The NHS expresses concern over alarming revelations from the U.S. gender group WPATH, as highlighted by Hannah Barnes.

March 10, 2024

The NHS expresses concern over alarming revelations from the U.S. gender group WPATH, as highlighted by Hannah Barnes.

WPATH does not serve as a benchmark in the pursuit of evidence-based care for transgender children.

The medical transition of children has emerged as one of the most contentious and divisive issues in contemporary times, viewed by some as a medical scandal and by others as life-saving treatment. The recent leak of hundreds of messages from an internal forum of doctors and mental health professionals associated with the World Professional Association for Transgender Health (WPATH) has generated significant interest. WPATH positions itself as an "interdisciplinary professional and educational organization dedicated to transgender health" and is notably responsible for developing standards of care (SOC) that claim to reflect a "professional consensus" on the optimal approach to assisting individuals with gender dysphoria.

Despite its expansive title, WPATH is not exclusively a professional organization, as a considerable portion of its membership consists of activists. Furthermore, it does not represent a universally accepted global perspective on the best practices for caring for this demographic. The leaked messages, collectively referred to as the "WPATH files," paint a disconcerting picture. In a video, doctors acknowledge that some patients may be too young to fully grasp the implications of puberty blockers and hormones on their fertility. A Canadian endocrinologist candidly remarks, "It's always a good theory that you talk about fertility preservation with a 14-year-old, but I know I'm talking to a blank wall."

Dr. Marci Bowers, the president of WPATH, offers insights into the repercussions of early puberty blocking on sexual function in adulthood. In her statement, she mentions, "To date, I'm unaware of an individual claiming the ability to orgasm when they were blocked at Tanner 2," with Tanner stage 2 marking the onset of puberty, which can occur as early as nine years old in girls.

In other discussions within WPATH, there are remarkable deliberations on how to handle "trans clients" diagnosed with dissociative identity disorder (formerly known as multiple personality disorder), particularly when "not all the alters have the same gender identity." Surgeons explore procedures leading to bodies that defy natural norms, such as those with both sets of genitals undergoing "phallus-preserving vaginoplasty," double mastectomies lacking nipples, and "nullification" surgery resulting in smooth skin devoid of genitals. Additionally, doctors engage in discussions about the potential correlation between hormone intake and liver cancer in 16-year-old patients. The concern here lies not solely in the nature of the discussions but in the organization's lack of transparency when communicating publicly.

WPATH's perspectives hold significance for the UK, as the organization and its Standards of Care (SOC) have long been referenced as a benchmark for "best practice" in trans healthcare by various medical entities, including the British Medical Association and the General Medical Council, a stance that continues. The Royal College of Psychiatrists also incorporates WPATH into its own recommendations for care.

WPATH holds a significant role in the prevailing service specifications governing youth and adult gender clinics in England and Scotland, being cited as "good practice." However, it's noteworthy that the current specifications reference WPATH's previous Standards of Care (SOC). The most recent SOC eliminates age restrictions for hormone and surgical interventions at the beginning of puberty, except for female-to-male genital surgery, and includes a chapter on eunuchs.

Notably, numerous staff members at England's NHS adult gender clinics, including a former president, are not only WPATH members but also contributors to the current SOC. This includes individuals like Susie Green, the former head of the youth charity Mermaids, indicating that a lack of medical expertise does not hinder membership or policymaking influence within WPATH.

The sole NHS children's gender clinic in England, the Gender Identity Development Service (Gids) at London's Tavistock and Portman NHS Foundation Trust, is set to close in March. Despite its cautious approach compared to other WPATH practitioners, the 2016 service specification guiding Gids aligns with WPATH 7. Concerns have been raised about referrals for puberty blockers for young people claiming multiple personalities or identifying with another race.

While Gids staff have participated in WPATH conferences for a decade, the recent dissociation of NHS England from WPATH's guidelines contradicts the Department of Health's assertion that the NHS moved away from WPATH guidelines more than five years ago. Updated guidance for new youth gender services, effective April 1, omits mention of WPATH, and NHS England emphasizes that WPATH's views are irrelevant to the core recommendation that puberty blockers will no longer be part of routine clinical practice.

The ongoing debate on the best approach to care for gender-questioning children and young people has led some European countries to adopt a more cautious, less medical stance. NHS England asserts alignment with the independent Cass review's recommendations and the ability to formulate policies based on clinical evidence and expertise. However, challenges lie ahead, with professionals in gender services considering pushback against the yet-to-be-published final recommendations of the Cass review.

Gids faced challenges resisting external pressures, resulting in a decline in the quality of care it provided. Simultaneously, NHS England fell short in fulfilling its responsibility for adequate oversight. To prevent the repetition of past mistakes, both Gids and the administrators of new services must improve their practices. Without clear, evidence-based guidance on what constitutes good practice, organizations like WPATH will persist in wielding influence.

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