Intended for healthcare professionals

Feature Gender Identity

“Medication is binary, but gender expressions are often not”—the Hilary Cass interview

BMJ 2024; 385 doi: (Published 09 April 2024) Cite this as: BMJ 2024;385:q794
  1. Kamran Abbasi, editor in chief
  1. The BMJ
  1. kabassi{at}

The chair of the Independent Review of Gender Identity Services for Children and Young People tells The BMJ’s editor in chief Kamran Abbasi what her latest report says1

Your report describes a very complex situation. But at its heart is a concern for the wellbeing of young people?

Children and young people with gender related distress have been poorly served because we’ve exceptionalised them. Health professionals are nervous to see them in local services and so they have often been bypassed straight through to the Gender Identity Development Service at the Tavistock and Portman, whose waiting list has grown exponentially. Many have neurodiversity or other mental health problems that you would expect somebody to address locally. But if health professionals feel they can’t see them, then they sit on this long waiting list. And by the time they are seen, all of this has got much worse.

Video 1

Cass’s message for the young people and their families

You describe how the case mix has entirely changed over this period. What is driving that?

There’s a greater incidence of mental health problems, particularly in adolescent girls. Also, there’s a …

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