#wpath files

By: Gerald Posner

Published: Mar 4, 2024

Newly leaked files from the world’s leading transgender health-care organization reveal it is pushing hormonal and surgical transitions for minors, including stomach-wrenching experimental procedures designed to create sexless bodies that resemble department-store mannequins.

The World Professional Association for Transgender Health documents demonstrate it’s controlled by gender ideologues who push aside concerns about whether children and adolescents can consent to medical treatments that WPATH members privately acknowledge often have devastating and permanent side effects.

Yet the US government, American doctors and prominent organizations nonetheless rely on WPATH guidelines for advice on treating our youth.

The files — jaw-dropping conversations from a WPATH internal messaging board and a video of an Identity Evolution Workshop panel — were provided to journalist Michael Shellenberger, who shared the documents with me.

Shellenberger’s nonprofit Environmental Progress will release a scathing summary report, comparing the WPATH promotion of “the pseudoscientific surgical destruction of healthy genitals in vulnerable people” to the mid-20th-century use of lobotomies, “the pseudoscientific surgical destruction of healthy brains.”

‘Arbitrary’ age limits

The comparison to one of history’s greatest medical scandals is not hyperbole.

It is particularly true, as the files show repeatedly, when it involves WPATH’s radical approach to minors.

When the organization adopted in 2022 its current Standards of Care — relied on by the National Institutes of Health, the World Health Organization and every major American medical and psychiatric association — it scrapped a draft chapter about ethics and removed minimum-age requirements for children starting puberty blockers or undergoing sexual-modification surgeries.

It had previously recommended 16 to start hormones and 17 for surgery.

Not surprisingly, age comes up frequently in the WPATH files, from concerns about whether a developmentally delayed 13-year-old can start on puberty blockers to whether the growth of a 10-year-old girl will be stunted by hormones.

During one conversation, a member asked for advice about a 14-year-old patient, a boy who identified as a girl and had begun transitioning at 4.

The child insisted on a vaginoplasty, a surgery that removes the penis, testicles and scrotum and repositions tissue to create a nonfunctioning pseudo-vagina. It requires a lifetime of dilation. Was he too young at 14?

Marci Bowers, WPATH’s president and a California-based pelvic and gynecologic surgeon who is herself transgender, said she considered any age limit “arbitrary.”

But she would not do it. Why?

“The tissue is too immature, dilation routine too critical.”

In lay terms, that means boys who are too young do not have enough penal tissue for the surgery and the surgeon must harvest intestinal lining to build the faux vagina. Even Bowers admits that can lead to “problematic surgical outcomes.”

She would know since she has performed more than 2,000 vaginoplasties. Her highest-profile patient is 17-year-old Jazz Jennings, the transgender star of reality TV show “I Am Jazz.”

Three corrective surgeries were required to fix problems from the original vaginoplasty.

“She had a very difficult surgical course,” Bowers admitted in a 2022 appearance on the show. “We knew it would be tough — it turned out tougher than any of us imagined.”

Still, Bowers told her colleagues in the internal discussion forum of the best age for an adolescent to undergo surgery: “sometime before the end of high school does make some sense in that they are under the watch of parents in the home they grew up in.”

Christine McGinn, a Pennsylvania plastic surgeon and herself transgender, agreed. McGinn has performed “about 20 vaginoplasties in patients under 18” and thinks the “ideal time in the U.S. is surgery the summer before the last year of high school. I have heard many other surgeons echo this.”

Waiting until teens are older than 18 and in college is problematic, she said: “there are too many stressors in college that limit patients’ ability to dilate.”

Dangers downplayed

WPATH assures patients that surgical and hormonal interventions are tested and safe. It is a different matter in private.

President Bowers, for instance, said publicly in 2022 that puberty blockers are “completely reversible,” although in the internal forum she conceded it is “in its infancy.”

What about children who are infertile for life since they started hormone blockers before they reached puberty?

Bowers told her colleagues the “fertility question has no research.”

At other stages, members talk frankly about the complications for the transition surgery for girls, a phalloplasty in which a nonfunctioning pseudo-penis is fashioned from either forearm or thigh tissue.

It requires a full hysterectomy and surgical removal of the vagina. They also discuss other serious consequences, including pelvic inflammatory disease, vaginal atrophy, abnormal pap tests and incontinence.

A 16-year-old girl who had been on puberty blockers for several years before she was put on testosterone for a year had developed two liver tumors that an oncologist concluded the hormones had caused. Another member described “a young patient on testosterone for 3 years” who had developed “vaginal/pelvic pain/spotting . . . [and] atrophy with the persistent yellow discharge.”

Several colleagues described patients with similar conditions, some with debilitating bowel problems or bleeding and excruciating pain during sex (“feeling like broken glass”).

Vaginal estrogen creams and moisturizers as well as hyaluronic acid suppositories “can be helpful.”

One WPATH member seemed surprised: “The transgender people under my surveillance do not complain about this matter. However, I confess that I have never asked them about it.”

Rise of ‘de-gender’ surgery

The litany of transition surgery’s side effects did not stop WPATH from endorsing far more radical “nullification” surgeries for patients who do not feel either male or female and identify only as nonbinary.

Several dozen so-called “de-gendering” surgeries are designed to create a sexless, smooth cosmetic appearance that is unknown in nature. There is even an experimental “bi-genital” surgery that attempts to construct a second set of genitals.

In 2017, when tabloids reported a 22-year-old man had spent $50,000 to surgically remove his sex organs so he could “transform into a genderless extra-terrestrial,” it seemed a one-off oddity.

But WPATH has enshrined that concept in its Standard of Care — the same document in which the group endorsed for the time first time chemical or surgical castration for patients who identify as eunuchs. (WPATH even linked to the Eunuch Archives, where men anonymously share castration fetishes.)

These science-fiction-like surgeries are not only reserved for adults.

“How do we come up with appropriate standards for non-binary patients?” asked Thomas Satterwhite, a San Francisco-based plastic surgeon who has operated on dozens of patients younger than 18 since 2014. “I’ve found more and more patients recently requesting ‘non-standard’ procedures.”

What are nonstandard procedures? They include “non-binary top surgery,” a mastectomy without nipples. There are brutal procedures for girls that eliminate all or part of the vagina and for boys that amputate the penis, scrotum and testicles.

The goal, as one San Francisco surgical clinic proclaims on its website, “is a smooth, neutral body that is cosmetically free of sexual identification.” On TikTok the trend is called a “flat front.”

‘Too young to understand‘

A particularly intense subject of discussion was whether minors could understand the lifelong consequences of their gender treatments. Minors are presumed by law to be incapable of making an informed decision about having a vasectomy or tubal ligation.

Gender surgeries are an exception, however.

WPATH’s Standard of Care allows all procedures so long as the minor “demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.”

In a May 2022 internal workshop, “Identity Evolution,” WPATH members conceded that was all but impossible.

Daniel Metzger, the British Columbia endocrinologist who cowrote the Canadian Pediatric Society’s position paper on health care for trans minors, said, “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.”

Metzger noted adolescents are incapable of appreciating the lifelong consequence of infertility. “It’s always a good theory that you talk about fertility preservation with a 14-year-old,” he said, “but I know I’m talking to a blank wall. They’d be like, ‘ew, kids, babies, gross.’ Or, the usual answer is, ‘I’m just going to adopt.’ And then you ask them, ‘Well, what does that involve? Like, how much does it cost?’ ‘Oh, I thought you just like went to the orphanage, and they gave you a baby.’ . . . I think now that I follow a lot of kids into their mid-twenties, I’m always like, ‘Oh, the dog isn’t doing it for you, right?’”

There is extensive research showing adolescent brains are wired to have little control over rash behavior and are not capable of grasping the magnitude of decisions with lifelong consequences. It is why society doesn’t allow teens to get tattoos or buy guns. Car-rental agencies set 25 as the minimum age for renting a car, and Sweden sets the same limit for deciding on sterilization.

Detransitioners ignored, shunned

Although many WPATH members privately doubt that adolescents can give truly informed consent to life-altering procedures, they must affirm whatever children say about their gender.

Unless, the WPATH files disclose, the patient wants to reverse course and become a so-called detransitioner.

WPATH members mostly dismiss those cases as insignificant or overblown by the media and question whether minors who want to revert to their birth sex really understand what they are doing.

It’s a question that would never be asked for minors who declared themselves to be gender dysphoric.

One case involved a 17-year-old boy, just graduated from high school, who had been on testosterone for two years. He was reported to be “very distraught and angry. He reports he feels he was brainwashed and is upset by the permanent changes to his body.”

A self-described “queer therapist” did not believe any young person could be brainwashed. “In my experience, those stories come from people who have an active agenda against the rights of trans people.”

WPATH President Bowers said that “I do see talk of the phenomenon [detransitioners] as distracting from the many challenges we face.”

‘Frankenstein files’

The leaked files put a spotlight on the danger of mixing ideological activism with medicine and science. They should serve as an urgent wakeup call for the medical associations and government agencies that rely on WPATH guidance for transgender health.

The files might even prompt investigations into how those with distorted personal agendas seized control of the organization at the expense of science and patients.

Investigating what has gone wrong at WPATH might prove uncomfortable for some gender progressives in the Biden administration, none more so than Adm. 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.

She says it “assesses the full state of the science and provides substantive, rigorously analyzed, peer-reviewed recommendations to the medical community on how best to care for patients who are transgender or gender non-binary. It is free of any agenda other than to ensure that medical decisions are informed by science.”

Either Levine is unaware of the hormonal and surgical experimentation the group promotes or refuses to acknowledge it.

“The Frankenstein files.”

That is how a pediatrician described the leaked documents after I shared them with her.

Unfortunately, this is no horror novel.

Erin In The Morning:

On Friday, numerous conservative accounts and news sources promoted headlines that the "American College of Pediatricians" had issued a statement against transgender care. A video accompanied the announcement featuring Dr. Jill Simons, who, wearing a white lab coat, states that there must be an end to "social affirmation, puberty blockers, and cross-sex hormones" for transgender youth. Despite the official-looking attire and name, the organization's name serves to mislead observers into thinking they are the much larger American Academy of Pediatrics, which represents tens of thousands of pediatricians. In reality, the ACP is a hyper-conservative Christian group of doctors created in 2002 to oppose gay parenting. In the announcement released on Friday, Simons called for an end to social transition and gender-affirming care for transgender youth. One video, which went viral, begins with a statement that the organization has released a "declaration" authored by the American College of Pediatricians, along with "hundreds of doctors and healthcare workers," opposing transgender care. It references the highly-politicized Cass Review from the United Kingdom, whose author controversially blames pornography for being transgender, as well as the Climategate-style leak of the “WPATH Files” to support the statement.

The video, which was viewed over 51 million times on Twitter, cuts off just before the next speaker is introduced: Dr. Andre Van Mol, who represents the Christian Medical and Dental Associations. Van Mol serves on the board of the Bethel Church of Redding, which made headlines in 2019 for attempting to pray a dead child back to life. He is followed by representatives from several other Christian medical organizations that also support banning transgender care. The website promoted at the event lists signatories to the statement, including the Catholic Medical Association, Genspect, The National Catholic Bioethics Center, the Family Research Council, and the Discovery Institute, an organization that promotes intelligent design over evolution in schools.

The American College of Pediatricians has been hugely influential in the promotion of anti-trans policy in the United States, relying in part to its misleading name. Members of the organization testify in state houses and courtrooms across the United States, misleading legislators into thinking they are the much larger American Academy of Pediatrics, the professional society that represents 67,000 pediatricians in the United States. In 2023, the organization inadvertently left a Google Drive public, leading to the leak of a massive trove of files showing their extremist roots. According to these documents, the group received significant donations from the Alliance Defending Freedom, a right-wing organization that has played a large role in the passage and defense of anti-LGBTQ+ laws in the United States. It also received free video production from Family Watch International, a group of Christian fundamentalists opposing homosexuality, birth control, abortion, and sex education. The American College of Pediatricians itself has been listed as a hate group by the Southern Poverty Law Center since 2012, when the group’s leader stated that “homosexuality poses a danger to children” and that the group was “essentially a Judeo-Christian values organization.”

[...] Despite the widespread misinformation, every major medical organization in the United States supports gender-affirming care. In February, the American Psychological Association, the largest psychological association in the world, released a policy resolution stating that gender-affirming care is medically necessary and saves lives. The American Academy of Pediatrics currently recommends that transgender youth have access to gender-affirming care tailored to their unique needs. The Advocates for Trans Equality maintains a list of over 30 of the largest U.S.-based medical organizations that support transgender care, including the Endocrine Society, the Pediatric Endocrine Society, the American Public Health Association, and the American Medical Association.

Anti-trans extremists such as X owner Elon Musk and numerous right-wing and anti-trans pundits and websites are touting a video from American College of Pediatricians (ACPeds) Dr. Jill Simons issuing a statement opposing gender-affirming care for trans children.

In contrast to radical right-wing whacko group ACPeds, mainstream medical organizations support gender-affirming care as a medically necessary.

TL;dr:

WPATH doesn't authorize medical transition procedures for immature patient. They actually verify that the patient is mature enough, before allowing the procedure. They also need parental consent.

WPATH doesn't ignore the risks of gender-affirming care. They explain them to both patient and parents, in detail. And if issues do show up, they try to fix them instead of sweeping them under the rug.

WPATH isn't trying to "desex (sterilize) children". That's just the same, old, tired "they're coming for your children!" narrative used against Jewish people, gay people etc etc.

WPATH doesn't disbelieve detransitioners, they support them.

My name is Dr Jill Simons. I'm a board-certified pediatrician and the executive director for the American College of Pediatricians. Today I'm here alongside my colleagues representing the Coalition of co-signers of the Doctors Protecting Children Declaration. Our coalition consists of physicians together with nurses, behavioral health clinicians, other health professionals, scientists, researchers and public health and policy professionals. And we have serious concerns about the physical and mental health effects of the current protocols promoted for the care of children and adolescents in the United States who express discomfort with their biological sex.

This declaration was authored by the American College of Pediatricians, but really it was developed from the expertise of hundreds of doctors researchers and other healthcare workers and leaders wh, for years have been sounding the alarm on the harmful protocols that continue to be promoted by the medical organizations in the United States. Despite recent revelations from the leaked WPATH Files and the recent release of the final report from the Cass Review, these medical organizations have not changed course.

So, we are calling on these medical organizations of the United States, including the American Academy of Pediatrics, the Endocrine Society, the Pediatric Endocrine Society, the American Medical Association, the American Psychological Association and the American Academy of Child and Adolescent Psychiatry to follow the science and their European colleagues and immediately stop the promotion of social affirmation, puberty blockers, cross-sex hormones and surgeries for children and adolescents who experience distress over their biological sex.

In our declaration, we affirm that sex is a dimorphic, innate trait defined in relation to an organism's biological role in reproduction: male and female this genetic signature is present in every nucleated somatic cell in the body and is not altered by drugs or surgical interventions. Consideration of these innate differences is critical to the practice of good medicine and to the development of sound policy for children and adults alike. Medical decision-making should be based upon an individual's biological sex. It should respect biological reality and the dignity of the person by compassionately addressing the whole person.

We are here defying the claims made by these medical organizations in the US that those of us who are concerned are a minority and that their protocols are consensus. They are not consensus, and we are speaking in a loud unified voice: enough.

[ Full press conference: https://youtu.be/C2tU90XPFlg ]

--

Doctors Protecting Children Declaration

As physicians, together with nurses, psychotherapists and behavioral health clinicians, other health professionals, scientists, researchers, and public health and policy professionals, we have serious concerns about the physical and mental health effects of the current protocols promoted for the care of children and adolescents in the United States who express discomfort with their biological sex.

We affirm:

1. Sex is a dimorphic, innate trait defined in relation to an organism’s biological role in reproduction. In humans, primary sex determination occurs at fertilization and is directed by a complement of sex determining genes on the X and Y chromosomes.  This genetic signature is present in every nucleated somatic cell in the body and is not altered by drugs or surgical interventions

2. Consideration of these innate differences is critical to the practice of good medicine and to the development of sound public policy for children and adults alike.

3. Gender ideology, the view that sex (male and female) is inadequate and that humans need to be further categorized based on an individual’s thoughts and feelings described as “gender identity” or “gender expression”, does not accommodate the reality of these innate sex differences. This leads to the inaccurate view that children can be born in the wrong body. Gender ideology seeks to affirm thoughts, feelings and beliefs, with puberty blockers, hormones, and surgeries that harm healthy bodies, rather than affirm biological reality.

4. Medical decision making should not be based upon an individual’s thoughts and feelings, as in “gender identity” or “gender expression”, but rather should be based upon an individual’s biological sex. Medical decision making should respect biological reality and the dignity of the person by compassionately addressing the whole person.

We recognize:

1. Most children and adolescents whose thoughts and feelings do not align with their biological sex will resolve those mental incongruencies after experiencing the normal developmental process of puberty.

Desistance is the norm without affirmation as documented by Zucker in his article “The Myth of Peristence”. (1) Zucker, KJ. The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender nonconforming children” by Temple Newhook et al. International Journal of Transgenderism. 2018: 19(2), 231–245. Published online May 29, 2018.http://doi.org/10.1080/15532739.2018.1468293 [1]

In the “largest sample to date of boys clinic-referred for gender dysphoria,” there was a desistance rate of 87.8%. (2) Singh D, Bradley SJ and Zucker KJ. A Follow-Up Study of Boys With Gender Identity Disorder. Front Psychiatry. 2021;12:632784. doi: 10.3389/fpsyt.2021.632784

The pro-affirmation Endocrine Society Guidelines (2017) admit: “…the GD/gender incongruence of a minority of prepubertal children appears to persist in adolescence.” (3) Hembree, W., Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline J Clin Endocrinol Metab. 2017; 102:1–35.

A longitudinal study from the University of Groningen in the Netherlands followed 2772 adolescents (recruited from a psychiatric clinic) from age 11 years through 22 – 26 years. “In early adolescence 11% of participants reported gender non- contentedness. The prevalence decreased with age and was 4% at the last follow-up (around age 26).” Even in this psychiatric patient study group for which interventions were not addressed, but “gender affirmation” is most likely, gender non-contentedness (essentially gender noncongruence) decreased substantially from early adolescence to young adulthood.(4) Rawee P, Rosmalen JGM, Kalverdiijk L and Burke SM. Development of gender non-contentedness during adolescence and early adulthood. Archives of Sexual Behavior. 2024; https://doi.org/10.1007/s10508-024-02817-5

2. Responsible informed consent is not possible in light of extremely limited long-term follow-up studies of interventions, and the immature, often impulsive, nature of the adolescent brain. The adolescent brain’s prefrontal cortex is immature and is limited in its ability to strategize, problem solve and make emotionally laden decisions that have life-long consequences.[2]

3. Sex-trait modification or “Gender affirming” clinics in the United States base their treatments upon the “Standards of Care” developed by the World Professional Association for Transgender Health (WPATH). However, the foundation of WPATH guidelines is demonstrably flawed and pediatric patients can be harmed when subjected to those protocols.

The two Dutch studies that form the foundation for treatment guidelines as documented in the WPATH “Standards of Care” guidelines version 7 (SOC 7) had serious flaws.[3]

These studies did show that the appearance of secondary sex characteristics in adolescents and young adults could be changed by hormonal and surgical interventions, but they failed to demonstrate meaningful long-term improvement in psychological well-being.

Scientific concerns with these studies also include a lack of a control group, small sample sizes, significant numbers of patients lost to follow up, and the elimination of patients who experienced significant mental illness from entering the studies.

It is concerning that the Dutch studies did not address complications and adverse outcome in the adolescent cohort that underwent transition. These complications included new onset diabetes, obesity and one death.[4]

4. There is now sufficient research to further demonstrate the failure of the WPATH, American Academy of Pediatrics and Endocrine Society protocols.

The Cass Review was released on April 10, 2024, as an “independent review of gender identity services for children and young people”. The following points are from Cass’s final report:[5]

Commissioned by the National Health Service (NHS) England, and chaired by Dr. Hilary Cass, the 388-page report utilized systematic reviews, qualitative and quantitative research, as well as focus groups, roundtables and interviews with international clinicians and policy makers.

As part of the evaluation, they reviewed the research on social transition, puberty blockers, and cross-sex hormones.

Social transition

“The systematic review showed no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence.

However, those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway.”

Puberty blockers

“The systematic review undertaken by the University of York found multiple studies demonstrating that puberty blockers exert their intended effect in suppressing puberty, and also that bone density is compromised during puberty suppression. However, no changes in gender dysphoria or body satisfaction were demonstrated [emphasis added].”

“There was insufficient/inconsistent evidence about the effects of puberty suppression on psychological or psychosocial wellbeing, cognitive development, cardio-metabolic risk or fertility.”

“Moreover, given that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinizing/ feminizing hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.”

Cross-sex hormones

“The University of York carried out a systematic review of outcomes of masculinising/feminising hormones.” They concluded, “There is a lack of high-quality research assessing the outcomes of hormone interventions in adolescents with gender dysphoria/incongruence, and few studies that undertake long-term follow-up. No conclusions can be drawn about the effect on gender dysphoria, body satisfaction, psychosocial health, cognitive development, or fertility.”

“Uncertainty remains about the outcomes for height/growth, cardio-metabolic and bone health.”

The Cass Review further stated, “Assessing whether a hormone pathway is indicated is challenging. A formal diagnosis of gender dysphoria is frequently cited as a prerequisite for accessing hormone treatment. However, it is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them.”

A 2024 German systematic review on the evidence for use of puberty blockers (PB) and cross-sex hormones (CSH) in minors with gender dysphoria (GD) also found “The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn’t suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD.”[6]  

5. There are serious long-term risks associated with the use of social transition, puberty blockers, masculinizing or feminizing hormones, and surgeries, not the least of which is potential sterility.

Youth who are socially affirmed are more likely to progress to using puberty blockers and cross-sex (masculinizing or feminizing) hormones.

“Social transition is associated with the persistence of gender dysphoria as a child progresses into adolescence.”[7]

“Gender social transition of prepubertal children will increase dramatically the rate of gender dysphoria persistence when compared to follow-up studies of children with gender dysphoria who did not receive this type of psychosocial intervention and, oddly enough, might be characterized as iatrogenic.”[8]

Puberty blockers permanently disrupt physical, cognitive, emotional and social development.

Side effects listed in the Lupron package insert include emotional lability, worsening psychological illness, low bone density, impaired memory, and the rare side-effect of pseudotumor cerebri (brain swelling).[9]

A coalition of physicians and medical organizations from around the world submitted a petition to the Commissioner of the U.S. Food and Drug Administration requesting urgent action be taken to eliminate the off-label use of GnRH (growth hormone) agonists in children.[10]

Testosterone use in females and estrogen use in males are associated with dangerous health risks across the lifespan including, but not limited to, cardiovascular disease, high blood pressure, heart attacks, blood clots, stroke, diabetes, and cancer.[xi],[12]

Genital surgeries affect future fertility and reproduction.

6. A report from Environmental Progress released on March 4, 2024, entitled “The WPATH Files” revealed “widespread medical malpractice on children and vulnerable adults at global transgender healthcare authority.”[13]

“The WPATH Files reveal that the organization does not meet the standards of evidence-based medicine, and members frequently discuss improvising treatments as they go along.”

“Members are fully aware that children and adolescents cannot comprehend the lifelong consequences of ‘gender-affirming care’ and, in some cases due to poor health literacy, neither can their parents.”

In addition, developmentally challenged and mentally ill individuals were being encouraged to “transition”, and treatments were often improvised.

7. Evidence-based medical research now demonstrates there is little to no benefit from any or all suggested “gender affirming” interventions for adolescents experiencing Gender Dysphoria. Social “affirmation”, puberty blockers, masculinizing or feminizing hormones, and surgeries, individually or in combination, do not appear to improve long-term mental health of the adolescents, including suicide risk.[14]

8. Psychotherapy for underlying mental health issues such as depression, anxiety, and autism, as well as prior emotional trauma or abuse should be the first line of treatment for these vulnerable children experiencing discomfort with their biological sex.

9. England, Scotland, Sweden, Denmark, and Finland have all recognized the scientific research demonstrating that the social, hormonal and surgical interventions are not only unhelpful but are harmful. So, these European countries have paused protocols and are instead focusing on evaluating and treating the underlying and preceding mental health concerns.

10. Other medical organizations are adhering to the evidence-based medicine documented in the Cass Review Final Report.

The constitution of the National Health Service in England will be updated to state, “We are defining sex as biological sex.”[15]

The European Society of Child and Adolescent Psychiatry issued a document titled “ESCAP statement on the care for children and adolescents with gender dysphoria: an urgent need for safeguarding clinical, scientific, and ethical standards.”

In this paper, they stated, “The standards of evidence-based medicine must ensure the best and safest possible care for each individual in this highly vulnerable group of children and adolescents. As such, ESCAP calls for healthcare providers not to promote experimental and unnecessarily invasive treatments with unproven psycho-social effects and, therefore, to adhere to the “primum-nil-nocere” (first, do no harm) principle”.[16]

11. Health care professionals around the world are also acknowledging the urgent need to protect children from harmful “gender-affirming” interventions.

In a letter to the British newspaper, The Guardian, sixteen psychologists, some of whom worked at the Tavistock Center for Gender Identity Development Service, acknowledged the role clinical psychologists played in placing children on an “irreversible medical pathway that in most cases was inappropriate.”[17]

In the United States, a group of psychiatrists, physicians and other health care workers wrote an open Letter to the American Psychiatric Association (APA), calling on the APA to explain why it glaringly ignored many scientific developments in gender-related care and to consider its responsibility to promote and protect patients’ safety, mental and physical health.[18]

12. Despite all the above evidence that gender affirming treatments are not only unhelpful, but are harmful, and despite the knowledge that the adolescent brain is immature, professional medical organizations in the United States continue to promote these interventions. Further, they state that legislation to protect children from harmful interventions is dangerous since it interferes with necessary medical care for children and adolescents.

The American Psychological Association states it is the largest association of psychologists worldwide. The organization released a policy statement in February 2024 stating, “The APA opposes state bans on gender-affirming care, which are contrary to the principles of evidence-based healthcare, human rights, and social justice.”[19]

The Endocrine Society responded to the Cass Review by reaffirming their stance. “We stand firm in our support of gender-affirming care…. NHS England’s recent report, the Cass Review, does not contain any new research that would contradict the recommendations made in our Clinical Practice Guideline on gender-affirming care.”[20]

The American Academy of Pediatrics (AAP) Board of Directors in August 2023, voted to reaffirm their 2018 policy statement on gender-affirming care. They did decide to authorize a systematic review but only because they were concerned “about restrictions to access to health care with bans on gender-affirming care in more than 20 states.”[21]

Of note, Dr. Hilary Cass called out the AAP for “holding on to a position that is now demonstrated to be out of date by multiple systematic reviews.”[22]

In Conclusion

By: Lauren Smith

Published: Mar 8, 2024

Recently leaked files confirm what many gender-critical voices have argued for many years: that so-called gender-affirming care is causing children lifelong harm. New documents expose how the World Professional Association for Transgender Health (WPATH) has routinely put children in harm’s way in the name of trans ideology.

As the global authority on gender medicine, WPATH has shaped the policies of hospitals and governments across the world. Its ‘standards of care’ guidance was treated as the gold standard for dealing with gender-confused youth by NHS England until recently – and it still is by NHS Scotland to this day.

Founded in 1979, WPATH is essentially a trans-activist lobby group masquerading as a scientific organisation. It has long advocated for an ‘affirmation only’ approach to treating children with gender dysphoria – in other words, medicate first, ask questions later, if at all. It has even argued that there should be no age limit on when minors are allowed to transition. In fact, its most recent guidelines recommend that children should have access to irreversible surgical procedures, including double mastectomies and phalloplasties. And this is just what WPATH has been willing to say publicly.

Now, leaked videos, emails and discussions on internal message boards have revealed the true extent of WPATH’s recklessness. These files were released this week by writer and journalist Michael Shellenberger and his nonprofit group, Environmental Progress. They paint a truly horrific picture of the danger that WPATH has exposed children to.

The ‘WPATH Files’ prove that, behind closed doors, doctors, psychologists and other medical professionals associated with WPATH are fully aware that children cannot properly consent to gender-affirming care. In a chilling video from an internal WPATH workshop in 2022, panel members discuss how hard it is to receive informed consent from their young patients – something that would ordinarily be required before any medical procedure. Canadian endocrinologist Dr Daniel Metzger tells the panel that he often has difficulties explaining the effects of puberty blockers and cross-sex hormones to children who ‘hadn’t even had biology in high school yet’.

One thread in the WPATH internal messaging forum reveals that even a developmentally delayed 13-year-old was seen as a suitable candidate for gender-affirming care. A physician assistant and professor at Yale Schools of Medicine discussed in the thread how the child was already on puberty blockers, but wanted to know if it would be ethical to allow them to progress to hormone therapy.

One problem that Metzger and his colleagues routinely face, according to the leaked workshop video, is trying to get young people to grasp that puberty blockers and hormones would likely affect their future fertility. Trying to convince 14-year-olds to preserve their eggs is like ‘talking to a blank wall’, Metzger says, to which the audience responds with nods and knowing smiles.

The WPATH Files also reveal the dire consequences such a blasé attitude to informed consent can have on child patients. Many kids who receive gender-affirming care at a young age grow up to regret the toll it takes on their ability to have biological children. In the leaked video, Metzger refers to a 2022 Dutch study, which found that 27 per cent of young people who underwent early puberty suppression and cross-sex hormones ended up regretting their lack of fertility. At an average age of 32, 44 per cent of biologically female and 35 per cent of biologically male patients say they would choose to preserve their fertility if they could turn back time.

Fertility issues aren’t the only problem facing the young people who get pushed down the path to transitioning. The WPATH Files also go into detail about some of the horrific side effects of hormone therapy and surgery. For females, these include vaginal atrophy (the thinning and inflammation of the vaginal walls), pelvic inflammatory disease (a potentially deadly infection that requires a hysterectomy to treat) and, for males, erections ‘feeling like broken glass’.

WPATH doctors even admit privately that hormone treatment can cause cancer. In one exchange from the internal WPATH forum in 2021, doctors discuss the case of a 16-year-old biologically female patient who developed liver tumours after a lengthy regimen of hormone therapy. Another doctor revealed that a female-to-male trans colleague developed an aggressive type of liver cancer after taking testosterone for about a decade.

For WPATH, potential side effects like liver cancer can’t be allowed to get in the way of a child’s gender transition. ‘At the end of the day’, one doctor is quoted as saying, ‘it is a risk / benefit decision’. Supposedly, if a child does not get the hormones they want, then they will commit suicide.

But this dilemma between ‘suicide or transition’ is not based on any evidence. It is a myth promoted by trans activists. As Mia Hughes notes in her report on the WPATH Files, several studies have found no evidence for a reduction in suicide risk after transition. On the contrary, some have found an elevated risk of suicide post-transition.

But it seems that, as far as WPATH is concerned, once a patient leaves the clinic, he or she is no longer the doctor’s responsibility. As one doctor put it, ‘as long as [the patient is] capable of making that decision of sound mind while informed of the risks, then that may be all you can do’. In other words, these healthcare professionals are attempting to wipe their hands of any responsibility for any negative effects that transitioning might have.

As WPATH president Marci Bowers puts it, ‘patients need to own and take active responsibility for medical decisions, especially those that have potentially permanent effects’. This might be true when adult patients are electing to have risky and non-essential cosmetic surgery. But we are also talking about children here – indeed, vulnerable children, usually with multiple mental-health difficulties – who have been told by medical professionals and other supposed adults that receiving this treatment will ‘fix’ them.

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.

We saw this in 2022, when Dr Hilary Cass published her damning interim report on the Tavistock Centre, the NHS’s specialist gender-identity clinic for children and young people. The review found that the Tavistock’s approach to treating children was ‘not safe’, and that there were a myriad of potential harms caused by puberty blockers that were not being properly acknowledged by staff. As a result, the Tavistock was ordered to be closed down.

Whistleblowers, media investigations and lawsuits had tried to draw attention to this for years. Yet the Tavistock remained operational, and is still only due to shut its doors this month. Trans ideology has so infected medical institutions that doctors, nurses and therapists feel they have no choice but to transition every child who claims to be born in the wrong body. And they fear that refusing to do so will see them branded as ‘transphobic’. Or, worse still, that not agreeing to prescribe gender-affirming treatment will lead to a child ending their own life.

What the WPATH Files make clear is that those who claim to care most about the plight of ‘trans youth’ are all too often the greatest threats to their safety. They are willing to sacrifice the health of deeply vulnerable children to the cult of gender affirmation. The treatments they tout as ‘life-saving’ and ‘life-affirming’ can actually be ‘life-ruining’. Gruesome side effects from cancer to infertility are dismissed as necessary evils on the path to transitioning. This is the opposite of compassionate.

Erin Reed at Erin In The Morning:

On Wednesday, Dr. Hillary Cass gave her first American interview with NPR about the Cass Review. The review, which appears heavily politicized and lends credence to debunked theories about being transgender, such as "social contagion," is being used as a pretext to ban care in the United Kingdom. In the interview, Cass called for "other ways" of managing dysphoria besides transitioning and blamed being trans on factors such as autism and pornography. However, one particular point of note was her response to a question about the evidence supporting gender-affirming care, where she suggested that the real measure of transition success should be the employment status of transgender people. When asked about “actual outcomes” for the effectiveness of cross-sex hormones in transgender youth, Cass sated that there was a need for long followups to see if transgender people thrive on hormones, and that the outcomes that she was most interested in included employment, “getting out of the house,” and relationships. See her answer here:

[CHAKRABARTI: Regarding cross sex hormones, the systematic review authors said there is a lack of high-quality research assessing the actual outcomes of cross sex hormones. CASS: Yes, because we need to follow up for much longer than a year or two to know if you continue to thrive on those hormones in the longer term. And we also need to know, are those young people in relationships? Are they getting out of the house? Are they in employment? Do they have a satisfactory sex life?] It is important to note that all of these potential outcome measurements may be heavily influenced by transphobic sentiments in society. Should transgender people be judged on their ability to be "employed" or their willingness to "get out of the house," their own discrimination may then be used against their ability to access medication. According to the National Center for Transgender Equality, more than one in four transgender people have lost a job due to bias, and three-quarters report experiencing workplace discrimination. Therefore, it is inaccurate to blame transgender people and their medication for what appears to be an issue with societal discrimination.

In recent years, many reports have emerged showing high levels of satisfaction and low levels of detransition for transgender people. A recent report in the 2022 US transgender survey shows that out of 90,000 transgender people, less than 1% report feeling less satisfied after beginning gender affirming hormone therapy, with the vast majority feeling “a lot more satisfied.” Detransition appears to be similarly rare. One recent study out of Australia found complete data on 548 of 552 transgender patients and discovered only 1% of transgender youth detransitioned over several years before being transferred to adult services. Another study showed that transgender youth are stable in their gender identity 5 years after transitioning, with only 2.5% reidentifying as their assigned sex at birth. Even Cass’s own report found less than 10 detransitioners out of the 3,000 trans youth patients in England, which led to her claiming that the real reason she didn’t find more detransitioners is because adult clinics refused to provide private patient data.

Dr. Hilary Cass, the woman behind the anti-trans Cass Review, made absurd claims that a person’s transition success should be measured by their employment status instead of satisfaction and joy.

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