Activist groups raise concerns over “deeply flawed” Cass Review on transgender healthcare

According to some activists, the Cass Review disregards studies not written in English and ignores widely-supported evidence on the benefits of gender-affirming care.

Group of people protesting anti-trans laws with sign that says
Image: Photo by Aiden Craver on Unsplash

Since its publication on April 10, 2024, the Cass Review has been met with concerns from some trans activist groups across the world, who have raised questions about its methodology.

The nearly 400-page report claims to advocate for more research, holistic care, and age-specific services, but also urges medical experts to take “extreme caution” in allowing minors to medically transition. It also suggests that young people should remain under the care of youth services until the age of 25.

Activists have noted that while the Cass Review claims to have found “remarkably weak evidence” supporting puberty blockers, it ignores decades of relevant studies supporting this essential gender-affirming care.

Trans Healthcare Action released a statement emphasising that decisions about trans healthcare need to be made by trans people and their healthcare providers, not by “misinformation and bias”.

Its statement says the Cass Review potentially threatens to undermine gender-affirming care and urges Ireland to implement an informed consent model for trans healthcare. The organisation additionally said it would share a more thorough analysis in the coming weeks.


The Cass Review has been described as “flawed” in its methodology for disregarding studies not written in English, and ignoring widely-supported evidence on the benefits of gender-affirming healthcare.

The report claims puberty blocker and hormone therapy studies are unreliable because they are not double-blind studies which compare a placebo group to a group receiving treatment, but these types of studies are not used for all treatments.

For double-blind studies to be successful, the subjects and researchers can not know which group is which. Medical experts explained that conducting this kind of study would be impossible in this case since placebo groups would quickly realise when they were not receiving hormone therapy or puberty blockers.

Dr Hane Maung wrote a statement for the UK private trans healthcare service GenderGP saying the review “neglects a vast amount of evidence on the benefits of gender-affirming medical treatment for trans youth”, which “indicates a serious misunderstanding of the roles and limitations” of the study.


Several transgender activist groups, including TENI, have raised concerns about the harmful implications of the Cass Review’s recommendations to limit gender-affirming healthcare.

Because the report favours a psychiatric approach over an affirming model of healthcare, many have raised concerns about the research’s intent. TransActualUK said: “Underpinning this report is the idea that being trans is an undesirable outcome rather than a natural facet of human diversity.”

Some right-wing groups have already used the report to justify their anti-trans ideologies, and Amnesty International UK issued a statement saying: “This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people.”

Meanwhile, a What the Trans opinion piece called the Cass Review “a deliberate part of a political project aiming to reduce the availability of trans healthcare” that “must be thrown out entirely.”


Although the report will likely impact how NHS treats trans youth in the UK, it is unclear how it will influence healthcare in Ireland.

Belong To has said: “Here in Ireland, we currently have no healthcare service at all for young trans people. This needs to be urgently rectified to allow young people and their families access to vital care, supports and information to help them make decisions about what is best for them.”

The LGBTQ+ youth organisation added: “For any trans young people who are feeling scared or worried right now, please know that Belong To are working to create an Ireland where you are equal, safe and valued” and urged anyone seeking support to reach out through this contact form.

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