BMA drop opposition to Cass review on gender treatment

The British Medical Association (BMA) has said that it no longer opposes the implementation of Baroness Cass’ review into gender identity medicine for children and young people.

The review conducted by Dr Hillary Cass (now Baroness Cass) in July 2024 recommended that the gender identity services offered by the NHS be overhauled, and that they move away from a “medical pathway” for gender-questioning children, who would have previously been offered puberty blocking medication. Following the publication of Cass’ review, the BMA’s council voted to “oppose the implementation” of the report’s proposals, saying that the recommendations were “unsubstantiated”.

The BMA have subsequently spent two years working on its own analysis of the Cass Review, which was published this week. The report vindicates the findings of the original review and concludes that the evidence base for puberty blockers and gender affirming hormones is limited and uncertain.

The report’s lead author, Professor David Strain, who is also the chair of the BMA’s board of science said that “the baroness has been vindicated in the way she approached the data” and when asked if he could name any of Cass’s recommendations which the BMA now opposed, he said “I can’t.” Approving of Cass’ methodology, he commented: “She approached an area of significant uncertainty with that prime rule of medicine, of ‘first, do no harm’.”

The BMA’s report said that there was “substantial disagreement” about the use of puberty blockers among the twelve authors, with two main perspectives represented. One view supported restrictions on puberty blocking medication because of “known and plausible harms”, while the second view favoured keeping puberty blockers available through the NHS. Four of the authors took the former view, and six took the latter, with two remaining neutral. The report itself made no firm conclusion on the subject.

Puberty blocking medication was stopped by the NHS after the Cass Review warned of risks to fertility and brain and bone development. Cass recommended a trial of the medication which had been due to start in January, but was paused after concerns about the “long-term biological harms” to children.

The BMA said that it was “continuing to oppose a ban on puberty blockers for several reasons, not least because it is a threat to the autonomy of a doctor. We spend decades training on how to use drugs, and to have a political decision affecting the way we prescribe is wrong.”