Skip to content

Cass Review: Children Deserve Better, Not Experimental Treatments

An English doctor’s expert review revealed major concerns about what is misleadingly called “gender-affirming care.”
Jonathan Scruggs
A counselor takes notes while speaking with a minor

As a rising number of young people have begun to struggle with gender dysphoria, some doctors have pushed the idea that the best way to help these children is to subject them to harmful, experimental, unnecessary, and often-irreversible procedures.

Speaking to the American Civil Liberties Union, one doctor falsely claimed that puberty blockers are “safe” and “reversible,” while another mischaracterized the prescription of puberty blockers as “life-saving treatment.” This kind of language has been used to justify providing puberty blockers, cross-sex hormones, and even surgeries to children who cannot give consent to such life-altering procedures.

But according to a new review from Dr. Hilary Cass, former president of the Royal College of Paediatrics and Child Health in England, the research on this issue is “remarkably weak” and does not justify the drastic and unethical practices being done on children today.

Cass review finds serious concerns

The National Health Service (NHS) in England commissioned Dr. Cass to perform an independent and thorough review to understand the rapid increase in the number of children seeking treatment for issues related to their perceived gender identity and discomfort with their bodies. The study also evaluates the NHS’s “gender care services” for children and provides recommendations on how to improve care.

What were the findings?

Contrary to the claims espoused by activists, Dr. Cass found that the science related to using puberty blockers, cross-sex hormones, and permanent surgeries on children with gender dysphoria is an area of study with “remarkably weak evidence.” In particular, she found that “we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.” In addition, the report says that systematic reviews “have demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to base clinical decisions.”

Yet that hasn’t stopped many in the medical community from pushing ideology over science.

Dr. Cass wrote that, while the normal practice is for doctors to cautiously wait years to change established medical practices (often to ensure new treatments are actually better than old ones), the opposite has happened when caring for children with gender dysphoria.

“Based on a single Dutch study, which suggested that puberty blockers may improve psychological wellbeing for a narrowly defined group of children with gender incongruence, the practice spread at pace to other countries,” Dr. Cass wrote.

She found that doctors relied on this study to begin prescribing cross-sex hormones to teenagers and even adolescents who fell outside of the study’s scope. Overall, she concluded that children “deserve very much better.”

Children need real care

In the report, Dr. Cass makes a number of recommendations for improving the care given to these children.

Using “extreme caution”

One of Dr. Cass’s recommendations is for doctors to use “extreme caution” when providing cross-sex hormones to anyone under the age of 18. She recommends that doctors not prescribe these drugs to minors unless they can provide “a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18.” This stands in sharp contrast with activist organizations like WPATH that push young children toward medicalized intervention.

In the U.S., 23 states agree that experimental procedures like puberty blockers, cross-sex hormones, and sterilizing surgeries are inappropriate for minors. For example, with input from medical professionals, Alabama passed a law in April 2022 limiting these harmful, potentially irreversible procedures on to children. Alliance Defending Freedom is assisting the Alabama Attorney General’s Office in defending the law against activists and the Biden administration.

Likewise, Idaho passed a similar law in 2023, and ADF, alongside the Idaho Attorney General’s Office, won an emergency stay at the U.S. Supreme Court to let Idaho’s law go into effect (except as to the challengers) and thereby protect children throughout the state. Courts are beginning to recognize the dangerous nature of these experimental procedures.

Addressing comorbidities through psychotherapy

In another recommendation, Dr. Cass says that children struggling with gender dysphoria ought to have access to standard, evidence-based psychological treatment “to support the management of the associated distress and cooccurring conditions” like anxiety or depression. She notes that “the focus on the use of puberty blockers for managing gender-related distress has overshadowed the possibility that other evidence-based treatments may be more effective.”

Unfortunately, states like Colorado are outlawing counseling for children that doesn’t lead to the government’s and activists’ foregone conclusions about “gender identity.”

A Colorado law currently prohibits counselors like Kaley Chiles (represented by ADF) from having any conversation with a minor client that helps them pursue the goal of affirming their sex. In other words, Colorado requires that counselors push the government’s view of gender identity to their young clients and does not let parents and children pursue conversations that could help them work through issues they are struggling with.

Children experiencing gender dysphoria deserve the best care possible, and that must include the option of becoming comfortable with their sex.

Keeping parents involved

Dr. Cass mentions parents repeatedly in her review and emphasizes that parents should be involved in medical decisions involving their child. She wrote that “parents should be actively involved in decision making unless there are strong grounds to believe that this may put the child or young person at risk.”

Under the U.S. Constitution, parents have the fundamental right to direct the upbringing, education, and health care of their children. But across the United States, many schools are hiding important information about students from their parents.

For example, one New York school began referring to a female student by a new masculine name and the third-person plural pronouns “they” and “them” without telling her parents. Making matters worse, it then hid its actions from her parents for months. The school’s principal only disclosed this information to the parents after a teacher urged him to do so.

As Dr. Cass’s review highlights, the suggestion that puberty blockers, cross-sex hormones, and life-altering surgeries are the only acceptable treatments for children struggling with gender dysphoria is patently false. Children deserve real care, not experimentation and dishonesty.

Jonathan Scruggs
Jonathan Scruggs
Senior Counsel, Vice President of Litigation Strategy & Center for Conscience Initiatives
Jonathan Scruggs serves as senior counsel and vice president of litigation strategy and the Center for Conscience Initiatives with Alliance Defending Freedom.