As a network of expert feminist academics and stakeholder groups who work on gender diversity, we are dismayed at the recommendations of the Cass Review (2024) for NHS provision of gender identity services for children and young people. The Feminist and Gender Equality Network urges the NHS not to act on these recommendations. 

We suggest that the Cass Review contains unsound methodology, unacceptable bias, and unsupported conclusions. As academics and experts in the field, we regard The Cass Review as potentially harmful to trans children.

As academics with a wealth of research experience between us, we can confidently say that The Cass Review is an inadequate piece of research. Its methodology is unsatisfactory and unreliable. It disregards the wealth of expertise at national and international levels on best practice guidelines to support young trans people.  

It does not include a proper systematic literature review since it disregards most research evidence because it fails to reach the impossibly high bar of a double-blind trial. In fact, trans healthcare is inappropriate for a double-blind trial since you cannot give hormones to one group of people and not to another. This practice would be unethical. Indeed, much medical practice is not based on this kind of evidence.

The Cass Review provides very little evidence for its proposals. The evidence it does draw upon is, in the main, anecdotal. In effect the Cass proposals are largely un-evidenced and seem to be based on anti-trans rhetoric rather than medical or scientific knowledge. 

The failure to systematically include trans peoples’ voices while liberally presenting anti-trans campaigners’ rhetoric – including those accused of supporting ‘conversion therapy’ – reveals a level of bias that is unacceptable. 

We regard The Cass Review as methodologically unsound, appears biased (despite its reasonable-sounding language), dangerous, and rights-stripping in its proposals. If implemented, its recommendations will cause great harm to trans and non-binary young people. This report should be rejected. Trans children and young children deserve so much better.  

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