Should politics stay out of medicine? In a damning 388-page report, paediatrician Dr Hilary Cass argues that gender services are “letting down” young people and failing to meet the standards of other NHS care.
New report: ‘Transgender children let down’
Should politics stay out of medicine? In a damning 388-page report, paediatrician Dr Hilary Cass argues that gender services are "letting down" young people and failing to meet the standards of other NHS care.
Trans bans
It is not often that an almost 400-page report is greeted with such a reception, sparking widespread and colourful debate. But the Cass Review, an independent report into the UK's gender identity services for under-18s, has achieved just this.
The Cass Review was commissionedDirected someone to make something or complete a task. by the NHS and led by paediatricianA doctor who works with children. Dr Hilary Cass. With 32 recommendations for changing the way future services are run, the report alleges that young people are being "let down" by the lack of substantial evidence on medical interventions related to gender identity.
"The reality is we have no good evidence on the long-term outcomes of interventions to manage gender-related distress," Dr Cass writes, expressing concern that gender clinics have been too hasty to prescribe "treatments" which have not been assessed for their long-term safety.1
Guidance in trans healthcare has changed dramatically in recent months and years. Just weeks before the publication of the Cass Review, NHS England announced that puberty blockers - hormonesChemicals created inside living creatures. They are used to send messages from one part of the body to another. which halt the progression of puberty temporarily - would no longer be routinely prescribed to children at gender identity clinics.
Meanwhile, from the age of 16, those who meet the clinical criteria for gender dysphoriaFeelings of discomfort or stress a person feels due to a mismatch between their gender identity and their sex assigned at birth. may be given gender-affirming hormones (testosteroneThe hormone that causes people to develop male sexual characteristics. Women also produce some testosterone. or oestrogenFemale sex hormones. After the menopause, these can increase the risk of cancer.) for medical purposes. However, Dr Cass recommends an urgent review of this policy in her report.
There has been a spike in young people accessing gender identity services in recent years. In 2009, the gender identity development service of the NHS saw fewer than 50 children in a year. By 2021-2022, this had increased a hundredfold to more than 5,000.2
This has led to huge backlogsPlural of backlog, meaning an accumulation of unfinished work.. For trans people, the wait for a first appointment at a gender identity clinic can be five years or more, despite a target of 18 weeks. NHS data shows that patients who attended their first appointment in November 2023 were referred, on average, a whopping seven years and three months earlier.3
The report has faced some criticism, with Mermaids, a charity which supports trans and non-binary youth, expressing concern that it "could be used to justify additional barriers to accessing care for some trans young people."4
Young trans woman Ellie Gomersall says that the report's criticism of prescribing puberty blockers for trans youth fills her with "fear", recounting her experience of going through male puberty.
"Knowing I was a girl, the irreversible change of my body caused me much distress and still continues to as an adult," she states.5
Some agree, fearing that the report is being used as a political tool rather than a medical one. The UK has been at the centre of a raging debate over transgender issues, with some describing it as a "moral panic". And this has been fuelled by vitriolicFilled with criticism or malice. political disagreements and a maelstrom of divisive media reporting.
Recent surveys show that 94% of trans people are happier after medically transitioning.6 Some say that we should be paying heed to these positive experiences, rather than letting political discord restrict trans people's access to potentially life-saving healthcare.
But others express concern that the polarisingTo cause people to divide into two opposing groups. debate has led some in the medical field to be scared to speak up with their doubts and concerns about gender-related treatments for fear of condemnation, restricting their ability to provide the best possible care.
Should politics stay out of medicine?
Yes: Policymakers should have nothing to do with medical decision-making. This should be done purely on evidence-based research, and the evidence shows that transitioning makes the vast majority of transgender people happier.
No: Politics has its place in medicine. It is where many people find representation of their concerns, and at present, trans healthcare is a central concern for many.
Or... Expressing concern about the rapid proliferation of gender-related treatments in the past decade is not "political". Nor is making reasonable statements about the fact that we are not aware of the long-term effects of some treatments.
Keywords
Commissioned - Directed someone to make something or complete a task.
Paediatrician - A doctor who works with children.
Hormones - Chemicals created inside living creatures. They are used to send messages from one part of the body to another.
Gender dysphoria - Feelings of discomfort or stress a person feels due to a mismatch between their gender identity and their sex assigned at birth.
Testosterone - The hormone that causes people to develop male sexual characteristics. Women also produce some testosterone.
Oestrogen - Female sex hormones. After the menopause, these can increase the risk of cancer.
Backlogs - Plural of backlog, meaning an accumulation of unfinished work.
Vitriolic - Filled with criticism or malice.
Polarising - To cause people to divide into two opposing groups.
New report: ‘Transgender children let down’
Glossary
Commissioned - Directed someone to make something or complete a task.
Paediatrician - A doctor who works with children.
Hormones - Chemicals created inside living creatures. They are used to send messages from one part of the body to another.
Gender dysphoria - Feelings of discomfort or stress a person feels due to a mismatch between their gender identity and their sex assigned at birth.
Testosterone - The hormone that causes people to develop male sexual characteristics. Women also produce some testosterone.
Oestrogen - Female sex hormones. After the menopause, these can increase the risk of cancer.
Backlogs - Plural of backlog, meaning an accumulation of unfinished work.
Vitriolic - Filled with criticism or malice.
Polarising - To cause people to divide into two opposing groups.