Hilary Cass on Woman's Hour 9.10.24

[WarriorN]

She will apparently be on the programme tomorrow talking about the impact of her report a year later.

I won't be able to listen but just a heads up if anyone else is interested.

@zibzibara Thank you for the transcript. It's very encouraging to be able to read Cass' own words and thoughts. I especially liked this:

The BMA's source of information were some online sources, mainly from the US, and those were not peer-reviewed. So I think that if, when thinking about evidence-based care, they haven't produced any evidence that the Review should be stopped.

I'm listening my way through the interview now and wanted to post this before I forgot it:

Cass said that there is no size limit to the number of spots available in the clinical trial and any child who wants to go on the blockers can be considered for a spot on the trial - I don't understand this; how is this not an ideal method of getting around the ban on blockers?!

And, I continue to be baffled by the idea that this clinical trial is allowable given the lifelong side effects on children when just letting them go through puberty has been shown to be effective at helping children to desist.

Cass said that there is no size limit to the number of spots available in the clinical trial and any child who wants to go on the blockers can be considered for a spot on the trial

I'm a little baffled because I didn't know the protocol is available as yet. And I'm a little surprised that this implied number of clinicians have the capacity to deliver and follow-up whatever the protocol is.

ETA:
It is envisaged that children and young people in both England and Wales will be able to participate in the study with access through NHS children and young people’s gender services. A multi-disciplinary team approach will be taken to identify those children who, with the consent of their parents, may be deemed clinically suitable for consideration of puberty suppressing hormones through the study. Children participating in the study will also continue to receive comprehensive psychosocial support.
The study will measure a range of potential treatment benefits and harms (for example whether puberty suppressing hormones impact in a meaningful way on levels of anxiety or depression, on body image, or brain development) using a range of validated tools, questionnaires and user feedback. Key measures included in the study, and the way data are collected, will aim to bridge gaps in existing research and will also be shaped by engagement with a range of stakeholders, including children and young people referred into NHS gender services and their families or carers.

www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/cyp-gender-dysphoria-research-oversight-board/

Some more thoughts after finishing my listen:

Nuala seemed to be determined to try and get some sort of apology or acknowledgement of blame from Cass, she brought it up more than once that people were unhappy with the ban on blockers. Cass must get really fed up with interviewers trying that tactic on her.

Also, Cass stating that surgical and hormonal interventions are less of a risk to people than the refusal to validate an assumed sex/gender - that also baffles me given how much I've read from people who've had surgical and hormonal interventions and have not achieved what they they were sold (surgical procedures in particular cause lots of health issues).

From what she's said in various interviews, it seems Cass is a tru trans believer and seems to think that gender identity is not just a philosophical stance. To me, it's like finding out a doctor who did a serious review into lobotomy discovered that lobotomy doesn't help everyone, although some people are happier since their lobotomy, and that the evidence base for lobotomy is so low we need more research to see who lobotomy might help. And there are alternatives to lobotomy but we should really research lobotomy to make sure if it is more helpful than the existing standard treatments such as psychiatric care.

I'm glad to hear this topic discussed on Women's Hour and want to see it happen more often in a calm and measured way.

Thanks Rethinking, I always find your input and explanations very helpful.

Any trial still needs to get past an ethics committee

But there are no proven side effects—that's why they’re conducting a clinical trial. Also, you're assuming that getting children to desist is a preferable outcome to transition, but that’s only true if you're approaching it from a transphobic point of view to begin with.

I'm approaching this with the view that adults can live as they want to but that ruining children's health with serious medications, rather than letting them grow up before they make any decisions, is wrong.

Women who've taken the drugs used to block puberty for issues such as precocious puberty and endometriosis have been reporting lasting horrific side effects for years. Here's an example article but you can find more info:

https://www.pbs.org/newshour/health/women-fear-drug-they-used-to-halt-puberty-led-to-health-problems

That article raises concerns, but there are no proven side effects, which is why they are conducting a clinical trial.

'The conclusions of the systematic reviews of evidence for adolescents are consistent with long-term adult studies, which failed to show credible improvements in mental health and suggested a pattern of treatment-associated harms. Three recent papers examined the studies that underpin the practice of youth gender transition and found the research to be deeply flawed. Evidence does not support the notion that “affirmative care” of today’s adolescents is net beneficial.'

https://link.springer.com/article/10.1007/s11930-023-00358-x

And this from the FDA also raises concerns about severe side effects from GNRH agonists such as the drugs used to block puberty:

https://publications.aap.org/aapnews/news/20636/Risk-of-pseudotumor-cerebri-added-to-labeling-for

https://nbcmontana.com/news/nation-world/fda-warns-puberty-blocker-may-cause-brain-swelling-vision-loss-in-children-rachel-levine

I don't think Dr Cass is a true trans believer but I do think she is a highly effective medical politician.

She focusses entirely on children (and more recently transition up to age 25 ish) and so side steps any discussion of adults.

She's also canny to recognise that if she went in and just scrapped puberty blockers and said no trans children ever existed then she would lose credibility with parents and children who are heavily invested this.

Coming from the angle of there isn't the evidence, these children need better services has been a more effective approach with health secretaries and NHS England.

The first paper is written by two prominent transphobes. I can’t access the second. The third discusses very rare side effects, which can be an issue with any drug.

Dr. Cass's anti trans views are precisely why she was chosen to lead the review.

I believe it's referred to as burying bad news.

Well, this is the BBC.

No offence intended to the SW peninsula.

I'm not sure I understand the point you're making - if people you say are deemed to be transphobes point out that a particular set of powerful drugs are causing serious, lifelong side effects on a range of people when used for a range of reasons (on both adults and children), we shouldn't listen to them and should ignore any evidence produced for ideological reasons?

Of course there are proven side effects of the drugs known as puberty blockers.

Common side effects of the GnRH agonists and antagonists include symptoms of hypogonadism such as hot flashes, gynecomastia, fatigue, weight gain, fluid retention, erectile dysfunction and decreased libido. Long term therapy can result in metabolic abnormalities, weight gain, worsening of diabetes and osteoporosis.

Source: https://www.ncbi.nlm.nih.gov/books/NBK547863/#:~:text=Common%20side%20effects%20of%20the,worsening%20of%20diabetes%20and%20osteoporosis.

Clinical trials aren’t conducted just to find side effects. They demonstrate benefits and disadvantages to treatments. When treatments have been evaluated, informed decisions can be made as to their use.

It’s shameful that, so far, no data has been collected so as to reliably evaluate the use of these very powerful drugs being prescribed off-label to treat a condition so ill-defined. (A likely reason for this is that most of the people involved in prescribing these treatments were aware that they had no benefit whatsoever.)

The first paper is written by two prominent transphobes.

So? That's your own cognitive bias, I'm afraid. You not agreeing doesn't make the research worthless.

What was concerning around the trial, aside that it was limitless, was that she stated there are known benefits from trials. Which I also took to mean impact and outcomes on physical and mental health. Which means there's a bias from the outset.

At the same time, the scant evidence available is damaging and Cass said several times that we have no idea which children will grow up to "be trans" their entire lives.

It's a subjective diagnosis. There's no true test to gain the diagnosis.

Just listened to this.
Baroness Cass is amazingly calm, measured and professional.
I wonder how many children will sign up for the trial bearing in mind they presumably may receive a placebo.

I guess a placebo based trial would be useless as it would be immediately obvious... hoping someone will come on who knows about trial formats.

That is the case for many, many recognised conditions.

And?

Can you give an example of another condition, in which it is enough for a child to declare that they have that condition, for a medical professional to agree and then administer life-changing medication?

What anti-trans views? And how do you know Dr Cass had expressed any views about children declaring transgender identities before she started this project?

I thought Dr Cass was chosen because she hadn't had any involvement at all with children with trans identities, so was coming from a completely neutral standpoint.