Cass Review shows children have been failed by medical and social ‘transition’

10 April 2024

The much-anticipated final report of the Cass Review of gender identity services for children and young people was published today (10 Apr).

The review makes clear that vulnerable children have been failed by clinicians who have followed an affirmative approach to treating children with gender dysphoria and prescribed powerful drugs which lack evidence to support their use in such ways.

Lack of evidence

The report states: “The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related stress.”

Addressing children and young people in her foreword, Cass states: “I have been disappointed by the lack of evidence on the long-term impact of taking hormones from an early age; research has let us all down, most importantly you.”

She also blames an “increasingly toxic, ideological and polarised public debate,” and notes that: “There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.”

One area where the review cites lack of evidence is in the numbers of people who subsequently detransition. The review states: “The percentage of people treated with hormones who subsequently detransition remains unknown due to the lack of long-term follow-up studies, though there is suggestion that numbers are increasing.”

Christian Concern and the Christian Legal Centre supported psychotherapist James Caspian who was prevented from studying ‘transgender regret’ by Bath Spa University, which said that the ‘politically incorrect’ research could lead to attacks on social media and harm the university’s reputation. A large part of the reason for lack of research into these matters is the stifling of debate as being ‘politically incorrect’.

It is clear from Caspian’s case that there is already a lack of academic freedom in this area.

Ban on ‘conversion therapy’ unhelpful

Concerns about the existing professional ban on ‘conversion therapy’ and planned new legislation to outlaw ‘conversion practices’ are raised in the review.

The review notes that “concerns were expressed about potential accusations of conversion practice when following an approach that would be considered normal clinical practice when working with other groups of children and young people.”


“Throughout the Review, clinicians working with this population have expressed concerns about the interpretation of potential legislation on conversion practices and its impact on the practical challenges in providing professional support to gender-questioning young people. This has left some clinical staff fearful of accepting referrals of these children and young people.”

Christian Concern has warned repeatedly about the dangers of new legislation to outlaw so-called ‘conversion practices’. We have also criticised the Memorandum of Understanding on Conversion Therapy (MoU) which constitutes a professional ban on the practice. Supported by the Christian Legal Centre, pre-action letters were sent to seven bodies challenging their support for the MoU in 2022. Last week, the UK Council for Psychotherapy (UCKP) announced that it had withdrawn its signature from the MoU citing concerns about the treatment of young people.

The problem is that the threat of being accused of ‘conversion practices’ is pressuring clinicians to adopt an affirmative model of care for children that will not question their gender identity. This is unhelpful and unsupported by evidence.

The review comments:

“Tragically deaths by suicide in trans people of all ages continue to be above the national average, but there is no evidence that gender-affirmative treatments reduce this. Such evidence as is available suggests that these deaths are related to a range of other complex psychosocial factors and to mental illness.”

This is a very important point to note since the threat of suicide has been frequently used to justify an affirmative approach to gender-questioning children.

Damaging effects of pornography

The review also notes the harmful effects of pornography and other online content on children. The review states:

“The Children’s Commissioner’s report in 2023 (Children’s Commissioner, 2023) found that pornography is so widespread and normalised that children cannot ‘opt out’. The average age when children first see pornography is 13, but 10% have seen it by age 9, and 27% by 11. The pornography that they are exposed to is frequently violent, depicting coercive, degrading or pain-inducing acts. Younger exposure had a negative impact on self-esteem.”

It continues:

“Young people aged 16-21 were more likely than not to assume that girls expect or enjoy sex involving physical aggression. Among all respondents, 47% stated that girls ‘expect’ sex to involve physical aggression such as airway restriction or slapping, a further 42% stated that most girls ‘enjoy’ acts of sexual aggression. A greater proportion of young people stated that girls ‘expect’ or ‘enjoy’ aggressive sex than boys do.”


“Several longitudinal studies have found that adolescent pornography consumption is associated with subsequent increased sexual, relational and body dissatisfaction (Hanson, 2020).”


“Research commentators recommend more investigation into consumption of online pornography and gender dysphoria is needed. Some researchers (Nadrowski, 2023) suggest that exploration with gender-questioning youth should include consideration of their engagement with pornographic content.”

‘Extreme caution’ on hormone treatments

While the review does not recommend an outright ban on social transition or on puberty-blockers or cross-sex hormones, it does advise “extreme caution” on these treatments.

The review notes that: “Whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down.”

Andrea Williams, Chief Executive of Christian Concern said:

“The Cass Review makes clear that children have not been told the truth by clinicians and other adults.

“It is not true that you may be born in the wrong body. It is not true that you can change gender. It is not true that puberty-blockers will help children. It is high time we stopped telling children these things.

“The pressure of an academic culture captivated by transgender ideology has prevented honest, independent, scientific research. Fundamental to science is the need to be driven by evidence-based scientific research. The NHS and other clinicians must return to evidence-based medicine, not ideological treatment of vulnerable children.

“It is now clear that the professional ban on conversion therapy is harming children. This ban needs to end. We welcome the UKCP withdrawing its signature from the MoU on Conversion Therapy. Other organisations need to follow. Clinicians cannot be pressured into adopting an affirmative approach through the threat of accusations of ‘conversion practices’.

“It is time for the government to drop entirely all plans to introduce new legislation to outlaw so-called ‘conversion practices’.

“The government needs to act to block all loopholes to accessing puberty blockers and introduce a complete ban on their use in this country.

“Once again, the damaging effects of online pornography are laid bare. More needs to be done to restrict access to such material to children in particular.

“I am pleased to see that the NHS will review all trans treatment following this review. Children have been badly served by an ideological system which believed that affirming children in a false gender identity and prescribing harmful drugs was helpful. This needs to stop. Children need to be told the truth. We are created male and female and we cannot change this. Most children will grow out of gender confusion as they go through puberty. Gender confused children need care and support and to be told the truth which will set them free.”

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