Summary

The Cass Review was set up after referrals to England's child gender service rose sharply and the patients changed to mostly teenage girls, many with autism or mental health problems. Its final report found that care had rested on 'remarkably weak' evidence. Reviews by the University of York could draw no conclusions on how puberty blockers (drugs that pause puberty) affect gender distress or mental health, and found only limited evidence for hormones. Cass recommended whole-person assessment, standard psychological support, blockers only in a research trial, 'extreme caution' with hormones before 18, national review of every medical case, and regional services. It is the most thorough review of its kind, and later reviews agree the evidence is weak. Its methods are disputed, critics and defenders both have stakes, and some advice rests on judgement rather than data.

Key findings

• این گزارش نهایی 388 صفحه‌ای که NHS England در 2020 تأسیس کرد و در 10 آوریل 2024 منتشر شد، 32 توصیه برای خدمات جنسیت کودکان و جوانان در انگلستان ارائه می‌کند.
• مرور دانشگاه یورک دربارهٔ بلوکرهای بلوغ 50 مطالعه را بررسی کرد (1 باکیفیت بالا، 25 متوسط، 24 پایین). گفت دربارهٔ اثرات بر ناراحتی جنسیتی، سلامت روان یا رشد مغز نتیجه‌ای نمی‌توان گرفت، و ممکن است سلامت استخوان و قد آسیب ببیند.
• مرور یورک دربارهٔ هورمون‌های جنس مخالف 53 مطالعه را بررسی کرد (1 بالا، 33 متوسط، 19 پایین). شواهدی با کیفیت متوسط یافت که سلامت روان ممکن است در طول درمان بهبود یابد، اما دربارهٔ اثرات دیگر نتیجه‌ای نمی‌توان گرفت.
• بازبینی ارزیابی همه‌جانبهٔ فرد را توصیه می‌کند، از جمله بررسی اوتیسم و شرایط مشابه و ارزیابی سلامت روان، با گفتاردرمانی‌ها و داروهای استاندارد و اثبات‌شده برای ناراحتی و سایر شرایط.
• بلوکرهای بلوغ باید فقط در چارچوب یک مطالعهٔ پژوهشی داده شوند (NHS England یک کارآزمایی را پیش برد). هورمون‌ها از 16 سالگی «احتیاط شدید» و دلیل روشنی برای منتظر نماندن تا 18 سالگی لازم دارند، و هر پرونده برای درمان پزشکی باید به یک پانل ملی کارشناسان برود.
• بازبینی دریافت که رهنمودها، از جمله رهنمود WPATH (انجمن جهانی سلامت افراد ترنسجندر)، با دقت تدوین نشده‌اند. شش کلینیک از هفت کلینیک جنسیت بزرگسالان NHS از اشتراک داده برای مطالعهٔ نتایج بلندمدت امتناع کردند و بازبینی می‌گوید باید به مشارکت ملزم شوند.
• خانواده‌هایی که دربارهٔ گذار اجتماعی (نام، لباس یا ضمایر جدید) برای کودکان خردسال تصمیم می‌گیرند باید زود به درمانگری باتجربه مراجعه کنند، و به همهٔ جوانان پیش از هر درمان پزشکی باید مشاورهٔ باروری و ذخیرهٔ تخمک یا اسپرم پیشنهاد شود.
• این گزارش را پروژهٔ یکپارچگی ییل (مک‌نامارا و همکاران، 2024) و یک مقالهٔ داوری‌شده (نونه و همکاران، 2025) نقد کردند. در Archives of Disease in Childhood (چئونگ و همکاران، 2025) و Journal of Sex & Marital Therapy (مک‌دویت و همکاران، 2025) از آن دفاع شد.

Abstract

1. The aim of this Review is to make recommendations that ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria receive a high standard of care. Care that meets their needs, is safe, holistic and effective. At its heart are vulnerable children and young people and an NHS service unable to cope with the demand. 2. Yet from the start, the Review stepped into an arena where there were strong and widely divergent opinions unsupported by adequate evidence. The surrounding noise and increasingly toxic, ideological and polarised public debate has made the work of the Review significantly harder and does nothing to serve the children and young people who may already be subject to significant minority stress. 3. Within this context the Review set out to understand the reasons for the growth in referrals and the changing epidemiology, and to identify the clinical approach and service model that would best serve this population. 4. There are conflicting views about the clinical approach, with expectation at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services. 5. Although some think the clinical approach should be based on a social justice model, the NHS works in an evidence-based way. Whilst navigating a way through the surrounding ‘culture war’, the Review has been acutely and increasingly aware of the need for evidence to support its thinking and ultimately the final recommendations made in this report. 6. When the Review started, the evidence base, particularly in relation to the use of puberty blockers and masculinising/feminising hormones, had already been shown to be weak. There was, and remains, a lot of misinformation easily accessible online, with opposing sides of the debate pointing to research to justify a position, regardless of the quality of the studies.

Conclusion

The Cass Review concludes that children and young people questioning their gender identity or experiencing gender dysphoria require a high standard of care that is safe, holistic, and evidence-based. The Review found that the evidence base for medical interventions, particularly puberty blockers and masculinising/feminising hormones, is weak, and that clinical practice has been complicated by a toxic, polarised public debate. The ten key recommendations focus on: (1) ensuring services meet standard NHS care standards with clear clinical leadership; (2) implementing holistic assessment frameworks including screening for neurodevelopmental conditions and mental health; (3) using standard evidence-based psychological and psychopharmacological treatments; (4) ensuring early clinical involvement in decisions about social transition of pre-pubertal children; (5-6) establishing robust research and data collection programmes to improve the evidence base; (7) requiring long-standing gender incongruence as essential but not sufficient for medical treatment; (8) exercising extreme caution in prescribing hormones from age 16; (9) requiring national Multi Disciplinary Team review for all medical treatment cases; and (10) offering fertility counselling and preservation before any medical pathway. The Review emphasises that the NHS must work in an evidence-based way rather than following a social justice model, and that the needs of vulnerable children and young people must be prioritised over ideological positions.