Hi Everyone The following is a list of peer reviewed papers that condemn or refute the,
"Independent review of gender identity services for children and young people. Final report. Published 10 April 2024." known as the
(Cass Review). These articles, statements or joint statements are from various bodies.
IntroductionThis reading list gathers leading critiques of the Independent review of gender identity services for children and young people. Each entry shows its publication date then summarises the core argument and links to the source for verification.
The selections span medicine, law and advocacy, highlight evidence standards, study selection, inference quality and ethics and assess clinical relevance with practical policy impact. Together they map areas of consensus and genuine dispute, identify where better data are needed then point to guidance aligned with established care for clinicians, policymakers and families.
Critiques of the Cass Review- 8 Jun 2024. Grijseels reviews the Cass Review's biological and psychosocial claims, finds citation errors, selective readings, weak inference, then concludes the Review's standards are suboptimal for clinical recommendations [1].
- 14 March 2024. Horton analyses Cass documents, identifies cisnormative bias, pathologisation, inconsistent evidence standards, then argues these systemic problems distort policy on trans children's healthcare [2].
- 10 May 2025. Noone et al apply the ROBIS tool to Cass commissioned reviews, find high risk of bias across domains, document protocol deviations and exclusions of relevant studies, then show unsupported claims in Cass commissioned primary research [3]
- 6 Oct 2025. Moore et al summarise internal contradictions in Cass, note exceptionalised standards not used elsewhere, highlight ethical concerns of research only access, then advise Cass should not guide care for trans youth [4].
Organisation statements that "Refute" the Cass Review- 8 May 2024. Endocrine Society states Cass adds no new evidence to change guidance, reaffirms support for gender affirming care, warns against policy built on misinformation [5]
- 17 May 2024. WPATH with USPATH critiques Cass methods and evidence handling, notes stronger systematic reviews underpin existing standards, warns that restricting indicated care raises harm [6]
- 22 Apr 2024. Royal College of Psychiatrists cautions against overinterpreting Cass, stresses holistic evidence based care, flags politicisation risks, urges services that centre young people's needs [7]
- Nov 2024. AUSPATH responds to Cass recommendations, defends multidisciplinary care continuity, calls for funding, collaboration, transparent benchmarking [8]
- 17 Jul 2024. British Medical Association leadership signals opposition to Cass, moves to formally critique its conclusions in the UK context [9]
- 11 Jun 2024. BMJ reporting records that major US bodies did not endorse Cass, highlights Endocrine Society and WPATH critiques as representative positions [10]
ConclusionThe Cass Review has been in circulation long enough to shape policy and practice, yet its impact has too often been restriction of care, suspension of treatment and predictable harm from untreated gender dysphoria. These outcomes are not incidental. They flow from major flaws in the report's design and reception.
The process was politicised from commissioning through interpretation. It applied exceptional standards to transgender health that are rarely demanded elsewhere, selectively framed evidence and failed to engage in good faith consultation with credentialed clinical and scientific peers as well as the communities affected. Internal contradictions and speculative claims were elevated over established practice and real world outcomes.
Going forward, care must be grounded in rigorous evidence, transparent methods and peer review with domain experts. Policymakers and clinicians should restore access to indicated treatments with appropriate safeguards, invest in high quality research that answers practical questions and include patients and frontline specialists in every stage of guideline development. The goal is simple and urgent. Reduce harm, respect evidence, deliver timely care.
The case is straightforward. Cass is not peer reviewed guidance, it shows methodological inconsistency, it excluded domain experts, it conflicts with major medical bodies. Ethical duties of non maleficence and proportionality support access to indicated care. Australian expert consensus already exists, so systems can act now to restore timely evidence based treatment.
Bibliography[1] Grijseels, D. M. (2024, June 08).
Biological and psychosocial evidence in the Cass Review: A critical commentary. International Journal of Transgender Health.
https://doi.org/10.1080/26895269.2024.2362304 🔗[2] Horton, C. (2024).
The Cass Review: Cis supremacy in the UK's approach to healthcare for trans children. International Journal of Transgender Health.
https://doi.org/10.1080/26895269.2024.2328249 🔗[3] Noone, C., Southgate, A., Ashman, A., Quinn, É., Comer, D., Shrewsbury, D., Ashley, F., Hartland, J., Paschedag, J., Gilmore, J., Kennedy, N., Woolley, T. E., Heath, R., Biskupovic Goulding, R., Simpson, V., Kiely, E., Coll, S., White, M., Grijseels, D. M., Ouafik, M., & McLamore, Q. (2025, May 10).
Critically appraising the Cass Review: Methodological flaws and unsupported claims. BMC Medical Research Methodology, 25, 128.
https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-025-02581-7 🔗[4] Moore, J. K., Rayner, C., Skinner, S. R., Wynne, K., Cavve, B. S., Fraser, B., Ganti, U., McAllister, C., Meyerowitz-Katz, G., Nguyen, T., Ravine, A., Ross, B., Russell, D. B., Saunders, L. A., Siafarikas, A., & Pang, K. C. (2025, October 6).
Cass Review does not guide care for trans young people. Medical Journal of Australia, 223(7), 331–337.
https://www.mja.com.au/journal/2025/223/7/cass-review-does-not-guide-care-trans-young-people 🔗[5] Endocrine Society. (2024, May 08). Statement in support of gender affirming care.
https://www.endocrine.org/news-and-advocacy/news-room/2024/statement-in-support-of-gender-affirming-care 🔗[6] World Professional Association for Transgender Health, United States Professional Association for Transgender Health. (2024, May 17).
Comment on the Cass Review. https://www.wpath.org/wp-content/uploads/2024/11/17.05.24-Response-Cass-Review-FINAL-with-ed-note.pdf 🔗[7] Royal College of Psychiatrists. (2024, April 22).
Detailed response to The Cass Review's final report. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2024/04/22/detailed-response-to-the-cass-review%27s-final-report 🔗[8] Australian Professional Association for Trans Health. (2024, November).
Response to the Cass Review recommendations. https://auspath.org.au 🔗[9] British Medical Association. (2024, July 17).
Council update on the Cass Review. https://www.bma.org.uk 🔗[10] Godlee, F. or BMJ staff. (2024, June 11).
Why the Cass Review failed to gain traction in the US context. The BMJ.
https://www.bmj.com 🔗
The way forward is to challenge them in the courts, which can target two things. First, the permanent order that bans private supply of puberty blockers to under 18s. Second, NHS England policies that limit access to clinical trials only.
Key legal grounds are process faults, equality duties, human rights, irrational use of evidence, and unlawful blanket rules that block clinical judgment.
Main remedies to seek are to quash the ban, force NHS England to redo its policies lawfully, declare that blanket bans breach rights and duties, protect current patients with interim orders, require disclosure of the evidence used and request fair cost protection.
Best Wishes AlwaysSarah BGlobal Moderator
