Dr Hilary Cass, who chaired a review of gender identity services for children and young people in England, has been giving evidence to the Holyrood's Health and Social Care Committee. 

Dr Cass, a retired consultant paediatrician, was speaking to MSPs as they grapple with the outcomes of her review, which called for widespread reform of gender services for young people, including an end to the use of puberty-blocking drugs.  

The use of such drugs has now been paused in Scotland and the two clinics which provide them, and across England and Wales.  

What is the Cass review?  

Commissioned by NHS England and NHS Improvement in 2020 following a rise in the number of youngsters seeking help for issues with their gender, the review was a wide-reaching report into the medical care available.  

Running to almost 400 pages, the review contained 32 recommendations and was scathing about the clinical approach being offered until now, saying much of the evidence supporting treatments was built on “shaky foundations”.  

It called for gender services to operate “to the same standards” as other health services for children and young people, with “a holistic assessment” of people referred, including screening for neurodevelopmental conditions such as autism, and a mental health assessment. 

The report also urged a review of the current policy on giving children masculinising or feminising hormones in the form of testosterone or oestrogen from the age of 16, urging “extreme caution”. 

Research by the University of York carried out alongside the report found evidence to be severely lacking on the impact of puberty blockers and hormone treatments, while the majority of clinical guidelines were found not to have followed international standards. 

NHS England immediately said it agreed to these recommendation. 

Dr Cass said it was “extremely disappointing” to find World Professional Association of Transgender Healthcare (WPATH) guidelines which were taken as an industry standard and adopted very widely internationally, “were very, very poorly evidence-based”. 

The Herald: Dr Hillary CassDr Hillary Cass (Image: PA)

How did this become a row in Scotland? 

The Cass Review's recommendations on healthcare in general and puberty blockers in particular, caused a major split in the the SNP and Scottish Greens, who together formed the Scottish Government.  

Then-First Minister Humza Yousaf did not immediately signal it would adopt the measures proposed in the review, initially saying: “Every recommendation that Dr Cass makes will be considered as part of that consideration of the entire report including the recommendations that she makes in relation to puberty blockers, and that is one element of the recommendations that Dr Cass makes. 

“There’s a number of recommendations – all of them will be given consideration.” 

READ MORE: Hilary Cass evidence to MSPs on gender identity services

READ MORE: Yousaf urged to provide ‘clear timeline’ for Cass Review response

READ MORE: Patrick Harvie — Cass Review 'reminiscent of the homophobia of the 1980s and 1990s'

His comments came a day after an interview by Scottish Greens co-leader Patrick Mr Harvie, where he failed to say if he accepted the findings of the during an interview. 

Asked five times if he accepted the report, the then-minister refused to say, instead claiming it has been “politicised and weaponised” against trans people. 

He later said:  "When it comes to the Cass Report, it's very clearly been politicised by those trying to abolish trans people’s healthcare, trans people's rights, and exclude trans people from a whole host of public spaces.

“Not only the Scottish Greens, but the Scottish Government are not part of that culture war against trans people.

“It is so reminiscent of the homophobia of the 1980s and 1990s".

His comments led to the Alba MSP Ash Regan to table a vote of no confidence in Mr Harvie as a Minister, though the power-sharing agreement was dissolved before this came to pass.  

The Herald: Lorna Slater, Humza Yousaf and Patrick Harvie Lorna Slater, Humza Yousaf and Patrick Harvie (Image: PA)

Three days later, both NHS Greater Glasgow and Clyde (NHSGGC) and NHS Lothian took up the recommendation. 

Both said the decision came with the support of Scotland’s chief medical officer, Professor Sir Gregor Smith. 

NHSGGC covers Scotland’s only gender clinic for under-18s while NHS Lothian provides care to those aged 17 and over at its Chalmers gender identity clinic. 

The move was welcomed by Scottish Health Secretary Neil Gray.  

Did the puberty blockers decision play a part in Humza Yousaf’s downfall? 

After being sacked from the Scottish Government with the ending of the Bute House Agreement, the Scottish Greens said they would back a Scottish Conservative motion of no confidence in Humza Yousaf. 

Parliamentary arithmetic meant he was unlikely to survive such a vote, and he stood down before one could be taken.  

Lorna Slater, co-leader of the Scottish Greens, said her party no longer had “confidence in a progressive government in Scotland doing the right thing for climate and nature.” 

However, her party had already called and Emergency General Meeting to vote on the future of the Bute House Agreement, amid anger over the Scottish Government’s ditching of its 2030 target to cut climate emissions.  

The Rainbow Greens, the party’s LGBT wing, were also putting pressure on the leadership to end the agreement over the puberty blockers decision, saying the Scottish Government “does not care about the welfare or rights of transgender people in Scotland”.  

The Rainbow Greens also criticised the move by Scotland’s NHS and accused the Cass Review of being “deeply flawed, biased and widely described by many of those who took part as being conducted by regularly ignoring witnesses and disregarding internationally accepted, peer-reviewed evidence”.