SEEN in Health wrote to the Chair of the BMA, the doctors' union, on 6 August 2024 to express our concern about its decision to publicly critique the Cass Review.

Read the full text of the letter below.

Dear Prof. Banfield

We write to express our dismay and disbelief at the decision by the BMA Council to ‘publicly critique’ the Cass Review and to lobby against the implementation of its recommendations. It is not clear if the BMA committee has read the BMJ editorial by Kamran Abbasi welcoming the Cass Review – we strongly recommend that you do. Dr Cass reached the conclusion that there is not enough evidence to support the use of puberty blockers for gender-distressed children following four years reviewing all the available literature and speaking to more than 1000 people with direct personal involvement with the issue.

As medical professionals, we should be guided always by the principle of ‘first do no harm’. Promoting puberty blockers as a treatment for gender confused children flies in the face of this principle – not only is there scant evidence of their benefits, but emerging evidence links their use with an increased risk of osteoporosis, stroke and heart conditions, and impact on brain development.

The overwhelming majority of gender confused children and young adults are same sex attracted, have autism spectrum disorders, or other mental health difficulties. Puberty blockers are an intervention that takes away their future choices and puts them on the path to becoming lifelong patients. Cass specifically says that more must be done for these children. Indeed, it is well known that mental health services have been failing for years. But physical treatments are no replacement for psychological services and affirmative treatments such as puberty blockers would not be considered for other conditions in a similar cohort, such as anorexia.

SEEN in Health believes it is important that we can talk freely and without fear about how best to treat gender distressed children, and this must include young people who now regret the ‘gender affirming’ treatments they received. The medical profession cannot allow itself to become part of an ideological movement rather than promoting a careful scientific approach to new treatment.

At SEEN in Health we have a wealth of relevant experience in General Practice, Emergency Medicine, Psychiatry and Psychology, Medical Ethics and Law, and in assessing systematic reviews. We can offer support for the BMA to reach an evidence-based patient centred assessment of Cass, taking into account the protected characteristic of sex. We urge you to reconsider your stance on this and to engage with us in good faith to ensure that the best interests of children and young people struggling with gender distress are at the forefront of policy and practice.