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 WPATH 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. It will go down as one of the worst medical scandals in history.
Why I Am Publishing WPATH Files And How I Got Them
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 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 the link below. That link also provides a link to the full WPATH video.
What follows are simply a few highlights. People with a serious interest in the topic should read the report and all the files:
“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”
“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...”
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, “It's out of their developmental range sometimes to understand the extent to which some of these medical interventions are impacting them.”
“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 Will Happen To Their Children
“I try to kind of do whatever I can to help them understand best they, best I can,” says a therapist. “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. At times, their response to such regret appears callous.
“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… 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 posted 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 did Satterwhite and his colleagues miss the fact that the person they operated upon had a serious psychiatric condition?
But Satterwhite was focused on 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, committed to the maxim, “First, do no harm.”
Our Awful 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,” which is one of several pseudoscientific myths repeated within the WPATH Files.
“Something is off… I am wondering if they might have schizoaffective disorder or schizophrenia”
“...I was surprised to find that 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] patients... 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 and hallucinated during the assessment session...”
“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 be aware and consent to the changes."
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.”
“...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.”
As we saw above, many WPATH members waive away the evidence of medical mistreatment.
But others appear genuinely concerned by the lack of informed consent.
A therapist describes talking to parents after they meet with a medical doctor.
“I would go in, and say, ‘Okay, so tell me what you learned.’ They would 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 tell that her comment had an impact from the long and awkward pause that followed.
Unbelievable. President Lula’s own party, the PT, is breaking the law and posting on X. They are like the pig rulers from Orwell’s “Animal Farm.” The laws don’t apply to them. This is a what totalitarianism looks like.
The biggest media company in Brazil, Globo, which has been demanding censorship, is also breaking the law and posting on X. Globo is a state-funded propaganda network. Lula increased government funding for Globo by 60%. This is grotesque. Brazil’s elites are lawless.
Brazil President @LulaOficial says he respects free speech, the rule of law, and free markets, but he doesn't. @LulaOficial and @Alexandre de Moraes are about block X and have just frozen the bank accounts of @ElonMusk 's @Starlink . Both acts are flagrantly illegal..
Brazil is now a dictatorship. It is run by two men, President @LulaOficial and Supreme Court Justice @Alexandre de Moraes. They are today ending both freedom of speech and free markets. Brazil is no longer safe for foreign investment and its currency should reflect that.
When I first saw this story, I thought it was fake news, but it's accurate. The story is from Globo News, which received a 60% increase of government money under @LulaOficial , and Valdo Cruz is a reporter who is very sympathetic to Lula and De Moraes.
The media says @KamalaHarris is strong, intelligent, and democratic enough to be president of the US.
But she's apparently not strong, intelligent, and democratic enough to hold a press conference or have a serious sit-down interview with a journalist since announcing her candidacy five weeks ago.
Democrats and the media defend Harris. @JamesCarville said, “Where is it written that you have to sit down for a press interview?” He's right. It's not.
But that's because nobody ever thought it needed to be written down.
In a democracy, politicians talking to reporters and taking questions directly from the people is an unstated norm. This norm has existed since before our founding as a nation.
In fact, that norm is ancient. It has existed for thousands of years. And isn't it "norms" that the media and Democrats constantly accuse Trump of violating?
By not talking to the public or the press, Harris is behaving like a dictator. And those defending her behavior are defending the most authoritarian and undemocratic political campaign in American history, one that started with Harris being appointed, not elected.
In June, Carville attacked the media as not biased enough. "F— your objectivity," he said. "The real objectivity in this country right now is we’re either going to have a Constitution or we’re not.”
Who are the real tyrants here? The ones avoiding hard questions? The ones bullying reporters into being even more one-sided?
Harris is avoiding the press and the public because she's terrible at talking in an open and democratic way.
You might think, "She doesn't have to be good at thinking on her feet to be a good president."
But she does. How will she be able to confront Xi and Putin and other tough foreign leaders if she's not comfortable speaking on her feet, whether privately or publicly? And how would Harris be able to claim to represent the will of the people if her campaign consisted entirely of one-sided propaganda?
The purpose of democracy is for the people to decide. The people can't decide if they can't ask hard questions of the people who want to rule them.
As such, Harris's behavior and that of her media and party enablers are neither smart, courageous, nor democratic. Shame on everyone who is encouraging this farce of a "strategy" to continue.
This is the third time in three presidential elections that Democratic Party elites have subverted democracy to choose a presidential candidate.
Why? Because it's a party controlled by the media, donors, and the deep state, not the people. It's a party of the societal elites known as the professional-managerial class.
However, one feels about the GOP, the same can't be said for Republicans. Republican voters rejected their own party leaders, donors, and the foreign policy establishment to nominate Trump for president in 2016.
Democrats by contrast sided with the establishment candidate in choosing Clinton in 2016 and Biden in 2020.
Democratic Party elites have displayed authoritarian characteristics on COVID, climate change, and social media censorship. Progressive professionals treat their ideological and political views as settled science and demand that democracy defer to committees of credentialed experts.
They condemn Republicans as being in the grip of right wing authoritarianism. They are projecting. Research shows that it's progressive professionals who are highest in entitlement and grandiosity typical of narcissism and left wing authoritarianism.
They express their grandiosity when they claim to be saving democracy from Trump. They express their entitlement when they violate democratic norms to censor their opponents, manipulate elections, and attempt to incarcerate their enemies.
Now they are telling us that Kamala Harris should not have to speak to the people or to the press. It's disgraceful.
For now, we are still free. But Britain is imprisoning people for things they said online, censorship leaders are re-grouping in the U.S., and Brazil's government has forced X to close its office there. This is what the transition to global totalitarianism looks like.
Around the world, the crackdown on free speech is accelerating. In Britain, the courts are sentencing people to years in prison for things they posted on X, formerly Twitter. In the United States, the architects of the Censorship Industrial Complex are raising money for Kamala Harris in hopes of re-imposing government censorship on social media platforms after she wins.
And in Brazil, the government has forced X to end its operations after threatening to arrest X’s employees in Brazil if the company continues to refuse to permanently ban disfavored journalists, influencers, and elected political leaders from its platform. The Brazilian government may soon block access to X in Brazil, forcing its citizens to rely upon VPNs, or virtual private networks, in order to access X illegally.
On the one hand, none of these events appear to have anything in common. In Britain, there were riots triggered by misinformation that the killer of two children was an illegal immigrant. In the United States, the Censorship Industrial Complex emerged in reaction to the 2016 election of Donald Trump. And in Brazil, a single Supreme Court justice has taken it upon himself to demand extreme levels of censorship in reaction to the election of a populist president in 2018.
But at another level, all of these events are connected. Starmer, Harris, and Lula have all embraced the first and most important step toward totalitarianism, which is censorship. This is even more alarming given the events of the last few days, when Harris announced that she would seek price controls on food and a housing agenda that would significantly expand the role of the government without increasing supply.
I don’t think the labels of communist or fascist accurately describe the systems that Starmer, Harris, and Lula are creating. In some ways, those three leaders are drawing upon elements of both totalitarian systems. But trying to compare what’s happening now to what happened in the early 20th Century risks confusing us as to what is happening before our very eyes.
But I do think the label of totalitarianism is accurate to describe what these leaders are doing and where they appear to be headed.
Part of what’s so alarming about what they are doing is that they are melding together the demands of global capital and of Woke Leftists at the grassroots level. Both are driven by intolerance of free speech and free expression. Scarcely a day passes without the mainstream media attacking Elon Musk as a threat to democracy because he has allowed freedom of speech on X. Why are they doing that? Because the mainstream media are financed by and should be thought of as global capital’s marketing and propaganda operation.
And, as alarming, there is strong evidence that those leaders are and have been working together to impose a censorship industrial complex worldwide. Europe, Australia, and Brazil have all sought to ban and censor disfavored views and individuals not just in their home countries but worldwide. Over the last decade, these governments, politicians, and political parties have worked to coordinate their work at the United Nations, World Economic Forum, and other NGOs that operate across borders. And reporting by Public and others has uncovered collaboration between intelligence agencies in all three nations.
Media disinformation that populism poses a threat to democracy has increased the public’s support for online censorship. From 2018 to 2023, the share of Democrats who told Pew they wanted the government to engage in more censorship of disfavored online speech rose from 40% to 70%. An identical dynamic is occurring in Brazil and Britain, whereby the mainstream news media and Left-wing political activists have called for the censorship of their political enemies.
Friends, I’m sorry to say, but this is what the global transition to totalitarianism looks like. Big businesses, left-wing governments, and the legacy news media have made clear that they cannot tolerate free speech online. They grew accustomed to controlling public opinion first through the legacy media and then through Facebook, Google, and Twitter.
Global elites have made clear that they believe that freedom of speech on a single social media platform, and one that is far smaller than Facebook or Google, is intolerable. This desire for total control is the central characteristic of the totalitarianism that is presently emerging from elites at the corporate and political levels around the world.
In addition to pushing censorship, these leaders and global elites are seeking to overturn liberal democracies and impose a radically different system of iliberal rule in the Western world. Rather than meritocracy and equal justice for all, elites are seeking to impose a Woke racialist hierarchy that gives preferential treatment to some groups and prejudicial treatment to other groups supposedly based on historic oppression.
There are signs of hope. Recently, a group of censorsial advertisers called the group of advertisers, called the Global Alliance for Responsible Media (GARM) disbanded after X sued them.
But X cannot defend freedom of speech alone. We need a global free speech movement to defend our fundamental freedom against tyranny. If we lose free speech we will lose everything else, including our civilization. The step between censorship and price controls and shortages will be a very small one.
We are working with our allies around the world to raise the alarm. In June we gathered free speech advocates from the United States, Britain, Brazil, and other countries, and we are now working together on a combined effort to stand up for freedom and against the tyrants.
If you’d like to support our work, please subscribe now to Public. If you can do more than that, please consider a tax-deductible donation to support the free speech movement.
The moment we have been warning about is approaching more rapidly than any of us expected.civilizationworks.org/donate
Germany is on the brink of becoming a police state.
"The Federal Ministry of the Interior wants to give the Federal Criminal Police Office (BKA) the right to secretly enter and search homes. The draft reform of the BKA law provides for the authority to secretly enter homes as an accompanying measure to online searches and source telecommunications surveillance. The draft has been made available to SPIEGEL."