'You Could Be Vulnerable': How a Trans-Care Leader Told Doctors to Handle Nonbinary Surgeries Without Outcome Data

This is the latest installment in the ongoing series in which I’m publishing the trove of World Professional Association for Transgender Health conference videos I obtained and covered in a recent article for Compact magazine. This particular video concerns the panel at the 2022 WPATH conference that introduced a long-awaited new chapter in the organization’s transgender-care guidelines, concerning caring for patients identifying as nonbinary.

For an eloquent and eyebrow-raising account of this and several other nonbinary-focused conference videos included in the videos I obtained, I also direct you to Leor Sapir’s December article in The Free Press. He wrote:

One of the biggest revelations from the recordings is how these clinicians acknowledge performing unproven, seemingly experimental treatments—only it appears there is often no protocol being followed, no formal research being conducted, and no ethics-board approval being sought. These practitioners say their goal is to fulfill the “embodiment” desires of their patients, whatever these may be, and doing this may require “deviat[ing] from guidelines.”

The conference video I’m documenting in this Substack includes a particularly astonishing admission by one care provider that made it into Dr. Sapir’s headline. The provider said, “We’re all just winging it” where medical interventions for nonbinary patients are concerned.

To see all the previous WPATH conference videos I’ve published, see:

I Obtained 100s of Conference Videos From the Leading Transgender Medical Association

Despite a paucity of research to guide gender interventions for nonbinary patients, the WPATH presenters in the 2022 nonbinary session insisted that this fast-growing population had a genuine medical need for all manner of experimental hormonal treatments and body-modification surgeries, sometimes effecting bodies that do not appear in nature. And the audience members who came up to the mic made it clear that they generally wanted guardrails stripped down to facilitate access to meet the swelling patient demand.

(Psychologist Jean M. Twenge, note, has recently presented data in her Substack suggesting that nonbinary identification has sharply declined in adolescents and young adults in the years since this conference. This has added fodder to the argument that such an identity is largely shaped by shifts in culture and not by fixed biological forces.)

As Dr. Sapir wrote, there was a heavy emphasis on treatment “goals” in this and other conference presentations about nonbinary-related treatment. Such a service-minded orientation took over this field because, as the presenters acknowledged, there is sometimes no established precedent for the medical interventions this population seeks. This is all a part of a larger postmodern, deconstructionist project to “move away from the binary” in the gender-care field. Such an academic project has merged with a departure from traditional medical paternalism, in which the doctor was seen as an infallible demigod, and toward more patient-led care with minimal guardrails around what any individual person might seek from a white-coated professional bearing a medical license and a prescription pad or a scalpel.

The 2022 presentation opened with words from Dr. Joz Motmans, who is the director of the Centre for Sexology and Gender at Ghent University Hospital in Belgium. Dr. Motmans was one of a slew of coauthors of the new nonbinary chapter in WPATH’s Standards of Care, Version 8. The SoC 8, as it’s known, is the trans-care guideline update that was published to much fanfare in September 2022, days before this particular conference.

As was often the case in the WPATH conference videos I reviewed, Dr. Motmans apologized for a lack of racial diversity in the leadership. (I made particular note of this brand of self-flagellation in a recent essay I published in UnHerd.) He alluded to the fact that the coauthors of the SoC 8 nonbinary chapter were all white. “We do miss some diversity in the authorships,” he said. “But I think that’s the case in most of the chapters.”

Dr. Motmans said that doctors should observe a particularly open mind when caring for nonbinary patients, saying: “It’s very important that health care professionals recognize a need of an individual to access gender-affirming medical procedures and that you cannot predict that need based on someone’s gender role, expression, or identity,” He continued: “So it’s important that health professionals provide information about existing medical procedures and options that might help alleviate gender dysphoria or incongruence and increase body satisfaction without making assumptions about which treatment options may best fit.”

Next, Dr. Walter Bouman, a transgender care specialist at the Nottingham Centre for Transgender Health in the United Kingdom, took to the lectern. Along with Dr. Motmans, he led the WPATH working group on nonbinary genders.