Here’s why the ‘Cass Review’ matters—even if you aren’t in the U.K.

ANALYSIS: A new report is setting the stage for the future of trans healthcare in the U.K.—and it could spell bad news

A new report published this week is going to set the stage for the future of trans healthcare in the U.K.—and for many young trans people looking to access care around the world, it could spell bad news. 

The Cass Review—also known as the Independent Review of Gender Identity Services for Children and Young People—is a nearly 400-page report published this week and commissioned by the U.K.’s National Health Service (NHS), who asked pediatrician Dr. Hilary Cass to conduct a review of the country’s trans healthcare services in 2020.

@xtramagazine What is the Cass Review and how will it impact transgender healthcare? The long-awaited report commissioned by the NHS from U.K. doctor Hilary Cass is here. And it’s already facing tough scrutiny from trans people and allies for some of its questionable conclusions. The NHS has said it will start implementing some of Cass’s recommendations right away, but the report could also have huge impacts across the pond in Canada and the U.S. 🏳️‍⚧️🇬🇧 #fyp #foryoupage #lgbtqnews #unitedkingdom #transgender ♬ original sound – Xtra Magazine

Both Cass and the report have been rightfully under scrutiny for years. An interim report published in 2022 was slammed by LGBTQ2S+ advocates and allies for leaning into anti-trans talking points, and for being used as support for suggesting conversion therapy as treatment for young trans folks. It also played a significant role in the closure of the Tavistock Gender Identity Development Service, the U.K.’s only specialized gender identity clinics for children and young people. 

Proponents of the report—and Cass herself—argue that it demonstrates a clear lack of evidence around the efficacy of gender-affirming care for young people, and makes the case for slowing or restricting access to certain care. But its critics point out that the report itself is grounded in significant misinformation and anti-trans talking points. 


For example, it includes baffling claims like “for centuries, transgender people have been predominantly trans females who present in adulthood” (which is just straight-up not true), and that boys are biologically inclined to prefer playing with trucks, and girls with dolls. It also cites research from widely debunked and retracted scholars, including Lisa Littman and her theory of “rapid-onset gender dysphoria.”

It also endorses the idea that being trans may be caused by mental health struggles like anxiety or depression, despite the American Psychological Association thoroughly rebutting that argument.

Still, despite these and plenty of other questionable conclusions being pointed out by a number of experts on social media, the Cass Review is being taken very seriously by the powers that be. 

The NHS has already confirmed they will move forward and implement Cass’s recommendations. Last month, the organization took steps to suspend the prescription of puberty blockers to young people in England, per Cass’s recommendation, and despite the overwhelming international medical consensus that they are safe.

And the Cass Review is likely to find audiences across the pond as well. Poorly structured “research” like this is often cited in restrictive anti-trans legislation, and as justification for rolling back hard-fought victories for trans rights. Even in name, the report mirrors the 2022 Florida Review—which similarly argued that trans healthcare doesn’t meet national standards, and therefore should be restricted. 

The Florida Review—which was commissioned under Florida governor Ron DeSantis—was quite a clear influence on Cass. As journalist and Xtra contributor Erin Reed reported on Substack, Cass expressed interest in the report, and even met with Patrick Hunter—a member of the anti-trans Society for Evidence-Based Gender Medicine and the Catholic Medical Association—who is on the Florida Board of Medicine and helped inform the Florida Review

Transphobic policy decisions have international origins and international consequences, as the past few years have shown. Just because this review pertains to the British medical system, doesn’t mean it won’t influence policymakers in Canada and the U.S. too. And in a current moment when anti-trans restrictions are rolling out across North America, we must look at research like this critically and call it out for what it is.

Senior editor Mel Woods is an English-speaking Vancouver-based writer and audio producer and a former associate editor with HuffPost Canada. A proud prairie queer and ranch dressing expert, their work has also appeared in Vice, Slate, the Tyee, the CBC, the Globe and Mail and the Walrus.

Oliver Haug

Contributing editor Oliver Haug (they/them) is a freelance writer based in the Bay Area, California. Their work focuses on LGBTQ2S+ issues and sexual politics, and has appeared in Bitch, them, Ms and elsewhere.

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