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.

Discrimination from Stagecoach

Tonight I witnessed a shockingly casual act of discrimination against a man in a wheelchair from an employee of Stagecoach Warwickshire.

I was heading home from the University of Warwick campus, where I’d been to watch some fantastic live music. I arrived at a bus stop absolutely crammed with students and the odd academic – many intending to head to Leamington Spa for an evening out, others heading home from the night.

busesThis crowd caught the (slightly delayed) 22:50 bus – the last one due for an hour. Students pushed and shoved in order to ensure they wouldn’t be left standing in the cold wind and rain. This isn’t an unusual situation; the bus service is frequently abysmal during university term times. Passengers boarding at the Arts Centre bus stop can often expect to miss several buses due to overcrowding. This isn’t such a problem in the early evening when services are more frequent, but is unacceptable at a time of night when only one bus is running every hour.

One of the people waiting at the bus stop was a wheelchair user. A large number of individuals pushed in front of him, but eventually he found his way to the front of the queue – only to be turned away by a Stagecoach employee who was managing the flow of people onto the bus.

I witnessed the argument that took place as the man was turned away. The Stagecoach employee informed him quite firmly that he was not allowed on the bus. When pressed for an explanation, he stated that there was only one wheelchair space on the bus, and that this was already occupied by another wheelchair user.

The man and his friends pointed out that there was actually space for more than one wheelchair on the bus. They put several options to the Stagecoach employee. These included placing the second wheelchair alongside the first (upon later alighting the bus, I observed that there was clearly space for this), putting the wheelchair in the space normally reserved for pushchairs, or otherwise temporarily storing the chair whilst its owner moved to sit in one of the chairs set aside for disabled users.

The stagecoach employee rejected all of these suggestions. He insisted that this type of bus could only carry one wheelchair at a time, for insurance purposes. This was because the law requires that certain things should be present: e.g. a specific amount of space, a handrail etc. There was only enough of this for one wheelchair. The crux of his argument was that by taking the wheelchair user onto the bus, Stagecoach would be breaking the law, invalidating their insurance and endangering lives through overcrowding.

Eventually the wheelchair user and his friends left, quite understandably frustrated.

The Stagecoach employee then proceeded to let abled people onto the bus until it was completely rammed. The official limit for individuals standing (according to a nice big sign on the bus) was 17, in the case of no wheelchair and minimal baggage being present. I noted plenty of baggage, a wheelchair, 28 people standing and three people sitting on the stairs. The bus was quite clearly over capacity, and dangerously so.

The hypocrisy and ableism of the Stagecoach employee was utterly blatant. It was clearly more than his job’s worth to break a rule by asking some people to move around a little to allow a wheelchair onto the bus, potentially leaving a small number of abled individuals at the back of the queue unable to board. Instead he turned away a disabled man and his friends, choosing to break a whole load more rules by allowing abled individuals to cram on board.

There are also a couple of wider issues here. The first is that Stagecoach services between the University of Warwick and Leamington Spa are not fit for service.

It is not good enough that people at the main bus stop on a university campus are regularly left standing as already (over)full buses drive past.

It is not good enough to run one service an hour late at night when existing services do not have enough room for existing passengers (many of whom have bus passes, meaning that they have already paid for the service that is not being provided).

It is not good enough that Stagecoach buses have room for only one wheelchair, particularly given the above issues. If two people using a wheelchair happen to turn up to catch the same bus, then one of those people won’t be getting a bus. This is absolutely unacceptable.

The second issue is that legislation supposedly written to ensure that disabled individuals have fair access to public services is being used to actively discriminate against people. It takes a very special kind of ignorance and privilege to officiously cite equality laws when refusing someone a service on the grounds of physical difference. Of course, disabled activists have been writing about this kind of thing for years. But it’s about time more of us paid attention.