UK’s largest doctors’ union condemns Cass Review’s attacks on gender-affirming care

The British Medical Association (BMA), the largest doctor’s union in the United Kingdom, voted to publicly critique the Cass Review, a wide-ranging review of Britain’s medical interventions for transgender youth that was condemned by many trans people and allies.

The review has been used to limit and restrict the ability of trans minors to receive gender-affirming care. The BMA found that the Cass Review’s findings are “unsubstantiated,” and voted to oppose the implementation of the review’s recommendations.

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The BMA’s critique of the review follows a recent court ruling that allows the government to ban the use of puberty blockers on an emergency basis. The ruling referenced the review in its judgment.

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The Cass Review was released in April of this year, with research beginning in 2020. It found that “there is not a reliable evidence base” for transgender children to receive gender-affirming medical care. It says that trans children should generally not have access to hormone blockers or hormone replacement therapy (HRT) and should instead pursue therapy or psychological treatment. Although the review does not outright ban trans medical care, it coincides with the National Health Service (NHS) significantly restricting puberty blockers for trans youth.

In response to the Cass Review, Britain’s National Health Service recently ordered all adult clinics to deny services to any clients younger than 18 and also told clinics to stop prescribing puberty blockers to minors, leaving many without a way to quickly receive care. The U.K. also recently forced Google’s search engine to remove any regional search results for two pharmaceutical websites that sell hormones without requiring a prescription.

A wealth of studies dispute the Cass Review’s findings. The Yale Law Review recently released released its own critique which found that the Cass Review “repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculation.” It also says that the Cass Review “subverts widely accepted processes for development of clinical recommendations and repeats spurious, debunked claims about transgender identity and gender dysphoria.”

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

The BMA did not just stop at condemning the Cass Review, it also said that healthcare services for transgender people in the U.K. are inadequate. The BMA further stated that the Casa Review “engaged in ‘unexplained study deviations'” and “ambiguous eligibility criteria” while excluding evidence supporting transgender care.

The full resolution says that the BMA wants to “publicly state support for transgender people, particularly transgender youth, and provision of prompt access to gender identity services and treatment at all ages” and “condemn the increasing political transphobia which is ostracising transgender people and discriminating against them by blocking their access to healthcare.”

They also seek to produce a fuller critique of the Cass Review through a “task and finish” group, which it expects to complete “towards the end of the year,” which will focus on the methodology errors in the Cass Review.

BMA’s full resolution is below:

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

i. Publicly critique the Cass Review;  
ii. Lobby and work with other relevant organisations and stakeholders to oppose the implementation of the recommendations made by the Cass Review;  
iii. Lobby the Government and NHS in all four nations to ensure continuity in provision of transgender healthcare for patients younger than 18 years old;  
iv. Lobby the Government and NHS in all four nations to ensure continuity in provision of transgender healthcare for patients aged 18 or older;  
v. Publicly state support for transgender people, particularly transgender youth, and provision of prompt access to gender identity services and treatment at all ages;
vi. Condemn the increasing political transphobia which is ostracising transgender people and discriminating against them by blocking their access to healthcare’

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