A minister on Wednesday promised a “fundamental change of direction” for NHS gender care for children after a landmark review found that the pillars of gender medicine are “built on shaky foundations”.
The Cass Review, published by paediatrician Dr Hilary Cass, found that the NHS had used unproven treatments such as puberty blockers and cross-sex hormones on vulnerable children despite “remarkably weak evidence” of their effectiveness.
Doctors were “afraid” to discuss their views on treatment because of the “toxicity” of the debate around gender, the report found, leaving young people “caught in the middle of a stormy social discourse”.
The 388-page report was first commissioned by NHS England in 2020 in response to a significant rise in referrals to the Gender Identity Development Service (GIDS) at Tavistock and Portman NHS trust in Hampstead. Around 9,000 children and young people were treated at the clinic between 2009 and 2020, with an average age at referral of 14.
The review contains 32 recommendations for overhauling NHS services, including strengthening research and commissioning a separate service for people who wish to “detransition”, referring to the process where someone discontinues or reverses a medical gender transition.
Young people referred for gender treatment on the NHS should also be given screening for neurodevelopment conditions such as autism and a full mental health assessment, Dr Cass wrote.
The most high profile case of "detransitioning" is that of Keira Bell, who began taking puberty blockers aged 16 before transitioning to a male. She later decided to reverse treatment, claiming she never should have been given the medication in the first place and that the Tavistock clinic should have challenged her more.
Victims and safeguarding minister Laura Farris said the findings would kickstart a “fundamental change of direction” in gender care.
She told Sky News: “We are going to have regional support centres across the UK so that a child who is questioning their gender will be given a holistic package of support, not just funnelled down an irreversible pathway where they may find that they reach adulthood and then, a bit like Keira Bell, wonder how on earth they were ever allowed to take those steps.”
In the report, Dr Cass makes it clear that the review is not about “defining what it means to be trans” or “undermining the validity of trans identities”, but rather is “about what the healthcare approach should be, and how best to help” the rising number of children and young people seeking NHS support around gender identity”.
The publication of the report comes weeks after NHS England confirmed it would no longer prescribe children puberty blockers at gender identity clinics over safety concerns. However, children can still be given masculinising or feminising hormones such as testosterone or oestrogen from the age of 16.
In the review, Dr Cass said she had been “disappointed by a lack of evidence on the long-term impact of taking hormones from an early age”.
The prescribing of hormones should only be done “with extreme caution” and there should be a “clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18”, she wrote.
Addressing children directly impacted by the treatment failings in the foreword to the report, she said: “Research has let us all down, most importantly you.”
Last month, the gender identity development service (Gids) at the Tavistock and Portman NHS Foundation Trust closed, with two regional hubs opening in London and the north of England in a bid to move away from a single-service model.
Prime Minister Rishi Sunak welcomed the findings of the report and said that the lack of evidence around the long-term impact of gender medicine meant that doctors should exercise “extreme caution” when treating children.
“We acted swiftly on Dr Cass’s interim report to make changes in schools and our NHS, providing comprehensive guidance for schools and stopping the routine use of puberty blockers, and we will continue to ensure that we take the right steps to protect young people,” he told LBC.
NHS England thanked Dr Cass for the report and said it had already made “significant progress” towards establishing a different gender service for children and young people.
