UK transgender report should not change care: advocates

The long-awaited final report from Dr Hilary Cass comes down against puberty blockers, but Australian doctors warn that it ignores a large body of evidence.

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Weeks after NHS England banned the prescription of puberty blockers for gender-affirming care, paediatrician Professor Hilary Cass has handed down her long-awaited report into care for transgender children.

It’s made headlines across mainstream media, but Australian experts are calling for a measured response.

The independent review was commissioned by NHS England back in 2020 and an interim report was released in 2022.

It had a two-pronged aim: understanding why the number of young people presenting with gender dysphoria was growing and to identify the best-practice clinical approach.

The final report identified 11 key findings. The one with the biggest potential to change practice was that there was only “weak evidence” for the effect of puberty suppressing drugs on gender dysphoria, mental or psychosocial health.

NHS England had already moved to ban the use of gonadotropin-releasing hormone agonists for gender dysphoria in young people.

“For most young people, a medical pathway will not be the best way to manage their gender-related distress,” Professor Cass wrote.

“For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.”

Professor Cass also noted that the controversy surrounding medical treatments had taken the focus away from what the individualised care and treatment is meant to achieve for young people.

Brisbane GP Dr Fiona Bisshop, a past president of transgender medicine peak body AusPATH, told The Medical Republic that the Cass Review had disregarded a large body of evidence in support of gender affirming care.

“The review ignored the fact that there is already international consensus on the use of puberty blockers and hormones for trans youth from the Endocrine Society, the American Academy of Pediatrics, WPATH and the AMA, to name a few, and the review findings ignored existing guidelines around the world,” she said.

“This review should not in any way be allowed to impact upon Australian services.

“There is already broad consensus across a number of medical organisations in Australia when it comes to medical care for trans youth – from the AMA, APS, RACGP, RACP, Endocrine Society of Australia and AusPATH.”

Dr Bisshop also pointed out that the independent review was specifically in response to the failings at the Tavistock centre run by the NHS, a clinic that closed primarily because its long wait times and low staff numbers made it unfit for service.

NHS England has since redesigned the care pathway for young people with gender dysphoria; whereas the Tavistock model was centralised through one clinic, the new model involves regional multidisciplinary hubs.

Speaking to Equality Australia, AusPATH vice president Dr Portia Predny reiterated that Australia’s care landscape does not look like the UK’s.

“In Australia, our guidelines for gender affirming care for young people already prioritise holistic, individualised and person-centred care with the involvement of multidisciplinary teams of clinicians with all kinds of areas of expertise, to help and support young people to navigate their gender journey,” she said.

Addressing the Cass Review finding that the existing evidence on puberty blockers was low quality, Dr Predny said there were areas of medicine where it was not feasible to conduct randomised control trials.

“One such area is gender-affirming care but there are many others, including perinatal care and a lot of paediatric care generally,” she said.

“Additionally, when you have multiple observational studies looking at a particular intervention and those studies are producing similar findings, the cumulative evidence becomes compelling.”