The panelists’ records appear to disqualify them under the WHO’s conflict-of-interest policies.
The panel convened by the World Health Organization to develop guidelines for “gender-affirming care” consists of individuals who have clear conflicts of interest that would appear to disqualify them under WHO policy, according to a National Review analysis of the panelists’ past publications and professional affiliations.
The WHO Guideline Development Group (GDG) tasked with establishing the influential public-health body’s policies on the “health of trans and gender diverse people” is almost entirely made up of activists who have extensive records of advocating a “trans-affirmative” approach that seeks to remove barriers to medicalization.
“The majority of the GDG clearly have strong, one-sided views in favor of promoting hormonal gender transition and legal recognition of self-asserted gender,” reads a January 4 letter by Reem Alsalem, United Nations special rapporteur on violence against women and girls, addressed to the WHO Director-General Tedros Ghebreyesus. “Of the 21 announced GDG members, not one appears to represent a voice of caution for medicalizing youth with gender dysphoria or the protection of female only spaces.”
WHO guideline-group policies bar the appointment of individuals who have “any interest” that could affect their objectivity, including “prior publication of a study or systematic review that is part of the evidence base under consideration in the guideline,” “prior public declaration of a firm opinion or position,” or affiliation with a relevant organization.
A number of proposed GDG members, those included on the original list released in June and those added in December, appear to violate those restrictions.
Florence Ashley, a self-described “biorg witch with flowers in their hair” and also a “transfeminine jurist, bioethicist, public speaker, and activist,” has argued that minors should have nearly unrestricted access to “gender-affirming care.”
“Due to trans youths’ unique knowledge of their gender identity and embodiment, fundamental components of their personal identity, parents and courts should only hold decisional authority in the rarest and most extreme of cases,” Ashley argued in a paper first published in 2022.
In another publication, Ashley wrote, “Unbounded social transition and ready access to puberty blockers [for “trans youth”] ought to be treated as the default option, and support should be offered to parents who may have difficulty accepting their youth.”
Ashley has written about undergoing facial feminization and vaginoplasty surgery.
“Boo, now I have to dilate four times a day and wash my coochie every single time afterwards, eating up half my day,” Ashley wrote in an article. “Dilating feels a lot like taking it up the ass, minus the fear of pooping everywhere.”
Ashley, whose name did not appear on an updated list of guideline-group members, claims to have voluntarily severed ties with the WHO.
“I withdrew for personal reasons that are unrelated to (and predate) conservative media flipping its sh**,” Ashley wrote on social media. Ashley did not respond to interview requests.
Several proposed panel members are affiliated with the World Professional Association for Transgender Health (WPATH), an organization whose vision is “a world wherein people of all gender identities and gender expressions have access to evidence-based health care, social services, justice and equality.”
WPATH board member Chris McLachlan, who self-identifies as “gender non-binary, trans masculine,” is among the seemingly compromised WHO guideline-group members. McLachlan’s publication “Que(e)ring trans and gender diversity,” which supports “gender-affirming” treatment, was cited in WPATH’s eighth edition of its “Standards of Care,” published online in 2022.
“As psychologists and their clients explore the gender binary, the psychologist can support clients’ coming into being through embracing their own gender identity,” reads McLachlan’s 2019 article. “Research indicates that through accessing gender affirming care, the trans and gender diverse client is able to alleviate gender dysphoria and live a more fulfilling life.”
Fellow WHO proposed guideline-group member Gail Knudson co-authored the WPATH’s seventh and eighth editions of “Standards of Care” and receives an honorarium as a co-chair of the WPATH Global Education Institute. Knudson currently serves on the International Medical Advisory Panel of the International Planned Parenthood Federation, which issued a statement in 2023 endorsing “gender-affirming” hormone therapy as “part of the affirmation of gender identity for many TGD [transgender and gender diverse] people,” adding that “providing this service assists them in realizing their sexual and gender rights.”
Walter Bouman, another proposed member of the guideline group, served as treasurer and then president of the WPATH. Bouman was an executive board member and founding board member of European Professional Association of Transgender Health from 2013 to 2017. The group issued a policy position in 2015 stating that “withdrawing care for all transgender youth or adults or threatening to criminalize conscientious healthcare providers who work with transgender patients or clients using evidence-based care is a clear abuse of administrative and legislative power.”
An anonymously drafted online petition urging the WHO to “go back to the drawing board” on its guideline-group has racked up nearly 12,000 signatures. The petition points out that three-fourths of the 21 guidance panel members are trans-identifying individuals, members of advocacy organizations, or members of the World Professional Association for Transgender Health.
“WHO has a responsibility to fully disclose and balance such conflicts among members to ensure they produce unbiased guidelines,” reads the petition. “There should be as many pro-affirmation individuals on the GDG as there are members concerned about its potential harms.”
Other proposed members of the guidance panel have extensive history as activists.
Yanyan Araña is described as “an empowered transgender woman” who is “continuously pushing for the inclusivity and accessibility of sexual, reproductive, and transgender health care.”
Araña previously worked at LoveYourself, a Philippines-based LGBTQ-advocacy organization that offers hormone-replacement therapy consultations and HIV-related treatments. Araña also served as “National Directress” of Miss Trans Global Philippines division, an international pageant for transgender women.
“I was a late bloomer. Years ago, I experienced depression, which I believed was due to identity crisis. [I was] questioning myself,” Araña said in an interview. “Then I realized that I wasn’t gay. I wasn’t fit to be gay. I started researching and learning things about transgender people. And by October 2015, I believed in myself that I am a woman. I felt I am a woman. Then I started taking Hormonal Replacement Therapy (HRT) as part of the transition process.”
Thoughtful Therapists, an organization of UK- and Ireland-based counselors, clinical psychologists, and psychotherapists sharing “concern about the impact of gender identity ideology on children and young people,” issued a statement criticizing the lack of “necessary breadth of expertise” on the proposed guidance group.
“A number of the panellists from the above countries specialise in HIV/AIDS prevention rather than transgender healthcare as such. In countries where homosexuality is criminalised, it is safer to be seen as trans than homosexual,” reads the statement by Thoughtful Therapists. “Whilst we understand the need to make access to health care for LGBT individuals easier in those countries where access is restricted because of discrimination, we feel that promoting gender affirming care is a dangerous approach. It can lead to ‘transing the gay away’ and does nothing to help lesbian, gay and bisexual individuals gain their human rights in the long term.”
Zakaria Nasser, another proposed GDG member, has been active in “trans and queer feminist organizing in Lebanon” for over a decade and co-founded Qorras, described as “a group producing queer feminist knowledge” that has received funding from the European Union. Nasser serves on the board of directors for Global Action for Trans Equality (GATE), which has argued that children should have access to “gender-affirming” care, including hormonal treatments.
“The problem is not that WHO invited people to the table who agree with the trans-affirmative approach for adults,” Leor Sapir, a researcher at the Manhattan Institute, told National Review. “The problem is that it assumed, through its selection of participants, that the only reasonable approach is the trans-affirmative approach.”
The WHO did not respond to a request for comment.
Prior to releasing the list of proposed guidance panel members, the WHO solicited advice from LGBTQ-advocacy organizations.
Global Action for Trans Equality (GATE), said in its 2022 annual report that it “participated and presented” in a “community consultation kick-off call” organized by the WHO for the production of “gender-affirming” care guidelines.
GATE, which has criticized the “anti-gender movement,” describes its organizational work as “advocacy, political mobilization, and campaigning” and aims for “ensuring access to legal gender recognition, and gender-affirming health care and coverage.”
The Society for Evidenced-based Gender Medicine (SEGM) issued a statement raising “concerns” that the WHO’s December announcement included “biased guideline panel composition, an inappropriately handled public comment period, and [a] rushed guideline development process overall.” The SEGM further argued that the several of the panel members violated the WHO’s standards for non-financial conflicts of interest.
“This biased panel composition where the majority of the GDG group have expressed one-sided strong opinions on the subject matter appears to be in contradiction of WHO’s own conflict of interest management policies,” the SEGM wrote.
Genspect, an organization that advocates “an evidence-based approach to gender-related distress,” issued a statement condemning the guidance group’s “inherent bias toward a single perspective” that is “contrary to many of the core principles of WHO guidance development.”
“WHO has a long history of being respectable and has really good guidelines about how to create panels. But they have broken their own rules,” Stella O’Malley, director and founder of Genspect, told National Review. “It’s unfortunate that they have chosen a very biased panel. There are no de-transitioners and no organizations represented who take something other than the affirmative approach.”
According to the WHO’s policies, not all members of a guideline-development group must be technical experts; the group may include “representatives of groups most affected by the recommendations in the guideline, such as service users and representatives of disadvantaged groups” because they “can assist the GDG in understanding the impact of the recommendations in real life” and ensure that “important aspects of the experience of illness are considered.”
While critics of the “trans-affirmative” approach remain troubled by the composition of the gender-guidelines group, many were pleased when the WHO stated in January that there is little evidence supporting “gender-affirming” care for minors and further clarified that the forthcoming guidelines would apply only to adults.
“The evidence base for children and adolescents is limited and variable regarding the longer-term outcomes of gender affirming care for children and adolescents,” reads an FAQ document from the WHO, released on January 15.
“It’s a very significant concession from the supposed global authority on medical guideline development,” Sapir told National Review.
In its January 15 update, the WHO confirmed that some of the criteria for selecting “technical experts” to serve on the guidance panel included “gender diversity” and “representatives of people affected by the guidelines.” The WHO further clarified that the list of panel members is not final and may undergo additional changes.
“What happens now is pivotal in how the WHO will manage gender issues in the coming years,” O’Malley told National Review.