Below you will find an excellent letter sent by a concerned Canadian citizen to various government ministers and medical societies, including the Canadian Paediatric Society. Responses from Health Canada and the Canadian Paediatric Society are below. Both seem ignorant of the significance of the Cass Review findings and are dismissive of concerns related to the need for extra caution surrounding the practice of gender medicalization of minor children.
Notably, Health Canada views WPATH as a “standard of care”. WPATH has been exposed as an activist organization that selectively uses evidence that suits its purposes, and was caught manipulating evidence it sponsored at Johns Hopkins University because it did not support positive findings related to gender affirming care. WPATH is generally recognized in much of the developed world (Sweden, Finland, Norway, UK, etc) as no longer a reliable organization offering a so-called “standard of care”.
The CPS issued a very vague statement referring to “current evidence,” which is remarkably tone deaf. Recent developments in the field have caused all reasonable medical societies and publicly funded health authorities to take a step back from the practice of unquestioned gender affirming care, particularly with respect to the use of puberty blockers.
These letters are over one year old at time of publishing as CGR was made aware of them very recently. We urge all concerned Canadian citizens to email your MP and MPP, your provincial and federal Minister of Health and the CPS with this type of letter.
Letter of concern
Dear Ministers, Public Health Officials, and Medical Authorities,
I am writing to express profound concern and demand immediate action regarding the Canadian healthcare system’s continued endorsement of gender-affirming care for minors, despite overwhelming evidence of its risks and lack of scientific foundation, as detailed in the Cass Review, WPATH files, and a recent letter by 19 Canadian physicians. As a concerned citizen, I am appalled by the gross negligence—bordering on criminal malfeasance—demonstrated by health authorities and medical professionals who prioritize ideology and profit over the welfare of children. This letter follows my previous correspondence, sent over six months ago, which was either ignored or dismissed with vague claims of “other research” that, when challenged, could not be substantiated. Your failure to act on this evidence is unacceptable and demands urgent rectification.
Failure to Acknowledge Critical Evidence
The Cass Review, published on April 10, 2024, is a globally recognized, independent assessment commissioned by NHS England, led by Dr. Hilary Cass, a distinguished pediatrician. It concluded that the evidence for gender-affirming interventions, including puberty blockers and cross-sex hormones, is “remarkably weak,” with no definitive proof that these treatments alleviate gender dysphoria in minors. The review criticized the World Professional Association for Transgender Health (WPATH) guidelines as lacking scientific rigor, relying on circular references and insufficient evidence.
Similarly, the WPATH files, leaked in 2024, exposed internal admissions of inadequate evidence for gender-affirming treatments, concerns about informed consent, and pressure to align with ideological agendas. Court documents further revealed that the Biden administration influenced WPATH to remove age restrictions from its Standards of Care 8, prioritizing politics over patient safety. These revelations have led countries like the UK, Sweden, and Finland to restrict or ban puberty blockers for minors, yet Canada remains an outlier, clinging to discredited practices.
Most recently, a letter from 19 Canadian physicians, published in early 2025, echoed these concerns, condemning the Canadian Paediatric Society (CPS) and other bodies for dismissing the Cass Review as a “critique” by a “single individual” and ignoring its evidence-based recommendations. These physicians highlighted a dangerous adherence to ideology over science, accusing authorities of failing to protect vulnerable children. Their call for a moratorium on medical interventions for minors until robust evidence is established is a damning indictment of your inaction.
Gross Negligence and Ideological Bias
Your refusal to engage with this evidence constitutes a breach of your duty to uphold public health and patient safety. Over six months ago, I wrote to several of you, citing the Cass Review and WPATH files, and received responses claiming “other research” justified current practices. When I requested specifics—particularly research not already reviewed by Dr. Cass, who examined over 100 studies—your offices failed to provide any credible sources. This evasiveness suggests either ignorance of the evidence or deliberate obfuscation to protect ideological and financial interests.
The CPS, for instance, has falsely claimed that “current evidence shows puberty blockers to be safe when used appropriately,” a statement directly contradicted by the Cass Review’s findings and the UK’s subsequent ban on puberty blockers for minors. Health Quality Ontario’s draft standards for gender-affirming care, released in 2024, similarly rely on WPATH’s discredited guidelines, ignoring international shifts toward evidence-based care. This blind adherence to a flawed model, despite global rejections, raises serious questions about whether profit motives—such as pharmaceutical interests or private clinic revenues—are superseding child welfare.
Criminal Negligence and Harm to Children
The consequences of your inaction are dire. Canadian children are being subjected to irreversible medical interventions with lifelong implications, including infertility, loss of sexual function, and increased mental health risks, based on what the Cass Review describes as “poor quality” evidence. The WPATH files reveal clinicians’ awareness of these risks, yet Canadian authorities continue to promote these treatments under the guise of “affirmation.” This is not mere oversight; it is a systemic failure that prioritizes ideological conformity over the Hippocratic principle of “first, do no harm.”
The letter from 19 Canadian physicians underscores that this negligence is causing measurable harm, with rising numbers of detransitioners—young people who regret irreversible procedures—struggling to find support in Canada. Your failure to act on this evidence, despite international warnings and domestic dissent, suggests a level of recklessness that could be construed as criminal negligence, as it knowingly endangers vulnerable minors.
Demand for Immediate Action
As stewards of Canada’s healthcare system, you are legally and morally obligated to protect citizens, especially children. Your dismissal of the Cass Review, WPATH files, and the 19 physicians’ letter is a betrayal of this duty. I demand the following actions:
- Immediate Moratorium: Suspend the use of puberty blockers, cross-sex hormones, and gender-affirming surgeries for minors until a comprehensive, independent review of evidence is conducted, mirroring the Cass Review’s methodology.
- Investigation of Bias: Launch an inquiry into why Canadian health authorities, including the CPS and HQO, have ignored or misrepresented evidence, including potential conflicts of interest with pharmaceutical companies or activist groups.
- Response to Prior Correspondence: Provide a detailed explanation of the “other research” cited in your previous responses, including specific studies not reviewed by Dr. Cass, or admit that no such evidence exists.
- Support for Detransitioners: Establish dedicated healthcare services for detransitioners, addressing the physical and psychological harm caused by unproven treatments.
- Public Accountability: Issue a public statement acknowledging the concerns raised by the Cass Review, WPATH files, and the 19 physicians, and commit to aligning Canadian policies with evidence-based standards, as adopted by the UK, Sweden, and others.
- Engagement with Stakeholders: Convene a public forum with independent experts, detransitioners, and concerned citizens to address these issues transparently, as called for by the Canadian Gender Report.
Failure to respond substantively within 30 days will be interpreted as further evidence of negligence, and I will escalate this matter to legal authorities, advocacy groups, and the media, as necessary. The welfare of Canadian children cannot be sacrificed on the altar of ideology or profit.
Conclusion
The evidence is clear: gender-affirming care for minors, as currently practiced in Canada, lacks scientific validity and poses significant risks. The Cass Review, WPATH files, and the courageous stand of 19 Canadian physicians demand your immediate attention and action. Your continued silence or reliance on discredited guidelines is not only a dereliction of duty but a moral and potentially legal failure. I urge you to prioritize science, evidence, and the well-being of children over ideological agendas. History will judge your response—or lack thereof.
Sincerely,
Louisa Chiaramonte
Response from Health Canada
From: Health Programs and Strategic Initiatives – Direct Reply/Programme de santé et intiatives stratégiques – Réponse directe <HPSI.DR-PSIS.RD@hc-sc.gc.ca>
Sent: April 19, 2024 3:22 PM
To: Louisa Chiaramonte <>
Subject: Urgent Appeal to Review Current Standards of Gender Affirming Care and immediately halt GAC in children
Dear Louisa Chiaramonte,
On behalf of the Honourable Ya’ara Saks, Minister of Mental Health and Addictions and Associate Minister of Health, we are responding to your e-mail of April 13, 2024, concerning gender-affirming care.
Thank you for sharing your concerns regarding gender affirming care in Canada. To improve access to sexual and reproductive health care support, information, and services – including protecting access to abortion care – Budget 2021 committed $45 million over three years for people in Canada who face the greatest barriers to access. Budget 2023 renewed and extended this investment for a further $36 million over three years, starting in 2024-25.
The government believes that trans and non-binary young people, and their families, should have access to gender affirming, evidence based, and high-quality health care. The World Professional Association for Transgender Health (WPATH) offers guidelines called “Standards of Care” to provide clinical guidance for health professionals to assist transgender and gender diverse people with safe and effective pathways to care. The Government of Canada is confident that the WPATH Standards of Care are evidence-based. National Medical Associations like the Canadian Paediatric Society, the American Academy of Pediatrics, the American Psychological Association, and other global institutions reference WPATH Standards of Care in their support of age-appropriate, individualized gender-affirming care for youth and adults.
The Government is committed to working towards a more equitable, diverse and inclusive country, where everyone is free to be themselves and participate fully in society. This is especially important when homes and communities are not welcoming spaces for diversity. Protections from discrimination exist for 2SLGBTQI+ people in the Canadian Charter of Rights and Freedoms, as well as the Canadian Human Rights Act.
Should you require further clarification or have any questions, please contact the Sexual and Reproductive Health Unit, Health Programs and Strategic Initiatives Directorate, Strategic Policy Branch, Health Canada via email at SRH-SSR@hc-sc.gc.ca.
Health Programs and Strategic Initiatives
Strategic Policy Branch
Health Canada
Response from Canadian Paediatric Society
From: Info <info@cps.ca>
Sent: April 15, 2024 9:11 AM
To: Louisa Chiaramonte <>
Subject: RE: Cass Review & WPATH Files
Hi Louisa,
Thanks for reaching out. Please feel free to use the following CPS statement on gender-affirming care, which should address some of your concerns:
The Canadian Paediatric Society (CPS) supports an individualized, affirming, and non-directive approach to treating gender diverse children and youth. Each case is unique and the individual’s physical, mental, and emotional wellbeing should be considered and managed appropriately with evidence-based treatments.
As with all areas of medicine, new and emerging evidence is evaluated as it becomes available. The CPS is committed to upholding the highest standard of care for children in Canada and continues to monitor the scientific knowledge base in the treatment of gender-diverse children and youth.
Current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within a wider view of the patient’s mental and psychosocial health.
Thank you,
Laura Newman
Coordinator, Media and Public Affairs
Canadian Paediatric Society
