Cass Review

The Independent Review of Gender Identity Services for Children and Young People, more commonly known as the Cass Review or Cass Report, is a 388-page government report on the provision of gender-affirming care to young people in the United Kingdom. Commissioned by the NHS as an "independent review" headed by paediatrician Hilary Cass, the report took four years to produce and led to swift, sweeping policy changes (including a ban on puberty blockers) after its release in April 2024. As it was a review (and the final report was not itself subject to traditional peer review Freely readable on ResearchGate. although that matters less than one may think), it didn't itself produce new evidence.
Prior to Cass, one review in this area of medicine was Cornell University's 2018 review by the What We Know Project.(2018). "What does the scholarly research say about the effect of gender transition on transgender well-being?". What We Know Project, Cornell University. Out of nearly sixty studies considered by that review, the Cass Review and its associated systematic reviews for some reason found occasion to reference precisely zero of the same papers. The Cass Review has, predictably given some of its content and background, been well-received by anti-trans lobby groups and activists. Outside the echo chamber inhabited by transphobes, it has been roundly criticised by major medical organisations for its limitations and serious methodological flaws, and has been cited as an example of policy-based evidence making.Tweet by Jolyon Mauham (@JolyonMaugham) Archived.Tweet by TransSafetyNow (@DadTrans). Archived.Tweet by Mark Boylan (@MarkBoylanEd). Archived. Despite its flaws, the Cass Review doesn't call for a ban on any of the options that doctors and their patients might pursue.
==Rigging the game==
===Hand-picked from a shortlist of one===
The NHS announced in January 2020 that it was establishing an "independent expert group" chaired by to "support a review of puberty suppressants and cross-sex hormones" in paediatric gender care. In September 2020, the NHS announced that Cass would also head this review, which it billed as an "independent review into gender identity services for children and young people." Both press releases hailed her as "Dr Hilary Cass OBE, former President of the Royal College of Paediatrics and Child Health." They didn't mention that Cass lacks clinical experience or expertise in caring for trans youth.
The World Professional Association for Transgender Health condemned Cass's appointment as occurring "without any transparent or competitive process" in a statement released after the review's publication in 2024. A freedom-of-information (FOI) request that same year revealed that Cass was the only candidate considered for the job (from a "shortlist" of one).(July 11, 2024). "FOICRM (NHS ENGLAND - X24), NHS England". Twitter thread by @ReactiveAshley with screenshot of response to the FOI request. Archived.
Tory minister a DeSantisHeather Stewart (April 30, 2023). "Florida's rightwing governor Ron DeSantis backs Kemi Badenoch's 'war on woke'". The Guardian. and Murdoch darling,Stefan Boscia (October 2, 2023). "Tory rising star Kemi Badenoch held secret talks with Rupert Murdoch". Politico. proudly admitted in a June 2024 tweet that political manipulation paved the way for Cass.Archived tweet by Kemi Badenoch. Transcript: According to Badenoch, the review wouldn't have been commissioned under a Labour government, and it was "when the ministers changed" that her party no longer faced "opposition from the system." She said a decisive factor in the production of the Cass Review was "having gender-critical men and women in the UK government, holding the positions that mattered most in Equalities and Health." Cass was not-coincidentally awarded a life peerage in the House of Lords by transphobe and outgoing Prime Minister Rishi Sunak in July 2024. The aforementioned Badenoch took credit, saying she "managed to get Dr Hilary Cass a peerage", and that if she were made Tory leader, would offer J. K. Rowling one, too.Amy Watson (October 17, 2024). "Kemi Badenoch: I would give JK Rowling peerage for her gender stance". The Scotsman.Christopher McKeon (October 17, 2024). "I would give JK Rowling a peerage for gender stance, says Kemi Badenoch". The Independent.
The Cass Review appears to have engaged in questionable handling of public records from an early stage.Tweet thread by @ReactiveAshley(9 January 2025). "FOICRM (NHS ENGLAND - X24), NHS England". An FOI request filer seeking "internal drafts" spanning October 2020 to 
April 2024 was told that "NHS England did not receive snapshots or drafts" as this fell "outside of the review's 
data handling policy."
===Engagement with anti-LGBT perspectives===
The Review consulted many non-experts, and many sources who were explicitly, self-admittedly in denial that transgender minors, the topic of the review, exist at all (32 percent of those surveyed). Cass herself was presented as impartial and thus especially fit to carry out the review. The interim report released by the NHS in February 2022 described her as having "no prior involvement or fixed views" amidst an alleged clinical "polarisation" on trans healthcare. However, according to a white paper released in August 2024 by Max Davie and Lorna Hobbs, clinicians working in child and adolescent gender care in the UK, she was "known by colleagues to oppose medical transition" at the time of her appointment.
Davie and Hobbs' paper included a footnote stating that Cass had "strongly recommended" the anti-trans book Irreversible Damage: The Transgender Craze Seducing Our Daughters.Twitter thread with screenshots of the original and updated footnote Screenshots of this footnote were widely shared on social media. Davie updated the paper to clarify that Cass called him to "discuss [his] potential involvement" in the review "towards the end of 2020." In Davie's recollection, Cass "expressed concerns about practice" during this conversation, finding it "shocking" that "97% of children" prescribed puberty blockers progressed to HRT. When Davie countered that this was likely due to "accurate triage," Cass reportedly "recommended that [he] read Irreversible Damage." Davie claimed that he first became "aware of Dr Cass's scepticism about the GiDS model" when they collaborated on a project. Cass dismissed the Irreversible Damage anecdote as "baseless and wholly untrue" in response to a request for comment from PinkNews. In the statement, she denied having ever read the book and asserted that "the suggestion that I recommended it to anyone is fabrication," noting that she had "already been reviewing the evidence for six months" at the time of its publication. Davie later removed (but did not retract) the anecdote from the paper, stating that "Dr Cass obviously saw [it] as an attack" and that he and Hobbs had set out to "robustly critique the review, not make personal attacks."Twitter thread by Max Davie (@maxdavie). Archived copies of constituent tweets: 1, 2, 3, 4, 5, 6, 7, 8.
Cass' statement to PinkNews raised new questions. It suggests that Cass believes her work on the Cass Review began in January 2020. It also implies that she has been aware of Irreversible Damage since its American release. The book was initially released by Regnery Publishing in June 2020.Listing for the hardback edition of Irreversible Damage on Amazon. It was not published in the UK until December 2020.Listing for Irreversible Damage on the Swift Press website.The LGB Alliance told its followers to "buy the book" and "tell everyone [they] know" in a June 2020 tweet. It seems likely that imported American copies were already in circulation in the UK by that time. It's also possible that people may have received of the Swift Press edition prior to its publication. Regnery is a right-wing imprint that mainly sacrifices trees for pundits like Ann Coulter and Dennis Prager. Regnery also has a history of endorsing anti-science junk such as Peter Duesberg's Inventing the AIDS Virus (1996). UK publisher Swift Press has cultivated a similar reputation for "standing up to groupthink." The author of Irreversible Damage, Abigail Shrier, is a conservative opinion columnist. Natalie Wynn characterised Shrier's book as "essentially to transmasculine people what The Transsexual Empire was to trans women.""J.K. Rowling" by ContraPoints on YouTube The book centres on Lisa Littman's debunked hypothesis that peer pressure and social media are "seducing" AFAB teens into identifying as trans boys.
Cass has followed Graham Linehan, LGB Alliance, and online, among other anti-trans activists and organisations.Archived screenshots of Cass's Twitter follows by Erin Reed (@erininthemorning)Archived screenshots of Cass's Twitter follows by @TS_Erica_SArchived screenshot of Cass's Twitter follows by @shadell131 In 2022 she met with Patrick Hunter of the anti-trans SPLC-designated hate group"Hate Map: Idaho, Anti-LGBTQ Groups". Southern Poverty Law Center. SEGM to discuss a stitched-up report used to ban gender-affirming care in Florida. Hunter also belongs to the , an anti-abortion, anti-gay) (Non-PDF landing page). organisation that opposes gender transition because, according to their interpretation, it "violates the teachings of the Church.""Case 4:23-cv-00114-RH-MAF Document 180 Filed 11/06/23". United States District Court for the Northern District of Florida, Tallahassee Division Cass was due to speak at a cancelled 2022 teleconference for trainee child psychiatrists in the UK alongside Lisa Littman, Transgender Trend founder Stephanie Davies-Arai, Genspect founder and anti-trans columnist Helen Joyce.
===Exclusion of trans-friendly perspectives===
With a transphobe specially recruited as its lead author, the Cass Review systematically excluded input from expert clinicians, trans people, and other stakeholders. In a paper in the International Journal of Transgender Health, Cal Horton observed that "[The Review], by design, prioritized cis professionals with no experience in trans healthcare." In Horton's assessment, people consulted by Cass were chosen for their "absence of trans specific knowledge experience, including exclusion of those with lived experience of being trans." The original for the Review explicitly stated it "deliberately does not contain subject matter experts or people with lived experience of gender services." This was later amended to a vague note on the exclusion of parties with a "significant interest in the outcome of the Review" (, trans people concerned about their access to care). Cat Burton, who was consulted as director of the Gender Identity Research & Education Society (GIRES), concluded that "it was obvious that the review had been written before we started."Tweet by Cat Burton (@CatBurton_UK). Archived.
The Cass Review convened several focus groups of "former, current and potential future service users" in Spring 2023. The stated aim was to "understand [the] experiences" of trans youth and to "capture their thoughts and ideas about what they need and want from services and how they would want to access them." Multiple participants in these focus groups have expressed that they felt pressure to "'prove' to clinicians that they were transgender." One stated that clinicians had "probed [them] so hard" for "'alternative' reasons" for their transness, including "childhood trauma, with emphasis on sexual assault." This is an alternative fact propagated by anti-trans advocates, like Genspect and Parents of ROGD Kids."Other Known Causes for Gender Dysphoria". Parents of ROGD Kids, via the Wayback Machine.
The full membership of the Cass Review's advisory board remains unknown. Richard Byng and Richard Stephens of SEGM are known members.Twitter thread by TransSafetyNow (@DadTrans) Finnish child psychiatrist Riittakerttu Kaltiala is another.CV on Kaltiala's professional website Kaltiala established Finland's youth gender program, which has been accused of "grueling assessments, mockery, misgendering, and intrusive personal questions." A 15-year-old transmasculine patient reported being grilled on his masturbatory habits and told to report back after experimenting as "homework." Kaltiala decried youth transition in Finland's leading medical journal in 2011. One of the few studies rated as "high quality" by the Cass Review was a 2020 paper by Kaltiala et al. concluded that medical transition does not "improve functioning and relieve psychiatric comorbidities" in young patients. In 2022, Kaltiala testified in support of Florida's ban on gender-affirming care for minors, and she personally introduced Cass to anti-trans Traditionalist Catholic activist Patrick Hunter.
==Scientific response and general criticism==
thumb|right|300px|Headquarters of the British Medical Association.
The Cass Review has been widely criticised by medical bodies outside TERF Island since its April 2024 release. WPATH|, in a joint statement with its American counterpart USPATH, determined that the Cass Review "relies on selective and inconsistent use of evidence, and its recommendations often do not follow from the data presented in the systematic reviews." of New Zealand held that the Review makes several "harmful recommendations" and "ignores the consensus of major medical bodies around the world." The the the and the have all rejected the Cass Review's findings and recommendations. The Endocrine Society's statement noted that the Cass Review "does not contain any new research that would contradict" existing clinical guidelines on gender-affirming care for minors. 
A report produced by several researchers for Yale's Integrity Project concluded that the Cass Review "levies unsupported assertions about gender identity, gender dysphoria, standard practices, and the safety of gender-affirming medical treatments," and the systematic reviews it relies upon "have serious methodological flaws, including the omission of key findings in the extant body of literature."
In July 2024, the The systematic reviews produced for the Cass Review were published in Archives of Disease in Childhood. This is one of several journals belonging to the BMJ Group, publisher of the BMA's trade magazine, the British Medical Journal, which maintains editorial independence. This editorial independence has grown increasingly apparent in recent years, as the BMJ has become an outlet for fringe ideas on trans healthcare, while the BMA's policy positions have reflected scientific consensus. broke ranks with the UK's institutional transphobia, Madeline Fitzgerald (June 29, 2022). "The Roots of Anti-Trans Feminism in the U.K.". U.S. News & World Report. Rachel Muller-Heyndyk (June 19, 2018). "Transphobia rife among UK employers". HR Magazine. announcing it planned to "undertake an evaluation of the Cass Review" by the year's end. The statement cited international and domestic concerns over "weaknesses in the methodologies used in the Review and problems arising from the implementation of some of the recommendations." The UK's anti-trans commentariat were predictably outraged.
The Cass Review drew general criticism for using AI-generated images of children throughout its final published version.Xtra Magazine soon released two reports referencing the Cass Review's use of AI-generated images:1. "How AI image generators fail queer and trans people" (April 16, 2024).2. "Who does queer AI 'art' actually represent?" (May 16, 2024). A member of Cass's "team" confirmed the use of both "real" and AI-generated "Adobe stock images" to 404 Media, explaining that, given the "sensitive and contentious" nature of the report, a "conscious" effort was made to avoid "images that could identify any individuals." Abigail Anthony of National Review wrote a bizarre defense of the AI images while conceding that the cover art has "creepy fingers." The Cass Review also allegedly "borrowed" the chart presented as "Figure 11" (see below) from SEGM's website without attribution. The only modification was the removal of SEGM's logo from the lower right corner. SEGM co-founder Zhenya Abbruzzese commented in an Undark interview that the group were "both surprised and pleased" to discover their chart in the Cass Review. The Review's teal-and-orange colour scheme was seemingly inspired by SEGM's graphics.Compare to the selection of charts featured on the main page of the SEGM websites below the self-congratulatory "SEGM in Media" section.
==Methodological issues and unsupported claims==
===A brief rundown of everything Cass got wrong===
The Cass Review and the systematic reviews it drew on repeatedly violated conventional standards of evidence evaluation; violated what can be surmised of its own standards of evidence evaluation; made some completely unsupported or disproven assertions; botched the use of technical terminology; misrepresented/misinterpreted its own presented data; claimed to oppose conversion therapy while uncritically and favorably citing papers "proposing methods that claim to suppress transgender identity"; failed to rigorously define or explain its standards or reasoning for evidence quality; failed to seriously consider other factors recommended for evaluation in the care of trans patients by e.g. a such as risk-benefit ratios, which can be important especially given the limits for achievement of "gold standard" evidence in many types of medicine. (September 3, 2020). "Only 1 in 10 Medical Treatments Is Backed by High-Quality Evidence, Study Finds". The Conversation (via ScienceAlert).
They failed to contextualize transgender medicine within wider pediatric medicine (in such a way as to create an implicit double-standard); misrepresented the careful and considered deployment of transgender medicine as instead careless (which ran against the review's own data); oversimplified some nuanced findings; framed patients' advancement from social transition to medical transition as though the former caused the latter, rather than this being a demonstration that the patients are genuinely transgender; and cited papers based on surveys from anti-transgender websites while ignoring or underplaying major findings from certain papers that were based on much more rigorous methodologies, including even some papers that the Cass Review's own systematic reviews rated as "moderate" or "high" quality. Basically, this means the final report failed to reference certain positive evidence for trans medicine that the review's own evidence-evaluators found.
===Throwing out the majority of research===
The Cass Review's biggest methodological flaw is its nearly-wholesale dismissal of the existing body of scientific research supporting gender-affirming care. Cass recruited researchers at the University of York to carry out seven (SRs) of the available scientific literature for use in the review. McNamara et al. (2024) found that the York authors their intent to assess study quality in all seven SRs using the Mixed Methods Appraisal Tool (MMAT). However, they ultimately switched to a version of the Newcastle-Ottawa Scale (NOS) with "several adaptations" introduced by themselves for half of the SRs, which McNamara et al. judged to be "a divergence from standard practices designed to minimize bias in systematic reviews" and "not a minor one." This switch was not explained or acknowledged in the SRs.
After the SRs conducted by the York researchers were printed in Archives of Diseases in Childhood, the journal's publisher, BMJ Group, put out a press release boasting that two of them had rejected all but one out of a pool of 50 or more studies considered. Applying ROBIS, a tool recommended by for evaluating risk of bias in systematic reviews, all of the seven systematic reviews used by the Cass Review were determined to be at a high risk of bias on every single measure (of four measures) — except for one that was low risk of bias on a single measure. This was "driven by unexplained protocol deviations, ambiguous eligibility criteria, inadequate study identification, and the failure to integrate consideration of these limitations into the conclusions derived from the evidence syntheses."
In laymen's terms, this means the Cass Review applied incomprehensible standards to its evaluation of evidence, seemingly picking-and-choosing what studies to include and exclude on an arbitrary or selective basis. This is worse than the explanation that the Review dismissed everything but double-blind randomized controlled trials (RCTs) as "low quality." That misconception has made it into media coverage and popular commentary. RCTs have limitations. RCTs are ethically questionable or practically infeasible in certain fields, including chemotherapy, abortion medication, and gender care.This doesn't disqualify RCTs from being used in the listed fields. When testing the effectiveness of a treatment, a placebo is generally used as a control in RCTs. However, when RCTs are done for new treatments for which withholding of treatment would be considered unethical, the control group usually consists of a currently proven treatment instead. 
Cancer treatment is a perfect example. RCTs are common in cancer research. However, instead of using a placebo for the control group (as withholding treatment for a disease with such a high rate of death would be unethical), the control group generally receives the same kind of treatment they would expect from your average hospital. It's still an RCT, but the C is slightly different, with no ethical qualms. As McNamara et al. explain, "the presence or absence of 'high-quality evidence' alone should not be used to decide whether to offer treatment" with proven benefits, since "RCTs specifically are ill-suited to studying the effects of many interventions" on trans people's well-being. In the case of puberty blockers, it would be impossible to successfully conduct a double-blind RCT on their efficacy in treating gender dysphoria in trans adolescents, as the placebo cohort would realise their lot upon experiencing unwanted body changes (e.g. breast development in trans boys). The overall prevalence of RCTs in pediatric medicine has declined or stagnated since the 1980s for various reasons.
===Weird, ridiculous, and harmful assertions===
* Toy preferences are biological: The Cass Review claims children's "toy preferences, play, and physicality" are "influenced by biological and social factors." It asserts that "there is evidence for [strong] prenatal and postnatal hormonal influence" in girls' apparent preference for dolls and boys' preference for trucks, but that this is somehow not also the case for gender identity despite there being evidence for that, including evidence mentioned in the Cass Review itself (though it frames prenatal sex hormones in this case as "environmental influences" for some reason). It cites a 2015 study by Melissa Hines, who also co-authored a 2002 study claiming "sexually differentiated object preferences" in vervet monkeys. In other words, it claimed that male vervets showed greater interest in a "car and a ball" while females preferred the "doll and [cooking] pot," a finding that assumes animals understand the purpose of human-made objects. A later, smaller study with rhesus macaques had different findings from Hines's, so it might even depend on the species of primate. (Humans are most closely related to bonobos and chimpanzees, which differ behaviorally, being matriarchal and patriarchal respectively.Adam Omary (August 17, 2022). "What Primates Can Teach Us About Gender". Psychology Today.Jose Yong (April 4, 2023). "Bonobos and chimps: what our closest relatives tell us about humans". The Conversation.)
* Porn makes kids trans?: The Cass Review suggests "more investigation into consumption of online pornography and gender dysphoria is needed." The only source it cites to prove the supposed need for such research is a 2024 commentary by Karin Nadrowski. Nadrowski argues that exposure to violent, degrading porn may induce transness in AFAB youth by increasing "shame and fear of becoming a woman," claiming that "working through" patients' sexual trauma "may correct false beliefs about gender inequality and therefore might alleviate gender dysphoria." Nadrowski, a clinical psychiatrist and detransitioner, belongs to a pro-conversion therapy lobby group. Cass stated in a May 2024 interview with NPR that "early exposure to pornography" may drive trans identification among AFABs.
* Tumblr makes kids trans?: The Cass Review stops short of endorsing the debunked concept of rapid-onset gender dysphoria (ROGD) as fact.It does cite a 2021 survey by Lisa Littman, author of the earlier paper proposing ROGD, in a section on respondents' stated reasons for detransitioning. However, the Review makes a point of concern trolling that some of the parents it consulted were worried about online "influencers," who they believe have exerted "a substantial impact on their child's beliefs and understanding of their gender."The sentence initially attributes these concerns to "gender-questioning young people and their parents" before the Review tips its hand with "their child." It does this after spending several pages fretting over whether social media and smartphones have increased the incidence of depression, sleep disorders, and body-image issues among young people. The notion that trans identities are spread via "social contagion" has been popularised by Abigail Shrier's Irreversible Damage. A colleague of Hilary Cass has alleged that she "strongly recommended" this book to him in 2020.
* Autistic people cannot know themselves: The Cass Review states that research has found "transgender and gender-diverse individuals are three to six times more likely to be autistic" than cis people. The cited study, Warrier et al. (2020), did indeed reach this conclusion. At least one other paper supports a link between gender variance and neurodivergence. The trouble lies in the Review's suggestion that issues with sensory processing and emotional expression mean autistic trans kids cannot be trusted to accurately articulate "how they are feeling about their internal sensations, their gender identity and their sexual identity." It uncritically repeats a 2011 study's assertion that "it can be complicated to disentangle" whether autistic trans kids' dysphoria "evolves from a general feeling of being just 'different' or a whether a true 'core' cross-gender identity exists." The Nadrowski paper more bluntly opines that the "reduced mentalization capacities" of AFAB autistics make them more vulnerable to being transed by porn. The Cass Review recommends screening young NHS gender patients for "neurodevelopmental conditions, including autism spectrum disorder." Its claims are part of a wider ableist assault on autistic people's right to self-determination. Trans autistics have reported being delayed or blocked in accessing care by clinicians. Several U.S. states restricted or banned gender-affirming care for autistics in 2023.
==Political context and impact==
===Puberty blocker ban===
Puberty blockers were banned for gender dysphoria patients under 16 in the UK following the High Court's decision in in December 2020. The decision was overturned by the Court of Appeal in the September 2021. In May 2024, shortly before the dissolution of Parliament ahead of that year's general election, Tory health secretary Victoria Atkins announced a ban on new blocker prescriptions for dysphoria patients under 18. The surprise move exploited an emergency legal mechanism that was last invoked in 1999 to ban a poisonous herb (Aristolochia) used in traditional Chinese medicine following two deaths. TransActual and the Good Law Project quickly mounted a legal challenge of Atkins' ban, arguing she hadn't shown a "serious danger to health" that justified emergency action. A judge held that Atkins' use of emergency powers was "lawful" in late July. 
The ban would've automatically expired in September 2024 given the mechanism's emergency intent. announced his plan to make the ban permanent within days of his instalment as health secretary under the newly-elected Labour government in early July. The "temporary" ban was extended on August 22. Sinn Féin implemented the ban in Northern Ireland soon after. The "temporary" ban was extended a second time in November. The ban was made indefinite in December in all regions of the UK. It will be "reviewed" in 2027 following the (presumably pre-written) findings of a government-run "clinical trial" that kids seeking GAC in the UK will be funnelled into going forward. As of September 2024, the Cass Review had reportedly been cited for bans in ten U.S. states and one Canadian province, despite this seeming to go beyond even the review's own published recommendations.
Blockers remain legal in the UK for the treatment of (, they're fine for cis kids, but not for trans kids).Ojeda et al. (September 2024). "Afirmación de género y evidencia en torno al suicidio: Aportes para el debate público" ["Gender affirmation and evidence surrounding suicide: Contributions to public debate"]. Sexuality Policy Watch (in Spanish). In a letter to a Labour constituent, Streeting claimed that suppressing "abnormally high" hormone levels in young children has been "extensively tested" and meets "strict safety guidelines," but that "stopping the normal surge of hormones" at puberty might be bad for nebulous reasons involving "psychological and brain development."Twitter post by Paul Ilett (@Paul_Ilett). Archived. A subsequent FOI request offered no answer as to whether Streeting had examined evidence or consulted experts on the safety of precocious puberty treatment before making these claims. According to an academic paper in the Journal of Paediatrics and Child Health:
===Alleged suicide coverup===
Barrister revealed in June 2024 that multiple whistleblowers had come forward with allegations of a "huge increase" in trans youth deaths since Bell v Tavistock.Twitter thread by Jo Maugham (@JolyonMaugham) According to one whistleblower, there were 16 deaths of trans youth on the NHS waiting list in the three years after Bell, in contrast to only a single death in the seven years before the decision. This whistleblower brought these alarming numbers to the attention of Hilary Cass and a director of the Tavistock clinic. When Maugham contacted Cass about the whistleblower's claims, a representative replied pointing him to a section of the Cass Review that references "deaths of patients," but attributes suicides to those with "multiple comorbidities and/or complex backgrounds." A second whistleblower alleged that Tavistock staff who planned to expose the numbers in an open letter were threatened with "disciplinary proceedings and being reported to their regulatory bodies."
Maugham's revelations prompted the UK government to hastily commission an "independent review" from University of Manchester psychiatry professor Louis Appleby. Appleby's review concluded that "the data do not support the claim" of a "large rise in suicide" among Tavistock patients. In response, Maugham pointed out that that Appleby's review examined suicides among "current and former patients," while the whistleblowers' claims concerned those stuck in waiting-list limbo.Twitter thread by Jo Maugham (@JolyonMaugham) with associated images. All archived. Trans people seeking gender-affirming care through the NHS face years-long waitlists. In August 2024, a 17-year-old trans man who spent four years on the GIDS waiting list without an appointment told The Guardian that trans youth were "being used for political gain and treated as an intellectual exercise, rather than as human beings." Another young trans person who resorted to DIY hormone therapy after waiting five years stated that she "had to become [her] own doctor." The Labour government directed kids "unsure how the ban applies to their circumstances" to a list of crisis hotlines in its August 22 announcement. Caroline Litman filed a FOI request to learn her daughter widely-reported suicide was not included in Appleby's review.Archived post by Caroline Litman on Bluesky, a 20-year-old trans woman from Brighton, took her life in May 2022 after spending 1,023 days on the waiting list without a first appointment. Her death prompted an inquiry in which a coroner determined that languishing on a waiting list for nearly three years "contributed to a decline in her mental health." The coroner concluded that Alice's transition from children's to adult services was "non-existent," remarking that, "it seems to me that shortly after Alice turned 18, she was offered a 'coping strategies' course in a quite frankly half-hearted final offer of some kind of support." Cass told The Times in December 2024 that it was "irresponsible for people to shroud-wave" over trans youth suicides. This merely insults people as "irresponsible" for criticizing the government's policy that resulted in deaths.
In a 2024 survey by researcher Natacha Kennedy, parents of trans youth in the UK reported that their children experienced "sharply declining mental health, increased depression, social isolation, anxiety, stress, self-harm, attempts to avoid school and suicide ideation" following the blocker ban. This is consistent with other past research into the impacts of anti-LGBT government policy on mental health. Another 2024 study found a 72% increase of suicide attempts among trans and non-binary youth (TGNB) following the enactment of anti-trans legislation in several U.S. states. The American study noted "the lack of an observable in the time periods leading up to the enactment of the laws," proposing that this may be due to the long, bureaucratic legislative process "diffus[sing] the effects the bill debates had on the mental health of TGNB young people." Clinicians have also expressed concerns over the impact of anti-trans laws on the treatment of eating disorders (EDs) among trans youth. These young people may fall into "harmful eating behaviors" to "make their bodies conform to a masculine or feminine ideal," with trans boys in particular seeking to end menstruation or delay its onset through malnutrition.
==See also==
*American College of Pediatricians
*The BMJ
*Genspect
*Littman 2018 ROGD study
*SEGM
*Jesse Singal
==External links==
*"White Paper Addresses Key Issues in Legal Battles over Gender-Affirming Health Care", Yale Integrity Project (PDF)
*"BMA to undertake an evaluation of the Cass Review on gender identity services for children and young people", British Medical Association
*Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth, Journal of Adolescent Health
*Gender affirmation and evidence surrounding suicide: Contributions to public debate, Sexuality Policy Watch (in Spanish)
*"What's wrong with the Cass Review? A round-up of commentary and evidence", Dr. Ruth Pearce
*"Biological and psychosocial evidence in the Cass Review: a critical commentary", International Journal of Transgender Health
*"Cass Review slammed by transgender associations", MedicalBrief
*"Critically Appraising the Cass Report: Methodological Flaws and Unsupported Claims", preprint
*"What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth", CBC News
*"Media Boosted Anti-Trans Movement With Credulous Coverage of 'Cass Review'", Fairness & Accuracy In Reporting
*Episode #995 (news item 3 at 39:54–1:08:10), The Skeptics' Guide to the Universe
*"The U.K.'s Cass Review Badly Fails Trans Children", Scientific American
*Posts tagged "Cass Report", at Assigned Media
==Notes==
==References==
Category:British politics
Category:Documents
Category:Medicine
Category:Moral panics
Category:Propaganda
Category:Transphobia
Category:United Kingdom