The Cass Review is a devastating blow to trans ideology

Want to read spiked ad-free? Become a spiked supporter.

In 2020, the NHS commissioned Dr Hilary Cass, a leading paediatrician, to review its gender services for children and young people. Today, four years on, her eagerly anticipated findings have been published.

At its core, the Cass Review severely criticises the NHS’s approach to ‘gender confused’ children, and reaffirms the principle of evidence-based practice in medicine. It warns that the medical pathway is unsuitable for most young people with gender issues. And it states that clinicians should take extreme care before allowing anyone under the age of 25 to take pharmaceutical steps to ‘transition’ to look like the opposite sex.

Cass notes that many young patients referred to gender-identity services are often dealing with many other issues, such as trauma, neglect and abuse. Furthermore, she points out that there is no ‘good evidence’ available on the long-term outcomes of the treatments that have been given to children. In particular, she slams the international guidelines for transitioning, developed by the World Professional Association of Transgender Healthcare (WPATH), criticising them for their lack of ‘developmental rigour’.

The Cass Review was commissioned in order to ‘ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria, and need support from the NHS, receive a high standard of care’. In accepting this task, Cass, a former president of the Royal College of Paediatrics and Child Health, was effectively asked to keep afloat in a shark-infested septic tank. There’s little doubting her bravery.

Yet while the Cass Review vindicates those who have raised concerns about the threat transitioning poses to children, it is far from a takedown of transgender ideology. It accepts, for instance, that it’s possible for children to have an innate sense of gender identity that is not aligned with their biological sex. Cass often uses the language of the trans lobby and refers to ‘transgender males’ and ‘transgender females’.

She also appeals to such voguish concepts as ‘lived experience’ and ‘minority stress’, and talks about the possible biological underpinnings of transgenderism – even though it is becoming increasingly clear that it is a form of social contagion.

She also refers to the ‘toxicity’ of the debate around trans issues and criticises both sides for being extreme. This is a little irritating. It was only one side – namely, the trans activists – who pushed children forward for experimental treatments. On the other side, grassroots parents groups and whistleblowing clinicians have only ever asked that ‘gender medicine’ be held to the same evidentiary standards as every other field.

But in many ways these are mere quibbles. The Cass Review represents a vital and overdue return to sanity on the question of so-called trans kids.

Stephanie Davies-Arai, founder of Transgender Trend, has been sounding the alarm about the rise in children and young people identifying as trans for a decade. ‘I’m relieved that the Cass Review has come up with detailed, practical recommendations to get the NHS England service into line with normal standards of paediatric healthcare’, she tells me.

As Davies-Arai explains, the Cass Review places ‘gender confused’ children within a framework of childhood development and adolescent mental health, ‘rather than treating them as mini adults within a social-justice movement’.

Davies-Arai now hopes that the Cass Review will encourage the depoliticisation of child healthcare. This won’t be easy, but as she puts it, ‘we now need full commitment from NHS England to purge gender ideology from the NHS and go back to the evidence-based care advocated for by Cass’.

What matters now is how the Cass Review’s conclusions are implemented. The NHS has been stewing in the nonsense of trans activism for at least a decade. From staff networks to the national adviser for LGBT health at NHS England, Dr Michael Brady, there are transgender activists at every level of the health service. There is a risk that NHS employees might simply dismiss the Cass Review as politically motivated transphobia and attempt to ignore it. Or worse, the training Cass recommends for clinicians dealing with gender-confused kids could be handed to lobby groups like Stonewall. Perhaps that’s why the tone of the report is so muted – Cass is determined to avoid inevitable accusations of transphobia.

Those who wanted the Cass Review to come down harder on those who have let children down for far too long will be disappointed. Personally, I’d like all of those who said that dangerous puberty blockers were merely a ‘pause’, or who told parents their children were at risk of suicide if not affirmed in their cross-sex identities, to be put in stocks outside the General Medical Council. The adults who allowed vulnerable kids to be experimented upon should not get away with this. I wanted Cass to run a clean, truthful sword through the tangled ideology of gender identity. But I can understand why she did not.

Though Cass has hardly dished out retribution, she has vindicated many of the points made by the brave parents, doctors and campaigners who have spent the past decade warning against the medicalisation of gender-confused youth. In that most important regard, the Cass Review represents real progress.

And perhaps justice will still be served. As Cass herself observes at the end of the report, there remain many troubling questions that need answering, such as ‘how and why the care of these children and young people came to deviate from usual NHS practice [and] how clinical practice became disconnected from the clinical evidence base’.

The answers to these questions could make for very uncomfortable reading for many in the NHS.

Jo Bartosch is a journalist campaigning for the rights of women and girls.