A long-awaited independent review of gender identity services in England says the medical case for gender-altering treatments for minors constitutes “an area of remarkably weak evidence.” The Cass Review—led by Dr. Hilary Cass, a leading British pediatrician and consultant—also called the debate around gender transition “toxic.”
“There are few other areas of healthcare where professionals are so afraid to openly discuss their views,” wrote Cass in the review’s foreword.
The Cass Review was released on Wednesday, four years after the country’s National Health Services (NHS) commissioned it following concerns from whistleblowers about treatment at gender identity clinics for children and teens.
Cass pointed out doctors in the United Kingdom began prescribing puberty blocking hormones—which research suggests have negative, life-long effects on overall health—at an alarming rate after one Dutch study suggested the drugs may increase positive outcomes for young people with gender dysphoria.
Part of her foreword addresses children and teens seeking transition services.
“I have been disappointed by the lack of evidence on the long-term impact of taking hormones from an early age,” she writes. “Research has let us all down, most importantly you.”
Currently, children in the U.K. can begin receiving cross-sex hormones including testosterone and estrogen as early as age 16—but Cass’ review urges doctors to wait until after children are age 18 to prescribe these drugs.
“Our current understanding of the long-term health impacts of hormone interventions is limited and needs to be better understood,” she writes.
Beginning April 1, England’s National Health Service (NHS)—the government’s health arm—permanently stopped prescribing puberty blockers for children younger than 16. The policy, which was implemented last year on an interim basis, also applies to Wales. The Associated Press reported Northern Ireland and Scotland are considering adopting the age restriction.
NHS England says there is not enough evidence about long-term effects puberty blockers, including “sexual, cognitive or broader developmental outcomes.”
Cass’ report notes that many teens and young adults eventually regret medically or socially transitioning.
While most of the report focuses on medical services for children and teens seeking medical and social transition, she also mentions the harmful impact—and widespread availability—of pornography.
“Research commentators recommend more investigation into consumption of online pornography and gender dysphoria is needed,” she writes. “Some researchers … suggest that exploration with gender-questioning youth should include consideration of their engagement with pornographic content.”
Christian Concern, a U.K.-based Christian advocacy group, praised much of the review’s content. Andrea Williams, who serves as the group’s chief executive, urged the NHS to “return to evidence-based medicine, not ideological treatment of vulnerable children.”
“Children have been badly served by an ideological system which believed that affirming children in a false gender identity and prescribing harmful drugs was helpful,” Williams said. “We are created male and female, and we cannot change this. Most children will grow out of gender confusion as they go through puberty. Gender-confused children need care and support and to be told the truth, which will set them free.”
Writing at The Gospel Coalition, Andrew T. Walker, associate professor of Christian ethics at The Southern Baptist Theological Seminary, outlines the Biblical basis for dealing with gender issues:
“God created humanity, male and female, in his image for one another. To deny any part of this teaching is to subject God’s purposeful design to the desires of humanity.”
