Advocates of gender-affirming care say it’s evidence-based.
But now, newly released internal files from the World Professional Association for Transgender Health (WPATH) prove that the practice of transgender medicine is neither scientific nor medical.
American Medical Association, The Endocrine Society, the American Academy of Pediatrics, and thousands of doctors worldwide rely on WPATH. It is considered the leading global authority on “gender medicine.”
And yet WPATH’s internal files, which include written discussions and a video, reveal that its members know they are creating victims and not getting “informed consent.”
Victims include a 10-year-old girl, a 13-year-old developmentally delayed adolescent, and individuals suffering from schizophrenia and other serious mental illnesses.
The injuries described in the Files include sterilization, loss of sexual function, liver tumors, and death.
WPATH members indicate repeatedly that they know that many children and their parents don’t understand the effects that puberty blockers, hormones, and surgeries will have on their bodies. And yet, they continue to perform and advocate for gender medicine.
The WPATH Files prove that gender medicine is comprised of unregulated and pseudoscientific experiments on children, adolescents, and vulnerable adults and will go down as one of the worst medical scandals in history.
Why I Am Publishing The WPATH Files
The written WPATH Files come from WPATH’s member discussion forum, which runs on software provided by DocMatter.
Ninety seconds of the 82-minute video was made public last year. We are making the full video available for download for the first time.
One or more people gave me the WPATH Files, and my colleagues and I attempted to summarize them as a series of articles. We quickly realized the topic was too sensitive, complex, and large to be dealt with as a work of journalism, and we moved the project to the research institute I founded seven years ago, Environmental Progress (EP).
The Files are authentic. We redacted most names and left only those individuals who are leading gender medicine practitioners to whom we sent “right-of-reply” emails. We know WPATH members discussed our emails internally. No WPATH leader or member has denied that the Files are anything other than what they appear to be.
EP is publishing a 70-page report to provide context for the 170 pages of WPATH Files. Mia Hughes is the author of the report. It and accompanying summary materials can be downloaded at this link. That link also provides a link to the full WPATH video.
What follows are simply a few highlights from the written files and the video. All video selections are also included in the video above.
People with a serious interest in the topic should read the report and all the files.
Part I: Children and Adolescents
“We're explaining things to people who haven't even had biology in high school…”
“I think the thing you have to remember about kids is that we're often explaining these sorts of things to people who haven't even had biology in high school yet,” says Dan Metzger, an endocrinologist.
“The 14-year-olds, you just... It's like talking [about] diabetic complications with a 14-year-old. They don't care. They're not going to die. They're going to live forever, right? So I think when we're doing informed consent, that's still a big lacuna.”
“14 year old trans female who started transition since she was 4… wants to have Gender Affirming Surgery”
There are other discussions of the challenge of getting informed consent from 14-year-olds in the written files.
“I’ve recently received questions from an [‘Assigned Female At Birth’] pre-menarche 10 y/o patient about whether blockers will ‘stunt’ his growth…”
“It is very difficult to ask that they wait until age 16”
WPATH members resist efforts to make children and adolescents wait to have drugs and surgery.
A “16 y/o patient…found to have two liver masses… the likely offending agents were the hormones…”
The problem is that drugs can cause tumors, even, apparently, in people as young as 16 years old.
“To what degree… providers discuss actual rates of surgical complications… (e.g., pain…additional surgeries, necrotic tissue, infection, hematomas…”
Many young patients experiencing gender distress do not appear to understand that they may suffer serious consequences from long-term hormone use and genital surgery.
“I feel the best time for surgery in the U.S. is the summer before their last year of high school.”
Despite the widespread and growing expression of concern within the WPATH Files over the negative side effects of gender medicine, WPATH members urge that irreversible surgeries take place when adolescents are just 16 or 17 years old.
“Most of the kids are nowhere in any kind of brain space to really talk about it seriously.”
One WPATH member says, in the video above, that “It's out of their developmental range sometimes to understand the extent to which some of these medical interventions are impacting them.“
Says another, “We try to talk about it, but most of the kids are nowhere in any kind of a brain space to really, really, really talk about it seriously.”
Many Parents Don’t Understand What’s Happening To Their Children
“I try to kind of do whatever I can to help them understand best they, best I can,” says a therapist in the video. “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.
“In a developmentally delayed 13yo… what is the ethical approach?”
The situation of obtaining informed consent is complicated further when the adolescents are also developmentally delayed and, in the case below, “may not reach the emotional and cognitive developmental bar set” by WPATH’s already very low standards of care.
“Oh, the dog isn’t doing it for you?”
Many gender medicine victims are filled with regret that they were sterilized. Nobody knows this more than the doctors who mistreated them. Their response to such regret is often rather callous.
In the video above, one of them says, “I follow a lot of kids into their mid twenties, I'm always like, ‘Oh, the dog isn't doing it for you, right?’ They're like, ‘No, I just found this wonderful partner and now we want kids. So you know, it doesn't surprise me.”
“I’m unaware of an individual claiming ability to orgasm when they were blocked at Tanner 2.”
Many gender medicine patients lose sexual function, including experiencing orgasm. As such, they are not only deprived of sexual pleasure, they are significantly undermining their ability to form long-lasting romantic relationships.
It’s clear from the Files that even many people within gender medicine do not understand this.
On January 14, 2022, the surgeon and President of WPATH, Marci Bowers, explained this reality in a low-key way.
Seven days later, a WPATH member asked Bowers to clarify.
“After 8-10 years of [testosterone, they] developed hepatocarcinomas…linked to hormonal treatment. He was in his midlife…died a couple of months after.”
For some gender medicine patients, there are fates worse than both sterility and loss of sexual function.
Part II: Mental Illness
“A Patient Who Became Dangerous”
On an unknown date, a San Francisco-based surgeon named Thomas Satterwhite posts an urgent new message to WPATH’s internal message board. “I had a patient who became dangerous/threatening to our care team post-op,” he wrote, “which ultimately ended in a restraining order.”
Satterwhite explained that “This patient had undiagnosed mood disorders that did not surface until post-op, after which, she travelled around the country to find other surgeons to provide care.”
It’s a chilling story and one that raises many questions about the ethics and legality of gender-affirming medicine. At the top of that list is how in the world did Satterwhite and his colleagues miss the fact that the person they operated upon had a serious psychiatric condition?
But Satterwhite had a more prosaic question. What was the best “medicolegal” way that he could warn other doctors and health care providers that his former patient was “potentially dangerous”?
There is no evidence in the WPATH Files, nor elsewhere, that the experience shook Satterwhite enough to question whether gender-affirming care is, in reality, medicine, a profession that begins with the promise to “First, do no harm.”
The History Of Mistreating Mental Illness
Nations have struggled to care properly for people with mental illness and psychiatric disorders for centuries.
After every past scandal, we pledge to do better next time, relying more on science than ideology.
Readers of the WPATH Files may walk away with the sense that we have learned nothing.
Repeatedly throughout the WPATH Files, we see gender medicine practitioners waive away evidence that mental illnesses and psychiatric disorders have been misdiagnosed as gender dysphoria.
The WPATH Files are a picture of people single-mindedly committed to the hammer of gender medicine and thus seeing every patient who comes to them as a nail.
“Disordered eating,” “purposeful malnutrition,” and a “high prevalence of eating disorders”
A therapist raises concerns in a message about the age of a patient. “I have an incoming 13yo (soon to be 14 yo)... I was under the impression that is more the exception to start for kids under 16, not the norm…”
But the person has another piece of troubling information.
“A possible complication,” the therapist warns, is that it “sounds like there is some purposeful malnutrition and restrictive eating for ‘a more non-binary appearance.’”
The chief medical officer of a health center in Texas chimed in that the therapist had best hurry the 13-year-old teenager along the gender-affirming path because “waiting appears to increase the rate of suicide.”
“Something is off… I am wondering if they might have schizoaffective disorder or schizophrenia”
“Several of my clients met criteria for dissociative disorders.”
“Someone can have schizophrenia and be ready for surgery…”
“I have noted a high incidence of dissociative disorders”
“I have operated on three DID [Dissociative Identity Disorder]... All three did okay out to the six month mark.”
“In the last 15 years I had to regrettably decline writing only one letter, mainly b/c the person evaluated was in active psychosis...”
“They had alters who were both male and female gender and it was imperative to get all alters who would be effected by [Hormone Replacement Therapy]... to consent…”
Part III: Ethics
“I’m not aware of any other medical procedure that requires the approval of a therapist.”
Frequently, WPATH members push back against “gatekeeping,” including the requirement for sound mental health before undergoing a lifelong regime of drugs and surgery.
“If an individual patient feels that they made a mistake… be careful with that not letting that change the way others receive care.”
At times, WPATH members speak of the growing number of “detransitioners” who regret gender medicine.
Some gender medicine practitioners express less concern for the detransitioners than for the threat they may pose to gender medicine.
“Patients need to own and take active responsibility for medical decisions, especially those that have potentially permanent effects.”
There is evidence within the WPATH Files of WPATH members, as well as its president, Marci Bowers, blaming their victims.
“Those conversations can be ongoing even after the intervention has occurred.”
Readers of the WPATH Files may be struck, as we were, by how flexible WPATH members were in rationalizing their mistreatments.
Faced with rising amounts of regret and detransition, WPATH members describe what’s happening as a “gender journey” not a single “transition.”
And faced with their own failure to achieve informed consent, WPATH members re-frame it as a “process,” and an “on-going conversation,” in the video above.
Explains one, “...informed consent [is a]... process... not one conversation at one point in time ... those conversations don't have to stop once the Medicaid and intervention has been started. Those conversations can be ongoing even after the intervention has occurred.”
“What has been currently happening is, frankly, not what we need to be doing, ethically.”
The WPATH Files show WPATH members encouraging pseudoscientific mistreatments without achieving informed consent.
But some appear to be aware that they know what they’re doing is wrong.
In the video above, a therapist named Dianne Berg describes talking to parents after they meet with a doctor. “I would go in and I would say, ‘Okay, so tell me what you learned.’ They would just be like, ‘We have no idea what they were talking about.’
“Part of it is that they feel less deferential to the kind of doctor I am than the kind of doctor the medical doctor is. And because they really are seeking the care, they're just going to say they know when they really aren't picking up on what's happening.
“And so I think the more we can normalize that it is okay to not get this right away, that it is okay to have questions, is, you know, the more we're going to actually do a real informed consent process than what I think has been currently happening and that I think is, frankly, not what we need to be doing ethically.”
You can hear the power of Berg’s comments in the long and awkward pause that follows.
The WPATH Files