WPATH and the U.S. government try to interfere with research on gender care

Below are three articles, the first one in The Economist, the second in the NYT, and the latest from Colin Wright’s Substack site, showing that both the U.S. government and WPATH (World Professional Association for Transgender Health: the most influential organization dealing with doctors and therapists who provide care for gender dysphoric and trans people) have been pressuring scientists to get rid of minimum age limits for “affirmative care”. (WPATH, by the way, though purporting to be a “World Professional Association”, is influential only in North America, having almost no bearing on transgender care in other countries.)

As you know, “affirmative care” is that form of care for gender-dysphoric adolescents that guides and pressures them to become trans people, affirming (rather than exploring) their feelings that they’re in the wrong bodies. Beyond cursory “rah rah” therapy, the program then gives adolescents puberty blockers that supposedly pause their development to give them time to decide, and then urges hormonal treatment and—sometimes—top or bottom surgery.  It’s the “affirmative” part—the idea that the child’s views and desires must be catered to—that bothers many of us.  Involved in this are three issues:

1.)  Are adolescents to be trusted with making decisions about medical care that can affect their lives in a major way, decisions that involve taking hormones and having surgery that can sterilize them and (in the case of bottom surgery) lead to severe complications?  Shouldn’t there be a minimum age limit for making such decisions?  According to the NYT article below, the Biden administration had issued draft guidelines, but these were never enacted. (To my mind, these guidelines seem way too young. 17 for genital surgeries and 14 for hormone treatments?)

The draft guidelines, released in late 2021, recommended lowering 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.

Now, it appears, many people want NO age minimums, and that includes the U.S. government.

2.)  The long-term effects of puberty blockers on adolescents are not known very well. In some European countries the use of such blockers as regular therapy is banned, and blockers are employed only in clinical trials.

3.)  The bulk of cases of gender dysphoria resolve themselves on their own, without dysphoric people needing hormones or surgery before puberty, and many on hormone therapy stop that therapy, which may not (as gender advocates say) be completely irreversible. Many of these children resolve as homosexuals, which involves neither medicine nor surgery.  As Pamela Paul of the NYT noted, with links:

Studies show that around eight in 10 cases of childhood gender dysphoria resolve themselves by puberty and 30 percent of people on hormone therapy discontinue its use within four years, though the effects, including infertility, are often irreversible.

Europeans are taking a more watchful approach to these questions, but somehow in the U.S. many gender activists want no minimum age limit for affirmative care (including the use of blockers when kids are quite young), only perfunctory therapy for gender-dysphoric adolescents (perhaps only a single session), and make decisive (and erroneous) pronouncements that puberty blockers are not only perfectly safe, having no long-term effects, but are also completely reversible.

This first report, from the Economist (click to read) shows that WPATH tried to impede the work of scientists and researchers working on reviews of transgender issues, reviews meant to inform WPATH’s own guidelines for transitioning. In other words, WPATH wanted researchers to come up with only those results that the organization wanted, results that buttressed affirmative therapy.

Both this article and the NYT article resulted from discovery documents and emails released in a court case challenging Alabama’s ban on transgender medical care for minors.

Here are some experts showing how WPATH resisted systematic analysis of relevant data. (WPATH adamantly denied the results of the NHS’s Cass Review in England, which put considerable brakes on affirmative care in the UK).

Court documents recently released as part of the discovery process in a case involving youth gender medicine in Alabama reveal that WPATH’s claim was built on shaky foundations. The documents show that the organisation’s leaders interfered with the production of systematic reviews that it had commissioned from the Johns Hopkins University Evidence-Based Practice Centre (EPC) in 2018.

From early on in the contract negotiations, WPATH expressed a desire to control the results of the Hopkins team’s work. In December 2017, for example, Donna Kelly, an executive director at wpath, told Karen Robinson, the EPC’s director, that the WPATH board felt the EPC researchers “cannot publish their findings independently”. A couple of weeks later, Ms Kelly emphasised that, “the [WPATH] board wants it to be clear that the data cannot be used without WPATH approval”.

There was then a negotiation stipulating that WPATH didn’t have to approve the data, but could offer review and feedback to the researchers without “meddling” in publication:

Eventually WPATH relented, and in May 2018 Ms Robinson signed a contract granting WPATH power to review and offer feedback on her team’s work, but not to meddle in any substantive way. After WPATH leaders saw two manuscripts submitted for review in July 2020, however, the parties’ disagreements flared up again. In August the WPATH executive committee wrote to Ms Robinson that WPATH had “many concerns” about these papers, and that it was implementing a new policy in which WPATH would have authority to influence the EPC team’s output—including the power to nip papers in the bud on the basis of their conclusions.

But only one review was ever published, about the effects of hormone therapy on transgender people, and, six years later, there are no more articles published, despite the fact that the EPC group has enough data for SIX more reviews.  Something fishy is going on, but what it is we don’t know. (Bolding below is mine.)

No one at WPATH or Johns Hopkins has responded to multiple inquiries, so there are still gaps in this timeline. But an email in October 2020 from WPATH figures, including its incoming president at the time, Walter Bouman, to the working group on guidelines, made clear what sort of science WPATH did (and did not) want published. Research must be “thoroughly scrutinised and reviewed to ensure that publication does not negatively affect the provision of transgender health care in the broadest sense,” it stated. Mr Bouman and one other coauthor of that email have been named to a World Health Organisation advisory board tasked with developing best practices for transgender medicine.

Since WPATH is all out for affirmative care, and demonizes those who call for caution (e.g., the Cass Review), the bit in bold above looks like arrant interference by WPATH with the scientific process.  One could lump WPATH’s behavior in this case along with attempts by other ideologues to make reality comport with ideology—what I call the “reverse appeal to nature”, or “What we consider good and moral must be seen in nature.”

But what seems even worse, at least to American liberals, is that officials in the Biden Administration, including the trans woman who is the assistant secretary for Health and Human Services, have tried to get WPATH to drop all its guidelines for age minimums.  And the pressure worked! WPATH has no more age guidelines.

Click below to read the NYT piece, or find it archived here

Some excerpts (I’ve added a link to Levine):

Health officials in the Biden administration pressed an international group of medical experts to remove age limits for adolescent surgeries from guidelines for care of transgender minors, according to newly unsealed court documents.

Age minimums, officials feared, could fuel growing political opposition to such treatments. [JAC: That apparently means that age limits indicate that there are issues involved with decisions to undergo such treatments. But this is not a political issue!]

Email excerpts from members of the World Professional Association for Transgender Health recount how staff for Adm. Rachel Levine, assistant secretary for health at the Department of Health and Human Services and herself a transgender woman, urged them to drop the proposed limits from the group’s guidelines and apparently succeeded.

Now WPATH, an organization to which many American doctors and therapists adhere, has no age guidelines at all.  If an eight-year-old girl says she feels like she’s in a boy’s body, then affirmative care could begin immediately, and hormones administered soon thereafter. And surgery at any age!

Now I’m not sure about the ethics of a trans woman in the government —or any person, be they cis or trans—pressuring a professional organization to drop age limits for “adolescent surgeries”, but it doesn’t sound kosher.  No bureaucrat should be applying any pressure. for this is an issue best left to doctors and medical ethicists. Yet the pressure from Levine and her office was constant:

The email excerpts released this week shed light on possible reasons for those guideline changes, and highlight Admiral Levine’s role as a top point person on transgender issues in the Biden administration. The excerpts are legal filings in a federal lawsuit challenging Alabama’s ban on gender-affirming care.

One excerpt from an unnamed member of the WPATH guideline development group recalled a conversation with Sarah Boateng, then serving as Admiral Levine’s chief of staff: “She is confident, based on the rhetoric she is hearing in D.C., and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out.”

Another email stated that Admiral Levine “was very concerned that having ages (mainly for surgery) will affect access to care for trans youth and maybe adults, too. Apparently the situation in the U.S.A. is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them.”

There are a lot more emails that I haven’t read, but here’s one more bit showing that even within WPATH there was dissent about removing age limits:

In other emails released this week, some WPATH members voiced their disagreement with the proposed changes. “If our concern is with legislation (which I don’t think it should be — we should be basing this on science and expert consensus if we’re being ethical) wouldn’t including the ages be helpful?” one member wrote. “I need someone to explain to me how taking out the ages will help in the fight against the conservative anti-trans agenda.”

The international expert group ultimately removed the age minimums in its eighth edition of the standards of care, released in September 2022. The guidelines reflected the first update in a decade and were the first version of the standards to include a dedicated chapter on medical treatment of transgender adolescents.

The fact is that we know very little about the long-term effects of various medical interventions on the health and mental well-being of gender-dysphoric adolescents. And with WPATH and the government trying to impose their own dictates on what the results should be, gender care in America looks dire.  Like any other branch of medicine and therapy, it should be informed by science, not ideology, and ideologues should not be dictating how the scientific results should turn out. Yet WPATH continues to make statements without evidence, preferring anecdotes:

The final WPATH guidelines state that distress about breast development in particular has been associated in transgender teenagers with higher rates of depression, anxiety and distress.

“While the long-term effects of gender-affirming treatments initiated in adolescence are not fully known, the potential negative health consequences of delaying treatment should also be considered,” the guidelines state.

“Gender-affirming surgery is valued highly by those who need these services — lifesaving in many cases,” Dr. Bowers said.

I’m pretty sure the “lifesaving part”, as epitomized in the advice given parents of gender-dysphoric children, “Do you want a live son or a dead daughter?”  Gender dysphoria is often accompanied by depression and other mental issues, and there’s no evidence I know of that gender-dysphoria alone causes suicide in the absence of affirmative care.

UPDATE: I’d missed this article from Reality’s Last Stand, but it’s highly relevant. Click below to read it:

 

An excerpt, noting that apparently the NYT had even more damning emails but didn’t publish them (bolding below is the author’s):

Last night, I had drinks with a friend I hadn’t seen in a long time, determined not to talk about The Issue. But a few minutes before I arrived, I found out that The New York Times had decided not to publish a part of a story about the World Professional Association for Transgender Health—an advocacy group that creates “standards of care” for trans medicine, which American medical groups avow to adhere to (they don’t) and claim are evidence-based (they aren’t).

That part of the story would have discussed recently unsealed WPATH documents, subpoenaed by the state of Alabama, as part of a lawsuit, Boe v. Marshall. Alabama parents, medical providers, and a Birmingham pastor named Paul Eknes-Tucker sued the state because of its ban on “gender-affirming care” for minors—and the criminalization of those who practice it.

. . .The emails show that Hopkins did conduct a systematic review, and that—like all the other SRs—it found diddly squat in terms of evidence supporting the efficacy of hormones and surgeries. But WPATH prevented Johns Hopkins from publishing these reviews because they didn’t come to WPATH’s preferred conclusions. WPATH hid this very important information from the entire world, then published standards of care saying an evidence review was impossible. And a government agency knew this!

We are talking about kids and the most invasive possible interventions here. We are talking about venerable academic institutions and government agencies and censorship and secrets.

. . . Turns out, there’s a whole heckuva lot more of these damning emails. The New York Times had access to them but chose not to cover them. A source told me this is because no one from Johns Hopkins would comment on the record. The documents will be available via the LGBT Courage Coalition tomorrow (I will add a link and start a thread when it’s up), but I had a chance to preview them. If you have not yet had what GIDS whistleblower Anna Hutchinson called her “holy fuck!” moment, now’s the time.

After discussing the concessions the Johns Hopkins researchers made to WPATH, apparently deep-sixing six review papers, author Davis says this:

Can you believe the John Hopkins folks agreed to this? This is not science. WPATH is not credible. And this is why we in America are the outliers: we’re not basing guidelines on systematic reviews, or reality. We’re basing them on an activist group’s political agenda, and even the HHS knows there’s no good evidence. In fact, AHRQ was asked to review guidelines for treating gender dysphoric youth back in 2020, because, the request said:

There is a lack of current evidence-based guidance for care of children and adolescents who identify as transgender, particularly regarding the benefits and harms of pubertal suppression, medical affirmation with hormone therapy, and surgical affirmation. While these are some existing guidelines and standards of care,2, 5-6 most are derived from expert opinion or have not been updated recently so a comprehensive evidence review is currently not available.

What did AHRQ decide, after communicating with the Hopkins researchers?

The EPC Program will not develop a new systematic review because we found protocols for two systematic reviews that addresses portions of the nomination, and an insufficient number of primary studies exist to address the remainder of the nomination.

Basically, they said someone was already doing it, and there wasn’t enough evidence to sort through. But the someone already doing it had already agreed to put science aside and only discuss benefits, not harms.

In future years the suppression of scientific research on gender medicine in America will be seen as a scandal. And besides unforeseen damage to people’s lives, we can expect a spate of lawsuits.

Both WPATH and the Biden Administration bear the blame for the latest series of missteps.  In its efforts to placate the progressive Left (something I didn’t predict when Biden was elected), the Biden Administration has badly mishandled issues of sex and gender.

h/t: Rosemary