WPATH was founded in 1979. Its stated goal is to “promote evidence-based care, education, research, advocacy, public policy and respect in transgender health”. The guidelines she created have been used to inform policy and clinical practice around the world. However, many argue that WPATH is effectively acting as a partisan lobby group for the trans movement, rather than a disinterested body. Many of its senior members self-identify as trans or non-binary, or are known as trans rights activists.
The most worrying aspect of the new guidelines is that they remove any reference to minimum age limits for children to have access to puberty blockers, sex-crossing hormones and sex-reassignment surgeries. As long as a child has reached “Tanner Stage 2” puberty, which can be up to nine years old, the WPATH guidelines suggest that these invasive and irreversible sex reassignment processes might be appropriate. Disturbingly, minimum age recommendations were included in a previous version of the guide that appeared online before being abruptly removed by a “correction”.
The guidelines state that double mastectomies – the removal of a girl’s breasts – “may be considered in minors”. Similarly, according to WPATH guidelines, “vaginoplasty,” or the construction of a false vagina, may be considered for boys under the age of 18.
Health workers are also instructed to teach children how to bind their breasts or tuck their genitals on the basis that these practices will offer “comfort” and “reduce the rate of wrong sex”. This is despite the fact that breast binding in girls can cause pain, infection, and even hernias, while genital uplift in boys can lead to lower sperm counts. Hormone treatment is also recommended for children, although guidelines acknowledge that it can cause “infertility.”
Throughout the guidelines, language is based on trans-ideology and not on medicine or biology. For example, irreversible medical and surgical interventions are referred to as “gender-affirming healthcare.” Double mastectomies are referred to as “breast masculinization surgery.” The guide also uses ideological terms such as “cisgender” (meaning anyone who does not identify as transgender). And it includes the scientifically and factually inaccurate term “gender assigned at birth” (where biological gender is actually one observed at birth).
The guidelines also sideline the role of parents in raising their children. When parents “do not support” their child’s medical transition, health professionals are encouraged to give them “psychoeducation.” Medical professionals are also being told not to worry about prescribing hormone treatment to children without parental involvement when such involvement would be “unnecessary.”
WPATH’s policies unknowingly expose the consumerist nature of trans ideology. They offer what appears to be a shopping list of surgeries recommended for children and adults with “trans” identity. These include body contouring, voice surgery, jaw augmentation, liposuction, brow lifts, lip shortening, calf implants, mastectomy, phalloplasty, and hysterectomy.
By now, the principles of protecting mental health seem to have been completely abandoned. The guidelines explicitly state that therapy or counseling should not be “mandatory” for patients before being prescribed irreversible drugs or surgery. And that also applies to children.
Therapists are told not to impose their own biases on patients who identify as trans. At the same time, however, the guidance insists that practitioners must be “gender-affirming.” These attitudes are completely contradictory. They are essentially telling therapists not to bother understanding or exploring their patients’ struggles with gender.
Some of the updated guidelines are downright bizarre. It even includes a new chapter dedicated to the “eunuchs”. Eunuchs are described as people who were “destined to be male at birth and wish to eliminate”. [their] male physical characteristics…or genitalia”. The guidelines seem to support people who seek “castration”, even if this desire is based on a sexual fetish, as such people supposedly fall under the “gender diversity umbrella”.
From an ethical and therapeutic perspective, all of this is deeply worrying. As the WPATH guidelines must acknowledge, the evidence base for these interventions is poor. The guidelines state: “There are only a few outcome studies that follow adolescents into adulthood”. And despite the increased visibility of people seeking “detransition” in the media, there appear to be “no clinical cohort studies.” [that] have reported on profiles of young people who regret their first decision”. In other words, there is no evidence that the drastic medical interventions recommended by WPATH do more good than harm to young people in the long term.
The impact of the new guidelines could be significant. For example, the NHS refers to previous WPATH guidelines on standards of care in a variety of medical documents. And the Scottish Government has admitted using earlier versions of it when drafting guidelines.
Previous WPATH guidelines were also used by numerous private health clinics in the UK. That includes the now-disgraced Gender GP. A co-founder of Gender GP was recently banned from the medical profession. The other, recently found by a medical court to have put patients at “unjustified risk of harm,” has done so tweeted praise of the new WPATH guidelines.
The new WPATH guidelines must be resisted. We need to hear reassurances from Government and NHS leaders that the new recommendations will not affect how we deal with gender dysphoria in the UK, particularly when it comes to vulnerable children. We must not allow trans ideology to take over medicine. The stakes for children are just too high.
James Essen is co-founder of Thoughtful Therapists.