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Is the Cass Review Relevant to Australia?

In short - yes, the Cass Review[1] is highly relevant to Australia due to several key factors:

  1. International Applicability of the Dutch Protocol:

    • The Cass Review highlights that gender clinics worldwide, including those in Australia, use the same Dutch protocol involving puberty blockers and cross-sex hormones for minors. This protocol's evidence base is considered weak[2], as noted by Dr. Cass, making the findings of the Cass Review universally pertinent.

  2. Weak Evidence Base for Hormonal Treatments:

    • Dr. Cass's independent systematic reviews underscore the remarkably weak evidence supporting hormonal treatments for minors. The NHS's decision to limit puberty blockers to clinical trials reflects this uncertainty and experimental nature. This contrasts with the routine administration of these treatments in Australia without the basic transparency of regular public reporting of data on patient numbers and birth sex, treatment begun or ceased[3], etc. Dr Cass advises "extreme caution" in any use of cross-sex hormones[4] for those under 18.

  3. Critique of the Gender-Affirming Approach:

    • The Cass Review criticises the dominant gender-affirming treatment approach[5], which has shifted services away from exploratory methods to avoid being labelled by advocacy groups as "gatekeeping." Australia's adoption of the gender-affirming model, championed by groups like AusPATH, overlooks the exploratory therapy needed to address non-gender issues such as mental health or autism.

  4. Legislative and Clinical Safeguards:

    • The Cass Review warns against deceptive “gender identity conversion therapy” bans, which deter clinicians from engaging with gender-distressed youths due to fear of legal challenges. This concern is directly relevant to Australia's legislative environment, where recent bans have been criticised for potentially disadvantaging the very children they aim to protect, because fearful clinicians will avoid taking on these young people as clients.

  5. Evaluation of Treatment Guidelines:

    • The Cass Review's evaluation of international treatment guidelines, including those from the Royal Children's Hospital Melbourne, 2018, the Endocrine Society’s 2017, and the World Professional Association for Transgender Health (WPATH) 2022, found them to be of low quality. This assessment raises serious questions about the reliability of guidelines used in Australian clinics and calls for a re-evaluation of the protocols followed. All three were not recommended for use. The report says: "The guideline appraisal raises serious questions about the reliability of current guidelines."

  6. Survey of International Clinics:

    • The Cass Review's survey of 15 gender clinics, including five from Australia, criticized the fast-tracking of puberty blockers for children as young as 8-9 without safety data. This highlights significant concerns about the practices in Australian clinics and the need for a more cautious and evidence-based approach.

    • "Health ministers and gender clinicians in Australia have dismissed the idea that they can learn from the Cass review, claiming they already provide effective multidisciplinary care. However, Cass’s findings reveal that international guidelines often emphasize “multidisciplinary” approaches without a clear consensus on assessing gender-distressed children. Clinicians worldwide acknowledge the challenge of predicting which young people would benefit from medical transition versus alternative interventions [6]. The Cass-commissioned survey included responses from five Australian clinics, which the researchers criticized for fast-tracking puberty blockers in children as young as 8-9, despite lacking safety data."


These points demonstrate the direct relevance of the Cass Review's findings and recommendations to the Australian context, challenging the current practices and advocating for a more evidence-based and cautious approach to treating gender-distressed minors.


[1] Cass Review - Final Report”, April 2024


Cass Review' author: 'More 'caution' advised for gender-affirming care for youth', May 2024

[3], “Rapidly expanding gender-affirming care based on consensus instead of evidence justifies rigorous governance and transparency.”

Andrew James Amos, April 2024.

[4] - “Medical Risks & Damages of Gender Affirming Care”, July 2023

[5] Care Is Dangerous. I Know Because I Helped Pioneer It.’

'My country, and others, found there is no solid evidence supporting the medical transitioning of young people. Why aren’t American clinicians paying attention?'  Riittakerttu Kaltiala, October, 2023

[6] 'Gender medicine in the US: how the Cass review failed to land' BMJ 2024; Published 23 May 2024

(Thank you to Bernard Lane who's twitter post we have paraphrased and expanded on)

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