Letter to the Canadian Paediatric Society Discussing the Cass Review

Dear Dr. Caulfield,

We, as members of LGB (Lesbian, Gay, Bisexual) Alliance Canada, are writing to you today to express our grave concern regarding the suppression of vital medical evidence concerning “gender-affirming care” - including puberty blockers, cross-sex hormones and surgeries - for children, teens and young adults in Canada. There is broad agreement that the vast majority of these young people, who are being rushed into medical transition on the basis of a hastily assigned trans identity, are in fact same-sex attracted. We are therefore appalled and outraged at the irreversible medical procedures that are being practised on the next generation of gays and lesbians. 

But the main point of our current complaint is that ground-breaking research supporting our claims has been misrepresented, disparaged and dismissed by the Canadian Paediatric Society, the body clearly charged with acting swiftly and robustly in response to such research. The follow is from the Canadian Gender Report:

“Canadian clinicians representing the CPS position statement on gender-affirming care openly disparaged the Cass Review, calling it a ‘critique’ and the work of a ‘single individual’ and have misrepresented the quality of the methodology used to gather and assess the available evidence on gender-affirming care” (https://genderreport.ca/canadian-paediatric-society-on-a-mission-to-try-to-tarnish-cass-review/).

In the spring of this year, after four years of intense study, esteemed paediatrician Dr Hilary Cass (OBE) submitted her final report and recommendations to NHS England in her role as Chair of the Independent Review of gender identity services for children and young people. The Review was commissioned by NHS England to make recommendations on how to improve NHS gender identity services, and ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria receive a high standard of care, one that is safe, holistic and effective. 

Overview of key findings

There is broad agreement that the increase in the numbers of predominantly young people and young adults claiming a trans identity is a result of a complex interplay between biological, psychological and social factors, particularly the explosion in the use of social media. 

Systematic evidence reviews demonstrated the poor quality of published studies, meaning there is not a reliable evidence base upon which to make clinical decisions. 

Ideology has overtaken the evidence base on the care of children and young people.

The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health.

The use of masculinising/feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means there is inadequate information about the range of outcomes for this group.

Clinicians are unable to determine with any certainty which children and young people will go on to manifest a persistent trans identity.

For most young people, a medical pathway will not be the best way to manage their gender-related distress. 

Recommendations

Young people referred for gender services must receive a holistic assessment of their needs to inform an individualized care plan. This should include a mental health assessment, including screening for autism spectrum disorder.

The vast majority of young people in purported gender distress are same-sex attracted; the implicit homophobia in the entire exercise of gender identity ideology needs to be identified and addressed.

Services should establish a separate pathway for pre-pubertal children and their families, ensuring that they are prioritized for early discussion about how parents can best support their child in a balanced and non-judgemental way. 

There needs to be provision for people considering detransition, recognising that they may not wish to re-engage with the services whose care they were previously under.

The case of every young person presenting for gender treatment needs to be part of rigorous follow-up.

As in the case of other countries, including Finland, Sweden, Norway and the Netherlands, the use of puberty blockers needs to be considered experimental. 

Responses both in the UK and internationally

Britain’s new Labour Party Secretary for Health and Social Care, Wes Streeting, has noted that the “Cass review found there is not enough evidence about the long-term impact of puberty blockers for gender incongruence to know whether they are safe or not, nor which children might benefit from them. The evidence should have been established before they were ever prescribed.” He called out wild predictions of suicide among trans-identifying youth denied hormone suppression. “Some of the public statements being made are highly irresponsible and could put vulnerable young people at risk,” he said. Mr. Streeting may impose a permanent ban on blockers for gender, The Telegraph has reported.

The Scottish government, on the implications of the Cass review, has recommended that the use of puberty blockers for gender-distressed minors remain suspended until clinical trials can be undertaken. 

Dr. Cass was recently featured in a webinar for hosted by Australia’s National Association of Practising Psychiatrists. 

All of this follows the 180-degree turn on the medicalization of gender-distressed young people in Sweden, Finland, the Netherlands and Norway, among other countries. 

The Canadian scene

The release of the Cass Report barely caused a ripple in Canada, where the application of “gender-affirming care” is the rule. Lisa Johnson’s article for the CBC, published on its website on April 15, 2024, was entitled “What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth.” However, the only doctors whose observations she cited were those in robust support of current practices in “gender medicine,” with no account of dissenting opinions. Or is it the case that there are none of these to be found, given the overwhelming pressure on medical professionals to toe the line in this crucial and contested area? 

It is the responsibility of Canadian media organizations to bring the findings of Dr. Cass and her team to the attention of all Canadians, in particular the medical establishment. 

It is clear that much harm is being done to vulnerable young people. How can Canada’s medical professionals, including pediatricians, psychiatrists, psychologists, endocrinologists and surgeons continue to betray this core component of the Hippocratic Oath, which is to “do no harm”?

Why has Dr. Cass not been invited to speak to medical professionals in this country? Why has the rigorous and painstaking work undertaken to produce her report not been appropriately conveyed to Canadians by the principal media organizations in this country? Ideology must not be allowed to obstruct the representation of evidence; of the truth itself. 

These lapses must be remedied as soon as possible, as the first steps that must be taken in order to halt the dire harms being done to vulnerable, distressed children, teens and young adults, the vast majority of whom, if given the help and support they need, would grow into healthy, happy gays, lesbians and bisexuals. 

Sincerely, 

LGB Alliance Canada