The British Medical Association (BMA) – the trade union for doctors and medical students in the United Kingdom – has voiced its support for the controversial Cass Review of gender-affirming care, formally dropping its previous opposition to the review and to Cass’ recommendations.
“[Dr. Hilary Cass] has been vindicated in the way she approached the data,” the lead of BMA’s review and chair of its board of science, Professor David Strain, told The Times. Strain claimed that Cass “approached an area of significant uncertainty with that prime rule of medicine, of ‘first, do no harm.’” When asked if he could name a single recommendation from the review that he opposed, he responded, “I can’t.”
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The Cass Review, first published in April 2024, enraged trans advocates by pushing for treatment of trans youth to move away from medical intervention in favor of a more “holistic” approach. Cass recommended therapy, suggesting the need for treatment of coexisting mental illness, as well as examining potential neurodivergence or family issues.
The medical form of gender-affirming care that Cass recommends moving away from is supported by all major U.S. medical associations. That treatment – which has been deemed safe and, in many cases, reversible – has been linked to reduced rates of depression, anxiety, and suicide attempts in trans youth.
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BMA originally opposed the Cass Review with strong language, saying the findings were “unsubstantiated.” Announcing its plan to publicly critique the Cass Review in July 2024, BMA noted, “Doctors and academics in several countries, including the UK, voiced concern about weaknesses in the methodologies used in the Review and problems arising from the implementation of some of the recommendations.”
But BMA reversed course on that position this week. Twelve members, who have been kept anonymous for stated security concerns, have said that “the evidence base for puberty suppression and gender affirming hormones is limited and uncertain,” according to the British Medical Journal, which is owned by BMA. The review supported “the findings of the original landmark review into gender identity services for young people.”
BMA’s report was originally scheduled to be released in January 2025, but it ended up taking almost two years after “significant delays.”
The review was led by Professor David Strain of the University of Exeter Medical School, who works with older adults and focuses on diabetes treatment. In a statement in 2024, when the review was announced, he noted that he did not “treat children and young people for gender dysphoria.”
While he claimed that the first phase of the review would be to listen to people with lived experience, it is unclear who those people were or what experiences they might have had. Discussions of gender-affirming care in the United Kingdom have often focused primarily on the vanishingly small number of “detransitioners,” with that direction being championed by anti-trans advocates such as JK Rowling and Maya Forstater.
The original Cass Review has been criticized for failing to include trans advocacy groups until “late in the process,” and while Cass interviewed at least 1,000 young people about their lived experiences, she said that their views had to be “balanced with the perspectives of clinicians and academics”.
While BMA has dropped its opposition, it has maintained its criticism of the United Kingdom’s ban on puberty blockers. The legislation for the ban was introduced by Wes Streeting, Secretary of State for Health and Social Care of the United Kingdom, in 2024 following the release of the Cass Review, but BMA believes the move went beyond Cass’ recommendations.
BMA still feels that puberty blockers should not be widely prescribed to trans youth, but that the decision should be made by doctors, its stance being more related to government overreach.
The group announced it is “continuing to oppose a ban on puberty blockers for several reasons, not least because it is a threat to the autonomy of a doctor. We spend decades training on how to use drugs, and to have a political decision affecting the way we prescribe is wrong.”
An NHS trial for puberty blockers has been recommended by Cass to get a better understanding of how they work and their long-term effects. That was due to start in January of this year, but it was put on hold after people raised concerns about “long-term biological harms.”
Cis children who suffer from precocious puberty in the United Kingdom are exempt from the ban on puberty blockers.
Editor’s note: This article mentions suicide. If you need to talk to someone now, call the Trans Lifeline at 1-877-565-8860. It’s staffed by trans people, for trans people. The Trevor Project provides a safe, judgement-free place to talk for LGBTQ youth at 1-866-488-7386. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255.
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