What Is The Cass Report?—Here's Everything You Need To Know

The controversy surrounding gender-affirming care for minors new levels of scrutiny following a string of scandals at GIDS—the UK’s only specialist clinic designed to help children questioning their gender. It was later revealed that the clinic's entire practice used one heavily critiqued study called The Dutch Protocol to develop its entire methodology. They used this controversial study to justify treating over 2,000 young people with hormone blockers and cross-sex hormones. This eventually led to the recent Cass Report, which we'll get to in just a moment.

What is The Dutch Protocol?

First, you need to know about the "Dutch Protocol," which entails a three-step treatment pathway for children with gender-related issues. It requires starting puberty blockers at the brink of puberty to prevent the development of male or female sex characteristics, and that step is followed by cross-sex hormones to change one's appearance to be more masculine or feminine, according to the distressed child's preferences. The protocol concludes with irreversible genital surgeries and breast augmentations when the child becomes an adult.

The Dutch Protocol study claimed that after puberty suppression alone, their test group of 70 young people experienced a reduction in behavioral and emotional problems, decreased symptoms of depression, and a significant improvement overall. However, the GIDS clinic was not able to replicate similar results, which they didn't admit until 2021, years after they'd already used the protocol on thousands of children.

Enter Dr. Hillary Cass

As the GIDS clinic was rocked with scandals, whistleblowers, and lawsuits, more medical professionals became divided on the issue, and Dr. Hilary Cass was employed by the NHS to conduct a review of all published evidence on the use of puberty blockers and cross-sex hormones in children. In 2021, she stated that she and her team had not been able to find evidence “strong enough to form the basis of a policy position.” That was the first clue that GIDs' affirming practices were on very shaky ground.

Accordingly, Dr. Cass made some interim recommendations that included creating new regional "hubs" rather than centralizing all care in GIDs. Dr. Cass also emphasized the need for a more integrated approach to caring for these children, such as treating issues like nutrition and mental health, rather than automatically putting them on hormone treatments.

Despite these efforts, challenges persisted. Deep-seated ideological conflicts and lingering influences of activistism stalled any real changes. Kathleen Stock's investigative work shed light on the persistent problems within the hubs, primarily due to the NHS' continued adherence to radical "progressive" gender ideology rather than evidence-based healthcare, as well as their choice to put pro-trans activists in leadership positions. Stock's findings suggested that these entrenched activist ideologies continued to compromise their services.

In fact, due to the mounting evidence that gender-affirming care actually increases a child's distress in many cases (as well as the growing number of lawsuits being filed by those children now that they are adults), the NHS announced last month that they will no longer offer puberty blockers to children and teens in England and Wales.

The Final Cass Report

The full 388-page Cass Report (published this week) confirms that for the vast majority of young people under the age of 25, "a medical pathway will not be the best way to manage their gender-related distress.” She states that not only is there no way for a clinician to accurately determine who will continue to identify as trans for life and who won’t, but that the reason for using puberty blockers in the first place “remains unclear," which is astounding when you consider how many parents and children have been told such extreme therapies are the way to prevent the child from committing suicide.

Cass also makes it clear that the factors influencing gender-related distress are likely as much social as it is psychological or biological, with a particular focus on the growing group of adolescent girls who now make up the majority of gender clinic patients.

Mixed Responses to The Report

Despite the significant evidence against "gender-affirming" care, some progressive activists have quickly doubled down, choosing to prioritize their precious politics over the welfare of children. Some are quietly backpedaling their previous support for gender-affirming rhetoric, and most legacy media outlets are following suit. One of the most notable is The Guardian admitting that "Analysis finds most research underpinning clinical guidelines, hormone treatments, and puberty blockers to be low quality" in a recent article on the report.

Many on X are pointing out the deeply nefarious role the media has played in harming these children by their refusal to investigate and accurately report on these issues sooner. Instead, they let political activists steer the narrative and are only just now trying to save face.

Others, like J.K. Rowling, who has openly and unapologetically opposed gender-affirming care for minors despite extreme backlash, shared her thoughts on the Cass Report on X.

"Over the last four years, Hilary Cass has conducted the most robust review of the medical evidence for transitioning children that's ever been conducted. Mere hours after it was released to the press and public, committed ideologues are doubling down."

"These are people who've deemed opponents 'far-right' for wanting to know there are proper checks and balances in place before autistic, gay, and abused kids - groups that are all overrepresented at gender clinics-are left sterilised, inorgasmic, lifelong patients," she continued.

"I understand that the review's conclusions will have come as a seismic shock to those who've hounded and demonised whistleblowers and smeared opponents as bigots and transphobes, but trying to discredit Hilary Cass's work isn't merely misguided. It's actively malign. Even if you don't feel ashamed of cheerleading for what now looks like severe medical malpractice, even if you don't want to accept that you might have been wrong, where's your sense of self-preservation? The bandwagon you hopped on so gladly is hurtling towards a cliff."

"And if I sound angry, it's because I'm bloody angry," she continued. "I read Cass this morning and my anger's been mounting all day. Kids have been irreversibly harmed, and thousands are complicit, not just medics, but the celebrity mouthpieces, unquestioning media, and cynical corporations. The consequences of this scandal will play out for decades. You cheered it on. You did all you could to impede and misrepresent research. You tried to bully people out of their jobs for opposing you. Young people have been experimented on, left infertile and in pain."

"Thought the last tweet was going to be my last, but I just burst into tears," she added, concluding her thread with this: "The #CassReview may be a watershed moment, but it comes too late for detransitioners who've written me heartbreaking letters of regret. Today's not a triumph, it's the laying bare of a tragedy."

Rowling is also calling out individuals and groups who are denying their culpability, and she's coming with receipts. For example, when the CEO of Mermaids (an organization that targets distressed children for various "services") claimed that her employees "[aren't] medical experts, we don’t advocate for any [medical] pathway," Rowling was quick to remind her of reality.

Many are saying medical professionals, educators, journalists, and others who recklessly pushed these practices on minors and their parents should face serious criminal charges. And as more evidence mounts against gender-affirming care and detransitioners speak out, that seems like a real possibility.

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