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US tells states: Follow Cass Review in treatment of ‘trans' children
The US government is pressuring states to halt funding for puberty blockers for children and follow the UK's Cass Review.
The Center for Medicare and Medicaid Services (CMS), which provides health coverage to more than 160 million Americans, urged directors to adopt the findings of the report, which concluded children who think they are transgender should not be rushed into treatment they may regret.
In a letter sent to medical directors, seen by The Telegraph, the agency said that Britain has 'diverged' from the United States and that the National Health Service's new approach is more effective.
Under Donald Trump, the US has quickly moved to ban all 'destructive and life-altering procedures' associated with transitioning children.
Some 27 states have enacted laws that ban or restrict gender‑affirming care for minors. But puberty blockers are still available in many others.
'Several developed countries have recently diverged from the US in the way they treat gender dysphoria in children,' the letter reads. 'The United Kingdom, Sweden, and Finland have recently issued restrictions on medical interventions for children, including the use of puberty blockers and hormone treatments.
'In particular, the Cass Review, an independent review of the evidence in the United Kingdom, noted that despite the considerable research in the field of gender dysphoria in children, 'systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.''
Led by Dr Hilary Cass, the review was prompted by concerns about the high rate of young people being referred to the Tavistock gender clinic in London, which referred children as young as 10 for treatment with puberty blockers.
The final review, released in April 2024, concluded that too many children were being pushed towards medication with not enough mental health care.
Dr Cass recommended that the most important treatment for the majority of children should be talking therapies instead of irreversible medical treatments such as puberty blockers.
The letter went on to imply Britain is more effective in upholding the US government's commitment to 'do no harm to America's children'.
'In recent years, medical interventions for gender dysphoria in children have proliferated,' the letter added.
'These interventions include surgical procedures that attempt to transform an individual's physical appearance to align with an identity that differs from his or her sex or that attempt, for purposes of treating gender dysphoria, to alter or remove an individual's sexual organs to minimise or destroy their natural biological functions.'
The letter also said medical interventions for gender dysphoria in children have 'proliferated' in America and the Cass Review, which is rumoured to be backed by Mr Trump, could be used by states to reduce cases.
The move is a rare example of British policy influencing American direction under Mr Trump, who moved to ban puberty blockers almost immediately upon arriving in the White House. His administration has largely been critical of Britain's policies, repeatedly raising concerns about free speech.
In May, The Telegraph revealed the president had sent a delegation to meet British anti-abortion activists who say their freedom of expression has been threatened. A five-person team from the US State Department spent several days in the country and interviewed campaigners.
Trump has intervened on transgender issues
Trans activists have long fought to retain puberty blockers as a treatment option for children with gender dysphoria. Democratic attorneys general in Washington, Oregon and Minnesota sued the Trump administration over its plans to pull funding from institutions that provide gender-affirming care.
The US president has signed a number of executive orders targeting transgender people, claiming that it is a radical ideology driven to 'deny the biological reality of sex'.
In January, he signed an order that aimed to restrict gender-affirming treatments for all young people below the age of 19 by asking federal agencies to stop endorsing interventions such as puberty blockers, hormone therapy, and surgery for minors.
In July 2024, The Integrity Project at Yale Law School released a white paper which said the Cass Review had 'serious flaws'.
It suggested that the review 'levies unsupported assertions about gender identity, gender dysphoria, standard practices, and safety of gender-affirming medical treatments'.
The white paper concluded that the review 'is not an authoritative guideline or standard of care, nor is it an accurate restatement of the available medical evidence on the treatment of gender dysphoria'.
