This article critiques the Cass Review, a report commissioned by England’s National Health Service (NHS) in 2024, which argues that there is insufficient evidence to support gender-affirming care (GAC). The Review has been used to justify restrictions on GAC, such as banning puberty blockers and closing pediatric gender clinics in England. It has also influenced U.S. state-level bans, including Tennessee’s contested restrictions on GAC.
The authors argue that the Review violates standard medical, legal, and regulatory principles, pointing out that its evidentiary demands exceed those applied elsewhere in pediatric medicine. While the Review insists on randomized controlled trials (RCTs) for GAC, similar standards are not required for treatments like puberty blockers for precocious puberty or hormone therapy for delayed puberty in cisgender adolescents.
Additionally, the article critiques the lack of peer review and transparency in authorship, noting that the Cass Review excludes both GAC experts and patients from oversight. The authors highlight potential bias in participant selection, citing that one-third of interviewed clinicians denied the existence of transgender children.
Further, the Cass Review’s rigid evidentiary approach contradicts United Kingdom and U.S. drug-approval standards, which emphasize expedited access to treatments rather than requiring RCTs for every indication. This disproportionate scrutiny on transgender care is framed as part of a historical pattern of using medicine to enforce gender norms, likening it to past restrictions on abortion and intersex surgeries.
Ultimately, the authors assert that the Review and its associated bans are not based on scientific integrity but on ideological attempts to regulate gender expression, posing broad threats to informed consent protections beyond GAC.
This article critiques the Cass Review, a report commissioned by England’s National Health Service (NHS) in 2024, which argues that there is insufficient evidence to support gender-affirming care (GAC). The Review has been used to justify restrictions on GAC, such as banning puberty blockers and closing pediatric gender clinics in England. It has also influenced U.S. state-level bans, including Tennessee’s contested restrictions on GAC.
The authors argue that the Review violates standard medical, legal, and regulatory principles, pointing out that its evidentiary demands exceed those applied elsewhere in pediatric medicine. While the Review insists on randomized controlled trials (RCTs) for GAC, similar standards are not required for treatments like puberty blockers for precocious puberty or hormone therapy for delayed puberty in cisgender adolescents.
Additionally, the article critiques the lack of peer review and transparency in authorship, noting that the Cass Review excludes both GAC experts and patients from oversight. The authors highlight potential bias in participant selection, citing that one-third of interviewed clinicians denied the existence of transgender children.
Further, the Cass Review’s rigid evidentiary approach contradicts United Kingdom and U.S. drug-approval standards, which emphasize expedited access to treatments rather than requiring RCTs for every indication. This disproportionate scrutiny on transgender care is framed as part of a historical pattern of using medicine to enforce gender norms, likening it to past restrictions on abortion and intersex surgeries.
Ultimately, the authors assert that the Review and its associated bans are not based on scientific integrity but on ideological attempts to regulate gender expression, posing broad threats to informed consent protections beyond GAC.
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