The Cass Report Is Out—An Early Analysis of Findings and Recommendations

Mainstream gender theory is about to have its foundation shattered thanks to a new groundbreaking report.

Dr. Hilary Cass recently published a nearly 400-page report on “gender identity services for children and young people”. The report, which was commissioned by the National Health Service (NHS) England roughly four years ago, found “remarkably weak evidence” to support the use of puberty blockers and hormone treatments for gender distressed children. The report also includes 32 specific recommendations on how gender services should operate in England.

Dr. Cass is not someone whose opinions can be easily dismissed. She enters this politically-charged arena with impressive credentials. Not only is Dr. Cass Chair of the Independent Review of Gender Identity Services, but she is past President of the Royal College of Pediatrics and Child Health, past Chair of the British Academy of Childhood Disability, and was awarded an Order of the British Empire (OBE) for her services and accomplishments. Her opinion carries some significant weight.

In conducting the review, Dr. Cass examined 50 studies on puberty blockers and 53 on hormone treatments. The “remarkably weak evidence” that these studies provide lead her to call for “extreme caution” in treating gender distressed kids.. This echoes the calls that Do No Harm has made to “review the research” behind pediatric gender medicine.

Dr. Cass also found that external factors have influenced and stifled conversation around gender identity treatments. For example, Dr. Cass suggests that parents may “unconsciously influence the child’s gender expression.” Similarly, health professionals are “afraid to openly discuss their views” on these issues due to fear of the social repercussions.

We’ve let them down because the research isn’t good enough and we haven’t got good data…The toxicity of the debate is perpetuated by adults, and that itself is unfair to the children who are caught in the middle of it. The children are being used as a football and this is a group that we should be showing more compassion to.

For years, those with the courage to express trepidation about pediatric gender medicine have had targets placed on their backs. Now, Dr. Cass confirms that attempts to stifle debate not only run counter to the spirit of open scientific inquiry but endangered kids who might have benefited from public skepticism and debate.

Dr. Cass details numerous suggestions for moving toward safer practices, including reviewing and scrutinizing the use of hormones and puberty blockers on young people; elevating the standards for gender services to the same standards that other medical procedures must abide by; taking a “holistic approach” to any gender-related interventions (including a mental health assessment and autism screening); and encouraging workplace supports to foster candid engagements by health professionals on the clinical treatment of gender-questioning children.

Other specific recommendations include:

• Dramatically improving the supply of available research on gender-related medical interventions;
• Offering children fertility counseling and preservation before proceeding to a medical pathway;
• Establishing follow-through services for 17- to 25-year-olds;
• Improving guardrails around the dispensing of relevant prescription medications;

Dr. Cass is not alone in sounding the alarm. Other European countries including Denmark, Finland, Sweden, Ireland, and Italy have either imposed restrictions on pediatric gender medicine or are currently debating it. That these countries already took a more conservative approach than the United States makes the continued insistence of safety and efficacy in the United States all the more absurd and untenable.

Our children deserve better than to be used as a football in a political debate. Dr. Cass rightfully acknowledges that the medical pathway is not the best way to manage gender-related distress in young people and that it is impossible to identify which children might persist in their feeling of gender dysphoria. Preventing children from accessing these irreversible interventions is the only sensible path forward.