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The Cass Review is an overdue reality check

Ellis Coughlan
April 17, 2024

The publication of the Cass Review last Wednesday serves as a critical wake-up call for policymakers, medical professionals, and ideologues alike. This independent four-year review of gender identity services for young people is a pivotal moment that demands recognition, and its findings must not be diminished.

The 398-page report, written by Dr Hilary Cass OBE, has made 32 recommendations. Several of these affirm what many of us have known for some time: gender care for young people requires rapid remodelling.

The report acknowledges that the rise in gender confusion among children and young people stems from more than just gender dysphoria. It also highlights the toxic polarisation in the transgender debate. We urgently need more nuanced and evidence-based approaches in addressing these sensitive, complex issues.

The increase in referrals to the NHS’s gender identity development services (Gids) is a pressing concern. Between 2009 and 2021 there has been just under a 10,000 per cent increase in referrals. Figures rose dramatically, particularly among those assigned female at birth.

Cass rightly attributes part of this rise to socio-cultural factors and the significant rise in social media usage. Young people in the report consistently cited difficulties in finding trusted information. Meanwhile, some online influencers even encourage secrecy from parents.

Children are heavily influenced by online content and are often more susceptible to social influence than guidance from professionals.

The broader mental health crisis among adolescents is also to blame. The report noted marked increases in self-harm and eating disorders, particularly among girls.

It is no coincidence that there is a higher prevalence of those with autism spectrum disorder purporting gender distress. Also, many de-transitioners retrospectively cite poor mental health pre-transition. Patients must receive the appropriate treatment, whether this be gender-related care, or mental health support.

Adolescence is a difficult period. It is dangerous to blindly affirm anyone experiencing gender incongruence at such a fundamental time. A 15-year longitudinal study of 2,700 children found most of those experiencing gender non-contentedness during adolescence grew out of it. These results help adolescents realise that it is normal to have doubts about their gender identity.

This is not to say that some of those experiencing gender incongruence should not be allowed to transition. However, it is hard to justify medical interventions on the basis of weak evidence. It is irresponsible, and counterproductive to the trans cause. Hormone treatments should be allowed at 16 for those diagnosed with gender dysphoria. 16-year-olds can consent to sex, leave home, join the army, or even get married. However, as Cass notes, hormones must be prescribed with extreme caution.

A holistic approach that transcends ideology is paramount. Young people experiencing gender distress must be screened for neurodevelopmental conditions and given mental health assessments.

Young people experiencing gender distress must be screened for neurodevelopmental conditions and given mental health assessments. Quote

In recent years, the transgender debate has been trapped in a binary tug-of-war. Polarising statements like those from the Prime Minister, who declared “a man is a man and a woman is a woman”, only exacerbate this divide. Such rhetoric is unhelpful and negates constructive dialogue.

Ideology must be removed from the clinical debate. It is disappointing that some NHS trusts refused to cooperate with the review. This could prove detrimental to developing effective care pathways.

A balanced discourse is absolutely essential. Healthcare professionals must be able to discuss openly without professional repercussions or fear of being maligned.

Dr Cass even notes “there are few areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media and where name-calling echoes the worst bullying behaviour.” I echo her sentiments in this regard: “This must stop.”

Wes Streeting’s assertion that he welcomes the Cass review is promising. Thousands of children are stuck on waiting lists for gender identity treatment. Only by taking an evidence-based approach can an incoming Labour government cut these lists down.

Most importantly, implementing the findings of the report will ensure children and young people receive the gender treatment, or mental health support, they desperately need.

Removing ideology from medical and public discourse is not merely a recommendation. It is a necessity for truly supporting the wellbeing of transgender young people. The government must heed, and build on, the findings of the Cass Review.

We must strive for a healthcare system which embraces complexity and individuality with empathy and scientific rigour. This is crucial in ensuring effective medical care and affirming dignity for all young people, regardless of their gender identity.

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Ellis Coughlan is a Political and Media Consultant at Bridgehead Communications. 

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