NHS's entire gender treatment model for children is demolished in bombshell report: Teens suffered irreversible changes based on 'remarkably weak evidence', 'toxic' debate taints key issues - and schools are ALSO blasted by eminent doctor

Children given NHS transgender treatment have been set on a path of irreversible change despite scant medical data, a report has concluded.

NHS gender identity services for children and young people have been based on 'remarkably weak evidence', the independent review by leading paediatrician Dr Hilary Cass warned.

Her study, commissioned nearly four years ago, makes 32 recommendations to overhaul NHS trans services to improve the care that children receive.

Prime Minister Rishi Sunak welcomed the report and called for 'extreme caution' in treating youngsters in the future.

Campaigners hailed it as 'a return to common-sense decision-making'. In other developments:

■ Dr Cass said the 'toxicity of the debate' over trans care for children was 'exceptional' – and revealed she was herself singled out for criticism during her work;

■ The report said there was a 'lack of high-quality research' on the effects of giving children puberty blockers and hormones, and recommended that NHS England establish its own research programme;

■ Long NHS waiting lists were said to have driven trans children into the arms of private clinics, with GPs 'pressurised to prescribe';

■ Dr Cass laid the groundwork for schools to introduce clearer guidance when dealing with trans children, ending the exclusion of parents;

■ The report called for the creation a separate service for those wanting to 'de-transition', where a gender transition is stopped or reversed;

■ Dr Cass recommended a 'follow-through service' for 17 to 25-year-olds to protect teenagers 'falling off a cliff edge' in care when they hit 17.

■ NHS England launched a similar review of adult gender services led by an independent expert.

Dr Cass warned that her review had been hampered by how polarised the debate on trans care for children has become. She said medical professionals had been left '[too] afraid to openly discuss their views'.

Dr Cass said: 'Despite the best intentions of everyone with a stake in this complex issue, the toxicity of the debate is exceptional.

'I have faced criticism for engaging with groups and individuals who take a social justice approach and advocate for gender affirmation, and have equally been criticised for involving groups and individuals who urge more caution.

'This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate.

'There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop. 

'Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.'

Dr Cass described having come into contact with some 'very aggressive people' during meetings as part of her work. The report found evidence for the use of puberty blockers and hormone treatments relied heavily on 'shaky foundations' and guidelines not backed by science.

Dr Cass addressed recent debates over 'social transitioning', such as changing names and pronouns.

The report found those who socially transition at an earlier age or before seeing a medical professional were 'more likely to proceed to a medical pathway'.

She said 'the importance of what happens in school' cannot be over-estimated and said parents must not be excluded from conversations over their children's welfare.

Unregulated private clinics were singled out for some of Dr Cass's toughest criticism as she echoed GPs' warnings over prescriptions issued by services based abroad.

The review said family doctors had 'expressed concern about being pressurised to prescribe hormones after these have been initiated by private providers'.

It said no GP should be expected to 'enter into a shared care arrangement with a private provider', especially one acting outside NHS guidance. Mr Sunak said the report emphasised the need for caution over treatment.

He said: 'We simply do not know the long-term impacts of medical treatment or social transitioning on children.

'The wellbeing and health of children must come first.'

Helen Joyce of charity Sex Matters, said: 'Hilary Cass's report demolishes the entire basis for the current model of treating gender-distressed children.

'It is a shameful day for NHS England, which for too long gave vulnerable children harmful treatments for which there was no evidence base.

'Cass's review is a breath of fresh air, marking a return to common-sense decision-making and evidence-based medical treatment.'

A spokesman for Bayswater, a group that supports parents of trans children, said the Cass Report 'represents a sea change in the treatment of trans-identified children and young people'.

The report was also welcomed by Labour. Shadow health secretary Wes Streeting described it as 'a watershed moment for the NHS's gender identity services'.

The report comes weeks after NHS England confirmed it would no longer prescribe children puberty blockers at its gender identity clinics, saying there is not enough evidence to support their 'safety or clinical effectiveness'.

A spokesman said: 'NHS England is very grateful to Dr Cass and her team for their comprehensive work.'

READ MORE: Dr Hilary Cass: How world-renowned paediatrician behind damning review of NHS gender care for children is no stranger to 'toxic' debates (and loves a Snickers!)