Toxic debate, a culture of fear and weak evidence caused the NHS to fail children with gender dysphoria through the overprescription of puberty blockers and cross-sex hormones, a landmark 388-page report from paediatrician Dr Hilary Cass has concluded.

The Cass Review, commissioned in 2021 by then health secretary Sajid Javid, signals the nation’s recognition of a long scandal where, in Javid’s words: “Quite simply, ideology replaced the best interests of children, thousands of whom have now been failed.” 

Cass, the former president of the Royal College of Paediatrics and Child Health, has done an outstanding job at delivering an urgent yet evenhanded report that, with 32 recommendations, will surely trigger a major overhaul of trans healthcare in Britain. 

The report urges extreme caution for anyone transitioning under the age of 25 and individualised care plans for each child. It recommends that gender identity services are brought up to the standard of other medical departments dealing with children and that an evidence-based approach is adopted which “should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment.” 

In the foreword to the report, Cass said she was shocked at the toxicity of the debate: “Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional. I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution.”

Indeed, many women – too many to mention – have been villianised, hounded and threatened by the trans lobby for raising the alarm bells about the dangers of youth transitioning. It is, by now, an old and all too common tale. The Cass Report is a turning point in this hot area of the culture war. When it comes to children’s safety, as concerned adults have been arguing, there is no room for ideology. 

Much of today’s reaction has been from Labour MPs. Shadow health secretary Wes Streeting said that he was “pretty angry” that some medical professionals involved in gender identity clinics had refused to cooperate with the report. He said that will not be possible under a future Labour government and there will be accountability for such refusals. 

Shadow home secretary Yvette Cooper said Labour welcomes the report’s recommendations. When asked about the toxic atmosphere around this debate that prevented many medical professionals from speaking out for fear of being targeted, she said: “I hope this is a watershed moment for the NHS.” Cooper added that it was time to rely on evidence and not get “caught up” in culture war debates.

Some, however, think that without “culture war” debates and worried adults raising awareness of the dangers of puberty blockers, this scandal would never have been noticed. The trans lobby’s hostility to any conversation about whether puberty blockers and cross-sex hormones for children is the correct medical pathway is what turned it into a culture war issue in the first place, some say.

Trans charity Mermaids CEO Lauren Stoner told Sky News: “We’re not medical experts, we don’t advocate for any [medical] pathway.” However, according to documents seen by The Telegraph, Mermaids’s ex-chief Susie Green, previously demanded to be regarded as a “professional” so she could send referrals for young people to the Tavistock clinic that were unsupported by their GP.

The Cass Report concluded that doctors are “unable to determine with any certainty which children and young people will go on to have an enduring trans identity”. Mostly, they need time to think and time to let their body and brain develop to maturity when, as a recent Dutch study showed, the majority are likely to grow out of their trans identity. 

It is of course impossible to know what each unique child needs in terms of support, therapy or medical treatment. They all have had different experiences and a unique way of seeing themselves. Unfortunately, nuance and variety are not what the gender-affirming model of care allows for. The Cass Report’s findings are a vital step towards protecting Britain’s children.

Write to us with your comments to be considered for publication at