Dr. Cass Backpedals From Review: HRT, Blockers Should Be Made Available

Dr. Cass's latest statements are likely to cast more doubt on the validity of the study, which has come under fire for disregarding substantial evidence on trans care.

Photo by Karollyne Videira Hubert on Unsplash [update: I received a message that one of the people in this picture goes by Cas. This is not the same person as Dr. Hillary Cass, who is not in this photo.]

In the latest twist over the Cass Review, a controversial report released in England last week targeting transgender care, the review’s leader has seemingly walked back recommendations and findings that have already led to a crackdown on transgender care in the United Kingdom. Dr. Hilary Cass, in an interview with LGBTQ+ organizations, reportedly stated that puberty blockers and hormone therapy should be made available at differing ages based on individual need, and that current policies in England often result in those medications being offered too late. This stands in stark contrast to the report itself, which presents much more restrictive findings and recommendations on trans youth care that have been used to ban treatments in the UK and cited by far-right organizations behind bans in the United States.

The Cass Review was commissioned and produced in England in the wake of political attacks on transgender people in the United Kingdom after clinic closures and skyrocketing wait times. The “independent” review was led by Dr. Hilary Cass, who reportedly followed several anti-trans organizations on social media and who met with Governor DeSantis’ medical board and offered information in their efforts to ban care in Florida, leading to some to question that independence. Last week, the final review was published, leading to bans on puberty blockers in the country, citing the report as justification for doing so.

The report disregarded a substantial amount of evidence for transgender care as not "high quality" enough and then described the evidence surrounding transgender care as weak, despite other reviews, major medical organizations, and the largest psychological organization in the world finding the evidence compelling enough to support gender affirming care. This has led to a group of over 100 Irish academics decrying the review in a group letter. The report made a series of recommendations, such as Recommendation 8, which states that hormone therapy is available for 16-year-olds but should be administered with "extreme caution," and encourages clinicians to delay the treatment until age 18 unless there are "clear rationales" for earlier intervention. It also called for significant restrictions on puberty blockers, limiting them to research studies only. These recommendations and Cass’s findings have been used to justify severe crackdowns on transgender care.

See recommendation 8 here:

Recommendation 8, Cass Review.

Now, in an interview first reported on twitter by TransSafetyNow, Dr. Hilary Cass appears to substantially walk back much of her review, interpretations of that review, and even attempts to brush off her meetings with political appointees in the DeSantis administration who met with her to obtain information they would later attempt to use to ban trans care there. In the interview with UK-based LGBTQ+ organization The Kite Trust, Dr. Hilary Cass is asked if she believes it is OK to prescribe puberty blockers. Her answer is significantly out of alignment with her report:

“In the data the Cass Review examined, the most common age that trans young people were being initially prescribed puberty suppressing hormones was 15. Dr. Cass’s view is that this is too late to have the intended benefits of suppressing the effects of puberty and was caused by the previous NHS policy of requiring a trans young person to be on puberty suppressing hormones for a year before accessing gender affirming hormones. The Cass Review Report recommends that a different approach is needed, with puberty suppressing hormones and gender affirming hormones being available to young people at different ages and developmental stages alongside a wider range of gender affirming healthcare based on individual need.”

Her answer aligns more closely with the current provision of transgender care in many countries, where individual needs and circumstances are prioritized for each patient. However, this is not the tone of the report, which has been used to advocate for significant restrictions and even outright bans. In the United States, the report has been cited by the Heritage Foundation (retweeted) and the Alliance Defending Freedom, organizations that have been actively involved in bans on trans care. In the United Kingdom, the report has even prompted an inquest into adult trans care, raising concerns about its potential impact on this care as well.

Some have accused her answers in the interview as being an attempt to deflect criticism. This is particularly evident in her response regarding a meeting with Dr. Patrick Hunter, a Catholic Medical Association doctor who was tapped by Governor Ron DeSantis in the United States to ban transgender care. Following the publication of the Florida reviews and standards of care, which bears a resemblance to the Cass Review, lawsuits revealed that the review was deceitfully conducted. Evidence, including a PowerPoint document, showed that the decision to ban trans care had been made before the review had even begun. Documents produced by the lawsuit also revealed that Dr. Cass had taken a meeting and exchanged emails with the Florida team.

Dr. Cass, in the latest interview, denies any wrongdoing, stating:

“Patrick Hunter approached the Cass Review stating he was a paediatrician who had worked in this area. The Cass Review team were not aware of his wider connections and political affiliations at this time and so he met the criteria for clinicians who were offered an initial meeting. This initial contact was the same as any paediatrician who approached the study. The Cass Review team declined any further contact with Patrick Hunter after this meeting. Patrick Hunter and his political connections has had no influence on the content of the Cass Review Report.”

However, in a new email made exclusively available to "Erin In The Morning," Dr. Cass's denial of impropriety does not appear to tell the whole story. Although she claims that she was not aware of his political affiliations, we learn that the meeting was actually set up by Dr. Riittakerttu Kaltiala, a member of the Cass Advisory Board (declared in her conflicts of interest) whom Dr. Patrick Hunter says has worked with him many times in the past. In this email, we also learn that Dr. Cass followed up with information she wanted to share with the board.

Email from Dr. Patrick Hunter about meeting with Dr. Cass.

Furthermore, Dr. Cass's claim that this was the only meeting between members of the Cass Review team and medical board members appointed by Governor DeSantis to ban care is contradicted by a court deposition citing "regular meetings" with Dr. Kaltiala, the member of the Cass Review Advisory Board who arranged the meeting between Dr. Cass and Dr. Hunter.

Deposition of Dr. Roman in Florida Case

The interview is likely to further embroil the Cass Review in scandal both in the United Kingdom and internationally. It seems to represent a significant attempt to deflect criticism from the report by softening some of its conclusions. Moreover, the defensive tone of the report regarding those who influenced its production and meetings with politically charged appointees, who themselves have faced scrutiny over unethical and deceitful practices in reports on transgender healthcare, is bound to raise eyebrows. However, it remains to be seen whether politicians in England or in red states in the United States, who are aggressively seeking any pretext to restrict care, will pause their efforts even with Dr. Cass tempering the implications of her report.