The report disregarded a substantial amount of evidence for transgender care as not “high quality” enough and then described the evidence surrounding transgender care as weak, despite other reviews, major medical organizations, and the largest psychological organization in the world finding the evidence compelling enough to support gender affirming care. This has led to a group of over 100 Irish academics decrying the review in a group letter. The report made a series of recommendations, such as Recommendation 8, which states that hormone therapy is available for 16-year-olds but should be administered with “extreme caution,” and encourages clinicians to delay the treatment until age 18 unless there are “clear rationales” for earlier intervention. It also called for significant restrictions on puberty blockers, limiting them to research studies only. These recommendations and Cass’s findings have been used to justify severe crackdowns on transgender care.