TL;DR: The Levy Review will explore the provision of adult gender services in NHS England in a manner similar to how the Cass Review looked at youth provisions. A freedom of information request has attempted to reveal some initial information about the review.
NHS England has begun a review of adult gender services led by Dr. David Levy; it will be known as the Levy review. The review was brought forward after Dr. Hilary Cass wrote to NHS directors raising concerns after the Cass Review into transgender youth’s health provision.
The Cass Review resulted in restrictions on healthcare for trans youth, including the controversial ban on puberty blockers. A recent US study found similar bans caused a 72% increase in suicide attempts, highlighting their harmful impact, so one might anticipate similar concerns with the Levy Review.
How did the review come about?
Although there is little we know about the review into adult gender services, its context is important to understand as its inception quickly followed the advice of the now widely criticised Dr Hillary Cass, who recommended adult care should be reconsidered in her review.
In her letter to NHS directors about some adult care, Cass also makes a suggestion that trans people with mental health issues and neurodivergent conditions don’t have the “cognitive ability” to understand and consent to treatment.
This, among other advice issued in the report, was criticised given that the advice was based on dismissing research on the benefits of gender-affirming care while promoting an unproven psychological approach likened to ‘conversion therapy.’ Under her review, such changeswould lead to a massive restriction of services those under 25 can access.
Some of those involved with the Cass Review were also revealed to be members of the Society for Evidence in Gender Medicine, a pro-’conversion therapy’ organisation designated as an anti-LGBTQ hate group by the Southern Poverty Law Centre.
What do we know about the adult review?
The NHS says The Levy Review will seek the views of experts and patients but has otherwise given little further information on the review process. What we do know is thanks to a freedom of information request.
In response to this, NHS England declined to release the Terms of Reference for the review, stating the terms are currently in draft form and will be released at an unspecified later date.
The information released did however reveal that Dr. Levy, the cancer specialist whose surname is now intrinsically tied to the report , was the only such person identifiedto lead the review despite appearing to have no prior experience in transgender healthcare.
This is a similar practice to that used in the Cass Report, where Dr. Cass was also the only person considered to lead the review of youth gender services. Seperatly we were told Cass was appointed on the basis that she had “no prior involvement or fixed views in this area”.
Analysis: We still have time to act
As a neurodivergent trans woman with mental health issues, I’m worried the Levy Review will lead to harmful restrictions on trans healthcare for people like me.
Gender-affirming hormones have been life-changing for me, but accessing them has been difficult where I’ve had to resort to using the ‘grey market’ to get them before all while on a 5-year waiting list for an NHS clinic since 2021.
Not having access to hormones would mean forced medical detransition - a reality already faced by trans youth following the Cass Review.
Worrying about this is already affecting my mental health, and it’s not just me. The lack of access to gender-affirming care alongside a rise in transphobia has already contributed to a mental health crisis among transgender people in the UK.
For now, trans people are being left in the dark - but we’re not helpless.
We now know the Cass Review was about justifying restrictions to trans healthcare, not about improving services, as its authors claimed. We won’t be fooled again.
Past battles around queer healthcare, such as the fight to force the NHS to prescribe PrEP, show that we can take the NHS to court and win.
There’s still time to demand more information and the inclusion of trans voices. We can hold NHS England to account and protect our access to life-saving healthcare.
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