UK gender identity services failed thousands of trans youth, Cass Review states

Belong To issued a response to the report, assuring trans youth that LGBTQ+ organisations are working to create an Ireland where they are equal, safe and valued.

Photo of hands typing on lap top next to stethoscope representing the recent Cass Review on transgender healthcare
Image: Photo by National Cancer Institute on Unsplash

On April 10, 2024, a nearly 400-page report was published, which suggests the NHS has failed thousands of transgender youth. Entitled the ‘Cass Review’ after its author Dr Hilary Cass, it includes 32 recommendations advocating for more research, holistic care and age-specific services.

The Tavistock Gender Identity Development Service was established in 1989 as the NHS’s sole care provider for trans and gender-questioning youth in the UK. It treated 9,000 young people from 2009-2020, and the HSE has referred Irish patients to Tavistock for psychological assessment under the Treatment Abroad Scheme (TAS).

In 2020, the NHS commissioned an independent youth gender report in response to concerns raised about the clinic’s care and ability to meet the demand for its services.

The review was conducted by Dr Hilary Cass, a paediatrician who stressed that her work was not intended to undermine the validity of trans identities or challenge people’s right to transition, but rather identify NHS failings and improve the services available to transgender youth.

The report suggests that thousands of transgender youth have been let down by the NHS due to ineffective treatments as well as the “toxicity” of the trans debate.

However, it should also be noted that LGBTQ+ experts are refuting some of the findings.

For example, the ‘Cass Review’ states that there is “weak evidence” surrounding whether puberty blockers improve the well-being of young people. Previous research conducted by Cass contributed to NHS England’s decision to stop prescribing puberty blockers to children, and while the report claims that the effects of puberty blockers are under-researched, numerous studies have demonstrated they are safe, effective, and dramatically improve mental health.

The report also advises that clinic staff advise youth on the “risks and benefits” of social transitioning and suggests the NHS should consider offering separate services for people who wish to detransition. It additionally recommends that all young transgender people are assessed at the NHS for neurodevelopmental conditions and mental health prior to receiving gender-affirming care.

Cass has also stated that she questions if future clinics should include “gender” in the name, instead, she says we should: “move away from just calling these gender services”.

Belong To, Ireland’s national LGBTQ+ youth service, has responded to the Cass Review, saying it will conduct an analysis of the report and use its findings to continue to advocate for access to vital care, supports, and information for transgender youth and their families in Ireland.

The team firmly believes that Ireland has an opportunity to learn from the UK and the Cass Review to create a safe and effective model of healthcare for trans youth.

In a statement addressing the report, Belong To said: “We all want a healthcare service that centres the safety and wellbeing of young people – no matter what we look like or how we identify. But for trans young people and their families, accessing healthcare is like knocking on a closed door, as 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.”



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In reference to the review’s findings, the statement continued: “This learning can help us to build a model of care in Ireland that meets the needs of trans people of all ages. Such a model would holistically attend to trans people’s physical, mental and social health needs and wellbeing, while respectfully affirming their gender identity.

“It would provide wraparound healthcare and supports for trans people and their families, in their local communities. Most importantly, it would make young trans people happier and safer.

“There are trans young people across Ireland and their families who are tuning into relentless public debates about their lives. We need to remember the impact this can have on their mental health and wellbeing.

“For any trans young people who are feeling scared or worried right now, please know that Belong To and a wide number of organisations are working to create an Ireland where you are equal, safe and valued. We offer young people a safe space to explore their sexual orientation, gender identity and various LGBTQ+ topics without fear of judgement, harassment or discrimination.”

Anyone who needs support is encouraged to get in touch with Belong To youth workers today.

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