A letter from RANZCP members: Cass Review Final Report

As RANZCP members, we believe our serious professional concerns regarding the gender interventions being provided to Australian children and adolescents are not being adequately represented by the College in its media communications and political advocacy. 

On 10 April 2024, the Cass Review Final Report was released. Commissioned by the UK’s NHS, the report conducted eight independent systematic reviews of the global research literature to underpin its recommendations. It reveals there is no clear evidentiary basis for gender affirmation interventions and evidence for puberty suppression and cross-sex hormone treatment is of such poor quality that no foundation exists for clinical decisions and informed consent. 

The review recommends puberty blockers be restricted to ethics-approved research trials and cross-sex hormones be used with extreme caution in people between ages 16 and 18, with approval from an independent expert panel required. It cautions that social transition is an active intervention that may have significant effects on psychological functioning and longer-term outcomes. It concluded: “the evidence does not adequately support the claim that gender affirming treatment reduces suicide risk” and that treatment for gender dysphoria should not be based on the “gender-affirming” model, which is the model used by Australian paediatric gender services.  

We request the RANZCP urgently:

• acknowledge the recommendations of the Cass Review as relevant to Australian paediatric gender services, and 
• call for health ministers to establish an independent body to investigate Australian paediatric gender services and implement relevant recommendations from the Cass Review  

Submitted by:

Jillian Spencer
Phillip Morris
Melinda Hill
Alida Connell
Shannon Morton
Mary Jessop
Antony Davis
Peter Parry
Catherine Llewellyn
Ian Munt
Mani Rajagopalan
Laura Hamilton 
Penny Brassey
Ainslie Haggitt
Andrew Amos
Michael Beech
Suren Putter-Larem

RANZCP response

The College is committed to respectful, sensitive and appropriate mental health care being provided to individuals who identify as LGBTIQ+. Being Trans or Gender Diverse is not a mental health condition, and the RANZCP unequivocally supports the rights of trans and gender diverse people to have equal access to safe and effective mental health care that is underpinned by dignity, empathy and respect.

The Cass Review Final Report is one of a number of reviews on healthcare for trans children and transgender health. The RANZCP acknowledges the dialogue and academic debate that arises from the publication of reports which review emerging evidence and the subsequent recommendations that are made.

Consistent with Position Statement 103: The role of psychiatrists in working with Trans and Gender Diverse people, the College continues to acknowledge that while a number of major professional organisations support the use of puberty suppressants and cross sex hormones for adolescents, we recognise that health authorities in some European countries have recommended restrictions be placed on their use.

The College does not call for the Government to commission an Inquiry following the release of the Cass Review. The College does continue to support the development of a nationally consistent framework for service provision and outcomes monitoring in order to enable the provision of consistent high-quality specialist care for people experiencing gender dysphoria. 

The College emphasises that assessment and treatment should be patient centred, evidence-informed and responsive to and supportive of the child or young person’s needs and that psychiatrists have a responsibility to counter stigma and discrimination directed towards trans and gender diverse people.

Dr Elizabeth Moore
President