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Review of gender identity services for children and young people

BMJ 2022; 376 doi: (Published 10 March 2022) Cite this as: BMJ 2022;376:o629

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Services for children with gender dysphoria need fundamental reform, says interim review

Rapid Response:

Re: Review of gender identity services for children and young people

Dear Editor,

We welcome the

Independent review of gender identity services for children and young people: Interim report (the "Cass Review").-

We are also pleased to see this opinion piece by Dr Cass in the BMJ encouraging clinical staff at all levels in the NHS and the Royal Colleges to support the findings of the report and work to improve the quality and safety of care of these children and young people with gender dysphoria. We also welcome the recommendation in the Cass report that any other clinical presentations be addressed, and that psychological and social support be available.

This is a detailed and thorough report and addresses many of our concerns as clinicians. The report makes clear that the very rapid rise in the number of cases and the large changes in the demographics of the patient population mean that the current model is the wrong model and that a national service provider is the wrong structure. The report makes clear the very poor evidence base for treatment.

It helpfully states that an affirmative approach is not appropriate for this patient group and is at odds with the ordinary practice of clinical care. The interim report provides an excellent overview of the risks of puberty blockers and also the lack of clinical evidence for their effectiveness. It clarifies that social transitioning should not be regarded as a neutral intervention.

We are particularly pleased that the review has chosen to include within its recommendation young people aged 16-25.

Dr David Bell
Retired Consultant Psychiatrist

Dr Lucy Griffin
Consultant Psychiatrist

Dr Seth Bhunoo
Consultant Psychiatrist

Dr Sallie Baxendale
Consultant Neuropsychologist. Honorary Associate Professor UCL

Dr Az Hakeem
Consultant Psychiatrist. Hon Clinical associate professor UCL

Dr Louise Irvine

Dr John Higgon
Consultant Clinical neuropsychologist

Dr Angela Dixon

Dr Madeleine Ni Dhalaigh

Dr Robin Ion
Senior lecturer in mental health nursing

Bob Withers
Analytical Psychotherapist

Prof David Pilgrim
Chartered Clinical Psychologist

Dr Maja Bowen

Dr Tessa Katz

Dr Ellen Wright

Competing interests: No competing interests

13 March 2022
Angela Dixon
Dr David Bell, Dr Lucy Griffin, Dr Seth Bhunoo, Dr Sallie Baxendale, Dr Az Hakeem, Dr Louise irvine, Dr John Higgon, Dr Madeleine Ni Dhalaigh, Dr Robin Ion, Bob Withers, Prof David Pilgrim, Dr Maja Bowen, Dr Tessa Katz, Dr Ellen Wright
Kirkcaldy Health Centre KY1 2NA