Cass review: how has report affected care for transgender young people?

At the heart of the controversy about how to meet the needs of young people questioning their gender has been the huge rise in referrals to the Tavistock – previously the only dedicated clinic in England and Wales treating children with gender dysphoria.

The clinic was closed one month before the Cass review into youth gender identity services, commissioned by NHS England and led by the British paediatrician Hilary Cass, which found that children had been “let down” by the NHS amid a “toxic” public discourse.

Her report recommended a significant shift in treatment away from medical intervention towards a more holistic approach to care, including therapy and treatment for coexisting mental ill health, neurodivergence or family issues, and to be provided by a network of regional hubs rather than concentrated in one location.

Fourteen months later and the exponential rise in referrals for NHS care has halted, with figures showing a sharp reduction from up to 280 referrals a month at the Tavistock to between 20 and 30 a month this year, a 10th of the earlier rate.

James Palmer, the medical director for specialised services at NHS England, who is responsible for implementing the recommendations of Cass, suggests a number of factors are behind the decrease. Young people can now only be referred for the youth gender service through mental health or paediatric specialists, rather than by a GP.

Palmer also believes the reduction is partly because of the “change in philosophy” brought in by Cass about hormone treatments. Her review concluded there was “remarkably weak evidence” that puberty blockers (prescribed to give young people experiencing distress and dysphoria about their bodies time to consider their next move) and cross-sex hormones (which masculinise or feminise people’s appearances) improve young people’s wellbeing and there was concern they may harm health.

Cass prompted a temporary ban on the use of puberty-blocking drugs, which was extended indefinitely by the health secretary, Wes Streeting, last December. Cross-sex hormones may be prescribed to 16- to 18-year-olds in rare cases but in practice none have been since the review.

“There’s also an impact – completely immeasurable – of the change in stance in this country and around the world,” Palmer adds. The Cass review was clear, he argues, that even social transition is “not a neutral act” and better information is needed about the outcomes for children who do so, as well as support for parents and schools. “But there is also an impact from the global political environment which has become less accepting of trans people and gender-questioning young people.”

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Source: The Guardian, 2 July 2025