On Tuesday, 12 March, the United Kingdom’s National Health Service (NHS) announced that they will prohibit the prescription of puberty-suppressing hormones (PSHs) for minors with gender dysphoria, sparking a wave of speculation about the future of healthcare for transgender youth, in Europe and across the world.
The UK’s publicly funded healthcare system made the decision following the recent completion of the ‘Independent Review of Gender Identity Services for Children and Young People,’ commonly known as the ‘Cass Review,’ after the study’s author, the results of which were made public on 10 April. The paper, comprising nearly 400 pages, synthesises data gathered over a four-year period and advocates for a “holistic assessment” of the needs of those seeking NHS gender services, which includes “screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment,” in order to form an “individualised care plan”. These recommendations, among others, were made following findings in the report that “the rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health.”
The landmark report and the subsequent NHS announcement have been met with mixed reactions, both across the UK and abroad. Stonewall UK, Europe’s largest LGBT+ charity organisation, while welcoming the report, stated their “firm belief” that “trans children and young people deserve to be listened to and given access to the care and support that they need.” Similarly, the transgender activist charity Mermaids announced that they were “deeply disappointed, although not surprised, that Dr Cass’ own calls for compassion and respect have been completely disregarded,” following the aftermath of the publications. Scotland’s Chief Medical Officer, Jenni Minto, remarked that the report would require “careful consideration,” both in terms of the recommendations made within the report, as well as how they would be addressed by the government.
The NHS’ decision, while thoroughly symbolic in and of itself, marks another step in a trend that has picked up across Northern Europe in the past few years – in 2020, the Finnish Health Authority declared that psychotherapy was to be used as the first recourse in dealing with youth with gender dysphoria, a heavily-criticised decision that was later amended. In 2022, Sweden made the decision to restrict hormone therapy for minors “except in very rare cases,” with Norway making similar recommendations last December, and Denmark planning to act likewise in the coming months.
Following the report’s publication, many hypotheses have emerged about a possible precedent being set, and whether or not the policy of the UK and other Northern European countries will affect the actions of other States across the world. A recent article from The Guardian speculated about the implications of the UK’s review on Australia’s transgender policy; however, the state of Victoria’s health minister, Mary-Anne Thomas, defended the country’s stance, saying that she is “fiercely proud of the important work” done by local gender clinics. Similar speculation has taken place in Canada, although some of the country’s doctors have spoken out against the Cass Review’s findings, with Dr. Jake Donaldson saying that, “There actually is a lot of evidence [supporting the use of puberty blockers], just not in the form of randomized clinical trials.”
Elsewhere, however, the review and its findings have been met with strong acclaim for encouraging a balanced discussion of the issue – a report from The Economist concluded that “America should follow England’s lead on transgender care for kids” as it promotes a “cautious approach,” the likes of which are seldom seen in the U.S, in Democrat and Republican-controlled states alike. The report was also praised by The UN Special Rapporteur on Violence Against Women and Girls, Reem Alsalem, who remarked that implementation of the findings is “key to protecting girls from serious harm,” and that the review had “very clearly shown the devastating consequences that policies on gender treatments have had on human rights of children, including girls.” Girls, Alsalem noted, are more likely to experience temporary body image dissatisfaction and low self-esteem issues during puberty due to an increasing prevalence of mental health issues, making them question their gender identity at a high rate.
Overall, the NHS’ ruling can be seen as a largely symbolic one – under 100 minors are currently prescribed puberty blockers, all of whom will be able to continue their treatment. However, for an issue as central as it currently is within the ‘culture wars,’ the decision is likely to have a lasting effect in months and years to come.
Cover Image: Dr. Hilary Cass Presents the Results of Her Landmark Study on 10 April, 2024
