The recently published Cass Review is the result of a four-year investigation initiated by the United Kingdom’s National Health Service England (NHSE) into the scientific basis of treating transgender youth and the experiences of those involved in transgender care in the UK. It contains 32 recommendations for a reorganization of transgender care for youth in England and Wales. The review took place after concerns arose around the increase in referrals, the evidence base for gender-affirming medical care, and the functioning of the NHS Tavistock Clinic’s Gender Identity Development Service (GIDS), the only national care service with a long history of clinical experience and knowledge, which had operated since 1989 and was closed in March 2024. To date there are no new services in operation, and there will be none in the foreseeable future, despite what NHS England or Hillary Cass may claim. WPATH and USPATH are extremely concerned that this has left young transgender and gender diverse (TGD) people and families with little opportunity to obtain transgender care. This is a devastating situation for transgender youth and their families, whose rights are breached as they are being denied medically necessary care. We believe this to be a complete breach of the seven core values enshrined in the NHS Constitution.

Overall, WPATH and USPATH remain deeply concerned about the facts regarding the Cass Review’s process and content, as well as its consequences for the provision of care for trans and gender diverse youth. Here are some of the reasons:

1. NHS England, which commissions and finances specialist medical services, including trans health care for youth and adults in England, appointed Hillary Cass in 2020 without any transparent or competitive process. Hillary Cass is a pediatrician with hardly any clinical experience or expertise in providing transgender healthcare for young people. Furthermore, Hillary Cass lacks significant research qualifications or research expertise in transgender health. Yet, the Cass Review purports to make “evidence-based” recommendations based on six systematic reviews carried out by the University of York in the UK, which do not contain any new research that would contradict the recommendations made in professional consensus guidelines of the American Academy of Pediatrics (AAP), the Endocrine Society, and WPATH to name a few.

2. The Cass Review is hailed by some as an “independent” review, referring to the fact that Hillary Cass had negligible prior knowledge or clinical experience of trans and gender diverse youth or indeed transgender medicine and surgery. One senior psychiatrist at a gender identity clinic in England told a national newspaper in the UK that the failure to include those with personal or professional experience “had concerned many within the field.” They said: “The terms of reference stated that the Cass Review ‘deliberately does not contain subject matter, experts or people with lived experience of gender services’ and Dr. Cass herself was explicitly selected as a senior clinician ‘with no prior involvement … in this area.’ Essentially, ignorance of gender dysphoria medicine was framed as a virtue. I can think of no comparable medical review of a process where those with experience or expertise of that process were summarily dismissed.” WPATH and USPATH agree completely.

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