Leading Trans Medical Org Members Privately Voiced Concerns about Risks of Child Transition, Documents Reveal

Members of WPATH, the leading global medical organization devoted to transgender health care, have admitted privately that youth gender interventions are largely experimental and that minors struggle to give informed consent before undergoing the procedures, according to newly released internal documents.

The World Professional Association for Transgender Health (WPATH) advocates for minors to seek transition hormones and surgeries if they feel sure of their trans identity. Adolescents who have received a diagnosis of “gender incongruence” should have access to puberty blockers, cross-sex hormones, and surgeries so long as they demonstrate “the emotional and cognitive maturity required to provide informed consent/assent for the treatment,” WPATH recommends in its Standards of Care 8.

Multiple prestigious medical organizations follow WPATH’s guidance on youth gender transition. WPATH’s gender-affirmative standard of care has been endorsed by the professional medical organizations and agencies such as the American Academy of Pediatrics (AAP), the American Medical Association (AMA), the American Psychiatric Association, the American Academy of Child & Adolescent Psychiatry, the Endocrine Society, and the U.S. Department of Health and Human Services Office of Population Affairs.

While WPATH and the organizations that follow its lead unhesitatingly advocate for the medicalization of trans children, internal documents obtained by the nonprofit Environmental Progress reveal that WPATH members have acknowledged behind closed doors that young people often lack the health literacy and discernment to comprehend the gravity of the life-altering medical decisions they’re making and their possible ramifications, such as sterility, derailed sexual development, and general regret.

In an internal panel titled Identity Evolution Workshop held on May 6, 2022, WPATH member Dr. Daniel Metzger, a Canadian endocrinologist, explained the challenge of obtaining consent from youth “who haven’t even had biology in high school yet,” the documents show.

Many young people seeking medical interventions such as hormone therapy don’t understand that the injections cause irreversible physical changes that can’t be disaggregated, Metzger explained. Patients don’t always realize they can’t opt for a lower voice without facial hair, for example.

“It’s hard to kind of pick and choose the effects that you want,” Metzger said. “That’s something that kids wouldn’t normally understand because they haven’t had biology yet, but I think a lot of adults as well are hoping to be able to get X without getting Y, and that’s not always possible.”

Metzger said he has had to teach young people that their gender identity may not “be binary, but hormones are binary.”

“You can’t get a deeper voice without probably a bit of a beard,” and “you can’t get estrogen to feel more feminine without some breast development,” he said he’s explained to children.

During the panel, prominent WPATH member Dianne Berg, a child psychologist and co-author of the child chapter of Standards of Care 8, added that children lack the ability to “understand the extent to which some of these medical interventions are impacting them.”

In January 2022, WPATH president Marci Bowers said during a board meeting that the effects of puberty blockers on fertility and “the onset of orgasmic response” are not fully known. Boys who have their puberty blocked early can have “problematic surgical outcomes,” she said, and extreme difficulty climaxing.

On this “thornier” question, she said, clinical experience has shown that boys who have their puberty blocked at Tanner Stage 2, the beginning of pubertal development, “are completely unable to orgasm.”

“Clearly, this number needs documentation, and the long-term sexual health of these individuals needs to be tracked,” she said, indicating that the possibility of sexual dysfunction had not been thoroughly investigated before these procedures were widely prescribed to children.

WPATH has an internal messaging forum, where many conversations have taken place among WPATH members on the youth gender issue. Membership in the forum is open to professionals working in disciplines such as medicine, psychology, law, social work, counseling, psychotherapy, nursing, family studies, sociology, anthropology, speech and voice therapy, and sexology, WPATH states on its website.

In a discussion thread dated March 24, 2022, a nurse practitioner mentioned in the chat a female “young patient” who after three years of testosterone developed pelvic inflammatory disease and vaginal atrophy, a typically post-menopausal phenomenon that makes intercourse painful and can also lead to distressing urinary symptoms. Another commenter in the chat said that males they knew had similar discomfort and suffering. A registered nurse reported male patients who described erections as “feeling like broken glass.”

Some WPATH members have also recognized that the industry’s so-called treatment protocol may be correlated with advanced disease, like cancer. In December 2021, a doctor in the WPATH forum said that a 16-year-old patient had developed large liver tumors after being prescribed norethindrone acetate, which can serve as a puberty-blocker substitute, to suppress menstruation for several years and testosterone for one year.

“Pt found to have two liver masses (hepatic adenomas) – 11x11cm and 7x7cm – and the oncologist and surgeon both have indicated that the likely offending agent(s) are the hormones,” the doctor wrote.

Another doctor responded that a female colleague had a similar experience, developing hepatocarcinomas after eight to ten years of taking testosterone. “To the best of my knowledge, it was linked to his hormone treatment,” the doctor said.

Though it is the responsibility of parents to provide legal consent before a doctor can halt a child’s puberty or prescribe cross-sex hormones, parents are often just as clueless, Berg, the prominent child psychologist, said.

“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,” she said. The best approach, Berg said, is to “normalize” ignorance on the issue and encourage patients to ask questions so a “real informed consent process” can happen. The status quo of deferring to parents to do serious due diligence on behalf of the kids, Berg suggested, is “not what we need to be doing ethically.”

Despite the uncertainty among its members in the field, WPATH has publicly claimed that opposition to child sex-change operations and pharmaceuticals is a threat to transgender existence. The organization releases rare but urgent blanket statements that lack the nuance and caution that its affiliated members have shared behind the scenes.

“Anti-transgender health care legislation is not about protections for children but about eliminating transgender persons on a micro and macro scale,” Bowers said in a May 2023 statement.

In a recent statement opposing U.S. restrictions on the gender medicalization of minors, WPATH said, “the benefits that these medically necessary interventions have for the overwhelming majority of youth . . . are well-documented.”

Asked about the apparent incongruence between its public position and the hesitance its members express behind closed doors, Bowers, the WPATH president, defended the group’s work.

“WPATH is and has always been a science- and evidence-based organization whose recommendations are widely endorsed by major medical organizations around the world,” Bowers said in a statement.

“We are the professionals who best know the medical needs of trans and gender diverse individuals—and stand opposed to individuals who misrepresent and de-legitimize the diverse identities and complex needs of this population through scare tactics,” she added. “The world is not flat. Gender, like genitalia, is represented by diversity. The small percentage of the population that is trans or gender diverse deserves healthcare and will never be a threat to the global gender binary.”

Originally called the Harry Benjamin International Gender Dysphoria Association, which took a more balanced approach to assessing and treating youth gender dysphoria, WPATH by 2012 had descended into the aggressive gender-affirmation model. In 2010, WPATH demanded the “de- psychopathologization of gender variance worldwide” to characterize gender dysphoria not as a mental disorder but a normal variation in the human experience.

WPATH’s SOC7 pushed puberty blockers despite insufficient research and endorsed the “informed consent model of care,” which removes psychotherapy as a first resort and allows medical professionals to prescribe hormones at will. SOC7 then forced the conclusion that mental-health struggles in transgender people are a result of “minority stress,” or stigmatization by society, rather than underlying psychiatric problems.

A panel recently convened by the World Health Organization to develop guidelines for “gender-affirming care” consisted of several proposed members who are affiliated with WPATH, National Review reported last month.