{"id":3515,"date":"2025-10-09T11:59:09","date_gmt":"2025-10-09T09:59:09","guid":{"rendered":"https:\/\/trajectoiresjeunestrans.fr\/non-categorise\/censorship-and-defunding-the-cass-review-and-continental-consensuses-scientific-updates-our-takeaways-from-epath-2025\/"},"modified":"2026-01-25T18:16:54","modified_gmt":"2026-01-25T17:16:54","slug":"censorship-and-defunding-the-cass-review-and-continental-consensuses-scientific-updates-our-takeaways-from-epath-2025","status":"publish","type":"post","link":"https:\/\/trajectoiresjeunestrans.fr\/en\/news\/censorship-and-defunding-the-cass-review-and-continental-consensuses-scientific-updates-our-takeaways-from-epath-2025\/","title":{"rendered":"Censorship and defunding, the Cass Review and continental consensuses, scientific updates\u2026 our takeaways from EPATH 2025"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text css=””]This year, as two years ago<\/a><\/span>, 13 members of our hospital and community-based teams attended the congress of the European Professional Association for Transgender Health (EPATH), which took place in Hamburg from 3 to 6 September. The teams presented three contributions, focusing on the study by Claire Vandendriessche (community coordinator and peer mediator at TJT), already discussed on our website here<\/a><\/span>, as well as those by Marine Bouron and Alice McGovern (residents in the EPPAT team at Robert Debr\u00e9 Hospital). Marine Bouron\u2019s study was entitled \u201cComparison of quality of life in young transgender adults according to the timing of masculinising chest surgery: before or after the age of 18\u201d, and Alice McGovern\u2019s was \u201cExploring the emergence of transgender identity: age and modes of appearance in a self-declared transgender population through an online survey\u201d. Both will be discussed on our website after their publication. <\/p>\n

Here are some reflections on selected presentations we attended.<\/p>\n

Censorship and massive defunding under Trump: the situation in the United States and worldwide<\/strong><\/p>\n

Asa Radix, an infectious disease physician at the Callen-Lorde Community Health Center in New York and current president of the World Professional Association for Transgender Health (WPATH), spoke about the situation of trans people in the United States since the beginning of Donald Trump\u2019s new presidency.<\/p>\n

His intervention<\/a><\/span>, sombre in tone, reflected the depth of despair among trans people affected by Trump\u2019s policies directed against them, both in the United States and across the rest of the world. He recalled that the global prevalence of HIV among transfeminine people is extremely high, around 20 %, corresponding to a probability of infection 66 times higher than that of the general population (Stutterheim et al., 2021<\/a><\/span>). Drawing on multiple studies, he emphasised that access to hormonal and surgical care, as well as to trans-affirming clinical environments, constitutes a highly influential public health lever to improve retention in antiretroviral care, and thus to better combat the HIV\/AIDS epidemic within the trans community as well as in the general population. Accordingly, in September 2022 the HHS (US Department of Health and Human Services) recommended that a gender-affirming model of care be implemented in infectious disease services \u201cto improve retention in antiretroviral care and maximise the likelihood of achieving sustained viral suppression.\u201d This was described as a \u201cstrong\u201d recommendation, supported by \u201cwell-designed non-randomised clinical trials or long-term observational cohort data.\u201d <\/p>\n

On 20 January 2025, President Donald Trump issued the following order (Executive Order 14168):<\/p>\n

\u201cIt is the policy of the United States to recognise two sexes, male and female. These sexes are not interchangeable and are grounded in a fundamental and incontestable reality. [\u2026] Each agency and all federal employees must apply the laws [\u2026] in order to protect men and women as biologically distinct sexes. [\u2026] Agencies must remove any statements that promote or in any way inculcate gender ideology. [\u2026] Repeal all documents incompatible with this order<\/strong>.\u201d <\/em><\/p>\n

Within 24 hours of this order, federal agency websites removed all references to transgender\/LGBTQ+ content; the CDC (Centers for Disease Control and Prevention) deleted content referring to \u201cgender,\u201d \u201ctransgender,\u201d or \u201cLGBT\u201d; the State Department suspended all new changes of sex markers on passports and reprinted new passports with the previous sex designations, and also removed all \u201cLGBT\u201d content from its human rights reports. The Trump administration also attempted to defund public institutions providing care to transgender minors, an effort that was curtailed by court decisions. Best practice guidelines issued by the HHS, based on the state of scientific knowledge and addressing trans people living with HIV, were removed from federal agencies.<\/strong>[\/vc_column_text]

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<\/div>[vc_column_text css=””]Six days later, another government decree (Executive Order 14187) declared all gender-affirming care to be \u201cmutilating,\u201d ordered the federal defunding of gender-affirming care (including for trans adults), and threatened to fully defund hospitals that continued providing care to trans minors. As a result, 22 hospitals were forced to shut down their specialised clinics. <\/p>\n

Between January and August 2025, USD 800 million in budget cuts to NIH (National Institutes of Health) research funding for LGBT health were upheld by the US Supreme Court, which has a conservative majority. Along the same lines, another government decree (Executive Order 14169) froze the PEPFAR <\/a><\/span>fund for the global fight against HIV\/AIDS, abruptly cutting off the supply of global health humanitarian services to tens of millions of people living with HIV worldwide. Programmes deemed to promote \u201cgender ideology or diversity, equity, and inclusion (DEI)\u201d were particularly targeted by this freeze, leading to the closure of clinics providing trans people with antiretroviral treatment or prophylaxis (PrEP), mental health care, gender-affirming care, and harm reduction services for drug use – all of which have demonstrated effectiveness in reducing HIV-related risks. <\/p>\n

The Cass Review: how independent is it?<\/strong><\/p>\n

German professor of psychiatry Georg Romer, coordinator of the 2025 AWMF clinical practice guidelines for transgender youth (already discussed on Trans Youth Trajectories<\/a><\/span>), returned to the 2024 report by Hilary Cass. In his presentation<\/a><\/span>, he recalled that this report had been commissioned by NHS England (the UK health authority) in order \u201cto improve care for children and adolescents questioning their gender or experiencing gender incongruence,\u201d and that it had been entrusted to a person deemed \u201cindependent\u201d (the British paediatrician Hilary Cass), on the grounds of her lack of expertise in the field under consideration (no clinical practice with the population whose care was being evaluated). <\/p>\n

Looking at previous \u201cindependent reports\u201d commissioned in the United Kingdom, Georg Romer notes that \u201cthe independence of evaluators vis-\u00e0-vis the services under review was ensured, while being combined with recognition of their expertise in the relevant field<\/strong>. Independence from specialised expertise – that is, the ability to consider a complex field \u2018from the outside\u2019 – had not previously been defined as a required quality.\u201d Between the lines, Georg Romer suggests that independence, as it had been conceived prior to the Cass Review, did not amount to ignorance of the field. <\/p>\n

Georg Romer then turns to the question of the independence of the Cass Review itself, recalling that only a single author<\/a><\/span> (Hilary Cass) was declared by NHS England, and that no declaration of interests had been published<\/strong>, preventing any assessment of the actual independence of the report from potential conflicts of interest.<\/p>\n

Regarding independence from political agendas, Georg Romer recalls public statements made in June 2023 by Sir Sajid Javid, former UK Secretary of State for Health (2021-2022): \u201cI became Secretary of Health in June 2021 [\u2026] The NHS had already began an independent review of the GIDS service by Dr Hilary Cass. She was getting close to publishing her interim report, so she had a lot of findings, and so I wanted to meet with her and I asked her to do so. And what I was hearing here was that you were getting these young people presenting themselves to the NHS saying: \u2018I think I\u2019m a girl in a boy\u2019s body,\u2019 or vice versa, and instead of questioning, whilst taking this tentatively, it was an affirmative, a completely affirmative approach, it was a self-diagnosis. This was a huge scandal. As soon as I heard all of that I felt that something had to be done. I met with NHS leaders, and I started the process of shutting down the Tavistock.\u201d[\/vc_column_text]

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<\/div>[vc_column_text css=””]According to the former minister\u2019s public statements, Hilary Cass presented him with a catastrophising portrayal of the British hospital-based medical approach providing gender-affirming care to trans minors (the GIDS units of the Tavistock Trust), and did so even before the literature meta-analyses commissioned for the Cass Review and published in 2024 were available. This profoundly calls into question the paediatrician\u2019s supposed independence, particularly with regard to political power. The \u201chuge scandal\u201d invoked by the former minister must be assessed in light of the findings of the audit later conducted by Cass<\/a><\/span> herself and published in 2024: among the population followed at the Tavistock\u2019s specialised GIDS service between April 2018 and December 2022, only 27 % of patients were referred to endocrinology, after an average of 6.7 paediatric consultations<\/strong> (Appendix 8, p. 9). Moreover, among the 3,306 patients included in the audit, Cass observed fewer than 10 cases of detransition, i.e. less than 0.3 % of the patient population<\/strong> (Appendix 8, p. 13). <\/p>\n

Without drawing a conclusion on Hilary Cass\u2019s actual or supposed independence from public authorities, Georg Romer states that \u201cdespite its recognised merits in offering an overall view of the field and a holistic approach, the Cass Review cannot be considered as – nor substitute for – medical guidelines that comply with international standards of evidence-based medicine.\u201d He instead turns to the definition of evidence-based medicine<\/strong> given by the German Medical Association: \u201cEvidence-based medicine is the conscientious, explicit, and judicious use of the best available external scientific evidence to inform decisions about patient care. The practice of evidence-based medicine involves integrating individual clinical expertise with the best external evidence from systematic research. It rests on three pillars: individual clinical experience, patient values and preferences, and the current state of research<\/strong>.\u201d In short, no one can develop evidence-based clinical recommendations without having clinical expertise in the field concerned. <\/p>\n

As examples of evidence-based recommendations, Georg Romer cites the meta-analysis by Meng and colleagues (2022<\/a>): 82 % of medical recommendations for paediatric off-label drug prescribing are based on uncertain to very uncertain evidence. Yet they are nonetheless recommended as first-line treatments, either because they have demonstrated efficacy in adults, because their safety has already been shown in other paediatric indications, because of a lack of therapeutic alternatives, or because the absence of prescription would be ethically unjustifiable. Romer thus warns against the false equivalence<\/strong> that is sometimes drawn – exclusively in medicine related to gender incongruence – between certainty of evidence and strength of clinical recommendations, as such an equivalence does not exist elsewhere. <\/p>\n

Continental consensuses since 2024<\/strong><\/p>\n

Since 2024 and the publication of Hilary Cass\u2019s report, what evidence-based recommendations have been published in continental Europe? In his presentation, Georg Romer identifies five: <\/p>\n