Oregon Is Writing Gender Policy with Blinders On
As Europe runs from WPATH, Oregon runs toward it
The day before Election Day, Oregon released a “Notice of Proposed Rulemaking,” related to their House Bill 2002. An NPRM is a document that both outlines a government agency’s new or changed regulation, and sets a deadline for public comment on it—in this case, that deadline is November 25.
HB2002 “prohibits a carrier offering a health benefit plan from denying or limiting coverage for medically necessary gender-affirming treatment that is prescribed in accordance with accepted standards of care.” [Emphasis mine.]
The NPRM focuses on just what those “accepted standards of care” should be, and who creates them.
In America, there is no standard agency to turn to for such matters, and certainly no impartial body. You might assume standards of care are decided by, say, medical associations. But medical associations are actually lobbying and advocacy groups that represent the interests of the professionals they charge for membership. Their goals are to get as many paying members as possible, and to maintain their power and reputations—not to provide the best, evidence-based, and safest treatment to patients. In a country with very little centralized control over health insurance and healthcare, individual governments or in courts of law may be deciding those standards—drawn from groups that might not have the best interests of patients in mind.
In the case of Oregon, lawmakers want the standards of care to be determined by The World Professional Association of Transgender Health (WPATH)—specifically their “Standards of Care 8,” or SOC8.
A bit about WPATH: Until 2007, the group was known as the Harry Benjamin International Gender Dysphoria Association. It was funded by a trans man named Reed Erikson and named after an endocrinologist who’d once pedaled phony testosterone rejuvenation treatments. Later, he found a demand for his hormone supply: trans women. He treated Christine Jorgenson—who’d flown to Copenhagen for sex-change surgery and returned stateside to a flurry of media attention—and the many others who desired cross-sex hormones after. When Erikson’s funding dried up, the group reinvented itself, and not just in name: it went from being led by clinicians to being led by British legal scholar and trans man Stephen Whittle, WPATH’s first president.
All this is to say that, from its inception, WPATH was more an advocacy group than a scientific one—even more so than medical associations.
And for what do they advocate? SOC8 famously nixed a chapter on ethics, but added one on “eunuch gender identity,” citing as sources websites for eunuch fetishists. Meanwhile, these so-called standards were supposed to suggest when kids could get what interventions. As I wrote for The Free Press back in 2022:
Last December, WPATH released draft guidelines, which included minimum age recommendations for life-changing treatment, including age 14 for receiving estrogen or testosterone (the previous WPATH standards had been age 16), and allowing minors to have mastectomies (which the guidance often calls “chest-masculinization surgery”) beginning at age 15, and vaginoplasty and hysterectomy at 17.
The official guidelines were then released online to the public September 15. Within hours, a major correction was appended that said that the recommended age minimums were being removed from the final document. It turns out that between the draft release and the final version, WPATH had backtracked on providing age minimums, preferring to leave decisions to practitioners.
Many of us wondered why those age limits were removed, until various lawsuits against gender-affirming care bans revealed the truth. It turned out that Biden appointee, Assistant Secretary for Health Dr. Rachel Levine, had pressured WPATH to remove those limits—because it wasn’t good for politics, and might give leverage to those pushing bans on gender medicine.
WPATH, meanwhile, had contracted Johns Hopkins University’s Evidence-Based Practice Center to conduct systematic evidence reviews of “gender-affirming care.” They turned up “little to no evidence about children and adolescents”—a finding they shared with HHS’s Agency for Healthcare Research and Quality, which repeated it.
Perhaps unsatisfied with that result, WPATH then censored Johns Hopkins, preventing them from publishing the unfavorable reviews, and went on to write their 8th “standards of care” without them. Also revealed: almost everybody writing them had serious conflicts of interest.
The Cass Review, the world’s most comprehensive document about gender-affirming care, found that WPATH’s SOC8 lacks “developmental rigor.” This was a document largely designed to appease activists and protect the clinicians who serve them. It is not scientific. It is not evidence-based. It is not acceptable.
Except, that is, in Oregon, where the proposed rule states: “‘Accepted standards of care’ includes, at a minimum, the World Professional Association for Transgender Health's Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (WPATH-8).”
Not only that, but “The rule mandates that health care providers reviewing adverse benefit determinations denying or limiting access to gender-affirming treatment complete the ‘WPATH SOC-8 Health Plan Providers Training,’ which is specifically designed for providers responsible for such reviews, or an equivalent training,” their notice reads. That’s right, providers will have to pay WPATH for training, too—before they can turn anyone or anything down. (If anyone has taken such a training, I’d love to hear from you.)
Countries like Finland, Sweden, and England have run from WPATH, creating their own, more rigorous and evidence-based guidelines based on the systematic reviews that WPATH censored. Oregon is running toward WPATH.
You may also recall that Oregon tied gender-affirming care to abortion in law, making it impossible for Democrats to object to one without objecting to the other. And that they rejected an amendment that would cover detransition care—which was proposed by a Republican. Democrats should be in the midst of a massive soul-searching after the election. They forfeited their title to the party of science, the party of kindness and compassion, the party of the big tent. This proposed rule will only make it harder to get back.
I reached out to Oregon’s Department of Consumer and Business Services, which is handling the matter, but they didn’t respond.
You need not live in Oregon to submit public comments until November 26th, so please do. You can write to the Rules Coordinator Karen Winkel at karen.j.winkel@dcbs.oregon.gov. Subject line: Public Comment opposing 2025 Gender-Affirming Treatment Rules
I suggest using Lisa's piece to craft your email. If helpful, here is what I wrote to her, thanks to a notice from the LGBT Courage Coalition yesterday. (The hyperlinks don't stay in the cut and paste, but not the most important thing). Some parts I just used their sample letter, such as the Insurance Commissioner promising that detransitioners needs would be addressed, but I assume that is accurate.
Dear Karen Winkel:
I’m writing to submit a public comment to Oregon’s Insurance Commissioner about his proposed rules on gender-affirming treatment.
If enacted, these rules would be harmful to Oregonians. They would prevent ethical medical practitioners from providing the best support to their patients by forcing them to adhere to unscientific and harmful ideological guidelines.
These new rules are not informed by scientists or public health experts, but by activists with extreme and unpopular agendas. They go well beyond what the legislature authorized last year in HB2002.
While HB2002 simply required insurers to cover “medically necessary” care prescribed by a licensed provider and deferred clinical questions to the medical community, the Insurance Commissioner’s proposed rules go much further. They define “accepted standard of care” as adhering to WPATH-8, a controversial document developed by transgender rights activists. As covered in the New York Times, Economist, The BMJ, and a briefing filed by the Alabama Attorney General with the US Supreme Court, WPATH-8 is heavily influenced by a radical political agenda.
WPATH, the organization which created these "standards of care," has been increasingly discredited as an authoritative source for policy direction. It is a grave mistake to follow their guidance as a lode star for gender-distressed people. Too many have already been harmed by WPATH's "guidance." As an example, in WPATH-8 there are no mandated age limits for surgeries and medicalization for gender distressed youth. WPATH-8 also removed a section on ethics and included a section on "Eunuch Gender Identity."
Neither the Insurance Commissioner nor his staff possess any medical expertise or licensure. Their agency regulates financial institutions, not healthcare. Furthermore, no licensed health care professionals were included on the advisory committee that helped draft these rules – rules that now define a legally binding clinical standard of care for the practice of medicine regarding individuals experiencing gender distress.
In addition, while the Insurance Commissioner promised the legislature that he would use this new law to require insurers to pay for “detransition” services, the proposed rules are completely silent on this issue. Further, no detransitioners were included in the advisory group that helped write the rules.
Please research WPATH further before putting the lives and well-being of Oregonians at risk. Please talk to detransitioners and listen to their stories. Do not implement these rules as they stand.
I appreciate your consideration of this matter.
This is excellent Lisa. In particular this piece provides an informative, well-researched review of the background on WPATH that should be tremendously helpful for those who are not yet conversant with these issues, which is, unfortunately, still far too many people. I hope it will be widely read and shared.