UK's largest doctors' union condemns Cass Review's attacks on gender-affirming healthcare

The British Medical Association (BMA), the UK’s largest doctors’ union, has voted to publicly criticise the Cass Review, a major review of UK medical interventions for young trans people that has been condemned by many trans people and allies.

The study was used to limit and restrict the ability of transgender minors to receive gender reassignment care. The BMA found the findings of the Cass review to be “unfounded” and voted against implementing the study’s recommendations.

The BMA’s criticism of the study follows a recent court ruling that allows the government to ban the use of puberty blockers in an emergency. The ruling refers to the study in its judgment.

The Cass review was published in April this year, and research began in 2020. It found that there is no reliable evidence base for transgender children to receive gender-affirming medical care. It states that transgender children should generally not have access to hormone blockers or hormone replacement therapy (HRT) and should instead receive therapy or psychological treatment. While the review does not outright ban transgender medical care, it coincides with the National Health Service (NHS)’s significant restriction on puberty blockers for transgender youth.

In response to the Cass inquiry, the UK’s National Health Service recently ordered all adult clinics to refuse services to clients under the age of 18 and also asked clinics to stop prescribing puberty blockers to minors, leaving many patients without a way to receive prompt care. The UK also recently forced Google’s search engine to remove all regional search results for two pharmaceutical websites that sell hormones without a prescription.

Numerous studies have challenged the Cass Review’s findings. The Yale Law Review recently published its own critique, which concluded that the Cass Review “repeatedly misuses data and violates its own standards of evidence by basing many conclusions on speculation.” It also claims that the Cass Review “subverts widely accepted processes for developing clinical guidelines and repeats false and debunked claims about transgender identity and gender dysphoria.”

In an interview with The New York TimesThe author of the Cass Review has supported the debunked theory that being transgender could be a “social contagion”. There is no evidence for this theory, but it has been widely used by conservatives as a reason to withhold gender-affirming care and to accuse adults who support it of “pressuring” young people to identify as transgender.

The BMA not only condemned the Cass report, it also said that healthcare services for transgender people in the UK were inadequate. The BMA further said that the Casa report “engaged in ‘unexplained study gaps’ and ‘ambiguous eligibility criteria’ while excluding evidence supporting transgender care.”

The full resolution states that the BMA wishes to “publicly express its support for transgender people, particularly transgender youth, and ensure timely access to gender identity services and treatment at all ages” and “condemn the growing political transphobia that ostracizes and discriminates against transgender people by blocking their access to health care.”

They are also seeking to produce a more comprehensive critique of the Cass Review through a “task and finish” group, which they plan to complete “towards the end of the year”, and which will focus on the Cass Review’s methodological errors.

The full BMA resolution is below:

“This meeting recognises that the provision of gender identity services in the UK is inadequate and that transgender people should be treated with compassion and respect for their bodily autonomy. Following the publication of the Cass Review on Gender Identity Services for children and young people, this meeting is concerned about its impact on the provision of healthcare to transgender people due to its unsubstantiated recommendations driven by unexplained study protocol deviations, ambiguous eligibility criteria and the exclusion of evidence affirming transgenderness. Therefore, this meeting calls on the BMA to:

I. Publicly criticize Cass magazine;
ii. Lobby and work with other relevant organisations and stakeholders to oppose the implementation of the recommendations made by the Cass Report;
iii. Lobby the government and NHS in all four countries to ensure continuity of transgender healthcare provision for patients under 18;
iv. Lobby the government and NHS in all four countries to ensure continued provision of healthcare to transgender people aged 18 or over;
not. Publicly declare support for transgender people, particularly transgender youth, and ensure timely access to gender identity services and treatment at all ages;
vi. Condemn the growing political transphobia that ostracizes and discriminates against transgender people by blocking their access to health care.

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