The recent Supreme Court ruling on the legal definition of a woman shows again how tenuous minority legal rights are in a system based on the exploitation of the majority by a small elite, who ultimately can only maintain their power through the methods of divide and rule. One year on from its publication SARAH SACHS-ELDRIDGE assesses the role of the Cass Review in the ‘culture wars’.
The context in which the Cass Review was published in April 2024 is years of whipping up of anti-trans hate by capitalist politicians and the big business-owned media.
The 2021 census in England and Wales found that 0.5% of the population, or around 262,000 people, identified as a gender different from their sex assigned at birth. In the year ending March 2023, 4,732 hate crimes against transgender people were recorded – up 11% on the previous year and an indication of how bigoted rhetoric affects trans lives. However, it is also necessary to note that the Tories’ decisive eviction from government was not prevented by their enormous investment in divisive ‘culture war’ tactics, with vicious attacks on trans women very prominent.
Starmer’s New Labour government is learning no lessons that culture wars cannot overcome the crisis of a party seeking to defend capitalism on the backs of the working class. March 2025 research showed that Labour has already lost the support of 40% of those who voted for them last summer, with almost half described as ‘economically insecure’. Just like their Tory co-thinkers, Labour turns to harsher attacks on minority groups, migrants, benefit claimants, and trans people in the hope of whipping up division and distraction from their brutal austerity.
Culture wars
Culture wars are not new. In times of crisis, when its system’s inability to take society forward is exposed, the capitalist class faces challenges to its right to rule. But it has honed the means to undermine potential opposition including its ability to use the differences that exist among the heterogeneous working class to whip up division. Appeals to workers to identify with their capitalist oppressors are based on claims of a ‘shared culture’ or ‘community’, normally in distinction from other workers who they claim pose a threat to that culture or community. Who constitutes the ‘others’ varies across time and geography but are identified on the basis of different races, ethnicities, and religions, and also have included migrants and LGBTQ+ people.
The capitalist class has many means to reinforce its divisive messages including through educational institutions, the courts system – the apex of which in Britain is the Supreme Court – parliament, religious institutions, and big business-owned media. According to research from the Independent Press Standards Organisation, there was a reported 400% increase in news stories about transgender issues in the UK media between 2009 and 2019, for example. But the capitalist class also has other advantages when it comes to bolstering claims of cross-class ‘shared’ culture and community. When it comes to whipping up racism, capitalist classes have invested in ideas of nationalism that have been constructed, used and adapted since the capitalist system was founded, and are therefore deep-rooted.
When it comes to homophobia, the capitalist class can also appeal to the gender norms they have established that are linked to the social and economic role of the family under capitalism. The family has a dual role – on a personal level and as an economic and ideological unit geared towards capitalist interests. Most people’s perception of the role of the family is of a provider of care and support. The material disadvantage of being separated from family, also gives authority to appeals to defend the family model. Single parents, LGBTQ+ people, even unmarried couples, and anyone whose life doesn’t conform, have at times been presented as a threat through laws, culture, and religion. Despite the gains the working class has made in the welfare state in many countries, the gendered unpaid labour of caring in the family home remains the fallback position. Appeals to defend the family unit often come from the very destroyers and deniers of public services who expect impoverished families, especially women, to take up the slack rather than society providing the public services and resources needed.
The ideas that underlie culture wars are also reinforced by those who claim to be on the side of the oppressed. This has included capitalist parties like the US Democrats who have sucked in movements such as the women’s marches at the start of Trump’s first term, the subsequent abortion rights campaign, and movements for LGBTQ+ rights since Stonewall in 1969. The ability of the capitalist class to divide is reinforced by pro-capitalist trade union leaders and social democratic politicians who fail to link clearly opposing racism, anti-war campaigning, fighting for women’s liberation, and defending LGBTQ+ rights to the general tasks of the working class in organising to take power and change society.
Their role is a consequence of accepting the limits of the framework of existing capitalism – that there is a fixed slice of the national cake that is available to the working class. The logic of that position is that any advance for one section of the working class must be compensated for by sacrifices by another. This is what lies behind the trade union leaders who accept the lie that there are irreconcilable conflicts of interest between trans women and other women – a position which if adopted by the workers’ movement would divide and weaken our class.
The trade unions also have a dual nature in class society. They are key mass organisations through which the working class can act collectively and develop its programme, cohesion and confidence. This includes building an independent workers’ political voice that can express the interests of all the sections of our class. But the trade unions are also organisations in which the authority of trade union leaders who accept the framework of existing capitalism and do not demand an alternative, socialist organisation of society can be used by the ruling class to amplify its divisive ideas that can undermine that collective programme, cohesion and confidence.
How Cass fits in
The publication by NHS England (now a target of Labour austerity) of Dr Hilary Cass’s ‘independent review of gender identity services for children and young people’ has been used as scientific cover by various capitalist politicians, both in Britain and internationally, to continue the attacks they were already making on trans people. But the authority of a weighty 388-page piece of university research can only be used to challenge trans identities and rights if there is no response to these attacks by the organised working class.
Years of Tory anti-trans rhetoric and failure to improve the rights of trans and non-binary people to self-identify are now being supplemented by cuts to services used by trans people, specifically the closure of the Gender Identity Development Service (GIDS) and limiting the ability of trans children and young people to get a prescription for puberty blockers through the NHS. However, the Review does not clearly back every attack that has and will be made.
It certainly could not be said that the Cass Review is a document for defending trans rights. However, it is notable that although it was published at a time when leading Tory and Labour politicians were denying trans women’s identities, the Review starts by asserting the existence of trans identities. In the foreword Dr Cass writes: “This Review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people’s rights to healthcare. It is about what the healthcare approach should be, and how best to help the growing number of children and young people who are looking for support from the NHS in relation to their gender identity”.
While the Cass Review reflects divisive culture war narratives it is also an expression of the significant changes to social attitudes that have taken place in recent decades. These are the product of the expansion of the working class, the confidence that has accompanied that, and struggle against oppression, all products of the collective experience of the working class under capitalism which can undermine divisive ideology.
The Review therefore also reflects the growing acceptance of LGBTQ+ identities in Britain in which struggles, including against Thatcher’s Section 28 clause in the Local Government Act of 1988, and the solidarity developed in the 1984-85 miners’ strike, have helped to cut across the perceived division between the struggles of different sections of the working class. The People’s History Museum explains the impact of the solidarity brought by Lesbians and Gays Support the Miners during the strike: “The miners committed to supporting their new allies, including rallying to oppose Section 28 legislation which prohibited the discussion of LGBTQIA+ people in schools, colleges, or local government funded institutions like museums. The NUM [miners’ union] pushed for LGBT rights to be included in both TUC (Trades Union Congress) and Labour Party policies. Attempts to make these organisations fight for LGBT rights had been made before and it was the NUM’s block voting in favour that made this campaign successful where others had failed”.
The 2023 British Social Attitudes (BSA) survey found that “67% think a sexual relationship between two people of the same sex is never wrong, compared with 17% in 1983”, the year before the miners’ strike. The BSA, it is true, also found a drop from 82% to 64% in those who “describe themselves as not prejudiced at all against people who are transgender”, showing the impact of the divisive ideas being pumped out and not answered by the workers’ movement. But, without in any way being complacent that a fightback isn’t needed, the figures also indicate that such a concerted torrent of bigotry left two-thirds still supporting trans rights, a very high figure historically.
Who blocked the blockers?
Puberty blockers, as defined by the NHS, are “synthetic (man-made) hormones that suppress the hormones naturally produced by the body and in doing so, suppress puberty, with the aim of reducing the level of puberty-related anxiety in an individual with gender incongruence [when your gender is not the one assigned at birth]”. They have been available on the NHS in gender-affirming treatment since 2011. The Review says that “the original rationale for use of puberty blockers was that this would buy ‘time to think’ by delaying onset of puberty and also improve the ability to ‘pass’ in later life. Subsequently it was suggested that they may also improve body image and psychological wellbeing”.
Puberty blockers are cleared for the treatment of children, in instances of precocious puberty. However, the Review found that “the evidence base, particularly in relation to the use of puberty blockers and masculinising/feminising hormones, had been shown to be weak”. To be extremely cautious of unsafe, unproven, and/or unnecessary health interventions, especially when it comes to children, is a good starting point. And it is certainly correct to fight for the means to investigate outcomes of all treatments to the utmost extent possible – which cannot be left in the hands of big business and capitalist politicians. The Cass Review says that NHS England (NHSE) was advised in July 2023 that “because puberty blockers only have clearly defined benefits in quite narrow circumstances, and because of the potential risks to neurocognitive development, psychosexual development and longer-term bone health, they should only be offered under a research protocol”.
But, at time of writing, Labour health secretary Wes Streeting, who committed himself to the “full implementation of the Cass Review”, has failed to launch this protocol which, by the way, is proposed to have no cap on numbers. In other words, the Labour government has imposed the block. However, even research that found fully in favour of the provision of puberty blockers or any treatment would not replace the need for democratic working-class oversight of medical research and usage. Genuine safety in healthcare must include full public funding of the NHS and democratic working-class control and management of health services, not to mention the nationalisation of the pharmaceutical industry as part of a socialist NHS and the fight for a socialist transformation of society.
The other main measure taken in the name of the Cass Review is the closure of the Gender Identity Development Service at the Tavistock Centre. It has been claimed that GIDS was giving out prescriptions for puberty blockers in vast numbers and with great haste. But the BBC reported that at the time the Tory government brought in the ban on puberty blockers for trans young people, there were fewer than one hundred such prescriptions through NHSE. The Cass Review notes that, of the 3,306 patients who had been discharged from GIDS between 1 April 2018 and 31 December 2022, 893 (27%) received puberty-pausing medication, gender affirming hormones (ie oestrogen or testosterone), or both. Another 2,413 (73%) received no medical intervention at all. The data also show that most people waited over two years on an initial waiting list and then attended an average of 6.7 assessment appointments, rising to an average of 15.8 appointments since 2019 in response to recommendations, often with months in between each appointment.
The Review talks about the dangers of interfering with a natural process of ‘normal puberty’. However, there is research that finds that millions of children risk having their normal puberty process interrupted – not by puberty blockers but by austerity. Poverty can be linked to early puberty and malnutrition can be a factor in delayed pubertal development. Condemning babies and children to capitalism’s privation and precarious living conditions disrupts ‘normal’ processes every day.
Unanswered questions
In the chapter called ‘Understanding the patient cohort’ the main takeaway is how much remains not understood. The obstacles to understanding include that the reality of young people seeking self-expression contradicts capitalism’s established ideology and poses a threat to its dominance.
The Review notes the disproportionate increase in the number of young people presenting at gender clinics who were registered female at birth. Of 3,499 patients audited (who had attended at least two appointments at GIDS and been discharged between 1 April 2018 and 31 Dec 2022), 73% were birth-registered female and 27% birth-registered male. The Review admits “there is very limited understanding” of why this is the case. The reason this poses a challenge to the established understanding of trans identity is because it contradicts the framework of the capitalist anti-trans division. Trans men have barely been mentioned. That’s because the anti-trans approach bases itself on an appeal to the fear of male violence and of attacks on women’s rights, including women-only spaces. Like all culture-war appeals, the invitation to feel this fear has a basis in capitalist society which has sanctioned male violence and whose austerity hits women hardest. There is no irony in capitalist politicians pointing to trans women as the main threat to safety within the very public services whose funding they cut and privatise.
The Review also picks out the high instance of neurodivergence in the cohort of young people seeking support at gender clinics. Some research argues that autistic and other neurodivergent individuals can be less constrained by societal norms and expectations that have been constructed within the context of class oppression. The Review cites studies that have found that “people who do not identify with the sex they were assigned at birth are three to six times as likely to be autistic as cisgender people are”.
Capitalism has invested in the imposition of the gender norms it inherited from previous class societies and – although it has been able to adapt and be flexible when mass pressure has been exerted – has a material interest in maintaining them. The UK Office for National Statistics worked out that in 2014 women carried out 60% of unpaid work in the home in Britain and that its value was just over £1 trillion, the equivalent of 56% of GDP! As well as saving billions in care and other services, gender stereotypes aid the profits of the beauty, leisure, pharmaceutical and porn industries. They won’t easily be relinquished nor challenges to them benignly tolerated.
The chapter on social transition concludes that “that there is no clear evidence that social transition in childhood has positive or negative mental health outcomes” but that it “is clear that social transition is a cause of concern for many people”. Social transition is “broadly understood to refer to social changes to live as a different gender such as altering hair or clothing, name change, and/or use of different pronouns”. In other words, it can pose a challenge to the dominant gender ideology. At the same time, it is also a condition of the current, unchanged Gender Recognition Act that applicants live in their ‘acquired gender’ for at least two years before they can apply for a Gender Recognition Certificate.
The Review researchers found that “in the UK, 54.6% of children and adolescents referred to the GIDS in 2012–2013 had socially transitioned”. The waiting times for gender care appointments can be years long and will be a factor in young people taking their health into their own hands. A survey in 2023 found that three-quarters of secondary school teachers in England said they had taught pupils who had come out as transgender or non-binary. Sunak’s Tory government was unable to finalise its draft guidance on gender questioning children. It sought scientific authority from the Cass interim Review when charging teachers with telling parents that their child was socially transitioning. Education unions pushed back, no doubt with Thatcher’s disastrous Section 28 in mind.
Socialist conclusions
The Cass Review certainly does not draw socialist conclusions. It refers to horrendous NHS wait times for treatment without mentioning how underfunding, privatisation and austerity affect these. But the first point of its ‘Summary and recommendations’ section says: “The aim of this Review is to make recommendations that ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria receive a high standard of care. Care that meets their needs, is safe, holistic and effective”. Many of the Review’s recommendations refer to ‘holistic’ approaches, including how NHS staff could work together in a ‘National Provider Collaborative’ to develop treatment and support each other.
It is correct that the BMA, one of the unions at the fore of the strike wave and the first to take national action under the new Labour government, has decided to take time assessing its response to the Review. This should be coupled with the BMA and other health trade unions and those accessing gender healthcare looking at how it should be run to be available for all who need it. That needs to be linked to the trade union movement taking the lead on a mass campaign to defend the NHS so children and young people can access all the services they need – from mental health support to gender care and beyond – and fight all austerity and oppression. That campaign must include building a workers’ political voice that opposes Streeting and Starmer’s privatisation and austerity drive. To save the NHS and defend trans rights and identities means a struggle for the working class organising to run society in the interest of all our needs.
US culture wars – with or without Cass
American trans workers and young people are today living in fear of Donald Trump’s attacks which predate the Cass Review but claim authority from it. The lessons of previous appeals to culture wars in the US can cast some light on what is taking place.
In the 1940s, LGBT workers gained confidence as part of the process of mass rapid US urbanisation and proletarianisation. Twenty million Americans moved to newly created jobs in the cities and military in that decade. They left rural areas where the family was the dominant social sphere to one where the workplace was. Trade union membership grew, and LGBT workers started to develop their own organisations as well as visibility in society with gay clubs and bars starting to open in the cities.
The outcome of World War Two had left the US ruling class in a global conflict with Stalinism. The Soviet Union represented an alternative economic system even though by then Stalin’s grip meant the democratic working-class control and many of the gains of the Russian revolution, including LGBT+ rights, had been pushed back. Its appeal posed a threat to US imperialism including among US workers. The post-war period saw US capitalism compelled to invest in developing the economy as part of a challenge to the USSR for dominance and influence. But there was also massive investment in divisive culture wars to undermine the working-class confidence that was developing.
Gay history specialist Allan Berube explains that “churches, the media, schools, and government agencies conducted a heavy-handed campaign to reconstruct the nuclear family, to force women back into their traditional roles, and to promote a conservative sexual morality. A tactic of this campaign was to isolate homosexual men and women and identify them, like Communists, as dangerous and invisible enemies”. In the context of improving living standards in the anomaly of the post-war economic upswing, those capitalist institutions could command authority. Today they face a deepening crisis of legitimacy. The ‘Red and Lavender Scares’ Berube refers to were state-sponsored witch-hunts that backed up the propaganda and the dividing and weakening of working-class organisation and confidence. LGBT workers were banned by President Eisenhower’s Executive Order 10450 from federal jobs in 1953. It is cruelly ironic that this was done on the basis that their supposed susceptibility to blackmail made them a threat to national security – a concept that could only be conjured because it was illegal to be gay.
It is estimated that up to10,000 LGBT workers were sacked or resigned out of fear of being caught in the ban. Not only did the Democrats not fight it, they played a role. In 1950, a Democrat from North Carolina and committee chairman, Senator Clyde Hoey, issued a report, Employment of Homosexuals and Other Sex Perverts in Government, with recommendations about federal hiring practices.
But the workers’ movement also did not have a leadership that withstood the pressure of capitalist propaganda. A number of the trade union leaders in the AFL and CIO did not stand for a socialist alternative and therefore did not recognise the threat of the scares, actively driving left activists out of the unions. Today’s widely understood idea that trade unions should at least stand for LGBTQ+ rights against repression was yet to be won – with LGBT workers organising being one key component in that process. The Communist Party of the USA was by the 1950s in decline and its leaders, taking the line from Stalin, banned gay people from membership until 1970. Although Communist Party members built key LGBT rights organisations, there was no mass united opposition to the division of the working class or capitalism. Fear of being ‘out’ in the workplace can cut across the potential for solidarity and understanding to develop which would undermine stereotypes and bigotry.
This weakening of the working class linked to the absence of building a mass workers’ political voice has a long legacy. At the start of this decade, it was still legal in all but 22 US states for individuals to be refused employment, housing or business services because of their sexual preference or gender identity. The share of wealth going to the US working class has fallen. In 1976, the richest 1% held about 8% of total income. As of 2024, the top 1% possesses 28.3% of total income.
The lesson is that every one of Trump’s attacks requires a united working-class response, including on trans youth health care. However, Trump cannot make attacks on the scale of 1953 today. Since then, the working class has grown in size and strength. Since 1950 the percentage of the US population living in urban areas has increased from 64% to 83%. The experience of decades of living and working alongside workers of all races, genders and sexualities and of the inability of capitalism in crisis to improve living standards puts certain limits on today’s culture warriors. When asked ‘do you think marriages between same-sex couples should or should not be recognized by the law as valid, with the same rights as traditional marriages?’, 69% in the US answered ‘should’ in 2024 and 29% were opposed. This represents a slight drop on the previous year from 71% which is a warning of the impact of unanswered division – but also an increase from 27% in 1996. And today, Trump’s promise of improving living standards will be exposed and become a factor in challenges to all his attacks, including on trans rights. Division will be whipped up – but so too will workers’ united action against a system that only offers austerity and oppression.