Hillary Cass at Scottish parliamet - live

[ArabellaScott]

This started at 9am.

https://www.scottishparliament.tv/meeting/health-social-care-and-sport-committee-may-7-2024

'Independent Review of Gender Identity Services for Children and Young People: The Committee will take evidence from— Dr Hilary Cass, Chair, The Cass Review.'

https://www.parliament.scot/chamber-and-committees/committees/current-and-previous-committees/session-6-health-social-care-and-sport-committee

'deep concerns about private provision'

'does put young people at significant level of risk' (private provision)

Question about detransitioners:

Cass talking about irreversible effects of hormones, they don't know numbers for level of regret.

Talks about a mtf transitioner who passes very well but recognises with hindsight dysphoria was caused by 'intense internalised homophobia', who will not 'detransition' but does regret.

Gillian McKay. (Greens)

Could PBs be the right intervention for some?

Cass: Yes, hormones for some are right treatment. We don't know which young people those are. Evidence base for PBs - much less clear.

'no evidence that PBs 'buy time to think''

Puberty as a 'psychosexual pathway'

Do PBs make patient outcomes better? No evidence or weak evidence that wasn't replicated.

One indication thta they may be helpful for males to prevent irreversible changes to enable to pass, but a downside is it stopped looking at other ways of managing distress.

Gillian McKay is wearing a rainbow lanyard.

Mackay: activists think that your report presented transition as the worst possible outcome. Your response?

Cass: risk is that treatment may be given to the wrong group of people. Reason that's negative is because transition does not come without costs, fertility, sexual functions, bone health risk, limitations of surgery, etc

Cass: The group that we hve least understanding about is the most common group now in clinics - female adolescents.

Mackay: What does good research look like to you? Should trans people be represented?

Cass; We need well designed studies with adequate follow up, clear comparisons with other treatment options, that's what's been lacking. Team is thinking about the most ethical and acceptable ways to do that, there will be careful engagement with service users.

Question on self medication and risk:

Cass: Major shortfalls on child mental health provision, no support, no addressing of comorbidities, only have internet advice/peer support groups, higher risk actions implicated, living in a situation where care is failing them. Big problem is fearfulness among HCPs, specifically towards treating 'gender questioning'. HCPS worried about the toxicity of debate, get passed instantly to GIDS, existing issues don't get treated.

Carol Mochan, queston about 'affirming' care and diagnostic overshadowing. How do conversion therapy ban would affect that situation? Can you advise?

Cass: Big challenge. I'm a doctor not a litigator. Issue has been about 'intent', if therapist engages with a YP and YPs views change, and they subsequently blame the therapist - how can a therapist's intent be legally determined? The anxiety is making clinicians even more anxious about working in this area.

Mochan: Question re same sex attracted young people - do we need to take that apart and look at a bill that deals with same sex attraction and trans identity?

Cass: Yes. A high percentage are same sex attraction, you can see how the issues get conflated, this may have been naive but I was surprised by how much homophobia there still is, as well as transphobia. We do have to support people to understand and express sexuality as well as gender identity

Mochan: Why no trans people included in review team?

Cass: That was 4 or 5 people. We weren't excluding. Nobody trans applied. Tokenist representative not helpful. We ensured wide engagement, with advocacy groups, service users, 18 focus groups with young people, roundtables with support groups, qualitative research, consulted internationally.

Question on what else was needed other than research:

Challenge for Gids was being a single service provider, makes it v difficult. setting up a more collaborative structure with central hub to support regional centres, same standards of care throughout, shared clinical guidance, training, research, shared data set.

Cass suggests Scotland sharing practise would probably be welcome on both sides.

How dare Gillian McKay wear a politically motivated lanyard; that was clearly deliberate. I hope Dr Cass is not intimidated.

Also I thought the Scottish parliament had removed the right to wear any activist or politically motivated lanyards and only the Scottish parliament official one was now allowed?

MSPs are exempt from that rule, I believe.

Also thanks Arabella for listening and writing all this down, much appreciated 👍

Question on adult services:

Number of people with concerns from adult services, same sorts of young people moving through that had complexity of presentation, clinical concerns about having to make decisions quickly.

Of course they are....🙄

Ash Regan: Question about females presenting, majority of whom are same sex attracted, more complexity of presentation. Screen for neurodiversity, can you expand on change in cohort, risks, etc.

Cass: Research was already weak on previous cohort, even more limited on current cohort, can't make any assumptions that original studies read across this group, important we consider this new group in a broader context of adolescent wellbeing, mental health stresses, social media, expectations ,exposure to porn, distress, for some yp that distress about gender norms may manifest in questioning 'gender identity'. New cohort - old research can't be relied on. One thing lost in debate is mind-body interaction, unpacking is complex and difficult.

Ash Regan's second question refused, meeting to end at 10 am.

So impressed by Cass' depth of knowledge, thoughtfulness, even handedness and grasp of the situation(s) and complexities. I suppose a lifetime of expertise and four years of immersion in a subject will do that.

😊

I just watched a bit of it. It was a brilliant brain having to explain complex issues to a bunch of mostly fools - most of whom believed that the Emperor was wearing invisible clothing rather than just walking around naked.

And a large number of whom were 100% complicit in harms caused to vulnerable children via a social movement using trite soundbites and performative virtue signalling in place of evidence based medicine.

How she didn't explode in rage the harms they've foisted upon confused children, I don't know.

It was impressive that Dr Cass kept her cool, I would have properly lost my temper at all of those idiots in the parliament complicit in this absolute horror show.

Thank you Arabella.