In a move raising alarm across the transgender community and medical ethics circles, England’s National Health Service (NHS) has proposed new guidance that would require all transgender and nonbinary children seeking gender-affirming care to undergo mandatory screening for autism, ADHD, learning disabilities, and other neurodevelopmental conditions.
The guidance, which stems from the highly controversial Cass Review, calls for a “holistic assessment framework” for youth referred to NHS gender identity services. According to a report by The Daily Telegraph, every young person attending the NHS Children and Young People’s Gender Service will now face screening by a multidisciplinary team, which will evaluate not only neurodevelopmental factors but also upbringing, family dynamics, and “emerging sexuality.”
The NHS confirmed that this draft guidance will soon be open for public consultation.
While framed as a medical safeguard, critics say the move reinforces outdated and harmful ideas that being transgender is inherently linked to mental illness or cognitive dysfunction. The notion that gender identity in neurodiverse youth is a symptom to be “explained away” by autism or ADHD, rather than affirmed, has long been pushed by anti-trans voices and has now gained institutional weight under the guise of clinical caution.
The guidance is a direct outgrowth of the Cass Review, an NHS-commissioned examination of youth gender care that has been broadly criticized by major medical bodies for methodological flaws, selective evidence use, and reliance on speculative conclusions. Despite framing itself as evidence-based, the Cass Review excluded hundreds of peer-reviewed studies supporting gender-affirming care. Independent evaluations, including a scathing analysis in the Yale Law Review, called out its misuse of data and failure to adhere to accepted clinical research standards.
Further condemnation came earlier this year from a 26-member consortium of medical organizations across Germany, Switzerland, and Austria. In a 400-page rebuttal, they rejected the Cass Review’s claims that psychotherapy should replace gender-affirming care, noting that none of the studies cited in the review demonstrated effectiveness in reducing gender dysphoria through therapy alone.
The NHS’s latest policy marks a sharp turn toward what some see as state-mandated gatekeeping. It appears to codify the unproven belief that neurodivergent youth may be “mistakenly” identifying as transgender due to autism, an argument frequently used by anti-trans activists to deny care.
“This policy implies that if you’re autistic, you can’t be trusted to know your gender,” said journalist Katelyn Burns in a statement on Bluesky. “That’s not clinical neutrality. That’s systemic discrimination.”
Autistic trans people and their allies have long challenged this narrative. As Jorie McKibbin wrote in LGBTQ Nation, autistic individuals are more likely to reject social norms, including those around gender, not because they are confused, but because they are uniquely resistant to societal conditioning. “It’s not that we’re suggestible,” McKibbin wrote. “It’s that we’re independent.”
Advocates are also concerned about the broader political climate shaping this shift. In April, the UK Supreme Court ruled that the Equality Act 2010’s definition of “woman” refers strictly to biological sex, a decision that effectively erases transgender women from the scope of legal protections once thought secure.
Combined, these developments reflect a growing institutional trend to redefine transgender identity through a lens of pathology and suspicion, rather than affirmation and support.
For trans youth and their families, the message is chilling: seeking care may now come with invasive psychological scrutiny, skepticism of your lived experience, and the presumption that your gender identity is a symptom, not your truth.
The draft NHS guidance is not yet finalized, and trans rights groups are urging allies to participate in the upcoming public consultation process. For now, the fight continues—not only for access to care but for the right to be recognized without conditions.
