The Scandal Goes All the Way to the White House—But It's Deeper than Levine

What the NYT left out

Flickr/Ted Eytan/Creative Commons license

I’ve been told this post, written in haste, reads a little like Inside Baseball. So here’s a short summary:

WPATH, the group that has appointed itself the creator of guidelines for trans people and youth with gender dysphoria, hired Johns Hopkins to conduct systematic reviews (SRs) for its revised standards of care (SOC8). When WPATH didn’t like the conclusions of the unbiased SRs, they forced Johns Hopkins to suppress them. The HHS knew this. Then WPATH published SOC8, claiming they couldn’t conduct evidence reviews, but asserting that studies supported these interventions. Every gender-distressed young person, every parent, was lied to—with the collusion of one of the most venerable academic institutions; the advocacy group that sets the standard; and the federal government. They were told these interventions were evidence-based and lifesaving, safe and effective, and none of it was true.

The American Academy of Pediatrics and Dr. Rachel Levine, Asst. Secretary of Health, then pressured WPATH to hurry the release of the not-evidence-based SOC8 and insisted that they remove all age limits for surgeries—not because the science held up, but because they wanted to protect against lawsuits and political backlash.

Democrats, this is your off-ramp.

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Last night, I had drinks with a friend I hadn’t seen in a long time, determined not to talk about The Issue. But a few minutes before I arrived, I found out that The New York Times had decided not to publish a part of a story about the World Professional Association for Transgender Health—an advocacy group that creates “standards of care” for trans medicine, which American medical groups avow to adhere to (they don’t) and claim are evidence-based (they aren’t).

That part of the story would have discussed recently unsealed WPATH documents, subpoenaed by the state of Alabama, as part of a lawsuit, Boe v. Marshall. Alabama parents, medical providers, and a Birmingham pastor named Paul Eknes-Tucker sued the state because of its ban on “gender-affirming care” for minors—and the criminalization of those who practice it.

We got a sneak peak of some WPATH internal communiques a few weeks ago, when the advocacy group Do No Harm shared emails between Johns Hopkins and the federal Health and Human Services’ Agency for Healthcare Research and Quality. AHRQ had been asked to conduct a systematic evidence review on “gender-affirming care,” and knew that WPATH had hired Hopkins researchers to conduct such a review. Maybe they could share?

The emails show that Hopkins did conduct a systematic review, and that—like all the other SRs—it found diddly squat in terms of evidence supporting the efficacy of hormones and surgeries. That is, the evidence was mostly low or very low quality, meaning no proof of benefits could be drawn from studies or mapped onto the larger population.

But WPATH prevented Johns Hopkins from publishing these reviews because they didn’t come to WPATH’s preferred conclusions. WPATH hid this very important information from the entire world, then published standards of care saying an evidence review was impossible. And a government agency knew this!

We are talking about kids and the most invasive possible interventions here. We are talking about venerable academic institutions and government agencies and censorship and secrets.

Turns out, there’s a whole heckuva lot more of these damning emails. The New York Times had access to them but chose not to cover them. A source told me this is because no one from Johns Hopkins would comment on the record. The documents will be available via the LGBT Courage Coalition tomorrow (I will add a link and start a thread when it’s up), but I had a chance to preview them. If you have not yet had what GIDS whistleblower Anna Hutchinson called her “holy fuck!” moment, now’s the time.

An executive summary of the docs tells us:

WPATH leadership went to great lengths to suppress systematic reviews (SR) commissioned from Johns Hopkins because the reviews’ conclusions did not support the WPATH plans to recommend wide access to hormones and surgeries for all those who desired them. The evidence suppression was achieved via a 2-prong strategy. First, WPATH forced JHU to withdraw the manuscripts that were already submitted for publication as they did not meet the desired conclusions. Next, WPATH instituted a new policy whereby WPATH would have to approve all future publications by JHU.

More on the policy:

WPATH developed an approval checklist, which required that the authors must have the “intention to use the Data for the benefit of advancing transgender health in a positive manner,” the content approval must involve SOC8 chapter leads, and the review must include “at least one member of the transgender community in the design, drafting of the article, and the final approval of the article.”

Two levels of WPATH approval were required before JHU could submit a publication: first, the proposal which includes the conclusion had to be approved; and then, the actual manuscript draft, with WPATH retaining the rights to alter content.

Only the reviews passing both levels of approval could be submitted by JHU for publication—and they had to carry a specific disclaimer that “the authors are solely responsible for the content of the manuscript, and the manuscript does not necessarily reflect the view of WPATH in the publication.”

Can you believe the John Hopkins folks agreed to this? This is not science. WPATH is not credible. And this is why we in America are the outliers: we’re not basing guidelines on systematic reviews, or reality. We’re basing them on an activist group’s political agenda, and even the HHS knows there’s no good evidence. In fact, AHRQ was asked to review guidelines for treating gender dysphoric youth back in 2020, because, the request said:

There is a lack of current evidence-based guidance for care of children and adolescents who identify as transgender, particularly regarding the benefits and harms of pubertal suppression, medical affirmation with hormone therapy, and surgical affirmation. While these are some existing guidelines and standards of care,2, 5-6 most are derived from expert opinion or have not been updated recently so a comprehensive evidence review is currently not available.

What did AHRQ decide, after communicating with the Hopkins researchers?

The EPC Program will not develop a new systematic review because we found protocols for two systematic reviews that addresses portions of the nomination, and an insufficient number of primary studies exist to address the remainder of the nomination.

Basically, they said someone was already doing it, and there wasn’t enough evidence to sort through. But the someone already doing it had already agreed to put science aside and only discuss benefits, not harms.

How could a federal agency abdicate its responsibility? Wouldn’t you know it, the Assistant Secretary for Health for Health and Human Services (HHS) is Dr. Rachel Levine. And as the NYT did report, and as I summarized briefly in The Free Press this morning, Levine pressured WPATH to remove age restrictions from guidelines—not based on science, again, but on advocating for Levine’s own trans community.

It’s officially a scandal now, and it goes all the way to the White House. Holy fuck.

Needless to say, I was not able to ignore The Issue at drinks.