Fear and doubt

Dogmatic in public, the gender doctors of WPATH identify as troubled and unsure in their more candid moments

Photo by Pawel Czerwinski on Unsplash

The WPATH Files—leaked internal messages and video of a panel discussion involving members of the US-based World Professional Association for Transgender Health—were published on Twitter by journalist Michael Shellenberger. His March 5 launch tweet has almost 7 million views.

“The WPATH Files prove that gender medicine is comprised of unregulated and pseudoscientific experiments on children, adolescents, and vulnerable adults. It will go down as one of the worst medical scandals in history,” Mr Shellenberger tweeted.

I have pulled together samples of political reaction to the WPATH Files, media coverage and online commentary. WPATH and its standards of care have been relied on in many countries to claim that gender medicine is legitimate; that puberty blockers, cross-sex hormones and surgery for minors are safe, effective and medically necessary.

First, an outline of the WPATH Files. The full report published by Mr Shellenberger—who was offered the leak because of his involvement in the 2022 Twitter Files—runs to 241 pages. It begins with a 72-page analysis by journalist Mia Hughes, followed by the leaked files. The analysis—with chapter headings such as “WPATH is not a scientific group”— draws a parallel between gender medicine and lobotomies. Mr Shellenberger hosted a Twitter space discussion of the files here.

WPATH president Marci Bowers issued a statement saying the organisation “is and has always been a science- and evidence-based organization whose recommendations are widely endorsed by major medical organizations around the world… The world is not flat. Gender, like genitalia, is represented by diversity.” WPATH members were urged not to respond to media inquiries.

Some 33 WPATH members were invited to appear on a WPATH Files special edition of Andrew Doyle’s GBNews program Free Speech Nation; none took up the offer.

What follows is my selection of the responses to the WPATH Files. I begin with official reaction and mainstream media because these may reach wide audiences with little knowledge about what happens under the rubric of “gender medicine.” The category of streaming TV, podcasts and online commentary is rich in content and analysis but more likely to “preach to the converted”—those already aware that WPATH is an activist organisation unlike any mainstream medical society.

Video: Genspect’s webinar series on the WPATH Files

Political and government reaction

The UK Department of Health told Daily Mail that England’s National Health Service (NHS) had “moved away from WPATH guidelines more than five years ago.” That is misleading, as journalist Hannah Barnes explained in The Observer.

Science author Michael Shermer wrote: “In the WPATH Files what we see is the rights of underage adolescents and vulnerable adults being violated by the very people tasked with protecting them, so I agree with the authors’ call for ‘the US government to oversee a bipartisan national inquiry to investigate how activists with little respect for the Hippocratic Oath could have risen to such prominence as to set the standards of care for an entire field of medicine, leading to the medical abuse of minors and vulnerable adults’.”

For Unherd magazine Eliza Mondegreen wrote: “For decades, the field of gender medicine has insulated itself from scrutiny and criticism. The public and policymakers were never supposed to get a glimpse into the inner workings of the field. They were supposed to defer to the “experts” and not look too closely at what they were being asked to support. The WPATH files look much too closely, shining a spotlight on risks and uncertainties and harms so specific that they will be difficult to forget... These files provide fuel for policymakers seeking to regulate youth gender transition and patients trying to sue. The fallout is just beginning.”

In Australia, Liberal Party Senator Claire Chandler tweeted that media outlets and bureaucracies had cited WPATH as an authority when repeatedly dismissing “concerns about the dangers and lack of evidence behind the gender medicine industry… How many of those media outlets will now ignore this scandal to protect their own failings?”

In Ireland, the Health Service Executive said its new transgender health plan would not have to follow the standards of care issued by WPATH.

In Florida, a senior health official said the WPATH revelations showed the logic of that state’s policy to restrict under-18 gender medicine. Also vindicated, the official said, was Florida’s attempt during previous litigation “to compel the American Academy of Pediatrics, the Endocrine Society, and [WPATH] to disclose internal documents regarding their recommendations for so-called ‘gender-affirming care’.”

In the UK, psychiatrist David Bell, who had raised concerns about the London-based Tavistock gender clinic, said the Scottish NHS should cut its ties with WPATH. “These leaks show that WPATH is influenced not by science or evidence but by ideology,” Dr Bell told The Telegraph. A spokesman said the Scottish government did not follow the latest, 2022 standards of care issued by WPATH.

In the Australian state of Tasmania, political candidate Louise Elliot said: “What has happened to children [as shown by the WPATH Files] is an abomination. The practice needs to cease immediately and a full review undertaken. Our children deserve genuine, true evidence-based care. Not delusions acted out through horrific surgeries and medicalisation.”

Video: On GBNews, Andrew Doyle presented a special edition on the WPATH Files, an 84-minute deep dive with Michael Shellenberger, Mia Hughes and several others

Media coverage

Gerald Posner in The New York Post: “Investigating what has gone wrong at WPATH might prove uncomfortable for some gender progressives in the Biden administration, none more so than Admiral Rachel Levine, the assistant secretary for health. Levine, the first transgender four-star military officer, is a WPATH member and has lavished praise on the organization.”

Hannah Barnes in The Observer: “Despite its grand title, WPATH is neither solely a professional body—a significant proportion of its membership are activists—nor does it represent the ‘world’ view on how to care for this group of people. There is no global agreement on best practice. The leaked [files] are disturbing. In one video, doctors acknowledge that patients are sometimes too young to fully understand the consequences of puberty blockers and hormones for their fertility. ‘It’s always a good theory that you talk about fertility preservation with a 14-year-old, but I know I’m talking to a blank wall,’ one Canadian endocrinologist says.”

The Economist: “‘I’m definitely a little stumped,’ says one [WPATH] therapist about trying to get patients as young as nine to understand the impact that interventions would have on their fertility. (Hormone medications can permanently reduce fertility, and even cause sterility in some cases.) Colleagues agree that talking to a 14-year-old about fertility preservation brings reactions such as: ‘Ew, kids, babies, gross’, or ‘I’m going to adopt.’ One clinician admits that ‘We try to talk about it, but most of the kids are nowhere in any kind of brain space to really talk about it in a serious way.’ He adds: ‘That has always bothered me’.”

Daniel Martin in The Telegraph: “A gender therapist [and WPATH member] said they had only turned one person down for treatment in 15 years. ‘I have also intervened on behalf of people who have been diagnosed with major depressive disorder, complex post-traumatic stress disorder, homeless and got at least an orchiectomy [testicle removal],’ they said. ‘In the last 15 years, I had to regrettably decline writing only one letter [approving treatment], mainly because the person evaluated was in active psychosis and hallucinated during the assessment session. Other than that—nothing—everyone got their assessment letter, insurance approval, and are living (presumably) happily ever after’.”

Kathleen Stock in The Telegraph: “From the mouths of doctors we find risky experimental surgeries recommended for minors, and a relative disregard for complications that in any other branch of medicine would be treated as unacceptable. Perhaps the most shocking revelation from the leaked files is a clinician prepared to recommend a radical double mastectomy for a 16-year-old girl already suffering from liver cancer, despite believing—along with the girl’s surgeon and oncologist—that the cancer is probably due to the cross-sex hormones she had been prescribed… The scandal of an international organisation like WPATH may seem irrelevant to the UK, but it is not. For years, the organisation has been mindlessly cited in British medical contexts as a source of ‘international best practice’.”

Clinical Advisory Network on Sex and Gender: The group notes a 2022 admission by Robert Garofalo, chief of adolescent medicine at the Lurie Children’s Hospital in Chicago and a WPATH member that, ‘Only now, I think, are we really beginning to do the type of research where we’re looking at short, medium, and long term outcomes of the care that we are providing in a way that I think hopefully will be either reassuring to institutions and families and patients or also will shed a light on things that we can be doing better’.”

Megan McArdle in The Washington Post: “Youth gender medicine is increasingly treating puberty as though it were a life-threatening condition like cancer or diabetes, and natal sex organs as though they were potentially dangerous growths. This is, of course, entirely appropriate if they are threatening, and letting nature take its course will end in suicide or a lifetime of emotional agony. Of course, with that kind of diagnosis you want to be very sure—and unlike doctors treating cancer or diabetes, who can rely on blood tests and imaging, gender-medicine doctors ultimately have only the patient’s feelings to go by.”

Sharon Kirkey in National Post: “[Canadian endocrinologist and WPATH member Daniel Metzger] discusses the challenges of getting proper informed consent when starting youth on testosterone or estrogen, and the permanent changes that can happen. ‘I think the thing you have to remember about kids is that we’re often explaining these sorts of things to people who haven’t even had biology in high school yet.’ He says he wasn’t surprised by a recent Dutch report about reproductive regret, telling those assembled that, ‘now that I follow a lot of kids into their mid-twenties, I’m like, ‘Oh, the dog isn’t doing it for you, is it?’ They’re like, ‘No, I just found this wonderful partner’ and now want kids. He also expresses concern that puberty blockers may be ‘robbing these kids of that sort of early to mid-pubertal sexual stuff that’s happening with their [non-trans] cisgender peers’.”

“In a post to the [WPATH] internal messaging forum, a Halifax nurse practitioner describes a patient with PTSD, major depressive disorder and traits of schizoid personality disorder who was eager to start hormones. ‘My practice is based fully on the informed consent model, however this case has me perplexed; struggling,’ the nurse wrote. ‘I’m missing why you are perplexed,’ a University of California, San Francisco psychiatrist responded. ‘The mere presence of psychiatric illness should not block a person’s ability to start hormones if they have persistent gender dysphoria, capacity to consent,’ and the benefits outweigh the risks, he said. ‘So why the internal struggle as to ‘the right thing to do’? This is harm reduction and so doing nothing is not a ‘neutral option’.”

Sarah Vine in Daily Mail: “Put bluntly, [WPATH clinicians] knew. They all knew the potential risks of these drugs and surgeries, and the negative effects they could have on very young and very vulnerable patients. In one case, unbelievably, they even had to seek consent from all the different identities of a patient with a multiple personality disorder, which gives you a sense of the mental health issues some of these patients were facing. And yet they went ahead anyway. Why? There can be only one explanation: blind ideology.”

Video: Monica Harris, executive director of the Foundation Against Intolerance and Racism, welcomes the release of the WPATH files

Streaming TV, podcasts and online commentary

Linda Blade, Twitter: Blade shares a clip in which a WPATH member explains that the organisation’s latest standards of care are “a big deal” because both private insurance companies and government-funded insurers will look to this document when determining insurance coverage.

Trish Wood is Critical podcast, host Trish Wood and Ms Hughes of the WPATH Files discuss parallels with previous medical scandals.

Psychiatrist David Bell, The Critic: “In part simply because of the audacious name of the organisation, which makes it sound authoritative, WPATH has had a remarkable and wholly unwarranted degree of influence. Many medical organisations, both in the UK and elsewhere, proudly state they follow WPATH guidelines and standards of care, as if they were following the guidelines of an appropriately constituted authority (such as NICE.)”

Detransitioner Luka Hein, Twitter: “Because of organizations like WPATH I’m missing body parts and struggle with pain. Let the reckoning begin.”

Physiotherapist Elaine Miller, Twitter: “Every person I have met or worked with who used cross-sex hormones was incontinent. The concerning thing was they all told me that speaking about negative effects is taboo in the community, in case you put others off. So, even if there was help, they’d not seek it.”

Science journalist Jennifer Block, Twitter: “WPATH has effectively set the ‘affirming’ standard of care in gender medicine. [The WPATH Files allow] us to eavesdrop on both leaders and clinicians re patient care. One thing you’ll hear is a lot of doubt and uncertainty. The [Files] reveal private message board chatter between clinicians—is my patient too young to understand? Too mentally ill? What if a 14yo wants genital surgery? Apparently WPATH’s [latest standards of care] have not given them adequate guidance.”

Transgender Trend: This UK website charts the influence of WPATH on the London-based Tavistock clinic.

Susan Nagel—4thWaveNow, a pioneering blog on youth gender medicine—posts an article “Fortress on a fault line: Shaky evidence undermines pediatric gender medicine.”

Leor Sapir, Twitter: “[It’s] important to keep in mind that WPATH has been using mainstream medical associations like the Endocrine Society to launder its pseudoscientific claims and promote experimental and harmful practices. At least six of the 10 authors of the Endocrine Society’s 2017 clinical practice guideline were/are WPATH members. That guideline is still in effect today. Recently, the Endocrine Society decided to convene a new group to update its guidelines. It did so in secret, but last week, I very likely forced the exposure of this initiative. The chair of the guideline update committee is Dr Joshua Safer, a former president of USPATH (the US chapter of WPATH).”

Bev Jackson of LGB Alliance, Twitter: “Even if the WPATH Files are glossed over by mainstream media and ignored by politicians, they provide essential evidence for those taking these quacks to court. That will impact on insurance. Ultimately, ending this barbaric experiment will hinge on money and litigation.”

Physician Stanley Goldfarb, Do No Harm: “We’re talking about a complete absence of informed consent—by patients or their parents—of the dangerous, life-altering, and irreversible consequences of this ‘care.’ Medical professionals are supposed to do no harm, not intentionally inflict it behind closed doors.”

Endocrinologist Roy Eappen, Do No Harm: “The WPATH Files make clear that this is not a medical society giving best evidenced advice for vulnerable children and adolescents, but indeed has been taken over by activists with an agenda to move forward with these treatments in spite of risks and consequences.”

Stella O’Malley, Genspect: “[WPATH members] are also well aware of the regret experienced by young people who medically transition. Dr Daniel Metzger [the Canadian endocrinologist], pointed out that ‘Some of the Dutch researchers gave some data about young adults who had transitioned and [had] reproductive regret, like regret, and it’s there, and I don’t think any of that surprises us.’ These young people, who now have an average age of 32, regret their infertility. In my clinical practice I often work with people who experience infertility; the age for infertility regret becomes heightened in the late thirties and typically is most intense around the early forties, and so the enormity of the impact of their infertility has yet to unfold.

“The WPATH Files reveal the smoking gun whereby it is clear that ‘First, do no harm’ has changed to ‘buyer beware.’ The consumers of gender medicine believe that the clinicians know what they’re doing. But they don’t. They are operating without an evidence-base and the files show that they know their work is hurting children, adolescents and vulnerable people. We anticipate some will try to undermine the WPATH Files by reframing this material as just a series of normal conversations between doctors and therapists. Yet these files show that this is an unfolding medical scandal of catastrophic proportions.”

Colin Wright, Twitter: “I find it darkly amusing that while doctors in the WPATH Files lament their patients’ lack of basic biology knowledge regarding hormones, biologists like myself lament the profound ignorance of basic sex biology exhibited by these doctors.”

Lauren Smith, Spiked Online: “Unfortunately, to anyone who has been paying attention to the trans debate, these revelations may not be that surprising. We have long seen the warning signs that children are being harmed by this dangerous ideology. And worse still, we have seen adults in positions of authority either encouraging this harm, or standing aside and keeping silent.”

Skeptic magazine publisher Michael Shermer, Twitter: “In more than 30 years of studying pseudoscience I have never encountered anything so far removed from reality. In the WPATH Files here’s a discussion of Dissociative Identity Disorder (DID, or multiple personalities) for which consent for transitioning must be obtained from each ‘alter.’ DID is a bogus diagnosis. There are no ‘alternate’ personalities. ‘Sybil’ & ‘3 Faces of Eve’ were debunked long ago. This is all utter madness.”

Nellie Bowles, The Free Press: “I’ve said it before, but as a one-time butch teenager with rabid political opinions and the knowledge that I was Correct About Everything, now a happy gay adult with no political opinions and the knowledge that I am Usually Wrong: thank god this movement [championed by WPATH] wasn’t around when I was 14.”

Clinical psychologist James Cantor, Twitter: “The WPATH president claims credibility on the basis of other medical associations. Yet, those other associations claim credibility on the basis of WPATH.”

4thWaveNow, Twitter: “One of the more disturbing revelations in the WPATH Files is a post by a clinician asking when to start hormones for a developmentally delayed 13-yr-old who was ALREADY on puberty blockers. ‘Affirming’ clinicians have been medically transitioning such people for years.”

Detransitioner Michelle Alleva, Twitter: “How many exposés can WPATH survive?”