The fallout from the Cass Review: what it means for transgender children and families
Families with transgender children continue to face uncertainty as NHS gender identity services evolve in response to the Cass Review.
The Review, formally the Independent Review of Gender Identity Services for Children and Young People, concluded that there were significant gaps in the evidence base underpinning clinical practice, particularly in cases where gender-related distress presents alongside complex mental health or neurodevelopmental conditions. It recommended a more cautious, holistic model of care.
Immediate impact on NHS services
Following publication of the Cass Review in 2024, NHS England confirmed that puberty blockers (PBs) would no longer be routinely prescribed to under-18s outside of a formal research setting. Young people already receiving treatment have been permitted to continue under clinical supervision, but new prescriptions remain restricted.
A proposed clinical trial into the use of puberty blockers – which had been supported by Baroness Cass – was paused in February 2026, leaving families in limbo while further research is undertaken.
Meanwhile, six new regional NHS centres are due to be operational by the end of 2026, intended to provide broader, multidisciplinary support. However, waiting lists for assessment and mental health services remain lengthy.
Legal implications and the role of the courts
The changes to NHS practice have prompted significant legal debate. In 2024, TransActual, supported by the Good Law Project, brought a judicial review challenging the Government’s emergency restrictions on puberty blockers.
The High Court dismissed the claim, finding that the Secretary of State had acted lawfully. However, the Good Law Project has since launched an appeal against that decision. As of February 2026, the appellate process remains ongoing, meaning aspects of the regulatory framework may still be subject to further judicial scrutiny.
Alongside this litigation, there is continued discussion about whether puberty blockers and cross-sex hormones could in future be treated as a “special category” of medical treatment requiring court authorisation in certain or all cases. While not automatically required by law, court involvement may sometimes be necessary where parents or clinicians cannot agree on a child’s treatment.
The impact on children and families
One report noted that children referred for gender dysphoria or gender incongruence often present with elevated levels of anxiety, depression, self-harm and neurodevelopmental conditions, compared to the general population.
Prolonged uncertainty, delayed access to services, or parental conflict about treatment or social transition can compound emotional distress. Whatever the wider policy debate, it is widely recognised that sustained conflict does not help children’s mental health.
How family lawyers can help
Family law is concerned with one central principle: the best interests of the child.
Where parents disagree about medical treatment, social transitioning, schooling or wider welfare decisions, the Family Court may be asked to determine what arrangement best promotes the child’s wellbeing. In a changing legal landscape, clear and balanced advice is essential.
The Attwaters Family Law team advises on:
- Disputes between parents about medical or therapeutic treatment
- Applications for Specific Issue or Prohibited Steps Orders
- Cases involving school or social transition decisions
- Situations where court oversight of medical treatment may become necessary
Our approach is child-focused, measured and non-confrontational wherever possible.
Supporting children through uncertainty
The law and clinical guidance in this area continue to evolve. For families navigating complex decisions about a child’s gender identity, early legal advice can help minimise conflict and provide clarity.
To speak to a member of our Family Law team, you can either email familylaw@attwaters.co.uk or call 0330 221 8855.
