US tells states: Follow Cass Review in treatment of ‘trans' children

The US government is pressuring states to halt funding for puberty blockers for children and follow the UK's Cass Review.
The Center for Medicare and Medicaid Services (CMS), which provides health coverage to more than 160 million Americans, urged directors to adopt the findings of the report, which concluded children who think they are transgender should not be rushed into treatment they may regret.
In a letter sent to medical directors, seen by The Telegraph, the agency said that Britain has 'diverged' from the United States and that the National Health Service's new approach is more effective.
Under Donald Trump, the US has quickly moved to ban all 'destructive and life-altering procedures' associated with transitioning children.
Some 27 states have enacted laws that ban or restrict gender‑affirming care for minors. But puberty blockers are still available in many others.
'Several developed countries have recently diverged from the US in the way they treat gender dysphoria in children,' the letter reads. 'The United Kingdom, Sweden, and Finland have recently issued restrictions on medical interventions for children, including the use of puberty blockers and hormone treatments.
'In particular, the Cass Review, an independent review of the evidence in the United Kingdom, noted that despite the considerable research in the field of gender dysphoria in children, 'systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.''
Led by Dr Hilary Cass, the review was prompted by concerns about the high rate of young people being referred to the Tavistock gender clinic in London, which referred children as young as 10 for treatment with puberty blockers.
The final review, released in April 2024, concluded that too many children were being pushed towards medication with not enough mental health care.
Dr Cass recommended that the most important treatment for the majority of children should be talking therapies instead of irreversible medical treatments such as puberty blockers.
The letter went on to imply Britain is more effective in upholding the US government's commitment to 'do no harm to America's children'.
'In recent years, medical interventions for gender dysphoria in children have proliferated,' the letter added.
'These interventions include surgical procedures that attempt to transform an individual's physical appearance to align with an identity that differs from his or her sex or that attempt, for purposes of treating gender dysphoria, to alter or remove an individual's sexual organs to minimise or destroy their natural biological functions.'
The letter also said medical interventions for gender dysphoria in children have 'proliferated' in America and the Cass Review, which is rumoured to be backed by Mr Trump, could be used by states to reduce cases.
The move is a rare example of British policy influencing American direction under Mr Trump, who moved to ban puberty blockers almost immediately upon arriving in the White House. His administration has largely been critical of Britain's policies, repeatedly raising concerns about free speech.
In May, The Telegraph revealed the president had sent a delegation to meet British anti-abortion activists who say their freedom of expression has been threatened. A five-person team from the US State Department spent several days in the country and interviewed campaigners.
Trump has intervened on transgender issues
Trans activists have long fought to retain puberty blockers as a treatment option for children with gender dysphoria. Democratic attorneys general in Washington, Oregon and Minnesota sued the Trump administration over its plans to pull funding from institutions that provide gender-affirming care.
The US president has signed a number of executive orders targeting transgender people, claiming that it is a radical ideology driven to 'deny the biological reality of sex'.
In January, he signed an order that aimed to restrict gender-affirming treatments for all young people below the age of 19 by asking federal agencies to stop endorsing interventions such as puberty blockers, hormone therapy, and surgery for minors.
In July 2024, The Integrity Project at Yale Law School released a white paper which said the Cass Review had 'serious flaws'.
It suggested that the review 'levies unsupported assertions about gender identity, gender dysphoria, standard practices, and safety of gender-affirming medical treatments'.
The white paper concluded that the review 'is not an authoritative guideline or standard of care, nor is it an accurate restatement of the available medical evidence on the treatment of gender dysphoria'.

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Telegraph

34 minutes ago

• Telegraph

The best yoga mats and non-slip exercise mats tried and tested, from Lululemon to Yogi Bare

Given its transformative benefits for mind and body, the barrier for entry to yoga is low. You need very little specialised clothing or equipment – in fact, all you need is a mat, a pair of gym leggings and a water bottle. The best yoga mat will provide you with a stable, grippy surface on which to practice. There is nothing less zen than finding your hands are slipping forward in downward facing dog, or that your peaceful warrior pose isn't feeling all that peaceful because your mat won't stay in place. To maintain a consistent yoga practice, a decent mat is key. Unlike other fitness equipment such as rowing machines and treadmills, a yoga mat won't clean out your bank account – some mats are as little as £20. But not just any old mat will do – Emma Henry, an expert yoga teacher at Triyoga, says that investing in a decent model will pay dividends further down the line. 'There's nothing more frustrating in a fast-paced Vinyasa flow than slipping, so enough grip is key,' says Henry, who recommends the Liforme mat. 'There are cheaper ones available that are decent, but they might not last as long.' We've reviewed the best yoga mats in depth below and provided answers to some frequently asked questions. However, if you're finding yourself strapped for time, here's a quick summary: The best yoga mats: At a glance JUMP TO REVIEWS How to choose the best yoga mat When selecting the best yoga mat, thickness is paramount: a standard mat (around 3mm) provides a stable base for balance and flow, while thicker mats (up to 6mm) offer extra cushioning for sensitive joints or restorative sessions. The right thickness prevents discomfort and helps protect knees and wrists during prolonged poses. Material matters for both performance and sustainability. PVC mats are durable and provide excellent grip, but may not align with eco-friendly values. Natural alternatives like rubber, cork, or jute are increasingly popular, offering good traction and a lighter environmental footprint. Cork, in particular, is antimicrobial, which is ideal for hot or sweaty practices. You also need a textured and grippy material for safety, especially during dynamic or heated classes. Portability is worth considering if you travel or commute to classes; lighter, foldable mats are easier to carry but may sacrifice some comfort. Ultimately, the best yoga mat is one that balances support, grip, sustainability and convenience to suit your personal practice and values. How we test yoga mats Every mat on this list was tested through completing a series of yoga sessions and HIIT (high intenstity interval training) workouts. For the yoga sessions, I used videos by YouTube sensation, Yoga with Adriene. I took note of how thick and comfortable each mat was, which meant considering how comfortable my knees felt on the ground and how my joints felt after a heavy session. I also thought about the weight of each mat while carrying them to and from gym sessions. I looked for a soft but supportive material that wasn't slipper and, of course, a decent price. Why you can trust Telegraph Recommended Our thorough, real-world tests will always help you find the best product. No manufacturer ever sees Telegraph Recommended reviews before publication and we don't accept payment in exchange for favourable reviews, nor do we allow brands to pay for placement in our articles. From running shoes to exercise bikes, all reviews are based on independent expert opinion and our hands-on testing. Visit our Who We Are page to learn more. The best yoga mats of 2025 1. Best Buy Yoga Mat: Lululemon The Mat Top marks for this double-sided mat from Lululemon, which offers unparalleled grip, a stable surface and plenty of support. It's unnoticeable in the best way; I felt grounded and supported, and my hands and feet didn't budge. Lululemon offers several thicknesses of mat, but I would opt for the 5mm for joint support. This mat is reversible and comes in a wide range of colours and designs. One side is smooth and the other is slightly textured, but both are made from natural rubber. It's the perfect size – a touch longer and wider than most standard yoga mats, at 180cm x 66cm. This means it offers plenty of space to stretch out. Thanks to its slightly thicker construction, I found it also makes the perfect partner to HIIT and strength workouts. Despite being thicker than most others, it's not unduly heavy, at 2.4kg. That's the upper end of what I'd consider to be an easy weight to carry, but it means that this mat excels both at home and in class. The only downside is that it doesn't come with a carry strap or bag – but that really is nitpicking. Put simply, it's a brilliant all-rounder that is more than worth the investment. Key specifications 2. Best Value Yoga Mat: Manduka Prolite Yoga and Pilates Mat The Manduka Prolite is wonderfully durable. It's favoured by The Telegraph's Boudicca Fox-Leonard, a part-time yoga instructor. Fox-Leonard says: 'For the yogi looking to find a mat that will be able to follow them on their practice journey without flaking, Manduka mats are hard to beat on quality and simplicity. They also have ethical credentials: they're non-toxic and 100 per cent latex free, with an emissions-free manufacturing process. 'While Manduka's range is overwhelming, opt for the Manduka Prolite. You'll get a mat light enough to carry (it weighs 1.8kg) without compromising on cushioning. It might prove slippy for those first few practices, but then you and your mat will be stuck to each other for life.' Manduka promises its mats are made for life, and they come with lifetime guarantees. The most durable option you can find. Key specifications Material: PVC Measurements: 80cm x 61cm Thickness: 4.7mm Weight: 3.08kg 3. Best Non-slip Yoga Mat: Liforme Original Yoga Mat Yoga teacher Emma Henry's favoured mat is the Liforme original. There's no getting around the fact that it's expensive, but this is a mat that will last for years and years. It has a uniquely smooth surface whilst still offering unparalleled grip. It is also one of only a handful to be printed with a handy alignment guide. At 185 x 68cm and 4mm thick, it's slightly larger than average, so perfect for practicing at home – however, given it weighs 2.5kg, it's not the easiest to lug to a yoga class. If you're looking for a mat to use on the move, Henry also recommends the Liforme travel mat (£99.95, Amazon). Liforme also has impressive eco credentials; their mats are made from natural rubber and eco-friendly polyurethane and are biodegradable. Key specifications Material: Rubber Measurements: 185cm x 68cm Thickness: 4.2mm Weight: 2.5kg 4. Best Yoga Mat for Allergies: Gaiam Sol Studio Select Dry-Grip Yoga Mat If you have a latex or rubber allergy, this Gaiam Dry-Grip Yoga Mat is for you – it's made out of polyvinyl chloride (PVC), a type of plastic. PVC isn't as sustainable as the natural rubber used by other mats on this list but it has a low carbon footprint and is highly durable, so you won't need to replace your mat in a hurry. The 5mm thick mat had a good amount of cushioning and I found it soft on my joints both for yoga and HIIT workouts. The smooth top layer wicked away sweat from my palms and feet. More impressively the grippy underside stuck to the shiny fake hardwood floor in my flat which is usually slippery, without budging. At 2.1kg it's completely manageable to carry if you tend to take your yoga mat to the gym though you'll have to buy a separate bag or straps. I also love the design – the mandala in the middle of the mat is an excellent point of focus for trickier yoga positions. Key specifications 5. Best Ethical Yoga Mat: Yogi Bare Wild Forest Ever Grip Paws Yoga Mat I loved testing this mat – primarily because it's refreshingly lightweight and transportable when paired with Yogi Bare's Carry Bag (£20), and it's also easy to store as a result. Where it truly shines is its patented Ever Grip technology, which means the surface is extra grippy, durable and stain-free, while remaining as eco-conscious as ever. Having tested this mat over several weeks during both yoga and HIIT workouts, I can attest to the excellent grip and lack of marking – it still looks as good as it did out of the box. At 4mm thick, it's certainly on the thinner end of the spectrum, but I still find it supportive enough for my joints. That said, my wrists, where I have a particular weakness as a result of previous injury, would have preferred a little more cushioning. It measures 180cm x 66cm, so it's a touch narrower than the Liforme mat, but I found it to be more than spacious enough. For reference, I could easily still squat while facing sideways. Living in a small London flat, I actually appreciated the narrow form and it was plenty long enough for my 174cm height. Other small but appreciated features include the alignment and orientation guides to keep you on track during different movement types, and notes of affirmation which depend on the colour you choose – my 'desert sand' colourway told me 'you belong here', which was reassuring during a particularly gruelling ab workout. As for the sustainability credentials, Yogi Bare uses natural rubber, plant-based dyes and recycled packaging. The mats themselves are biodegradable and recyclable, with discounts on new mats offered if you recycle directly with Yogi Bare. Key specifications 6. Best Travel Yoga Mat: Yogamatters Sticky Yoga Mat This budget-friendly mat is available in all the colours of the rainbow, and you can't fault the grip – it's as sticky as its name suggests. I like the distinctive textured design and how light it is to carry (it weighs just 1.2kg). However, I found it slightly too sticky – it feels as if it leaves a slight residue on your hands. It also doesn't come with a strap, but given the texture, it's more than sticky enough to simply roll up and store. This would be an excellent mat for taking to a class or using on the move, but for home practices I would choose something with a smoother surface and a bigger footprint. Key specifications Yoga mat FAQs What to look for in a yoga mat You want a good grip, a thick base and high-quality material like natural rubber for support, and a light enough weight that it can be carried to and from a gym. Visual alignment markers, to help with the placing of hands and feet are also useful. There are other factors to consider, too: texture and size. 'I like a big, heavy mat for home practice, but when you're travelling you need it to be lighter,' says Emma Henry, yoga teacher at Triyoga, who uses a Liforme travel mat or Lululemon '(Un)mat' when she's on the move. She also considers the ethics of a company: 'what they're doing to support yoga teachers and what they're doing environmentally.' Consider too the style of yoga you practice – hot yoga, in which you're likely to sweat a lot, will require a mat that offers plenty of grip and is easy to clean, whereas a slower restorative or yin yoga class might require a mat that's thicker and more supportive. How to clean a yoga mat To stay on top of keeping your yoga mat clean, you should try to disinfect it before and after each session with equal parts water and white vinegar, and a dash of tea tree oil. For bigger cleans, every couple of weeks, or more or less depending on your usage, put your yoga mat in a bath or shower and give it a good scrub with water and dish soap, leave it to dry, then roll it up. Most yoga mats cannot be put in the washing machine, but check the individual instructions. How thick should a yoga mat be? As a general rule of thumb, stick to yoga mats between 4mm and 6mm. Bear in mind a thinner mat will be more portable, while a thicker mat will be easier on the joints. If you're doing more floorwork yoga, you might choose a thicker mat as well for the extra cushioning. That said, too much thickness can affect the flow of movement so it's all about finding the balance. How long does a yoga mat typically last? A yoga mat typically lasts between six months and two years, but it can depend on how often you use it and care for it. What is the best material for a yoga mat? Most standard yoga mats are made from polyvinyl chloride. Newer, more eco-friendly options include natural and recycled rubber, jute, and cotton. Can yoga mats be recycled? Polyvinyl chloride mats are the most difficult to recycle as they may contain plasticisers, UV retarders, dyes, and dirt. Rubber yoga mats and biodegradable mats are much easier to recycle. It is always worth checking with the manufacturer to be sure.

Daily Mail​

an hour ago

• Daily Mail​

EXCLUSIVE I ignored all the signs... then doctors found an aggressive cancer. Here is what I wish I knew

An Oregon man who blamed his extreme fatigue and weight loss on work stress actually had terminal cancer. Once an ultramarathon champion and self-proclaimed 'health nut,' the 41-year-old had grown accustomed to intense weight training and running up to five miles a day. He mostly steered clear of alcohol and processed foods and prioritized a balanced diet with all organic vegetables and lean proteins. But earlier this year, he noticed he could no longer get through his regular exercise routine - 'the first big change' that signaled a deadly issue. Over the course of several months, he suffered extreme fatigue and dropped 30 pounds without trying. 'I thought it was just stress at work,' the mechanical engineer said. However, bloodwork and an abdominal CT at his yearly checkup revealed stage four pancreatic ductal adenocarcinoma, the most common form of pancreatic cancer. Just one in eight patients with pancreatic cancer is expected to survive five years, data shows, and when it's diagnosed in later stages, which happens most of the time, survival rates dwindle to just three percent. The man, who posted his story in an anonymous Reddit thread, has just six months left to live despite living 'a very healthy lifestyle' and having no family history of the disease. He said: 'I never smoked, almost never drank, ate clean and exercised daily. Sometimes biology lets you down.' Pancreatic cancer affects roughly 67,000 Americans every year and kills about 52,000. More than half the time, the disease is first spotted after it has already reached stage three or four due to its vague symptoms. These include abdominal pain, weight loss, back pain, jaundice and floating or clay-colored stools. This leads patients to assume their symptoms are from more benign causes like irritable bowel syndrome (IBS). This was the case for Clair Honeywood, a 45-year-old from the UK who chocked her severe stomach pain up to IBS. She was diagnosed with inoperable pancreatic cancer and given a year to live. And Matthew Rosenblum of Michigan assumed his bone-white stools in 2021 were from Crohn's disease, but it was actually stage four pancreatic cancer at age 32. It's unclear exactly what causes pancreatic cancer, but smoking, obesity and diabetes are thought to increase the risk by inducing harmful inflammation that causes cells to divide and become mutated more easily. The man in the Reddit thread, however, blames his diagnosis on bad luck. He said: 'Before this diagnosis, I was in perfect health. I thought I had another 50 years left. The first thought was 'This is too soon.'' The former engineer said he will soon move into hospice care and try psilocybin therapy for pain and the mental health effects that have come with his diagnosis. Psilocybin, the psychoactive ingredient in magic mushrooms, has been thought to reduce anxiety and depression in cancer patients. He also has signed up for several clinical trials. It's unclear if he will be getting standard treatments like chemotherapy or radiation. For now, he is focusing on using up his savings on vacations, scuba diving, skydiving and other items on his bucket list. His main regret is not taking enough risks like 'starting a business, moving to another place, trying something you were interested in but didn't know if you could do.' 'In the end, your failures are often not as consequential as you might think,' he added. He said: 'I'm glad I've been able to experience life. In all the possible realities I could've existed in, this was a pretty good one. Even if it's short. 'I don't have any grandiose aspirations for my legacy. A simple 'that guy was alright' is good enough for me. 'The biggest piece of advice I would give is to not take the time you have for granted. I know that's probably a worn out statement, but it rings incredibly true when you realize how finite your life really is.'

Daily Mail​

2 hours ago

• Daily Mail​

EXCLUSIVE I died after giving birth...The vision I had before doctors saved me shook my faith in the afterlife

Samantha had an uneventful pregnancy and delivery eight months ago, so it shocked everyone when she had a life-threatening complication four weeks later. In October 2024, a month after welcoming her baby, Zuma, she began to bleed profusely, eventually losing four liters of blood, almost everything in her body. As doctors rushed to save her life, her eyes closed, and everything faded to black. She could feel herself dying. 'It was silent and dark, and I was just simply at peace,' she said. 'I didn't feel anything, and in my mind, I knew that I was dying, but I wasn't scared. It felt like I was just going to sleep.' In that moment, she didn't see the tunnel of light or deceased loved ones she was expecting, but she felt an immense peace take over. Doctors found that Samantha had a pseudoaneurysm – a collection of blood outside of a blood vessel, which, given the proximity to her C-section, was considered a delayed postpartum hemorrhage - or excessive bleeding after birth. Samantha spent a week in the ICU following the emergency, missing some of the early days of her daughter's life as she slowly recovered from the ordeal. 'Once I was aware enough to realize that I was in the ICU, and that my daughter wasn't with me, it was so sad,' she said: 'She was only four weeks old and we both needed each other – we were still in the new mommy/baby phase and we were bonding. I just wanted to see her and hold her.' Samantha's pregnancy and most of her labor had gone smoothly, but an emergency C-section was needed when her baby's heart rate dropped. Although she experienced minor bleeding after the surgery, she recovered well. However, four weeks later — the morning after she and her husband marked the anniversary of their first date — she woke up in a terrifying condition. She said: 'I woke up at 5am to a wet, gushing feeling. I looked down and was absolutely covered in blood. My shorts and legs were soaked, and the blood had also soaked through my sheets, mattress topper, and mattress. 'Because I had already hemorrhaged in the hospital, I knew what was happening. This time was just so much worse.' At the hospital, doctors rushed her into surgery and administered multiple blood transfusions while she fell in and out of consciousness. 'Apparently, at some point, the bleeding got worse and I began to crash,' she said. 'My pulse dropped down to 52, my hemoglobin level dropped to a three, a crash cart was brought out, and I just knew that I was dying. 'In an awake state during this, I shouted out to my husband that I loved him more than anything and to take care of our new baby.' That was the moment she felt her life slipping away. While Samantha was unconscious, doctors rushed her into surgery. They found a blockage and weakened blood vessel (an aneurysm) in her right uterine artery, which was causing the bleeding. To stop it, they performed a procedure called a Bilateral Uterine Artery Embolisation — where the blood supply to the uterus is deliberately reduced — using an absorbable sponge to block the artery, like a temporary cork. A surgeon was kept on standby in case an emergency hysterectomy (removal of the uterus) was needed, something Samantha and her husband, Louie, hoped to avoid to preserve their chance of having more children. The four-hour surgery worked, but Samantha spent a week in intensive care, missing some of her baby's early days as she recovered. 'Once I was aware enough to realize that I was in the ICU, and that my daughter wasn't with me, it was so sad,' she added. 'I kept asking my husband to bring her to see me, but we decided together that she shouldn't be coming to the ICU around all those germs. Coming home was the best feeling ever.' Samantha described the lasting trauma she experienced after the ordeal, saying she struggled with severe PTSD. For months, she barely ate or slept, was plagued by nightmares, and felt anxious about being too far from the hospital in case she started bleeding again. She cried daily, suffered frequent panic and anxiety attacks, and constantly checked for signs of bleeding, sometimes even feeling phantom sensations. In the months that followed, she underwent several scans to ensure no new aneurysms had developed, and after six months, her blood count finally returned to normal. Still, the experience left her fearful about the risks of future pregnancies and whether something similar could happen again. 'I want more babies, and because my case was so rare, I don't really have answers,' she said. 'Could this happen to me again? Yes. Could this happen during a future pregnancy? Yes. Was this aneurysm brought on because of my pregnancy? Nobody knows.' A hemorrhage is relatively rare, affecting 0.2 percent to 2.5 percent of postpartum women. After all she has been through, the artist has a whole new appreciation for life that she is taking with her into the future. 'I know it is so cliché, but this gave me a new perspective on life. I feel like I am a lot more chill, and things really don't bother me as much, because I know what could have been,' she said. 'So what if I'm stuck in traffic or if my phone dies – I'm alive!'