Cass Review#NHS Scotland

{{See also|Gender Identity Development Service}}

File:Referrals to GIDS by assigned sex in each financial year.svg

The Gender Identity Development Service (GIDS) was the specialist clinic nationally commissioned by NHS England to provide care to transgender and gender diverse children, including those with gender dysphoria. In the years leading up to the Cass Review, several GIDS staff members voiced concerns over the evidence base for the treatments being given and the extent of prior assessment.{{cite news |last1=Connett |first1=David |title=NHS gender identity clinic whistleblower wins damages |url=https://www.theguardian.com/society/2021/sep/04/gender-identity-clinic-whistleblower-wins-damages |work=The Observer |access-date=1 January 2025 |archive-url=https://archive.today/20210905135440/https://www.theguardian.com/society/2021/sep/04/gender-identity-clinic-whistleblower-wins-damages |archive-date=5 September 2021 |language=en |date=4 September 2021 |url-status=live}}{{cite news |last1=Barnes |first1=Hannah |title=Children's gender identity clinic concerns go back 15 years |url=https://www.bbc.co.uk/news/uk-54374165 |work=BBC News |archive-url=https://archive.today/20201001225634/https://www.bbc.com/news/uk-54374165 |archive-date=1 October 2020 |language=en |date=1 October 2020 |url-status=live}}{{cite news |last1=Cooke |first1=Rachel |author1-link=Rachel Cooke |title=Tavistock trust whistleblower David Bell: 'I believed I was doing the right thing' |url=https://www.theguardian.com/society/2021/may/02/tavistock-trust-whistleblower-david-bell-transgender-children-gids |work=The Observer |access-date=29 December 2024 |archive-url=https://archive.today/20230403150628/https://www.theguardian.com/society/2021/may/02/tavistock-trust-whistleblower-david-bell-transgender-children-gids |archive-date=3 April 2023 |language=en |date=2 May 2021 |url-status=live}} At the same time, professional disagreements over the strength of evidence for treatments provided to children and young people, such as puberty blockers, was growing.{{cite journal |last1=Block |first1=Jennifer |title=Gender dysphoria in young people is rising—and so is professional disagreement |journal=BMJ |date=23 February 2023 |volume=380 |pages=382 |doi=10.1136/bmj.p382 |pmid=36822640 |language=en}}{{cite news |last1=Rigby |first1=Jennifer |last2=Respaut |first2=Robin |last3=Terhune |first3=Chad |title=England's trans teens, lost in limbo, face mounting barriers to care |url=https://www.reuters.com/investigates/special-report/britain-transyouth/ |work=Reuters |access-date=1 January 2025 |archive-url=https://archive.today/20221217111400/https://www.reuters.com/investigates/special-report/britain-transyouth/ |archive-date=17 December 2022 |language=en |date=15 December 2022 |url-status=live}} The case of Bell v Tavistock also explored issues of informed consent.{{cite news |last1=Siddique |first1=Haroon |title=Appeal court overturns UK puberty blockers ruling for under-16s |url=https://www.theguardian.com/society/2021/sep/17/appeal-court-overturns-uk-puberty-blockers-ruling-for-under-16s-tavistock-keira-bell |work=The Guardian |archive-url=https://archive.today/20231110184442/https://www.theguardian.com/society/2021/sep/17/appeal-court-overturns-uk-puberty-blockers-ruling-for-under-16s-tavistock-keira-bell |archive-date=10 November 2023 |language=en |date=17 September 2021 |url-status=live}}{{cite news |last1=Lawrie |first1=Eleanor |title=Ruling limiting under-16s puberty blockers overturned |url=https://www.bbc.co.uk/news/uk-58598186 |work=BBC News |archive-url=https://archive.today/20241229223232/https://www.bbc.com/news/uk-58598186 |archive-date=29 December 2024 |language=en |date=17 September 2021 |url-status=live}}{{cite journal |last1=Dyer |first1=Clare |title=Doctors can decide if children are able to consent to puberty blockers, say judges |journal=BMJ |date=20 September 2021 |volume=374 |pages=n2307 |doi=10.1136/bmj.n2307 |pmid=34544798 |language=en}} Several systematic reviews had found the evidence base supporting these treatments to be poor,{{cite journal |last1=Thompson |first1=Lucy |last2=Sarovic |first2=Darko |last3=Wilson |first3=Philip |last4=Irwin |first4=Louis |last5=Visnitchi |first5=Dana |last6=Sämfjord |first6=Angela |last7=Gillberg |first7=Christopher |title=A PRISMA systematic review of adolescent gender dysphoria literature: 3) treatment |journal=PLOS Global Public Health |date=8 August 2023 |volume=3 |issue=8 |page=43 |doi=10.1371/journal.pgph.0001478 |doi-access=free |pmid=37552651 |pmc=10409298 |quote=There is a lack of evidence on treatment for GD in adolescence. Although there is a growing body of literature providing data, there are limitations to the scope and quality, and prospective studies with long-term follow-up from a range of centres internationally is required. This review series has highlighted a lack of quality evidence in relation to adolescent GD in general: epidemiology, comorbidity, and treatment impact is difficult to robustly assess. Without an improvement in the scientific field, clinicians, parents, and young people are left ill-equipped to make safe and appropriate decisions.}}{{cite journal |last1=Ludvigsson |first1=Jonas F. |last2=Adolfsson |first2=Jan |last3=Höistad |first3=Malin |last4=Rydelius |first4=Per-Anders |last5=Kriström |first5=Berit |last6=Landén |first6=Mikael |title=A systematic review of hormone treatment for children with gender dysphoria and recommendations for research |journal=Acta Paediatrica |date=November 2023 |volume=112 |issue=11 |pages=2279–2292 |doi=10.1111/apa.16791 |pmid=37069492}}{{cite journal |last1=Levine |first1=Stephen B. |last2=Abbruzzese |first2=E. |title=Current Concerns About Gender-Affirming Therapy in Adolescents |journal=Current Sexual Health Reports |date=14 April 2023 |volume=15 |issue=2 |page=115 |doi=10.1007/s11930-023-00358-x |publisher=Springer Nature |language=en |doi-access=free}} and European countries, such as Finland and Sweden, limited the use of puberty blockers and other hormone treatments for this patient cohort, citing a lack of evidence supporting their use.{{cite news |last1=Ghorayshi |first1=Azeen |title=Youth Gender Medications Limited in England, Part of Big Shift in Europe |url=https://www.nytimes.com/2024/04/09/health/europe-transgender-youth-hormone-treatments.html |work=The New York Times |access-date=1 January 2025 |archive-url=https://archive.today/20240709224010/https://www.nytimes.com/2024/04/09/health/europe-transgender-youth-hormone-treatments.html |archive-date=9 July 2024 |language=en |date=9 April 2024 |url-status=live}}{{cite news |title=Sweden puts brakes on treatments for trans minors |url=https://www.france24.com/en/live-news/20230208-sweden-puts-brakes-on-treatments-for-trans-minors |work=France 24 |access-date=1 January 2025 |archive-url=https://archive.today/20231106181041/https://www.france24.com/en/live-news/20230208-sweden-puts-brakes-on-treatments-for-trans-minors |archive-date=6 November 2023 |language=en |date=8 February 2023 |url-status=live}}{{cite news |last1=Min |first1=Roselyne |title=As Spain advances trans rights, Sweden backtracks on gender-affirming treatments for teens |url=https://www.euronews.com/health/2023/02/16/as-spain-advances-trans-rights-sweden-backtracks-on-gender-affirming-treatments-for-teens |work=Euronews |access-date=1 January 2025 |archive-url=https://archive.today/20240222131622/https://www.euronews.com/health/2023/02/16/as-spain-advances-trans-rights-sweden-backtracks-on-gender-affirming-treatments-for-teens |archive-date=22 February 2024 |language=en |date=17 February 2023 |url-status=live}} In January 2021, the Care Quality Commission (CQC) gave GIDS an "inadequate" rating (the lowest one possible).{{cite news |last1=Brooks |first1=Libby |title=Gender identity development service for children rated inadequate |url=https://www.theguardian.com/society/2021/jan/20/gender-identity-development-service-for-children-rated-inadequate |work=The Guardian |access-date=1 January 2025 |archive-url=https://archive.today/20210120013755/https://www.theguardian.com/society/2021/jan/20/gender-identity-development-service-for-children-rated-inadequate |archive-date=20 January 2021 |language=en |date=20 January 2021 |url-status=live}}{{cite news |last1=Hunte |first1=Ben |title=NHS Tavistock child gender clinic rated 'inadequate' |url=https://www.bbc.co.uk/news/health-55723250 |work=BBC News |access-date=1 January 2025 |archive-url=https://archive.today/20210130134111/https://www.bbc.com/news/health-55723250 |archive-date=30 January 2021 |language=en |date=20 January 2021 |url-status=live}} These issues led to GIDS becoming controversial and gaining extensive news coverage.{{cite news |last1=Brooks |first1=Libby |title=Tavistock gender identity clinic is closing: what happens next? |url=https://www.theguardian.com/society/2022/jul/28/tavistock-gender-identity-clinic-is-closing-what-happens-next |work=The Guardian |access-date=1 January 2025 |archive-url=https://archive.today/20230106161157/https://www.theguardian.com/society/2022/jul/28/tavistock-gender-identity-clinic-is-closing-what-happens-next |archive-date=6 January 2023 |language=en |date=28 July 2022 |url-status=live}}

The Cass Review was commissioned by NHS England in September 2020, following a significant increase in referrals to the Gender Identity Development Service{{efn|Between 2009–10 and 2019–20, the number of referrals increased from 77 to more than 2,700.{{cite news |last1=Gregory |first1=Andrew |last2=Thomas |first2=Tobi |last3=Gentleman |first3=Amelia |title=What Cass review says about surge in children seeking gender services |url=https://www.theguardian.com/society/2024/apr/10/what-cass-review-says-about-surge-in-children-seeking-gender-services |work=The Guardian |access-date=30 December 2024 |archive-url=https://archive.today/20240410211937/https://www.theguardian.com/society/2024/apr/10/what-cass-review-says-about-surge-in-children-seeking-gender-services |archive-date=10 April 2024 |language=en |date=10 April 2024 |url-status=live}}{{cite news |last1=Cohen |first1=Deborah |title=Puberty blockers: Can a drug trial solve the big debate? |url=https://www.bbc.co.uk/news/articles/clyd2qe5kkjo |work=BBC News |access-date=30 December 2024 |archive-url=https://archive.today/20241230214053/https://www.bbc.com/news/articles/clyd2qe5kkjo |archive-date=30 December 2024 |language=en |date=9 December 2024 |url-status=live}}{{cite journal |last1=Dyer |first1=Clare |title=Gender dysphoria service rated inadequate after waiting list of 4600 raises concerns |journal=BMJ |date=21 January 2021 |volume=372 |pages=n205 |doi=10.1136/bmj.n205 |pmid=33478948 |language=en}}}} and a shift in the service from a psychosocial and psychotherapeutic model to one that included hormonal treatment.{{efn|Over time, the service adopted international standards from the Dutch Protocol and the WPATH and the Endocrine Society guidelines.{{sfn|Cass review final report|2024|pp=68-74}}{{harvnb|Bannerman|Beal|Hayward|Koronka|2024}}: "The report finds that treatment on the NHS since 2011 has largely been informed by two sets of international guidelines, drawn up by the Endocrine Society and the World Professional Association of Transgender Healthcare (WPATH)"}}{{efn|"Before 2011, Gids would give puberty blockers to children only once they had turned 16. But as gender clinics around the world began providing blockers to those who had just begun puberty, reports grew of UK children going overseas to buy the drugs. And in 2011, a medical study was approved through which younger children could access these drugs...In 2014, despite the patchwork of information about the study – which was still running – a change in Gids' policy was approved by NHS England: children with gender dysphoria, who were just beginning puberty, could now be eligible for blockers."{{cite news |last1=Barnes |first1=Hannah |last2=Cohen |first2=Deborah |title=Transgender treatment: Puberty blockers study under investigation |url=https://www.bbc.co.uk/news/health-49036145 |work=BBC News |access-date=30 December 2024 |archive-url=https://archive.today/20240601070215/https://www.bbc.com/news/health-49036145 |archive-date=1 June 2024 |language=en |date=22 July 2019 |url-status=live}}{{cite news |last1=Barnes |first1=Hannah |title=The crisis at the Tavistock's child gender clinic |url=https://www.bbc.co.uk/news/uk-56539466 |work=BBC News |access-date=30 December 2024 |archive-url=https://archive.today/20241230204631/https://www.bbc.com/news/uk-56539466 |archive-date=30 December 2024 |language=en |date=30 March 2021 |url-status=live}}}} Hilary Cass, a former president of the Royal College of Paediatrics and Child Health (RCPCH), was asked by NHS England and NHS Improvement's Quality and Innovation Committee to chair an independent review with the aim of improving gender identity services for children and young people. The Cass Review's final report stated the concerns which led to its creation included very long waiting lists, of over two years per patient; an "exponential" increase in the number of children and young people requesting gender-affirming care from the NHS; a change towards earlier medical treatment in this patient cohort;{{efn|According to Cass: "In 2011, a study began to evaluate the impact of administering puberty blockers to younger children. By 2014, when the study had just finished recruiting its final participants, GIDS lowered the age at which young people could be referred for treatment with blockers from 16 to those in the early stages of puberty. There was no lower age limit as such, but it meant in some instances that children of nine or 10 could now be eligible to be referred for this medical intervention."{{Cite journal |last=Cass |first=Hilary |date=6 September 2024 |title=Gender identity services for children and young people: navigating uncertainty through communication, collaboration and care |url=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/gender-identity-services-for-children-and-young-people-navigating-uncertainty-through-communication-collaboration-and-care/D0F6B23F37C3D82B38C2470DF65854C9 |journal=British Journal of Psychiatry |volume=225 |issue=2 |language=en |pages=302–304 |doi=10.1192/bjp.2024.162 |pmid=39237983 |issn=0007-1250}}}} and concerns that there was insufficient evidence to justify the treatments being given.{{efn|Between 2019 and 2020, issues were raised about services and the evidence base for treatments in reports by the Royal College of General Practitioners (RCGP), an NHS England Policy Working Group, and the National Institute for Health and Care Excellence (NICE).{{cite web |date=25 June 2019 |title=RCGP calls for whole-system approach to improving NHS care for trans patients |url=https://www.rcgp.org.uk/about-us/news/2019/june/rcgp-calls-for-whole-system-approach-to-improving-nhs-care-for-trans-patients.aspx |website=Royal College of General Practitioners |access-date=13 January 2020 |archive-date=13 January 2020 |archive-url=https://web.archive.org/web/20200113013109/https://www.rcgp.org.uk/about-us/news/2019/june/rcgp-calls-for-whole-system-approach-to-improving-nhs-care-for-trans-patients.aspx |url-status=live}}{{sfn|Cass review final report|2024|pp=75-77}}}}

The Cass Review was a non-peer-reviewed, independent service review which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS.{{efn|According to a report by RAND Health & Wellbeing: "The Cass Review was another highly comprehensive effort to summarize research evidence on interventions for gender dysphoria in TGE youth, informed in part by systematic reviews of evidence for social transition (Hall et al., 2024), other psychosocial interventions (Heathcote et al., 2024), and hormonal interventions (Taylor, Mitchell, Hall, Langton, et al., 2024; Taylor, Mitchell, Hall, Heathcote, et al., 2024). (The Cass Review also incorporated input from professionals, both in the United Kingdom and other countries, as well as from youth and caregivers.) [...] Overall, it is important to recognize that the purpose and approach of the Cass Review report were guided by its mandate to make recommendations for UK National Health Service policy. Although policymakers elsewhere have begun considering how the Cass Review findings could inform their decisions, given its prominence and comprehensiveness, that mandate certainly affects the applicability of those findings for decisionmaking in other contexts. As one example, the Cass Review did not include evidence for gender-affirming surgery because the National Health Service had already restricted that intervention to individuals age 18 or older. In contrast, we sought to provide evidence summaries that practice and policy decisionmakers could more broadly consider across diverse contexts."{{Cite report |url=https://www.rand.org/content/dam/rand/pubs/research_reports/RRA3200/RRA3223-1/RAND_RRA3223-1.pdf |title=Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research - RAND_RRA3223-1.pdf |last1=Dopp |first1=Alex R.|last2=Peipert |first2=Allison |last3=Buss |first3=John |last4=De Jesús-Romero |first4=Robinson |last5=Palmer |first5=Keyton |last6=Lorenzo-Luaces |first6=Lorenzo |date=26 November 2024 |publisher=RAND Corporation |access-date=28 December 2024 |orig-date=28 December 2024 |ref={{SfnRef|Dopp|2024}} |archive-url=https://web.archive.org/web/20250115015259/https://www.rand.org/content/dam/rand/pubs/research_reports/RRA3200/RRA3223-1/RAND_RRA3223-1.pdf |archive-date=15 January 2025}}}}{{Cite web |title=Terms of Reference – Cass Review |url=https://cass.independent-review.uk/about-the-review/terms-of-reference/ |access-date=6 January 2025 |website=cass.independent-review.uk |language=en}} To assist its decision-making,{{Cite web |title=Gender Identity Service Series |url=https://adc.bmj.com/pages/gender-identity-service-series |access-date=3 January 2025 |website=Archives of Disease in Childhood |language=en |archive-url=https://web.archive.org/web/20240411130615/https://adc.bmj.com/pages/gender-identity-service-series |archive-date=11 April 2024}} the Cass Review commissioned a series of several peer-reviewed,{{sfn|Cass review final report|2024|p=26}} independent{{cite journal |last1=Grijseels |first1=D. M. |title=Biological and psychosocial evidence in the Cass Review: a critical commentary |journal=International Journal of Transgender Health |date=8 June 2024 |pages=1–3 |doi=10.1080/26895269.2024.2362304}} systematic reviews that looked into different areas of healthcare for children and young people with distress related to gender identity,{{cite journal |last1=Thornton |first1=Jacqui |date=April 2024 |title=Cass Review calls for reformed gender identity services |journal=The Lancet |type=News |volume=403 |issue=10436 |pages=1529 |doi=10.1016/S0140-6736(24)00808-0 |pmid=38643770 |quote=Cass commissioned four systematic reviews of the evidence on key issues...}}{{sfn|Cass review final report|2024|p=28}} supplemented by qualitative and quantitative research into the treatment and experiences of young people with gender dysphoria and their health outcomes.{{sfn|Cass review final report|2024|pp=52–53}} A single search strategy was used for all reviews, with an initial search in May 2021, updated in April 2022. The research programme was carried out by the University of York's Centre for Reviews and Dissemination,{{efn|The Centre for Reviews and Dissemination is one of three bodies funded by the National Institute for Health and Care Research (NIHR) to provide a systematic review service to the NHS.{{sfn|Cass review final report|2024|p=56}}}} and was published in Archives of Disease in Childhood.{{sfn|Cass review final report|2024|loc=Appendix 2|p=8}}{{cite web |title=Homepage {{pipe}} Archives of Disease in Childhood |url=https://adc.bmj.com/ |website=Archives of Disease in Childhood |access-date=19 December 2024 |archive-url=https://archive.today/20241219195107/https://adc.bmj.com/ |archive-date=19 December 2024 |language=en |url-status=live}}{{cite journal |last1=Clayton |first1=Alison |last2=Amos |first2=Andrew James |last3=Spencer |first3=Jillian |last4=Clarke |first4=Patrick |title=Implications of the Cass Review for health policy governing gender medicine for Australian minors |journal=Australasian Psychiatry |date=31 August 2024 |volume=33 |issue=1 |pages=89–95 |doi=10.1177/10398562241276335 |pmid=39216994 |language=en |doi-access=free |pmc=11804132}} The reviews examined English-language studies of minors,{{efn|The systematic reviews considered studies of patients up to 18 years old, although young adults up to 30 were included in the qualitative research to discuss their prior experiences.{{Cite web |title=Lived Experience Focus Groups – Cass Review |url=https://cass.independent-review.uk/contribute-to-the-review/lived-experience-focus-groups/ |access-date=3 January 2025 |website=cass.independent-review.uk |language=en |archive-url=https://web.archive.org/web/20250103101206/https://cass.independent-review.uk/contribute-to-the-review/lived-experience-focus-groups/ |archive-date=3 January 2025}}}} excluding case studies, and the quality of studies was assessed using the Mixed Methods Appraisal Tool and a modified version of the Newcastle–Ottawa scale,{{sfn|Cass review final report|2024|p=161}}{{sfn|Cass review final report|2024|loc=Appendix 2|pp=2–3}} though certainty-of-evidence ratings were not provided for individual outcomes. The systematic reviews covered:{{cite web |title=Gender Identity Service Series |url=https://adc.bmj.com/pages/gender-identity-service-series |url-status=live |archive-url=https://web.archive.org/web/20240410082126/https://adc.bmj.com/pages/gender-identity-service-series |archive-date=10 April 2024 |access-date=10 April 2024 |website=Archives of Disease in Childhood |type=Series of reviews commissioned to inform the Cass Review}}

• Characteristics of children and adolescents referred to specialist gender services{{cite journal |last1=Taylor |first1=Jo |last2=Hall |first2=Ruth |last3=Langton |first3=Trilby |last4=Fraser |first4=Lorna |last5=Hewitt |first5=Catherine Elizabeth |date=9 April 2024 |title=Characteristics of children and adolescents referred to specialist gender services: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326681 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s3–s11 |type=Review |doi=10.1136/archdischild-2023-326681 |issn=0003-9888 |pmid=38594046 |archive-url=https://web.archive.org/web/20240410152521/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326681 |archive-date=10 April 2024 |access-date=11 April 2024|doi-access=free }}
• Impact of social transition in relation to gender for children and adolescents{{cite journal |last1=Hall |first1=Ruth |last2=Mitchell |first2=Alex |last3=Taylor |first3=Jo |last4=Heathcote |first4=Claire |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |last7=Hewitt |first7=Catherine Elizabeth |date=9 April 2024 |title=Impact of social transition in relation to gender for children and adolescents: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326112 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s12–s18 |type=Review |doi=10.1136/archdischild-2023-326112 |pmid=38594055 |archive-url=https://web.archive.org/web/20240422134915/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326112 |archive-date=22 April 2024 |access-date=22 April 2024}}
• Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence{{cite journal |last1=Heathcote |first1=Claire |last2=Mitchell |first2=Alex |last3=Taylor |first3=Jo |last4=Hall |first4=Ruth |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |last7=Hewitt |first7=Catherine Elizabeth |last8=Jarvis |first8=Stuart William |date=9 April 2024 |title=Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326347 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s19–s32 |type=Review |doi=10.1136/archdischild-2023-326347 |pmid=38594045 |archive-url=https://web.archive.org/web/20240423162758/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326347 |archive-date=23 April 2024 |access-date=23 April 2024 |ref=psychosocialreview}}
• Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers){{cite journal |last1=Taylor |first1=Jo |last2=Mitchell |first2=Alex |last3=Hall |first3=Ruth |last4=Heathcote |first4=Claire |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |last7=Hewitt |first7=Catherine Elizabeth |date=9 April 2024 |title=Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326669 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s33–s47 |type=Review |doi=10.1136/archdischild-2023-326669 |issn=0003-9888 |pmid=38594047 |archive-url=https://web.archive.org/web/20240410222540/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326669 |archive-date=10 April 2024 |access-date=11 April 2024}}
• Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy){{cite journal |last1=Taylor |first1=Jo |last2=Mitchell |first2=Alex |last3=Hall |first3=Ruth |last4=Langton |first4=Trilby |last5=Fraser |first5=Lorna |last6=Hewitt |first6=Catherine Elizabeth |date=9 April 2024 |title=Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326670 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s48–s56 |type=Review |doi=10.1136/archdischild-2023-326670 |issn=0003-9888 |pmid=38594053 |archive-url=https://web.archive.org/web/20240410222522/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326670 |archive-date=10 April 2024 |access-date=11 April 2024|doi-access=free }}
• Care pathways of children and adolescents referred to specialist gender services{{cite journal |last1=Taylor |first1=Jo |last2=Hall |first2=Ruth |last3=Langton |first3=Trilby |last4=Fraser |first4=Lorna |last5=Hewitt |first5=Catherine Elizabeth |date=9 April 2024 |title=Care pathways of children and adolescents referred to specialist gender services: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326760 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s57–s64 |type=Review |doi=10.1136/archdischild-2023-326760 |pmid=38594052 |archive-url=https://web.archive.org/web/20240428170610/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326760 |archive-date=28 April 2024 |access-date=28 April 2024|doi-access=free }}
• Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence{{cite journal |last1=Taylor |first1=J |last2=Hall |first2=R |last3=Heathcote |first3=C |last4=Hewitt |first4=CE |last5=Langton |first5=T |last6=Fraser |first6=L |date=9 April 2024 |title=Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1). |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326499.long |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s65–s72 |type=Review |doi=10.1136/archdischild-2023-326499 |pmid=38594049 |access-date=13 April 2024 |archive-date=2 August 2024 |archive-url=https://web.archive.org/web/20240802152411/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326499.long |url-status=live}}{{cite journal |last1=Taylor |first1=J |last2=Hall |first2=R |last3=Heathcote |first3=C |last4=Hewitt |first4=CE |last5=Langton |first5=T |last6=Fraser |first6=L |date=9 April 2024 |title=Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2). |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326500.long |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s73–s82 |type=Review |doi=10.1136/archdischild-2023-326500 |pmid=38594048 |archive-url=https://web.archive.org/web/20240629234058/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326500.long |archive-date=29 June 2024 |access-date=13 April 2024}}

The review supplemented{{sfn|Cass review final report|2024|pp=20,47,52-53}}{{sfn|Cass|2024|p=302|ps=: "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians."}} the evidence with an engagement programme which included listening sessions and focus groups with service users and parents, and meeting with advocacy groups.{{sfn|Cass review final report|2024|p=60}}

{{Primary sources|section|date=March 2025}}

File:Sigmund Freud statue, London 2.jpg in front of the Tavistock Centre, at which the GIDS was based.]]

The interim report of the Cass Review was published in March 2022. It said the rise in referrals had led to staff being overwhelmed, and recommended the creation of a network of regional hubs to provide care and support to young people. The report said the clinical approach used by the Gender Identity Development Service (GIDS) "has not been subjected to some of the usual control measures" typically applied with new treatments, and raised concerns about the lack of data collection by GIDS.{{sfn|Cass review interim report|2022|p=15}}{{cite web |last1=Brooks |first1=Libby |date=10 March 2022 |title=NHS gender identity service for children can't cope with demand, review finds 10 March 2022 |url=https://www.theguardian.com/society/2022/mar/10/nhs-gender-identity-service-for-children-cant-cope-with-demand-review-finds |url-status=live |archive-url=https://web.archive.org/web/20220313002234/https://www.theguardian.com/society/2022/mar/10/nhs-gender-identity-service-for-children-cant-cope-with-demand-review-finds |archive-date=13 March 2022 |access-date=13 March 2022 |work=The Guardian}}{{cite news |last=Bannerman |first=Lucy |date=10 March 2022 |title=Tavistock gender clinic not safe for children, report finds |url=https://www.thetimes.com/article/tavistock-gender-clinic-not-safe-for-children-report-finds-w0ngnjnnf |url-status=live |archive-url=https://web.archive.org/web/20220329105531/https://www.thetimes.co.uk/article/tavistock-gender-clinic-not-safe-for-children-report-finds-w0ngnjnnf |archive-date=29 March 2022 |access-date=29 March 2022 |work=The Times}} While most children referred to GIDS did not receive endocrine treatment, there was insufficient detail provided about their broader needs when they did.{{sfn|Cass review interim report|2022|p=40}}

The report said that while the GIDS approach to hormone interventions was initially based on the Dutch protocol, there were "significant differences" in the current NHS approach.{{sfn|Cass review interim report|2022|p=18, 31}} For example, the report said there were no clear guidelines for when to provide psychological support before or instead of medical treatment, endocrinologists administering puberty blockers did not attend multidisciplinary meetings, and there was insufficient capacity to increase (or even maintain) appointments once adolescents received puberty blockers.{{sfn|Cass review interim report|2022|p=18}}

The interim report said GPs and other non-GIDS staff felt "under pressure to adopt an unquestioning affirmative approach" to children unsure of their gender. The report also said that diagnosis of gender-related distress sometimes led to "diagnostic overshadowing", where comorbidities such as poor mental health – which were usually managed by local services – were overlooked.{{sfn|Cass review interim report|2022|p=17}} The report suggested that long wait times to access GIDS had resulted in increased distress for patients and their families, as well as less time for exploration – since patients arrived having already begun social transition and with expectations of a rapid assessment process.{{sfn|Cass review interim report|2022|pp=17, 19}} In response, the Tavistock and Portman NHS Foundation Trust said "being respectful of someone's identity does not preclude exploration", and that it agreed "support should be holistic, based on the best available evidence" without making assumptions about "the right outcome for any given young person".{{cite web |last1=Crawford |first1=Angus |date=23 April 2022 |title=Sajid Javid to review gender treatment for children |url=https://www.bbc.co.uk/news/uk-politics-61203575 |url-status=live |archive-url=https://web.archive.org/web/20220424021814/https://www.bbc.co.uk/news/uk-politics-61203575 |archive-date=24 April 2022 |access-date=24 April 2022 |website= |publisher=BBC News |type=News}}

The interim report further said there were "gaps in the evidence" over the use of puberty blockers. A public consultation was held and a further review of evidence by NICE said there was "not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones to make the treatment routinely available at this time". Subsequently, NHS England stopped prescribing them to children.{{cite news |last1=Campbell |first1=Denis |date=12 March 2024 |title=Children to stop getting puberty blockers at gender identity clinics, says NHS England |url=https://www.theguardian.com/society/2024/mar/12/children-to-stop-getting-puberty-blockers-at-gender-identity-clinics-says-nhs-england |url-status=live |archive-url=https://archive.today/20240312203845/https://www.theguardian.com/society/2024/mar/12/children-to-stop-getting-puberty-blockers-at-gender-identity-clinics-says-nhs-england |archive-date=12 March 2024 |access-date=26 April 2024 |work=The Guardian |language=en |type=News}}{{cite news |last1=Parry |first1=Josh |date=12 March 2024 |title=NHS England to stop prescribing puberty blockers |url=https://www.bbc.co.uk/news/health-68549091 |url-status=live |archive-url=https://archive.today/20240313005559/https://www.bbc.com/news/health-68549091 |archive-date=13 March 2024 |access-date=26 April 2024 |work=BBC News |language=en |type=News}}{{cite news |last1=Ghorayshi |first1=Azeen |date=9 April 2024 |title=Youth Gender Medications Limited in England, Part of Big Shift in Europe |url=https://www.nytimes.com/2024/04/09/health/europe-transgender-youth-hormone-treatments.html |url-access=subscription |url-status=live |archive-url=https://archive.today/20240421150508/https://www.nytimes.com/2024/04/09/health/europe-transgender-youth-hormone-treatments.html |archive-date=21 April 2024 |access-date=26 April 2024 |work=The New York Times |language=en |type=News}}

In April 2022, Health Secretary Sajid Javid told MPs that services in this area were too affirmative and narrow, and "bordering on ideological".{{Cite news |date=23 April 2022 |title=Sajid Javid to review gender treatment for children |url=https://www.bbc.com/news/uk-politics-61203575 |url-status=live |archive-url=https://web.archive.org/web/20240509230031/https://www.bbc.com/news/uk-politics-61203575 |archive-date=9 May 2024 |access-date=9 May 2024 |work=BBC News |language=en-GB |type=News}} In November 2022, the World Professional Association for Transgender Health (WPATH) – along with regional groups ASIAPATH, EPATH, PATHA, and USPATH – issued a statement criticising the NHS England interim service specifications based on the interim report.{{cite web |date=25 November 2022 |title=WPATH, ASIAPATH, EPATH, PATHA, and USPATH Response to NHS England in the United Kingdom (UK): Statement regarding the Interim Service Specification for the Specialist Service for Children and Young People with Gender Dysphoria (Phase 1 Providers) by NHS England |url=https://www.wpath.org/media/cms/Documents/Public%20Policies/2022/25.11.22%20AUSPATH%20Statement%20reworked%20for%20WPATH%20Final%20ASIAPATH.EPATH.PATHA.USPATH.pdf |url-status=live |archive-url=https://web.archive.org/web/20240414191906/https://www.wpath.org/media/cms/Documents/Public%20Policies/2022/25.11.22%20AUSPATH%20Statement%20reworked%20for%20WPATH%20Final%20ASIAPATH.EPATH.PATHA.USPATH.pdf |archive-date=14 April 2024 |access-date=13 April 2024 |type=Press release}}

The final report of the Cass Review was published on 10 April 2024, alongside a series of systematic reviews and a survey carried out by the University of York, encompassing the patient cohort, service pathways, international guidelines, social transitioning, puberty blockers, hormone treatments, and psychosocial treatments.{{harvid|Cass review final report|2024|p=33}}

File:Quality of relevant studies determined in systematic reviews commissioned by the Cass Review.svg

The report states that the existing evidence for both endocrine (puberty blockers and hormone therapy) and non-endocrine treatments (psychosocial interventions) in children and adolescents with gender incongruence is weak.{{efn|On medical treatments: "When the Review started, the evidence base, particularly in relation to the use of puberty blockers and masculinising or feminising hormones, had already been shown to be weak"; and that after the examination of over 100 pieces of potential evidence, that "there continues to be a lack of high-quality evidence in this area".{{sfn|Cass review final report|2024|p=20}} On psychosocial treatments: "A problem, that has become increasingly apparent as the Review has progressed is that research on psychosocial interventions and longer-term outcomes for those who do not access endocrine pathways is as weak as research on endocrine treatment. This leaves a major gap in our knowledge about how best to support and help the growing population of young people with gender-related distress in the

context of complex presentations.{{sfn|Cass review final report|2024|p=33}}}}

File:Cass-review-figure-11.png

The report found no clear explanation for the rise in the number of children and adolescents with gender dysphoria, but said there was broad agreement for attribution to a mix of biological and psychosocial factors. The report's suggested influences included a lower threshold for medical treatment, social media-related mental health consequences, abuse, access to information regarding gender dysphoria, struggles with emerging sexual orientation, and early exposure to online pornography. The report considered a rise in acceptance of transgender identities to be insufficient to explain the increase on its own.{{bulleted list|

| {{harvnb|Cass review final report|2024|pp=114–121}}

| {{cite news |last=Martin |first=Daniel |date=8 April 2024 |work=The Daily Telegraph|url=https://www.telegraph.co.uk/news/2024/04/08/trans-children-mental-health-issues/ |title=Children must not be rushed to change gender, report warns |access-date=14 April 2024 |archive-date=13 April 2024 |archive-url=https://web.archive.org/web/20240413192202/https://www.telegraph.co.uk/news/2024/04/08/trans-children-mental-health-issues/ |url-status=live}}

| {{harvnb|Bannerman|Beal|Hayward|Koronka|2024}}

}}

{{main|Social transitioning}}

A systematic review evaluated 11 studies assessing the outcomes of social transition in minors using a modified version of the Newcastle-Ottawa scale and considered nine to be low quality and two to be moderate quality.{{sfn|Cass review final report|2024|p=161}} The report said that insufficient evidence was available to assess whether social transition in childhood has positive or negative effects on mental health, and that there was weak evidence for efficacy in adolescence. It also said that sex of rearing seems to influence gender identity, and suggested that early social transition may "change the trajectory" of gender identity development in children.{{sfn|Cass review final report|2024|p=32, 164}}

The report said that although social transition was not usually seen as a treatment, it should be considered an "active intervention". It suggests taking "a more cautious approach" for social transition for children than for adolescents, and said pre-pubertal children undergoing social transition should be seen "as early as possible" by an experienced clinician.{{sfn|Cass review final report|2024|pp=32, 164–165}}{{sfn|Bannerman|Beal|Hayward|Koronka|2024}}{{cite news |title=Children failed by NHS amid toxic debate on gender identity, major review finds |url=https://www.independent.co.uk/news/health/cass-review-gender-identity-nhs-b2525787.html |work=The Independent |first=Rebecca |last=Thomas |date=10 April 2024 |access-date=14 April 2024 |archive-date=10 April 2024 |archive-url=https://web.archive.org/web/20240410031147/https://www.independent.co.uk/news/health/cass-review-gender-identity-nhs-b2525787.html |url-status=live}}

{{main|Puberty blocker}}

The report said the evidence base and rationale for early puberty suppression remains unclear, with unknown effects on cognitive and psychosexual development. A systematic review examined 50 studies on the use of puberty blockers using a modified version of the Newcastle–Ottawa scale and rated one as high quality, 25 as moderate quality, and 24 as low quality. The review concluded that the lack of evidence means no conclusions can be made regarding the impact on gender dysphoria and mental health, but did find evidence of bone health being compromised during treatment. The review suggested puberty blockers did not provide children and young people with "time to think", since nearly all patients who went on blockers later proceeded with hormone therapy.{{sfn|Cass review final report|2024|p=176}}{{cite news |last1=Parry |first1=Josh |last2=Pym |first2=Hugh |date=9 April 2024 |title=Hilary Cass: Weak evidence letting down children over gender care |url=https://www.bbc.co.uk/news/health-68770641 |url-status=live |archive-url=https://archive.today/20240409235757/https://www.bbc.com/news/health-68770641 |archive-date=9 April 2024 |access-date=17 April 2024 |work=BBC News |language=en}} For youth assigned male at birth, the report states that blockers taken too early can make a later penile inversion vaginoplasty more difficult due to insufficient penile growth.{{sfn|Cass review final report|2024|p=178}} The report states one of the benefits of puberty blockers is preventing the irreversible changes of a lower voice and facial hair.{{sfn|Cass review final report|2024|p=180}}

{{main|Transgender hormone therapy}}

The report said many unknowns remained for the use of hormone treatment among under-18s, despite longstanding use among transgender adults, with poor long-term follow-up data and outcome information on those starting younger. A systematic review evaluated 53 studies on transgender hormone therapy using a modified version of the Newcastle-Ottawa scale, and rated one study as high quality, 33 as moderate quality and 19 as low quality. Overall, the review found some evidence that hormone treatment improves psychological outcomes after 12 months, but found insufficient evidence regarding physical benefits and risks. The review said hormone therapy should be available from 16 years old, but that there should be a "clear clinical rationale" for the prescription of hormone therapy for anyone under 18.{{sfn|Cass review final report|2024|p=35}}{{cite news |url=https://www.theguardian.com/society/2024/apr/10/gender-medicine-built-on-shaky-foundations-cass-review-finds|title=Gender medicine 'built on shaky foundations', Cass review finds |work=The Guardian |first1=Andrew |last1=Gregory |first2=Nicola |last2=Davis |first3=Ian |last3=Sample |date=10 April 2024 |access-date=15 April 2024 |archive-date=2 August 2024 |archive-url=https://web.archive.org/web/20240802152514/https://www.theguardian.com/society/2024/apr/10/gender-medicine-built-on-shaky-foundations-cass-review-finds |url-status=live}}

A systematic review assessed ten studies on the efficacy of psychosocial support interventions in transgender minors using the Mixed Methods Appraisal Tool and rated one as medium quality, and nine as low quality. The review said that no robust conclusions can be made and more research is needed.{{sfn|Cass review final report|2024|p=153}}

The report said the evidence for psychosocial interventions was "as weak as research on endocrine treatment".{{sfn|Cass review final report|2024|p=196}} It recommended that psychosocial interventions also form part of a research programme, along with endocrine interventions.{{sfn|Cass review final report|2024|p=35}}

File:Cass-review-figure-34.png

The report said that clinicians cannot be certain which children and young people will have an enduring trans identity in adulthood, and that for most, a medical pathway will not be the most appropriate. When a medical pathway is clinically indicated, wider mental health or psychosocial issues should also be addressed. Due to a lack of follow-up, the number of individuals who detransitioned after hormone treatment was unknown.{{sfn|Cass review final report|2024}}

The Cass Review attempted to work with the Gender Identity Development Service and the NHS adult gender services to "fill some of the gaps in follow-up data for the approximately 9,000 young people who have been through GIDS to develop a stronger evidence base." However, despite encouragement from NHS England, "the necessary cooperation was not forthcoming."{{cite journal |last=Abbasi |first=Kamran |date=11 April 2024 |title=The Cass review: an opportunity to unite behind evidence informed care in gender medicine |url=https://www.bmj.com/content/385/bmj.q837 |journal=BMJ |volume=385 |pages=q837 |doi=10.1136/bmj.q837 |issn=1756-1833 |access-date=11 April 2024 |archive-date=11 April 2024 |archive-url=https://web.archive.org/web/20240411145134/https://www.bmj.com/content/385/bmj.q837 |url-status=live }}{{sfn|Cass review final report|2024|pp=190–191}}

File:Cass-review-table-6.png

A systematic review assessed 23 regional, national and international guidelines covering key areas of practice, such as care principles, assessment methods and medical interventions. The review said most guidelines lacked editorial independence and developmental rigour, and were nearly all influenced by the 2009 Endocrine Society guideline and the 2012 WPATH guideline, which were themselves closely linked. The Cass review questioned the guidelines' reliability, and concluded that no single international guideline regarding transgender care could be applied in its entirety to NHS England.{{sfn|Cass review final report|2024|pp=27–8, 132}}

The report said there were conflicting views among clinicians regarding appropriate treatment. It suggested that disputes over language such as "exploratory"{{efn|Defined as "Therapeutic approaches that acknowledge the young person's subjective gender experience, whilst also engaging in an open, curious, non-directive exploration of the meaning of a range of experiences that may connect to gender and broader self identity (Bonfatto &

Crasnow, 2018; Churcher Clarke & Spiliadis, 2019;

Di Ceglie, 2009; Spiliadis, 2019)."{{sfn|Cass review final report|2024|p=240}}}} and "affirmative"{{efn|Defined as "A model of gender healthcare that originated in the USA, which affirms a young person's subjective gender experience while remaining open to fluidity and changes over time (Chen et al., 2021; Ehrensaft et al., 2018; Hidalgo et al., 2013; Olson-Kennedy et al., 2019). This approach is used in some key child and adolescent clinics across the Western world."{{sfn|Cass review final report|2024|p=235}}}} approaches meant it was difficult to establish neutral terminology. Some clinicians avoided working with gender-questioning young people.{{sfn|Cass review final report|2024|p=20, 202}} The report said some professionals were concerned about being accused of conversion therapy, and were likewise concerned about the impact of legislation to ban conversion therapy.{{sfn|Cass review final report|2024|pp=150, 202}}{{cite news |title=Hilary Cass warns Kemi Badenoch over risks of conversion practices ban |url=https://www.theguardian.com/world/2024/apr/11/hilary-cass-warns-kemi-badenoch-over-risks-of-conversion-practices-ban |work=The Guardian |first1=Aletha |last1=Adu |first2=Amelia |last2=Gentleman |date=11 April 2024 |access-date=14 April 2024 |archive-date=3 July 2024 |archive-url=https://web.archive.org/web/20240703233057/https://amp.theguardian.com/world/2024/apr/11/hilary-cass-warns-kemi-badenoch-over-risks-of-conversion-practices-ban |url-status=live}}

The report made 32 recommendations covering areas including assessment of children and young people, diagnosis, psychological interventions, social transition, improving the evidence base underpinning medical and non-medical interventions, puberty blockers and hormone treatments, service improvements, education and training, clinical pathways, detransition and private provision.{{sfn|Cass review final report|2024|pp=28–45}}

Recommendations included:

• Care provision:
• A designated medical practitioner who takes personal responsibility for the safety of children receiving care.{{sfn|Cass review final report|2024|p=28}}
• Individualised care plans, including mental health assessments and screening for neurodivergent conditions such as autism.{{sfn|Cass review final report|2024|p=29}}
• The use of standard psychological and pharmacological treatments for co-occurring and associated conditions like anxiety and depression.{{sfn|Cass review final report|2024|pp=30, 31}}
• That children and families considering social transition should be seen as soon as possible by a relevant clinical professional.{{sfn|Cass review final report|2024|p=32}}
• Longstanding gender dysphoria must be a prerequisite for medical transition, but is not the only criteria in deciding whether to allow a transition.{{sfn|Cass review final report|2024|p=35}}
• There should be a clear clinical rationale for the prescription of masculinising/feminising hormone therapy below the age of 18, and no masculinising/feminising hormone therapy below the age of 16.{{sfn|Cass review final report|2024|p=35}}
• Every case considered for medical transition must be discussed by a national multi-disciplinary team.{{sfn|Cass review final report|2024|p=35}}
• All minors should be offered fertility counselling and preservation prior to embarking upon a medical pathway.{{sfn|Cass review final report|2024|p=35}}
• A separate pathway should be established for the treatment of pre-pubertal children, who are ideally to be treated as early as possible.{{sfn|Cass review final report|2024|p=41}}
• Changing how the NHS provides care:
• The development of a regional network of centres, and continuity of care for 17–25 year olds.{{sfn|Cass review final report|2024|pp=210, 224–225}}{{cite news |last1=Newton |first1=Storm |title=Cass Review: What are the recommendations on child gender care? |url=https://www.independent.co.uk/news/health/cass-review-child-gender-care-recommendations-b2526172.html |work=The Independent |date=10 April 2024 |language=en |access-date=27 April 2024 |archive-date=23 April 2024 |archive-url=https://web.archive.org/web/20240423221833/https://www.independent.co.uk/news/health/cass-review-child-gender-care-recommendations-b2526172.html |url-status=live}}
• The DHSC should direct NHS gender clinics to participate in the data linkage study, with the resulting research being overseen by NHS England's Research Oversight Board.{{sfn|Cass review final report|2024|p=34}}
• A multi-site service network should be developed as soon as possible, and the National Provider Collaborative to oversee the multi-disciplinary team should be established without delay.{{sfn|Cass review final report|2024|p=37}}
• To increase the available workforce, joint contracts should be used for health providers across a wide array of NHS services; and requirements for gender services should be built into the workforce planning for adolescent health services.{{sfn|Cass review final report|2024|p=38}}
• NHS England should develop a formal training program and competency framework for gender services, including a module on the holistic mental assessment framework.{{sfn|Cass review final report|2024|p=39}}
• Similar changes should be considered for adult gender services over the age of 25.{{sfn|Cass review final report|2024|p=42}}
• NHS England should "ensure there is provision for people considering detransition", which may require separate services.{{sfn|Cass review final report|2024|p=43}}
• The DHSC and NHS England should consider the implications of private healthcare on any future requests by patients for treatment under the NHS.{{sfn|Cass review final report|2024|p=44}}
• The DHSC should work to define the dispensing responsibilities of pharmacists receiving private prescriptions, and work to halt the sourcing of transition medication obtained through prescriptions acquired in Europe.{{sfn|Cass review final report|2024|p=44}}
• Future research:
• The establishment of a full program of research which will carefully study the characteristics, interventions, and outcomes of every person seen by NHS gender services.{{sfn|Cass review final report|2024|p=35}}
• A central evidence and data resource for gender services should be established, with specifically defined datasets for both local and national services.{{sfn|Cass review final report|2024|p=39}}
• National infrastructure should be put in place to manage continual data collection on gender services, including through the ages of 17 to 25.{{sfn|Cass review final report|2024|p=39}}{{sfn|Cass review final report|2024|p=42}}
• A unified research strategy shall be established to ensure the most meaningful data and numbers are collected.{{sfn|Cass review final report|2024|p=40}}
• A living systematic review over all of this research should be collected.{{sfn|Cass review final report|2024|p=41}}
• The NHS should establish requirements for the collection of data from patients of NHS gender services.{{sfn|Cass review final report|2024|p=45}}

NHS England responded positively to the interim and final reports. {{as of|April 2024}} they have implemented a number of measures. In response to the interim report, in March 2024 NHS England announced that it would no longer prescribe puberty blockers to minors outside of use in clinical research trials, citing insufficient evidence of safety or clinical effectiveness.{{Cite news |date=12 March 2024 |title=NHS England to stop prescribing puberty blockers |url=https://www.bbc.co.uk/news/health-68549091 |url-status=live |archive-url=https://archive.today/20240313005559/https://www.bbc.com/news/health-68549091 |archive-date=13 March 2024 |access-date=20 August 2024 |work=BBC News |language=en-GB}}{{Cite news |last=John |first=Tara |date=13 March 2024 |title=England's health service to stop prescribing puberty blockers to transgender kids |url=https://www.cnn.com/2024/03/13/uk/england-nhs-puberty-blockers-trans-children-intl-gbr/index.html |url-status=live |archive-url=https://web.archive.org/web/20240316040825/https://amp.cnn.com/cnn/2024/03/13/uk/england-nhs-puberty-blockers-trans-children-intl-gbr/index.html |archive-date=16 March 2024 |access-date=20 August 2024 |work=CNN |language=en}} GIDS closed in March 2024, being replaced by the new NHS Children and Young People's Gender Services.{{cite web |date=7 August 2024 |title=Children and young people's gender services: implementing the Cass Review recommendations |url=https://www.england.nhs.uk/long-read/children-and-young-peoples-gender-services-implementing-the-cass-review-recommendations |url-status=live |archive-url=https://archive.today/20240808090232/https://www.england.nhs.uk/long-read/children-and-young-peoples-gender-services-implementing-the-cass-review-recommendations/ |archive-date=8 August 2024 |access-date=3 January 2025 |website=NHS England |language=en}}{{cite news |last1=Bowers |first1=Shauna |date=29 April 2024 |title=What now for transgender healthcare in Ireland after publication of the Cass review? |url=https://www.irishtimes.com/health/2024/04/29/what-now-for-transgender-healthcare-in-ireland-after-publication-of-the-cass-review/ |url-status=live |archive-url=https://archive.today/20240429052858/https://www.irishtimes.com/health/2024/04/29/what-now-for-transgender-healthcare-in-ireland-after-publication-of-the-cass-review/ |archive-date=29 April 2024 |access-date=3 January 2025 |newspaper=The Irish Times |language=en}}{{cite news |date=28 July 2024 |title=What to do if your child wants to transition |url=https://www.telegraph.co.uk/health-fitness/parenting/children/what-to-do-if-your-child-wants-to-transition/ |url-status=live |archive-url=https://archive.today/20240728170715/https://www.telegraph.co.uk/health-fitness/parenting/children/what-to-do-if-your-child-wants-to-transition/ |archive-date=28 July 2024 |access-date=3 January 2025 |work=The Daily Telegraph |language=en |quote=A first step for a parent would be to approach the child’s GP, who can refer them to the NHS Children and Young People’s Gender Services, where they will be seen by psychologists, psychotherapists and social workers, she says.}} Two new services, located in the north-west of England and in London, opened in April 2024, and are intended to be the first of up to eight regional services. These will follow a new service specification for the "assessment, diagnosis and treatment of children and young people presenting with gender incongruence". Puberty suppressing hormones are no longer routinely available in NHS youth gender services. New patients that have been assessed as possibly benefiting from them will be required to participate in a clinical trial that is being set up by the National Institute for Health and Care Research.{{cite web |title=Final report – FAQs – Cass Review |url=https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/ |url-status=live |archive-url=https://web.archive.org/web/20240428180330/https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/ |archive-date=28 April 2024 |access-date=28 April 2024 |website=cass.independent-review.uk |language=en}} A new board, chaired by Simon Wessely will encourage further research in the areas highlighted in the review as having a weak evidence base.

On August 7, 2024, NHS England announced a status update for young people being considered for referral to specialist gender services, including the publication of a new pathway specification.{{Cite web |date=7 August 2024 |title=NHS England » Referral pathway for specialist service for children and young people with gender incongruence |url=https://www.england.nhs.uk/publication/referral-pathway-for-specialist-service-for-children-and-young-people-with-gender-incongruence/ |url-status=live |archive-url=https://web.archive.org/web/20240808175855/https://www.england.nhs.uk/publication/referral-pathway-for-specialist-service-for-children-and-young-people-with-gender-incongruence/ |archive-date=8 August 2024 |access-date=11 August 2024 |website=NHS England}} Referrals will only be accepted from an NHS-commissioned paediatric or children's mental health service instead of general practitioners and other professionals,{{Cite web |last=Colivicchi |first=Anna |date=2024-08-08 |title=GPs to no longer refer directly into children gender services |url=https://www.pulsetoday.co.uk/news/clinical-areas/paediatrics/gps-to-no-longer-refer-directly-into-children-gender-services/ |access-date=2025-04-09 |website=Pulse Today |language=en-gb}}{{Cite web |last=Spencer |first=Ben |date=2025-04-05 |title=NHS swaps gender drugs for 'holistic' care |url=https://www.thetimes.com/uk/healthcare/article/nhs-swaps-gender-drugs-for-holistic-care-jxhm3b6vk |access-date=2025-04-06 |website=www.thetimes.com |language=en}} and those considering social transition should be seen quickly by a clinical professional with relevant experience. NHS England will also "explore the issues around a detransition pathway by October 2024".{{Cite news |last=Searles |first=Michael |date=7 August 2024 |title=NHS to launch first service for trans patients wanting to return to birth gender |url=https://www.telegraph.co.uk/news/2024/08/07/trans-first-service-detransition-cass-review-birth-gender/ |url-status=live |archive-url=https://web.archive.org/web/20240816021159/https://www.telegraph.co.uk/news/2024/08/07/trans-first-service-detransition-cass-review-birth-gender/ |archive-date=16 August 2024 |access-date=16 August 2024 |work=The Daily Telegraph |language=en-GB |issn=0307-1235}}

In April 2025, James Palmer, NHS England's national medical director for specialised services, said the NHS had not issued any new prescriptions of gender affirming hormones to minors in the year since the report's publication, even though they have not been banned, with the NHS instead prioritising "holistic care". Palmer said these new services only have 30 referrals per month, compared to 5,000 per year at GIDS. One paediatric mental health expert said this was due to the increased complexity of the new referral process and families seeking treatment elsewhere — such as by acquiring hormones on the black market or abroad.

The clinical trial on puberty blockers for children and young people, due to start late 2024, has now been delayed.

Conservative Prime Minister at the time Rishi Sunak said that the findings "shine a spotlight" on the need for a cautious approach to child and adolescent gender care.{{cite news |title=PM urges 'extreme caution' on gender treatments – as major review finds NHS failed children |url=https://news.sky.com/story/cass-report-pm-urges-extreme-caution-on-gender-treatments-as-nhs-plans-major-review-of-clinics-13111445 |url-status=live |archive-url=https://web.archive.org/web/20240414211015/https://news.sky.com/story/cass-report-pm-urges-extreme-caution-on-gender-treatments-as-nhs-plans-major-review-of-clinics-13111445 |archive-date=14 April 2024 |access-date=15 April 2024 |work=Sky News |type=News}}{{cite news |date=11 April 2024 |title=Cass review: Health secretary criticises gender care 'culture of secrecy' |url=https://www.bbc.co.uk/news/uk-68786030 |url-status=live |archive-url=https://archive.today/20240411110756/https://www.bbc.com/news/uk-68786030 |archive-date=11 April 2024 |access-date=17 April 2024 |work=BBC News |language=en |type=News}} In their manifesto for the 2024 United Kingdom general election, the Conservatives promised to implement the Cass Review recommendations.{{cite web |last1=McKay |first1=Lucy Brisbane |title=Explainer: what do the UK party manifestos say about trans+ issues? |url=https://www.thebureauinvestigates.com/stories/2024-07-02/explainer-what-do-the-uk-party-manifestos-say-about-trans-issues/ |website=The Bureau of Investigative Journalism |access-date=20 October 2024 |date=2 July 2024}}

Wes Streeting, the Labour shadow Health Secretary at the time, welcomed the final report, saying it was "a watershed moment for the NHS's gender identity services". Both Streeting and then Shadow Home Secretary Yvette Cooper said Labour would implement the report's recommendations in full.{{bulleted list|

| {{cite news |last=Crerar |first=Pippa |date=12 April 2024 |title=Cass review must be used as 'watershed moment' for NHS gender services, says Streeting |url=https://www.theguardian.com/society/2024/apr/12/cass-review-watershed-moment-nhs-gender-services-wes-streeting-young-trans-people |url-status=live |archive-url=https://web.archive.org/web/20240703233058/https://www.theguardian.com/society/2024/apr/12/cass-review-watershed-moment-nhs-gender-services-wes-streeting-young-trans-people |archive-date=3 July 2024 |access-date=15 April 2024 |work=The Guardian |type=News |issn=0261-3077}}

| {{harvnb|Campbell|Gentleman|Vinter|2024}}

| {{cite news |last=Paul |first=Mark |date=10 April 2024 |title=British Labour says it will implement Cass findings on care for trans children if it wins election |url=https://www.irishtimes.com/world/europe/2024/04/10/british-labour-says-it-will-implement-cass-findings-on-care-for-trans-children-if-it-wins-election/ |url-status=live |archive-url=https://web.archive.org/web/20240415213307/https://www.irishtimes.com/world/europe/2024/04/10/british-labour-says-it-will-implement-cass-findings-on-care-for-trans-children-if-it-wins-election/ |archive-date=15 April 2024 |access-date=16 April 2024 |newspaper=The Irish Times |type=News}}

| {{cite news |date=10 April 2024 |title='How could we be giving kids puberty blockers for 20 years?' – Labour on Cass report |url=https://news.sky.com/video/how-could-we-be-giving-kids-puberty-blockers-for-20-years-labour-on-cass-report-13112037 |url-status=live |archive-url=https://web.archive.org/web/20240410093738/https://news.sky.com/video/how-could-we-be-giving-kids-puberty-blockers-for-20-years-labour-on-cass-report-13112037 |archive-date=10 April 2024 |access-date=10 April 2024 |work=Sky News |type=News}}

}} In its statement, LGBT+ Labour urged their party to "exercise caution in responding to the review", saying that while it got things right, it had "received credible criticism from trans advocacy groups and researchers".{{Cite news |last1=Naylor |first1=Dylan |last2=Parker |first2=Willow |date=16 May 2024 |title=Cass report: Here's why politicians should not treat it as gospel |url=https://www.lgbtlabour.org.uk/cass_report_here_s_why_politicians_should_not_treat_it_as_gospel |access-date=1 January 2025 |publisher=LGBT+ Labour |language=en |archive-url=https://web.archive.org/web/20250101233957/https://www.lgbtlabour.org.uk/cass_report_here_s_why_politicians_should_not_treat_it_as_gospel |archive-date=1 January 2025}}

In April 2024, the Green Party of England and Wales released a statement on the review. This was withdrawn an hour later, after the LGBTIQA+ Greens threatened to remove support for their party's leaders. The withdrawal was criticised by gender-critical members.{{Cite news |last=Church |first=Sophie |date=14 June 2024 |title=Green Party Withdrew Statement on Cass Review After LGBTIQA+ Greens Threatened To Remove Support For Leaders |url=https://www.politicshome.com/news/article/green-party-withdrew-statement-cass-review |access-date=1 January 2025 |language=en |archive-url=https://web.archive.org/web/20250114113632/https://www.politicshome.com/news/article/green-party-withdrew-statement-cass-review |archive-date=14 January 2025}}

The Equality and Human Rights Commission, a non-departmental public body, described the Cass Review as a "vital milestone" and called for all service providers to fully implement its recommendations.{{Cite web |title=Statement on the final report of the Cass Review |url=https://www.equalityhumanrights.com/statement-final-report-cass-review |url-status=live |archive-url=https://web.archive.org/web/20240417145101/https://www.equalityhumanrights.com/statement-final-report-cass-review |archive-date=17 April 2024 |access-date=17 April 2024 |website= |publisher=Equality and Human Rights Commission |type=Press release}}

The Scottish Government said it would "take the time to consider the findings" of the review.{{cite news |last1=Paton |first1=Craig |date=10 April 2024 |title=Scottish Government pledges to consider findings of Cass Review into gender |url=https://www.independent.co.uk/news/uk/scottish-government-government-nhs-england-snp-scottish-b2526273.html |url-status=live |archive-url=https://archive.today/20240417141127/https://www.independent.co.uk/news/uk/scottish-government-government-nhs-england-snp-scottish-b2526273.html |archive-date=17 April 2024 |access-date=17 April 2024 |work=The Independent |language=en |type=News}} Humza Yousaf, First Minister of Scotland and Scottish National Party (SNP) leader at the time, said the review would be given "utmost consideration", that "all recommendations" made by it would be considered, and that decisions on changes to treatments as a result of the review would be made by clinicians rather than politicians.{{cite web |last=Brooks |first=Libby |date=16 April 2024 |title=No case for closing Scotland's only NHS gender service clinic, says first minister |url=https://www.theguardian.com/society/2024/apr/16/no-case-to-close-scotlands-only-nhs-gender-services-clinic-says-first-minister-humza-yousaf |url-status=live |archive-url=https://web.archive.org/web/20240703233059/https://www.theguardian.com/society/2024/apr/16/no-case-to-close-scotlands-only-nhs-gender-services-clinic-says-first-minister-humza-yousaf |archive-date=3 July 2024 |access-date=16 April 2024 |work=The Guardian |type=News}}{{cite web |last1=Walker |first1=James |title=Humza Yousaf responds to calls for children's puberty blocker ban in Scotland |url=https://www.thenational.scot/news/24255848.humza-yousaf-responds-calls-puberty-blocker-ban-scotland/ |website=The National |access-date=5 May 2024 |archive-url=https://archive.today/20240418105940/https://www.thenational.scot/news/24255848.humza-yousaf-responds-calls-puberty-blocker-ban-scotland/ |archive-date=18 April 2024 |language=en |date=16 April 2024 |url-status=live}}

The Scottish Greens, then a part of the Scottish Government, criticised the review at its initial publication.{{Cite news |last=Geddes |first=Jonathan |date=5 July 2024 |title=Scottish government advised to halt puberty blockers |url=https://www.bbc.com/news/articles/cx02gkzz0z7o |work=BBC News |access-date=1 January 2025 |language=en-GB |archive-url=https://web.archive.org/web/20250214115249/https://www.bbc.com/news/articles/cx02gkzz0z7o |archive-date=14 February 2025}} Patrick Harvie, co-leader of the Scottish Greens, said he'd seen "far too many criticisms" of the review for him to say it was a "valid scientific document".{{cite news |last1=Andrews |first1=Kieran |title=Patrick Harvie will not accept Cass review on gender identity |url=https://www.thetimes.com/article/patrick-harvie-scottish-green-party-cass-review-gender-identity-5tm3hcznk |work=The Times |access-date=5 May 2024 |archive-url=https://archive.today/20240422165732/https://www.thetimes.co.uk/article/patrick-harvie-scottish-green-party-cass-review-gender-identity-5tm3hcznk |archive-date=22 April 2024 |language=en |date=5 May 2024 |url-status=live}}{{cite news |title=Green co-leader will quit if party ends power-sharing deal |url=https://www.bbc.co.uk/news/articles/cqvn3jnj1z5o |work=BBC News |access-date=5 May 2024 |archive-url=https://archive.today/20240505135512/https://www.bbc.com/news/articles/cqvn3jnj1z5o |archive-date=5 May 2024 |language=en |date=23 April 2024 |url-status=live}} Harvie's comments were controversial and widely critcised,{{cite news |last1=Bol |first1=David |title=Bute House Agreement: SNP figures pressure Humza Yousaf to rethink Bute House deal with Greens |url=https://www.scotsman.com/news/politics/bute-house-agreement-snp-figures-pressure-humza-yousaf-to-rethink-bute-house-deal-with-greens-4600847 |work=The Scotsman |access-date=5 May 2024 |archive-url=https://archive.today/20240423084643/https://www.scotsman.com/news/politics/bute-house-agreement-snp-figures-pressure-humza-yousaf-to-rethink-bute-house-deal-with-greens-4600847 |archive-date=23 April 2024 |language=en |date=23 April 2024 |url-status=live}}{{cite news |last1=Lyst |first1=Catherine |title=Patrick Harvie does not know if Greens will stay in government |url=https://www.bbc.co.uk/news/uk-scotland-scotland-business-68869020 |work=BBC News |access-date=5 May 2024 |archive-url=https://archive.today/20240505131113/https://www.bbc.com/news/uk-scotland-scotland-business-68869020 |archive-date=5 May 2024 |language=en |date=21 April 2024 |url-status=live}}{{cite magazine |last1=Deerin |first1=Chris |title=Humza Yousaf has turned on the Scottish Greens too late |url=https://www.newstatesman.com/politics/scotland/2024/04/humza-yousaf-has-turned-on-the-scottish-greens-too-late |magazine=New Statesman |access-date=5 May 2024 |archive-url=https://archive.today/20240425105427/https://www.newstatesman.com/politics/scotland/2024/04/humza-yousaf-has-turned-on-the-scottish-greens-too-late |archive-date=25 April 2024 |language=en |date=25 April 2024 |quote=Last weekend, Patrick Harvie refused to accept the findings of the Cass review into gender identity services for children, insisting that it had been "politicised and weaponised" against trans people. There was deep concern among senior Nats about the impact the deal was having on the SNP’s electoral prospects and the sense that the government’s priorities are woefully out of touch with middle Scotland. |url-status=live}} and the resulting tension with the SNP has been cited as a factor in the collapse of the Bute House Agreement.

The Welsh Senedd initially voted against a motion tabled by the Welsh Conservatives Shadow Social Justice Minister to accept the findings of the Cass Review in full. Subsequently, the Senedd voted unanimously to pass an amended motion noting "NHS England has concluded there is not enough evidence to support the safety or clinical effectiveness of puberty suppressing hormones for the treatment of gender dysphoria in children and young people" and "the Welsh Government will continue to develop the transgender guidance for schools taking account of the Cass review and stakeholder views".{{cite web |title=MSs vote against adopting recommendations of Cass Review |url=https://nation.cymru/news/mss-vote-against-recommendations-of-cass-review/ |website=nation.cymru |access-date=15 October 2024 |date=2 May 2024 |archive-url=https://web.archive.org/web/20241117061325/https://nation.cymru/news/mss-vote-against-recommendations-of-cass-review/ |archive-date=17 November 2024}}

Citing the Cass Review findings, in August 2024 the Northern Ireland Executive agreed to the extension of the ban on the private sale and supply of puberty blockers to Northern Ireland.{{cite web |title=Temporary ban on prescription and supply of puberty blockers extended to NI |url=https://www.health-ni.gov.uk/news/temporary-ban-prescription-and-supply-puberty-blockers-extended-ni |website=Department of Health |access-date=15 October 2024 |date=23 August 2024}} This was supported by all parties in the Executive at the time apart from the Alliance Party.{{cite web |last1=Manley |first1=John |title=Alliance isolated in Stormont executive as puberty blockers ban extended to Northern Ireland |url=https://www.irishnews.com/news/northern-ireland/alliance-isolated-in-stormont-executive-as-puberty-blockers-ban-extended-to-northern-ireland-NSA2O3E6L5FPRCGFACKIP5P53Y/ |website=The Irish News |access-date=15 October 2024 |date=23 August 2024 |archive-url=https://web.archive.org/web/20241006011119/https://www.irishnews.com/news/northern-ireland/alliance-isolated-in-stormont-executive-as-puberty-blockers-ban-extended-to-northern-ireland-NSA2O3E6L5FPRCGFACKIP5P53Y/ |archive-date=6 October 2024}}

In April 2024, the British Psychological Society (BPS) said they supported "the report's primary focus of expanding service capacity across the country" and acknowledged that "while psychological therapies will continue to have an incredibly important role to play in the new services, more needs to be done to assess the effectiveness of these psychological interventions." BPS president Roman Raczka said the review was "thorough and sensitive", and welcomed the recommendation for a consortium of relevant bodies to develop better trainings and upskill the workforce.{{cite web |last1=Stewart |first1=John |last2=Palmer |first2=James |date=10 April 2024 |title=BPS responds to final Cass Review report |url=https://www.bps.org.uk/news/bps-responds-final-cass-review-report |url-status=live |archive-url=https://web.archive.org/web/20240703233100/https://www.bps.org.uk/news/bps-responds-final-cass-review-report |archive-date=3 July 2024 |access-date=13 April 2024 |website=The British Psychological Society |type=Press release}} Rob Agnew, chair of the BPS's Sexualities Section, described it as "bad news for our trans youth" and said it was "out of step with better quality, more comprehensive reviews".{{Cite news |last=Barnes |first=Hannah |date=8 May 2024 |title=Hilary Cass: "Do I regret doing it? Absolutely not" |url=https://www.newstatesman.com/ns-interview/2024/05/hilary-cass-interview-review-transgender-identity-tavistock-puberty-blockers-do-i-regret-it |access-date=25 February 2025 |work=New Statesman |language=en-US |archive-url=https://web.archive.org/web/20250209120802/https://www.newstatesman.com/ns-interview/2024/05/hilary-cass-interview-review-transgender-identity-tavistock-puberty-blockers-do-i-regret-it |archive-date=9 February 2025}}

The Royal College of Psychiatrists (RCP) welcomed the report. They supported the emphasis on a holistic and person-centred approach and research to improve the evidence basis for treatment protocols. They said that some of its trans members, and the wider trans community, had concerns about availability of treatments while awaiting research, said there was "a strong view that the report makes assumptions in areas such as social transition and possible explanations for the increase in the numbers of people who have a trans or gender diverse identity, which contrasts with the more decisive statements about treatment approaches", and called for direct and comprehensive involvement of those with lived experience.{{sfn|Smith|2024}}

The Royal College of Paediatrics and Child Health (RCPCH) said they would take the time to review the recommendations in full and said that data collected had identified a lack of confidence by paediatricians and GPs to support this patient group, which the RCPCH pledged to address by developing new training.{{sfn|RCPCH|2024}} In August 2024, the RCPCH acknowledged there had been some academic criticism of the Cass Review and a call to pause the implementation of recommendations, but that "pausing the implementation of the Cass report recommendations would be a backwards step for Gender Identity Services, as this will again delay care and therefore risks causing further harm to this patient population". They stated they were engaged with NHS England and as a part of this would "encourage NHSE to consider emerging criticisms of any chosen approach, as would be the case in the delivery of any other children's health service."{{cite web |date=5 August 2024 |title=Calls to evaluate the Cass Review - RCPCH response |url=https://www.rcpch.ac.uk/resources/gender-identity-services-advocacy-children-young-people#calls-to-evaluate-the-cass-review---rcpch-response |url-status=live |archive-url=https://web.archive.org/web/20240524093311/https://www.rcpch.ac.uk/resources/gender-identity-services-advocacy-children-young-people#calls-to-evaluate-the-cass-review---rcpch-response |archive-date=24 May 2024 |access-date=8 August 2024 |website=RCPCH |language=en}}

In July 2024, the Royal College of General Practitioners updated its position statement on the role of the GP in transgender care in response to the Cass Review. They advise that, for patients under 18, GPs should not prescribe puberty blockers outside of clinical trials, and the prescription of gender-affirming hormones should be left to specialists. The GCGP says it will fully implement the Cass Review recommendations. They specifically highlight recommendations for continuity of care for 17–25 year olds, and the need for additional services for those people considering detransition.{{sfn|RCGP|2024}}

The same month Vassili Crispi, a member of the governing council of the British Medical Association (BMA) and member of its LGBTQ+ network, brought a motion calling for the BMA to initiate an evidence-based critique of the review's methodology and oppose the governments legislative approach. He later stated the Cass Review was commissioned, funded, and published "by an openly gender-critical government", representing a conflict of interest.{{Cite news |last=Baker |first=Sasha |date=2024-09-02 |title=Inside the fight against Britain's trans healthcare ban |url=https://www.dazeddigital.com/life-culture/article/64466/1/the-fight-against-britains-trans-healthcare-ban-cass-review-puberty-blockers |access-date=2025-03-24 |work=Dazed Digital |language=en}} The BMA, which represents 190,000 doctors, passed the motion calling for the organisation to "publicly critique" the Cass Review and oppose the implementation of its "unsubstantiated recommendations". After the motion was leaked to journalist Hannah Barnes, more than 1,500 doctors (including nearly 1,000 BMA members) signed an open letter to the BMA which criticised the council for "going against the principles of evidence-based medicine and against ethical practice".{{Cite news |last=Hayward |first=Eleanor |date=27 August 2024 |title=BMA members resign in revolt over transgender children stance |url=https://www.thetimes.com/uk/healthcare/article/bma-members-resign-in-revolt-over-transgender-children-stance-nvqd0vgv5 |access-date=27 August 2024 |work=The Times |language=en |archive-date=27 August 2024 |archive-url=https://web.archive.org/web/20240827154910/https://www.thetimes.com/uk/healthcare/article/bma-members-resign-in-revolt-over-transgender-children-stance-nvqd0vgv5 |url-status=live}}{{Cite journal |last=Thornton |first=Jacqui |date=14–20 September 2024 |title=BMA members oppose its stance on the Cass Review |url=https://linkinghub.elsevier.com/retrieve/pii/S0140673624019238 |journal=The Lancet |type=News |language=en |volume=404 |issue=10457 |pages=1004–1005 |doi=10.1016/S0140-6736(24)01923-8 |pmid=39278226 |access-date=23 September 2024 |archive-date=18 September 2024 |archive-url=https://web.archive.org/web/20240918000831/https://linkinghub.elsevier.com/retrieve/pii/S0140673624019238 |url-status=live}} In September 2024, the BMA council voted to instead maintain a neutral position on the issue until the completion of its own evaluation of the Cass Review.{{Cite news |date=27 September 2024 |title=BMA takes 'neutral position' on gender review |url=https://www.bbc.com/news/articles/c20pn0164ypo.amp |access-date=28 September 2024 |work=BBC News |language=en-gb |archive-date=28 September 2024 |archive-url=https://web.archive.org/web/20240928133202/https://www.bbc.com/news/articles/c20pn0164ypo.amp |url-status=live}}{{Cite web |last=Barnes |first=Hannah |date=27 September 2024 |title=The BMA turns away from rejecting the Cass Report |url=https://www.newstatesman.com/thestaggers/2024/09/the-bma-turns-away-from-rejecting-the-cass-report |access-date=28 September 2024 |magazine=New Statesman |language=en-US |archive-date=27 September 2024 |archive-url=https://web.archive.org/web/20240927123559/https://www.newstatesman.com/thestaggers/2024/09/the-bma-turns-away-from-rejecting-the-cass-report |url-status=live}}

The Academy of Medical Royal Colleges (AoMRC) released a statement in August 2024 in support of the report's recommendations, stating that "further speculative work risks greater polarisation", and that "our focus should be on implementing the recommendations of the Cass Review".

In April 2024, the British Association of Gender Identity Specialists (BAGIS) said it was "deeply troubled by some of the content of the Cass Review and the potential impact thereof". In December 2024, BAGIS also said it was "dismayed" to see the Department for Health and Social Care's "indefinite ban" on puberty blockers for under-18s, stating: "The Cass Review finds that puberty blockers have clearly defined benefits in narrow circumstances, which is inconsistent with a legislative ban".{{Cite web |title=Position & Process Statements: Initial BAGIS statement on the Cass Review |url=https://bagis.co.uk/position-process-statements/ |access-date=21 December 2024 |website=BAGIS |language=en-US |archive-url=https://web.archive.org/web/20250116111616/https://bagis.co.uk/position-process-statements/ |archive-date=16 January 2025}}

In July 2024, the UK's Association of LGBTQ+ Doctors and Dentists (GLADD) criticised the British Medical Journal's coverage of the Cass Review, stating that some recommendations could be beneficial while others could create new barriers to care for transgender youth. It also criticised "The weaponisation of the Cass review against trans people" by political parties and campaigners.{{Cite news |last=Fox |first=Dale |date=17 July 2024 |title=LGBTQ+ doctors' group GLADD challenges BMJ article on Cass review for trans healthcare |url=https://www.attitude.co.uk/news/gland-response-bmj-cass-review-469835/ |work=Attitude |access-date=2 January 2025 |language=en-GB |archive-url=https://web.archive.org/web/20250102002144/https://www.attitude.co.uk/news/gland-response-bmj-cass-review-469835/ |archive-date=2 January 2025}} In October, GLADD released an official response to the review, stating they were broadly supportive of its recommendations but were "concerned with what we believe to be an ingrained bias against the autonomy of trans people throughout the narrative text" which had also been noted by others. Of the 32 recommendations of the Cass Review, GLADD supported 15, and said that it could support a further 14 with provisos, could not support two, and was neutral on one. GLADD also said the Cass Review "may implicitly pathologise trans and non-binary identities" or "perpetuate stigmatisation of this population", including in its discussions of social transition, the suggestion that gendered toy preference is biologically deterministic, and the language used regarding masculinising/feminising hormones as a negative or undesirable outcome.{{Cite web |date=28 October 2024 |title=GLADD Response to the Cass Review |url=https://res.cloudinary.com/gladd/image/upload/v1730663301/GLADD_Response_to_the_Cass_Review_2024_xp8uoq.pdf |archive-url=https://web.archive.org/web/20250212195200/https://res.cloudinary.com/gladd/image/upload/v1730663301/GLADD_Response_to_the_Cass_Review_2024_xp8uoq.pdf |archive-date=12 February 2025 |website=The Association of LGBTQ+ Doctors and Dentists (GLADD)}}

In an interview given the week after the release of the final report, Cass described receiving abusive emails and said she was given security advice to avoid public transport.{{cite news |last1=Beal |first1=James |title=Hilary Cass: I can't travel on public transport after gender report |url=https://www.thetimes.com/article/hilary-cass-i-cant-travel-on-public-transport-any-more-35pt0mvnh |access-date=20 April 2024 |work=The Times |date=19 April 2024a |archive-date=20 April 2024 |archive-url=https://web.archive.org/web/20240420091742/https://www.thetimes.co.uk/article/hilary-cass-i-cant-travel-on-public-transport-any-more-35pt0mvnh |url-status=live}} She said that "disinformation" had frequently been spread online about the report. Cass said deliberate attempts "to undermine a report that has looked at the evidence of children's healthcare" were "unforgivable" and put children at risk. There were widespread misleading claims from critics of the report that it had dismissed 98% of the studies it collected and all studies which were not double-blind experiments.{{Cite web |date=20 May 2024 |title=It's misleading to say 100 studies were not included in the Cass Review |url=https://fullfact.org/health/cass-butler-stonewall-100-studies/ |access-date=13 December 2024 |website=Full Fact |language=en}} Cass described these claims as being "completely incorrect". Although only 2% of the papers collected were considered to be of high quality, 60% of the papers, including those considered to be of moderate quality, were considered in the report's evidence synthesis.{{cite news |last1=Mackintosh |first1=Thomas |date=20 April 2024 |title=Cass Review: Gender care report author attacks 'misinformation' |url=https://www.bbc.co.uk/news/health-68863594 |url-status=live |archive-url=https://archive.today/20240421024057/https://www.bbc.com/news/health-68863594 |archive-date=21 April 2024 |access-date=23 April 2024 |work=BBC News |language=en |type=News}}{{cite news |last1=Gecsoyler |first1=Sammy |title=Hilary Cass warned of threats to safety after 'vile' abuse over NHS gender services review |url=https://www.theguardian.com/society/2024/apr/20/doctor-hilary-cass-warned-of-threats-to-safety-after-vile-abuse-over-nhs-gender-services-review |work=The Guardian |access-date=23 April 2024 |archive-url=https://archive.today/20240421024954/https://www.theguardian.com/society/2024/apr/20/doctor-hilary-cass-warned-of-threats-to-safety-after-vile-abuse-over-nhs-gender-services-review |archive-date=21 April 2024 |language=en |date=20 April 2024 |url-status=live}}{{sfn|Beal|2024b}} Cass criticised Labour MP Dawn Butler for repeating inaccurate claims that the review had dismissed more than 100 studies during a debate in the House of Commons.{{cite news |last1=Vickers-Price |first1=Rachel |title=Hilary Cass says criticism of gender care review 'inaccurate' and 'unforgivable' |url=https://www.independent.co.uk/news/uk/dawn-butler-british-victoria-atkins-nhs-labour-b2531821.html |work=The Independent |access-date=28 April 2024 |archive-url=https://archive.today/20240428173851/https://www.independent.co.uk/news/uk/dawn-butler-british-victoria-atkins-nhs-labour-b2531821.html |archive-date=28 April 2024 |language=en |date=20 April 2024 |url-status=live}}{{cite news |title=Hilary Cass says criticism of gender care review 'inaccurate' and 'unforgivable' |url=https://www.itv.com/news/2024-04-20/hilary-cass-says-criticism-of-gender-care-review-inaccurate-and-unforgivable |work=ITV News |access-date=23 April 2024 |archive-url=https://archive.today/20240420091559/https://www.itv.com/news/2024-04-20/hilary-cass-says-criticism-of-gender-care-review-inaccurate-and-unforgivable |archive-date=20 April 2024 |language=en |date=20 April 2024 |url-status=live}}{{cite news |title=Cass Review: Gender report author cannot travel on public transport over safety fears |url=https://news.sky.com/story/cass-review-gender-report-author-cannot-travel-on-public-transport-over-safety-fears-13119107 |work=Sky News |access-date=23 April 2024 |archive-url=https://archive.today/20240423120726/https://news.sky.com/story/cass-review-gender-report-author-cannot-travel-on-public-transport-over-safety-fears-13119107 |archive-date=23 April 2024 |language=en |date=20 April 2024 |url-status=live}} After talking with Cass, Butler used a point of order to admit her mistake and correct the record in Parliament, stating the figure came from a briefing she had received from Stonewall.{{bulleted list|

| {{harvnb|Beal|2024b}}

| {{cite news |last1=Hansford |first1=Amelia |title=Labour MP says she 'inadvertently misled' parliament on Cass report |url=https://www.thepinknews.com/2024/04/24/dawn-butler-cass-report/ |access-date=25 April 2024 |work=Pink News |date=24 April 2024 |archive-date=24 April 2024 |archive-url=https://web.archive.org/web/20240424163611/https://www.thepinknews.com/2024/04/24/dawn-butler-cass-report/ |url-status=live}}

| {{cite web |title=Points of Order: Volume 748: debated on Monday 22 April 2024 |url=https://hansard.parliament.uk/commons/2024-04-22/debates/4E2D9E6C-065B-43B8-9578-3F24F2F3FFD6/PointsOfOrder#663 |website=Hansard |access-date=24 April 2024 |date=22 April 2024 |archive-date=24 April 2024 |archive-url=https://web.archive.org/web/20240424082354/https://hansard.parliament.uk/commons/2024-04-22/debates/4E2D9E6C-065B-43B8-9578-3F24F2F3FFD6/PointsOfOrder#663 |url-status=live}}

}}

In a May 2024 interview with The New York Times, Hilary Cass said:

{{blockquote|I think there is an appreciation that we are not about closing down health care for children. But there is fearfulness — about health care being shut down, and also about the report being weaponized to suggest that trans people don't exist. And that's really disappointing to me that that happens, because that's absolutely not what we're saying.}}

She also said that the review was not about defining what trans means or rolling back healthcare, stating: "There are young people who absolutely benefit from a medical pathway, and we need to make sure that those young people have access — under a research protocol, because we need to improve the research — but not assume that that's the right pathway for everyone."{{cite news |first=Azeen |last=Ghorayshi |date=13 May 2024 |title=Hilary Cass Says U.S. Doctors Are 'Out of Date' on Youth Gender Medicine |url=https://www.nytimes.com/2024/05/13/health/hilary-cass-transgender-youth-puberty-blockers.html |url-status=live |archive-url=https://web.archive.org/web/20240513160349/https://www.nytimes.com/2024/05/13/health/hilary-cass-transgender-youth-puberty-blockers.html |archive-date=13 May 2024 |access-date=13 May 2024 |work=The New York Times |language=en}}

In a May 2024 interview with WBUR-FM, Cass responded to WPATH's criticism about prioritising non-medical care, saying the review did not take a position about which is best. Cass hoped that "every young person who walks through the door should be included in some kind of proper research protocol" and for those "where there is a clear, clinical view" that the medical pathway is best will still receive that, and be followed up to eliminate the "black hole of not knowing what's best". Responding to claims that the review assumed a trans outcome was the worst outcome for a child, Cass emphasised that a medical pathway, with lifetime implications and treatment, required caution but "it's really important to say that a cis outcome and a trans outcome have equal value".{{cite web |date=8 May 2024 |title='The evidence was disappointingly poor': The full interview with Dr. Hilary Cass |url=https://www.wbur.org/onpoint/2024/05/08/nhs-hilary-cass-review-gender-transgender-care |url-status=live |archive-url=https://web.archive.org/web/20240516094220/https://www.wbur.org/onpoint/2024/05/08/nhs-hilary-cass-review-gender-transgender-care |archive-date=16 May 2024 |access-date=19 May 2024 |website=www.wbur.org |publisher=WBUR-FM |language=en}}

Professional organisations and transgender health providers have widely criticised the Review's findings.{{sfn|Xian|Dietz|Fabi|2025}}

The Endocrine Society responded to the report by reaffirming their support for gender-affirming care for minors and saying that their current policies supporting such treatments are "grounded in evidence and science".{{cite web |date=8 May 2024 |title=Cass Review' author: More 'caution' advised for gender-affirming care for youth |url=https://www.wbur.org/onpoint/2024/05/08/hilary-cass-review-caution-nhs-gender-affirming-care-youth |url-status=live |archive-url=https://web.archive.org/web/20240509000947/https://www.wbur.org/onpoint/2024/05/08/hilary-cass-review-caution-nhs-gender-affirming-care-youth |archive-date=9 May 2024 |access-date=9 May 2024 |website=WBUR-FM |type=News}} The Endocrine Society said the Review "does not contain any new research that would contradict the recommendations made in our Clinical Practice Guideline on gender-affirming care" and concluded "Banning evidence-based medical care based on misinformation takes away the ability of parents and patients to make informed decisions.".

The World Professional Association for Transgender Health (WPATH) released an email statement saying the report is "rooted in the false premise that non-medical alternatives to care will result in less adolescent distress" and further criticised recommendations which "severely restrict access to physical healthcare, and focus almost exclusively on mental healthcare for a population which the World Health Organization does not regard as inherently mentally ill".{{cite news |last1=Fiore |first1=Kristina |date=16 April 2024 |title=Cass Review Finds Weak Evidence for Puberty Blockers, Hormones in Youth Gender Care |url=https://www.medpagetoday.com/special-reports/transgender-medicine/109605 |url-status=live |archive-url=https://web.archive.org/web/20240427234410/https://www.medpagetoday.com/special-reports/transgender-medicine/109605 |archive-date=27 April 2024 |access-date=27 April 2024 |work=MedPage Today |type=News}}{{cite news |last=Riedel |first=Samantha |date=12 April 2024 |title=Advocates Say a Controversial U.K. Report on Healthcare for Trans Kids Is "Fundamentally Flawed" |url=https://www.them.us/story/cass-review-nhs-trans-youth-healthcare-report |url-status=live |archive-url=https://web.archive.org/web/20240414015225/https://www.them.us/story/cass-review-nhs-trans-youth-healthcare-report |archive-date=14 April 2024 |access-date=13 April 2024 |work=Them |type=News}} An official statement expanded on these concerns, saying Hilary Cass had "negligible prior knowledge or clinical experience" and that "the (research and consensus-based) evidence" suggests medical treatments such as puberty blockers and hormone therapy were "helpful and often life-saving". It questioned the provision of puberty blockers only in the context of a research protocol: "The use of a randomized blinded control group, which would lead to the highest quality of evidence, is ethically not feasible."{{cite web |title=WPATH and USPATH Comment on the Cass Review |url=https://www.wpath.org/media/cms/Documents/Public%20Policies/2024/17.05.24%20Response%20Cass%20Review%20FINAL.pdf |url-status=live |archive-url=https://web.archive.org/web/20240518073315/https://www.wpath.org/media/cms/Documents/Public%20Policies/2024/17.05.24%20Response%20Cass%20Review%20FINAL.pdf |archive-date=18 May 2024 |access-date=18 May 2024 |publisher=WPATH and USPATH |type=Press release}}

In 2022, WPATH, ASIAPATH, EPATH, PATHA, and USPATH, responding to the NHS policy changes arising from the Interim Report, had stated they "makes assumptions about transgender children and adolescents which are outdated and untrue" including "the supposition that gender incongruence is transient in pre-pubertal children", arguing it "quotes selectively and ignores newer evidence about the persistence of gender incongruence in children" in addition to noting issues with the older studies. They further said the statement "the primary intervention for children and young people... is psychosocial (including psychoeducation) and psychological support and intervention" was alarming. They said "this 'psychotherapeutic' approach, which was used for decades before being superseded by evidence-based gender-affirming care, has not been shown to be effective. Indeed, the denial of gender-affirming treatment under the guise of 'exploratory therapy' has caused enormous harm to the transgender and gender diverse community and is tantamount to 'conversion' or 'reparative' therapy under another name".

International transgender healthcare bodies, other international organisations,{{Cite report |url=https://rm.coe.int/prems-124824-gbr-2575-right-to-the-highest-attainable-standard-of-heal/1680b1ba4d |title=Right to the Highest Attainable Standard of Health and Access to Healthcare for LGBTI People in Europe |date=September 2024}}{{Cite news |last=Castle |first=Stephen |date=11 December 2024 |title=U.K. Bans Puberty Blockers for Teens Indefinitely |url=https://www.nytimes.com/2024/12/11/world/europe/uk-bans-puberty-blockers-under-18.html |access-date=28 January 2025 |work=The New York Times |language=en-US |issn=0362-4331}} researchers,{{Cite report |url=https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf |title=An Evidence-Based Critique of 'The Cass Review' on Gender-affirming Care for Adolescent Gender Dysphoria |date= |publisher=Integrity Project - Yale Law School}} and politicians{{Cite web |date=28 January 2025 |title=Puberty-suppressing Hormones - Hansard - UK Parliament |url=https://hansard.parliament.uk/Commons/2024-12-11/debates/03C1AD39-5B5E-4568-BFF3-FC6DB87575E6/Puberty-SuppressingHormones |access-date=28 January 2025 |website=hansard.parliament.uk |language=en}} have also criticised the recommendation that children and young people accessing puberty blockers should be required to sign up to a research trial.

The Royal Australian and New Zealand College of Psychiatrists rejected calls for an inquiry into trans healthcare following the release of the Cass Review, characterising it as one review among several in the field. They emphasised that, "assessment and treatment should be patient centred, evidence-informed and responsive to and supportive of the child or young person's needs and that psychiatrists have a responsibility to counter stigma and discrimination directed towards trans and gender diverse people."{{cite web |last=Moore |first=Elizabeth |date=29 May 2024 |title=A letter from members regarding the Cass Review and the College's response |url=https://www.ranzcp.org/news-analysis/a-letter-from-members-regarding-the-cass-review-and-the-college-s-response |url-status=live |archive-url=https://web.archive.org/web/20240703233109/https://www.ranzcp.org/news-analysis/a-letter-from-members-regarding-the-cass-review-and-the-college-s-response |archive-date=3 July 2024 |access-date=19 June 2024 |website=The Royal Australian and New Zealand College of Psychiatrists |type=Letter and reply}}

The Professional Association for Transgender Health Aotearoa (PATHA), a New Zealand professional organisation, said the Cass Review made "harmful recommendations" and was not in line with international consensus. It suggested that "Restricting access to social transition is restricting gender expression, a natural part of human diversity". It also said trans or non-binary people were not included in the Cass Review's planning and decision-making – including clinicians experienced with affirmative care – while several people involved in the review had "previously advocated for bans on gender-affirming care" in the U.S., and had "promoted non-affirming 'gender exploratory therapy', which is considered a conversion practice". PATHA criticised the exclusion of those with clinical and lived experience of gender-affirming care from "its decision-making, conclusions, or findings" and the exclusion of trans people from the review's Governance Assurance Group "on the basis of potential bias".{{sfn|PATHA|2024}}

A joint statement by Equality Australia, signed by the Australian Professional Association for Trans Health (AusPATH) and PATHA among others, said the review "downplays the risk of denying treatment to young people with gender dysphoria and limits their options by placing restrictions on their access to care".{{sfn|PATHA|2024}}{{cite web |date=10 April 2024 |title=Cass Review out-of-line with medical consensus and lacks relevance in Australian context |url=https://equalityaustralia.org.au/cass-review-out-of-line-with-medical-consensus-and-lacks-relevance-in-australian-context/ |url-status=live |archive-url=https://web.archive.org/web/20240410095637/https://equalityaustralia.org.au/cass-review-out-of-line-with-medical-consensus-and-lacks-relevance-in-australian-context/ |archive-date=10 April 2024 |access-date=11 April 2024 |website=Equality Australia |type=Press release}}{{cite news |last1=Deor |first1=Antimony |date=14 April 2024 |title=How Will The Cass Review Affect Aussie Trans Youth? |url=https://www.starobserver.com.au/news/how-cass-review-affect-aussie-trans-youth/230011 |url-status=live |archive-url=https://web.archive.org/web/20240424001546/https://www.starobserver.com.au/news/how-cass-review-affect-aussie-trans-youth/230011 |archive-date=24 April 2024 |access-date=24 April 2024 |work=Star Observer |type=News}}

The Canadian Pediatric Society responded that "Current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within a wider view of the patient's mental and psychosocial health." Members of the Canadian Pediatric Society's Adolescent Health Committee stated "there are significant limitations, biases, and inaccuracies within the Review", that "the Review has been noted to include incorrect citations of evidence (6) and inaccurate, sometimes scientifically disproven speculations", and concluded "The Cass Review is a critique, authored by a single individual, presenting a perspective on current practices in a particular context, and it will inform care. It does not, however, purport to be 'the new international standard of care', and it should not be treated as such."{{sfn|Vandermorris et al.|2024|pp=415–416}}

In June 2024, the European Society for Child and Adolescent Psychiatry (ESCAP) issued a statement which referred to the Cass Review systematic reviews along with previous reviews conducted in the UK, Sweden, Finland and Germany which also found a lack of evidence for the safety or efficacy of puberty blockers and cross-sex hormones to treat minors with gender dysphoria. ESCAP stated that "there is an urgent need to apply widely endorsed clinical, scientific, and ethical standards to the care of children and adolescents with gender dysphoria", called for healthcare providers "not to promote experimental and unnecessarily invasive treatments with unproven psycho-social effects", and insisted on the importance of "respect for all kinds of different views and attitudes" in professional debate.{{cite journal |last1=Drobnič Radobuljac |first1=Maja |last2=Grošelj |first2=Urh |last3=Kaltiala |first3=Riittakerttu |last4=Drobnič Radobuljac |first4=Maja |last5=Vermeiren |first5=Robert |last6=Anagnostopoulos |first6=Dimitris |last7=Çuhadaroglu Çetin |first7=Füsun |last8=Crommen |first8=Sofie |last9=Eliez |first9=Stephan |last10=Kaltiala |first10=Riittakerttu |last11=Kravić |first11=Nermina |last12=Kotsis |first12=Konstantinos |last13=Fegert |first13=Jörg M. |last14=Anagnostopoulos |first14=Dimitris |last15=Danese |first15=Andrea |last16=Drobnič Radobuljac |first16=Maja |last17=Eliez |first17=Stephan |last18=Hillegers |first18=Manon |last19=Hoekstra |first19=Pieter J. |last20=Kiss |first20=Enikő |last21=Klauser |first21=Paul |last22=Kotsis |first22=Konstantinos |last23=Råberg Christensen |first23=Anne Marie |last24=Schröder |first24=Carmen |last25=Vermeiren |first25=Robert |last26=Crommen |first26=Sofie |last27=Kotsis |first27=Konstantinos |last28=Danese |first28=Andrea |last29=Hoekstra |first29=Pieter J. |last30=Fegert |first30=Jörg M. |title=ESCAP statement on the care for children and adolescents with gender dysphoria: an urgent need for safeguarding clinical, scientific, and ethical standards |journal=European Child & Adolescent Psychiatry |date=June 2024 |volume=33 |issue=6 |pages=2011–2016 |doi=10.1007/s00787-024-02440-8 |pmid=38678135 |url=https://www.sgkjpp.ch/fileadmin/SGKJPP/user_upload/documents/Radobuljac_ESCAPStatementGenderdysphoria_2024.pdf |access-date=29 March 2025 |quote="The NICE reviews and other independent reviews from UK, Sweden, Finland, and recently Germany (which updated the original NICE reviews by examining all studies published until August 2023) were consistently critical of the current evidence base. The reviews highlighted that research on treatment benefits and harms of gonadal suppression and cross-sex hormones for children and adolescents with gender dysphoria has significant conceptual and methodological flaws, that the evidence for the benefits of these treatments is very limited, and that adequate and meaningful long-term studies are lacking. The reviews, therefore, recommend extreme caution in using these interventions."}}

In September 2024, in reference to the NHS' planned implementation of this recommendation that puberty blockers be restricted to clinical trials, as well as a similar protocol in Sweden, a thematic report prepared by the Council of Europe Committee of Experts on Sexual Orientation, Gender Identity and Expression, and Sex Characteristics (ADI-SOGIESC) said: "There are ethical implications of only offering treatment to a small group of patients, potentially violating the fundamental ethical principles governing research ... as for many young people the only way to receive treatment is to participate in the trial, therefore calling into question whether consent can be constituted as free and informed in these situations".

In 2025 a collaboration of Germany, Austria, and Switzerland, led by the Association of the Scientific Medical Societies in Germany, produced new clinical practice guidelines on transgender healthcare which criticized the Cass Review's methodology, conclusions, and lack of transparency. The guidelines stated there are "no proven effective treatment alternative without body-modifying medical measures for a [person with] permanently persistent gender incongruence" and criticized the potentially harmful recommendation of psychotherapy for distress related to gender dysphoria as no studies in the review showed a reduction in dysphoria through psychotherapy. It further criticized the Cass Review's lack of involvement from medical professional societies, its "assurance group" being explicitly uninvolved in the development of recommendations, and the presence of an "advisory board" whose composition and contributions weren't documented. The guidelines stated: "If, in individual cases, the progressive pubertal maturation development creates a time pressure in which health damage would be expected due to longer waiting times to avert irreversible bodily changes (e.g. male voice change), access to child and adolescent psychiatric or psychotherapeutic clarification and medical treatment options should be granted as quickly as possible."{{Cite web |date=2025 |title=Geschlechtsinkongruenz und Geschlechtsdysphorie im Kindes- und Jugendalter – Diagnostik und Behandlung (S2k) |url=https://register.awmf.org/assets/guidelines/028-014l_S2k_Geschlechtsinkongruenz-Geschlechtsdysphorie-Kinder-Jugendliche-Diagnostik-Behandlung_2025-03.pdf |website=AWMF Online |pages=17}}{{sfn|Reed|2025}}

In August 2024, the {{ill|Japanese Society of Psychiatry and Neurology|ja|日本精神神経学会}} published updated guidelines on the treatment of gender dysphoria. The guidelines considered the Cass Review, describing it as specific to the unique situation in the UK, noted criticism of the Cass Review by other international organisations, and stated that the WPATH SOC8 considered more systematic reviews. The guidelines further said it is "self-evident" that, unless puberty is suppressed, development of sex characteristics are irreversible in AMAB individuals. The society stated they will continue to track and recommend prescriptions of puberty blockers in Japan to minors and expand to tracking discontinuations and switches to hormone therapy.{{Cite web |date=August 2024 |title=Seibetsu fu gō ni kansuru shindan to chiryō no gaidorain (dai 5-ban) |script-title=ja:性別不合に関する診断と治療のガイドライン (第 5 版) |trans-title=Guidelines for the diagnosis and treatment of gender dysphoria (5th ed.) |url=https://www.jspn.or.jp/uploads/uploads/files/activity/gid_guideline_no5.pdf |url-status=live |archive-url=https://web.archive.org/web/20241001004744/https://www.jspn.or.jp/uploads/uploads/files/activity/gid_guideline_no5.pdf |archive-date=1 October 2024 |access-date=29 September 2024 |website=The Japanese Society of Psychiatry and Neurology |pages=16–18 |language=ja}}{{Cite web |title=Seibetsu fu gō ni kansuru shindan to chiryō no gaidorain |script-title=ja:性別不合に関する診断と治療のガイドライン |trans-title=Guidelines for the diagnosis and treatment of gender dysphoria |url=https://www.jspn.or.jp/modules/advocacy/index.php?content_id=23 |url-status=live |archive-url=https://web.archive.org/web/20241001004731/https://www.jspn.or.jp/modules/advocacy/index.php?content_id=23 |archive-date=1 October 2024 |access-date=28 September 2024 |website={{ill|Japanese Society of Psychiatry and Neurology|ja|日本精神神経学会}} |language=ja}}

The Amsterdam University Medical Center said it agrees with the goals of reducing wait times and improving research, but disagrees that the research-base for puberty blockers is insufficient, stating that puberty blockers have been used in trans care for decades. It stated they did not consider it ethical to mandate youth who desire puberty blockers to be registered in research trials, that it was worrying that after closing GIDS youth seeking trans healthcare were deprived of care, and that it "regrets that this situation arose for patients in England."{{Cite web |date=18 April 2024 |title=Een reactie van Amsterdam UMC op de Cass review over transgenderzorg |url=https://www.amsterdamumc.org/nl/vandaag/een-reactie-van-amsterdam-umc-op-de-cass-review-over-transgenderzorg.htm |url-status=live |archive-url=https://web.archive.org/web/20240703233109/https://www.amsterdamumc.org/nl/vandaag/een-reactie-van-amsterdam-umc-op-de-cass-review-over-transgenderzorg.htm |archive-date=3 July 2024 |access-date=19 April 2024 |publisher=Amsterdam UMC |type=Press release}}

A Polish Framework guidelines for the process of caring for the health of adolescent transgender (T) and non-binary (NB) people experiencing gender dysphoria was released in 2024 which said the Cass Review "caused a stir in public opinion and immediate harsh criticism from the medical and patient communities worldwide" and criticised Cass being chosen for her lack of experience in trans healthcare. It stated "the common thread of many objections to the Cass report is the multifaceted downplaying of the importance of the voices of adolescents and their families, clinical practice, the scientific knowledge base, and national and global recommendations, while misleading the public that a complete lack of clinical experience in a given field is a guarantee of reliability."{{sfn|Gawlik-Starzyk et al.|2025|p=}}{{pn|date=March 2025}}

The American Academy of Pediatrics responded to the report by reaffirming its support for gender-affirming care for minors and saying that their current policies supporting such treatments are "grounded in evidence and science". The American Psychological Association stated they were studying the Cass report but "stand by" their position statement in support of gender-affirming care.{{Cite journal |last=Block |first=Jennifer |date=23 May 2024 |title=Gender medicine in the US: how the Cass review failed to land |url=https://www.bmj.com/content/385/bmj.q1141 |journal=BMJ |language=en |volume=385 |pages=q1141 |doi=10.1136/bmj.q1141 |pmid=38782450 |access-date=20 January 2025}}

In May 2025, the United States Department of Health and Human Services under Secretary Robert F. Kennedy Jr. and President Donald Trump released a report in compliance with an executive order forbidding the government from supporting gender transitions under 19.{{Cite web |date=2025-01-28 |title=Trump signs order to end federal support for gender transitions for people under 19 |url=https://www.pbs.org/newshour/politics/trump-signs-order-to-end-federal-support-for-gender-transitions-for-people-under-19 |access-date=2025-05-01 |website=PBS News |language=en-us}}{{Cite web |date=2025-05-01 |title=Trump's HHS urges therapy for transgender youth, departing from broader gender-affirming health care |url=https://www.pbs.org/newshour/health/trumps-hhs-urges-therapy-for-transgender-youth-departing-from-broader-gender-affirming-health-care |access-date=2025-05-01 |website=PBS News |language=en-us}} The report expressed support for the Cass Review and its findings, which it cited extensively, calling it the "most comprehensive" and "most influential" evaluation of youth gender affirming care to date.{{Cite web |last=Smyth |first=Chris |date=2025-05-01 |title=NHS puberty blocker trial is not ethical, US review says |url=https://www.thetimes.com/uk/healthcare/article/trump-us-gender-review-baroness-cass-52pwgdqhc |access-date=2025-05-01 |website=www.thetimes.com |language=en}}{{Cite web |title=Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices |url=https://opa.hhs.gov/sites/default/files/2025-05/gender-dysphoria-report.pdf |website=HHS.gov}}

Some academics in the UK agreed with the Cass Review's findings stating a lack of evidence;{{sfn|Campbell|Gentleman|Vinter|2024}}{{Cite news |last=Bell |first=David |date=26 April 2024 |title=The Cass review of gender identity services marks a return to reason and evidence – it must be defended |url=https://www.theguardian.com/commentisfree/2024/apr/26/cass-review-gender-identity-services-report |access-date=29 April 2024 |work=The Guardian |language=en-GB |issn=0261-3077 |archive-date=3 July 2024 |archive-url=https://web.archive.org/web/20240703233108/https://www.theguardian.com/commentisfree/2024/apr/26/cass-review-gender-identity-services-report |url-status=live}} others, both in the UK{{cite news |last=Vinter |first=Robyn |date=11 April 2024 |title=Trans children in England worse off now than four years ago, says psychologist |url=https://www.theguardian.com/society/2024/apr/11/trans-children-in-england-worse-off-now-than-four-years-ago-says-psychologist |access-date=14 April 2024 |work=The Guardian |issn=0261-3077 |archive-date=3 July 2024 |archive-url=https://web.archive.org/web/20240703233109/https://www.theguardian.com/society/2024/apr/11/trans-children-in-england-worse-off-now-than-four-years-ago-says-psychologist |url-status=live}} and internationally, disagreed with the report's methodology and findings.{{cite news |last=Johnson |first=Lisa |date=15 April 2024 |title=What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth |url=https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920 |url-status=live |archive-url=https://web.archive.org/web/20240416185549/https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920 |archive-date=16 April 2024 |access-date=17 April 2024 |work=CBC News |type=News}}{{cite news |title=Contentious UK gender medicine report prompts reflection, outrage in Australia |url=https://www.smh.com.au/lifestyle/health-and-wellness/contentious-uk-gender-medicine-report-prompts-reflection-outrage-in-australia-20240410-p5fivg.html |work=Sydney Morning Herald |access-date=11 April 2024 |archive-date=12 April 2024 |archive-url=https://web.archive.org/web/20240412024025/https://www.smh.com.au/lifestyle/health-and-wellness/contentious-uk-gender-medicine-report-prompts-reflection-outrage-in-australia-20240410-p5fivg.html |url-status=live}}{{cite news |author= |date=10 April 2024 |title=NZ Government won't say if it will follow UK's move to ban routine use of puberty blockers as treatment for trans youth |url=https://www.nzherald.co.nz/nz/nz-government-wont-say-if-it-will-follow-uks-move-to-ban-routine-use-of-puberty-blockers-as-treatment-for-trans-youth/XM4LR3XIVZF2JAKJU74OOELSOU/ |access-date=19 April 2024 |work=The New Zealand Herald |archive-date=19 April 2024 |archive-url=https://web.archive.org/web/20240419060004/https://www.nzherald.co.nz/nz/nz-government-wont-say-if-it-will-follow-uks-move-to-ban-routine-use-of-puberty-blockers-as-treatment-for-trans-youth/XM4LR3XIVZF2JAKJU74OOELSOU/ |url-status=live}}

Several scholars and organisations have criticised the Cass Review's conclusions and the evidence base used to support them.{{Cite web |last1=Horton |first1=Cal |last2=Pearce |first2=Ruth |title=The U.K.'s Cass Review Badly Fails Trans Children |url=https://www.scientificamerican.com/article/the-u-k-s-cass-review-badly-fails-trans-children/ |access-date=26 January 2025 |website=Scientific American |language=en}} Researchers Cal Horton and Ruth Pearce have said of the Cass Review, "its most controversial recommendations are based on prejudice rather than evidence". Cal Horton criticised the Interim Report and other documents for prioritising research on aetiology of trans identities, saying: "Research into the causation of trans identities has a pathologized history, running parallel to efforts to prevent or cure transness."{{sfn|Horton|2024}} Cal Horton also criticised the Interim Report's support of exploratory therapy.{{sfn|Horton|2024}}

Various scholars also criticised the emphasis on high and moderate quality evidence, saying that paediatric care often relies on low quality evidence in other areas; that in downgrading qualitative research, the patient voice was minimised; and that the highest quality evidence (such as from randomised controlled trials) may be difficult or unethical to obtain in this area.{{sfn|Xian|Dietz|Fabi|2025}}{{sfn|Horton|2024}}

Academics have critiqued claims in the Cass Review that the majority of those with gender dysphoria "desist", which is based on older studies using outdated definitions of gender dysphoria.{{sfn|Horton|2024}} Specific criticism surrounded the Cass Review's citation of research by Kenneth Zucker, who advocates methods of suppressing transgender identity in children.

Academics have also criticised unsupported claims that social transition and puberty blockers may "change the trajectory of psychosexual and gender identity development" and that youth who transition may lose the opportunity to experience adulthood as a gender they don't identify with.{{sfn|Xian|Dietz|Fabi|2025}}

In September 2024, the Journal of Adolescent Health, the peer-reviewed medical journal of the international Society for Adolescent Health and Medicine, published a paper describing other scholars' "lengthy and nuanced rebuttals to the Cass report". The paper says that Cass' conclusions generally focus on "limiting or minimizing medical gender-affirming care (GAC) for youth" and that she "minimizes the robust data and the potential negative impact of increasing barriers for an already disenfranchised group". The paper states that "GAC for youth is well supported by evidence" and that concerns about the evidence base and the need for more research "do not warrant removal of access to this important care". The paper further suggests that randomised controlled trials (RCT) would not be ethically feasible for young people experiencing gender dysphoria.{{Cite journal |last1=Budge |first1=Stephanie L. |last2=Abreu |first2=Roberto L. |last3=Flinn |first3=Ryan E. |last4=Donahue |first4=Kelly L. |last5=Estevez |first5=Rebekah |last6=Olezeski |first6=Christy L. |last7=Bernacki |first7=Jessica M. |last8=Barr |first8=Sebastian |last9=Bettergarcia |first9=Jay |last10=Sprott |first10=Richard A. |last11=Allen |first11=Brittany J. |date=28 September 2024 |title=Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth |url=https://linkinghub.elsevier.com/retrieve/pii/S1054139X24004397 |url-status=live |journal=Journal of Adolescent Health |volume=75 |issue=6 |pages=851–853 |doi=10.1016/j.jadohealth.2024.09.009 |pmid=39340502 |issn=1054-139X |archive-url=https://web.archive.org/web/20241002055611/https://linkinghub.elsevier.com/retrieve/pii/S1054139X24004397 |archive-date=2 October 2024 |access-date=6 October 2024}}

In November 2024, over 200 educational psychologists signed an open letter addressed to education secretary Bridget Phillipson. The letter expressed concerns about the "processes and findings of the Cass review" and the impact of the Cass Review on children and young people in education.{{Cite news |last=Perry |first=Sophie |date=12 November 2024 |title=Concerns over Cass Review raised by more than 200 educational psychologists |url=https://www.thepinknews.com/2024/11/12/educational-psychologists-open-letter-cass-review-trans/ |access-date=21 December 2024 |work=Pink News |language=en-US |archive-url=https://web.archive.org/web/20250115175831/https://www.thepinknews.com/2024/11/12/educational-psychologists-open-letter-cass-review-trans/ |archive-date=15 January 2025}} That same month, the healthcare division of the RAND Corporation (a US-based research institute), released its own systematic review into treatments for trans and gender expansive young people, in which it described several similarities and differences between its own approach and that of the Cass Review.{{Efn|According to the report: "The systematic reviews conducted for the Cass Review used similar methods to our work, with some variations—for example, the reviews were restricted to studies with participants age 18 and younger, excluded case studies and non-English studies, used different risk-of-bias assessment tools, excluded studies meeting less than 50 percent of bias assessment criteria from syntheses in the hormonal intervention reviews, and did not provide certainty-of-evidence ratings for outcomes (Taylor, Mitchell, Hall, Langton, et al., 2024; Taylor, Mitchell, Hall, Heathcote, et al., 2024)."{{sfn|Dopp|2024|pp=31–2}}}} The report rated the existing evidence base as having low and very low certainty, but also found the treatments to be low risk and with little evidence of side-effects, regret, or dissatisfaction.{{Efn|According to the report: "Our review found that the available evidence suggests low risks of harmful outcomes from gender-affirming interventions, such as regret, dissatisfaction, side effects, or complications. Potential harms, such as bone health and fertility effects of hormonal interventions, warrant ongoing clinical and research attention because of the very low certainty of evidence available, as well as limited evidence for adjunctive interventions that mitigate those harms (e.g., fertility preservation). Nevertheless, these interventions have not shown the serious risks of harm that would suggest the need for policies to restrict the interventions. The low regret rate—though again based on very low certainty of evidence—is consistent with a meta-analysis (Bustos et al., 2021), primarily of adult literature, that found that regret rates were under 2 percent for gender-affirming surgery (i.e., the most intensive TGE-affirming intervention). That finding continues to be replicated (e.g., Bruce et al., 2023). By comparison, a systematic review that explored a variety of other surgical procedures unrelated to gender dysphoria (Wilson, Ronnekleiv-Kelly, and Pawlik, 2017) found an average regret rate of 14 percent."{{sfn|Dopp|2024|pp=v—vi, 38}}}} It said the Cass Review was "highly comprehensive", but said its findings may have limited applicability outside the context of the NHS.{{Efn|According to the report: "As one example, the Cass Review did not include evidence for gender-affirming surgery because the National Health Service had already restricted that intervention to individuals age 18 or older. In contrast, we sought to provide evidence summaries that practice and policy decisionmakers could more broadly consider across diverse contexts."{{sfn|Dopp|2024|p=32}}}}

In July 2024, The Integrity Project at Yale Law School released a white paper which said the Cass Review had "serious flaws".{{cite news |last=Hunter |first=Ross |date=2 July 2024 |title=Cass Review contains 'serious flaws', according to Yale Law School |url=https://www.thenational.scot/news/24425388.cass-review-contains-serious-flaws-according-yale-law-school/ |access-date=3 July 2024 |work=The National |archive-date=2 July 2024 |archive-url=https://web.archive.org/web/20240702160738/https://www.thenational.scot/news/24425388.cass-review-contains-serious-flaws-according-yale-law-school/ |url-status=live}}{{cite news |last=Alfonseca |first=Kiara |date=9 July 2024 |title=New report critiques UK transgender youth care research study |url=https://abcnews.go.com/Health/yale-releases-report-critical-uk-transgender-youth-care/story?id=111639373 |url-status=live |work=ABC News |archive-url=https://web.archive.org/web/20240711230053/https://abcnews.go.com/Health/yale-releases-report-critical-uk-transgender-youth-care/story?id=111639373 |archive-date=11 July 2024 |access-date=13 July 2024}}{{Cite web |date=1 July 2024 |title=White Paper Addresses Key Issues in Legal Battles over Gender-Affirming Health Care {{!}} Yale Law School |url=https://law.yale.edu/yls-today/news/white-paper-addresses-key-issues-legal-battles-over-gender-affirming-health-care |access-date=9 August 2024 |website=law.yale.edu |language=en |archive-date=9 August 2024 |archive-url=https://web.archive.org/web/20240809123111/https://law.yale.edu/yls-today/news/white-paper-addresses-key-issues-legal-battles-over-gender-affirming-health-care |url-status=live}} The white paper, co-authored by a group of eight legal scholars and medical researchers, suggests that the Cass Review "levies unsupported assertions about gender identity, gender dysphoria, standard practices, and safety of gender-affirming medical treatments, and it repeats claims that have been disproved by sound evidence". It concluded that the review "is not an authoritative guideline or standard of care, nor is it an accurate restatement of the available medical evidence on the treatment of gender dysphoria."

The white paper criticised the review's recruitment for focus groups, which included individuals who were not clinicians and who had unclear expertise, and said that the review "is not an accurate restatement of the available medical evidence on the treatment of gender dysphoria". In reference to one question, where a third of respondents agreed with the statement "There is no such thing as a trans child", the authors write: "Denying the existence of transgender people of any age is an invalid professional viewpoint. The involvement of those with such extreme viewpoints is a deeply concerning move for a document that issues recommendations on clinical care."{{bulleted list||{{harvnb|Horton|2024}}|{{harvnb|Aaron|Konnoth|2025}}|{{harvnb|Xian|Dietz|Fabi|2025}}}} The Yale Integrity Project white paper suggested that what the Cass Review referred to as the "exponential change in referrals" to youth gender services was not actually exponential, and that the recorded growth could be the result of double counting data points. Further, the paper criticises the Cass Review for suggesting that "peer and socio-cultural influence" are driving the increase in referrals, a claim which originates from a single article that has been heavily corrected for numerous well-documented fatal flaws. The Cass Review also suggested that the provision of gender-affirming care appeared "rushed, careless, and common", though its data showed waiting times for assessment were over two years and only 27% of patients seen during the review were referred to endocrinology for consideration of medical intervention.{{sfn|Xian|Dietz|Fabi|2025}} The Yale Integrity Project also criticised the review's discussions of evidence quality, since it introduces the GRADE approach and uses its terminology but does not evaluate evidence using the GRADE framework, and "takes the unusual step of elevating its own assessment of evidence quality above the considerations that guideline developers value".

Amnesty International criticised "sensationalised coverage" of the review, stating it was "being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people".{{cite news |date=10 April 2024 |title=UK: Cass review on gender identity is being 'weaponised' by anti-trans groups |url=https://www.amnesty.org.uk/press-releases/uk-cass-review-gender-identity-being-weaponised-anti-trans-groups |url-status=live |archive-url=https://web.archive.org/web/20240412102118/https://www.amnesty.org.uk/press-releases/uk-cass-review-gender-identity-being-weaponised-anti-trans-groups |archive-date=12 April 2024 |access-date=11 April 2024 |work=Amnesty International |type=Press release}}{{cite news |last1=Alfonseca |first1=Kiara |date=11 April 2024 |title=What the trans care recommendations from the NHS England report mean |url=https://abcnews.go.com/Health/trans-care-recommendations-nhs-england-report/story?id=109081565 |url-status=live |archive-url=https://web.archive.org/web/20240423232304/https://abcnews.go.com/Health/trans-care-recommendations-nhs-england-report/story?id=109081565 |archive-date=23 April 2024 |access-date=24 April 2024 |work=ABC News |type=News}}

The International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA), international LGBTQ student organisation IGLYO, and Transgender Europe released a joint statement which criticised the Cass Review's "poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts", as well as the review's exclusion of service users and trans healthcare experts.{{Cite web |date=2 September 2024 |title=Joint statement: Trans children and young people in schools deserve safety and understanding |url=https://www.ilga-europe.org/news/trans-children-and-young-people-in-schools-deserve-safety-and-understanding/ |access-date=2 January 2025 |website=ILGA, Transgender Europe, and IGLYO |language=en-GB}} ILGA and Transgender Europe also raised concerns about "pathologizing approaches" and the use of language like "gender questioning" to refer to transgender youth.

Trans youth charity Mermaids and the LGBTQ+ charity Stonewall endorsed some of the report's recommendations, such as expanding service provisions with the new regional hubs, but raised concerns the review's recommendations may lead to barriers for transgender youth in accessing care.{{cite news |author= |date=11 April 2024 |title=How LGBTQIA+ charities are responding to the Cass review |url=https://www.gaytimes.co.uk/life/what-is-the-cass-review-final-recommendations/ |url-status=live |archive-url=https://web.archive.org/web/20240411182500/https://www.gaytimes.co.uk/life/what-is-the-cass-review-final-recommendations/ |archive-date=11 April 2024 |access-date=11 April 2024 |work=Gay Times |type=News}}

In October 2024, 100 LGBTQ+ organisations and activists signed a letter to Wes Streeting expressing a "deep lack of confidence" in the Review. Concerns included Cass's selection without consideration of other candidates, "secrecy" regarding the report's commissioning, and "explicit exclusion of any trans people from involvement in the Governance Assurance Group, on the basis of potential bias". It described the review as "an absurd spectacle" with extensively documented technical failings and said, "There is a real concern, therefore, that the review promotes an inherently flawed approach to determining the efficacy and safety of clinical support for trans healthcare".{{Cite news |last=Hansford |first=Amelia |date=18 October 2024 |title=LGBTQ+ experts criticise Cass Review in open letter to Wes Streeting |url=https://www.thepinknews.com/2024/10/18/open-letter-transactual-cass-review/ |access-date=2 January 2025 |language=en-US}}{{Cite web |date=5 October 2024 |title=Letter to Wes Streeting from TransActual and others re the Cass Review |url=https://transactual.org.uk/wp-content/uploads/Letter-to-Wes-Streeting-from-TransActual-and-others-re-the-Cass-Review-Oct-2024.pdf |website=TransActual}}

Trans advocates have criticised the Cass Review for its alleged connections with anti-trans activism.{{Cite news |last=Riedel |first=Samantha |date=12 April 2024 |title=Advocates Say a Controversial U.K. Report on Healthcare for Trans Kids Is "Fundamentally Flawed" |url=https://www.them.us/story/cass-review-nhs-trans-youth-healthcare-report |archive-url=https://web.archive.org/web/20250217191201/https://www.them.us/story/cass-review-nhs-trans-youth-healthcare-report |archive-date=17 February 2025 |access-date=28 January 2025 |language=en-US}}{{Cite web |last=Tannehill |first=Brynn |date=15 April 2024 |title=The Cass Review heralds how all trans medicine will die |url=https://www.losangelesblade.com/2024/04/15/the-cass-review-heralds-how-all-trans-medicine-will-die/ |archive-url=https://web.archive.org/web/20250201130604/https://www.losangelesblade.com/2024/04/15/the-cass-review-heralds-how-all-trans-medicine-will-die/ |archive-date=1 February 2025 |access-date=1 February 2025 |website=Los Angeles Blade |language=en-US}} LGBTQ advocates specifically criticised meetings between Cass, members of her team, and members of Florida governor Ron DeSantis' medical board, which restricted transgender healthcare in Florida.{{Cite web |last=Dazed |date=2 September 2024 |title=Inside the fight against Britain's trans healthcare ban |url=https://www.dazeddigital.com/life-culture/article/64466/1/the-fight-against-britains-trans-healthcare-ban-cass-review-puberty-blockers |archive-url=https://web.archive.org/web/20250206172346/https://www.dazeddigital.com/life-culture/article/64466/1/the-fight-against-britains-trans-healthcare-ban-cass-review-puberty-blockers |archive-date=6 February 2025 |access-date=28 January 2025 |website=Dazed |language=en}}{{Cite news |last=Lazine |first=Mira |date=13 May 2024 |title=Cass Review author says leading medical org only supports trans health care under "political duress" |url=https://www.lgbtqnation.com/2024/05/cass-review-author-says-leading-medical-org-only-supports-trans-health-care-under-political-duress/ |archive-url=https://web.archive.org/web/20250206172347/https://www.lgbtqnation.com/2024/05/cass-review-author-says-leading-medical-org-only-supports-trans-health-care-under-political-duress/ |archive-date=6 February 2025 |access-date=28 January 2025 |work=LGBTQ Nation |language=en}} Cass met with board member Patrick Hunter, a member of the Society for Evidence-Based Gender Medicine (SEGM) and Catholic Medical Association.{{Cite news |last1=Woods |first1=Mel |last2=Haug |first2=Oliver |date=12 April 2024 |title=Here's why the 'Cass Review' matters—even if you aren't in the U.K. |url=https://xtramagazine.com/health/trans-health/united-kingdom-cass-review-trans-health-264642 |archive-url=https://web.archive.org/web/20250210183614/https://xtramagazine.com/health/trans-health/united-kingdom-cass-review-trans-health-264642 |archive-date=10 February 2025 |access-date=28 January 2025 |work=Xtra Magazine |language=en-CA}}{{Cite news |last=Ring |first=Trudy |date=11 December 2024 |title=U.K. bans puberty blockers for trans youth indefinitely |url=https://www.advocate.com/news/uk-bans-puberty-blockers-indefinitel |archive-url=https://web.archive.org/web/20250128193854/https://www.advocate.com/news/uk-bans-puberty-blockers-indefinitel |archive-date=28 January 2025 |access-date=28 January 2025 |work=The Advocate |language=en}} Hunter and Cass exchanged materials and Cass was invited to present to the board.{{Cite news |last=Carnell |first=Henry |date=10 May 2024 |title=The UK's new study on gender affirming care misses the mark in so many ways |url=https://www.motherjones.com/politics/2024/05/cass-review-transgender-health-care-nhs-gender-affirming-care/ |archive-url=https://web.archive.org/web/20250128194010/https://www.motherjones.com/politics/2024/05/cass-review-transgender-health-care-nhs-gender-affirming-care/ |archive-date=28 January 2025 |access-date=28 January 2025 |work=Mother Jones |language=en-US}}{{Cite news |last=Riedel |first=Samantha |date=12 April 2024 |title=Advocates Say a Controversial U.K. Report on Healthcare for Trans Kids Is "Fundamentally Flawed" |url=https://www.them.us/story/cass-review-nhs-trans-youth-healthcare-report |archive-url=https://web.archive.org/web/20250217191201/https://www.them.us/story/cass-review-nhs-trans-youth-healthcare-report |archive-date=17 February 2025 |access-date=28 January 2025 |work=Them.us |language=en-US}}

In June 2024, the University and College Union's (UCU) national executive committee unanimously passed a motion criticising the review's methodology, sourcing and claims.{{efn|The motion said the review has "serious methodological flaws", "provides no evidence for the 'new approach' it recommends", and is based on "selective use of evidence and promotion of unevidenced claims".}} This was met with criticism from some academics and union members, who said the move "risks making the union appear anti-scientific".{{Cite news |last=Grove |first=Jack |date=3 July 2024 |title=Anger over UCU's 'anti-scientific' fight against Cass Review |url=https://www.timeshighereducation.com/news/anger-over-ucus-anti-scientific-fight-against-cass-review |access-date=6 January 2025 |work=Times Higher Education |language=en |archive-url=https://web.archive.org/web/20250114100235/https://www.timeshighereducation.com/news/anger-over-ucus-anti-scientific-fight-against-cass-review |archive-date=14 January 2025}} The UCU brought a version of the motion to the Trades Union Congress (TUC) LGBT+ conference, where it was carried without opposition.{{Cite news |last=Fitzmaurice |first=Matilda |date=29 July 2024 |title=British Trade Unions Oppose the Cass Report. Here's Why That Matters. |url=https://ucucommons.org/2024/07/29/british-trade-unions-oppose-the-cass-report-heres-why-that-matters/ |access-date=6 January 2025 |language=en-GB |archive-url=https://web.archive.org/web/20250117021720/https://ucucommons.org/2024/07/29/british-trade-unions-oppose-the-cass-report-heres-why-that-matters/ |archive-date=17 January 2025}}

{{see also|21st-century anti-trans movement in the United Kingdom}}

Gender-critical organisations including Sex Matters and Genspect welcomed the report. Stella O'Malley of Genspect said that if a conversion therapy ban were to criminalise any exploration into why a child identifies as trans, it "would ban the very therapy that Cass is saying should be prioritised".{{cite news |date=10 April 2024 |title=The Cass Review damns England's youth-gender services |url=https://www.economist.com/britain/2024/04/10/the-cass-review-damns-englands-youth-gender-services |url-status=live |archive-url=https://web.archive.org/web/20240416193327/https://www.economist.com/britain/2024/04/10/the-cass-review-damns-englands-youth-gender-services |archive-date=16 April 2024 |access-date=17 April 2024 |newspaper=The Economist |type=News}}{{Cite web |date=9 April 2024 |title=The Cass Review is a damning indictment of what the NHS has been doing to children |url=https://sex-matters.org/posts/schools-and-safeguarding/the-cass-review-is-a-damning-indictment-of-what-the-nhs-has-been-doing-to-children/ |access-date=8 October 2024 |website=Sex Matters |language=en-GB}}

In May 2024, then Health Secretary Victoria Atkins implemented an emergency three-month ban on the prescription of puberty blockers by medical providers outside of the NHS.{{efn|NHS England had already announced it would no longer prescribe puberty blockers to minors outside of clinical trials in March 2024.}} It went into effect on 3 June 2024 and was set to expire on 3 September 2024. The ban restricted their use to those already taking them, or within a clinical trial. In July, this ban was challenged by campaign groups TransActual and the Good Law Project who brought a legal case arguing the ban was unlawful.{{cite news |last1=Siddique |first1=Haroon |date=12 July 2024 |title=Puberty blockers ban motivated by ex-minister's personal view, UK court told |url=https://www.theguardian.com/world/article/2024/jul/12/ban-on-childrens-puberty-blockers-motivated-by-ex-health-secretarys-personal-view |url-status=live |archive-url=https://web.archive.org/web/20240802152520/https://www.theguardian.com/world/article/2024/jul/12/ban-on-childrens-puberty-blockers-motivated-by-ex-health-secretarys-personal-view |archive-date=2 August 2024 |access-date=15 July 2024 |work=The Guardian}} On 29 July 2024, the High Court of Justice ruled that the ban was lawful.{{Cite news |first=Jabed |last=Ahmed |date=29 July 2024 |title=Streeting pushes ahead with NHS puberty blockers trial following high court ruling |url=https://www.independent.co.uk/news/health/pubery-blocker-ban-high-court-ruling-lawful-b2587503.html |url-status=live |archive-url=https://web.archive.org/web/20240730192445/https://www.independent.co.uk/news/health/pubery-blocker-ban-high-court-ruling-lawful-b2587503.html |archive-date=30 July 2024 |access-date=30 July 2024 |work=The Independent |language=en}}{{Cite news |last=Siddique |first=Haroon |date=29 July 2024 |title=Puberty blockers ban imposed by Tory government is lawful, high court rules |url=https://www.theguardian.com/society/article/2024/jul/29/puberty-blockers-ban-tory-government-lawful-high-court-rules |url-status=live |archive-url=https://web.archive.org/web/20240802153019/https://www.theguardian.com/society/article/2024/jul/29/puberty-blockers-ban-tory-government-lawful-high-court-rules |archive-date=2 August 2024 |access-date=30 July 2024 |work=The Guardian |language=en-GB |issn=0261-3077}}

The Health Secretary Wes Streeting welcomed the decision as "evidence led", and said efforts were being made to set up a clinical trial to "establish the evidence on puberty blockers". Following the ruling, TransActual announced they would not appeal the decision due to limited funds and the unlikelihood of an appeal being heard before the ban expires.{{Cite news |date=1 August 2024 |title=TransActual will not appeal puberty blocker case |url=https://transactual.org.uk/blog/2024/08/01/transactual-will-not-appeal-puberty-blocker-case/ |url-status=live |archive-url=https://web.archive.org/web/20240816084612/https://transactual.org.uk/blog/2024/08/01/transactual-will-not-appeal-puberty-blocker-case/ |archive-date=16 August 2024 |access-date=16 August 2024 |work=TransActual}}

On 22 August 2024, the government extended the emergency ban until 26 November 2024. The ban was also extended to cover Northern Ireland, following agreement from the Northern Ireland Executive and came into effect on 27 August 2024.{{Cite web |date=22 August 2024 |title=The Medicines (Gonadotrophin-Releasing Hormone Analogues) (Emergency Prohibition) (Extension) Order 2024 |url=https://www.legislation.gov.uk/uksi/2024/868/article/1/made |url-status=live |archive-url=https://web.archive.org/web/20240824073125/https://www.legislation.gov.uk/uksi/2024/868/article/1/made |archive-date=24 August 2024 |access-date=24 August 2024 |website=UK Government}}{{Cite web |date=22 August 2024 |title=Puberty blockers temporary ban extended |url=https://www.gov.uk/government/news/puberty-blockers-temporary-ban-extended |url-status=live |archive-url=https://web.archive.org/web/20240824073125/https://www.gov.uk/government/news/puberty-blockers-temporary-ban-extended |archive-date=24 August 2024 |access-date=24 August 2024 |website=UK Government}}{{Cite news |date=23 August 2024 |title=Puberty blocker ban extended to Northern Ireland |url=https://www.bbc.com/news/articles/cwy3l8pnld9o |url-status=live |archive-url=https://web.archive.org/web/20240824073125/https://www.bbc.com/news/articles/cwy3l8pnld9o |archive-date=24 August 2024 |access-date=24 August 2024 |work=BBC News}} On 6 November 2024 the ban was extended again to 31 December 2024.{{Cite web |title=Extension to temporary ban on puberty blockers |url=https://www.gov.uk/government/news/extension-to-temporary-ban-on-puberty-blockers |access-date=9 November 2024 |website=GOV.UK |language=en}} On 11 December 2024, the ban was renewed indefinitely and is set to be reconsidered in 2027.{{Cite news |last=Gregory |first=Andrew |date=11 December 2024 |title=Puberty blockers to be banned indefinitely for under-18s across UK |url=https://www.theguardian.com/society/2024/dec/11/puberty-blockers-to-be-banned-indefinitely-for-under-18s-across-uk |access-date=11 December 2024 |work=The Guardian |language=en-GB |issn=0261-3077}}

In January 2025, the Commission on Human Medicines (CHM) delivered a report on the proposed permanent restriction of the use of puberty blockers for children and young people. The review stated that both "Baroness Cass and the independent CHM found that there is a lack of evidence for the efficacy of these medicines in the treatment of gender incongruence and/or gender dysphoria, and that there is currently an unsafe prescribing environment." The report recommended an indefinite ban until prescriptions could be deemed safe, with legislation to be reviewed in 2027. According to the report, the proposed ban was opposed by the Royal College of General Practitioners, the British Medical Association and the Royal College of Psychiatrists.{{Cite web |title=Commission on Human Medicines report into the safety implications of proposed puberty blockers legislation: factsheet |url=https://www.gov.uk/government/publications/chm-report-into-the-safety-implications-of-proposed-puberty-blockers-legislation-factsheet/commission-on-human-medicines-report-into-the-safety-implications-of-proposed-puberty-blockers-legislation-factsheet |access-date=25 January 2025 |website=GOV.UK |language=en}}{{Cite web |title=Commission on Human Medicines report on proposed permanent order to restrict the sale and supply of GnRH agonists in children and young people under 18 years of age for the purpose of puberty suppression in gender incongruence and/or gender dysphoria |url=https://www.gov.uk/government/publications/chms-report-on-proposed-changes-to-the-availability-of-puberty-blockers/commission-on-human-medicines-report-on-proposed-permanent-order-to-restrict-the-sale-and-supply-of-gnrh-agonists-in-children-and-young-people-under-1 |access-date=25 January 2025 |website=GOV.UK |language=en}}

The Cass Review did not cover adult care, but in April 2024, NHS England said it would also initiate a review of adult gender clinics.{{Cite news |last1=Searles |first1=Michael |last2=Donnelly |first2=Laura |last3=Martin |first3=Daniel |date=9 April 2024 |title=NHS to review all transgender treatment |url=https://www.telegraph.co.uk/news/2024/04/09/nhs-review-transgender-treatment/ |url-status=live |archive-url=https://web.archive.org/web/20240415202241/https://www.telegraph.co.uk/news/2024/04/09/nhs-review-transgender-treatment/ |archive-date=15 April 2024 |access-date=16 August 2024 |work=The Daily Telegraph |language=en-GB |issn=0307-1235}} NHS England National Director of Specialised Commissioning John Stewart sent a letter to Cass stating that it would review the use of transgender hormone therapy in adults in a similar manner as was done for puberty blockers in the Cass Review.{{cite web |last1=Campbell |first1=Denis |last2=Gentleman |first2=Amelia |date=10 April 2024 |title=Adult transgender clinics in England face inquiry into patient care |url=https://www.theguardian.com/society/2024/apr/10/adult-transgender-clinics-in-england-face-inquiry-into-patient-care |url-status=live |archive-url=https://archive.today/20240410192331/https://www.theguardian.com/society/2024/apr/10/adult-transgender-clinics-in-england-face-inquiry-into-patient-care |archive-date=10 April 2024 |access-date=17 April 2024 |website=The Guardian |language=en |type=News}}{{cite web |date=6 August 2024 |orig-date=10 April 2024 |title=NHS England's Response to the Final Report of the Independent Review of Gender Identity Services for Children and Young People |url=https://www.england.nhs.uk/long-read/nhs-englands-response-to-the-final-report-of-the-independent-review-of-gender-identity-services-for-children-and-young-people/ |url-status=live |archive-url=https://web.archive.org/web/20240410222633/https://www.england.nhs.uk/long-read/nhs-englands-response-to-the-final-report-of-the-independent-review-of-gender-identity-services-for-children-and-young-people/ |archive-date=10 April 2024 |access-date=15 April 2024 |website=NHS England |type=Letter}}{{cite news |last1=Searles |first1=Michael |last2=Donnelly |first2=Laura |last3=Martin |first3=Daniel |date=9 April 2024 |title=NHS to review all transgender treatment |url=https://www.telegraph.co.uk/news/2024/04/09/nhs-review-transgender-treatment/ |url-status=live |archive-url=https://web.archive.org/web/20240415202241/https://www.telegraph.co.uk/news/2024/04/09/nhs-review-transgender-treatment/ |archive-date=15 April 2024 |access-date=16 April 2024 |work=The Daily Telegraph |type=News}}

In May 2024, Cass wrote to NHS England to pass on the feedback regarding adult care from clinicians who had approached her during the review process. Clinicians across the country in adult gender services had expressed concern about both the clinical practice and model of care. Some clinicians in other settings, especially general practice, had raised concerns about the treatment of patients under their care.{{Cite web |last=Cass |first=Hilary |date=16 May 2024 |title=Independent Review of Gender Identity Services for Children and Young People – Adult Gender Dysphoria Clinics |url=https://www.england.nhs.uk/wp-content/uploads/2024/08/PRN01451-letter-from-dr-cass-to-john-stewart-james-palmer-may-2024.pdf |url-status=live |archive-url=https://web.archive.org/web/20240810194428/https://www.england.nhs.uk/wp-content/uploads/2024/08/PRN01451-letter-from-dr-cass-to-john-stewart-james-palmer-may-2024.pdf |archive-date=10 August 2024 |access-date=11 August 2024 |website=NHS England |ref=none}} On 7 August, NHS England included a response to the adult care letter in a status report for the under-18s services.{{Cite web |title=NHS England » NHS England update on work to transform gender identity services |url=https://www.england.nhs.uk/long-read/nhs-england-update-on-work-to-transform-gender-identity-services/ |url-status=live |archive-url=https://web.archive.org/web/20240808175855/https://www.england.nhs.uk/long-read/nhs-england-update-on-work-to-transform-gender-identity-services/ |archive-date=8 August 2024 |access-date=11 August 2024 |website=NHS England}}

On 8 August, they stated the review of adult services would be led by Dr. David Levy, medical director for Lancashire and South Cumbria integrated care board, to assess "the quality (i.e. effectiveness, safety, and patient experience) and stability of each service, but also whether the existing service model is still appropriate for the patients it is caring for"; and that Dr. Levy would work with a group of "expert clinicians, patients and other key stakeholders, including representatives from the CQC, Royal Colleges and other professional bodies and will carefully consider experiences, feedback and outcomes from clinicians and patients, past and present". The first onsite visits are planned to start in September 2024. The findings will be used to support an updated adult gender service specification which will then be liable to engagement and public consultation. Unlike the Cass Review, the review of adult gender services is expected to be completed within months, rather than years.{{Cite news |date=7 August 2024 |title=Review into safety of adult gender services to begin within weeks |url=https://www.independent.co.uk/news/uk/lancashire-nhs-b2592534.html |url-status=live |archive-url=https://web.archive.org/web/20240811092040/https://www.independent.co.uk/news/uk/lancashire-nhs-b2592534.html |archive-date=11 August 2024 |access-date=11 August 2024 |work=The Independent |language=en}}{{Cite news |last=Fox |first=Aine |date=7 August 2024 |title=Review into safety of adult gender services to begin within weeks |url=https://www.standard.co.uk/news/health/lancashire-nhs-b1175188.html |url-status=live |archive-url=https://web.archive.org/web/20240811092041/https://www.standard.co.uk/news/health/lancashire-nhs-b1175188.html |archive-date=11 August 2024 |access-date=11 August 2024 |work=Evening Standard |language=en}}

In December 2024, it was reported that a number of GPs had begun refusing or withdrawing hormone treatment from adult trans patients, for reasons including insufficient funds, the Cass Review, and the Royal College of GPs' response to the Cass Review – despite the Cass Review only applying to youth services.{{Cite news |first1=Billie Gay |last1=Jackson |first2=Holly |last2=Bancroft |date=7 December 2024 |title=GPs halting transgender patients' hormone treatment or refusing prescriptions |url=https://www.independent.co.uk/news/uk/home-news/gp-nhs-transgender-hormone-treatment-b2658721.html |access-date=8 December 2024 |work=The Independent |language=en |archive-url=https://web.archive.org/web/20250128050140/https://www.independent.co.uk/news/uk/home-news/gp-nhs-transgender-hormone-treatment-b2658721.html |archive-date=28 January 2025}}

On 18 April 2024, NHS Scotland announced that it had paused prescribing puberty blockers to children referred by its specialist gender clinic.{{Cite news |title=Scotland's under-18s gender clinic pauses puberty blockers |url=https://www.bbc.co.uk/news/uk-scotland-68844119.amp |url-status=live |archive-url=https://web.archive.org/web/20240703233059/https://www.bbc.co.uk/news/uk-scotland-68844119.amp |archive-date=3 July 2024 |access-date=19 April 2024 |work=BBC News |type=News}} The chief medical officer of Scotland set up a multidisciplinary clinical team to assess how the Cass Review's 32 recommendations might be applied to NHS Scotland. Their Cass Review – implications for Scotland: findings report was published in July 2024 and found that the majority of recommendations were applicable to NHS Scotland to a varying degree, with some modification dealing with differences in the Scottish health service. They recommended that the use of puberty blockers be paused until clinical trials are begun. NHS Scotland will participate in the forthcoming UK study.{{cite web |title=Improving gender identity healthcare |url=https://www.gov.scot/news/improving-gender-identity-healthcare/ |access-date=14 September 2024 |website=Scottish Government |language=en |archive-url=https://web.archive.org/web/20241217221522/https://www.gov.scot/news/improving-gender-identity-healthcare/ |archive-date=17 December 2024}} That report was fully accepted by the Scottish government in September. Among the changes recommended are that the gender identity service for children and young people should be moved to a paediatric setting and more than one service offered across the regions. In common with other specialities, a referral to these services will now have to come from a clinician.

In May 2024, the UK government released a draft of new Relationships, Sex and Health Education (RSHE) guidelines. The guidelines would ban lessons on the "contested theory of gender identity" and emphasised that any instruction on transgender people must focus on the legality of transitioning and the fact one has to be 18 to legally change their gender. A press release accompanying the guidelines stated that "In light of the Cass Review, it is important that schools take a cautious approach to teaching about this sensitive topic and do not use any materials that present contested views as fact, including the view that gender is a spectrum."{{Cite news |last=Riedel |first=Samantha |date=16 May 2024 |title=New Proposed Sex Ed Rules Ban the "Contested Topic" of Gender Identity in the U.K. |url=https://www.them.us/story/uk-gender-identity-schools-proposed-ban |work=Them.us |access-date=6 January 2025 |language=en-US |archive-url=https://web.archive.org/web/20250114134925/https://www.them.us/story/uk-gender-identity-schools-proposed-ban |archive-date=14 January 2025}}{{Cite news |last=Baboolal |first=Samara |date=17 May 2024 |title=UK government announces draft 'ban' on contested sex education topics in UK schools |url=https://www.jurist.org/news/2024/05/uk-government-announces-draft-ban-on-contested-sex-education-topics-in-uk-schools/ |work=Jurist |access-date=6 January 2025 |language=en-US |archive-url=https://web.archive.org/web/20250114192650/https://www.jurist.org/news/2024/05/uk-government-announces-draft-ban-on-contested-sex-education-topics-in-uk-schools/ |archive-date=14 January 2025}}

In January 2025, the government rejected a petition signed by over 11,000 people which called for an independent evaluation of the Cass Review. The petition said trans healthcare should be "based on unbiased research that is peer-reviewed" and a "transparent process" would ensure "children aren't being unduly harmed" and "guarantee fair access and treatment for trans children, as well as restore faith in the current NHS services". The government and NHS England wrote that they "do not support an independent evaluation of the Review" and are "fully committed to implementing all recommendations from the independent and evidence-based Cass Review".{{Cite news |last=Billson |first=Chantelle |date=15 January 2025 |title=Government rejects call for independent review of Cass Review |url=https://www.thepinknews.com/2025/01/15/government-rejects-call-for-independent-review-of-cass-review/ |work=Pink News |access-date=17 January 2025 |language=en-US |archive-url=https://web.archive.org/web/20250218223251/https://www.thepinknews.com/2025/01/15/government-rejects-call-for-independent-review-of-cass-review/ |archive-date=18 February 2025}}

• 21st-century anti-trans movement in the United Kingdom
• Bell v Tavistock
• Evidence-based medicine
• Time to Think
• Transgender health care
• Transgender rights in the United Kingdom
• Trump administration HHS gender dysphoria report
• LGBTQ rights in the United Kingdom
• Transgender history in the United Kingdom

{{notelist}}

{{reflist}}

{{refbegin}}

• {{Cite journal |last1=Aaron |first1=Daniel G. |last2=Konnoth |first2=Craig |date=15 January 2025 |title=The Future of Gender-Affirming Care — A Law and Policy Perspective on the Cass Review |url=http://www.nejm.org/doi/10.1056/NEJMp2413747 |journal=New England Journal of Medicine |volume=392 |issue=6 |pages=526–528 |language=en |doi=10.1056/NEJMp2413747 |pmid=39813640 |issn=0028-4793}}
• {{cite news |last1=Bannerman |first1=Lucy |last2=Beal |first2=James |last3=Hayward |first3=Eleanor |last4=Koronka |first4=Poppy |date=10 April 2024 |title=Nine key findings from the Cass review into gender transition |url=https://www.thetimes.com/article/cass-report-review-key-findings-nhs-gender-puberty-blockers-j09ggw09c |work=The Times |access-date=14 April 2024 |archive-date=14 April 2024 |archive-url=https://web.archive.org/web/20240414004539/https://www.thetimes.co.uk/article/cass-report-review-key-findings-nhs-gender-puberty-blockers-j09ggw09c |url-status=live}}
• {{cite news |last1=Beal |first1=James |date=23 April 2024b |title=Cass author condemns 'misinformation' spread by trans lawyer |url=https://www.thetimes.com/uk/article/cass-author-condemns-misinformation-spread-by-trans-lawyer-b5t9hd92m |work=The Times |access-date=23 April 2024 |archive-url=https://archive.today/20240422223249/https://www.thetimes.co.uk/article/cass-author-condemns-misinformation-spread-by-trans-lawyer-b5t9hd92m |archive-date=22 April 2024 |language=en |url-status=live}}
• {{cite news |last1=Campbell |first1=Denis |last2=Gentleman |first2=Amelia |last3=Vinter |first3=Robyn |date=10 April 2024 |title=Thousands of children unsure of gender identity 'let down by NHS', report finds |url=https://www.theguardian.com/society/2024/apr/10/thousands-of-children-unsure-of-gender-identity-let-down-by-nhs-report-finds |url-status=live |archive-url=https://web.archive.org/web/20240703233058/https://www.theguardian.com/society/2024/apr/10/thousands-of-children-unsure-of-gender-identity-let-down-by-nhs-report-finds |archive-date=3 July 2024 |access-date=10 April 2024 |work=The Guardian |type=News}}
• {{cite web |last=Cass |first=Hilary |date=10 March 2022 |title=Interim report – Cass Review |url=https://cass.independent-review.uk/publications/interim-report/ |access-date=15 January 2023 |website=The Cass Review |ref={{harvid|Cass review interim report|2022}} |archive-date=13 January 2023 |archive-url=https://web.archive.org/web/20230113125000/https://cass.independent-review.uk/publications/interim-report/ |url-status=live}}
• {{cite web |last=Cass |first=Hilary |date=10 April 2024 |title=Final Report – Cass Review |url=https://cass.independent-review.uk/home/publications/final-report/ |access-date=10 April 2024 |website=The Cass Review |ref={{harvid|Cass review final report|2024}} |archive-date=9 April 2024 |archive-url=https://web.archive.org/web/20240409231432/https://cass.independent-review.uk/home/publications/final-report/ |url-status=live}}
• {{Cite journal |last1=Gawlik-Starzyk |first1=Aneta |last2=Dora |first2=Marta |last3=Baran |first3=Dorota |last4=Szostakiewicz |first4=Łukasz |last5=Trofimiuk-Müldner |first5=Małgorzata |last6=Müldner-Nieckowski |first6=Łukasz |last7=Bielska-Brodziak |first7=Agnieszka |last8=Adamczewska-Stachura |first8=Milena |last9=Antosz |first9=Aleksandra |last10=Bajszczak |first10=Katarzyna |last11=Barg |first11=Ewa |last12=Barteczka-Eckert |first12=Barbara |last13=Chodecka |first13=Aleksandra |last14=Cichoń |first14=Lena |last15=Dobiała |first15=Ewa |date=2025 |title=Framework guidelines for the process of caring for the health of adolescent transgender (T) and non-binary (NB) people experiencing gender dysphoria — the position statement of the expert panel |url=https://journals.viamedica.pl/endokrynologia_polska/article/view/104289/81774 |journal=Endokrynologia Polska |language=en |volume=76 |issue=1 |pages=1–28 |doi=10.5603/ep.104289 |issn=2299-8306 |doi-access=free |ref={{harvid|Gawlik-Starzyk et al.|2025}} }}
• {{Cite journal |last=Horton |first=Cal |date=14 March 2024 |title=The Cass Review: Cis-supremacy in the UK's approach to healthcare for trans children |journal=International Journal of Transgender Health |pages=1–25 |doi=10.1080/26895269.2024.2328249 |issn=2689-5269 |doi-access=free}}
• {{cite web |date=11 April 2024 |title=Cass Review out of step with high-quality care provided in Aotearoa |url=https://patha.nz/News/13341582 |url-status=live |archive-url=https://web.archive.org/web/20240411012336/https://patha.nz/News/13341582 |archive-date=11 April 2024 |access-date=11 April 2024 |website=PATHA – Professional Association for Transgender Health Aotearoa |type=Press release |ref={{harvid|PATHA|2024}} }}
• {{cite web |title=The role of the GP in transgender care |url=https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care |url-status=live |archive-url=https://web.archive.org/web/20240729180836/https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care |archive-date=29 July 2024 |access-date=2 August 2024 |publisher=Royal College of General Practitioners |language=en |type=Position statement |ref={{harvid|RCGP|2024}} }}
• {{cite web |date=10 April 2024 |title=RCPCH responds to publication of the final report from the Cass Review |url=https://www.rcpch.ac.uk/news-events/news/rcpch-responds-publication-final-report-cass-review |url-status=live |archive-url=https://web.archive.org/web/20240521200950/https://www.rcpch.ac.uk/news-events/news/rcpch-responds-publication-final-report-cass-review |archive-date=21 May 2024 |access-date=18 May 2024 |publisher=Royal College of Paediatrics and Child Health |language=en |type=Press release |ref={{harvid|RCPCH|2024}} }}
• {{Cite news |last=Reed |first=Erin |date=12 March 2025 |title=New German, Swiss, and Austrian guidelines recommend gender-affirming care, slam Cass Review |url=https://www.advocate.com/health/europeans-recommend-gender-affirming-care |access-date=24 March 2025 |work=The Advocate |language=en }}
• {{cite web |last=Smith |first=Lade |date=22 April 2024 |title=Detailed response to The Cass Review's Final Report |url=https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2024/04/22/detailed-response-to-the-cass-review%27s-final-report |url-status=live |archive-url=https://web.archive.org/web/20240516031627/https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2024/04/22/detailed-response-to-the-cass-review%27s-final-report |archive-date=16 May 2024 |access-date=18 May 2024 |publisher=Royal College of Psychiatrists |language=en |type=Press release}}
• {{Cite journal |last1=Vandermorris |first1=Ashley |last2=Metzger |first2=Dan |last3=Vyver |first3=Ellie |last4=Harrison |first4=Megan |last5=Harvey |first5=Johanne |date=1 September 2024 |title=Response to the Letter to the Editor on the Canadian Paediatric Society statement on gender-affirming care |url=https://academic.oup.com/pch/article-abstract/29/6/415/7816713?redirectedFrom=fulltext |journal=Paediatrics & Child Health |language=en |volume=29 |issue=6 |pages=415–416 |doi=10.1093/pch/pxae066 |issn=1205-7088 |pmc=11557130 |pmid=39539773 |pmc-embargo-date=10 October 2025 |ref={{harvid|Vandermorris et al.|2024}} }}
• {{Cite journal |last1=Xian |first1=Sophia |last2=Dietz |first2=Elizabeth |last3=Fabi |first3=Rachel |date=15 January 2025 |title=Trans Experiences In Healthcare: Testimonial Injustice in Clinical Practice |url=https://journals.library.columbia.edu/index.php/bioethics/article/view/13149 |journal=Voices in Bioethics |language=en |volume=11 |doi=10.52214/vib.v11i.13149 |issn=2691-4875 |doi-access=free}}

{{refend}}

• {{Official website|https://cass.independent-review.uk/}}

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