Everything you need to know about the 広範囲にわたる 400-page Cass 報告（する）／憶測, 含むing why it was 始める，決める-up four years ago and what has happened since

An 熱望して-を待つd review into the care of gender-尋問 children in England and むちの跡s today tore apart 現在の practices.

Dr Hilary Cass's 近づく 400-page 報告（する）／憶測 明言する／公表するs children have been let 負かす／撃墜する by a 欠如（する） of 研究 on 医療の 介入s like powerful puberty blockers.??

And 指導基準s for 扱う／治療するing children who want to 交換（する） gender also aren't 証拠-based, the?尊敬（する）・点d paediatrician said.

Her 目録 of damning findings will be used as 弾薬／武器 to 精密検査する one of the most 議論の的になる areas of modern 薬／医学 both in the UK and the 残り／休憩（する） of the world.?

Here, MailOnline, answers your questions on the Cass 報告（する）／憶測, from what it 設立する, what the next steps are, to how it started in the first place.

Dr Hilary Cass’s final 報告（する）／憶測 on NHS care for gender 尋問 青年 has now been published

Retired 顧問 paediatrician Dr Cass speaking about the 出版（物） of the 独立した・無所属 Review of Gender 身元 Services for Children and Young People, April 9

What did the Cass 報告（する）／憶測 概して find?

The major review of care for gender 尋問 青年 in England 設立する youngsters were 存在 let 負かす／撃墜する by a?欠如（する） of 研究 and 証拠 on the 医療の 介入s that had become 基準 in the field.

As Dr Cass herself bluntly put it, the entirety of gender 薬／医学 for young people is 'built on 不安定な 創立／基礎s'.

These 含むd the use of 議論の的になる puberty blockers, which pause the physical changes of puberty such as breast 開発 and facial hair growth.?

It also took 目的（とする） at the 証拠, or 欠如（する） thereof, on social 移行ing, where a child is 扱う／治療するd as if they had switch genders, for example changing pronouns and the use of cross-sex hormones in 十代の少年少女.?

の中で the 報告（する）／憶測’s 32 推薦s are a call for gender services to operate 'to the same 基準s' as other health services for children and young people, with 'a holistic 査定／評価' of people referred.

Such a holistic approach would 含む 審査 for neurodevelopmental disorders such as autism, and a mental health 査定／評価.

The Cass 報告（する）／憶測 also 勧めるd the NHS to change some other 基準s of its gender care.

This 含むs a review of its 政策 on giving children masculinising or feminising hormones from the age of 16, with the 報告（する）／憶測 勧めるing 'extreme 警告を与える'.

Dr Cass said there 'should be a （疑いを）晴らす 臨床の 合理的な／理性的な for 供給するing hormones at this 行う／開催する／段階 rather than waiting until an individual reaches 18'.

The use of such hormones, the review said, should be part of a 研究 programme と一緒に a 以前 報告（する）／憶測d puberty blocker 裁判，公判 which is 推定する／予想するd to be in place by December.?

What did it say 特に about social 移行ing??

Dr Cass's 報告（する）／憶測 also 警告するd a 'more 用心深い approach' must be taken for children than for adolescents when it comes to social 移行ing, which is where someone might change their pronouns, 指名する and/or 着せる／賦与するing.

When families are making 決定／判定勝ち（する）s about social 移行ing, it is important 'parents are not unconsciously 影響（力）ing the child’s gender 表現', the review said.

The Tavistock Centre の近くにd a couple of weeks ago after it was 設立する not to be 'a 安全な or viable long-称する，呼ぶ／期間／用語 選択'

It 追加するd that?there was no （疑いを）晴らす 証拠 that social 移行 in childhood had any 肯定的な or 消極的な mental health 結果s.

But it 公式文書，認めるd that 'those who had socially 移行d at an earlier age and/or 事前の to 存在 seen in clinic were more likely to proceed to a 医療の pathway'.?

Has there been any reaction to 報告（する）／憶測?

答える／応じるing to the 報告（する）／憶測, NHS England said it had written to 地元の NHS leaders to pause first 任命 申し込む／申し出s at adult gender clinics to young people before their 18th birthday, and is 'bringing 今後 its systemic review of adult gender services'.

More 概して, the health service said it was 'very 感謝する to Dr Cass and her team for their 包括的な work on this important review', and that it would '始める，決める out a 十分な 実施 計画（する） に引き続いて careful consideration of this final 報告（する）／憶測 and its 推薦s'.?

Most trans 権利s groups have not yet seen the 報告（する）／憶測, but the findings and 関心s 最高潮の場面d are likely to be 論争d by some.?

Robbie de Santos, director of （選挙などの）運動をするs and human 権利s at LGBTQ+ 権利s organisation Stonewall, had a mixed 返答.

'What is important, above all, is that trans and gender-diverse children get the 質 healthcare that they need and deserve,' he said.?

'The Cass Rev iew can play a 決定的な 役割 in 達成するing this 目的（とする） if its 推薦s are 器具／実施するd 適切に.

'Many 推薦s could make a 肯定的な 衝撃 ? such as 拡大するing the 準備／条項 of healthcare by moving away from a 選び出す／独身 国家の service に向かって a 一連の 地域の centres while recognising that there are many different 治療 pathways that trans young people might take.

'But without 予定 care, training or その上の capacity in the system, others could lead to new 障壁s that 妨げる children and young people from 接近ing the care they need and deserve.'

Dr Cass herself, perhaps 心配するing some 消極的な reaction, 含むd the に引き続いて 公式文書，認めるs in the 報告（する）／憶測 itself.

She 主張するd her review was 'not about defining what it means to be trans, nor is it about 土台を崩すing the 有効性，効力 of trans 身元s, challenging the 権利 of people to 表明する themselves, or rolling 支援する on people’s 権利s to healthcare'.

Instead, and 演説（する）／住所ing gender 尋問 children 直接／まっすぐに, she said: 'I have been disappointed by the 欠如（する） of 証拠 on the long-称する，呼ぶ／期間／用語 衝撃 of taking hormones from an 早期に age; 研究 has let us all 負かす／撃墜する, most importantly you.'

What do other doctors think??

医療の 専門家s have 概して welcomed Dr Cass's findings.?

Dr Lade Smith, 大統領，／社長 of the 王室の College of Psychiatrists, said: 'Dr Hillary Cass has published a rigorous 独立した・無所属 review.?

'Crucially, it is 知らせるd by the 見解（をとる）s of people with lived experience, but also a 幅の広い 範囲 of 見解（をとる）s from stakeholders, healthcare professionals, social 労働者s and of course, parents.

The College will now review, in 詳細（に述べる）, the 推薦s of this i mportant 報告（する）／憶測 and what they mean for 患者s, psychiatrists and mental health services. Once this work is 完全にする, we will 答える／応じる in 十分な to its findings.'

Professor Steve Turner, 大統領，／社長 of the 王室の College of Paediatrics and Child Health (RCPCH), said the review was a '大規模な 請け負うing' and the college will 'closely consider the 報告（する）／憶測’s 推薦s'.

'It is 必須の that NHS England now 供給するs the necessary 付加 指導／手引 and support needed for paediatricians and the wider child health team to 請け負う their important 役割 of caring for children who are gender 尋問 or experiencing gender dysphoria,' he said.?

Professor Ashley Grossman, an 専門家 in endocrinology at the University of Oxford said the new 報告（する）／憶測 shone a much-needed light on the use of puberty blockers in gender care.?

'For many years we have been using puberty blockers in young children who are going into 早期に puberty to 延期する puberty to a normal time ? this has been very successful with much 詳細（に述べる）d 証拠,' she said.?

'This is a different 状況／情勢 ? this 始める，決める of reviews is looking at using these 麻薬s to 延期する normal puberty.?

'This very 詳細（に述べる）d 始める，決める of 分析 now 示唆するs that there are not enough good data showing the long-称する，呼ぶ／期間／用語 影響s in children with gender dysphoria.

'More carefully run 臨床の 裁判，公判s are needed so that we can understand how and when such スパイ／執行官s are 正当化するd and of 利益.'

Some charities have also welcomed the findings.

These 含む The Children’s Society, a charity 連合した to the Church o f England which called it a 'watershed moment'.

示す Russell, the charity's 長，指導者 (n)役員／(a)執行力のある said: 'Children and young people 調査するing their gender 身元 still 直面する 容認できない 障壁s in getting the support they 批判的に need, 最高潮の場面ing that there are 非常に／多数の oversights in how gender 身元 services are 現在／一般に designed and 配達するd.

'This 報告（する）／憶測 should 示す a watershed moment; an 適切な時期 to 取り去る／解体する the 存在するing 障壁s and foster an 環境 which places the wellbeing and safety of all children at its heart.'

What happens now? Are NHS gender care services for children still running?

Gender care services for young people in England and むちの跡s will continue as usual, while the NHS considers the Cass 報告（する）／憶測.

Just weeks before final 報告（する）／憶測 （機の）カム out, the NHS 制限するd the use of puberty blockers 特記する／引用するing a 欠如（する） of 証拠 on their 'safety or 臨床の 有効性'.?

However, NHS England's 決定／判定勝ち（する） is not an 完全な 禁止（する） on the puberty blockers 完全に.

Some 100 children 現在／一般に on the 麻薬s 経由で the NHS will be 許すd to continue their 治療 to its 結論 and there are 計画（する）s, as supported by the Cass 報告（する）／憶測, for a 臨床の 裁判，公判 in their use in the 未来.?

Additionally, in a 調印する of changes 存在 進行中で the NHS's old Gender 身元 開発 Service (GIDS) at the Tavistock and Portman NHS 創立／基礎 信用 shut its doors two weeks ago.

This was followed by two new 地域の 中心s 開始 in London and the north of England in an 成果／努力 to move away from a 選び出す／独身-service model.

NHS bosses hope to open seven or eight such centres in the 未来.

Will the 報告（する）／憶測 change how 私的な gender clinics operate?

No, at least not 直接／まっすぐに.

As they are not under NHS purview, 私的な clinics in England can still dish out puberty blockers and hormones to children as they have done in the past.??

However, the Cass 報告（する）／憶測's findings on a 欠如（する） of 証拠 on the safety and 有効性 of such 治療s will likely be used by 選挙運動者s who are calling for such 私的な gender clinics to be 制限するd.?

The review itself has? 明言する／公表するd that no GP should be 推定する／予想するd to 'enter into a 株d care 協定 with a 私的な provider' if a young person has been given 接近 to puberty blockers 経由で that 大勝する.

It 追加するd GPs had '表明するd 関心 about 存在 pressurised to 定める／命ずる hormones after these have been 始めるd by 私的な providers and that there is a 欠如（する） of clarity around their 責任／義務s in relation to 監視するing'.

Dr Cass said the Department of Health and Social Care and NHS England must 'consider the 関わりあい／含蓄s of 私的な healthcare on any 未来 requests to the NHS for 治療, 監視するing and/or 関与 in 研究'.

Her review also 公式文書，認めるd that a young person’s 適格（性） to 参加する the NHS 熟考する／考慮する into puberty blockers could be 影響する／感情d if they took puberty blockers 供給するd by an 外部の source.?

Is the 報告（する）／憶測 for England and むちの跡s only?

Yes, the 報告（する）／憶測 was （売買）手数料，委託（する）／委員会／権限d by NHS England which also runs gender care services for under 18s in むちの跡s.?

Therefore, gender care services in other parts of the UK, like those in Scotland,?are not in its purview.

However, it will likely be 言及／関連d in 審議s about those services in the 未来.?

Indeed, Northern Ireland has already said it will follow England's lead on the use of puberty blockers に引き続いて the 告示 of the change last month.?

How did the Cass 報告（する）／憶測 get 進行中で?

The Cass 報告（する）／憶測 was （売買）手数料，委託（する）／委員会／権限d by NHS England in September 2020 to make?推薦s about NHS services for gender-尋問 children and young people.

It was led by Dr Hilary Cass, former 大統領，／社長 of the 王室の College of Paediatrics and Child Health.

NHS England said at the time that the review has been 設立するd 'in 返答 to a コンビナート／複合体 and diverse 範囲 of 問題／発行するs'.

One of these was a 大規模な 殺到する in referrals to the NHS Gender 身元 開発 Service (GIDS) over the previous １０年間.

Referrals for GIDS, hosted at the Tavistock and Portman NHS 創立／基礎 信用, went from just under 250 in 2011/12 to more than 5,000 in 2021/22.

During the same period wait times for 患者s in the system ballooned, with some waiting years to 接近 care.

At the same time practices at GIDS were coming under 増加するing scrutiny after former 患者s and whistleblowing staff （人命などを）奪う，主張するd youngsters were 存在 急ぐd の上に 医薬 like puberty blockers にもかかわらず 関心s over their use.

This 含むd Keira Bell who 以前 took the clinic to the High 法廷，裁判所, （人命などを）奪う，主張するing she had not been challenged enough, before 存在 定める／命ずるd puberty blockers at just 16.?

These 関心s, which have been 大部分は 実証するd by the Cass review, surrounded a 欠如（する） of 証拠 regarding the safety of their use in 患者s and 不確定 about their long-称する，呼ぶ／期間／用語 衝撃 on 患者s' health.?