Supreme Court Hearing Highlights Global Debate Over Transgender Healthcare Standards

A Supreme Court case challenging Colorado’s ban on conversion therapy became the latest battleground in the contentious debate over transgender healthcare this week, as attorneys cited the controversial UK-based Cass Review during oral arguments.

During Tuesday’s proceedings in Chiles v. Salazar, Alliance Defending Freedom attorneys told justices that the Cass Report “tells us [transitioning] comes with a lot of harm and devastation” as they argued against restrictions on conversion therapy practices.

Coincidentally, that same day, The Medical Journal of Australia (MJA) published a scathing rebuke of the Cass Review, titled “Cass Review does not guide care for trans young people.” The paper represents consensus from transgender healthcare experts across Australia, including specialists from every state and territory and doctors from all major pediatric hospital gender clinics in the country.

The MJA paper joins a growing body of medical literature challenging the methodology and conclusions of the Cass Review, which has been increasingly referenced in legislative and legal battles worldwide despite significant criticism from healthcare professionals who specialize in transgender care.

Dr. Hilary Cass, who lacks specialized experience treating gender dysphoria, led the UK government-commissioned review that has resulted in severely restricted access to gender-affirming care for transgender youth in Britain. Critics argue the report’s methodological approach and framing reveal an inherent bias that predetermined its conclusions.

“It is difficult to name another field in which regulators impose such a benchmark,” the Australian medical experts wrote, pointing out that gender-affirming care for transgender people faces scrutiny that exceeds standards applied to other medical treatments. “Much health care in other areas of medicine is guided by evidence of similar or lesser strength.”

The impact of the Cass Review in the UK has been substantial, effectively banning puberty blockers and hormone replacement therapy for most transgender youth except within clinical trials. The Australian experts highlighted the ethical concerns of forcing vulnerable young people into research protocols while delaying potentially necessary care.

“The Cass Review’s internal contradictions are striking,” the MJA paper notes. It points out that while the review acknowledged some transgender youth benefit from puberty suppression, its recommendations have made such treatments inaccessible. Similarly, the review found no evidence that psychological treatments improve gender dysphoria, yet recommended expanding their provision.

The Australian medical experts particularly criticized the Review’s characterization of transgender identity itself as problematic. “Disturbingly, the Review speculatively conceptualised the continuation of trans identity into adulthood as a potential harm of social transition,” they wrote, adding that this approach ignores the “profound distress, family conflict and school refusal” that often occur when a transgender child’s identity is not respected.

One significant criticism involves the Cass Review’s suggestion of an unexplained increase in transgender masculine individuals, which the Australian experts argue misrepresents improved recognition rates as a surge in prevalence. This framing, they suggest, feeds into unfounded “social contagion” narratives that have become prevalent in anti-transgender rhetoric.

The paper also challenges the Review’s handling of data on transition regret, claiming it exaggerated or cherry-picked studies showing higher rates while downplaying research showing consistently low regret rates among those who receive appropriate care.

Medical organizations worldwide have increasingly voiced concerns about the Cass Review’s influence on policy despite its methodological limitations. The Australian paper concludes with a pointed statement: “Trans people are not a moral, philosophical or social issue. They are people. The statement ‘some people are transgender’ is a demographic fact, not an ideological position.”

As the Supreme Court considers arguments in Chiles v. Salazar, the global medical community’s ongoing critique of the Cass Review underscores the highly charged political context surrounding transgender healthcare access and the significant gap between some policy directions and the consensus of specialized medical practitioners.