Newly published advice to Canada’s pediatricians continues to charge “full steam ahead” with the gender-affirming model of care in the face of increasing uncertainty about its safety, and suggests that parents who don’t unquestionably affirm their child’s expressed gender risk harming their child, concerned doctors say.

The advice, published in a brief paper in the Canadian Paediatric Society’s flagship journal, is silent on the Cass Review, a four-year long, independent British review that landed last spring that concluded the evidence base for gender-affirming care for minors is “remarkably weak” and that many unknowns remain about the impact of social transitioning, particularly on very young children.