Doctors handing on gender case children because of ‘toxic debate’ fears – expert

Gender questioning children experiencing “distress” are being passed to identity clinics because many doctors are “fearful” of the toxic debate, the author of the Cass Review has told a Holyrood committee.

Dr Hilary Cass appeared before the Scottish Parliament’s Health Committee on Tuesday to give evidence on her study into gender services in England.

The publication of the review saw NHS Greater Glasgow and Clyde and NHS Lothian pause the prescription of puberty blockers to new patients.

Dr Cass told the committee that children were accessing hormone replacement medications in an unregulated way “a lot more than we would wish”, primarily because of the significant waiting times for children to be seen by Gender Identity Development Services (Gids) south of the border.

Scottish Labour MSP Paul Sweeney asked about the wider harms of children across the UK waiting up to four years to be assessed at a gender dysphoria clinic, querying whether children were “self-medicating” due to the physical, psychological and social distress experienced.

Dr Cass said “major shortfalls” in adolescent mental health services were a key driver in the issue, leading to some young people taking “higher risk actions”.

But she also expressed concern around the “fearfulness” of medical practitioners who do not know how to treat the complexities of the gender dysphoria some children are presenting with, as well as the toxicity around the debate.

She told the committee: “The young people are in a state of distress and they’re not getting any support for that.

“And they only have available advice from the internet or peer support groups. It’s evitable they’re going to take what we would deem as higher risk actions and I can understand that because they’re often in a situation where the care provided by the health system is failing them.

“I think there is another big problem which is fearfulness amongst healthcare practitioners.

“These young people are more disadvantaged than other similarly distressed young people, certainly in England, because people have been bypassing them – somebody comes and says they’re gender questioning and health professionals feel nervous because they don’t think they’ve got the skills, they’re worried about the toxicity of the debate, they’re worried about saying or doing the wrong thing, so they’re passing them straight through to the Gids waiting list.”

The Holyrood committee are assessing whether the full recommendations of the Cass review, including the creation of a “follow-through service” for those aged 17 to 25, should be implemented in Scotland.

Dr Cass’s appearance comes as the Scottish Tories accuse ministers of “buck-passing” on the report.

The party will lead a debate on the issue on Wednesday.

The party’s deputy leader, Meghan Gallacher, said: “SNP ministers have let down vulnerable young Scots with their ducking, dithering and buck-passing on gender care in the wake of the Cass Review.

“They insisted the decision to pause puberty blockers to new patients was made solely by clinicians, refused to confirm whether they will implement any of the 32 Cass recommendations and failed to address the cuts to gender care services.”

A Scottish Government spokesperson said: “The Cass Review is a comprehensive and valid scientific document. In line with NHS England – for whom the report was commissioned – we are considering all of the recommendations.

“A multi-disciplinary clinical team within the office of the chief medical officer in the Scottish Government – including people with paediatric, pharmacy and scientific expertise – is leading this work.

“The chief medical officer will provide a written update to Parliament on the outcome of that clinical consideration process before the summer recess.”