The Government’s Impartial Trans Healthcare Reviewer Isn’t so Impartial, Colleagues Claim

The government’s landmark report on transgender healthcare has sustained another body blow, this time from two doctors one of whom previously worked with its author.

The doctors – one a consultant paediatrician, the other a clinical psychologist – claim that Dr Hilary Cass did not approach her review of gender-related healthcare for children and adolescents with an open mind as she has previously claimed – in fact, they say, “ Cass was “known by colleagues to oppose medical transition when she was appointed to the review”.

The article throws further doubt onto the impartiality of the government-appointed “independent” reviewer, whose lengthy findings and recommendations have formed the basis of both the Conservatives and the Labour party’s approach to the issue of transgender healthcare for children – though the Department of Health and Social Care (DHSC) insisted her report was “robust” and “firmly grounded in evidence”.

Drs Max Davie and Lorna Hobbs published their 7,000-word analysis of the Cass Report on Davie’s blog on Wednesday. They also made an unpaywalled version of the blog post available via Google Docs.

In the article, Davie and Hobbs write that Cass “expressed her dismay and shock at the practice of medical transition to one of us” before she began her review.

Neither Davie nor Hobbs worked on the Cass Review, nor do the authors state explicitly when, where or to whom Cass made her remarks – however, Cass and Davie appear to have worked alongside one another as consultant paediatricians at Guy’s and St Thomas’s NHS trust.

Davie and Hobbs both previously worked at the new child and adolescent gender services at Great Ormond Street Hospital, which made headlines in January after four of its newly-appointed team quit following disagreements over how gender dysphoric children should be treated. It is unclear whether Davie or Hobbs were among them.

In their article, Davie and Hobbs wrote that Cass “recommended strongly that we read the gender critical polemic “Irreversible Damage” on the subject”.

Subtitled “The Transgender Craze Seducing Our Daughters”, Irreversible Damage was published in 2020 by Regnery Publishing, which describes itself as “America’s leading publisher of conservative books”. Authored by former Wall Street Journal columnist Abigail Shrier, the book was criticised by several clinical professionals for misinterpreting data and ignoring evidence that doesn’t support its conclusions. It went on to win both The Economist and Times book of the year.

Cass’s report generated similar controversy when it was finally published in April this year, following a four-year review process. The 388-page report made 32 recommendations, including a more cautious approach to prescribing medical intervention, a “follow-through service” for 17-24-year-olds and a separate service for detransitioners. Among the criticisms of the report were that it exaggerated figures, discarded 98% of the clinical research into puberty blockers and hormone treatment, and made conclusions unsupported by its own analysis. Commentators also noted that transgender people were expressly excluded from the review’s governance committee.

In early July, nine American and Australian academics including from the Yale School of Medicine and Yale Law School co-authored a white paper on the Cass Review, finding that it “repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculations”. They added that the review “levies unsupported assertions about gender identity, gender dysphoria, standard practices, and the safety of gender-affirming medical treatments, and repeats claims that have been disproved by sound evidence.”

In response to the controversy, Cass – who was given a peerage by Rishi Sunak earlier this year – gave several interviews to media outlets, insisting on her impartiality. In one interview with the New Statesman stated: “When she was handed this unenviable task, Cass had no pre-conceived ideas. One of her friends was trans, but otherwise she was coming at it “pretty cold””. This, write Davie and Hobbs, is a “hilarious claim”.

Despite being widely criticised within the healthcare profession, the Cass Review – commissioned by the Conservative government in 2020 – has formed the basis of Labour’s approach to transgender healthcare. One of Wes Streeting’s first acts as health secretary was to unilaterally ban puberty blockers for transgender children, a decision recently upheld by the High Court. Streeting previously described the Cass Review as “a watershed moment for the NHS’s gender identity services”, describing Cass’s work as “thoughtful and thorough”.

In a statement to Novara Media, DHSC defended Cass’s report, and said that her recommendations would be rolled out.

A departmental spokesperson said: “The Cass Review is a robust report backed by clinicians and firmly grounded in evidence. NHS England will be implementing Dr Cass’s recommendations so that children and young people get the safe, holistic care and support they need.

“Yesterday NHSE announced the rolling out of new gender services as recommended by Dr Cass, and the setting up a clinical trial to establish the evidence on puberty blockers, because children’s healthcare should always be led by evidence.”

The NHS Cass Review team did not respond to Novara Media’s request for comment.