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It’s often argued that puberty blockers are urgent and necessary to prevent mental health harm, up to an including suicide. But Cass also found the evidence was weak regarding their impact on mental health conditions and gender dysphoria – a feeling of distress that your gender identity does not match your physical form.
The second phase of treatment – the use of masculinising or feminising hormones – in those under the age of 18 “also presents many unknowns”, according to Cass. Hormone treatments can have irreversible effects, such as a permanently deeper voice and facial hair for people born as women. They can also lead to infertility.
Cass said hormones from age 16 should an option but recommended “extreme caution” and a “clear clinical rationale” as to why the person could not wait until they were 18. Clinicians, Cass wrote, were unable to determine with any certainty which children and young people would go on to have an enduring trans identity.
“For most young people, a medical pathway will not be the best way to manage their gender-related distress,” Cass wrote. In response to the report, Australian governments and health services backed their existing approach.
The report also prompted an immediate backlash from LGBTQ groups, who said it ignored the consensus of major medical bodies around the world and lacked relevance to Australia.
Vice-president of the Australian Professional Association for Trans Health (AusPATH)Dr Portia Predny, disputed Cass’s conclusion that the evidence base for affirming care was weak, saying that, for ethical reasons, it was not feasible or ethical to conduct randomised control trials to collect the “highest quality” of evidence.
And Carlie Morris of Parents for Transgender Youth Equity said “young people know who they are and can work with clinicians to seek out options for their care”.
The Royal Children’s Hospital Melbourne, which runs Australia’s largest children’s gender service, did not respond when asked if it would reassess the evidence for gender-affirming treatment of children in the wake of policy change in the UK.
“As always, our gender service is underpinned by both national and international research methodology, and we will continue to monitor outcomes that will inform best practice,” a spokesperson said.
The NSW Health Department referred to a review already being conducted by its clinical advisory group into emerging evidence, and Health Minister Ryan Park said his department continued “to monitor developments in the evidence”.
The release of the report coincides with the finalisation of a Queensland Health evaluation of their children’s gender service.
A spokesperson for Australian Health Minister Mark Butler backed comments from LGBTQ groups and several experts that the system for the treatment of transgender children was different in Australian compared with the UK, but nonetheless dubbed the Cass report “significant”.
“Everyone, including the states and territories who are responsible for these services in Australia, will take the time to consider this review which has just been released,” they said.
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The Australian Medical Association (AMA) has historically fully supported gender-affirming care, saying there needs to be easier access to it. However, AMA president Professor Steve Robson backed a number of elements of the Cass report, including a call for more research.
Others supported the recommendations.
A parent from a Victorian support group for families questioning affirming care, who wanted to remain anonymous for fear of public backlash if they were identified, said: “We hope this is a wake-up call to Australian medical and educational institutions and that we will finally see some caution and questioning around what is happening to our children.”
The parent said that “in far too many cases our concerns have been ridiculed, our input ignored and our knowledge of our own children dismissed” by schools, professionals and politicians.
Mel Jefferies, a young woman who regrets her gender transition and has returned to her birth gender, also welcomed the Cass report.
Mel Jefferies describes herself as a “detransitioner”.Credit: Chris Hopkins
“I made permanent decisions off temporary feelings by medically transitioning. And the whole medical system is enabling that … if people are pushing this and causing substantial harm; how do you come back from this?”
Equality Australia legal director Ghassan Kassisieh said Australia required parental consent before young people could access treatment, so it was “already too difficult for trans young people to access the care and support they need”.
Endocrinologist and head of the University of Melbourne’s trans health research group Associate Professor Ada Cheung said there was already substantial observational evidence reporting on the wellbeing of transgender young people on puberty blockers.
Associate Professor Ada Cheung.
She noted that four studies rated as high quality showed those treated with puberty blockers had less depression and anxiety, less self-harm and suicidality and fewer problems with peer relations.
“The Cass report goes against the consensus of professional medical associations around the world and I don’t think is relevant to practice in Australia,” she said.
“It downplays the risk of denying treatment to young people with gender dysphoria and limits their options by placing restrictions on their access to care.”
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