Cass Review of Gender Identity Services – Final Report Released

Over the last five to ten years, there has been a rapid increase in the number of children and young people being referred to the NHS for issues relating to gender identity. This has resulted in many young people having to wait several years before they receive clinical support. Against this background, an independent review was commissioned by NHS England to make recommendations as to how to ensure children and young people are best served by the NHS and their welfare is protected.

The review was carried out by Dr Hilary Cass and her final report and recommendations were published on 10 April. The report begins with a foreword by Dr Cass in which she states, ‘The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress’. This sense of uncertainty pervades the remainder of the report, which makes several key findings and recommendations aimed at protecting children and young people who are referred to NHS gender services.

Key findings include that experts are far from agreed over a clinical approach, with little reliable evidence as to long-term outcomes for those referred to the NHS. The fact that the treatment and care of gender-questioning children and young people is a controversial topic, with deeply held opinions on all sides of the debate, has not been helpful in ensuring the focus remains on these young people and what their care needs to achieve.

The recommendations reflect these findings and seek to recentre children and young people at the heart of this report. Those referred to NHS gender services must receive a ‘holistic assessment of their needs’ which includes screening for neurodevelopmental conditions and a mental health assessment. A one-size-fits-all approach is inappropriate, and extreme caution must be taken prior to prescribing hormone treatment from age 16 onwards. From a forward-looking perspective, research must continue into the outcomes of those presenting to NHS gender services, with support provided for young people up to 25 years old, as well as for those considering detransition.

The report is already proving controversial. Dr Cass herself states in her foreword to the report that some children and young people may be disappointed by the findings and recommendations. Others state that the report highlights failings in the clinical approach to date. It remains to be seen what the long-term impact of the report will be, but NHS England has since stated that it intends to carry out a major review of its adult gender services and use of hormones.

Click here to view the Review of Gender Identity Services in full.