Cass Called for Caution; the High Court Says Carry On
Why licensing the Gender Plus clinic makes a mockery of the UK’s safeguards for youth
When the UK placed severe restrictions on paediatric medical transition following the publication of the Cass Report, it seemed the nation was finally moving to protect young people from the scandal of gender medicine. But in a case of two steps forward, one step back, the High Court just gave its blessing to a private clinic prescribing cross-sex hormones to 16- and 17-year-olds.
In the July 31 decision, Justice Eady ruled that health regulator, the Care Quality Commission (CQC) acted rationally when it gave the private clinic Gender Plus Healthcare an “outstanding” rating and registered it as a healthcare provider.
The judicial review, brought by former Tavistock nurse Susan Evans and the anonymous mother of a trans-identified teen, challenged the CQC's decision after the Cass Review urged “extreme caution” when administering these unproven drugs. Their complaint argued that the CQC approval permits the clinic—whose referrals come exclusively from an affiliated, affirmation-only service, Kelly Psychology—to bypass the strict safeguards now required by the NHS.
Justice Eady’s ruling raises the question: what is the point of regulating high-risk medical interventions if private clinics can operate under a watered-down set of rules?
That said, the judge’s role in the judicial review was not to re-evaluate the medical evidence for these irreversible drugs nor to assess arguments for and against their use. The scope of the review was narrow: did the CQC act lawfully and rationally when it approved the private gender clinic?
For Justice Eady, there was no “evidence of improper decision-making or anything else that could give rise to legitimate concerns relevant to patient safety or well-being.”
Yet, leaving aside the obvious risk to young people of powerful, irreversible drugs that lack a solid evidence base, for evidence of a threat to patient safety, one need look no further than the Gender Plus website, which boasts that its practice is “guided by WPATH (World Professional Association for Transgender Health) Standards of Care.” Founder and director Aiden Kelly and lead endocrine clinician Paul Carruthers are both prominent WPATH members.
Now, given the complete collapse of WPATH’s credibility in recent years—including the Cass Review’s finding that the group’s guidelines lacked developmental rigour, making them “not recommended” for use—rating any clinic that follows WPATH as “outstanding” would be laughable if it weren’t for all the medical harm that will undoubtedly follow.
So how could this decision be “rational” if it is the CQC’s job to ensure care is safe—especially for vulnerable patients? Isn’t it a legitimate concern that in its assessment of Gender Plus, the CQC didn’t investigate the credibility of WPATH, the controversial body guiding the clinic’s approach to care?
The heart of the issue is, the CQC tackled its assessment of Gender Plus as if it were an ordinary healthcare provider, indicating no grasp of the scandal surrounding paediatric gender medicine nor the astounding levels of fraud and corruption on the inside of WPATH. This is the same regulator that Health Secretary Wes Streeting recently called “not fit for purpose” after a scathing review exposed its lack of clinical expertise and failure to detect unsafe care. The CQC’s rating of Gender Plus as “outstanding” will surely do nothing to restore public confidence.
However, rather than meaningfully engaging with the concerns raised in the judicial review, the court deferred to the authority of the CQC, ignoring the ideologically entangled, closed-loop system of Kelly Psychology and Gender Plus. All teen referrals come from an unregulated, affirmation-only psychology service run by the same leadership as the hormone clinic? Nothing unusual about that. The clinic’s leaders publicly advocate for the treatment they profit from? That’s private sector healthcare. Sixty-nine teens referred, sixty-nine approved for hormones? That’s evidence of a rigorous referral process, not rigid ideological conformity.
This latest decision demonstrates why courtrooms are ill-suited to resolving complex medical controversies. Judges lack the medical and scientific knowledge to adjudicate such matters, so instead defer to the guidance of experts. In normal circumstances, this might not be catastrophic. But when it comes to gender medicine, none of the normal rules apply.
By narrowing in on the technicalities, the issues that matter most are missed. It’s the astonishing fraud of WPATH, the entire culture of affirmation, the abandonment of scientific principles, and the wholesale rejection of all existing knowledge about adolescent development that requires consideration here—not whether the CQC checked all the boxes in its assessment of Gender Plus.
In truth, this ruling will cause real-world harm. Gender Plus is already using the High Court’s endorsement as a seal of excellence, which will undoubtedly mislead young people and their families into believing this high-risk experiment is safe and ethical. The CQC had the chance to protect young people from harm. The High Court had the chance to insist upon it. Both failed. And some of society’s most vulnerable youth will pay the price.
Mia Hughes is the author of The WPATH Files, and director of Genspect Canada.
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The decision of the UK judge is infuriating! And more generally, the initial response of UK politicians to the Cass Report was encouraging but now seems like it was just lip service.