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[https://doi.org/10.1007/s10508-025-03335-8](https://doi.org/10.1007/s10508-025-03335-8)  \nThe Cass Review and Gender‑Related Care for Young People in Canada: A Commentary on the Canadian Paediatric Society Position Statement on Transgender and Gender‑Diverse Youth  \nChan Kulatunga Moruzi1 · Peter Sim2 · Ian Mitchell3 · Darrell Palmer4 · Ari R. Joffe5  \nReceived: 23 June 2024 / Revised: 26 September 2025 / Accepted: 27 September 2025 / Published online: 21 November 2025 © The Author(s) 2025  \nThe Canadian Paediatric Society Position Statement (CPSPS),“An affirming approach to caring for transgender and gender-diverse youth,”(Vandermorris & Metzger, 2023) requires reconsideration. The CPS-PS describes gender identity as a “critical facet of a young person’s sense of self”(p. 439) that emerges in early childhood and evolves overtime. Although it states that gender identity evolves, it makes no mention of the desistance and detransition literature or of the mental health comorbidities that may impact gender identity. The absence of any such discussion implies that gender identity development is linear and stable, reinforcing a model in which transition is understood to be a natural trajectory for youth with gender incongruity. The CPS-PS, therefore, directs pediatricians to center the “adolescent’s expertise in their own life experience”(p. 440) and proposes that doctors affirm a patient’s self-described gender identity and provide access to medical transition. The stated clinical role of the doctor is presumably not to engage in the etiology of gender distress to determine if transition is appropriate, but to facilitate the process by “support[ing] the adolescent in identifying and moving along the trajectory that best aligns with their individual goals”(p. 440) .  \nA shorter version of this Letter was published as a Letter to the Editor in Paediatrics and Child Health (Kulatunga Moruzi et al., 2024) and the authors of the Position Statement published a reply (Vandermorris et al., 2024) .  \n* Chan Kulatunga Moruzi [c.kulatunga.moruz@gmail.com](c.kulatunga.moruz@gmail.com)  \n1 Hamilton, ON, Canada  \n2 Winnipeg, MB, Canada  \n3 Department of Pediatrics, University of Calgary, Calgary, AB, Canada  \n4 Kaleidoscope Pediatric Consultants, Calgary, AB, Canada  \n5 Department of Pediatrics and John Dossetor Health Ethics Center, University of Alberta, Edmonton, AB, Canada  \nThis approach raises questions about clinical neutrality, diagnostic rigor, and safeguarding of informed decisionmaking. The endorsement of the treatments outlined in the CPS-PS implies that the benefits of gender-affirming treatments in children and adolescents are known, that they clearly outweigh the risks, and that young people are able to weigh such explicitly described risks and benefits in order to give informed consent. Here, we outline pertinent information Canadian physicians need to know about puberty blockers (PBs) and gender-affirming hormone therapy (GAHT) that are not covered in the CPS-PS. We also discuss critical information that should inform the care of gender-distressed young people, including the rapid rise of gender dysphoria over the last decade, the clinical presentation of these young people, and the literature on identity development, desistance, and detransitioners.  \nRights‑Based versus Evidence‑Based Approach to Treatment  \nA recent international conspectus of treatment models for gender dysphoria in children and adolescents found that these models lay on a continuum from a rights-based approach to an evidence-based approach (Kozlowska et al. , 2024) . The CPS-PS adopts a rights-based approach, emphasizing destigmatization, depathologization, centering patient autonomy, and support for the fulfillment of patient goals and self-determination. Under this rights-based model, a comprehensive biopsychosocial assessment prior to medical transition is often considered unnecessary (Ashley, 2019a; Oost","cbCain0Ai0EmdizC","https://ap.wps.com/l/cbCain0Ai0EmdizC","pdf",1087803,"English","# The Cass Review and CPS position statement critique\n## Rights-based versus evidence-based treatment approaches\n## Evidence grading and certainty (GRADE)","[{\"question\":\"What does the commentary argue is missing from the CPS position statement?\",\"answer\":\"It states that the CPS statement does not address desistance and detransition literature or mental-health comorbidities that may affect gender identity development.\"},{\"question\":\"How does the document frame the clinical role of doctors in the CPS approach?\",\"answer\":\"It contends that the CPS position implies doctors should affirm the patient’s self-described gender identity and facilitate access to medical transition, rather than assess etiologies of gender distress.\"},{\"question\":\"What comparison does the commentary make between rights-based and evidence-based approaches?\",\"answer\":\"It describes a continuum: rights-based models stress destigmatization, depathologization, and autonomy, while evidence-based models emphasize patient safety and treatment effectiveness grounded in research and clinical expertise, evaluated via methods such as GRADE.\"}]","The Cass Review and Gender-Related Care for Young People in Canada - A Commentary on the Canadian Paediatric Society Position Statement on Transgender and Gender-Diverse Youth | PDF",1790561794,48]