The WPATH Files

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{Michael Shellenberger @shellenberger | 04 March 2024}

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THE WPATH FILES

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:

[see VIDEO #1 at end of post]

Part I: Children and Adolescents

“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.”

[see VIDEO #2 at end of post]

“14 year old trans female who started transition since she was 4… wants to have Gender Affirming Surgery” [image]
 
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“I’ve recently received questions from an [‘Assigned Female At Birth’] pre-menarche 10 y/o patient about whether blockers will ‘stunt’ his growth…” [image]
 
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“It is very difficult to ask that they wait until age 16...” [image]
 
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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. [image]
 
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“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. [image]
 
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“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. [images]
 
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“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.”

[see VIDEO #3 at end of post]

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."

[see VIDEO #4 at end of post]

“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. [image]
 
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“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.”

[see VIDEO #5 at end of post]

“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. [images]
 
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Seven days later, a WPATH member asked Bowers to clarify. [image]
 
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“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. [image]
 
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[... continued with Part II in next post ...]


TWEETS WITH VIDEOS [hidden to save space]

 
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The WPATH Files: Part II

[... continued from Part I in previous post ...]

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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”? [image]
 
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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.’” [image]
 
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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” [image]
 
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“...I was surprised to find that several of my clients met criteria for dissociative disorders...” [image]
 
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“Someone can have schizophrenia and be ready for surgery…” [image]
 
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“...I have noted a high incidence of dissociative disorders...” [image]
 
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“I have operated on three DID [Dissociative Identity Disorder] patients... All three did okay out to the six month mark....” [images]
 
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“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...” [image]
 
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“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." [image]
 
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[... continued with Part III in next post ...]
 
The WPATH Files: Part III

[... continued from Part II in previous post ...]

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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. [images]
 
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“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. [image]
 
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“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. [images]
 
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“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.”

[see VIDEO #6 at end of post]

“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.

[see VIDEO #7 at end of post]

/END


TWEETS WITH VIDEOS [hidden to save space]

 
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.

The WPATH Files
Pseudoscientific surgical and hormonal experiments on children, adolescents, and vulnerable adults
https://environmentalprogress.org/big-news/wpath-files
{Mia Hughes | 04 March 2024}

Leaked files from WPATH reveal widespread medical malpractice on children and vulnerable adults at global transgender healthcare authority.

World Professional Association of Transgender Health (WPATH) members demonstrate a lack of consideration for long-term patient outcomes despite being aware of the debilitating and potentially fatal side effects of cross-sex hormones and other treatments

READ: THE WPATH FILES AND REPORT

Press Release: JDA Worldwide for Environmental Progress

March 4, 2024

Newly leaked files from within the leading global transgender healthcare body have revealed that the clinicians who shape how “gender medicine” is regulated and practiced around the world consistently violate medical ethics and informed consent. The files, which were leaked from within the World Professional Association for Transgender Health (WPATH), were published today by the US-based think tank Environmental Progress.

WPATH is considered the leading global scientific and medical authority on “gender medicine,” and in recent decades, its Standards of Care have shaped the guidance, policies and practices of governments, medical associations, public health systems and private clinics across the world.

However, the WPATH Files reveal that the organization does not meet the standards of evidence-based medicine, and members frequently discuss improvising treatments as they go along. Members are fully aware that children and adolescents cannot comprehend the lifelong consequences of “gender-affirming care,” and in some cases, due to poor health literacy, neither can their parents.

“The WPATH Files show that what is called ‘gender medicine’ is neither science nor medicine,” said Michael Shellenberger, President and founder of Environmental Progress. “The experiments are not randomized, double-blind, or controlled. It’s not medicine since the first rule is to do no harm. And that requires informed consent.”

The raw files have been published in a report called The WPATH Files: Pseudoscientific surgical and hormonal experiments on children, adolescents, and vulnerable adults, which contains analysis by journalist Mia Hughes that puts the WPATH Files in the context of the best available science on gender distress.

Environmental Progress has made all files available to read at the end of the report. The leaked files include screenshots of posts from WPATH’s internal messaging forum dating from 2021 to 2024 and a video of an internal panel discussion. All names have been redacted other than several WPATH members of public significance, such as Dr. Marci Bowers, an American gynecologist and surgeon who is the President of WPATH, and the Canadian pediatric endocrinologist Dr. Daniel Metzger.

In the WPATH Files, members demonstrate a lack of consideration for long-term patient outcomes despite being aware of the debilitating and potentially fatal side effects of cross-sex hormones and other treatments. Messages in the files show that patients with severe mental health issues, such as schizophrenia and dissociative identity disorder, and other vulnerabilities such as homelessness, are being allowed to consent to hormonal and surgical interventions. Members dismiss concerns about these patients and characterize efforts to protect them as unnecessary “gatekeeping.”

The files provide clear evidence that doctors and therapists are aware they are offering minors life-changing treatments they cannot fully understand. WPATH members know that puberty blockers, hormones, and surgeries will cause infertility and other complications, including cancer and pelvic floor dysfunction. Yet they consider life-altering medical interventions for young patients, including vaginoplasty for a 14-year-old and hormones for a developmentally delayed 13-year-old.

The WPATH Files also show how far medical experiments in gender medicine have gone, with discussions about surgeons performing “nullification” and other extreme body modification procedures to create body types that do not exist in nature.

A growing number of medical and psychiatric professionals say the promotion of pseudoscientific surgical and hormonal experiments is a global medical scandal that compares to major incidents of medical malpractice in history, such as lobotomies and ovariotomies.

“Activist members of WPATH know that the so-called ‘gender-affirming care’ they provide can result in life-long complications and sterility and that their patients do not understand the implications, such as loss of sexual function and the ability to experience orgasm,” Shellenberger said. “These leaked files show overwhelming evidence that the professionals within WPATH know that they are not getting consent from children, adolescents, and vulnerable adults, or their caregivers.”

Environmental Progress has written to every WPATH member named in the files, as well as additional members whose names have been redacted, to confirm their comments and offer a right of reply. Two people responded – one confirmed that the comments attributed to them were correct, and another did not deny their comments but refuted Environmental Progress’ interpretation of them. Mention of Environmental Progress’ outreach to members via email was then later seen in the form of comments on WPATH’s internal messaging forum.
 
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