British Medical Association drops opposition to Cass Review but still backs puberty blockers access

The British Medical Association (BMA) has softened its stance on the Cass Review.

Senior doctors now say they do not oppose its recommendations overall – while still arguing against a government ban on puberty blockers for trans young people.

The change marks a significant shift for the doctors’s union, which last year voted to “oppose the implementation” of the review into NHS gender identity services for children and teenagers.

British Medical Association changes position on Cass Review recommendations

At the time, the BMA described the review’s recommendations as “unsubstantiated” and criticised proposals to restrict access to puberty blockers, saying more research was needed to build “a solid evidence base for children’s care”.

Now, a new report produced by a 12-member BMA task group has backed much of the review’s approach.

Professor David Strain, chair of the BMA’s board of science and lead author of the report, told The Times that Dr Hilary Cass “has been vindicated in the way she approached the data”.

Strain also said he could not point to any of the Cass Review’s 32 recommendations that the BMA fundamentally disagreed with.

What did the Cass Review say about puberty blockers and NHS gender care?

“She approached an area of significant uncertainty with that prime rule of medicine, of ‘first, do no harm,’” he said.

The Cass Review, commissioned by NHS England and published in April 2024, examined gender identity services for children and young people. It concluded that there was limited evidence supporting the routine use of medical interventions including puberty blockers and hormone treatment for under-18s, and recommended a more cautious clinical model.

Its publication led to sweeping changes across NHS gender services. Later in 2024, health secretary Wes Streeting announced an indefinite ban on new NHS prescriptions of puberty blockers for trans under-18s across the UK.

The BMA said it still opposes that ban, arguing that prescribing decisions should be left to doctors rather than politicians.

The BMA says politicians should not decide access to puberty blockers

“We spend decades training on how to use drugs, and to have a political decision affecting the way we prescribe is wrong,” the organisation said.

Strain said puberty blockers should remain available through specialist clinicians, though not be “freely available”.

A separate study into the effects of puberty blockers on transgender adolescents – the PATHWAYS trial, led by King’s College London – was paused earlier this year after concerns were raised by the Medicines and Healthcare products Regulatory Agency about elements of its methodology.

Puberty blockers continue to be prescribed in the UK for other healthcare purposes, including the treatment of precocious puberty in cisgender children.