What the Cass Review Means for Trans Kids in Britain—and Beyond (2024)

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Additionally, because the London-based GIDS clinic was, for decades, the only NHS clinic in the UK that offered gender-affirming care, there had been an enormous and very slow-moving waiting list of patients from all over the nation. GIDS was shut down in March and, as Cass recommends, regional clinics will be established throughout the country, though there is concern that in the interim many young people may be left without care.

The review’s reception in the British trans community has been mixed. A number of trans youth have reported feeling “disappointed” and “ignored” by Cass—including many who’d been prescribed puberty blockers and had participated in focus groups for the review. British trans activists and researchers also expressed concern about how some of the pediatrician’s recommendations might be interpreted, and were especially worried about the suggestion that “social transitioning” may need clinical supervision. Several campaigners told The Nation that when it comes to recognizing the ongoing failures of Britain’s skeletal gender-affirming care services, however, the Cass review was welcome.

“It’s actually great to have a report to basically confirm what we’ve all been saying all along and to validate our concerns,” says writer and activist Eva Echo, calling trans healthcare in the NHS “beyond broken.”

Several years ago, Echo and three other claimants, including two children, took NHS England to the country’s High Court for what they saw as unlawful waiting times unseen in any other part of the health service—even as waiting lists for a number of treatments have grown in recent years. Their case was ultimately unsuccessful, and Echo, along with thousands of other adults and at least 5,000 children, are still waiting for their first NHS appointment for gender-affirming care.

Astronomical waiting times are just one of the failures the Cass Review identifies, highlighting that during these limbo periods, children are not offered any sort of support, including mental health services. This is especially egregious considering the NHS’s own Healthcare Safety Investigation Branch told Reuters in 2022 that the “‘incredibly distressing’ wait for gender care ‘created a significant patient safety risk for young people.’” There have been a number of suicides linked to waiting times, including Alice Litman, a 20-year-old who’d first sought gender-affirming care at age 15, and was still on a waiting list for more than 1,000 days when she died.

The review’s publication also comes as the country grapples with a stark rise in anti-trans hate crimes amid what Cass herself labeled the “exceptional” “toxicity of the debate” on trans youth healthcare. While some, like Kamran Abbasi, editor in chief of the The BMJ (formerly the British Medical Journal), see the Cass Review as “an opportunity to pause, recalibrate, and place evidence-informed care at the heart of gender medicine,” Amnesty International has warned that it is already being “weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people”. The Scottish author J.K. Rowling has already taken a victory lap on Twitter/X. In an election year, the independent review is also being misused by beleaguered Tories who, like the US right, have resorted to stoking culture wars to distract from dire conditions caused by their policy decisions over nearly 15 years.

It’s not just British anti-trans groups that could “weaponize” it, either. American LBGTQ+ activist and civil rights attorney Alejandra Caraballo has been paying close attention to the Cass Review from across the Atlantic, because the legal expert has identified a disturbing trend in recent years.

“Prominent anti-trans cases in Finland, Sweden, and especially the UK have been cited in US courts,” Caraballo told The Nation. It’s only a matter of time, she believes, before the Cass Review is used in American legal cases looking to further restrict trans rights.

Meanwhile, back in the UK, after years of mounting letdowns, the Cass Review has already transformed the country’s approach to gender dysphoria. It remains to be seen however, when it comes to the well-being of trans children and teens, whether those changes will be for better or for worse.