Leaked Files Reveal Ethical Concerns, Pseudoscience in WPATH Standards of Care

For years, the World Professional Association for Transgender Health (WPATH) has often been spoken of as one of the world’s leading authorities on so-called “gender medicine.” The organization’s “standards of care” have been widely looked to by doctors searching for guidance to help their young patients who may suffer from gender dysphoria.

But recently leaked internal discussions within WPATH have confirmed what critics have known and warned of for years: that those “standards of care” are neither scientific nor ethical. Rather, they constitute a politically and ideologically driven campaign that pushes harmful, experimental, unnecessary, and often-irreversible medical interventions on confused children and adults.

WPATH’s history: ideology over evidence

WPATH was formed in 1978 as the Harry Benjamin International Gender Dysphoria Association (HBIGDA). Based in part on the work of German endocrinologist Harry Benjamin, HBIGDA began developing “standards of care” (SOC) for treating what many now call “gender dysphoria” (formerly “gender identity disorder” or “transsexualism”). The first standards came out in 1979.

But as subsequent standards were created, activists began to have more sway in their formation. Dr. Stephen B. Levine, who chaired the SOC5 committee in 1998 (the 5th iteration of HBIGDA’s standards of care), eventually resigned from his role in HBIGDA in 2002 due to his “regretful conclusion that the organization and its recommendations had become dominated by politics and ideology, rather than by scientific process...”

In 2007, HBIGDA rebranded itself as the World Professional Association for Transgender Health (WPATH). SOC7, published in 2012, was highly influential. Yet SOC7 continued to disregard scientific and ethical principles, making assertions such as that puberty blockers are “fully reversible” without supporting scientific evidence.

The latest iteration of WPATH’s standards of care, SOC8, was published in 2022. The standards continue to radicalize, to the point that hundreds of scientists and mental health professionals have signed a statement saying that WPATH has discredited itself. To list just a few of the new changes, SOC8:

• Included a whole chapter on eunuchs as a “gender identity” to be validated with hormonal or surgical castration. If a man merely “identifies” as a eunuch, this could warrant removing his genitals to match his claimed identity.
• Removed minimum age requirements for puberty blockers, cross-sex hormones, and surgeries so doctors could “use their judgment” for giving these so-called “treatments” to younger and younger patients. (WPATH made this change just days after publishing SOC8.)
• Contained a chapter on “nonbinary” interventions for patients who desire no genitals or both sets of genitals.

Despite mounting evidence undermining WPATH’s “standards” from both national and international sources, WPATH continues to double down on advocating for harmful, experimental, unnecessary, and often-irreversible medical interventions for children and adults.

What do the WPATH files reveal?

The leaked internal discussions, including emails and videos of internal panel discussions, (WPATH files), were published by Environmental Progress, a U.S.-based think tank.

In the WPATH files, doctors, nurses, and other WPATH members had frank discussions about problems and concerns they frequently encounter in their practices. These discussions exposed numerous scientific and ethical deficiencies surrounding WPATH’s standards of care.

Informed consent

A major topic of conversation was whether children could give informed consent to undergoing these life-altering procedures when they (and often their parents) don’t understand the full ramifications of their decisions, e.g., infertility.

In a panel discussion, one doctor noted that some of these kids “haven’t even had biology in high school yet.” Another said, “It’s out of their developmental range sometimes to understand the extent to which some of these medical interventions are impacting them.”

Do these concerns stop WPATH from pushing so-called “transitions” on vulnerable children? No. Children cannot give informed consent to such life-changing decisions—and WPATH knows it.

Psychiatric comorbidities

Numerous studies show that children and adolescents who are referred to gender clinics have high rates of other pre-existing psychological conditions like depression, anxiety, post-traumatic stress disorder, borderline personality disorder, autism, dissociative identity disorder, etc. Many such mental health issues often predate any distress about their sex. Nevertheless, even patients with severe mental health issues are frequently pushed toward “transition.”

One nurse practitioner discussed struggling with whether to put a patient on hormones who also had PTSD, major depressive disorder, observed dissociations, and schizoid typical traits. Dr. Dan Karasic, the lead author of WPATH’s SOC8 chapter on mental health, responded, “I’m missing why you are perplexed … The mere presence of psychiatric illness should not block a person’s ability to start hormones…”

Downplaying detransition

It is well known within WPATH membership that many people who are put through these life-altering procedures later come to regret it, especially given the long-term health consequences like infertility and the lifelong medical treatments that must follow. Many of these patients, commonly referred to as “detransitioners,” stop identifying as the opposite sex and seek treatment to mitigate the impact of previous procedures. A lengthy set of chatroom entries is about how to “reframe” patients’ serious regret as simply “normal” exploration of gender over time.

WPATH is a discredited organization

The issues listed above barely begin to cover the extent of the unethical and pseudoscientific work of WPATH. The organization’s recent standards of care are born of a precommitment to a radical gender ideology and turn vulnerable children and adults into live test subjects.

WPATH has discredited itself, and no medical organization or government should use its “standards of care” as a basis for its decisions.