What’s wrong with the Cass Review? A round-up of commentary and evidence

[last updated 10/05/24]

Wednesday 10 April 2024 saw the long-awaited publication of the final report of the Cass Review. This report was commissioned by NHS England, and provides a review of evidence plus recommendations regarding gender identity services for children and young people.

On publication, the Cass Review’s findings and recommendations were welcomed by the majority of UK media outlets, NHS England, the Editor-in-Chief of medical journal the BMJ, conversion therapy proponents such as SEGM, Sex Matters and Transgender Trend, plus spokespeople for the Conservative and Labour parties, who promised to ensure it will be “fully implemented”.

Conversely, the Review has been extensively criticised by trans community organisations, medical practitioners working in transgender healthcare, and scholars working in the fields of transgender medicine plus feminist and gender studies. They have highlighted issues including overt prejudice, pathologisation, poor and inconsistent use of evidence, non-evidenced claims, and the intentional exclusion of service users and trans healthcare experts from the Review process.

This post provides a round-up of links to existing commentary and evidence regarding problems with the Cass Review, plus quotes pulled from each. I hope it will be useful to support actions opposing the full implementation of the Review’s findings, such as:

  • letters to MPs, Parliamentary candidates, and NHS bodies;
  • voluntary sector and trade union advocacy;
  • protests and demonstrations.

I will seek to keep this post updated with new material.


Responses from healthcare professionals

British Association of Gender Identity Specialists (professional body for GIC clinicians)
Initial BAGIS statement on the Cass Review

“We are aware that this week’s release of the Cass review raises many questions and uncertainties for people accessing or wanting to access gender identity services, as well as for the staff working in those services. We also know that this is likely to be a source of significant distress and worry. On first glance, BAGIS Council are deeply troubled by some of the content of the Cass Review and the potential impact thereof. We will be considering this lengthy document carefully, and in detail, before offering a comprehensive response to its recommendations and before making any relevant observations regarding the process that has underpinned them.”

~

Professional Association for Transgender Health Aotearoa
Cass Review out of step with high-quality care provided in Aotearoa

“The final Cass Review did not include trans or non-binary experts […] in its decision-making, conclusions, or findings. Instead, a number of people involved in the review and the advisory group previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming ‘gender exploratory therapy’, which is considered a conversion practice.”

~

The Australian Professional Association for Trans Health (plus others from Australia)
Cass Review out-of-line with medical consensus and lacks relevance in Australian context

“The Cass review recommendations are at odds with the current evidence base, expert consensus and the majority of clinical guidelines around the world.”

~

Therapists Against Conversion Therapy and Transphobia
Our interim response to the Cass Report

“TACTT is deeply concerned by the final report of the Cass Review, whose core underlying premise is effectively an eliminationist agenda, dressed up in the language of ‘reasonableness’ […] We urge clinicians to treat the Cass findings with extreme caution and not to assume that they represent best practice or that they have been arrived at after a full and impartial review of clinical data.”

~

CBC News
What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth

“While experts in the field say more studies should be done, Canadian doctors who spoke to CBC News disagree with the finding that there isn’t enough evidence puberty blockers can help. ‘There actually is a lot of evidence, just not in the form of randomized clinical trials,’ said Dr. Jake Donaldson, a family physician in Calgary who treats transgender patients, including prescribing puberty blockers and hormone therapy in some cases. ‘That would be kind of like saying for a pregnant woman, since we lacked randomized clinical trials for the care of people in pregnancy, we’re not going to provide care for you.… It’s completely unethical.'”

~

The National
Trans academics warn against ‘politicisation’ of Cass Review in Scotland

“[…] one experienced psychiatrist at a gender identity clinic in England – who did not wish to be identified – told the Sunday National that failure [to include those with lived or professional experience] had concerned many within the field. They said: “The terms of reference stated that the Cass Review ‘deliberately does not contain subject matter, experts or people with lived experience of gender services’ and Dr Cass herself was explicitly selected as a senior clinician ‘with no prior involvement … in this area’. ‘Essentially, ignorance of gender dysphoria medicine was framed as a virtue. I can think of no comparable medical review of a process where those with experience or expertise of that process were summarily dismissed’.”


Responses and publications from academic experts

Dr Cal Horton
The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children
(peer-reviewed article for the International Journal of Transgender Health)

“Inductive and deductive reflexive thematic analysis was applied to a collection of Cass Review publications related to trans children’s healthcare published between January 2020 and May 2023 […] Four concerns are presented and explored: (1) prejudice; (2) cisnormative bias; (3) pathologization; and (4) inconsistent standards of evidence. Each of these concerns impacts the Cass Review’s approach to trans children’s healthcare, with negative repercussions for trans children’s healthcare rights and well-being.”

Ten Dangerous Cass Review Recommendations

“Each of the recommendations summarised below is built on a foundation of prejudice, ignorance, cisnormativity and pathologisation of trans lives, running in direct opposition to the evidence base, and running in direct contravention of an NHS duty of care to children’s rights, children’s welfare, healthcare equality and healthcare ethics.”

Social transition, puberty blockers, and the Cass Review [added 08/05/24]

“The Cass Review has shown zero evidence of harms of social transition or puberty blockers. The only harm is this hypothesis that they change the trajectory and outcome, locking children into a trans lifetime. This hypothesis is based on the worst quality evidence I’ve ever seen. This is why trans healthcare researchers are feeling stress and dismay at UK media and politicians cheering on Cass’ evidence-based policy.”

~

Dr Natacha Kennedy
The Cass Review and Trans Exclusionism

“Despite the concern-laden language about “helping” and “supporting” trans children, it is my opinion that what Cass is attempting to establish is an all-enveloping ambient conversion therapy approach to trans children, removing their autonomy, freedom of expression, mental health, helpful support and healthcare. […] If imposed it will, in my view, result in the deaths and deterioration in mental health of many trans children.”

~

Dr Abs S Ashley
The Cass Review’s final report: The implications at the intersection of trans and neurodivergence

“Whilst the report cites adjacent NHS services using 0-25 models to justify a ‘continuity of care’ (224), designating trans persons as ‘vulnerable’ and confining them to child-oriented services indicates that more is at stake. These rhetorics contribute to the shoring up of state surveillance and intervention into the lives of legal adults who want to make choices the state disagrees with.”

~

Dr Chris Noone (and 200 colleagues) [added 26/04/24]
Irish academics say young trans people in Ireland deserve better than the recommendations of the Cass Review

“The Cass Review relies on six systematic reviews of different aspects of healthcare for young people accessing gender identity services. Systematic reviews are a way of compiling information from multiple studies that have looked at the same topic and come to an overall understanding of the results. There are very specific guidelines for how systematic reviews should be done but the Cass Review’s systematic reviews deviated from best practice in systematic review methodology in several ways […]”

~

Dr Gideon Meyerowitz-Katz [added 27/04/24]
Has there been an exponential increase in young people with gender dysphoria?

“One of the main arguments that the Cass review has made is that there has been a dramatic and hard-to-explain increase in the number of children who identify as transgender and attend UK clinics with gender dysphoria seeking help. In a number of places, the review describes this increase as “exponential”, and notes that it appears to have been accelerating in recent years. […] The authors say that this increase is far too big to be caused by social acceptance of trans people, and therefore there must be some form of pernicious influence such as social media, mental health problems, or some other issue causing kids to become trans at increasing rates. […] But if you look at the actual data in the reports that the review is discussing, not only is the increase not exponential, it’s not actually that surprising.”

What the review got right [added 08/05/24]

“I think it’s important to stick to the facts when critiquing a review such as the Cass report. […] I think the review made some serious mistakes in both science and interpretation, but they didn’t simply discard most of the evidence, or sneakily change their methodology to get rid of important research. The real story of the Cass review is much more complex than a single weakness that entirely discredits the work.”

Proving opponents of medical treatment for trans children wrong [added 08/05/24]

“Some of the main arguments AGAINST using hormones and medications for transgender children are contradicted by the Cass review. Barely anyone has noticed, because the review mentions this fact once in a single paragraph, and most of the data is relegated to Appendix 8. […] This should be a key point. A chapter of the review. “Common arguments against giving transgender children medications are wrong”. Instead, it’s a footnote. That raises all sorts of red flags. Why were these key findings shunted to an appendix and largely ignored?”

~

Dr Julia Serano [added 10/05/24]
The Cass Review, WPATH Files, and the Perpetual Debate over Gender-Affirming Care

“[The Cass Review] is just a review. In my previous essay, I cited numerous scientific reviews carried out by experts in the field which all came to a different conclusion than the Cass review: that gender-affirming care is beneficial and gender-disaffirming approaches harmful for trans and gender-diverse youth. If those reviews aren’t “authoritative” enough for you, then how about the American Academy of Pediatrics review, or the Endocrine Society review, or the WPATH Standards of Care, or any of the other health professional organizations who have come to similar conclusions.”

~

Dori Grijseels [added 27/04/24]
Biological and psychosocial evidence in the Cass Review: A critical commentary

“Several issues with the scientific substantiation are highlighted, calling into question the robustness of the evidence the Review bases its claims on, as such, calling into question whether the Review is able to provide sufficient evidence to substantiate its recommendations to deviate from the international standard of care for trans children and young people.”

~

Feminist Gender Equality Network
Letter from academics concerned about The Cass Review

“We suggest that the Cass Review contains unsound methodology, unacceptable bias, and unsupported conclusions. As academics and experts in the field, we regard The Cass Review as potentially harmful to trans children.”

~

Trans Learning Partnership
Initial Statement on the Cass Review

Some of [the] recommendations follow entirely spurious narratives and draw unfounded conclusions. The whole report is positioned in a way which considers continuation of current medication access as harmful, but removal of the current medication access as a neutral or beneficial act, despite no evidence to support this. We are particularly concerned about the content discussing neurodiversity; social transition; and access to medications for children and young people. The report positions the fact that clinicians are unable to predict the future of children and young people’s gender expression as a critical failing of current practice. No service can or should aim to predict the future of children or young people’s lives and the idea that a clinician will know a young person better than they know themselves is in direct contradiction to the United Nations Convention on the Rights of the Child. The aim for clinicians should be to provide a safe, accessible and supportive service which provides individualised care to all children and young people it encounters.”


Responses from trans community organisations

Trans Safety Network
TSN Statement on Cass Review Final Report

“[…] we believe there to be systemic biases in the ways that the review prioritises speculative and hearsay evidence to advance its own recommendations while using highly stringent evidence standards to exclude empirical and observational data on actual patients. This adds to the concerns we have previously had about Cass excluding trans people from the research oversight board – that Cass was set up from the start to impose a particular perspective without input from the patient cohort affected by the outcome.”

Do no harm? The trouble with Cass’ therapy recommendations

“In the absence of effective treatments for dysphoria outside of transition, ‘alternatives’ rely primarily on impossibilising transition […] any therapeutic paradigm for trans and gender-variant young people must explicitly centre the reality and accessibility of transition and affirm all potential genders/embodiments, and should provide information on what pseudo-therapeutic manifestations of anti-trans rhetoric look like, both in clinical and community settings. Models that do not include this risk endorsing the influence of transphobic hostility on identity formation, for instance, or affirming rhetoric that assigned sex is ‘reality’ when this coheres with a given young person’s identity.”

Did the NHS ever stop funding conversion therapy? [added 08/05/24]

“Whether Hilary Cass wants conversion therapy to be institutionalised on the NHS again is immaterial: her recommendations have made space for it. Therapy is a caring profession, and despite the crueller parts of its history, good work happens under its banner – but so does violence. The NHS must set out a clear and actionable plan to keep conversion therapy out of its services, and investigate instances where it may have been allowed to take place. Anything else is complicity.”

Trans Safety Network statement on NICE evidence reviews on trans affirming care

“In June of 2023 it was disclosed to us by members of the Cass Review team that anti-trans author and commentator Dr Az Hakeem was part of “NHS England’s policy working group which commissioned the NICE evidence reviews undertaken in 2020”. Dr Az Hakeem has long been a partisan opponent of gender affirming medical treatments. While Hakeem disavows conversion therapy or trying to dissuade trans people from medical interventions, on his personal website he directs readers looking for specialist support for gender dysphoria to conversion therapy activist groups, such as Bayswater Support Group, and the anti-trans pseudoscientific lobby group SEGM. Hakeem is also a member of CAN-SG who have from their earliest webinars (link) promoted the idea that trans people should be dissuaded from transition and instead either change their minds, or undergo therapy to live with the discomfort of gender dysphoria without accepting their trans identity — in other words, that trans people should undergo conversion therapy.”

~

Trans Actual
The Cass Review is bad science and should not be taken seriously by policymakers

“The report […] strays far beyond its scope and competence in recommending a review of adult services and in suggesting that young people ought to stay under the care of children and young people’s services until the age of 25. The latter is based on highly questionable understandings of brain development which have been repeatedly debunked as an oversimplification of the constant changes in human neurology over the course of our lives. […] Underpinning this report is the idea that being trans is an undesirable outcome rather than a natural facet of human diversity. This is clear not only from the recommendations but also from the exclusion of trans researchers from the design of the review process and the links individual members of the research team have to anti-trans groups, which the Cass team were warned about.”

~

The Cass Report – A Briefing

The Report dismisses almost all evidence around existing protocols for treating trans young people, including lived experience, on the spurious grounds it does not meet unobtainable levels of proof. The team do not apply the same rigorous evidential tests to their own proposals. Indeed, if such evidential requirements were imposed consistently and equally across the NHS, it would mean that many routine treatments, including treatments for menopause, palliative care and mental health, would also have to cease.”

~

Gender Identity Research & Education Society
GIRES Statement following the publication of the Cass Report

“Of note, many other paediatric medications that are routinely used in paediatric care, do not and cannot have the level of evidence that Cass and NHS England demand: medicines for ADHD, for example, anti-psychotic medications, and many others have comparable if not lower levels of evidence.”

GIRES Chair Cat Burton:

“I was invited to consult with the Cass review. After three discussions it was obvious that the review had been written before we started. She totally discounted evidence from trans people from the basis of knowledge or lived experience.”

~

Mermaids [added 26/04/24]
Mermaids’ response to The Cass Review – In Depth

“Young people we have spoken to are concerned about what they have read, including the desire to understand “why” young people are trans, and to place what feel like “limits” on gender expression, further pathologising and medicalising their identities. We share these concerns. We are deeply frustrated with the lack of clarity throughout the report, which has enabled wilful misinterpretation and the spread of harmful misinformation. Clear and accessible language is vital, especially when services are operating in a context where there is significant hostility to and misconceptions about trans people, particularly in the media. “

~

Trans Solidarity Alliance
Statement on the Cass Review

“In the world the Cass Review imagines a trans child will be seen quickly but not given the care they need. They will still wait for years if they want to access gender affirming healthcare. While they wait they will be expected to engage with therapy that risks becoming conversion practice. While they wait, they will go through a puberty they may find profoundly distressing. They will be treated for every other condition they have. They will be treated for conditions they develop as a consequence of denial of trans healthcare and living in a transphobic world. But they won’t get the care they need to feel comfortable in their own skin. This is a model of care that works for cis people who are upset by the idea of a trans child existing.”

~

Transgender Action Block
Our statement on the Cass Review

“The NHS has always been a violent, white supremacist, saneist, transphobic system; the Cass Report was never going to change that system, indeed it was designed to expand it. The NHS does not provide trans healthcare: it disciplines and punishes trans people, so we will transition in any way we can – with community-led care, private care, and overseas care. We will smuggle, borrow, share, and steal the medicine we need. We will take direct action to protect each other. We survive. We rebel. Fuck the NHS.”

~

The Dyke Project
Today, we dropped a 30ft banner

“Politicians will continue to create moral panics to distract and divide us from their own failings. The Cass Review, instead of focusing on a lack of funding, long waiting lists and overstretched staff is ultimately calling to restrict trans healthcare. Enough is enough. Trans youth don’t need to be studied, managed or saved. They need the same opportunities and quality of care that their cis friends and family receive.”


Responses from human rights groups

Amnesty International and Liberty
Cass review on gender identity is being ‘weaponised’ by anti-trans groups

“This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people. It’s concerning that sections of the media and many politicians continue to spread moral panic with no regard for the possible consequences for trans people and their families. The negative rhetoric by the Government about the dangers of so-called gender ideology, healthcare for young trans people, as well as the push against LGBT-inclusive sex and relationship education is harmful and extremely damaging.”


Critical and investigative journalism

Them
Advocates Say a Controversial Report on Healthcare for Trans Kids Is “Fundamentally Flawed”

“International medical organizations and transgender activists are roundly condemning a new U.K. report on gender-affirming care for minors, saying the report ignores years of research to propagate “harmful” misinformation.”

~

Assigned Media
What’s in the Cass Report?

“The Report included many recommendations for treatment of youth presenting at gender clinics in England. Some of these were fairly technical, describing proposed relationships between NHS entities such as regional centers, centralized authorities, and local/tertiary providers. Other recommendations were broader […] The recommendations synthesize a view of medical transition as a bad outcome to be avoided, and a belief that gender dysphoria can be successfully treated non-medically, despite no non-medical interventions being evaluated in any of the series of systematic reviews[.]”

~

Queer AF
Cass Review excluded 98% of gender-affirming hormone studies to reach its conclusion

“This week, when the Cass Review was released, news outlets rushed to cover the story, highlighting the report’s conclusions without taking time to consider whether the report could be flawed. In doing so, it amplified and solidified to the wider public the report’s key conclusions without balancing it against the evidence it excluded to reach them. […] Crucially, despite a four-year process, it still failed to find any smoking gun of widespread regret among trans folks who transition. It instead had to rely on a methodology that allowed it to exclude any data about how gender-affirming care helps trans people.”

~

What The Trans?!
The Cass Review needs to be thrown out entirely. This is why.

“We contend that the Cass Review is not fit for purpose. We suggest that it was not merely knocked off course by a flawed methodology. We believe the Cass Report is a deliberate part of a political project aiming to reduce the availability of trans healthcare, possibly eventually in its entirety. It is imperative that we understand this and act on it.”

Trans Community in Scotland Protests Against NHS and Scottish Government Betrayal

“The trans and questioning children who are at the centre of this conversation are in community with one another, and they understand exactly what is happening to them. While we are focussed on the bigger picture, I was taken by their confidence and eloquence when speaking of their experiences. [A speaker shared] a story about speaking to a trans kid they knew through their work, who, speaking of their many friends who had died of suicide: “Yeah, you know how it is.” And we do. We are used to just how extreme what is currently happening to us in the UK is, and the real effects it has on us. We have been sounding the alarm for years, but we are now feeling the UK’s uniquely slow and bureaucratic oppression start to bite[.]”

~

Yorkshire Bylines
The Cass review: trans care or trans scare?

“Children’s wellbeing is indeed at stake here, but that includes the wellbeing of children who are actually trans. Far from taking the matter out of politics, the review – and Rishi Sunak’s subsequent praise of it – has put it centre-stage. Some readers will remember the climate of homophobia that suffused the run-up to the 1997 general election, when the Conservative Party, desperate as it is now, brought out the “They’re coming for your children” rhetoric in a last-ditch effort to panic people into voting for it. This review – whose final report has been awaited for some time – feels like an attempt at the same thing.”

~

Erin in the Morning
Opinion: England’s Anti-Trans Cass Review Is Politics Disguised As Science

“It is important to note that the Cass Review contains very little new data and evidence. Any statements it makes are based on the same level of evidence that every major medical organization in the United States, along with some of the largest mental health societies in the world and professional associations of transgender health, have determined to support transgender care. If its claims differ from those institutions, it’s because reviewers made choices to view the evidence around transgender care negatively.”

Dr Cass met with DeSantis Pick Over Trans Ban: Her Review Now Targets England Trans Care

“The Cass Review seems to have emulated the Florida Review, which employed a similar method to justify bans on trans care in the state—a process criticized as politically motivated by the Human Rights Campaign. Notably, Hilary Cass met with Patrick Hunter, a member of the anti-trans Catholic Medical Association who played a significant role in the development of the Florida Review and Standards of Care under Republican Governor Ron DeSantis. Patrick Hunter was chosen specifically by the governor, who has exhibited fierce opposition towards LGBTQ+ and especially transgender people, and then immediately got to work on targeting transgender care. The Florida review was purportedly designed and manipulated with the intention of having “care effectively banned” from the outset, as revealed by court documents. The Florida Review was slammed by Yale Researchers as “not a serious scientific analysis, but rather, a document crafted to serve a political agenda,” and much of their full critique is applicable to the Cass Review as well.”

~

Trans Writes
The 32 things The Cass Review recommends and why they are concerning

“The 32 recommendations, informed by the highly conservative evidence base, look to impose further restrictions and control on trans lives — and not just the lives of trans youth with the scope of these recommendations including 25 year olds. Given that we know The Cass Review has been majorly influenced by anti-trans activists with ties to conversion therapy efforts, it’s probably worth looking at some of the recommendations and how they relate back to what transphobes are doing to organise against trans liberation.”

~

The Autonomy
Between Reproductive Past and Trans Future

“The overall recommendation is to force patients to wait through psychological busywork and relevant-sounding delays, implementing a largely-arbitrary set of hoops to jump through with the hopes the patient just gives up. Focus on the patient’s anxiety, focus on their autism, focus on any other issue except their gender and their desire for a sex change[.]”

~

404 Media
Review Used By UK to Limit Gender Affirming Care Uses Images of AI-Generated Kids

“Earlier this month, WIRED noted that generative AI has a track record of representing queer and trans people as a collage of stereotypes. It is not clear why the Cass team used AI-generated images in this report, which, again, has been used as evidence by the NHS to stop providing gender-affirming care to trans kids.”


Social media

Chamber Voice (published by policy institute Curia) [added 24/04/24]
How politically unbiased is Cass?

“Questions have been raised about the neutrality & evidence basis for the controversial #CassReview. The report’s author Hilary Cass has been asked to provide answers why she is meeting with Women’s Declaration in the House of Lords this week.”

Context note: under their old name of Women’s Human Rights Campaign, the organisation Women’s Declaration International have openly called for the “elimination” of trans people. More information on the meeting can be found here.

~

Ethel Weapon
#Cassflaws threads on Bluesky

“§6.18 presents us with the idea that toy choice is influenced by hormones. To accept this report is to accept that estrogen, for example, has a biological effect that causes a preference for play with toy cooking pans over toy trucks. In §6.23 we are directed to the work of Melissa Hines in support of this hypothesis. Hines was one of the two authors of the “vervet monkey” study that claimed to show such toy preferences in monkeys. A study that implies something about estrogen makes monkeys want to play with cooking pans.”

“Here is Cass citing “Thoughts On Things And Stuff”. This is a YouTuber whose channel includes a host of anti-trans video material, including material from notorious anti-trans figures, including ‘”‘Gays Against Groomers’.”

~

TransSafetyNow

“It has been drawn to my attention that [a booklet produced based on research cited by the Cass Review] was funded by SEGM’s William Malone & anti Trans lobby group Transgender Trend.”

~

猫好きな人

“In 2021, Trilby “Tilly” Langton, the sole gender affirming care “expert” involved in the Cass systematic reviews, went to lobby Kemi Badenoch about the conversion therapy ban. With a featured speaker at the 2024 CAN-SG conversion therapy conference.”

~

Simon Whitten
Did the Cass Review disregard the evidence of all but 2 of 103 studies on puberty blockers & hormones to reach it’s conclusions? Yes and no.

“The review found 5 studies of moderate certainty relevant to psychological health. All 5 supported the conclusion that treatment of trans teens with CSH [cross-sex hormones] improved psychological health. There were no findings of worsening psychological health. What conclusions would you draw from this? Our intrepid authors draw no conclusions from this whatsoever, instead declaring the evidence for every outcome for which there was no high certainty study “inconclusive.” Similar is true for other outcomes and for puberty blockers. This is the sense in which the Cass Review absolutely did ignore almost all evidence on the efficacy & safety of PBs [puberty blockers] and CSH. The majority of moderate certainty studies were included in the results section but then arbitrarily ignored in the conclusion entirely.”


Dr Cass Responds

The Kite Trust
Q&A with Dr Hilary Cass

“The Cass Review Report does not conclude that puberty suppressing hormones are an unsafe treatment. The report supports a research study being implemented to allow pre-pubertal children to have a pathway to accessing this treatment in a timely way and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria. In the data the Cass Review examined, the most common age that trans young people were being initially prescribed puberty suppressing hormones was 15. Dr. Cass’s view is that this is too late to have the intended benefits of supressing [sic] the effects of puberty and was caused by the previous NHS policy of requiring a trans young person to be on puberty suppressing hormones for a year before accessing gender affirming hormones. The Cass Review Report recommends that a different approach is needed, with puberty suppressing hormones and gender affirming hormones being available to young people at different ages and developmental stages alongside a wider range of gender affirming healthcare based on individual need.”

Some final thoughts: recommendations such as this from the Q&A are not clearly reflected in the content of the report or the later Q&A published on the Cass Review website. In a blog post accompanying that Q&A, Dr Cass complains about “some of the assertions being made on social media, and occasionally on mainstream broadcast media, which misrepresent the report and its findings, whether wilfully or otherwise“.

In my expert opinion, the critiques linked to in this blog post have yet to be properly addressed by the Cass Review team, let alone any of the politicians or healthcare service directors promising the implementation of the Review’s findings.

Regardless of whatever Dr Cass’ intention may or may not have been, the Review process itself intentionally and explicitly excluded any oversight from service users and trans healthcare experts, and involved collaboration with proponents of conversion practices. The final report relies on poor and inconsistent use of evidence, and makes recommendations that put young trans people in danger.

RCGP host conversion therapy conference in London – protest 23 March

On Saturday 23 March the Clinical Advisory Network on Sex and Gender (CAN-SG) are hosting at conference at 30 Euston Square, the headquarters of the Royal College of General Practitioners. CAN-SG are described by Trans Safety Network as “an organisation composed mainly of activists involved in the pseudoscience network SEGM, and the anti-trans conversion therapy campaigning body Genspect“.

A noise demonstration will be held outside the conference venue from 10am on 23 March, hosted by Transgender Action Block, Lesbians and Gays Support The Migrants, and The Dyke Project.

Protest poster, which reads as follows. Noise demo against Royal College of GPs conversion therapy conference. 30 Euston Square, March 23rd, 10am, 2024. Get loud, get angry against institutionalised abuse. No parasan. Full youth autonomy now. No cops, no SWP, no Tories.



According to the Memorandum of Understanding on Conversion Therapy, an agreement signed by 40 leading professional bodies and healthcare providers, conversion therapy “is an umbrella term for a therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other, and which attempts to bring about a change of sexual orientation or gender identity, or seeks to suppress an individual’s expression of sexual orientation or gender identity on that basis”. Conversion therapy has been described as a form of torture in academic work and by UN experts.

The CAN-SG event speaker lineup is a who’s who of conversion therapy proponents and anti-trans activists, including:

  • Stelley O’Malley, founder and director of Genspect, who has described seeking to suppress the gender identity of teenagers in her therapeutic work, adding: “I don’t think you should have empathy or sympathy” for young trans girls.
  • Michael Biggs, an anti-trans campaigner linked to a prolific troll account on Twitter.
  • Richard Byng, a member of anti-trans pseudoscience network SEGM.
  • Rachel Cashman, a campaigner against trans inclusion in schools, and supporter of Women’s Declaration International (WDI). Under their former name of Women’s Human Rights Campaign, WDI have openly called for the “elimination […] of the practice of transgenderism”.
  • Az Hakeem, a member of Genspect and an active opponent of a proposed legal ban on conversion therapy. Hakeem was reported for conversion therapy to the GMC by a former patient.
  • Anne Hutchinson, who has promoted materials by Genspect in training for South London and Maudsley NHS Mental Health Trust.
  • Riittakerttu Kaltiala, a Finnish clinician and opponent of affirmative care who contributed evidence for Florida’s ban on medical transition for young trans people. I have not found any evidence that Kaltiala opposed Finland’s policy of forced sterilisation as a condition of legal recognition for trans people, which was repealed only last year, but am willing to be corrected on this. According to a recent academic biography, Kaltiala sits on the advisor board of the Cass Review.

The Royal College of General Practitioners (RCGP) are signatories of the Memorandum of Understanding on Conversion Therapy. Signatories agree that conversion therapy is “unethical and potentially harmful”, and commit to ending this practice in the UK.

Following complaints from LGBTIQ+ groups and their own members, the Royal College of General Practitioners (RCGP) released a statement saying that the conversion therapy conference would go ahead. In the statement, they argue that their headquarters building, 30 Euston Square, is “an event space run by an independent events company”. However, the statement opens by saying that the RCGP has “reached the decision that the Clinical Advisory Network on Sex and Gender (CAN-SG) conference can go ahead”, and later adds that “the College would be at risk of being faced with a claim for breaching the Equality Act if we acted otherwise”. This implies that the RCGP do, in fact, have control over their own building, and have taken the active decision not to oppose the conference.

Legal threats are increasingly common from anti-trans campaigners, who argue that cancelling contracts or events constitutes an attack on their “gender critical” views as “protected beliefs”. The CAN-SG conference has been widely reported as a gender critical event, and indeed several of the speakers appear to describe themselves as “gender critical”. However, the issue with the event is not the beliefs of the speakers or organisers in and of themselves. It is that they are actively promoting disinformation and harmful practices.

The RCGP’s position is therefore one of gross cowardice, and demonstrates that they are not actually committed to preventing harm against trans people in healthcare settings. It costs the RCGP very little to sign a document claiming that they oppose conversion therapy, or condemn the UK government for failing to introduce a legal ban. However, now that the fight against conversion therapy has come to their door, they are not prepared to act.

It is within the power the RCGP to ensure that the CAN-SG conversion therapy is cancelled. They have chosen not to do this. It is within the power of the RCGP to oppose CAN-SG in court, if it came to that. They have chosen not to.

This reflects the same failures we have seen from bodies including NHS England and the Cass Review. I am often asked why trans people do not trust doctors. This is why. We are failed by medical professions over and over again.

Change happens not because powerful organisations allow it, but because ordinary people fight for it. A true commitment to ending conversion therapy can be seen not in the actions of RCGP, but in the work of groups like Transgender Action Block, Lesbians and Gays Support The Migrants, and The Dyke Project. I am also hugely grateful to grassroots organisations such as Trans Safety Network, Health Liberation Now, and Gender Analysis for gathering a lot of the information I collated in this post.

That power also potentially lies with you. Trans support groups and harm reduction networks for people self-medicating can be found across the UK, and will always benefit from your support. And you can complain to the RCGP here.

Natacha Kennedy at TRED 2011

Natacha’s talk at TRED 2011. The bulk of this presentation is a witty response to Az Hakeem’s 2010 paper Deconstructing Gender in Trans-Gender Identities. Natacha herself deconstructs three central arguments present within the paper:

1) Trans people can be prevented from having genital reassignment surgery through group therapy.

2) Gender is becoming less rigid for cis people but more rigid for trans people.

3) Sex is “real” and scientifically verifiable, whereas gender is not.

The talk concludes with a brief reflection upon the work of Kenneth Zucker and the “normality” of trans and intersex phenomena.

 

Trans* Education and Determination: a review

The Trans*Trans feminist symbol, designed by Helen G Education and Determination teach-in took place on Friday 20th May: the date on which a cancelled psychiatric event was intended to take place. It featured a number of talks, presentations and workshops exploring issues such as trans academia, counselling, psychiatric practice, and feminism.

The teach-in was a great success, and will hopefully lay the groundwork for future such events. This community effort – organised on the internet by a loose team of volunteers – was a powerful rebuke to the medical and psychiatric institutions that claim to speak for trans people whilst denying us a voice.

Trans* Education and Determination was originally envisaged as a response to the Royal College of Psychiatrists’ event Transgender: Time to Change, which was due to feature two transphobic speakers: Dr Az Hakeem and Julie Bindel. This event was cancelled following the announcement of a trans community protest and the withdrawal of support from Charing Cross Gender Identity Clinic. However, the decision was taken to go ahead with the teach-in.

Almost thirty people arrived at King’s College London for the launch of the teach-in on the Friday morning. This number gradually grew throughout the day as attendees freely came and went from the open event. Cheryl Morgan, Roz Kaveney and Juliet Jacques volunteered to act as chairs, taking turns to introduce speakers and facilitate questions and discussions.

PhD student Ruth Pearce informally opened the event during the introduction to her talk. She explored the theme of articulation, arguing that the teach-in offered a valuable opportunity to give voice to trans experiences and perspectives.

Ruth’s presentation offered some background on the evolution of trans academia and suggested that the internet has played a particularly powerful role in shaping the recent history of trans identity and community. She then provided some details of her planned research project, which will explore trans experiences of primary healthcare in the United Kingdom.

Attendees asked about Ruth’s research methods, which involve acquiring data from online communities. This led to a valuable discussion that explored the potential advantages, pitfalls and ethical implications of internet research.

Lunch was followed by a talk given by psychologist and sociologist Dr Lyndsey Moon. Lyndsey drew upon her experiences as a queer child, a practising counsellor and a teacher to critique the rigidity and contingency of psychiatric categorisation, particularly that found in the American Psychological Association’s Diagnostic and Statistical Manual (DSM). This talk illustrated the DSM’s failure to account for fluidity and complexity, and the danger this poses for professional understandings of gender and sexuality.

Lyndsey also explained how her own research had demonstrated that psychologists and psychiatrists receive practically no training on the impact of social phenomena such as gender, sexual orientation, disability, race and religion. She argued that psychology and psychiatry remain broadly white, middle-class and abled professions in the UK.

Attendees expressed their broad agreement with Lyndsey’s points and joked about artificiality of psychiatric classification. A number of individuals explained how they’d been treated poorly within academia because of the transphobic assumptions made about them.

Academic Natacha Kennedy provided an extended examination of Dr Az Hakeem’s 2010 paper “Deconstructing Gender in Trans-Gender Identities”. In this article, Hakeem argued that trans people reinforce gender norms, and advocated group therapy as an alternative to transition and stated.

Natacha questioned the logic of Hakeem’s claims, and demonstrated how he failed to provide evidence about many of his statements. Her frequently amusing deconstruction demonstrated how the paper relied greatly upon ideological statements rather than evidence-based study.

The presentation concluded with some background on the approach of Kenneth Zucker, a practitioner with somewhat more extreme views than Hakeem who is contributing to the next edition of the DSM. Natacha explained how her own research findings contradict some of Zucker’s claims during an anecdotal account of a previous trans protest.

NUS LGBT representative Kai Weston shared his perspective on the intersection of trans experiences and feminism. He provided a refutation of the radical feminist position held by Julie Bindel, drawing upon examples of gender variance from non-western societies and within trans communities to counter her argument that trans people reinforce binary gender norms.

Kai’s thoughts provided the introduction to an extended group discussion of intersectionality and the impact of feminist theory on trans lives. Attendees asserted the importance of countering sexism and misogyny whilst exploring the relative benefits and disadvantages of different feminist positions. Issues such as the invisibilisation of transmasculinity and the tensions between trans and intersex activism were also touched upon.

Journalist Jane Fae provided the final talk of the day, a deeply personal critique of psychiatry. She explained how Freud in particular relied upon deeply unrepresentative samples in order to justify his theory, suggesting that Freudian psychiatry therefore owes considerably more to abstract theorising than to empirical evidence. She provocatively claimed that the psychiatric profession and its accompanying academic literature is a psuedo-scientific scam.

Jane finished her talk with an emotional attack upon the psychiatric gatekeeping that requires trans patients to spend a considerable amount of time and/or money in order to pursue a physical transition.

The audience broadly welcomed the uncompromising central thrust of Jane’s argument, although there were some counter-examples illustrating benefits that psychiatry can bring. There was some confusion over the boundaries between psychiatry, psychology and psychotherapy, with a number of suggested solutions proposed.

Attendees broke away for individual discussions before the day finished with group feedback on the day, in which everyone present was offered the opportunity to share their thoughts and feelings. Positive criticism of the teach-in was shared with an eye towards similar events for the future.

Some felt that a less academic or “studenty” feel might help appeal to a wider audience. A number of individuals argued that any future events should remain free, although the possibility of a sliding scale entry fee was also suggested. Many agreed upon the idea of holding future trans teach-ins outside of London, hopefully within a somewhat more accessible, non-university building. It was also felt that more could be done to reach out to groups under-represented at the event, such as minority ethnic trans people.

Everyone welcomed the positive, productive atmosphere of the event, and thanks were offered to the many volunteers who worked hard to make the day a success.
Trans feminist symbol designed by Helen G.

Trans* Education and Determination: teach-in details confirmed

From the Facebook event page:

FRIDAY 20th MAY
A trans teach-in to discuss issues of psychiatry, community and care, originally conceived in response to the presence of transphobic speakers at the (now cancelled) Royal College of Psychiatrists’ event “Transgender: Time to Change.

There will be a number of talks and workshops throughout the day, alongside open discussions and debates. All are welcome!

Times: 11am-6pm

Location:

Ground Floor Room 2, Strand Building, King’s College London

Strand, WC2R 2LS
London, United Kingdom
Entry: FREE

Provisional timetable:

11am: event opens
11:30am: Dr Lyndsey Moon: a discussion of counselling practices
12:30pm: Lunch
1:30pm: Natacha Kennedy: a critique of “talking therapies”
2:30pm: Kai Weston: workshop
3:30pm: Ruth Pearce: identity and fluidity within trans communities
4:30pm: Jane Fae: a critique of psychiatry
5:30pm: community workshop/discussion

For further details, visit our blog: http://transfringe.wordpress.com/about/

This event is kindly hosted by KCL Women’s Officer and GenderMatters@Kings.

Trans community teach-in confirmed for 20 May

With the Royal College of Psychiatrists’ transphobic event cancelled, activists are going ahead with a proposed “teach-in”, originally due to take place alongside the RCPsych conference one part of a day of protest. Student feminists and academics at King’s College London are working to book a room in an accessible location.

The community event will therefore take place on Friday 20th May 2011 from 11am-6pm (provisional times).

It will be held in Kings College London, Strand Caucus, in central London with the room TBC. All are welcome.

I’ll post further details as I get them.

Regular updates will be made on the event blog: Trans* Education and Determination.

Transphobic conference CANCELLED

The Royal College of Psychiatrists have cancelled “Transgender: Time to Change“. This isn’t just a victory for the trans movement: it’s also a victory for angry blogging, community organising and the threat of peaceful protest.

Pink News have a really positive piece on the cancellation.

RCPsych claim that the cancellation was down to low ticket sales. However, it’s pretty telling that the event was cancelled right after Charing Cross Gender Identity Clinic put out this statement:

The team at the WLMHT Gender Identity Clinic (GIC) at Charing Cross Hospital notes the apparent shift of emphasis in the Royal College of Psychiatrists Gay & Lesbian Special Interest Group conference, ‘Transgender: Time To Change’ on May 20th and feels compelled to withdraw on this basis.

When we were originally asked to take part, GIC clinicians understood that our role was to outline the work we do within our own service and explain the very considerable evidence base which underpins it. We are very happy to do this and our more than 55 years of experience as the country’s leading NHS provider gives us a rich and robust data set from which to draw observations.

It now appears that the conference comes at trans issues from a very specific agenda, namely, to explore the validity or otherwise of gender diagnoses as medical and psychiatric phenomena. So long as this is the case, we feel we can’t support it.

Although we were somewhat wary of engaging in what is essentially a clinical discussion with a predominantly non-trans panel, which, moreover, features a non-clinician whose personal opinion is already well known, we agreed to do so in order that discussion might focus on evidence rather than anecdote.

The Royal College should be aware that there is a great deal of disquiet around this event within the trans community and interested parties should note that the discussion as it now stands will be one-sided at best..”

On the subject of “numbers”, it’s also worth pointing out that registration was meant to be open until 9th May. That suggests that the number of people signing up for the event was really low: an encouraging turn of events! Commentators elsewhere have suggested that many psychs will have been put off by the outdated views held by many of the speakers. I only hope this is the case.

This is well worth celebrating, but the good news shouldn’t be the end of the matter. There’s a few really important lessons we can learn from the whole affair, and some things we need to think about regarding future action.

Trans people are still treated awfully by the medical establishment in general, and the psychiatric establishment in particular. We need to explore how to bring about change: through research and its dissemination, through lobbying, and through protests. The simple threat of a colourful, vibrant protest on the PCPsych doorstep clearly had a massive impact, as did the actions of those who talked to psychs and to Charing Cross.

The gender clinics and gatekeepers of this country have a troubled relationship with the trans community, but it benefits us to work with them. Currently, they’re not particularly accountable: Charing Cross has a patient feedback group, but how many trans people even know of this group? How many know how to contribute to its feedback? How many know the vast majority of groups invited to attend the meetings are London-based? This situation needs to change, but the clinic’s actions on this occasion suggest that it can.

Julie Bindel will probably kick up a fuss. Personally, I feel we should let her get on with it. Any opportunity for us to promote our arguments against the approach taken by the cancelled conference is a good one.

Finally, I’ve been informed that activists are planning to go ahead with the community “teach-in” that was originally planned to coincide with the transphobic conference. After all, there are speakers and facilitators booked, so why not? People are talking about focusing on the continuing problems within trans health in general and psychiatry in particular, and exploring where we might go from here. The venue and timetable are still being arranged, so I’ll post again once there’s news on that front.

Transphobic conference: the RCPsych and Charing Cross perspective

There’s been some interesting commentary on the “Transgender: Time To Change” meeting emerging in the blogosphere over the past few days. Natacha Kennedy has posted some of the correspondence that has taken place between herself, journalist Jane Fae and the Royal College of Psychiatrists. It seems that RCPsych are keen to put the issue behind it by ignoring us really hard:

The conference aims to explore the recent academic, clinical and contemporary thinking on transgender issues. The SIG has invited speakers for their differing perspectives, including a speaker to give a personal perspective on transgender issues. The invitation of particular speakers does not mean that the SIG share the speakers’ views on the topic […]

You also say that the conference is “going to be perceived by those in the trans community as a threat”. The intention is not to cause alarm and distress to the transgender community, and we regret if our organising this event has done so.

Following this email, the discussion was (understandably) forwarded to Deborah Hart, the RCPsych Director of Communications and Policy. She had this to say:

The College is involved in organising numerous conferences about a wide range of issues. Any opinions expressed by individual contributors at these meetings are the personal opinions of those contributors and cannot be taken to represent the views of the College.

I feel that the previous correspondence from Liz Fox clarified the College’s position on this issue and that nothing further can be gained by continuing this debate as we have nothing further to add.

As Natacha and Jane point out, this response is entirely missing the point. By holding a conference on trans people in which the vast majority of trans people are not invited to participate, where individuals like Az Hakeem and Julie Bindel are invited to speak, the Royal College of Psychiatrists demonstrates its contempt for trans people. We deserve access to treatment, and we deserve to be treated with respect: RCPsych seem to be interested in neither of these outcomes.

Meanwhile, an interesting comment has appeared on Jane’s own blog, courtesy of  Stuart Lorimer, a psych at Charing Cross. I personally respect Lorimer a great deal for his no-bullshit approach to treatment, his broad support for trans rights, and his presence at numerous demos (including the 2008 Stonewall Awards protest). In his comment, he seems to suggest that Christina Richards and James Barrett signed up as speakers at the RCPsych conference with the intention of refuting Hakeem and Bindel:

Psychiatrists are intelligent people. Well, some of us are.

This “debate” has been on the cards for a while. It’s probably fair to say that, as a clinic, we’ve been divided in terms of how to respond to an event already set up with non-clinician Julie Bindel and Dr Az Hakeem providing stances based on anecdote but limited evidence. To some extent, it could be argued that even the act of engaging with an ostensibly absurd/obscene topic to point out its absurdity/obscenity lends that topic a spurious pseudo-legitimacy it does not deserve. This is a valid viewpoint and one with which we have wrestled.

Those of us taking part do so because we felt, after much discussion, that it was important to inject some actual clinical evidence/experience into what might otherwise be a display of largely uninformed opinion.

Please do not tar all psychs with the same brush.

I think it is important to bear Lorimer’s final statement in mind when we protest against this conference next month. I personally know a few individuals who will be attending in order to oppose the more regressive views promoted by the event, and we will only benefit from winning over attendees who are currently ignorant of the situation.

As such, we should be careful to protest the conference itself, whilst treating attendees with respect. We want to make allies, not enemies: this can be done by directly addressing attendees with our concerns in a friendly manner even as we shout slogans and wave colourful banners in the general direction of the fancy RCPsych building.

Mission Statement

In the light of certain accusations that have been levelled at trans activists in the wake of the Royal College of Psychiatrists’ upcoming conference (“Transgender: Time To Change“), I feel it’s important to clarify my position on trans activism. This post relates directly to the aforementioned conference, but also more generally to the kind of activism I promote on this blog.

I believe that trans activism is for everyone. Trans activism is about promoting gender liberation for all. I feel that Leslie Feinberg sums this up particularly well in hir introduction to “Trans Liberation: beyond pink or blue”:

The sight of pink-blue gender-coded infant outfits may grate on your nerves. Or you may be a woman or a man who feels at home in these categories. Trans liberation defends you both.

Each person should have the right to choose between pink or blue tinted gender categories, as well as the other hues of the palette. At this moment in time, that right is denied to us. But together, we could make it a reality.

Trans activism therefore incorporates and complements transsexual activism, but is noteably distinct. The goals of trans activism also complement those of feminism: we fight not for gender equality, but for gender liberation.

We fight to free individuals from the constraints of necessary gender categories and gender roles with the proviso that an individual be free to define their own gendered experience. If someone wants to wear dresses, or trousers, or make-up, or grow a moustache, or armpit hair, then cool. Be free, and liberated. Express yourself.

As a trans activist, I believe that individuals have a right to transition. A transition may be social or physical. It may involve new clothes, hormones, surgery…one of these things, or none of these things. It has to be contextual and right for the individual, and move at a speed that is right for them. Transsexed people often have deep-seated reasons for feeling extremely uncomfortable with their sex characteristics, and a transition can alleviate this. A a trans woman, I have benefitted a great deal from my transition. I am fortunate enough to live a more fulfilling life.

I do not feel that my experiences in any way put me at odds with feminism. I oppose outdates stereotypes of the woman as passive and ornamental. I support my sisters’ fight for equal rights and gender liberation: for equal pay, for body sovereignty, and against sexist, patriarchial institutions. I do not dress in a particularly feminine fashion: this is what works for me. I know some trans women who are very butch, and others who are high femme. As a trans activist, I believe in their right to express themselves.

However, I feel it is important for trans activism to also recognise the right not to transition. Transition is not right for all gender variant people. The important thing is that we are all free to express ourselves, regardless. No-one deserves to be pushed onto a particular gender path by overzealous medical institutions, feminists or trans communities with a point to prove.

I oppose the ethos of “Transgender: Time To Change” because I feel that the attitude of individuals such as Az Hakeem and Julie Bindel fly in the face of trans liberation. Transition should be available to all who need it, when they need it, be this in the form of medical intervention or appropriate counselling (not pathologising “talking therapies”: the same kind of interventions that have enabled the “ex-gay” movement). It is also disappointing when such organisations fail to listen to those expressing disappointment at their actions.

I also feel that gender variant individuals – particularly children – should be free to celebrate and explore their gender variance without being treated as mentally ill “fantasists” (Hakeem’s word). Currently, gender variant individuals are either told that to buckle up and be a Real Girl or Real Boy, or otherwise pushed towards transition. This is not real choice, nor is it gender liberation.

In a gender liberated world, we would all get to decide what it means for us to be female, male, androgyne, genderqueer, polygender, genderfluid etc, without the patriarchy telling us how to control and moderate our gendered behaviour. In a gender liberated world, there would be free access to transition, but no-one would be forced into transition as the only medically sanctioned option for gender dissent.

This, to me, is what trans activism is about. The Royal College of Psychiatrists and the few radical feminists who (bewilderingly) support them are denying gender liberation and upholding outdated oppositional binaries without understanding the freedom, fluidity and thoughtfulness of the contemporary queer movement. Trans activism stands in opposition to this, and dares to imagine a world of gender freedom.