Policy Statements

On 10th April, the final report of the Cass Review was published. 

It is clear from the outset that this review has used a patriarchal, cisnormative view of society and questionable research etiquette to make claims and recommendations which will have outstanding and immediate negative implications for the care provided to children and young people. 

While there are some recommendations that we believe would be beneficial to children and young people and their healthcare access if appropriately implemented, these recommendations are delivered with a tone of cis-supremacy and transphobia which serves to undermine the rights of children and young people.

The report is accompanied by several literature reviews prepared by the University of York. These reports determine that the evidence base in this area is generally of ‘low quality’. The report then dismisses this evidence, claiming that it cannot be considered in policy making. There is no acknowledgement that much of medicine, particularly for children and young people, uses evidence bases of similar quality to understand and direct developing policy.  

Additionally, the report makes multiple recommendations on the basis of other research without qualification to its quality. Some of these recommendations follow entirely spurious narratives and draw unfounded conclusions. The whole report is positioned in a way which considers continuation of current medication access as harmful, but removal of the current medication access as a neutral or beneficial act, despite no evidence to support this.

We are particularly concerned about the content discussing neurodiversity; social transition; and access to medications for children and young people. The report positions the fact that clinicians are unable to predict the future of children and young people’s gender expression as a critical failing of current practice. No service can or should aim to predict the future of children or young people’s lives and the idea that a clinician will know a young person better than they know themselves is in direct contradiction to the United Nations Convention on the Rights of the Child. The aim for clinicians should be to provide a safe, accessible and supportive service which provides individualised care to all children and young people it encounters. 

We also note that despite the review’s scope being limited to under 18 year olds, the report comments on adult care and makes recommendations which could be seen as threatening access to hormone medication for adults.

We believe that the report recommendations will lead to further gatekeeping for trans children and young people, particularly around access to medical treatment. This Review will also have international implications that will cause direct and irreparable harm to young trans people. The Trans Learning Partnership knows the importance of centering lived experience and community expertise in creating impactful research. We have long been concerned that the Cass Review does not understand this importance, and we believe this is clearly reflected in the final publication. 

We have already seen the negative effects of the media discussions of the report and want to reassure you that we will be taking time over the coming weeks to read and analyse the publications in full, and hope to share our fully-formed reflections with you, our community. All trans people, regardless of age, have the right to live as themselves, free from discrimination and violence, particularly from the institutions that should be there to protect them.

It is vital that we preserve bodily autonomy for everyone. The continued attacks on trans people’s autonomy cause very real harm for trans people and all people fighting for the right to bodily autonomy.

We will continue to fight for the care and dignity every trans person of every age deserves. 

Access to gender-affirming treatments should be free and accessible for all. However, in practice, this is not currently the case throughout the UK.

In order to access gender-affirming medical care, an individual must be referred by a GP to one of the NHS’ specialist Gender Identity Clinics (GICs). The current waiting times for an initial appointment with one of the seven English clinics vary between four and six years: this is an assessment appointment, and care is not initiated until at least a second appointment, for which there is another wait of at least a year, and many more years for surgery. As a result, many trans people are forced to fundraise so they can access essential care privately.

We need an informed consent model, where individuals are empowered to make decisions for themselves with all the information available to them, without doctors making these decisions for them. This would make care much more accessible for a range of people: for example, trans people with BMIs over 30, who many surgeons currently refuse to treat. We believe that gender affirming care should be delivered within primary care, where GPs can prescribe hormones and refer individuals on to other specialists in endocrinology or gynaecology, for example, where transition-related services are delivered alongside other types of care within each specialism (e.g., hormones are monitored by any endocrinologist, mastectomies are undertaken by surgeons who would be undertaking similar surgeries on cis individuals). Moving to this model of care would significantly improve the wellbeing of trans people.

Access to treatment should not be contingent on a certain level of distress experienced, as this is a poor understanding of transness, flattening it to an experience of distress. Instead, trans people’s motivations to transition can, and should, include a desire to experience more joy in one’s own body than currently experiencing. Trans people will continue to be pathologised until the need for a diagnosis of gender dysphoria to access treatment is removed.

We believe all children and young people have the right to explore their gender safely in a supportive, affirming environment. Children and young people should be supported in social and medical transition where this is the individual’s desired pathway. The NHS clinics must work to reduce the waiting list to access care, and treatment options must include access to puberty delaying medications and hormone replacement therapy.

Our position is led by the best global evidence, which consistently demonstrates that supporting and affirming a child or young person in their gender exploration leads to the best physical and mental health outcomes, and reduces the development of mental health struggles common among the trans community as a result of transphobia and untreated gender dysphoria.

The Government’s current policy of housing trans individuals in estates based on their birth sex, regardless of whether they have a Gender Recognition Certificate, with the possibility of reassignment following review is a violent, transphobic policy that puts trans people in immediate danger of harm.

We believe that trans inmates must be treated with dignity and respect, as any other human deserves. Trans people must be housed in the estate that reflects their gender, regardless of their birth sex or transition. This must also include protection from violence from other inmates and from prison authorities.

Currently, the placement of any prisoner, cis or trans, includes a risk assessment: due to the gendered nature of prisons, the highest security prisons are male-only, leading to occasions where cis women are housed in men’s prisons. This should be considered as equally abhorrent as the placement of trans women in men’s prisons: prison’s must be made safe for all.

Within a system of legal gender recognition, it is vital that the Government properly recognises all its citizens. Trans people must be able to declare their own gender without the current intrusive and humiliating system: there must be no requirements for medical diagnosis, no panel to which an individual must ‘prove’ themselves, and gender options must include non-binary people.

Proper legal recognition allows trans people to marry, die, and have their birth certificates reflect who they are: it does not impact any other parts of life, and despite false claims to the contrary, legal recognition will have no impacts on the rights of cis people.

Conversion practices are any attempt to suppress/change an individual’s gender or sexuality, on the grounds that the identity they express is considered undesirable or unnatural. These practices are abusive and harmful, and in some cases can amount to torture.

Conversion practices don’t always look violent: sometimes they can look and sound like legitimate psychotherapy, practised by licensed therapists across healthcare providers. For example, a new form of conversion practice known as ‘gender exploratory therapy’ has been gaining popularity amongst anti-trans groups, in which an individual explores the different reasons that could be causing their gender dysphoria: however, the goal of this practice is always to convince the individual that they are not trans, and to delay their transition as long as possible.

We are opposed to conversion practices in all their forms as they are violent and harmful. We are a member of the Ban Conversion Therapy coalition, and urge the Government to bring forth a full, trans-inclusive ban on conversion practices immediately.

Trans people must be allowed to play and compete in sports that reflect their gender.

Recent research demonstrates that trans women do not retain any physical advantage over cis women based on previously having a testosterone-dominant system. As such, there is no basis for excluding trans women from women’s sport. Notably, the focus on the involvement of trans feminine people in women’s sports (rather than an equal focus on trans masculine people in men’s sports) is reflective of the specific demonisation and hatred aimed at trans feminine people.

Discussions focus on professional athletes & world championships, but this just affects normal people/amateurs, focus on one potential person over all other trans people, even when there isnt a prize or professional stakes involved.

Even among cis individuals of the same gender, physiology varies greatly. There is no danger in trans individuals playing against people of their own gender. It’s also important to highlight that historically, the gendered division of sport is grounded in sexism, where it was deemed inappropriate and an invasion into men’s spaces for women to play sports. Women who did ‘too well’ would have their gender questioned as far back as the 1960s. This history is a reminder that men have always sought to exclude others from sports: it is vital that women and trans people stand together to resist erasure from spaces.

Excluding trans people from sports contributes to the poor health outcomes that trans people experience, excludes trans people from participating in community activities (and therefore increasing social isolation), and is not based on any substantial scientific evidence.

Trans people have the right to access single-sex spaces, such as bathrooms, changing rooms, and refuge services, that align with their gender. Trans people have this right regardless of whether they have a Gender Recognition Certificate or not.

Exemptions in the Equality Act 2010 allow for some instances in which trans people can be excluded from these settings, when this is considered a proportionate means for a legitimate aim: in these cases, the burden of evidence for this need is on the individual or organisation choosing to make the exclusion.

The Trans Learning Partnership is today publishing a statement of intent signalling our support for the introduction of dedicated sex and gender policies for biomedical, health and care research in the UK. We join with organisations across the UK medical research sector to publish this statement, which was produced in collaboration with The George Institute for Global Health’s Medical Science Sex and Gender Equity (MESSAGE) project.

High-quality, reproducible and inclusive medical research requires consideration of sex and gender at every stage, from study design and participant recruitment to data analysis and transparent reporting of results. Sex and gender influence the conditions people develop, the symptoms they experience, the treatment they receive, and their overall outcomes. 

The current evidence base has relied on studies conducted primarily on male cells, animals and people, contributing to persisting standards of worse care and worse outcomes for cis women and sex-and-gender-diverse people. Understanding sex and gender differences, as well as where similarities exist, is therefore essential to ensure that treatment and care is safe and effective for all people.

In addition, trans and/or nonbinary communities are chronically over-researched, but there remains an unavailability of answers to simple questions about their needs – the same or similar studies are frequently repeated because researchers don’t know where to look to find the existing answers, or how to access existing data. Our aim is to close this information gap and facilitate the production of large-scale research which can meaningfully interrogate data about trans and/or nonbinary communities in order to ensure they receive safe and effective care.

In contrast to other high-income countries – notably Canada, the United States and European nations under Horizon Europe – the UK has no standard, unified guidance for researchers about how to consider sex dimensions in cell and animal studies, and sex and gender dimensions in human studies. To address this need, the Trans Learning Partnership has collaborated with the MESSAGE project to co-design a sex and gender policy framework for UK research funders. We are working alongside the wider sector – including research funders, regulators, researchers, patient and public groups, academic publishers, and the Department of Health and Social Care – to develop priorities for change in this space and discuss how sex and gender policies should be best implemented. We welcome the launch of this framework in 2024, which sets a new gold standard for research in the UK and will ensure cohesion in requirements made of researchers going forwards.

Robyn Norton, Founding Director of The George Institute, Professor of Global Health at Imperial College London and co-principal investigator on the MESSAGE project, said, “We are delighted to see so many members of the UK research sector express their commitment to improving scientific rigour and equity in biomedical, health and care research. Today marks a huge advance for the UK research community, which will help provide the most effective evidence to improve outcomes for all patients.”

To support this effort, the TLP will continue its participation in MESSAGE labs as part of its efforts in all areas to improve best practices for the collection, management, and analysis of trans and/or nonbinary data.

You can find out more about the MESSAGE project at www.messageproject.co.uk or on X at @MESSAGE_TGI

Everyone deserves timely access to holistic, high-quality healthcare and to be treated with dignity, privacy and respect throughout their treatment and care. 

This includes trans, non-binary and intersex people who already face significant barriers and inequality when accessing NHS care.

The consultation closes on 25th June 2024, and will inform changes to the NHS Constitution that will be in place until 2035. 

We have concerns about some of the changes proposed, particularly those likely to impact trans patients and healthcare professionals. 

In the meantime, we’d like to remind everyone that these proposals are under consultation, and will not change how NHS healthcare is provided at this time. There is likely to be a lot said and written about these proposals, not all of which will be balanced.  

We’re looking carefully at the proposed changes and working with experts to understand their legal and practical impacts on trans, non-binary and intersex people and will share more with our communities in the coming weeks.

If you have concerns about your wellbeing or healthcare please reach out for support.

Signed by:

Gendered Intelligence

LGBT+ Consortium

LGBT Foundation

The Kite Trust

Mermaids

Stonewall

TransActual

Trans Learning Partnership

The Proud Trust