The Cass Review reveals that NHS England put gender dysphoric kids on puberty blockers despite inadequate evidence that they work.
Keira Bell detransitioned after being put on puberty blockers by the NHS, aged 16. (Photo by PA Images/Alamy Stock Photo)

The UK Mistreated Kids with Gender Dysphoria for Years

A damning new report reveals how a national health service failed to care for deeply distressed children.

A long-awaited report out this week found that medical professionals in the UK who advocate for gender transition in children are misguided ideologues.

Written by British pediatrician Dr. Hilary Cass, The Cass Review, which is nearly 400 pages and took more than four years to compile, comes to the following conclusions:

  • Thousands of vulnerable young people were given life-altering treatments with “no good evidence on the long-term outcomes of interventions to manage gender-related distress.” 

  • “It has been suggested that hormone treatment reduces the elevated risk of death by suicide in this population, but the evidence found did not support this conclusion.”

  • “Social justice” ideology is driving medical decision-making, and “the toxicity of the debate” has created an environment “where professionals are so afraid to openly discuss their views.”

Activists insist the science on this matter is settled, but Cass’s tone recalls a stern British nanny calmly explaining to unruly children how to get their room in order. She shows us that everything about this issue is unsettled, and unsettling. For instance, she notes that “social transition”—when very young children assume other gender identities—is an “active intervention” that may set youths on a path to medical transition. And it may even make gender dysphoria worse.

The review, commissioned by England’s National Health Service, comes after more than a decade of whistleblowing by clinicians at the country’s Gender Identity Development Services, or GIDS, which was established in 1989 (but mostly off the radar for its first 20 years, because few children and families sought its services). 

These whistleblowers detailed how kids were fast-tracked to medication while a culture of fear grew around raising any concerns, even as demand for youth gender medicine exploded. Eventually, the NHS decommissioned GIDS and hired the neutral, no-nonsense Cass to detail what went wrong and what to do right moving forward.

Her report made the further damning conclusions:

  • Clinicians “are unable to reliably predict which children/young people will transition successfully and which might regret or detransition at a later date.”

  • A disproportionate number of patients were “birth registered females presenting in adolescence. . . . a different cohort from that looked at by earlier studies.”

  • Many parents feared their children had been medicalized by professionals who didn’t take other difficulties into account, “such as loss of a parent, traumatic illness, diagnosis of neurodiversity, and isolation or bullying in school.”

  • There is a lack of strong evidence to show that puberty blockers “may improve gender dysphoria or overall mental health.”

  • The majority of gender-dysphoric patients in early studies found that their symptoms desisted during puberty, with most coming out as gay or bisexual later.

Cass notes that “for most young people, a medical pathway will not be the best way to manage their gender-related distress.” She supports expanding the treatment to regional, holistic centers, essentially ending the specialist gender clinic model. That treatment should be based on unbiased psychological care, and robust and consistent evaluation tools must be developed so reliable evidence can finally be gathered. 

This final report—and an interim one Cass issued in 2022—echoes what a number of Western nations, such as Finland and Sweden, have found when they reviewed their own youth gender services. It also underscores what we see in the United States: poor quality research, an unstudied population, and detransitioners traumatized by the treatment they received.

Today, red states are banning the medicalization of gender dysphoric youth, while some blue states have declared themselves medical sanctuaries for minors seeking transition. Medical associations—from the American Academy of Pediatrics to the American Psychological Association—continue to support the “affirmative” model criticized by Cass in her report. 

In her review, Cass directly addresses the 9,000 young people who have moved through gender treatments via the NHS, stating bluntly: research “has let us all down, most importantly you.” 

The U.S. needs to form a truly bipartisan commission that looks at the evidence regarding youth gender medicine. As things stand now, we will continue to be stuck in a perpetual culture war, with parents and distressed kids paying the price.

Lisa Selin Davis is a journalist and author of Tomboy. Read her piece exploring The Beginning of the End of ‘Gender-Affirming Care’, and follow her on Twitter at @LisaSelinDavis.

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