Dr Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, has produced a key report on gender care for young people which has been making headlines.

The report concludes that gender medicine for children and young people is built on shaky foundations” and is remarkably weak” evidence on medical interventions. Dr Cass found the toxicity” of the debate around gender meant professionals were afraid” to openly discuss their views even as the evidence of harm mounted.

The Cass Review was commissioned by NHS England in 2020, after a sharp rise in the number of patients referred to the NHS who were questioning their gender. In 2011-12 there were just under 250 referrals to the service; in 2021 – 22 the number had risen to over 5,000 referrals. The response was a gender-affirming” approach to care, putting children on a life-altering path involving puberty blockers and hormone treatment. Vulnerable young people overwhelmed the service demanding medical interventions – despite a lack of evidence on the long-term effects.

The final report is a damning indictment of the care being offered to vulnerable young people wrestling with questions of gender identity. It is hoped that this report will be a turning point in a global conversation that has often turned toxic. And while the Cass Review obviously doesn’t contain a theological section, its conclusions are largely consistent with the biblical picture. 


The Bible reminds us that we are made in the image of God. This is what grounds the Christian belief that all human beings must be treated with respect, love and dignity. From this flows the unique and transcendent value of every human being, the equality of every person and our understanding of inherent human rights. 

"...while the Cass Review obviously doesn’t contain a theological section, its conclusions are largely consistent with the biblical picture."

God created human beings in His image, both male and female. Man and woman are distinct, possessing equal value, made to glorify Him and together reflect His image. The human body, and therefore biological sex, is an intrinsic part of human identity. Cross-gender identification is problematic because it distorts the creational order of male and female.

A Christian Response to Cass

So, here are some of the key conclusions of the Cass Review that Christians should care about. The report highlights the wholly inadequate” evidence for the medical pathway and instead recommends more holistic treatment. It highlights concerns around social transitioning – which means treating a child as their preferred gender in terms of name, pronouns and clothing choices. Dr Cass says that young children should have therapy before they are allowed to socially transition. In fact, the report says under-25s should not be rushed into changing gender, but should receive unhurried, holistic, therapeutic support.” These life-changing” decisions must be properly considered in adulthood as the report notes that brain maturation continues into the mid-20s.

Childhood trauma, neglect and abuse feature heavily in the cohort of patients seeking gender changes, the report shows. Puberty blockers and hormone drugs should not be given until a child is at least 18, and there was no evidence the drugs buy time to think’ or reduce suicide risk’. The report also looks at why so many younger females are wanting to change gender and highlights an anxious, distressed and digital generation who consume more social media, are exposed to more online porn, and have lower self-esteem and more body hang-ups – particularly young women and girls. This correlates with Jonathan Haidt’s research and his new book, The Anxious Generation: How the great rewiring of childhood is causing an epidemic of mental illness.

Cass notes the toxic nature of the debate, but her report shifts the conversation from ideology to evidence. There will of course be areas of disagreement with her findings, and it will take time to filter through such areas as health and education, but there is much to encourage teachers, healthcare professionals, parents and youth leaders. It is not a moment for celebration – this report highlights the fact that a vulnerable group of patients have received inadequate care; but that has happened because campaign and lobby groups have driven the conversation.

"Dr Cass says that young children should have therapy before they are allowed to socially transition."

There have been other factors – the interventions of JK Rowling, the Kiera Bell and Maya Forstater cases, and the leaking of the WAPTH files – but it is hoped that this report will be a tipping point. The UK is leading the global conversation with France, Denmark and Sweden also moving away from an affirmative approach. Canada, Australia and the US are becoming the outliers in their unquestioning support of the affirmative approach and refusal to even allow a conversation based on the evidence.

A Grace and Truth Moment

This is a grace and truth moment. We need to pray with grace for those directly affected. Many have been misled in terms of their own treatment or how to support their loved ones. There will be a period of confusion following a report like this and it could be misused by any side to further particular agendas.

But there is also a moment of truth. This conversation is one of the most critical in our culture – evidence has been ignored in favour of ideologies – with terrible consequences for those involved. Bodies matter and they cannot be remoulded at will and an increasing number of people recognise this. The parents I speak to have sympathy for those experiencing gender confusion, but they are also concerned about the consequences when it comes to sport, schools and changing facilities.

Cass opens up the space for some fascinating missional conversations – right at the intersection of one of the most critical cultural controversies. A space for conversations about dignity, care, respect, bodies and reality – deep discussions on what it means to be human.

My prayer is that we are brave and kind enough to seize the moment.

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