Britain’s National Health Service (NHS) will review all transgender medical treatment in the wake of a highly-anticipated review that found such treatment is built on “weak evidence.”
The landmark final report released Tuesday by pediatrician Dr. Hilary Cass is the result of a major independent review on children and gender identity commissioned by the NHS in 2020. Cass is a former president of the Royal College of Paediatrics and Child Health.
“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” Cass stated in her report.
The evidence we do have for gender medicine is built on “shaky foundations,” she wrote in an accompanying editorial published in a medical journal.
Puberty blockers should no longer be prescribed to children except in the context of research due to these powerful drugs’ effects on brain development and bone health, the report says.
Cross-sex hormones — estrogen and testosterone — should be prescribed to trans-identifying 16 and 17-year-olds only with an “extremely cautious” approach, and there should be a “clear clinical rationale” for not waiting until the teen is 18, the report says.
Waiting would preserve fertility and manage any other conditions. The report also warns that children who are referred to gender services present with high rates of abuse and neglect including sexual abuse and parental substance abuse.
Cass cautioned that she has also spoken to detransitioners who “deeply regret” their earlier transitions.
The report also demanded an end to the “toxicity of the debate,” which it called “exceptional.”
“There are few other 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. This must stop,” Cass wrote.
The NHS released a statement on the Cass review a day after its publication, detailing the actions it will take in response.
The NHS said it will review all transgender treatment it provides, including to adults, and all new treatment for 16 and 17-year-olds will be paused immediately.
“In view of your advice about the need for caution in the initiation of medical interventions for young people under 18 years of age, our letter instructs the adult gender clinics to implement a pause on offering first appointments to young people below their 18th birthday,” the NHS said in its response.
The NHS is taking other measures as well, including establishing at least two new children’s gender services locations and working on clinical guidance explaining that puberty blockers are no longer routinely available.
Last week, the Tavistock clinic, England’s only youth gender identity clinic, officially closed its doors after being dogged by controversy for years.
The clinic, the biggest in the world, referred thousands of children for puberty blockers. In its last years, Tavistock began to see an increasing flood of young girls with gender-related distress asking for drugs despite having other mental issues like depression, anxiety, eating disorders, and histories of abuse.
In the U.S., at least 23 states have already moved to ban medical transgender services for children.