🚨BREAKING: Unsealed documents in suit over Alabama pediatric gender-transition treatment ban reveal inner workings of @WPATH
One exhibit is an export report by Canadian sex researcher @JamesCantorPhD, who has served as a paid expert testifying in favor of state bans.
See: 🧵
Cantor provided redacted internal @WPATH communications that portray the trans medical-activist group as bending the science to suit the narrative when drafting the Standards of Care 8 (SoC8), and in particular to aid in lawsuits and battles against unwanted state legislation.
"WPATH views evidence-based medicine as an obstacle to its policy goals, rather than as an important tool to beneficent health care for patients," @JamesCantorPhD writes.
WPATH members acknowledge that in developing the SoC8 guidelines for trans care:
▶️They didn't use the GRADE system to evaluate the quality of evidence.
▶️They are "painfully aware of the gaps in the literature."
▶️They acknowledge that the "policy changes" in Europe, Australia and New Zealand (restricting access to pediatric gender-transition treatment) pose a "threat to our assertion that the WPATH SOC are the Gold Standard used around the world."
▶️Chair of the SoC8 Steering Committee Dr. Eli Coleman sees as adversaries skeptical academics and scientists who pressure "health care to provide evidence-based care." This suggests, Cantor asserts, that Dr. Coleman sees evidence-based medicine itself as a threat, and thus does not see SoC-8 as evidence based.
Jesse Singal reports about Rachel Levine's efforts to get @WPATH to remove minimum age restrictions on pediatric gender-transition treatment and surgeries, as revealed in @JamesCantorPhD's expert report, just unsealed:
In the wake of an Oct 2021 @TheFP article by @AbigailShrier that quoted then-head of USPATH Erica Anderson saying that some gender care providers were providing "sloppy" care of minors, some @WPATH members acknowledged the veracity of her claim, per internal communications:
James Cantor quotes internal @WPATH communications indicating members' concern about a lack of evidence backing their Standards of Care 8 guidelines for trans care. They expressed concern about responding to critics such as @SEGM_EBM. They also don't have evidence for what type of psychosocial assessments are helpful, which is in keeping with @Jack_Turban's suggestion in his new book, Free to Be, that such assessments should be done away with for accessing puberty blockers.
Internal @WPATH communications suggest that "a global consensus" on the use of puberty blockers to treat gender dysphoria in adolescents "does not exist."
James Cantor writes about @WPATH internal communications: "Members of the Guideline Development Group expressed the view the SoC8 was endorsing a 'lax approach' to approval of [gender-transition] surgery that represented 'bad medicine."
These are quotes from WPATH members:
The Social Contagion Debate:
James Cantor writes: "Members of the [@WPATH] Guideline Development Group agree with me that adolescents may mistakenly come to believe that they are transgender due to 'social factors' and immature 'decision making'." Below are WPATH internal comms:
WPATH members' comments on social contagion, cont:
"Members of the [@WPATH] Guideline Development Group were sharply critical of the @AmerAcadPeds and positions it pressed WPATH to adopt in SoC8," writes @JamesCantorPhD.
▶️Criticizing the 2018 AAP policy statement on the gender-affirming care method as the work of "a few friends."
▶️The AAP guidelines (they're actually not guidelines, it's just a policy statement) "have a very weak methodology."
As @JesseSingal reported, the @AmerAcadPeds put pressure on @WPATH during the drafting processes for the 2022 Standards of Care 8:
"@WPATH documents reveal that the SoC8 development process was extensively influenced by factors other than medical science, including political pressure, litigation and legislative advocacy strategy, and the financial self-interest of WPATH members," @JamesCantorPhD writes.
At one point, a @WPATH member appears to suggest that during debates over the drafting of the Standards of Care 8 (SoC8) on transgender care, they sought to aid the efforts of @ChaseStrangio, who heads the trans litigation team at the @ACLU:
"Members of the @WPATH Guideline Development Group went so far as to explicitly advocate that SoC8 be written to maximize impact on litigation and policy even at the expense of scientific accuracy," @JamesCantorPhD writes.
"@WPATH made changes to the SoC8 for the explicit purpose of minimizing members' risk of malpractice liability," @JamesCantorPhD writes.
"After @WPATH removed age minimums after finalization and publication of SoC8 and without scientific justification, it fabricated a false explanation for public consumption," @JamesCantorPhD writes.
The @AmerAcadPeds issued an ultimatum to @WPATH: Delete the minimum age requirements for gender-transition treatment of minors or the AAP would both withhold endorsement of the Standards of Care 8 and also publicly oppose the SoC8, per internal WPATH communications:
How, @JamesCantorPhD asserts based on internal communications, @WPATH went about fabricating an explanation for why it removed all minimum age requirements for pediatric gender-transition treatment in the SoC8:
"WPATH did not even alert Soc8 committee members about, nor ask questions that would identify, direct financial conflicts of interest, or intellectual conflicts of interest," @JamesCantorPhD asserts, based on internal @WPATH communications.
One WPATH member wrote on his conflicts disclosure form: "Everyone involved in SOC process has a non-financial interest," meaning an intellectual conflict of interest. "Yet," @JamesCantorPhD writes, "WPATH assured the public that no conflicts of interest existed."
How sex researcher James Cantor produced his damming report on @WPATH's inner workings:
▶️The Alabama attorney general, in the dispute in the federal court system over the state's pediatric gender-transition ban, subpoenaed internal WPATH communications on the development of its Standards of Care 8 (SoC8) guidelines on trans care, published in 2022. They reportedly received millions of pages of documents from WPATH in response.
▶️@JamesCantorPhD, who has been a paid expert witness in multiple states testifying in support of state bans on pediatric gender-transition treatment, received documents generated by this subpoena, which otherwise remained under seal, on Sept. 7, 2023.
▶️Cantor wrote a report on those documents and submitted it on Feb. 2, 2024. He told me: "I wrote it for the court, on behalf of the legal team representing the state, acting in the public’s best interests."
▶️Cantor's report, catalogued in this tweet thread (see the tweets above), was unsealed on June 25. I obtained it from the AG's office.
▶️The original source material remains under seal, but according to the AG's office more documents from the subpoena will be unsealed soon; so it could become available.
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Clara Jeffery, editor in chief of Mother Jones, says that it is for the best that JD Vance’s children be subjected to boos at Disneyland, so that they “know now what their father is about.”
Debunking podcaster Michael Hobbes also endorses the jeers at @JDVance’s family at Disneyland.
Clara Jeffery, editor in chief of Mother Jones, adds the following to her post endorsing the jeering of @JDVance while he is with his children at Disneyland. She argues that he actually wants the optics of being booed while having family time in public. bsky.app/profile/claraj…
Democrats Lost Voters on Transgender Rights. Winning Them Back Won’t Be Easy.
The party’s vanguard position got ahead of voters in 2024, and the internal debate now underway reveals an uncertainty on how to adapt, by @chashomans for @nytimes.
"Stuck in a widening gulf between the views of the party’s liberal voters and advocacy organizations on one side, and those of the broader American electorate on the other, many Democratic politicians had resolved to say as little as possible about the subject. In surveys, Ms. Erickson and other public-opinion researchers had found that this allowed Republicans, who spent hundreds of millions of dollars on ads attacking Democrats on transgender rights in 2024, to define voters’ perceptions of Democratic policy positions."
The dilemma is reflective of the Democratic Party’s broader struggles with identity politics as it dissects its losses in 2024. Recovering its standing with voters, many in the party believe, requires coming to terms with the party’s transformation during the Obama and first Trump presidencies, when American liberals broadly embraced what had previously been vanguard positions on a range of social and cultural issues, including gender and race, immigration and policing.
Dr. Rachel Levine, a former Biden administration health official, tells @TheAdvocateMag that "the evidence base is strong for the safety and efficacy" of prescribing puberty blockers and cross-sex hormones to treat gender dysphoria in minors.
A slew of systematic literature reviews have found this is not the case. Instead, they have found that the relevant evidence is weak and inconclusive. They have suggested that the World Professional Association for Transgender Health erred in making strong recommendations for these treatments. Evidence-based medicine guidelines discourage making a strong recommendation based on weak evidence.
Despite subpoenaed email records showing that Dr. Rachel Levine pushed WPATH to remove age limits on pediatric gender-transition treatments and surgeries for political reasons, Dr. Levine denied ever having done so in an interview with @TheAdvocate.
The New York Times reported last year: nytimes.com/2024/06/25/hea…
One excerpt from an unnamed member of the WPATH guideline development group recalled a conversation with Sarah Boateng, then serving as Admiral Levine’s chief of staff: “She is confident, based on the rhetoric she is hearing in D.C., and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out.”
Another email stated that Admiral Levine “was very concerned that having ages (mainly for surgery) will affect access to care for trans youth and maybe adults, too. Apparently the situation in the U.S.A. is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them.”
Debunking podcaster Michael Hobbes has a new episode of his podcast If Books Could Kill, about the US v. Skrmetti Supreme Court decision upholding Tennessee's ban on pediatric gender-transition treatment.
Michael Hobbes, referring to a video, published in 2022 by @MattWalshBlog, of a Vanderbilt doctor talking about the money that gender-transition surgeries bring in, including bottom surgeries: “Bottom surgeries are essentially not performed on children," Hobbes says. "So the fact that she's talking about bottom surgeries here makes it very clear that she's talking about adults.”
This depends on your definition of "essentially." Phallopasties are not recommended by @WPATH for minors, but vaginoplasties are. Dr. Marci Bowers, a gender-affirming surgeon and a former WPATH president, recommends that trans girls get a vaginoplasty the summer before they leave for college, when they are 17 or 18.
A 2023 paper on a limited dataset of US minor patients did find evidence of one vaginoplasty in 2021. This suggests that if the study authors had access to all records in the nation, they would identify more such surgeries in minors.
Consequently, Hobbes is incorrect to presume that the Vanderbilt doctor was not referring to minors in the speech that Walsh published. It is entirely possible she was.
If, for the sake of argument, no one can prove that pediatric gender-transition treatment prevents suicide death only because such deaths are so rare, then why has this treatment been sold, first and foremost, as “lifesaving”?
Why have people who have called that claim into question been savagely attacked and sidelined?
Marci Bowers, former head of WPATH, herself told me last year that suicide death has never been a good metric of the success of this treatment.
Debunking podcaster Michael Hobbes is himself one of the prime sources of misinformation about pediatric gender-transition treatment. He has routinely falsely claimed that there is no evidence that children get these drugs after absent or cursory assessment periods. There is copious evidence that this happens routinely at some of the top gender clinics in the nation. Despite all this evidence, Hobbes has never acknowledged his fault.
But you can see here that he is combining his longstanding claim about assessments with a claim about what he characterizes as false claims that there are large numbers of kids getting these drugs. That question should not necessarily be conflated with the assessment question.
About 1 in 1,000 youth with private health insurance went on cross sex hormones by age 17 between 2018 and 2022. That number was higher for natal girls and was probably higher for all youth by the end of that period.
One thing that has concerned some people is not necessarily the number of kids getting these drugs, but the rate of increase of that number. They have been concerned over where that figure might end up.
If suicide deaths are so rare even in youth with gender dysphoria, then why have leading gender clinicians routinely told parents that absent blockers and hormones, their child was extremely likely to wind up dead? That’s what the mantra “Would you rather have a dead son or a live daughter?” implies. We now know from the leading litigator in this field that that threat was a false one, at the very least in the suggestion of how likely suicide death was in the first place.
Debunking podcaster Michael Hobbes, a prime source of misinformation about pediatric gender-transition treatment, slams @HelenLewis of @TheAtlantic for criticizing people such as him.