The PDA LGBT+ Committee believes that as pharmacists, we should understand what the Cass Review means for trans patients and the wider LGBT+ population. Representing the Scottish Trades Union Congress (STUC) Youth Committee, of which I am a member, on behalf of the PDA, I debated on a motion on repealing the Cass Review and the damaging misinformation surrounding this review, during the annual Scottish Trade Union Congress (STUC) on 28 April 25. A clip of this can be seen here from 38:25-53:21.
The Cass Review emphasised the need for additional psychological support for trans youth, which we agree is a positive outcome.
However, the Cass Review failed to appropriately review a plethora of evidence as part of its collection of systematic reviews and evidence-generation activities. These included international guidance set by the World Professional Association for Transgender Health (WPATH), national guidance set by French paediatric endocrinology experts, a New South Wales Health Ministry-commissioned evidence review and more.
The Cass Review focused on potential harm to transgender youth accessing GnRH (gonadotropin-releasing hormone agonists), also known as ‘puberty blockers’. Following its publication, further analysis has identified that the Cass Review dismissed evidence, yet does not provide a reason as to why the evidence that was included, considered weak, or to what extent certain contributions constituted acceptable or strong forms of evidence. The implication of this is that there is a high risk of bias within the Cass Review, as there is a lack of a framework towards assessing evidence as a group of multinational researchers highlighted.
Randomised controlled trials (RCTs) are widely considered to be one of the most reliable forms of research to collect data. However, there are certain ethical and financial limitations that apply uniquely to the delivery of RCTs within the context of transgender care. The implication of being able to access puberty blockers and relying on participation in research contains coercive elements and rings ethical alarm bells. Additionally, trials would not be possible to be blinded as there would be development or lack thereof in the use of GnRH or other hormone therapy.
The Cass Review engaged with multiple prominent anti-trans organisations, such as Our Duty, LGB Alliance, Sex Matters, and Transgender Trend. It is important to note that LGB Alliance is recognised as an anti-trans ‘hate group’, which is concerning in the context of safeguarding and protecting children against harm.
Another important point is that GnRHs are used in medicine for various indications in adults, prominently for prostate cancer, endometriosis, breast cancer and more. Additionally, GnRH are used among paediatric populations for precocious puberty. GnRH’s mechanism of action is well understood and sufficiently mapped out for medical use. Side effects are minimal; risks regarding osteoporosis need to be acknowledged, but these are well within medical knowledge to be able to be managed, since many other common medications, such as oral corticosteroids and proton pump inhibitors, are also associated with osteoporosis. The reversibility profile of GnRH is better compared to other options for gender affirming care for adolescents.
On the topic of paediatric medicine, the Cass Review described the evidence for puberty blocker use as ‘uniquely poor’, which is a misleading statement, as paediatric medicine as a whole suffers from a lack of targeted research, and paediatric medicine has a substantially higher usage of unlicensed or off-label medication in comparison to adults. One review identified that only 14% of unlicensed medicines used in children had sufficiently high evidence to support their use. There are multiple practical reasons for this, such as the variation in pharmacology across age ranges, reticence from patients and families to be recruited into research and many rare conditions affecting children which do not generate large enough sample sizes to adequately power a trial, making it financially attractive to pharmaceutical companies and inadequate research training within paediatric doctors in training. To uniquely target the use of puberty blockers while ignoring the overall climate of paediatric research politicises transgender lives and healthcare needs for gender incongruence, while also failing the many children with other conditions who would benefit from investment in further research into their conditions and treatment that recognises their unique needs.
It is also concerning that the government has decided to actively ban medicine for use when the review process is widely criticised in the LGBT+ community and medical organisations as flawed, and on the backdrop of ramping transphobia, as can be seen in the further deterioration of LGBT+ rights in Europe. This has been reported by the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA) Europe, which is part of the International Lesbian, Gay, Bisexual, Trans and Intersex Association. The UK went from one of the best countries for LGBT+ rights in Europe 10 years ago, to 22nd on the list, only 12 countries above Hungary, which has banned Pride events and criminalised organisers.
The commissioning of the Cass Review is similar to the commissioning of the Sewell Report, which states there is no institutional racism in the UK. Both reports attempt to lend credibility via institutions they represent; however, on closer inspection, they fail to withstand scientific or ethical scrutiny.
The PDA LGBT+ Committee calls for recalling the Cass Review and for NHS England to recommission a report that reviews gender affirming care for young people and children who are trans, that is based on best scientific and ethical considerations. The committee also calls for the UK government to reverse the ban on puberty blockers for trans youth and invest in gender affirming care.
By Soh Xi Ken (he/him), specialist clinical pharmacist and co-opted member of the PDA LGBT+ Committee
Get involved
- Join the PDA LGBT+ Network here.
- Follow the PDA LGBT+ Network on social media using the hashtag #PDAlgbt
- Contact the PDA LGBT+ Network committee by emailing [email protected]
Learn more
- STUC Congress 2025
- Standards of Care for the Health of Transgender and Gender Diverse People, Version 8
- Endocrine management of transgender adolescents: Expert consensus of the french society of pediatric endocrinology and diabetology working group
- Evidence for effective interventions for children and young people with gender dysphoria—update
- Recommended Minimum Standards for Provision and Commissioning of Gender Affirming Care in the UK
- Critically appraising the cass report: methodological flaws and unsupported claims
- LGB Alliance is an anti-trans ‘hate group’, says anti-extremism org
- Physiology of GnRH and Gonadotrophin Secretion
- SP05 Lights, camera and research action on medicine for children
- Understanding barriers for research involvement among paediatric trainees: a mixed methods study
- BMA to undertake evidence-led evaluation of the Cass Review
- Initial BAGIS statement on the Cass Review
- UK plummets down rankings for LGBT+ rights in Europe following Supreme Court ruling
- The Sewell Report was wrong about lived experience – here’s why
- The Sewell report risks turning the clock back on the fight against racism in the UK
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