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Services at Tavistock in London are being replaced by regional hubs Aaron Chown/PA Images
Gender Identity

Explainer: What's in the UK's Cass Review and what does it mean for trans healthcare?

Trans young people in Ireland “currently do not have access to any form of gender identity-related healthcare”, Trans Equality Together said.

THOUSANDS OF YOUNG people questioning their gender identity have been let down by the National Health Service in the UK, a landmark report has found.

The Cass Review, which was published today, states that the pillars of gender medicine are “built on shaky foundations” as there is a lack of evidence on the impacts of puberty blockers and hormone treatments.

The review was led by Dr Hilary Cass, former president of the Royal College of Paediatrics and Child Health. It found that healthcare for people questioning their gender “needs to be improved across the board”.

The review was commissioned by the NHS in September 2020 in response to “a complex and diverse range of issues” including the significant rise in referrals to the Gender Identity Development Service (Gids) at the Tavistock and Portman NHS Foundation Trust from just under 250 in 2011 and 2012 to more than 5,000 in 2021 and 2022.

Last month NHS England said it would no longer prescribe puberty blockers to young people as there was “not enough evidence of safety and clinical effectiveness”.

However, trans advocacy groups were critical of the move, saying puberty blockers are an important part of some people’s treatment. Stonewall, a leading LGBT+ rights charity in the UK, said at the time that all trans young people “deserve access to high quality, timely healthcare”.

“For some, an important part of this care comes in the form of puberty blockers, a reversible treatment that delays the onset of puberty, prescribed by expert endocrinologists, giving the young person extra time to evaluate their next steps,” the group noted.


Dr Cass makes 32 recommendations in her near-400 page report, including that gender services should operate “to the same standards” as other children’s health services.

The report states that any young person seeking NHS help with gender-related distress should be screened to see if they have any neurodevelopmental conditions such as autism spectrum disorder.

It also recommends that a “follow-through service” should be put in place for 17-25-year-olds, with regional centres either extending the age range of their patients or through “linked services”.

In her foreword, Cass said that the “toxicity” of the public conversation around gender identity and transitioning is “exceptional”.

She warned that “polarisation and stifling of debate” would also hamper essential research in an area with “remarkably weak evidence”.

‘Children used as a football’

In an interview with The Guardian today, Cass acknowledged that some young people waiting for treatment will be disappointed by her conclusions.

“We’ve let them down because the research isn’t good enough and we haven’t got good data,” she said.

The toxicity of the debate is perpetuated by adults, and that itself is unfair to the children who are caught in the middle of it.

“The children are being used as a football and this is a group that we should be showing more compassion to.”

An interim review published by Cass in 2022 stated that a “fundamentally different service model” to Tavistock was needed, and that a sole provider of such services was “not a safe or viable long-term option” amid rapidly rising referrals.

A few months later the NHS announced that Gids would close and be replaced with a regional network of clinics for children and young people.

Two new hubs – led by London’s Great Ormond Street Hospital and Alder Hey Children’s Hospital in Liverpool – opened at the beginning of this month. More regional hubs are expected to open in the future.

Irish people who cannot access certain services here will be referred to these hubs, as previously reported by The Journal.

The HSE is currently developing an updated model of care for transgender patients in Ireland and the findings of the Cass Review will be considered as part of this process.

Lack of services in Ireland 

Trans Equality Together, a coalition of groups led by Trans Equality Network Ireland (TENI), Belong To and LGBT Ireland, today said it is “committed to learning” from the Cass report’s findings.

In a statement released today, the coalition said it “will comprehensively review the report in order to highlight meaningful evidence and insights it can provide for the development of a model of care for trans young people in Ireland”.

The coalition noted that trans young people across the island of Ireland “currently do not have access to any form of gender identity-related healthcare”.

“Like all young people, trans young people need access to safe, timely and appropriate medical care. This is currently unavailable to trans young people in Ireland and Northern Ireland,” they added.

Contains reporting by Press Association