Former colleagues of Dr Hilary Cass, the author of a controversial review into youth gender care, have alleged that she recommended a “gender-critical” book to them prior to writing her report.

The paediatric expert was commissioned by NHS England in 2020 to head a review into the way in which youth gender clinics provide care to trans under-18s after a spike in referrals.

Published four years later, the Cass Review made upwards of 32 recommendations to restructure gender-affirming care provision in England.

The report has been criticised by activists and medical organisations, who argue that the review is “poor quality” and ignores evidence, especially on puberty blockers. Puberty blockers can be used to delay the changes of puberty in transgender and gender-diverse youth.

The latest criticism of the review comes from two of Cass’ former colleagues – consultant paediatrician Dr Max Davie and clinical psychologist Dr Lorna Hobbs, who described it as “deeply flawed.”

In a 7,000 word report on the Cass Review, Hobbs and Davie looked at “the good, the bad, [and] the critical” parts of the review, writing that NHS England can “do better than this.”

“Ultimately what matters about the Cass Review is the impact it has on gender diverse young people presenting to services for support,” they write. “For the foreseeable future, they are not going to be able to access medical intervention, which may have an uncertain evidence base, but one which broadly indicates benefit.

“The new service appears to be mainly involved in a watchful waiting approach, with a side-order of ‘don’t you think you might be better off cis?’.”

One of the criticisms in the report is an allegation that Dr Cass “was known by colleagues to oppose medical transition when she was appointed to the review.”

A footnote in the article further claims that she “expressed her dismay and shock at the practice of medical transition” to one of the co-authors prior to writing the review, and had recommended they read gender-critical materials.

Dr Cass allegedly “recommended strongly” that colleagues read the controversial “gender-critical polemic” Irreversible Damage: The Transgender Craze Seducing Our Daughters by Abigail Shrier, which baselessly argues that trans people exist because of a poorly defined “social contagion.”

The footnote has since been screenshotted and widely shared on social media.

The anti-trans book, which has been heavily criticised, hinges on the widely debunked “Rapid Onsent Gender Dysphoria” conspiracy theory which purports that trans people only exist because young people succumb to a “social and peer contagion.”

Davie and Hobbs did not work on the Cass Review and did not specify when Dr Cass made the alleged remarks, but added they believed it to be conflict of interest for an independent review.

“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,” the co-authors continued.

Dr Hilary Cass responded to our request for comment, saying: “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.”