The Cass review of the care of children and adolescents with gender dysphoria was a wake up call.1 Having commissioned several peer reviewed, systematic reviews of evidence, paediatrician Hilary Cass’s team drew on four years’ comprehensive engagement with service users, parents, clinicians, researchers, and advocacy groups, finding that most children’s gender dysphoria in historical cohorts resolves through puberty; suicidality is equivalent to children with diagnosed mental health problems and not helped by hormones; there are frequent concurrent neurodevelopmental and mental illnesses; and the evidence base for medical interventions is weak.2Recommendations were largely related to improving NHS services to align with conventional paediatric clinical practice and raise standards. Without established benefit, and with concerns about brain development, gonadotropin hormone releasing hormone (GnRH) analogues (“puberty blockers”) should only be used in research settings. This was well received by the royal colleges of general practice and psychiatry, and the British Psychological Society,345 but…
