The WPATH Files: Report Derides Influential Trans-Medicine Group As ‘Unethical’
A damning report based on leaked internal communications depicts the major transgender advocacy group as expressing confidence about gender-transition treatment in public but uncertainty in private.
A damning new report based on a trove of leaked internal communications from the World Professional Association for Transgender Health has lambasted WPATH as “neither scientific nor advocating for ethical medical care.”
The report is based on a WPATH internal-message forum and an internal panel discussion. These were leaked by at least one member of the highly influential transgender medicine and advocacy organization to journalist and climate advocate Michael Shellenberger, known for the so-called Twitter Files.
The resulting report, called The WPATH Files, was published by Mr. Shellenberger’s nonprofit, Environmental Progress, and spearheaded by British journalist Mia Hughes.
A weighty 216 pages, the report pulls no punches, characterizing WPATH as unscientific, unethical and guided by an improvisational attitude toward providing high-risk, often irreversible medical treatments to children, adolescents and vulnerable adults with gender-related distress. Quoting liberally from WPATH members’ private exchanges, the report depicts them as paying little mind to the myriad potential harms—including infertility—of puberty blockers, cross-sex hormones and sex-trait-modification surgeries.
The report calls for a congressional investigation into WPATH and its powerful influence on U.S. medical practices.
WPATH, the report says, “advocates for a transition-on-demand style of care, valuing patient autonomy over avoidance of harm.” And “notably absent,” the report continues, “is any consideration of the ethical concerns surrounding surgeries that destroy healthy reproductive organs.”
Mr. Shellenberger provided an advanced copy of the report, which went live at 7:01pm U.S. Eastern Time on Monday, to me and a small number of other reporters. I was not permitted to share the report with sources in advance of the embargo lifting; although I did seek comment from WPATH on Monday afternoon, with no reply. So this is a simple summary of the report, complete with screenshots of private WPATH message boards, without any outside voices reflecting upon its significance.
This Substack is essentially an article adaptation of a tweet thread I posted. I encourage you to share and comment on the tweets as well. Tweets associated with particular passages in this article are hyperlinked within the relevant text. Most of the individual tweets in the thread are written to stand on their own and be retweeted without the need for you to provide any additional context.
Later in the week, I will publish an article examining what fall-out WPATH might expect to see from the public release of scores of private communications among its members. Follow me on Twitter or here on Substack to receive notice of that article.
What Is WPATH and Why Is This Report a Big Deal?
Largely U.S. based, WPATH describes itself as an “interdisciplinary professional and educational organization.” The organization produces highly influential guidelines for treating gender dysphoria. It is not a standard medical society like the American Medical Association or the American Academy of Pediatrics. Many members are neither physicians nor mental-health providers.
Despite this, WPATH has gained substantial currency among U.S. medical societies in recent years. Groups like the AAP look to WPATH’s “Standards of Care” guidelines for signals on how to care for people who identify as transgender and to treat gender dysphoria.
Gender dysphoria is marked distress stemming from an internal conflict between an individual’s biological sex and their gender identity.
As the political debate in the US has raged over whether minors should be able to access gender-transition treatment — 23 states have banned at least some form of such treatment — the nation’s major medical societies have remained in lockstep in their support of such access and opposition to these bans. In this, they have effectively followed WPATH’s lead.
The authors of The WPATH Files report found that WPATH members express public confidence about gender-transition treatment for minors while in private they express uncertainty and concern—such as regarding the ability of children, and sometimes even parents, to understand the serious risks.
Accordingly, the report excoriates the organization:
“The WPATH Files reveal that WPATH is neither a medical organization nor a scientific organization. The group is engaging in an unregulated experiment on some of the most vulnerable individuals in society.”
—The WPATH Files report
“WPATH has broken the chain of trust in gender medicine,” the report asserts. It “presents itself as scientific but is, as the files reveal, an advocacy group promoting risky, experimental, and cosmetic procedures in the guise of well-researched and ‘medically necessary’ care.”
Mr. Shellenberger’s team has provided WPATH and its members who were named in the report with the chance to respond to its contents. Only one WPATH representative responded, and with legal threats. Members have reportedly been advised by the organization not to speak about the report publicly. WPATH has not denied the authenticity of the leaked communications.
The WPATH Files report includes the full names of quoted people who are in the organization’s leadership. It redacts names of others who are less prominent in WPATH and simply describes their professional position and location in a general way. For example, there are several references to an activist and law professor with no medical training at the University of Alberta.
What Do WPATH Members Say in Private About Gender-Transition Treatment?
The WPATH Files quote WPATH members saying:
Gender-transition treatment is at least sometimes given to those with at best a limited capacity to consent, including parents consenting on behalf of their children despite not understanding the implications of treatment
Treatment can have serious side effects
Minors often do not, or cannot, understand the long-term risks or treatment implications
Detransitioning is often conceived of as trivial by WPATH members
WPATH physicians are quoted discussing serious adverse events in patients following gender-transition treatment and surgeries, including:
Liver masses and cancer
Erections “feeling like broken glass”
Pelvic inflammatory disease
Pain with orgasm
Bleeding after sex
Thomas Satterwhite, a California surgeon, describes surgeries he has conducted—for non-binary people in particular—to create bodies with no natural equivalent, including:
Mastectomies without nipples
Vaginoplasties (the creation of a vagina) that leave the penis
Genital nullification (a lack of genitals)
In the following exchanges, one WPATH surgeon sought advice from other members within the internal message forum on whether to perform a gender-transition surgery on a 14-year-old patient. Dr. Christine N. McGinn replied that she’d performed about 20 vaginoplasties on minors over two decades. Dr. McGinn said that she had battled her hospital to do more of these operations where she deemed it “sound medical practice.”
A 2023 paper documented trends in sex-trait-modification surgeries in minors in the US. (I summarized the paper on Twitter.) Such surgeries are uncommon and are mostly mastectomies. The annual number was rising during the years leading up to the rash of state bans of such operations among minors.
These WPATH leaders suggested that minors often can’t understand the implications of medical transition:
Dr. Daniel L. Metzger, a Canadian endocrinologist
Dianne Berg, a child psychologist at the University of Minnesota and coauthor of the WPATH Standards of Care 8 child chapter
Dr. Christine McGinn, a plastic surgeon in New Hope, Pennsylvania.
Dr. Berg said that minors cannot consent to gender care. She further said during a videoconferencing panel with her WPATH peers:
“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 off for.”
—Psychologist Dianne Berg, WPATH member
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The report’s authors assert that WPATH follows “an unethical approach to consent among adults,” and that its members see as able to consent to gender-transition treatment adults with:
Dissociative identity disorder (a controversial diagnosis formerly known as multiple personality disorder)
Other severe mental health diagnoses
Homeless people with severe psychiatric diagnoses
What Does the WPATH Files Report Say About WPATH?
The report maintains a tone of indignant disdain and even horror regarding WPATH’s actions and how its internal discourse clashes with its public face. The text focuses overwhelmingly on potential harms of gender-transition treatment and not on potential benefits. The report characterizes the widespread adoption of such medical practices for minors and vulnerable adults as a “medical scandal” on par with the ultimately discredited use of lobotomies in the mid-20th century.
The report calls for “a national inquiry to investigate how activists with little respect for the Hippocratic Oath could have risen to such prominence as to set the Standards of Care for an entire field of medicine, leading to the medical abuse.”
“WPATH is held up as the source of all knowledge about gender-affirming care, but the scientific basis for their recommendations is exceptionally weak,” the WPATH Files report states. “The group exists solely to shield doctors from legal liability through the creation of guidelines it conveniently calls ‘standards of care,’ and to ensure insurance coverage.”
The report claims that WPATH values “patient autonomy over risk aversion” and “conceptualizes harm, as in ‘do no harm,’ as unfulfilled consumer desire.” The authors conclude: “This is a violation of medical ethics.”
The authors argue that health care providers should reject WPATH’s guidance and instead follow the systematic literature reviews from Sweden, Finland, England and Florida that found the evidence backing youth gender transition “insufficient and inconclusive.” In recent years, numerous European nations have moved to sharply restrict pediatric access to puberty blockers and cross-sex hormones to treat gender dysphoria.
An update of the British systematic literature review was published last month by German researchers, who concluded: “Current evidence does not clearly suggest that GD [gender dysphoria] symptoms and mental health significantly improve when [puberty blockers or cross-sex hormones] are given to minors with GD.”
Other Quotes From WPATH Members:
WPATH members, the report shows, repeat the common claim that prescribing puberty blockers or cross-sex hormones to gender dysphoric youths is life saving. Finnish researchers published a study last month that found no evidence to back this claim, as I reported for the New York Post.
Dr. Marci Bowers, president of WPATH, said that “acknowledgement that de-transition exists even to a minor extent is considered off-limits for many” in the trans community.
One researcher sought to reframe detransitioning as a non-negative outcome:
Jamison Green is a trans-rights activist, former WPATH president and a coauthor of a 2020 WPATH statement saying that in general, mental health and medical professionals do conduct evaluations of gender dysphoric youths before green-lighting gender transition treatment among them.
But in private, Mr. Green contradicted this:
WPATH leader Dianne Berg said she was “stumped” about how to communicate the risks of fertility loss to a gender dysphoric 9 year old.
Endocrinologist Dr. Daniel Metzger said gender-transition treatment is “to a degree robbing these kids of that sort of early-to-mid pubertal sexual stuff.”
The report argues that WPATH members are “improvising, experimenting without a structured framework” on trans-identified youths. WPATH president Dr. Marci Bower said in a 2022 forum, speaking about puberty blockers’ impacts, that the “fertility question has no research.”
A gynecologist told WPATH colleagues of a patient who after receiving a vaginoplasty, had prostate secretions leaking through the urethra. There’s no remedy for this, other WPATH members replied. A nursing lecturer who said she was “of trans experience” said to tell the patient to “enjoy the ride,” as it’s a sign of orgasm. “What’s not to like?” the NP said.
Surgeons often won’t perform elective surgeries on high-BMI patients given the associated risks. WPATH members, however, scoffed at such a barrier in their private forum, lambasting it as “systemic fat phobia.” WPATH member Dr. Scott Mosser, they noted, operates on people with a BMI up to 65.
In one WPATH message-board exchange, a Canadian nurse practitioner said she was struggling over whether a severely mentally ill patient should start cross-sex hormones. Dr. Dan Karasic, of the University of California, San Francisco, who was the lead author of WPATH’s Standards of Care 8 mental health chapter, scoffed at her hesitancy.
Endocrinologist Dr. Metzger portrayed young people as naïve about foreclosing on their ability to have biological children through gender-transition treatment.
Dr. Metzger acknowledged to his WPATH colleagues that suppressing the puberty of gender dysphoric natal boys at the onset of puberty prevents them from learning to masturbate and from thus producing a sperm sample to preserve.
The authors of the WPATH Files report say they could find only one instance in the leaked WPATH internal messages in which members expressed concern about the potential dangers and adverse effects of gender-transition treatment. This was regarding a trans female (a biological male) who wanted to lactate despite not having an infant to care for.
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Benjamin, thank you so much for all the work you do and your honesty. I am sorry for the abuse you take.....I see your twitter threads and the responses.
Thanks Benjamin. So much data to try to cover. You've done this well.