What is the Cass Review into gender services and why is it controversial?

The report on gender services for children and young people was published on Wednesday.

Dr Hilary Cass with her  Independent Review of Gender Identity Services for Children and Young People this week. (PA)
Dr Hilary Cass with her Independent Review of Gender Identity Services for Children and Young People this week. (PA)

NHS England must end the “culture of secrecy and ideology over evidence and safety” and make changes to children’s gender care swiftly, health secretary Victoria Atkins has said.

Her comments follow the release of the Cass Review, which said children have been let down by a lack of research and evidence on the use of puberty blockers and hormones.

“We simply do not know the lifelong impact of these medical interventions on young minds and bodies to be clear that they are safe," Atkins said.

Here, Yahoo News UK explains what the Cass Review is, what it found and why it has been controversial.

What is the Cass Review?

The Cass Review is a major report on gender services for children and young people that was published on Wednesday.

Also known as the Independent Review of Gender Identity Services for Children and Young People, it was commissioned by NHS England and NHS Improvement in 2020 to make recommendations about NHS services for gender-questioning children and young people.

It was established following a rise in the number of youngsters seeking help for issues with their gender. Referrals to the recently-closed Gender Identity Development Service (Gids) at the Tavistock and Portman NHS Foundation Trust rose from just under 250 in 2011/12 to more than 5,000 in 2021/22.

The review was led by Dr Hilary Cass, former president of the Royal College of Paediatrics and Child Health.

What did it find?

The long-awaited report said teenagers are “falling off a cliff edge” in their care when they reach 17.

It said children have been let down by a lack of research and evidence on medical interventions in gender care, in a debate which it said has become exceptionally toxic.

Among the 32 recommendations in the near-400 page report was that a “follow-through service” should be put in place for 17 to 25-year-olds, with regional centres either extending the age range of their patients or through “linked services”.

As a result of the report, NHS adult gender services in England will undergo a major review, while local NHS leaders have been told to pause first appointment offers at adult gender clinics to young people before their 18th birthday.

Watch: Dr Hilary Cass says children are being let down

Why is it controversial?

In a joint statement, humans rights groups Amnesty International UK and Liberty said “sensationalised coverage” of the review has led to the issue being “weaponised” by anti-trans groups.

They said: “All children have the right to access specialist effective care on time and must be afforded the privacy to make decisions that are appropriate for them in consultation with a specialist.

“This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people.

“It’s concerning that sections of the media and many politicians continue to spread moral panic with no regard for the possible consequences for trans people and their families.”

A number of transgender people and activists also denounced the report on social media. Journalist India Willoughby tweeted: "Sometimes you forget to state the most obvious thing of all. The fact the entire trans community rejects what the NHS now plan to do to trans kids should by itself tell you Cass is wrong.

"Kids crying, parents distraught @wesstreeting We have no agency over our own bodies," she added.

What do supporters say?

Harry Potter author JK Rowling, whose views on transgender issues have been making headlines for five years, welcomed the review, which said young people have been caught up in a “stormy social discourse” and gender care is currently an area of “remarkably weak evidence”.

She wrote on X, formerly known as Twitter, on Wednesday: “I read Cass this morning and my anger's been mounting all day. Kids have been irreversibly harmed, and thousands are complicit, not just medics, but the celebrity mouthpieces, unquestioning media and cynical corporations.”

She added the report was “not a triumph, it’s the laying bare of a tragedy”.

Shadow health secretary Wes Streeting told The Sun’s Never Mind the Ballots show: “I think she’s [Dr Cass] done a really important piece of work but I think it does raise some serious concerns that are pretty scandalous.”

He pledged that a Labour government would take an “evidence-led approach to this” area of healthcare in future.

Watch: Cass Review findings of weak evidence in gender care ‘scandalous’ – Streeting

What has the government said?

The findings have "shone a spotlight" on the need to “exercise extreme caution”, Rishi Sunak said this week.

Welcoming the review, the prime minister told LBC this week: “We care above all about the wellbeing of children and it’s clear that these things are not neutral acts, whether that’s social transitioning, any kind of medical intervention, we simply do not know the long-term effects of these things.

“And that’s why anyone involved in considering these issues, of course, has to treat people with sensitivity and compassion, but also have to be extremely cautious when it comes to taking any action.”

Read more