Cass Review Author Denounces As 'Baseless' And 'Cynical' Dissidents' Claim That She Touted Abigail Shrier's Scathing Polemic On Trans Kids
Two dissidents opposed to Britain's designs for reforming its care of gender-distressed kids claimed this week that Dr. Hilary Cass once "recommended strongly" Irreversible Damage by Abigail Shrier.
A pair of dissident clinicians, each of whom has been central to an internal effort to thwart the National Health Services’ implementation of a new system in the U.K. to care for gender-distressed children in line with the landmark Cass Review, this week boldly accused the review’s lead author of expressing opposition to pediatric gender-transition treatment even before she began work on the review.
In a response provided to me, Dr. Hilary Cass denied the dissidents’ claims as “wholly untrue” and accused them of engaging in a “cynical attempt to undermine the Review.”
This high-stakes back-and-forth began on Aug. 7, when Dr. Max Davie, a pediatrician, and Dr. Lorna Hobbs, a clinical psychologist, posted in a public Google document a non-peer-reviewed paper they wrote criticizing the Cass Review. (The paper had a number of glaring errors, which I detailed in a tweet thread but won’t belabor in this particular Substack.) This joined a number of similar papers that, absent peer review, have been rushed onto the internet in recent weeks in hopes of undermining the Cass Review as it exerts influence on gender-care policy in the UK and in the United States.
In Sept. 2020, the NHS commissioned Dr. Cass, who is a retired pediatrician, to conduct a review of pediatric gender medicine, and in particular the NHS’s pediatric gender clinic, the Gender Identity Development Service (GIDS). Published to great fanfare in April 2024, the review found that pediatric gender-transition treatment is based on “remarkably weak evidence,” as I reported for The New York Sun.
Dr. Hobbs worked for GIDS for several years. Both she and Dr. Davie were hired in 2023 as members of a team who engaged in what proved a combustible initial effort to establish a curriculum and training materials for the new gender-clinic system meant to replace GIDS, which was ultimately shuttered in March 2024. They were a member of one camp that was wedded to the old ways, which can be summed up as the “affirmative method.” They faced off internally against, in particular, two GIDS whistleblowers who were aligned with the Cass Review (an interim version of which was published in 2022) and held a preference for what is often known as the “exploratory” method of caring for gender dysphoric children. The new system is meant to approach caring for such children more holistically and not from the narrow lens of gender distress.
The following passage in the new paperback edition to Hannah Barnes’ book, Time to Think: The Inside Story of the Collapse of the World’s Largest Gender Service for Children, details whistleblower Dr. Anna Hutchinson arguing with Dr. Hobbs over whether it was appropriate to refer to children on the GIDS waiting list as “queer”.
In their new online paper, Dr. Davie and Dr. Hobbs wrote this week: “We have been dismayed at the uncritical way in which the deeply flawed Cass report has been accepted both professionally and in the wider political conversation. We wanted an alternative view, from experienced clinicians, to be out there in the public conversation.”
The two certainly buried the lede, given they tucked into a footnote a stunning accusation that challenges the presumption that the NHS drafted Dr. Cass to conduct her review because she was a non-biased medical expert coming to the subject with open eyes.
Dr. Davie and Dr. Hobbs wrote:
“Dr Cass expressed her dismay and shock at the practice of medical transition to one of us before she started this review, and recommended strongly that we read the gender critical polemic ‘Irreversible Damage’ on the subject. She is described on the Cass review website as an expert who came in with no fixed views — we will leave the reader to draw their own conclusions.”
Conservative journalist and commentator Abigail Shrier (who, incidentally, was a year ahead of me in college at Columbia University a quarter century ago) published the hardback edition of Irreversible Damage: The Transgender Craze Seducing Our Daughters in June 2020. The book, which became a best-seller and was instrumental in politicizing pediatric gender medicine in the United States, pulls no punches in portraying gender-transition treatment, plus the rising rates of trans identification in biological girls in particular, as malignant and horrifying societal trends that should be combatted, for one, by no-nonsense parenting.
Shrier also published the following incendiary report in 2020 with Bari Weiss’s Substack, which is now known as The Free Press:
To enthusiastically support and recommend Shrier’s book would effectively be to stand in opposition to minors’ access to puberty blockers and cross-sex hormones to treat gender dysphoria—a psychiatric diagnosis that is distress due to the misalignment of gender identity and biological sex.
Activist-Blogger Erin Reed, who as I’ve reported has published myriad falsehoods about the Cass Review, eagerly reported the claims that Dr. Cass was a Shrier fan and threw in the specter of the Holocaust along with it:
I asked Dr. Cass for a response to Dr. Davie and Dr. Hobbs’ accusations. She replied in a statement on Aug. 9:
Dr. Cass said: “This is a baseless and wholly untrue comment and should be seen for what it is, which is a cynical attempt to undermine the Review. Anyone who has actually read my Report will see that it advocates to provide appropriate support for all gender questioning young people, regardless of whether they choose a medical pathway or not.
“I have never read Irreversible Damage, and the suggestion that I recommended it to anyone is fabrication. I note that by the time it was published I had already been reviewing the evidence for six months and had spoken to people who had had successful medical transitions, and I continued to do so throughout my Review. I have consistently said, both in my report and in multiple public fora that this is the right pathway for some young people.”
In reply, Dr. Davie, who had gotten a viral tweet going about his and Dr. Hobbs’ online paper, replied to my tweet of Dr. Cass’s reply on Aug. 9 with a tweet saying: “*narrator voice*, the book was published before the review was commissioned.”
He then quickly deleted the tweet.
Otherwise, Dr. Davie tweeted: “I don’t want to get in a war of words but I do want to point out that Irreversible Damage came out in the UK in August 2020 and the Cass review was announced in September 2020. So go figure.”
It is true that the hardcover edition of Irreversible Damage was first published in the U.S. three months prior to the NHS officially commissioning the Cass Review from Dr. Cass. However, as the Cass Review states, an NHS team began reviewing the evidence behind pediatric gender medicine starting in January 2020. Dr. Cass was involved from the start in this prelude to her review, which aligns with her assertion that she “had already been reviewing the evidence for six months” prior to the publication of Shrier’s book.
I sent Dr. Davie a direct message on X, asking for his response to Dr. Cass’s denial of his claims about her. He did not reply to that question. Instead, he replied obliquely to my question about his involvement in the collapse of the NHS’s initial effort last year to begin establishing a new pediatric gender-care system—an effort was overseen by the Great Osmond Street Hospital (GOSH) in London.
“That story will come out eventually,” Dr. Davie said to me via direct message.
The story has already been documented in detail by The Guardian, by Kathleen Stock in UnHerd, and Time to Think.
Dr. Davie did not reply to my request to be more specific. Instead, he responded to my question about why he had deleted the “narrator voice” tweet.
“I needed to check something,” he said. “Also, I reflected that it was a little flippant. But it’s still true.”
Then, at 11pm UK time on Aug. 9 (note that the time stamp on all my screen shots of tweets is U.S. Eastern Time, so they’re 5 hours behind the U.K.), Dr. Davie backpedaled his claim about Dr. Cass.
Dr. Davie tweeted: “There have been misunderstandings of what the footnote means to convey. So I have deleted it and added a clarifying note at the end of the document. I hope that will help people to understand our position.”
The footnote regarding Irreversible Damage was indeed deleted from Dr. Davie and Dr. Hobbs’ paper and the following explanatory note was added to the end of the document:
Clarifying note from Dr Davie regarding footnote 28:
Towards the end of 2020, I was called by Dr Cass, to discuss potential involvement in her review, which had just been announced. This is my recall of that conversation.
We had worked together on a NICE working group looking at medical transition, which was a separate piece of work with a different governance structure to the subsequent review.
During this NICE exercise, I had become aware of Dr Cass’s scepticism about the GiDs model.
During the call, she expressed concerns about GiDs practice. She expressed the view that it was shocking that 97% of children who went onto puberty blockers then progressed to gender affirming hormones in the GiDs service. I suggested that this might have been due to accurate triage. She recommended that I read Irreversible Damage.
The call ended and I never heard anything about involvement in the review.
This is my recollection of the conversation. It may be that Dr Cass has a different recollection.
It is important to note that I am not saying that Dr Cass did not have a right to her opinions on transition. She did not explicitly state that she had read Irreversible Damage, or that she endorsed everything in it. I am not saying that having pre-existing opinions on medical transition disqualified her as chair of the review.
However, I still maintain that the content and tone of the conversation is not consistent with the statement subsequently made in the New Statesman interview that she went into the review at the end of 2020 with no pre-conceived notions.
That is all we meant to say in footnote 28, and apologise for any misunderstanding.
Dr. Davie also toned down the language at several key points in his paper compared with the archived original version. I’ve illustrated this below by striking out the words he deleted and putting in bold the new words he added:
“The Cass review could have been
a flawedan imperfect document that remained fairly uncontroversial.”“Dr Cass was known by colleagues to
opposebe scepitcal of medical transition when she was appointed to the review, after all.”Furthermore, the review team do not describe any of the
knownobserved positive outcomes of gender-affirming medical intervention (e.g. improved body satisfaction, congruency of appearance, improved quality of life, mental health and psychosocial functioning, and reduced suicidality).
It is worth noting that the UK’s libel laws are much stronger than those in the United States. That is likely why celebrities like Tom Cruise and Johnny Depp have used their court system for filing libel lawsuits.
Dr. Cass did not reply to a further request for comment.
Update, Aug 14:
Over the past few days, I’ve corresponded with Richard Stephens, who, as a parent, was selected by the NHS to participate on the NICE working group alongside Dr. Cass and Dr. Davie. I confirmed his identity with an independent source.
Stephens said when the NICE reviews came back in mid-2020, “it was blindingly obvious that we couldn't just recommission GIDS on a 'business as usual' basis, the evidence just wasn't there to justify that. So it was necessary to take a deeper look at what kind of service young people needed. We were stood down, and the [Cass] Review began.”
On Aug. 12, Dr. Davie issued a series of tweets explaining why he deleted the footnote in his paper regarding Dr. Cass:
In response, Stephens told me:
“Although in his new note Max [Davie] says it was clear during the working group that Hilary was sceptical of GIDS's practice (side note: the [Care Quality Commission] inspection amply supported any such scepticism), I didn't hear that from her during our meetings. What I did hear, was a commitment to listen to all participants, including to people who did have concerns. She wanted them to be heard, just as others who felt medical transition had been essential were heard and involved in that group. Such even-handedness was new at the time and I wonder if this is what Max experienced then and recalls now as scepticism? Especially if he himself had gone into the process with strong views about medical transition and GIDS.”
The following statement I received in an email from Stephens overlaps with his previous quote, but here it is just the same, for further context:
“Hilary Cass was chosen to chair this working group, and NICE were told to do evidence reviews to inform the discussion. When they came back, Hilary explained that [NHS England] had agreed that a more extensive review of gender services was needed, and we in the working group were stood down. This didn't happen in one conversation - at some point we were told that the plan for our group was changing and that we wouldn't do the further bits, but of course it took a while for the arrangements for the larger Cass Review to be agreed…[So] Max can't have been unaware of the context as it unfolded over several meetings and the NICE evidence reviews were the subject of extensive discussion, in meetings and by email. He says Hilary Cass was in another job, but the independent review grew directly out of the working group.”
With regards to Dr. Davie’s suggestion that, in Stephens’ words, “Cass was already sceptical about medical transition by the time the Review began,” Stephens said: “All that means is that she'd said, from the start, that she'd be led by the evidence, and she'd read the draft NICE evidence reviews, which demonstrated that the evidence cupboard was glaringly empty.”
I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News and The New York Sun. I have also written for the Washington Post, The Atlantic, The Nation, Thomson Reuters Foundation, New York, The Marshall Project, PBS, The Village Voice, The New York Observer, the New York Post, Money, Men's Journal, City & State, Quartz, Out and The Advocate.
Follow me on Twitter: @benryanwriter
And visit my website: benryan.net
Dr Davie's recollection of his conversation with Dr Cass reads like a hallucination. Why would a research oriented physician recommend to another physician a journalistic style book for the masses, and especially on the topic of desistance rates on puberty blockers?
I believe Cass when she states she has never read Irreversible Damage, and I also now believe neither has Dr. Davie.
This is a losing tactic in a debate. Shows you can’t argue the facts so you resort to insulting your opponent’s character.