Pediatric Gender Medicine Is Led by Activism, Not Science, New Documents Show
WPATH is a fringe activist organization that should be categorically excluded from clinical decision-making.
Reality’s Last Stand is a reader-supported publication. Please consider becoming a paying subscriber or making a one-time or recurring donation to show your support.
About the Author
Christina Buttons is an independent journalist with a forthcoming report on the connection between autism and gender dysphoria, as well as a detransition survey awaiting publication. She is developing a website that will feature the latest data, studies, and fact-checks that will debunk activist arguments related to gender medicine.
If you would like to support her work, please consider a paid subscription to her Substack or making a donation.
Newly released court documents reveal that the leading global authority on medical transitions for minors prioritized political goals over children’s well-being in developing their guidelines.
The World Professional Association for Transgender Health (WPATH) is a nonprofit organization of self-identified experts in transgender healthcare, known for its influential “Standards of Care” guidelines. These guidelines are endorsed by numerous medical organizations and widely adopted by pediatric gender clinics in the United States and internationally. WPATH claims these guidelines are “evidence-based” and represent the “gold standard” for treating gender dysphoria. Their recommendations advocate a highly medicalized approach for youth, including puberty blockers, cross-sex hormones, and gender-related surgeries.
This week, a trove of subpoenaed internal communications from WPATH, unsealed in a federal lawsuit regarding Alabama’s age restrictions on “gender-affirming care” for minors, reveal that their guidance is driven more by activism than by scientific evidence.
On Friday, the Alabama Attorney General submitted a motion for summary judgment to the US Circuit Court, summarizing extensive evidence gathered through subpoenas and depositions. Among the revelations was a damning statement from the authors of WPATH's most recent Standards of Care, 8th edition (SOC-8):
Our concerns, echoed by the social justice lawyers we spoke with, is that evidence-based review reveals little or no evidence and puts us in an untenable position in terms of affecting policy or winning lawsuits.
Having reported on the inadequacies of evidence supporting the gender-affirming model of care for minors for over two years, I never expected to see such a blatant admission. This statement demonstrates that WPATH’s priorities lie not in the best interests of vulnerable children, but in achieving its political objectives.
When evidence does not fit their narrative—that gender-affirming care is medically necessary, lifesaving healthcare backed by robust evidence—they are willing to conceal it.
Earlier this week, unsealed emails revealed that WPATH interfered with systematic reviews that it commissioned from Johns Hopkins University in 2018, which found “little to no evidence about children and adolescents.” WPATH rejected the Johns Hopkins team’s request to publish the reviews and implemented a new policy requiring them to seek “final approval” from WPATH.
Despite providing WPATH with material for six systematic reviews, the Hopkins team published only one paper. WPATH leadership explained that research must be “thoroughly scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender health care in the broadest sense,” an admission of their plan to a biased reporting of results.
The internal communications also revealed that Dr. Rachel Levine, a transgender woman and Assistant Secretary for Health at the U.S. Department of Health and Human Services, successfully pressured WPATH to remove age limitations for minors to receive hormonal and surgical sex-trait modifications in their Standards of Care 8 (SOC-8).
The initial draft of the guidelines had proposed reducing the age minimums to 14 for hormonal treatments, 15 for mastectomies, 16 for breast augmentation or facial surgeries, and 17 for genital surgeries or hysterectomies. The final version of the guidelines, published in 2022, eliminated these age-specific recommendations entirely.
Levine’s actions were also politically motivated, driven by concerns that such limitations would lead to “devastating legislation for trans care.” Following the news of Levine’s involvement, the Biden Administration announced their opposition to gender-affirming surgery for minors this week, a significant divergence from their previous statements supporting medical interventions for youth.
The SOC-8 also eliminated a chapter on ethics and introduced a new chapter on “eunuch gender identity.” Unsealed emails reveal that the authors aimed to design SOC-8 to secure coverage for almost any “embodiment goal” a patient might have by labeling it as “medically necessary,” including castration for individuals identifying as a eunuch.
During a deposition, Dr. Marci Bowers, the current president of WPATH, admitted that “there's not enough high-level evidence” to support the safety and clinical effectiveness of puberty-blocking drugs, despite WPATH’s guidelines recommending them for gender-dysphoric children at the first signs of puberty.
The Attorney General recommended that the Court disregard WPATH’s standards of care and grant summary judgment, stating, “In short, neither the Court nor Alabama should treat WPATH as anything other than the activist interest group it has proven to be.”
This is precisely what I, and many others who have been trying to sound the alarm for years but have largely been ignored by mainstream media, have been saying: that activism, not evidence-based medicine, has been dictating pediatric gender medicine all along.
On its “about” page, WPATH refers to itself as “evidence-based” four times. However, it does not adhere to the principles of evidence-based medicine (EBM). Systematic evidence reviews, considered the highest quality of evidence, have repeatedly demonstrated that transitioning minors is not supported by robust evidence.
Even the founder of the EBM movement has said that the current guidelines for transitioning youth should not be considered evidence-based and are untrustworthy. Yet, WPATH continues to misrepresent itself and ignore every opportunity to reevaluate their positions.
In April, the U.K.’s Cass Review, along with its associated systematic evidence reviews–representing the most thorough appraisal of pediatric gender medicine to date–found “remarkably weak” evidence supporting all interventions for gender transition in minors.
WPATH rejected the Cass Review’s findings as “harmful” and issued a statement firmly standing by their own guidelines, choosing to remain in its ideological echo chamber.
Meanwhile, public health authorities around the world are responding to the findings of the Cass Review by adopting a more cautious approach to treating gender-distressed youth, emphasizing psychotherapy and imposing restrictions on medical interventions for minors. In contrast, US-based medical authorities have resisted revising their guidelines to align with the best available evidence, continuing to support early medical interventions for minors.
Those resisting change base their guidelines for medical transitions for minors not on robust evidence, but rather on “circular referencing” of each other’s guidelines, effectively creating a citation cartel. Dr. Hilary Cass pointed out the problematic nature of this circular approach, stating, “It may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.”
While long-term data remains limited, emerging research suggests that gender-related distress in young people may often be temporary. A recent German study found that over half of young people across all age groups did not persist with a gender dysphoria diagnosis after five years. Furthermore, a long-term Dutch study indicated that most adolescents who initially expressed a desire to be the opposite sex no longer felt that way in adulthood.
In the United States, a comprehensive review of medical records revealed that 30 percent of youth and young adults discontinued hormone use after four years. Coupled with extensive early research on high rates of desistance among children and the growing visibility of detransitioners, these findings support the UK National Health Service’s characterization of gender incongruence as a possible “transient phase” for many young people, suggesting that therapy, not irreversible medical interventions, may be more appropriate.
Even as more evidence emerges, WPATH remains unyielding. Their actions—and now their own words—have clearly revealed their true agenda: influencing policy and winning lawsuits, even if it means concealing inconvenient evidence.
For too long, WPATH has misled many into believing it is a scientific authority. Now that these emails have been revealed, and more likely to be unsealed soon, one can only wonder how long they can maintain this charade.
Parents of gender-distressed children have placed their trust in the medical establishment, turning to WPATH for expert guidance. Unfortunately, WPATH has consistently shown a lack of concern for the well-being of the children it claims to support. These families deserve so much better.
WPATH should be identified for what it truly is—a fringe activist organization—and its guidelines should be categorically excluded from clinical decision-making.
Reality’s Last Stand is a reader-supported publication. If you enjoyed this article, please consider upgrading to a paid subscription or making a recurring or one-time donation below. Your support is greatly appreciated.
If you enjoyed this article, you may also like…
This is an excellent and important article. However, there was one sour note. I wish you would not refer to Rachel Levine as a "transgender woman," which I think undermines the evidence-based approach to these issues. Rachel Levine is a male. He may self-identify as a woman, but he isn't one and adding the modifier "transgender" doesn't alter that.
You know this, but for some reason defer to his delusion. We need to stop indulging those who are pushing the false notion that there is such a thing as a "transgender woman." There are males who identify as "transgender" and females who identify as "transgender," but they remain male or female. Language matters. The stakes are too high to be deferential to autogynephilic men or delusional women who push the fiction of transgenderism, whether out of some misplaced sense of politeness or whatever else may have motivated that choice of language.
I don't see any evidence for transitioning adults either...