‘Affirmation at All Costs’: What Internal Files Reveal About Transgender Care

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Recently released files from the World Professional Association for Transgender Health (WPATH) show a lack of informed consent and scientific evidence.

The battle over transgender care continues as a new report published by Environmental Progress (EP) highlights the potential dangers of “gender-affirming” medical care, based on internal files from the World Professional Association for Transgender Health (WPATH).

Michael Shellenberger, independent journalist and founder of EP, posted on X that WPATH’s internal files “reveal that its members know they are creating victims and not getting ‘informed consent.’”
The 242-page report by EP journalist Mia Hughes includes unedited content from WPATH over the past four years, an introduction from Mr. Shellenberger, and commentary and analysis of the internal WPATH files. Leaked discussions show doctors, therapists, social workers, and activists discussing specific cases and sharing advice on how to treat youth and adults with gender dysphoria.

In the report, Ms. Hughes states that the organization has abandoned the Hippocratic Oath to “do no harm.” She details how she believes WPATH has misled the public and why it should not be considered a medical or scientific group but rather an advocacy group.

Sounding the Alarm on ‘Gender-Affirming Care’

The report supports those who have been sounding the alarm on “gender-affirming care” and the movement against prescription hormones and life-altering surgeries for children under the age of 18. According to the World Health Organization (WHO), “gender-affirming care” encompasses a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity,” particularly when it conflicts with their biological sex.

Mary Margaret Olohan, a reporter for the Daily Signal who spoke to multiple detransitioners for her upcoming book, “Detrans: True Stories of Escaping the Gender Ideology Cult,” believes the WPATH files vindicate those who were pushed toward “gender-affirming care” by doctors and therapists at a young age.

Ms. Olohan told The Epoch Times, “[Destransitioners] have been saying for so long that these surgeries and hormones are experimental, that the doctors are aware that they’re experimental, and that the doctors don’t know what to do to help them once they are trying to detransition.”

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She said the WPATH files prove this and demonstrate that the so-called experts who encompass WPATH are “figuring it out as they go.”

Dr. Miriam Grossman, a psychiatrist focused on gender distress in children and adolescents and senior fellow at an organization called Do No Harm, contests that WPATH is not a medical organization yet has convinced the world that it is the gold standard when it comes to the treatment and care of gender-confused individuals, particularly youth.

“WPATH presents its approach to patients, parents, and providers as the only valid, evidence-based option, yet its recommendations have been formally rejected by Sweden, Finland, Norway, and Britain and questioned by medical groups in France, Australia, and New Zealand,” she writes in her book, “Lost in Trans Nation.” Indeed, many of the countries listed have reversed course on the “gender-affirming” model and are now preventing children from obtaining puberty blockers, cross-sex hormones, or invasive medical procedures.

In her book, she claims that WPATH operates with the goal of “affirmation at all costs” and is blinded by an ideology that rests upon research that is “inherently flawed or very low-quality.”

The Epoch Times reached out to WPATH for comment but did not receive a reply by press time.

Lack of Informed Consent

Of particular concern for many lawmakers and parents is the internal footage of a WPATH panel titled Identity Evolution Workshop, held on May 6, 2022, in which panel members discuss how difficult it is to get proper informed consent from young patients, especially when they do not yet have a strong understanding of human biology. Ms. Hughes claims that WPATH knows children do not understand the effects of hormone therapy and accuses it of placing adolescents “on a medical conveyor belt.”

There has been a rise in gender dysphoria diagnoses among patients ranging from 6 to 17 years of age. In 2021, about 42,000 children and teens across the United States received a diagnosis of gender dysphoria—nearly triple the number in 2017, according to data health technology company Komodo Health Inc. compiled for Reuters. At least 121,882 children in the same age range were diagnosed with gender dysphoria from 2017 through 2021. A report from the University of California–Los Angeles in 2022 states that approximately 300,000 children ages 13 to 17 identify as transgender.

The inability of young people to understand the full consequences of their decisions is “one of the most alarming things in the WPATH files,” Dr. Grossman told The Epoch Times. She pointed to a portion of the released workshop video in which Dan Metzger, an endocrinologist at British Columbia Children’s Hospital, talks about the difficulty of discussing preserving fertility with children during a WPATH panel discussion, which followed another panel member’s mention of puberty blockers.

In the video, Dr. Metzger says he is aware that many who undergo treatment in their youth come to regret their decisions when they are older and unable to have children.

Dr. Grossman shared: “You would think that they would then say, ‘Well, wait a minute. Should we really be doing this? Should we really be sterilizing these young kids?’ But no. They don’t. They just say, ‘Well, we want to keep the kids happy in the moment.’”

Dr. Grossman said she finds it chilling that her colleagues pursue a path of treatment without regard to the age of the child or lack of ability to offer informed consent.

The Link Between Mental Health and Gender Dysphoria

Those who suffer from gender dysphoria are often diagnosed with underlying mental health conditions. “It goes without saying that we have to first examine the mental health of these individuals who have intense dysphoria or discomfort with their bodies,” said Dr. Grossman.

In the leaked files, one member of WPATH stated, “trauma is common among trans clients” and that she had patients who presented with dissociative identity disorder (DID) or other specified dissociative disorder (OSDD) symptoms who “didn’t speak on the issue with other social services.”

When asked why the first line of defense for those suffering from gender dysphoria, particularly children, isn’t mental health doctors, Dr. Grossman said she believes that members of WPATH have compromised both the psychiatric and medical governing bodies.

“When [those seeking treatment] go to their pediatrician, the pediatrician is going to trust the American Academy of Pediatrics, but the American Academy of Pediatrics—their guidance and their views on this topic—are straight from WPATH, and WPATH is not a medical organization.”

She continued, “It’s a corrupt advocacy organization of activists that want to push this.”

What Changes Are Needed for Transgender Care?

Some contest that the released WPATH files are not as damning as others claim.

“There are aspects that don’t shine a particularly good light on WPATH, but I also don’t think this is the scandal EP is making it out to be,” said Julia Malott, a National Post columnist who identifies as transgender.

Ms. Malott told The Epoch Times, “I want to see changes. I think WPATH should take this seriously, and they should learn from it, and they should question whether or not they’re balanced and whether they’re getting enough perspectives, and I hope that we do see some changes from this.”

But Ms. Malott is concerned about the demonization of WPATH as if it offers no value. Gender dysphoric people do exist, she said, and the elimination of WPATH could mean the end of necessary care and support for that minority group.

“The path forward that we need is for WPATH to be balanced.” Ms. Malott asks: “Are they providing guidance that is holistic in its approach and really is guarding for the best outcome for anyone who is gender dysphoric?”

Ms. Olohan and Dr. Grossman don’t believe WPATH can offer the science-based, unbiased approach to gender care necessary to protect children from irreversible harm.

“A happy middle would be doctors who aren’t afraid to be looking for the facts and the science rather than the doctors that are taking their talking points from leftist, activist groups and then trying to fit the science in there,” said Ms. Olohan. “I would love to see an organization that includes researchers from both sides of the aisle.”



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