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.
“The White House issued a rare rebuke of Brazil Tuesday for banning the country’s residents from accessing X in a free-speech struggle with the platform’s billionaire owner Elon Musk.”
Finally!
Yes, this is real
“When it comes to social media, we have been very clear that we think that folks should have access to social media. It’s a form of freedom of speech,” White House press secretary Karine Jean-Pierre said in response to a press-briefing question from reporter Raquel Krähenbühl of Brazil’s TV Globo.
Wow — massive free speech victory! Europe’s top censor has quit. This comes a few weeks after he got in trouble for sending an open letter to Elon Musk claiming his upcoming interview with Donald Trump might violate Europe’s censorship laws.
Here’s the backstory, including media coverage about how @ThierryBreton got in trouble with his colleagues in Brussels. I don’t know that he quit because of this but it may be that @vonderleyen and others felt he had become a liability in their crusade to censor the Internet:
@ThierryBreton @vonderleyen In his letter, @ThierryBreton says that @vonderleyen asked France to withdraw Breton’s name as a nominee to serve five more years for “personal reasons.” 🤔
Brazilian President Lula and Supreme Court Justice Alexandre de Moraes say they must block X to protect Brazil’s independence. X is a platform for dangerous, false, and hateful words, they say, and many of those words violate Brazil’s laws and Constitution.
But their censorship goes far beyond what Brazil’s constitution allows. The government demanded that X and other social media networks censor and ban individual people, including journalists and politicians. Such bans are immoral, illegal, and unconstitutional. They constitute election interference and undermine democracy by preventing candidates from getting the word out.
I agree that lying is wrong, hate speech is ugly, and there are limits to freedom of speech. We must not allow people to use words that directly result in physical violence.
But everybody lies, everybody engages in hate speech, and the limits to free speech must never include elections. Imagine what would happen if it were illegal to lie: everyone should go to prison starting with the journalists and politicians. As for hate speech, did Lula express hatred when he praised Adolf Hitler? Does he not express hatred every time he speaks of Elon Musk and Jair Bolsonaro?
People blame speech for the chaos of January 6 in the United States and January 8 in Brazil. But the events of those days resulted from inadequate security, not anything anyone said online. And if the government can censor disfavored election information, how would anyone ever know if the government stole an election?
Democracy and secure elections depend on freedom of speech. The idea that we must censor speech to protect democracy ranks with other Orwellian ideas like “War is peace” and “Slavery is freedom.” For thousands of years, democracy and freedom walk hand in hand, as do censorship and dictatorship.
Everybody knows in their heart that censorship is wrong. We all know that we are imperfect and do not know everything. We know that we rely on others to discover the truth. Why, then, do so many people want censorship?
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The Washington Post has been attacking @elonmusk for years for not censoring more. Now, amazingly, it is praising him for standing up Brazil’s dictator.
“Whatever the threat to democracy that the accounts Mr. Moraes wanted gone might have posed, the threat from one government official limiting the speech of 220 million people is greater.”
“Taken together with Mr. Moraes’s choice to freeze the assets of internet-provider Starlink, a separate company of Mr. Musk’s, this move aligns Brazil not with the free world but with the likes of China and Russia.”
Thousands of Brazilians are resisting the order by the Dictators Moraes and Lula. They include journalists and Senators from Left, Right, and center. And people in the federal capital, Brasilia, are able to access X without VPN. Moraes’ immoral censorship crusade is doomed.
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.