The Protocol The Review
Jun 5, 2025
Hilary Cass, chair of the independent review into services for gender-questioning youth, and Marcy Bowers, a renowned surgeon in trans medicine, tackle the complex landscape of youth gender care. They reveal the weaknesses in existing research and discuss the ethical ramifications of current treatment protocols. The duo emphasizes the necessity for robust clinical evidence as trans youth seek care in a politically charged environment. Their candid insights challenge prevailing narratives and stress the importance of nuanced, personalized approaches in trans healthcare.
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Evidence Base Is Remarkably Weak
- Hilary Cass found the evidence base for youth gender medical care to be remarkably weak across many studies.
- She concluded that current research does not reliably show who benefits from medical pathways.
Key Study Limitations Identified
- Cass commissioned systematic reviews that found no randomized controlled trials and many methodologic weaknesses in available studies.
- Studies often lacked long follow-up, good comparison groups, or had high loss to follow-up.
Landmark Studies Have Serious Flaws
- Cass criticized the Dutch puberty-blocker study for selection bias and confounding by concurrent therapy.
- She noted the Tavistock replication failed to show average psychological improvement.