In 2024 two significant events have occurred in gender medicine.

The first came in March with the leak of documents from the internal chatboard of WPATH (the World Professional Association of Transgender Health). These shine an unflattering light on so-called “gender-affirming care” (GAC) or “transgender medicine” and suggest that it is leading to widespread medical malpractice on children and vulnerable young people.

The second came in April with the release of the Cass Review in the United Kingdom. This was a long and thorough review of the state of gender medicine commissioned by the UK government. Its conclusions questioned the professionalism and legitimacy of the whole field of gender medicine.

From the point of view of a professional psychologist like myself, the WPATH files are distressing. They demonstrate ignorance of child development, indifference to young people’s co-morbid conditions such as ASD, ADHD, even psychosis, family dysfunction, and social determinants, plus blindness to the cognitive immaturity of young people and their lack of readiness to make life-changing decisions.

Although most of the members of WPATH are Americans and gender-affirming care is strongest in the US, legal authorities in some states—22 have enacted legislation against the medicalization of children—are fiercely critical of the organisation. An amicus curiae brief from Alabama submitted to the US Supreme Court earlier this year is damning. It describes WPATH as base, dishonest, deceptive, delusional, and sociopathic.

The evidence has shown, according to Alabama’s document, that:

• The WPATH standards are not evidence based
• WPATH suppresses scientific inquiry
• Many clinicians do not follow the WPATH standards, particularly regarding lower age limits for medical interventions and surgery

Dr Gordan Guyatt, a pioneer of evidence-based medicine, says that guidelines need to be based on systematic reviews of evidence; “a bunch of experts writ[ing] whatever they felt like” does not constitute evidence-based medicine. Nonetheless, this is how the 2022 SOC 8 (Standards of Care 8) WPATH guidelines were written. Even the authors of SOC8 admitted that the guidelines were just “consensus based expert opinion”.

Callous remarks

WPATH’s leaked files are compelling reading. Its members make staggeringly ignorant and callous comments about their young and confused gender patients, which reveal their own confusion, lack of ethical practice, and lack of a sound scientific basis for decision making. They are cavalier and indifferent to young people who later become distressed and regret their actions.

Many WPATH members dismiss or trivialize the lifetime of regret and medical complications confronting many young people. For example, a WPATH-affiliated Washington DC psychologist mentioned a “distraught and angry” detransitioned 17-year-old girl who had been on testosterone for more than two years and felt she had been “brainwashed”. Several WPATH members dismissed her pain in the comments and described detransition as just another step in a “gender journey” that does not necessarily involve regret. By this self-serving logic, it is impossible for clinicians practising the affirmative model to ever be wrong.

Disgracefully, some WPATH practitioners blame their victims. WPATH president Marci Bowers, herself a transgender woman, stated in the files that “patients need to own and take active responsibility for medical decisions, especially those that have potentially permanent effects”.

How does that apply to Jazz Jennings? She first appeared on American television as a seven-year-old transgender girl. Later on she became a reality TV star chronicling her “gender journey”, complete with a “farewell to penis” party. She now faces years of cross-sex hormones, multiple genital surgeries for complications, and mental health issues. Is she completely responsible for her misfortunes?

Political interference

Evidence submitted to the US Supreme Court has revealed that WPATH suppressed unfavourable research findings and manipulated the publication process. Its recommendations were influenced by Admiral Rachel Levine, a doctor and trans woman and Assistant Secretary for Health for the U.S. Department of Health and Human Services. Levine suggested that SOC8 be revised to abolish lower age limits on children’s rights to be physically and psychologically mutilated by so-called “gender affirming care”.

These are shocking revelations.  Heads should roll. Enabler doctors and lawyers should be deregistered for life. Some should go to jail for misleading the public and callously and knowingly harming vulnerable young people. The behaviour of doctors who have withheld information, misrepresented the benefits of gender-affirming care, and understated the adverse effects is wicked. It is tantamount to medical malpractice, negligent infliction of physical harm and emotional distress, and deceptive trade practices. 

WPATH is lying when it tells children and families that they can change sex, that sex changes will align mind and body, and that it will “cure” ongoing mental health issues. Its members lied by omission by failing to disclose the multiple serious adverse consequences (e.g., sterility, sexual dysfunction, increased risks of cardiovascular disease and cancer, endless pain and infections from genital surgery etc) of attempting the impossible. They failed to tell young and vulnerable people that they would become lifelong patients and that the changes caused by cross-sex hormones would be permanent.

Above all, they refused to treat significant mental health issues that were at least partially causal of gender dysphoria. They also failed to alert young people and their families that there were alternatives to gender-affirming care before mutilating their bodies.