The Cass Review did not take place

The Cass Review released its final report last month. Criticisms of the final report from the trans community have been many and varied, but what do anti-trans actors think of it? And what does it have to do with what the report actually says?

For those of us in the real world, the Cass Review final report concluded, in my opinion incorrectly, that existing healthcare pathways for trans youth were poorly supported by the evidence. For anti-trans actors, the Cass Review final report is a millenarian event. It is the destruction of the gender house of cards. It is grounds for local councils across the UK to block popular and longstanding LGBTQ+ Pride events. It is proof that their colleagues should not put pronouns in their email signatures.

While the Cass Review final report states, again in my opinion incorrectly, that the evidence for the benefits of puberty blockers is on “shaky ground”, it failed to find any evidence of actual harm arising from their use and stops short of claiming that they do anything other than a) block puberty and b) increase the chances of a trans child becoming a trans adult (something that Cass seems to assume is a bad thing). Nowhere did it claim that gender affirming healthcare is, of itself, “abuse” and yet for many gender critical posters it is an article of faith that it did.

Whether you agree with the methods and conclusions of the Cass Review or you’re right it’s pretty clear that something funny is going on here. Nowhere in the 365 pages of the Cass Review final report do workplace email signatures or local council events licencing arrangements appear and Cass’ conclusions about puberty blockers and trans healthcare more broadly are nowhere near as maximalist as her loudest public supporters seem to think. I would argue that this is because there are two Cass Reviews.

The first Cass Review, the real review, was a review commissioned by NHS England on trans healthcare for children, it released its final report in April 2024 and made some claims and recommendations that many experts consider harmful but has been largely welcomed by the political and media classes. The second Cass Review, the imaginary review, tells gender critical activists who have spent the last six or seven years of their lives on an anti-trans crusade that they were right all along, that their sunk costs have been worth it after all, this review did not take place. The imaginary review refers to the real review, but they are not the same thing.

It’s easy to see how this came about. Before the Cass Review released its final report, gender critical activists had spent the previous two years loudly telling everybody who would listen that they’d be sorry when the Cass Review concluded. In the face of the real review, which said some things they wanted to hear but did not endorse every single claim they have ever made or succeed in silencing their critics forever, the imaginary review was an ideological necessity. The Cass Review they wanted did not exist and so it was necessary to invent it.