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News Cass Review

Guidelines on gender related treatment flouted standards and overlooked poor evidence, finds Cass review

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q820 (Published 09 April 2024) Cite this as: BMJ 2024;385:q820

Linked Opinion

Gender medicine for children and young people is built on shaky foundations. Here is how we strengthen services

Linked Feature

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

  1. Clare Dyer
  1. The BMJ

Developing a new NHS service for young people with gender dysphoria or incongruence has been a “phenomenal challenge,” says the paediatrician charged with the task, not least because of poor data on long term outcomes of treatment. Clare Dyer reports

Clinical guidelines used widely around the world to treat children and adolescents who raise issues about their gender were developed in breach of international standards on guideline development, a review set up by NHS England has concluded.1

The review, chaired by Hilary Cass, past president of the Royal College of Paediatrics and Child Health, calls for far reaching changes to the way children and adolescents with gender dysphoria and gender incongruence are treated. In an interim report in 2022 it recommended that these young people be brought within the mainstream NHS and treated by multidisciplinary teams that would look at them holistically, providing psychosocial interventions where needed.2

The review commissioned the University of York to research international practice and guidelines in the field. Cass noted, “The World Professional Association of Transgender Health (WPATH) has been highly influential in directing international practice, although its guidelines were found by the University of York’s appraisal to lack developmental rigour and transparency.”3

In its final report, published this week, Cass’s review pointed out that although most of the guidelines described insufficient evidence about the risks and benefits of medical treatment “many then went on to cite this same evidence to recommend medical treatment.”

The research carried out by York University, published in the Archives of Disease in Childhood, found that the evidence on the use of …

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