Major medical associations remain silent after the results of a four-year review commissioned by the National Health Service England undermined their recommendations for giving puberty blockers to children with gender dysphoria.

The Cass Report, conducted by Dr. Hilary Cass, a pediatrician and former president of the U.K.’s Royal College of Pediatrics and Child Health, found only “weak evidence” for offering puberty blockers to children.


Cass concluded that her findings, released April 10, “raise questions about the quality of currently available guidelines” offered by associations such as the World Professional Association for Transgender Health and the Endocrine Society, yet neither organization has committed to reviewing their guidelines.

The review recommends against treating children with puberty blockers outside of a research setting. It also urged “extreme caution” for providing cross-sex hormones to minors under 18 and stressed the need for a “clear clinical rationale.”

The review further suggested a “full programme of research be established” to “look at the characteristics, interventions, and outcomes of every young person presenting to the NHS [National Health Service] gender services.”

“Although a diagnosis of gender dysphoria has been seen as necessary for initiating medical treatment, it is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them,” The Cass Report noted.

The American Medical Association, the World Professional Association for Transgender Health, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Endocrine Society did not respond to multiple inquiries over the past week from the Daily Caller News Foundation asking whether they had concerns with the report’s findings or intended to conduct their own review.

Aside from WPATH, these organizations largely have failed to address the report publicly. In a written statement, the transgender health organization said it “supports policies that increase access to high-quality ethical care for transgender youth” and claimed that the report is rooted in a “false premise.”

The organization’s standards of care, eighth version, states that waiting several years to start a young adolescent on puberty blockers “is not always practical nor necessary given the premise of the treatment as a means to buy time while avoiding distress from irreversible pubertal changes.” However, it acknowledges that establishing a “sustained experience of gender incongruence” can be important before starting.

“The foundation of The Cass Report is rooted in the false premise that non-medical alternatives to care will result in less adolescent distress for most adolescents and is based on a lack of knowledge of and experience working with this patient population,” the World Professional Association for Transgender Health said in a press release. “It is harmful to perpetuate this notion and does not acknowledge the very real fact that medical pathways are an important treatment option for many young people.”

The Endocrine Society characterizes puberty blockers as a “reversible pause to puberty” and “a first step in treatment to allow the adolescent to explore their gender identity and/or to provide relief from distress.” WPATH’s guidelines likewise recommend putting adolescents on “puberty-suppressing hormones” to “alleviate gender dysphoria.”

Physicians at the World Professional Association for Transgender Health acknowledged puberty blockers can cause irreversible consequences in minors such as infertility, bone loss, and disrupted brain development in educational sessions from September 2022 previously obtained by the Daily Caller News Foundation.

Both the American Medical Association and the American Academy of Child and Adolescent Psychiatry recommend WPATH’s guidance for handling gender dysphoria in children. The AMA often opposes red state laws that ban sex-change procedures for minors, including puberty blockers.

The Cass Report notes that “there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.”

The report also questions WPATH and the Endocrine Society on the “circularity” of their citations, which make support for their positions appear stronger than they are.

Early versions of the two organizations’ guidelines influenced “nearly all” guidelines set by other organizations, the report notes. Their guidelines are also “closely interlinked” because WPATH provided input on the Endocrine Society’s recommendations, it says.

“The circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor,” the report states.

Originally published by the Daily Signal News Foundation