WPATH’s New Guidelines Promote Ideology Over Science
The most vulnerable suffer when we allow ideology to infect medicine.
Reality's Last Stand is a reader-supported publication. All articles are free, but if you would pay to access this article behind a paywall, please consider becoming a paying subscriber anyway, or making a one-time or recurring donation. I’d rather a million people view this content for free than have it be accessible to only a small group of paying subscribers, but that means I rely fully on the generosity of my readers for support. Thank you!
On September 6, 2022, the World Professional Association for Transgender Health (WPATH) published their updated Standards of Care (Version 8). The organization was founded in 1979, and their stated purpose is to “promote evidence-based care, education, research, advocacy, public policy, and respect in transgender health.”
However, despite this ostensibly scientific and nonpartisan mission, there have been concerns over the years that the organization appears to act more as a partisan lobby group than an independent organization focussed on medical safeguarding. These concerns are further enhanced by the fact that the make-up of WPATH’s senior members, many of whom identify as “trans” or “non-binary” themselves, are extremely visible activists in this space.
Gender ideology also appears at the forefront of the organization’s work, and ideological—rather than scientific—jargon appears in nearly every official document. For instance, WPATH runs an “Online Sexuality Workshop” that is aimed at “supporting trans erotic embodiments from a pleasure-centred praxis…working with children, adolescents…”
Furthermore, in the “recommended reading” section of their website, WPATH suggest the following ideologically driven books (among others):
Real Talk For Teens: Jump-Start Guide to Gender Transitioning and Beyond, by Seth Rainess. According to the book’s Amazon description, it is “the first book devoted exclusively to issues of gender transitioning for youth” and “takes early transitioning seriously.”
Transgender Warriors: Making History from Joan of Arc to Dennis Rodman, by Leslie Feinburg, who describes “hirself” as “a lifelong transgender revolutionary.” The book purports to combine “history, memoir, and gender studies to show that transgender people, far from being a modern phenomenon, have always existed and have exerted their influence throughout history.” This entails labeling historical figures who did not conform to traditional sex-based stereotypes—such as Joan of Arc, Dennis Rodman, and others—as “transgender.”
Unfortunately, the latest version of the WPATH Standards of Care is saturated with similar ideological jargon. This is extremely concerning from a medical ethics and child safeguarding perspective given that WPATH’s guidelines are “internationally accepted” and “designed to promote the health and welfare of transgender, transsexual and gender variant persons…”
Below are the most concerning aspects of Version 8 of WPATH’s Standards of Care:
Ideologically Driven Language
The guidelines feature language rooted in ideology, rather than medicine or biology, throughout. For example, irreversible medical and surgical interventions are referred to as “gender-affirming health care.” Double mastectomies are called “chest masculinization surgery.” Ideological terms such as “cisgender” are used, as well as the scientifically and factually inaccurate term “sex assigned at birth.” Regardless of the risks and impact on the safety and wellbeing of women, WPATH instructs health providers to implement “gender neutral toilets.”
Removal of Minimum Ages for Irreversible Medicalization
Any nuance surrounding the welfare and wellbeing of vulnerable children is omitted. This is particularly concerning given that gender dysphoria is a mental health condition, and many young people suffering from gender dysphoria have other co-morbidities or mental health diagnoses. The new guidelines have removed all minimum age recommendations for a child to be able to receive puberty blockers, cross-sex hormones, or sex-reassignment surgery (so long as that child has reached “Tanner Stage 2” of puberty, which can be as young as 9 years old).
Interestingly, minimum ages had been included in the originally published document before these were quickly removed via a “correction” online. The guidelines state that elective double mastectomies, euphemistically called “chest masculinization surgery,” “can be considered in minors.” Equally, vaginoplasty may also be performed on minors. The guidelines make it clear that there should be no requirement for a child to have taken cross-sex hormones prior to obtaining surgery—“if not desired” by a child—emphasizing the consumeristic nature of these guidelines. Hormone treatment is also recommended even though it can cause permanent infertility.
Chest Binding/Genital Tucking
Healthcare professionals are instructed to provide education to children on both “chest binding” and “genital tucking,” on the basis that this will provide “comfort” and “lower rates of misgendering” for a young person. However, this ignores the fact that the former can cause pain, infection, and even fractures, and the latter can cause decreased sperm concentration.
Alienation of Parents
Healthcare professionals are advised to “challenge” parents who are unsupportive of their child medically transitioning. Equally, they are recommended to prescribe hormone treatment for children without parental involvement if such involvement would be “harmful or unnecessary.”
Focus on Irreversible Surgery
The guidelines provide what is in essence a shopping list of surgeries that are recommended for children and adults with “trans” identities. These include, but are not limited to:
Abandonment of Mental Health Safeguarding
The guidelines explicitly state that therapy or counseling should “never be mandatory” before prescribing irreversible medication or surgery, including for children. Equally, therapeutic professionals are told that they must not impose their own narratives or preconceptions, yet are also told that they must be “gender affirming.” These principles are fundamentally incompatible.
Disregarding of Mental Ill-Health
Clinicians are advised that not all mental illness “can or should be resolved” prior to prescribing irreversible medication or surgery. Equally, the guidelines state that hormone treatment should not be withheld simply because a child has a “neurodevelopment condition.”
A completely new chapter has been added that is dedicated to “Eunuchs,” who they define as individuals “assigned male at birth and wish to eliminate masculine physical features or genitals.” The guidelines appear to support individuals seeking “castration,” who are now considered to fall under the “gender diverse umbrella.” From an ethical and therapeutic standpoint, this is deeply concerning. And from an ideological standpoint, this is completely absurd.
Patients in Prison/Psychiatric Hospitals
WPATH recommends that staff providing care to incarcerated individuals, such as those in prisons or psychiatric hospitals, should support them with “gender-affirming surgical treatment…when sought by the individual without undue delay.” This instruction for an unconditionally affirmative approach throws any semblance of safeguarding out of the window.
Ignoring the Lack of Research
All of the above recommendations are made despite WPATH fully acknowledging that “the number of studies is still low,” that “there are few outcome studies that follow youth in adulthood,” and that “no clinical studies have reported on profiles of adolescents who regret their initial decision.”
Given WPATH’s tremendous influence over the global landscape in gender medicine (especially given the fact that WPATH is a self-regulated membership body), this should be extremely alarming to anyone concerned about the safeguarding of society’s most vulnerable population—children.
The ramifications are considerable. For example, the NHS refers to the WPATH Standards of Care in a variety of medical documents. The Scottish government has also acknowledged their reliance on these Standards in their decision-making. These Standards featured heavily in the landmark case of Bell v Tavistock. They are also used by numerous private health clinics throughout the UK, enabling them to justify prescribing irreversible hormones and performing irreversible surgeries. Such private clinics include the now-disgraced Gender GP, which recently had one of its founders expelled from the medical profession, and another suspended, for risks posed to vulnerable children in their care.
We must ensure that there is significant and universal pushback anywhere these WPATH guidelines are being adopted so that they will will not change the medical and therapeutic landscape regarding the treatment for gender dysphoria, especially for children.
WPATH’s new Standards of Care is one of the most extreme and concerning examples of ideology infecting medicine I’ve ever seen, and this cannot be allowed to happen. The stakes are far too high.