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Cass Review out of step with high-quality care provided in Aotearoa

11 Apr 2024 8:05 AM | PATHA (Administrator)

The Professional Association for Transgender Health Aotearoa (PATHA) is disappointed to see the number of harmful recommendations made by the NHS-commissioned Cass Review, released yesterday in England. This review ignores the consensus of major medical bodies around the world and lacks relevance in an Aotearoa context.

The Cass Review is a report into England’s approach to providing gender affirming care through a centralised gender clinic model. The 2022 interim report found this model was not fit for purpose, with wait times for the service extending into years. As a result, the clinic was closed while the NHS determined a better approach to providing this service.

The final Cass Review did not include trans or non-binary experts or clinicians experienced in providing gender affirming care in its decision-making, conclusions, or findings. Instead, a number of people involved in the review and the advisory group previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming ‘gender exploratory therapy’, which is considered a conversion practice.

It’s shocking to see such a significant inquiry into transgender health completely disregard the voices of transgender experts. It would be like reviewing women’s health with no women, or Māori health with no Māori involved.

PATHA has shown the benefit of collaborations between transgender community members and clinicians providing gender affirming care. The lived experience and knowledge of our community members and clinicians does not make them biased - it means they’re the experts in this care.

The Review commissioned a number of systematic reviews into gender affirming care by the University of York, but seems to have disregarded a significant number of studies that show the benefits of gender affirming care. In one review, 101 out of 103 studies were discarded.

PATHA welcomes further research about the health interventions that support the wellbeing and lives of trans and non-binary people, and of trans communities locally and globally. While we certainly look forward to more longitudinal research, the evidence in support of gender affirming care is clear, and we’re disappointed to see this review discard so much robust work from researchers around the world. When multiple observational studies produce similar findings, the cumulative evidence becomes compelling.

The Review’s recommendations include restricting access to both social transition and gender affirming hormone therapy, and would require the approval of a national multi-disciplinary team for any gender affirming care to be provided to anyone under 18. Restricting access to social transition is restricting gender expression, a natural part of human diversity. Requiring clinical approval for haircuts and wardrobe changes is intrusive, inappropriate, and a waste of money and time.

We’ve seen the benefits that increased access to gender affirming care have had on trans communities around Aotearoa. Barriers to care have detrimental impacts on wellbeing, and create additional work for healthcare systems already under stress. Our holistic approach, utilising multi-disciplinary teams, works well for Aotearoa.

In Aotearoa, gender affirming care is available no matter where you live, and has evolved over the last 15 years based on clinical experience, emerging evidence, and updated guidelines. Clinicians around the country, supported by specialists and multidisciplinary teams where needed, work alongside whānau to ensure best practice that is holistic, individualised, and whānau centred, with the best possible outcomes for our rangatahi.

Clinicians working in gender-affirming care welcome the increasing body of evidence about puberty blockers. This is important to help young people and their families make the best decisions about their individualised care.

PATHA is proud to support clinicians and community members working to promote the health and wellbeing of trans and non-binary people around Aotearoa. Our members have contributed to the evidence base in support of gender affirming care, and of trans wellbeing more generally, and will continue to work to improve access and the quality of care around the country.

We’ve collaborated with AusPATH and other rainbow organisations on this statement released by Equality Australia, and encourage that everyone take good care of themselves, and take time to unplug and check in with those around you. Aroha nui and kia kaha.


The Professional Association for Transgender Health Aotearoa (PATHA) is an interdisciplinary professional organisation working to promote the health, wellbeing, and rights of transgender people. We are a group of professionals who have experience working for transgender health in clinical, academic, community, legal and other settings.


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