The Cass Review: Cis-supremacy in the UK's approach to healthcare for trans children.

Background: Since 2016 trans people in the UK, and particularly trans children, have experienced a sustained and escalating campaign to roll back trans freedoms, rights and access to healthcare. A series of legislative, politicized and media-driven campaigns have resulted in the year-by-year worsening of access to affirmative healthcare for trans children in the UK. Aim: This study examines publications from the NHS-commissioned 'Cass Review' into children's gender services, seeking to better understand what is happening in trans children's healthcare in the UK. Methods: Inductive and deductive reflexive thematic analysis was applied to a collection of Cass Review publications related to trans children's healthcare published between January 2020 and May 2023. Results: Four concerns are presented and explored: (1) prejudice; (2) cisnormative bias; (3) pathologization; and (4) inconsistent standards of evidence. Each of these concerns impacts the Cass Review's approach to trans children's healthcare, with negative repercussions for trans children's healthcare rights and well-being. Discussion: The Cass Review itself can be understood as an example of cis-supremacy, within a cis-dominant healthcare system lacking accountability to trans communities. These findings draw attention to systemic barriers to effective healthcare policy, with relevance for trans healthcare across and beyond the UK.