#wpath

By: Jesse Singal

Published: Jun 27, 2024

In April Hilary Cass, a British paediatrician, published her review of gender-identity services for children and young people, commissioned by NHS England. It cast doubt on the evidence base for youth gender medicine. This prompted the World Professional Association for Transgender Health (WPATH), the leading professional organisation for the doctors and practitioners who provide services to trans people, to release a blistering rejoinder. WPATH said that its own guidelines were sturdier, in part because they were “based on far more systematic reviews”.

Systematic reviews should evaluate the evidence for a given medical question in a careful, rigorous manner. Such efforts are particularly important at the moment, given the feverish state of the American debate on youth gender medicine, which is soon to culminate in a Supreme Court case challenging a ban in Tennessee. The case turns, in part, on questions of evidence and expert authority.

Court documents recently released as part of the discovery process in a case involving youth gender medicine in Alabama reveal that WPATH's claim was built on shaky foundations. The documents show that the organisation’s leaders interfered with the production of systematic reviews that it had commissioned from the Johns Hopkins University Evidence-Based Practice Centre (EPC) in 2018.

From early on in the contract negotiations, WPATH expressed a desire to control the results of the Hopkins team’s work. In December 2017, for example, Donna Kelly, an executive director at PATH, told Karen Robinson, the EPC's director, that the WPATH board felt the EPC researchers “cannot publish their findings independently”. A couple of weeks later, Ms Kelly emphasised that, “the [WPATH] board wants it to be clear that the data cannot be used without WPATH approval”.

Ms Robinson saw this as an attempt to exert undue influence over what was supposed to be an independent process. John Ioannidis of Stanford University, who co-authored guidelines for systematic reviews, says that if sponsors interfere or are allowed to veto results, this can lead to either biased summaries or suppression of unfavourable evidence. Ms Robinson sought to avoid such an outcome. “In general, my understanding is that the university will not sign off on a contract that allows a sponsor to stop an academic publication,” she wrote to Ms Kelly.

Months later, with the issue still apparently unresolved, Ms Robinson adopted a sterner tone. She noted in an email in March 2018 that, “Hopkins as an academic institution, and I as a faculty member therein, will not sign something that limits academic freedom in this manner,” nor “language that goes against current standards in systematic reviews and in guideline development”.

Not to reason XY

Eventually WPATH relented, and in May 2018 Ms Robinson signed a contract granting WPATH power to review and offer feedback on her team’s work, but not to meddle in any substantive way. After WPATH leaders saw two manuscripts submitted for review in July 2020, however, the parties’ disagreements flared up again. In August the WPATH executive committee wrote to Ms Robinson that WPATH had “many concerns” about these papers, and that it was implementing a new policy in which WPATH would have authority to influence the EPC team’s output—including the power to nip papers in the bud on the basis of their conclusions.

Ms Robinson protested that the new policy did not reflect the contract she had signed and violated basic principles of unfettered scientific inquiry she had emphasised repeatedly in her dealings with WPATH. The Hopkins team published only one paper after WPATH implemented its new policy: a 2021 meta-analysis on the effects of hormone therapy on transgender people. Among the recently released court documents is a WPATH checklist confirming that an individual from WPATH was involved “in the design, drafting of the article and final approval of [that] article”. (The article itself explicitly claims the opposite.) Now, more than six years after signing the agreement, the EPC team does not appear to have published anything else, despite having provided WPATH with the material for six systematic reviews, according to the documents.

No one at WPATH or Johns Hopkins has responded to multiple inquiries, so there are still gaps in this timeline. But an email in October 2020 from WPATH figures, including its incoming president at the time, Walter Bouman, to the working group on guidelines, made clear what sort of science WPATH did (and did not) want published. Research must be “thoroughly scrutinised and reviewed to ensure that publication does not negatively affect the provision of transgender health care in the broadest sense,” it stated. Mr Bouman and one other coauthor of that email have been named to a World Health Organisation advisory board tasked with developing best practices for transgender medicine.

Another document recently unsealed shows that Rachel Levine, a transwoman who is assistant secretary for health, succeeded in pressing WPATH to remove minimum ages for the treatment of children from its 2022 standards of care. Dr Levine’s office has not commented. Questions remain unanswered, but none of this helps WPATH’s claim to be an organisation that bases its recommendations on science. 

[ Via: https://archive.today/wJCI7 ]

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So, there are 6 completed reviews sitting somewhere, that WPATH knows shows undesirable (to them) results. And they know it. And despite - or perhaps, because of - that, they wrote the insane SOC8 anyway. And then, at the behest of Rachel Levine, went back and took out the age limits, making it even more insane.

This isn't how science works, it's how a cult works.

When John Templeton Foundation commissioned a study on the efficacy of intercessory prayer, a study which unsurprisingly found that it's completely ineffective, it was forced to publish the negative results.

Erin Reed at Erin In The Morning (05.08.2026):

Last night, Chief Judge James E. Boasberg of the U.S. District Court for the District of Columbia granted preliminary injunctions in two parallel cases—Endocrine Society v. FTC and World Professional Association for Transgender Health v. FTC—enjoining the Federal Trade Commission from enforcing civil investigative demands against the two leading medical organizations on transgender health. The judge ruled in both cases that the FTC likely violated the organizations' First Amendment rights and engaged in unlawful retaliation against them for their protected speech supporting gender-affirming care. Boasberg further found that the Trump administration and the FTC had pursued the organizations based on "extensive evidence of animus" and "wafer-thin justifications" for their demands. For now, the private communications, internal deliberations, and member information of these two organizations are protected from the Trump administration's escalating campaign of government censorship and retaliation against the medical institutions that support transgender people.

"On this preliminary record, with extensive evidence of animus and wafer-thin justifications lacking evidentiary support, [the Court] finds that WPATH is likely to demonstrate a causal link between its protected speech and the FTC's issuance of the CID,” said the judge in the WPATH ruling. In the parallel Endocrine Society ruling issued the same day, the judge went likewise found similar violations: "The Court finds the same systemic targeting of proponents of medical treatment for gender incongruence at work here. The Society is the latest casualty in some Executive Branch agencies' bid to investigate hospitals, medical providers, and charitable organizations that support transgender health. The CID's focus on academic and medical speech, combined with the FTC's paucity of logic or evidence pointing to a genuine investigation, confirms the conclusion that the CID was likely issued for a retaliatory purpose."

The cases center on Civil Investigative Demands—administrative subpoenas the FTC issued to both organizations in January 2026, demanding sweeping and unprecedented access to their internal operations. The FTC ordered the organizations to turn over decades of internal communications about their clinical guidelines on gender dysphoria, every educational and advocacy material, every financial record, and the names of every member who had ever helped develop claims about gender-affirming care—potentially thousands of people. The CID to WPATH alarmingly reached back to 1979, the year WPATH was founded. The CIDs are part of a sprawling Trump administration campaign to suppress speech about transgender people and crush the institutions that provide it: the Kennedy Declaration, which drove more than 40 hospital systems to shutter their trans youth programs before a federal judge vacated it as unlawful last month; CMS proposed rules that would bar Medicare and Medicaid-receiving hospitals from providing such care entirely; and DOJ subpoenas to hospitals across the country, which federal judges have repeatedly quashed as "smokescreens" for retaliation. The FTC's CIDs were the latest weapon in that campaign.

The organizations challenged the demands in federal court. Last night, they won. Boasberg ruled that the CIDs were retaliation against WPATH and the Endocrine Society for their protected speech in support of gender-affirming care, and that the FTC's campaign against them was rooted in extensive animus. Among the evidence the judge cited to show extensive animus towards transgender people was: Trump's executive orders denouncing gender identity as "subversive" and "false ideology" and labeling gender-affirming care "mutilation"; FTC Chair Andrew Ferguson's pre-appointment memo pledging to "fight back against the trans agenda" and investigate "the doctors, therapists, hospitals, and others" providing such care; senior FTC staff publicly accusing medical associations of "malpractice" and calling journalists covering trans issues "partisan morons"; and the FTC's July 2025 workshop "The Dangers of 'Gender-Affirming Care' for Minors," at which speakers called gender dysphoria "science fiction" and "the foundational fraud" and described their work as a "battle of good versus evil." The judge also noted that one workshop participant—who explicitly recommended investigating medical associations to make them "start losing members" and "lose revenue streams"—was subsequently hired by the FTC.

The liberal case for rethinking gender medicine

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