Medicine and Science from The BMJ

Improving NHS gender identity services - Hilary Cass

Apr 12, 2024

Hilary Cass, former president of the Royal College of Paediatrics, discusses improving NHS gender identity services. Topics include evidence base for transitioning, failures in siloed care, supporting young people in their gender journey without immediate medical intervention, and the need for holistic and evidence-based treatments for gender-questioning youth.

37:34

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Hilary Cass

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Quick takeaways

The need to support young people in exploring their gender without immediately resorting to medical intervention is crucial for the improvement of NHS gender identity services.

Evidence-based guidelines for gender medicine in children are lacking, with a focus on psychological interventions to enhance mental health rather than altering gender identity.

The transition from tertiary to secondary care in gender identity services should involve collaborative clinical protocols, research programs, and holistic support for children and young people.

Deep dives

Review of Gender Identity Services for Children and Young People

The long-awaited independent review of gender identity services for children and young people, known as the CAST Review, was significant in the UK's medical news. Hillary CAST, former president of the Royal College of Pediatrics, focused on improving NHS treatment through engagement with young people, families, and clinicians. The interim publication led to closure of the Tavistock Clinic, highlighting deviations from evidence-based treatments for gender questioning youth, citing poor quality studies within gender medicine.

Introduction

3min

Enhancing Gender Identity Services for Young Trans Individuals

7min

Supporting Gender Identity in Young People

16min

Evidence Discrepancies in Guidelines for Puberty Blockers

2min

Enhancing Gender Identity Services for Youth

5min

Supporting and Listening to Young People with Gender Identity Issues

5min

Hilary Cass, the former president of the Royal College of Paediatrics, has spent the last 3 years collating the evidence for treatment of gender questioning young people; engaging with those young people, their families and their clinicians - all with the aim of improving NHS treatment of this complex and vulnerable group.

In this interview, Kamran Abbasi, editor in chief of The BMJ, speaks in depth to Cass about her review - about evidence base for transitioning, but also about the way in which the siloing of care for young trans people has failed them.

They discuss the need to support young people in their journey - Cass is clear that the NHS should allow young people to explore their gender, but that ultimately, that may not mean medical intervention at all.

Reading list

The Cass Review - final report

The systematic review and meta-analyses published in Archives of Disease in Childhood

BMJ Opinion: Gender medicine for children and young people is built on shaky foundations