A robust British review found guidelines for the treatment of children with gender dysphoria ignored standards and are based on flimsy foundations. Pediatrician Hilary Cass' much-anticipated report found no reliable evidence on which to base gender-affirming care for youth; the rationale for blocking puberty in young children remains unclear and muddled and that the use of cross-sex hormones in the under-18s presents numerous unknowns. Cass said published studies suffer from "remarkably weak evidence," that results are "exaggerated or mispresented" by people on both sides of the debate over transgender health care to bolster their own viewpoint. Cass found that there is no solid evidence on the long-term outcomes of any of the interventions. Cass said the toxicity of the debate has been exceptional. "There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media and where name-calling echoes the worst bullying behaviour. This must stop," Cass wrote. The systematic review on puberty blockers found no evidence the drugs improve body image or dysphoria. The drugs might temporarily or permanently disrupt adolescent brain maturation, "which could have a significant impact on the young person's ability to make complex risk-laden decisions, as well as having possible longer-term neuropsychological consequences," according to the Cass report.