The Cass Review, an independent audit of gender-affirming care provided by the U.K.’s National Health Service (NHS), published today. The review provides recommendations for how the NHS should administer gender-affirming care going forward, concluding that young adults hoping to transition should “slow down.”
Discussion of the review online was so prevalent the hashtag #CassReview trended on X on Wednesday. Many outspoken anti-trans figures like J.K. Rowling and Maya Forstater, and organizations in opposition to gender-affirming care like Sex Matters and Genspect, said they feel vindicated by the report’s findings.
But some trans people and allies to the trans community denounced the almost 400-page report as incomplete.
The report was headed by Dr. Hillary Cass, a pediatrician who was the president of the Royal College of Paediatrics and Child Health between 2012 and 2015. She was appointed by the NHS to independently review the its Gender Identity Development Services (Gids) in 2020.
Gids opened in 1989 to “provide a space for a very small group of very distressed children and young people to talk about the difficulties they might be having with their gender,” said journalist Hannah Barnes, who wrote a book about the clinic, during an appearance on WBUR. Over time though, the clinic began offering medical transition procedures and medications as they became available, like hormone blockers in 2014.
After multiple whistleblowers who worked in the clinic came forward and said that concerns they’d had about the care the clinic was providing were “shut down,” a NHS Care Quality Commission inspection found the services provided at Gids were “inadequate” and were of “significant” concern. The NHS announced the clinic would close in 2022 and be replaced with multiple clinics to take on the large load of patients that had created long waiting lists for Gids.
Gids closed last month and new clinics just opened last week after multiple delays.
As described in the Cass report, its aim is to make recommendations that ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria receive a “high standard of care” and better understand why more minors in the U.K. are seeking out gender-affirming care.
The UK has seen an uptick in need for gender-affirming care recently: According to U.K. primary care medical records, there were more than five times as many people identifying as transgender in 2018 than there were in 2000, and most of those people were between 16 and 29 years old.
The medical—and social—transition of minors is also a hot-button issue in the U.S., too. In 2023, 185 bills were introduced in state legislatures across the U.S. targeting gender-affirming care healthcare. Thus far in 2024, 133 have been introduced.
To complete the review, Cass and her team reviewed existing evidence surrounding gender-affirming care—the report states there is “a lack of high-quality evidence”—and heard from people who had “lived experience” with the topic.
The report found that “young people’s sense of identity is not always fixed and may evolve over time,” and that “whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down.”
“For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/retransition and/or experience regret,” the report states. “The NHS needs to care for all those seeking support.”
Cass also recommends that any patient exploring hormone blockers or hormone replacement therapy (HRT) should be offered fertility counseling.
The report was heralded as “a watershed moment” by J.K. Rowling, who has pivoted from Harry Potter books to pushing transphobic beliefs. In her words, she wanted “to know there are proper checks and balances in place before autistic, gay and abused kids—groups that are all overrepresented at gender clinics—are left sterilised, inorgasmic, lifelong patients.”
The review mentions that relevant literature dictates that “many patients” who experience body dysmorphia were autistic and that “transgender and gender-diverse individuals are three to six times more likely to be autistic than cisgender individuals.” Separately, the review also cited that some detransitioners have said they transitioned because of homophobia or their own difficulties accepting their sexualities.
“The #CassReview may be a watershed moment, but it comes too late for detransitioners who’ve written me heartbreaking letters of regret,” Rowling tweeted. “Today’s not a triumph, it’s the laying bare of a tragedy.”
Maya Forstater, a prominent anti-trans researcher who was terminated from her job for transphobic social media posts and now runs Sex Matters, tweeted in support of the report, too. Sex Matters is an organization that espouses “gender-critical” beliefs.
“Thank you to the whistleblowers,” she tweeted. Forstater also spoke on British TV today, saying “there’s no ethical and safe way that you can transition any child in school.”
On social transition, the report states that it doesn’t have “any positive or negative mental health outcomes,” but those who socially transition are more likely to seek out a medical transition.
Genspect, the organization behind Detrans Awareness Day, also posted in support of the report—and some online used the report as proof that “there are no ‘trans’ children.”
For others, especially those in the LGBTQ community, the report fell flat. In addition to using the #CassReview, some included #TransRightsAreHumanRights, too.
Though the review stated that it spoke with people who had “lived experience” with gender-affirming care, Karl Rutlidge, a trans man, tweeted that the report was cruel and didn’t actually take into consideration the perspectives of trans people.
“The #CassReview refusing to listen to trans people is like conducting a review of women’s health by only asking for the views of men, or a similar exercise in relation to people of colour in which only white folk are allowed to contribute,” Rutlight tweeted. “It is absurd, and the results are cruel.”
Similarly, Tom Hayes-Isaacs, a gay activist, said he doesn’t care what the report says and instead prioritizes the experiences and perspectives of the trans community.
“I know the reality from speaking to trans friends, family & colleagues,” Hayes-Isaacs tweeted. “I am an ally. You are safe with me. I will protect your rights to the end.”
And Nadia Whittome, a member of the British Parliament representing Nottingham East, tweeted that in light of the review being published, her “thoughts are with the trans community.” Whittome is queer.
“Young trans people already face huge barriers to healthcare, including years-long waiting lists,” Whittome tweeted. “Their health and wellbeing should not be a front in a toxic culture war.”
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