While doctors tend to be cautious in implementing new findings in emerging areas of medicine, "quite the reverse happened in the field of gender care for children", said Hilary Cass.
Cass commissioned the University of York to conduct a series of analyses as part of her review. Here are the main findings:
Clinical guidelines
Increasing numbers of children and young people experiencing gender dysphoria are being referred to specialist gender services. There are various guidelines outlining approaches to their clinical care.
In the first two papers, the York researchers examined the quality and development of published guidelines or clinical guidance containing recommendations for managing gender dysphoria in children and young people up to 18.
They studied a total of 23 guidelines published in different countries between 1998 and 2022.
All but two were published after 2010. Most of them lacked "an independent and evidence-based approach and information about how recommendations were developed", the researchers said.
Few guidelines were informed by a systematic review of empirical evidence and lacked transparency about how their recommendations were developed. Only two reported consulting directly with children and young people during their development, they found.
Writing in the British Medical Journal (BMJ), Cass said that while medicine was usually based on the pillars of integrating the best available research evidence with clinical expertise and patient values and preferences, she found in gender medicine "those pillars are built on shaky foundations".
She said the World Professional Association of Transgender Health (WPATH) had been "highly influential in directing international practice, although its guidelines were found by the University of York's appraisal to lack developmental rigour and transparency".
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