The Cass Review into medical care provided to children with gender dysphoria has been released. Here’s what it found


There’s been a lot of discussion this week about the adequacy of medical care provided to children with gender dysphoria and whether change is needed.

It’s been sparked by a landmark investigation into gender-affirming care offered via the National Health Service [NHS] in England, conducted by well-known paediatrician Hilary Cass.

The outcomes of the report are designed to reshape how publicly-funded care is provided to young people in England.

Her report, known as the Cass Review, spans hundreds of pages and calls for sweeping changes to how the NHS provides treatment to young people through its gender clinics.

In a nutshell, it recommends the service significantly limit the prescribing of medications — colloquially known as puberty blockers — for people aged under 18 and for patient care to be multi-disciplinary and centred around mental health support rather than medical interventions.

It’s a recommendation the NHS England adopted last month, in anticipation of the findings.

“We have concluded that there is not enough evidence to support the safety or clinical effectiveness of [puberty blockers] to make the treatment routinely available at this time,” the NHS England wrote in March.

In her report, Dr Cass said she made the recommendations because of a lack of scientific evidence into the long-term use of the medications.

“NHS England recommends that access to [puberty blockers] for children and young people with gender incongruence/dysphoria should only be available as part of research.”

Prior to the change, the drugs had been prescribed to patients with gender dysphoria in England. Though, according to UK media, it was estimated fewer than 100 people were on the drugs via the NHS. Those patients would be allowed to continue to take them.

The review also recommends “extreme caution” in prescribing masculinising and feminising hormones under the age of 18.

In her report, Dr Cass said she made the recommendations because of a lack of scientific evidence into the long-term use of the medications in children.

“You must have the same standards of care as everyone else in the NHS, and that means basing treatments on good evidence,” Dr Cass wrote, directly addressing gender dysphoric children.

“I have been disappointed by the lack of evidence on the long-term impact of taking hormones from an early age; research has let us all down, most importantly you.”

A smiling woman with short blonde hair, glasses and a simple necklace.

Paediatrician Hilary Cass conducted the review.(Supplied)

Dr Cass’ findings were based on a series of systematic reviews of the medical evidence and international treatment guidelines undertaken by University of York.

“This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint,” she wrote.

As part of the work, researchers identified 23 guidelines published between 1998 and 2022 that contained recommendations about children and young people with gender dysphoria, four of those were international, three were regional and 16 were national.  

Dr Cass went on to call for both the scientific community and patients who are taking puberty blockers to come together to study their use.

As a result, questions are being asked about whether those findings should have implications in other countries, like Australia, where gender affirming care is available.

Will things change in Australia?

It’s not out of the question, but there is deep resistance.

In Australia the review has been acknowledged but most doctors and institutions, and even the government, have cautioned against applying the findings here, arguing the settings are very different.

Mark Butler wearing a suit and red tie stands in front of the australian and aborignal flags during press conference

Health Minister Mark Butler said the clinical pathways in Australia were different to those offered in the UK.(ABC News: Ian Cutmore)

Here, puberty blockers are only subsidised for patients who have certain cancers or those experiencing early puberty. Though, patients can access them without subsidy.

Health Minister, Mark Butler, described the Cass Review as “significant” but said the clinical pathways in Australia were different to those offered in the UK.

“Clinical treatment of transgender children and adolescents is a complex and evolving area in which longer term evidence to inform treatment protocols is still developing,” he said.



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