Gender medicine and the Cass Review: why medicine and the law make poor bedfellows
File(s)
Published version
Author(s)
Cheung, C Ronny
Abbruzzese, Evgenia
Lockhart, Elaine
Maconochie, Ian K
Kingdon, Camilla C
Type
Journal Article
Abstract
In April 2024, the final report of the Cass Review, an independent review chaired by Dr Hilary Cass, was published, offering recommendations to improve gender identity services for children and young people in the UK. The core purpose of the Review was to improve care for children and adolescents. Commissioned by National Health Service England, the Review identified a weak evidence base for medical endocrine interventions and recommended that these treatments be provided within a structured research framework. The Review received widespread support from the clinical community. However, in July, the British Medical Association Council, without consulting its own members, unexpectedly passed a motion calling for a public critique of the Review, citing concerns over methodological weaknesses - a position it then softened following public criticism from members, concluding that their review would come instead from a position of neutrality.
The original motion was based on two non-peer-reviewed online papers, prominently the work of McNamara et al—a paper which was written for a primarily litigious, rather than academic, purpose. We critically examine these sources and analyse the wider legal context in which they have been applied. We conclude that these sources misrepresent the Cass Review’s role and process (specifically, by mistakenly comparing the Review to clinical practice guideline development), while many of the methodological criticisms directed at the Cass Review, including its use of evidence appraisal and systematic reviews conducted by University of York (UK), are unfounded.
These misunderstandings, based on flawed and non-peer-reviewed analyses intended for legal (rather than clinical) purposes, jeopardise the implementation of crucial reforms in the care of gender dysphoric youth. The UK clinical community should move beyond these critiques and focus on the Cass Review’s recommendations to establish a safer, more holistic and evidence-based service model for children and young people experiencing gender identity issues.
The original motion was based on two non-peer-reviewed online papers, prominently the work of McNamara et al—a paper which was written for a primarily litigious, rather than academic, purpose. We critically examine these sources and analyse the wider legal context in which they have been applied. We conclude that these sources misrepresent the Cass Review’s role and process (specifically, by mistakenly comparing the Review to clinical practice guideline development), while many of the methodological criticisms directed at the Cass Review, including its use of evidence appraisal and systematic reviews conducted by University of York (UK), are unfounded.
These misunderstandings, based on flawed and non-peer-reviewed analyses intended for legal (rather than clinical) purposes, jeopardise the implementation of crucial reforms in the care of gender dysphoric youth. The UK clinical community should move beyond these critiques and focus on the Cass Review’s recommendations to establish a safer, more holistic and evidence-based service model for children and young people experiencing gender identity issues.
Date Issued
2025-04-01
Date Acceptance
2024-10-07
Citation
Archives of Disease in Childhood, 2025, 110 (4), pp.251-255
ISSN
0003-9888
Publisher
BMJ Publishing Group
Start Page
251
End Page
255
Journal / Book Title
Archives of Disease in Childhood
Volume
110
Issue
4
Copyright Statement
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39401844
PII: archdischild-2024-327994
Subjects
Adolescent Health
Child Health Services
Life Sciences & Biomedicine
Pediatrics
Science & Technology
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2024-10-14