The Leaked WPATH Files Expose The Pseudoscience Of Transgender Care

“Transgender care” has meant a lot of different things over the years. Gender dysphoria, or someone’s feeling that they were born in the wrong sex body, has historically been treated like a mental health condition rather than an identity. Due in large part to political and ideological developments, these days, medical treatment for gender dysphoric patients focuses more on aligning their bodies with their minds rather than their minds with their bodies, which has ushered in a new era of medicine, mostly reliant on new and experimental surgeries and treatments.

The World Professional Association for Transgender Health, known as WPATH, is one of the most prominent transgender care nonprofits in the world. The organization is responsible for publishing the standards of care for transgender health, meaning it’s ultimately the professional center calling the shots for the care that patients with gender dysphoria receive worldwide. WPATH has largely claimed to have a monopoly on evidence-based care, resulting in a medical system that marginalizes doctors who try to care for patients in ways that try to cure them of gender dysphoria rather than affirming it. Recently, though, leaked files from within the organization have revealed that the leading experts may not be entirely positive about what they’re doing to patients after all.

Files Leaked

WPATH frequently calls its standards of care evidence-based, leaning on a public persona of medical professionalism to act like the final authority in the transgender health space. Unlike most international medical governing bodies, though, the organization is mostly social justice activists, not doctors and researchers. Now, recently leaked communications from inside WPATH show that the people within the organization know that the authoritative front they’ve been showing the world is hiding a lot of uncertainty.

Michael Shellenberger, an award-winning journalist whose work has mostly centered around environmental policy, recently worked to leak files of messages and other communications from within WPATH message boards. Shellenberger, who’s historically been pretty left-leaning and a self-identified Democrat for the majority of his career, is now calling the treatment exposed by the leak the “greatest medical mistreatment scandal in recorded human history. Worse than lobotomies. Worse than Tuskegee.” 

The WPATH files detail the lack of informed consent from patients and the willful lack of evidence-based treatment from practitioners. 

Shellenberger admits that even he was surprised by what he learned in the leak. “It’s pretty shocking,” he says. “You don’t need to be an expert in medical science to read these conversations and come away absolutely shocked at the things they’re describing, how they’re sort of making it up as they go along.”

Informed Consent Issues

The WPATH files, which include almost 250 pages of content, detail the lack of informed consent from patients and the willful lack of evidence-based treatment from practitioners in WPATH’s network. WPATH advocates for transgender care for minors, promoting things like puberty blockers and cross-sex hormones to delay puberty and align children's bodies with their expressed preferences, while stressing the need for consent from children and their families for these medical interventions. The only problem? It seems like most children don’t really know what they’re consenting to. 

In the files, one doctor on a WPATH panel expressed his frustration about trying to get children to grasp what they were doing to their bodies, simply due to the medical complexity of it all. On the panel, he reminded his fellow doctors that they are often describing potential interventions to “people who haven’t even had biology in high school yet,” saying that it’s often even tough for adults to understand what they’re getting into with “gender-affirming care.” He describes kids thinking that they get to pick and choose which effects of hormones to receive, like biological girls hoping that testosterone can give them a lower voice but not chest hair, and says that he often struggles to explain to children that even though they might not feel binary, “hormones are binary.” The doctors admitted that even parents might not understand what they’re consenting to for their children, saying, “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.”

Medical Experimentation

Informed consent gets even murkier given the fact that even doctors aren’t entirely sure of the long-term effects on patients’ health. Since it’s not possible to actually change someone’s sex medically, the care that patients are receiving involves long-term hormonal and surgical interventions that leave them dependent on the medical system to maintain their state. Most of these procedures are considered experimental, since there’s not enough medical literature established to validate their long-term use. Drugs are used off-label every day, which isn’t inherently an issue, but the WPATH files show that doctors are concerned that the side effects might be more serious than previously thought – and more destructive than children are able to grasp.

WPATH already requires its doctors to warn children that cross-sex hormones can cause them to be infertile. Unfortunately, the files show that their own doctors realize that children aren’t fully capable of grasping what that means for the rest of their lives. One doctor, expressing his hesitations about cross-sex therapy, explained in a WPATH panel that many patients are too young to even know whether they’d like to be parents some day: “It’s always a good theory that you talk about fertility preservation with a 14-year-old, but I know I’m talking to a blank wall. They’d be like, ew, kids, babies, gross.” 

All personal clinical experience indicated that boys who have their puberty blocked at the beginning of pubertal development are completely unable to orgasm for life.

The files also show emerging research that many transgender patients have reproductive regret later on, which doctors say they aren’t surprised by after following their own patients into adulthood. “I think now that I follow a lot of kids into their mid-twenties, I’m like, ‘Oh, the dog isn’t doing it for you, is it?’” one recalled, “They’re like, ‘No, I just found this wonderful partner and now want kids.’”

Loss of fertility isn’t the only long-term complication, either. Since puberty blockers are being administered earlier and earlier, doctors are beginning to realize that many patients are actually rendered permanently unable to orgasm. In the files, the WPATH president admits that all personal clinical experience up to that point indicated that boys who have their puberty blocked at Tanner Stage 2, the beginning of pubertal development, are completely unable to orgasm for life. While WPATH does get written consent for these procedures, can it really be argued that children are able to grasp what it means to never be able to orgasm? Early puberty blocking also complicates surgical interventions, since the patient’s reproductive organs end up stunted, not giving doctors enough to work with. This trend is part of the reason that surgeries like phalloplasties end up with complication rates for as high as 76% of the patients who endure them.

Time for Changing Tides

While it may be too late for many of the children left infertile, disfigured, or otherwise permanently affected by the medical practices encouraged by WPATH, the fact that the doctors leading transgender medicine seem to be backtracking could be a cause of optimism. WPATH is in over its head and seems to be privately aware that its practices breach medical ethics and informed consent, which we can only hope will spell the beginning of the end for ideologically-driven medical experimentation on children.

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