Trans healthcare experts reject call to suspend Cass Review implementation

Experts from Scotland’s gender identity services have rejected calls to suspend the implementation of the Cass Review.

The council of the British Medical Association (BMA) voted to reject the findings of the review, which recommended a pause on prescriptions of hormones for young people reporting gender identity issues.

Puberty blockers and cross-sex hormones for new patients under-18 were suspended in Scotland after health leaders in England did the same in a decision that provoked criticism from trans rights campaigners.

In a move which led some of its members to quit, the BMA, a medical trade union, announced it has set up a  “task and finish” group to evaluate the Cass Review, which will report at the end of the year.

It has called for the pause on prescriptions to be lifted.

Appearing before MSPs today, key NHS Scotland medics defended the Cass Review’s methodology and said they did not agree that prescriptions should resume now.

Rhoda MacLeod, head of adult services at the specialist Sandyford Sexual Health Service run by NHS Greater Glasgow and Clyde (NHSGGC), said: “The BMA are not a clinical organisation. They're a staff-side organisation and they're entitled to have their own views and perspectives on it, but obviously we would adhere to what the clinical perspective is, and that's what we're doing.”

Critics have dismissed the methodology used by paediatrian Dr Hilary Cass and disputed the findings. However, NHS Lothian medical director Tracey Gillies said she would “place a level of reliance” on the work, which has been appraised by a University of York team which has a “strong track record in looking at evidence, understanding how that evidence has been gathered, and then bringing a perspective to that that has the sort of scientific basis that we would expect to see in any other area of clinical practice”.

MacLeod said the suspension of new prescriptions has been “distressing” for a “small number” of patients and their families, but the clinical risks of hormone treatments for young people with gender issues must be “weighed up”. She went on: “We don't know what the benefits truly are. We know what people tell us. We have reports of people saying ‘this is beneficial’, but systematically we don't know what the benefits are and what truly the risks are, and working in that uncertainty isn't good, so we actually have to put some controls on this.”

The Cass Review said the treatments could harm bone density and may not help patients resolve gender issues. It called for improved provision of mental health treatment for patients and raised links between gender incongruence and neurodiverse conditions.

MacLeod told the Health, Social Care and Sport Committee that 422 people on a waiting list for services via NHSGGC and NHS Lothian had been contacted since 8 August. She told the committee that seven in 10 of those contacted had “cooperated” with the calls. Arguing for a “holistic, child-centred service” and action to reduce waiting lists, she said: “Seventy percent of people on the waiting list are natal females. Fifty percent of them are reporting that they have an assessment completed for some form of neuro developmental issue, and just shy of a third report a diagnosis of a mental health condition.

“So this is a complex group of young people that needs a really good, robust, multidisciplinary team approach.”

Weekend media reports said children as young as seven had been referred to the Sandyford Clinic in Glasgow.

Ruth Maguire MSP said it was “shocking” to hear that “there hasn't been that curiosity about why young women who are neurodivergent” are seeking help for gender issues, or that children “haven’t been getting the best”.

MacLeod said that while numbers of patients in Scotland are low, “the shift in the population, the demography of who attends gender services now, has been quite significant over a very short period of time”. She added: “It helps to offer explanation about why we're kind of always feeling we're caught in the back pedal here.

“Where has this come from and how we found ourselves in this place? It's been quite significant change and it's happened over quite a short period of time.”

Stating that it is not realistic for specialist gender clinics to be set up across Scotland, MacLeod said: “Not everybody that is gender questioning needs an NHS service; I feel very strongly about that. There's lots of people who are gender questioning out there and they are just gender questioning, they don't necessarily need an NHS service. It depends about what else is going on for them and what their level of distress is, and how they're managing to cope and how they're managing to function and how are they best supported.”

Dr Emilia Crighton, director of public health at NHSGGC, said: “Part of the whole assessment is ensuring that there's that kind of patient-centred approach to what works best for them, and that is so there's the psychological interventions, there's the social transition, there's a medical treatment. What we envisage is that kind of coming together with a patient to identify what would be best for them and what would actually deliver what they truly require.

“We know that there will be a number of individuals that will benefit from medical treatment and surgical treatment, it's just identifying the ones that truly will have a long term benefit.”