🧵In July 2024 I broke news that the BMA was planning to vote on a motion to "disavow" the Cass Review & work with others to oppose implementation of its recommendations. Nearly two years' later, the union has officially dropped its opposition, after conducting its own review.
This followed backlash from members, including resignations. Today, 18 months after it was due, the BMA review's lead author told The Times, Cass had been “vindicated in the way she approached the data” & the union did not oppose a single recommendation
However, division endures. BMJ reports that while the report concluded evidence base for puberty suppression & hormones is "limited and uncertain", the BMA remains critical of Gov's response to Cass, e.g. the decision to ban puberty blockers for under 18s. bmj.com/content/393/bm…
Times reports "substantive disagreement" among the 12-person group who carried out BMA's review re: potential benefits/harms of puberty blockers. Four supported restricting their use; six supported keeping them available on the NHS; two were neutral. thetimes.com/uk/healthcare/…
To understand how we got here, below are the key turning points in the story - first reported by me for @NewStatesman.
Secrecy followed, with BMA refusing to confirm the precise wording of the motion voted upon. Backlash to the planned motion led to it being changed...
(26/07/24):Why are BMA Council’s confidential discussions on the Cass Review a matter of public interest? newstatesman.com/comment/2024/0…
In early August, doctors hit back. I revealed how nearly 900 doctors, 2/3 of whom were union members wrote to BMA's chair to express their "dismay" at union's stance on Cass
(8/8/24): Hundreds of doctors are challenging the BMA’s stance on puberty blockers newstatesman.com/politics/healt…
Tensions within the BMA grew as the row showed no signs of going away, and pointed to deeper divisions within the union.
(1/9/24): A long-read for the Sunday Times - "Politics, power and puberty blockers: the trans row dividing the BMA" thetimes.com/uk/healthcare/…
Next (and finally), late in Sept '24 the BMA dropped its opposition to Cass, instead choosing to "retain a neutral position" while the specialist group undertook its critique of Cass review.
(27/9/24): The BMA turns away from rejecting the Cass Report newstatesman.com/thestaggers/20…
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(🧵) NEW: Today’s news that NHS England has paused new prescriptions of cross-sex hormones for under 18s a) seems a bigger deal than being suggested, b) raises several questions, c) has potentially significant consequences for any forthcoming trial of puberty blockers...
England has - for a period at least - ended the medical transition of children on the NHS. This puts a stop to 20+ years of practice. (The former Tavistock Gender Identity Development Service [GIDS] referred 16 year olds for puberty blockers from around the year 2000.)
The precise trigger for the pause seems unclear. What is the “in-depth review of all available clinical evidence” referred to by NHSE in their statement? I have asked NHSE. NHSE's statement says it was triggered by Dr Hilary Cass’s 2024 major report into children's gender care...
🚨BREAKING: NHS-backed puberty blocker trial PAUSED as regulator raises safety concerns. The Medicines & Healthcare products Regulatory Agency (MHRA) has requested the King’s College trial team amend study protocol, to better reflect risks to children 🧵 assets.publishing.service.gov.uk/media/6998b06d…
Trial team are asked to increase the minimum age of participants to 14 because of fertility concerns.
MHRA explicitly recognises "sterilising effect of puberty blockers followed by cross sex hormones and that gamete retrieval to preserve fertility is not possible at the stage when puberty blockers are given (Tanner stage 2) as neither sperm nor ova have matured."
NEW: I’ve taken a deep dive into the new puberty blockers trial, exploring how we got here, what it will and won’t answers, with a sprinkling of new revelations too.
With contributions from Hilary Cass, trial team members (past & present) and MPs
A former member of the trial told me, “the early planning meetings were unlike any other clinical trial I’ve encountered. We could easily list all the potential harms to monitor and how to test for them, but we didn’t have a clear rationale for giving the drug in the first place”
I can also reveal:
- Close to one in eight children being seen at the London gender hub have disclosed self-medicating with hormones
- NHSE hasn’t started the data linkage study of former Gids patients & has not got the required ethical and regulatory permissions to do so AND…
NEW: Puberty blocker trial for children gets green light, but many questions remain. Sadly, my request to attend a media briefing & put some of them to study leads was turned down on the grounds I’m not a ‘specialist’ health/science journalist. newstatesman.com/politics/2025/…
E.g. Those permitted to join the trial will be considered by clinicians to have “a reasonable prospect of benefit[ting]” from blockers. How will they judge this? Dozens of clinicians from Tavistock GIDS told me it was impossible to tell - that was why some became more cautious.
(They did agree to share the recording of the 1.5 hour event with me several hours afterwards)
COURT CASE Big🧵: I was at High Court today watching Sue Evans v CQC. Psychotherapist & former Tavistock GIDS worker, Evans argues it was ‘irrational’ for the CQC to register private Gender Plus Hormone Clinic (GPHC) & allow it to prescribe (cross-sex) hormones to 16 & 17 yo
Quick note: Gender Plus Healthcare Ltd consists of Kelly Psychology (KP) and GPHC. Owner and director of both is clinical psychologist Dr Aidan Kelly, who worked at Tavistock Gender Identity development Service (gids) 2016 -2021. KP carries our assessments. GPHC is the prescriber
Tom Cross KC (TC) represented Evans and opened proceedings. TC argued that when CQC agreed to register GPHC and see if behaving safely it rightly looked to NHS practice. It judged that GPHC’s practices were “sufficiently aligned” w. NHS. But the situation has subsequently changed
CASE RESUMES: High Court is deciding whether to allow JR by Keira Bell (KB) against Health Secretary (WS) & NHSE in arguing it was "irrational" not to ban cross-sex hormones (CSH) along with puberty blockers (PB). Gov has announced new working group is looking at a pos ban now
Mr Steel for the government is resuming. S argues PB prescribed to v specific groups for specific reasons e.g young children for precocious puberty; adults for certain cancers - so relatively clear division by age group.
Anyone in puberty wld most likely be receiving them for gender dysphoria so easy for pharmacist to tell. This is not case with CSH - used for many reasons, and not so easy to tell why someone might be receiving them. Makes a S.62 order more difficult