Comment and Analysis

A response to Dr Helen Webberley’s open letter to Dr Hilary Cass

A response from the Clinical Advisory Network on Sex and Gender to Dr Helen Webberley’s open letter to Dr Hilary Cass, Chair of the Independent Review of Gender Identity Services for Children and Young PeopleC

Dr Helen Webberley’s challenge to Dr Hilary Cass recycles the inaccuracies and misconceptions that have resulted in far too many young people with gender related distress being medicalised into perpetual patients and suffering serious complications.

In her world, gender distressed children need rapid access to powerful medical treatment with gonadotrophins (puberty blockers) and cross sex hormones to avoid “untold harm”. If they don’t receive this treatment “now”, she suggests, they will be at risk of suicide – an often repeated and terrifying but discredited claim.

In fact, Dr Webberley could not be more mistaken. There are no long-term outcome data to support the medicalisation of adolescent gender dysphoria and there is growing evidence that these experimental treatments themselves cause significant harm. Adult lives of sexual dysfunction and infertility can result, alongside other physical and neurocognitive sequelae which are now starting to be understood. Dr Cass’s timely and important report, informed by evidence, has quite rightly put the brakes on this medical pathway, unless it is offered within a rigorous research framework.

The low quality sources cited by Dr Webberley are driven by ideology rather than evidence. Alongside the UK, countries such as Norway, France, Finland and the Netherlands are now recognising the potential for harm and urging caution when it comes to medicalising childhood gender dysphoria.

We know that many of these young people have backgrounds of childhood trauma and that many are autistic. We also know that much adolescent gender related distress is transient and that it clusters with other expressions of distress such as depression, anxiety, self-harm and eating disorders. Sensitive exploration of the underlying unhappiness and appropriate psychological support surely makes more sense than halting pubertal development and embarking on irreversible bodily modification.

The prospect of a ‘quick fix’ can be seductive for a distressed teenager, and for their private healthcare provider, but the growing testimony of detransitioners suggests that for many this turns out to be a highly damaging false promise. Many authorities concur that the prescription of puberty blockers to children with gender dysphoria should be considered as experimental treatment for individual cases rather than standard procedure. Dr Webberley is charismatic and has strong beliefs, but these haven’t convinced her peers. How can she really be sure that she is obeying her professional and ethical duty to ‘first do no harm’?


Independent Review of Gender Identity Services for Children and Young People

Levine, S.B., Abbruzzese, E. Current Concerns About Gender-Affirming Therapy in Adolescents. Curr Sex Health Rep (2023).

Ludvigsson JF, Adolfsson J, Höistad M, Rydelius PA, Kriström B, Landén M. A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. Acta Paediatr. 2023 Apr 17. doi: 10.1111/apa.16791. Epub ahead of print. PMID: 37069492.