The paediatrician behind last week’s landmark review on the treatment of children suffering from gender confusion has criticised the spread of “disinformation” around her report, including from a Labour MP, as she revealed she had been told not to travel on public transport over safety fears.
The Cass Review offers a strong – some would say unanswerable – challenge to the ‘gender affirmative model’ which in recent years has become the norm in the NHS’s Gender Identity Development Service (GIDS). Faced with cases of gender distress, this approach encourages clinicians to ‘affirm’ rather than question a child’s chosen gender identity, before then putting them on a medical pathway that can have lifelong, irreversible consequences.
Part of the problem, Dr Cass says, is that as this model took hold, the process of ‘differential diagnosis’ which the NHS typically adopts during diagnosis and management of every other form of distress, was entirely ignored. Or, as the report puts it: “Some practitioners abandoned clinical approaches to holistic assessment, which has meant that this group of young people have been exceptionalised compared to other young people with similarly complex presentations.”
More generally, the Report cautions that extreme care should be taken before anyone under the age of 25 transitions; calls for an end to the prescribing of puberty blockers and cross-sex hormones to under 18s; warns that children who change gender may regret it; finds that many gender confused adolescents have experienced trauma, neglect and abuse; and says there is no “good evidence” on the long-term benefits of the treatments that have been given to children.
In an interview with the Times, Dr Hilary Cass said she was pleased that, for the most part, both sides in the debate over the treatment of children with gender dysphoria had not “weaponised” her report. But she has still had to deal with a “pretty aggressive” response from some, particularly those in activist groups. She is also staying away from Twitter/X.
Cass said: “There are some pretty vile emails coming in at the moment. Most of which my team is protecting me from, so I’m not getting to see them.” Some of them contained “words I wouldn’t put in a newspaper”, she said.
She added: “What dismays me is just how childish the debate can become. If I don’t agree with somebody then I’m called transphobic or a TERF [trans-exclusionary radical feminist].”
Cass said the abuse spiked every time the review said something “people don’t like”.
Online discussion hardened following her interim report, in 2022, and the selection of Liz Truss as Tory Party leader and prime minister, she said. “That was when the debate got more aggressive and people got into bunkers, then the online furore heats up.”
But Cass, the former president of the Royal College of Paediatrics and Child Health, is remaining resolute, despite being thrown into the middle of the culture wars.
Of her critics, Cass said: “I have been really frustrated by the criticisms, because it is straight disinformation. It is completely inaccurate.
“It started the day before the report came out when an influencer put up a picture of a list of papers that were apparently rejected for not being randomised control trials.
“That list has absolutely nothing to do with either our report or any of the papers. If you deliberately try to undermine a report that has looked at the evidence of children’s healthcare, then that’s unforgivable. You are putting children at risk by doing that.”
In the days after the Cass review was published, activists claimed on social media that only two out of 100 studies were included in the report.
Labour MP Dawn Butler then repeated those claims in the House of Commons, saying: “There are around 100 studies that have not been included in this Cass report and we need to know why.”
Cass explained that researchers had appraised every single paper, but pulled the results from the ones that were high quality and medium quality, which was 60 out of 103.
Of Butler, she added: “You don’t get up in parliament with an intent to spread misinformation … [but] what I was dismayed about, was the understanding she got [from the report].”
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