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The Consequences of Ideology-Driven Medicine for Transgender Teens

What do leaked WPATH files and the Cass Review reveal? Youth gender medicine practices are unethical and harmful.

Over the past several months, two major events—you might even call them seismic—have rocked the field of youth gender medicine. Despite the attention gender identity tends to receive in the mainstream media, these stories have been largely downplayed or ignored in the mainstream news.

Doctors are knowingly performing experimental procedures on children.

 First, the release of leaked files from WPATH, the organization that has become the self-proclaimed global authority on “scientific, evidence-based” transgender health, revealed the organization to be anything but that. Second, and most recently, a highly anticipated study was released in the UK known as the Cass Review. Either event alone, and certainly both of them together, should significantly affect the care that gender-questioning youth receive. While most mainstream media outlets and gender-affirming organizations in the United States and Canada have been relatively quiet regarding information gleaned from these documents, particularly the WPATH Files, the findings from each will be impossible to ignore for long.

The WPATH Files

 Last year, whistleblowers leaked materials from the World Professional Association for Transgender Health (WPATH) to reporter Michael Shellenberger, who released the files in March, along with a comprehensive report by writer Mia Hughes. The materials include a recording of a virtual panel discussion by medical and mental health providers as well as screenshots of case discussions among WPATH members, revealing improvised, unethical, and arguably illegal conduct.

These materials show that doctors are knowingly prescribing medications and performing experimental procedures on children and vulnerable adults who don’t fully understand the consequences and risks. As one psychologist said in the panel discussion, “It’s out of [minors’] developmental range sometimes to understand the extent to which some of these medical interventions are impacting them.” Panelists acknowledged that many parents of minors defer to so-called experts, with the same psychologist stating, “But what really disturbs me is when the parents can’t tell me what they need to know about a medical intervention that apparently they signed up for.” 

Despite this lack of understanding and the providers’ awareness that some treatments eventually cause a lack of sexual functioning and sterility, another panelist—a pediatric endocrinologist—stated, “We still want the kids to be happier in the moment, right?”

Despite widespread claims that transition prevents suicide, these claims are unsupported by the evidence.

The documents further show that doctors are willing to perform surgeries on people who cannot legally or ethically consent to them—including homeless people, those on the autism spectrum, and those with serious mental illness, including psychotic symptoms. In many cases, these conditions make it impossible for patients to have a proper understanding of the procedures that the ethical duty of informed consent requires. The files also show that providers report more patients wanting bodies that “don’t exist in nature,” such as so-called “gender nullification” surgeries that make individuals appear sexless or to have both sets of genitalia. And more surgeons are offering these procedures.

Repeatedly, the documents reveal the propensity of gender-care providers to make ad hoc decisions not based on evidence. For instance, the forum discussions show clinicians offering various ideas for cases without referencing reputable studies or other evidence. In one conversation, providers discussed patients who appeared to have dissociative identity disorder (DID), formerly known as multiple personality disorder. One clinician wonders whether others have experienced difficulty in getting all of their DID patients’ “alters” (additional personalities) to agree to medical transition, “especially given that not all the alters have the same gender identity.” Another clinician responds by saying he or she has “concern about transition” in such cases, but no one urges the clinician to wait to administer treatment until the clinician’s patients with DID are mentally stable. 

The providers also frequently acknowledge that they are in uncharted clinical territory, essentially running unsanctioned experiments on a highly vulnerable segment of the population. As documented in the report, one of several examples is an endocrinologist admitting to experimenting with testosterone dosages on females.

Respected organizations such as the American Medical Association, American Academy of Pediatrics, American Psychological Association, and the Endocrine Society endorse WPATH guidelines and defer to their recommendations, as do many gender clinics and professionals across the country and throughout the world. In the Intermountain West, patients seeking gender transition surgeries come from Idaho, Arizona, and Wyoming to Denver Health in Colorado and the University of Utah. Both hospitals tout their adherence to the latest WPATH standards of care. 

In response to the leaked files, WPATH president Marci Bowers released a statement that did not address concerns nor provide any support for the organization’s assertion that it is evidence-based. Instead, Bowers made a circular appeal to authority by stating that WPATH is “widely endorsed by major medical associations throughout the world.” In other words, WPATH is widely respected because it is widely respected.

Bowers wrote further, “We are the professionals who best know the medical needs of trans and gender diverse individuals. …The world is not flat. Gender, like genitalia, is represented by diversity.” Like the organization itself, Bowers’s statement is based on ideology, not science.

England will likely ban all youth medical transition treatments outside of research settings.

Mia Hughes’ report accompanying the WPATH Files describes other concerns regarding WPATH, including questions raised about the content of its most recent standards of care document. This document includes a chapter on eunuchs, defined as males who are “part of the gender diverse umbrella” and who “wish to eliminate masculine physical features, masculine genitals, or genital functioning” or have already done so. In short, WPATH believes that “eunuch” is a valid gender identity, that males who identify this way may benefit from castration, and that doctors should accommodate these requests.

Another concern expressed in Hughes’ report is that the new standards of care removed all suggested age requirements for medical and surgical treatments of trans-identified youth. Psychologist Amy Tishelman, lead author of the child section in the standards of care, didn’t even try to claim this change was based on research. Instead, Tishelman said the removal was for “legal and insurance” reasons. “We wanted there to be some clinician judgment without being at risk for being held in court for not sticking completely to these standards. So we did write them in a way, I think, so that there is leeway.” 

The Cass Review

Transgender Teen care was the focus of the recent Cass Report
The Cass Report was a watershed moment in the science of transgender care for youth

The Cass Review, commissioned four years ago by England’s National Health Service, is the most comprehensive review of youth gender medicine ever undertaken. Released on April 10, the findings peppered throughout its 388 pages are sobering: again and again, it decries the weak evidence underlying youth gender transition, the dearth of information regarding long-term outcomes of social and medical interventions, and the serious risk of major harm being done to our young people. 

 The Review notes the recent dramatic rise in transgender identification, particularly among young females, as well as the high rate of co-occurring conditions such as significant mental illness, autism, and trauma. Despite widespread claims that transition prevents suicide, the Review shows that these claims are unsupported by evidence. Further, it confirms that the guidelines developed by WPATH lack any scientific rigor. The review recommends a focus on holistic treatment for youth based on psychotherapy rather than experimental medical treatments.

They need thoughtful care that takes a holistic approach.

Following the release of the Cass Review, many individuals who for years have sounded the alarm about youth gender treatment—often being censored, bullied online, and even losing employment as a result—are feeling vindicated in their longstanding concerns. England will likely ban all youth medical transition treatments outside of research settings.

In addition to England, Scotland, Sweden, Norway, France, and Finland have all substantially curtailed these treatments and now recommend a “therapy first” approach for minors and young adults. Other European countries may be “rethinking” their transition-first approaches.

The question now is, will the WPATH Files and the Cass Review have any influence here in the United States? At this time, federal government agencies and the influential scientific bodies that currently endorse WPATH standards do not appear to be changing course and may even be doubling down. And why would they not, with the money rolling in? A recent research report affirmed that the incredible growth of medical treatments for gender-related distress represents a financial bonanza for clinicians and pharmaceutical companies. With growth rates of almost 12% per year, the report projected that transition surgeries alone will balloon to a five billion dollar annual market by 2030.

One ray of light recently appeared in Utah with the opening of a new clinic that explicitly focuses on non-medical approaches to gender-related distress. It appears to be the first clinic of its kind in the U.S. to have this exclusive focus. (This article’s co-author is one of its founders.)

Gender-questioning youth have been poorly served by the medical and mental health establishment for far too long. They need thoughtful care that takes a holistic approach. The WPATH Files and the Cass Review make it increasingly clear that medical transition treatments for these youth are unscientific, unethical, and often harmful. We feel a professional and moral responsibility to call for a halt to all “gender-affirmative” medical interventions on minors, which are simply not based on good evidence.

About the authors

Rebecca Taylor

Rebecca Taylor is a psychotherapist practicing in Sandy, Utah.

Jeff Bennion

Jeff Bennion is a marriage and family therapist practicing in Murray, Utah, and a co-founder of the Gender Harmony Institute.
On Key

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