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.

Surgery often is mutilation - in that mutilation involves removing body parts. The body is no longer whole - and that is often how the person feels about themselves.

There's an excellent documentary programme on Netflix 'Regretters' about two men who transitioned decades ago ( each for different reasons)...one of them was the first to undergo 'sex change' surgery in the 1960s. Both recalled the trauma of waking up to discover that their genitalia had gone...and wandering what they had done. It was a feeling that never left them.

Thank you for the transcript @zibzibara

I enjoyed listening to the interview. Dr Cass is very reassuring. Professional, balanced and sticking firmly to her remit and to the facts.

Though I was surprised that she stated so confidently that for people with a "long-standing trans identity" " the costs ... of medical treatments, in terms of any side effects or any negatives of the medical or surgical interventions, are trivial compared to how difficult it would be to not be able to live in your identifed gender." That would be true for some of them and some of the interventions but the Transparency podcast has talked to transmen with enduring gender dysphoria who don't think that the benefits of all the medical and surgical treatments they had outweigh the negatives. Including the presenters.

Two things there - the cost of ‘not be able to live in your identified gender’ only ever counts the cost to the individual in question, never the cost to everyone else of a system that upholds regressive sex stereotypes and forces the association between those regressive stereotypes and sexed language and provision, or requires everyone to deny reality of someone’s sex. This includes the impact of obscuring facts in public health messaging that may lead to deaths eg from cervical cancer, or rapes arising from men accessing female spaces.

Secondly, how trivial were the costs to the transgendered individuals who died as a result of ‘transitioning’ or the young woman with locked in syndrome? Her statement relies on ignoring those outcomes which is anything but an evidence based assessment,

A reminder of an actual study into this found no benefit (once the paper had been corrected):

https://www.thepublicdiscourse.com/2020/09/71296/

Two things there - the cost of ‘not be able to live in your identified gender’ only ever counts the cost to the individual in question, never the cost to everyone else of a system that upholds regressive sex stereotypes and forces the association between those regressive stereotypes and sexed language and provision, or requires everyone to deny reality of someone’s sex.

I don't think Health Economics is set-up to do that, interestingly. You sometimes see carer utilities (gains) or disutilities (effectively, added caring responsibilities or impact) calculated with respect to an intervention, such as a new procedure or drug. There's also the rate of the discount over time (set by the Treasury).

https://source-he.com/will-discount-rates-change-for-uk-hta/

That's the sort of conundrum that should probably spark a few papers if York or another centre felt up to it. (In addition to world leader status in systematic reviews as part of evidence appraisals, York is, relatedly, world leading in health economics and appraisals.)

People defend this 'treatment' for so-called 'transgender children' generally fall into 3 categories.

1. Parents of 'transgender children'. People like Susie Green and the parents of Jazz Jennings. Anyone who posts on social media about getting 'treatment' for their 'trans child'. They can't afford to have doubts due to what they have done to their children.
2. People with a vested financial interest in there being a constant supply of 'transgender children' to treat with drugs and surgery. People like Helen Webberley and the Irish 'yeet the teets' surgeon in Florida.
3. Late transitioning males who use the belief in 'trans children' to sanitise their own identity as 'transwomen' by suggesting that they were just like those children when they were young, and that therefore their own Malaga Airport tendency is not a fetish, because obviously it isn't a fetish for the children.

Yes carers are sometimes included eg for dementia drugs. The difference here though is the ‘treatment’ is not limited to medical treatment (drugs and surgeries) but also to society (pretending a man is a woman, changing language, removing single sex spaces etc). Therefore a proper assessment of treatment must include the total costs to everyone of doing that too.

To be fair, the social costs of transition are mostly outside Dr Cass' remit. Her report did mention the effects on families and the need for (proper!) support for families.

I do agree on your second point though, especially as Dr Cass specifically mentioned surgery which I would have expected to be outside her remit as most surgery and especially the kind of surgery that resulted in the young man's death isn't practised on children here.

The difference here though is the ‘treatment’ is not limited to medical treatment (drugs and surgeries) but also to society (pretending a man is a woman, changing language, removing single sex spaces etc).

For clarity, I understood that.

I, obviously, failed to make it clear that calculating the disutility for society in addition to that for the carers is not something I've seen done and I don't think it's covered adequately by the Treasury discount.

The disutlity for society of different treatments is normally adequately represented by the cost to the public sector. I can’t think of another condition where the public, rather than the public sector, are expected to not only provide the ‘treatment’ but directly bare the disutility of that treatment.

I was mostly questioning Cass's use of the word "trivial". I have osteoporosis at a fairly usual age (sixties) and it is manageable but not trivial. Early onset osteoporosis is not a trivial cost. Even if it some people decide it is an acceptable cost that doesn't make it trivial. And of course a downside in the distant future may seem trivial compared to more immediate concerns and still turn out to be anything but trivial when it eventually happens.