, despite the fact that talking therapy cannot stop unwanted puberty.
Gender identity was sometimes presented as a symptom of trauma, depression, or autism, rather than an intrinsic part of a person.
There is no evidence that treating unrelated conditions changes someone’s gender identity.
There is evidence that withholding gender-affirming care increases distress, self-harm, and suicidality.
And yet, while acknowledging that trans youth face a heightened suicide risk, the Review restricts access to the very interventions shown internationally to reduce that risk.
How can this be justified?
The Real Cost of Delay
The Review’s recommendations have, in practice, halted NHS care and families are now left watching as their child’s body develops in ways that may be irreversible.
For many young people, the cost of delay is not theoretical, it is physical, emotional, social, and lifelong.
The Puberty Blocker Trial
As the new trial begins, we must be absolutely certain that decisions about young people’s lives are based on solid evidence, including the evidence that already exists.
Negative social narratives, political agendas, and discriminatory views cannot be allowed to shape medical treatment.
This moment could still become a turning point, with care and courage, the government can choose a path that prioritises young people’s wellbeing rather than fear or ideology.
A Caller’s View
One caller on LBC recently shared their perspective on puberty blockers and the Cass Review. Their comments capture how deeply this issue continues to affect public understanding and policy.
Over to You
What do you make of this ruling?
Was the ban on puberty blockers justified?
Has it done more harm than good?
Do we need a new trial or should we rely on the body of research we already have?
I’d love to hear your thoughts.
Subscribe and join the conversation below.
Sources and Further Reading
This post is part of a series examining cases, commentary, and hearings relating to gender identity. If you have a case or topic you’d like me to review, I’d love to hear from you.