Cass report: ‘Here’s why politicians should not treat it as gospel’

LGBT+ Labour stands in solidarity with trans, non-binary, and questioning young people who are trying to access support and healthcare. So should all politicians in our country.

It is because of this perspective that we urge Labour to exercise caution in responding to the review of gender identity services for children and young people published 10 April 2024. The health and well-being of vulnerable people is on the line, and Labour can’t afford to engage uncritically with any single report.

The mental health of the trans* community in the UK is in a dire state. Analysis by Just Like Us (the LGBT+ young people’s charity) suggests young trans* people are twice as likely to struggle with self-harm and suicidal thoughts and feelings than their non-LGBT+ counterparts.

76% of young trans people have self-harmed, and 88% have experienced suicidal thoughts (with the equivalent figures for non-binary people being 78% and 83% respectively). When discussing the highly emotive and complex area of healthcare for young trans* people, then, we need to remember that, at the heart of this discussion, there are real people who are struggling and deserve our empathy and respect.

What the Cass Review Gets Right

• Waiting lists for children and young people trying to access support in this country are far too long, and this is driven by a lack of proper staffing that must be addressed. This results in vulnerable young people being unable to access the care that they desperately need and has contributed tragically to a decline in the well-being of young trans* people, being found to have contributed to at least one death.
• The model of service delivery for Gender Identity Services in the UK should move away from a more centralised system (essentially a ‘postcode lottery,’ disadvantaging those who live in more isolated areas) and towards a model that ensures young people across the country can receive the same standard of care.
• NHS staff should receive better training on how to support and work sensitively with trans* and questioning young people.
• Young trans* and questioning people should not be treated as a homogeneous group. We are individuals with our own complex needs, desires, and identities, and generalisations about us are generally unhelpful.
• The toxicity of the debate surrounding treatment for young trans* people is ultimately letting down the young patients whose well-being should be the priority.

Why we are urging caution

The Cass Review has received credible criticism from trans advocacy groups and researchers, for various reasons. For example, much of the review is underlined by frustration at the lack of ‘high-quality’ evidence supporting current medical interventions to support young people with gender dysphoria.

It is notable, then, that one of the evidence reviews (in this case a review of the efficacy and safety of gender-affirming hormone therapy) commissioned to support the Cass Review questions the quality of many of the studies that demonstrate the clinical effectiveness of treatment with gender-affirming hormones based on a ‘lack of blinding’ (as can be found from page 109 onwards of the evidence review).

For a blind trial to be run, a patient/assessor must be unaware of what medication is being administered. The problem here is that running a blind trial with gender-affirming hormones or puberty blockers is highly challenging: when receiving gender-affirming hormone therapy or puberty blockers, obvious changes occur which alert the patient/assessor to that fact.

Put simply, the review sets an unreasonable standard for the kind of evidence it will accept — one which, given the nature of the research being done, cannot be met — then uses the resulting lack of evidence to suggest that existing medical interventions have no evidential basis. This undergirds many of the recommendations the review makes regarding changes to internationally established medical practice.

Additionally, the evidence review was prepared in October 2020 based on searches made in July 2020. This is not an inherent problem, but should be taken into account: it represents a moment in time, like any other review, and the speed of progress for research in this area is extremely quick.

It is worth noting that an audit of patients discharged from GIDS (the Gender Identity Development Service) commissioned for the Cass Review found that, of the 3,306 young people included in the analysis, less than 10 had detransitioned back to their birth-registered gender.

We should have empathy for young people who choose to detransition, of course, but this should put into perspective the claim that detransition is common, or even rampant. Detransition is, proportionally, rare.

‘Trans people are not a contagion or a threat’

Given the above information, politicians of all stripes should not unquestioningly accept all of the recommendations of the Cass Review. Labour should engage in critical analysis of each of the recommendations, considering carefully the effects that they will have on the lives of some of the most marginalised people in our society.

As a movement, we would do well to consider the context in which this review has been published and the discourse around it. Trans* people are not a contagion or a threat. In the current political climate, it is more important than ever that Labour is committed to social justice, progress, and equality — including for trans people.