Abstract
Background Since 2016 trans people in the UK, and particularly trans children, have experienced a sustained and escalating campaign to roll back trans freedoms, rights and access to healthcare. A series of legislative, politicized and media-driven campaigns have resulted in the year-by-year worsening of access to affirmative healthcare for trans children in the UK. Aim This study examines publications from the NHS-commissioned ‘Cass Review’ into children’s gender services, seeking to better understand what is happening in trans children’s healthcare in the UK. Methods Inductive and deductive reflexive thematic analysis was applied to a collection of Cass Review publications related to trans children’s healthcare published between January 2020 and May 2023. Results Four concerns are presented and explored: (1) prejudice; (2) cisnormative bias; (3) pathologization; and (4) inconsistent standards of evidence. Each of these concerns impacts the Cass Review’s approach to trans children’s healthcare, with negative repercussions for trans children’s healthcare rights and well-being. Discussion The Cass Review itself can be understood as an example of cis-supremacy, within a cis-dominant healthcare system lacking accountability to trans communities. These findings draw attention to systemic barriers to effective healthcare policy, with relevance for trans healthcare across and beyond the UK.
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