I’m not going to start a free trial to read the whole thing, but I did look elsewhere to read about this report.

https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920

There actually is a lot of evidence, just not in the form of randomized clinical trials," said Dr. Jake Donaldson, a family physician in Calgary who treats transgender patients, including prescribing puberty blockers and hormone therapy in some cases.

“That would be kind of like saying for a pregnant woman, since we lacked randomized clinical trials for the care of people in pregnancy, we’re not going to provide care for you.… It’s completely unethical.”

Donaldson called the systematic review paper and the broader Cass Review “politically motivated.”

Dr. Tehseen Ladha, a pediatrician in Edmonton and assistant professor at the University of Alberta, says the review may be misleading and ignores the context of pediatric medicine — where there is often imperfect evidence.

“That is the case in almost every sphere of medicine because the cost, time, feasibility and ethical ability to conduct what is considered a high-quality scientific trial, it is just not there,” she said.

Getting that research done can be even harder when it comes to marginalized populations like trans youth, she said. “They haven’t been thought of as priorities or important.”

Ladha wondered if the review was “coming from a place of bias.”

“I think the framing of it really made it feel as though it was trying to create fear around gender-affirming care,” she said.

So it reads to me like the Cass report is saying there isn’t enough evidence to support gender affirming care because there isnt enough research because we don’t do research on people we don’t like and want banned from existence.