The WPATH Files
Experts' secret admissions of uncertainty
Under the original Dutch protocol—the first set of guidelines for medically transitioning young people—kids with severe mental health problems were excluded from transitioning. This is partly why the initial data appeared to show good outcomes. Clinicians had narrowed the problem down—in theory—to distress about the sexed body. (Recent papers, however, have seriously questioned those outcomes.) Then again, those who started out high-functioning were relatively high-functioning after transition, so who knows how much of a role the meds played?
Since the rise of the affirmative model in the last 15 years or so, those limits on who can access care have largely vanished. Now, kids’ complex mental health problems are often seen as a result of gender dysphoria, rather than clinicians viewing gender dysphoria as a possible symptom of another mental health issue, or doing differential diagnoses to figure out what’s really going. Thus, say affirmative devotees, fixing GD will make those other problems fall away. That shift happened partly because of the push to destigmatize trans identities, the way homosexuality was (in theory) destigmatized—and because of the push to destigmatize mental health issues in general.
So what happened as a result of this zeitgeist shift? Short answer: chaos! Bedlam! Politicization! The upsidedown! And: diagnostic overshadowing, in which gender supersedes everything else, and affirming care is viewed as panacea, leaving other issues untended. (Long answer will be the book I’m writing now.)
All of this is background for the newly released “The WPATH Files: PSEUDOSCIENTIFIC SURGICAL AND HORMONAL EXPERIMENTS ON CHILDREN, ADOLESCENTS, AND VULNERABLE ADULTS,” a report by Mia Hughes, released by Michael Shellenberger’s nonprofit Environmental Progress, based on files leaked to him from WPATH insiders.
WPATH bills itself as the leading organization on transgender health, and government agencies look to it for guidance. They create what they call “Standards of Care,” which, as a doc on TikTok explains, help insurance companies and the government healthcare agencies decide what to pay for. As I wrote about for The Free Press, WPATH’s last iteration, SOC8, made suggestions about how to care for adolescents and kids, but in the end deferred to clinicians and patients, even removing almost all age requirements for puberty blockers, hormones, and some surgeries. I call this child-led medicine. They famously took out a chapter on ethics but left in one on eunuch gender identities.
The documents and videos in The WPATH files reveal inner communications from WPATH members that undermine a lot of their messaging about the medical interventions they support. They admit known unknowns and unknown unknowns about fertility, cancer, mental illness, detransition…and yet no matter what question they seek advice about from one another—schizophrenia, liver tumors, sexual trauma—the answer is always: affirm.
The goal of the release is to show that “the world-leading transgender healthcare group is neither scientific nor advocating for ethical medical care.” This is exemplified in a video in which clinicians discuss the challenge of prescribing hormones to kids who have no idea what those hormones are going to do. For instance, one therapist says:
“In general, you know, people want this, but they don't want this, but they want this, but they don't want this from a hormone, and I'm like, well, you know, you might not be binary, but hormones are binary, and so, you know, you can't get a deeper voice without probably a bit of a beard. It doesn't work that way, or you can't, um, you can't, uh, you know, get estrogen to feel more feminine without some breast development. It, that doesn't, that doesn't work very well.”
They admit that it’s impossible to get informed consent about effects on fertility because young people can’t understand what it is they’re giving up.
“[I]t's always a good theory that you talk about fertility preservation with a 14 year old, but I know I'm talking to a blank wall. And the same would happen for a cisgender kid, right? They'd be like, Ew, kids, babies, gross. Or, or the usual SPAC answer is I'm going to adopt. I'm just going to adopt. And then you ask them, well, what does that involve? Like, how much does it cost? Oh, I thought you just like went to the orphanage and they gave you a baby.”
Many others have written about the contents of the file, including Gerald Posner in The New York Post. The Economist and Newsweek covered it. The hope was for mainstream outlets to cover it, and for the shock the files caused to provide an off-ramp for liberals with that pit in their solar plexus telling them that something doesn’t add up. This shows them that the equation is faulty from the beginning.
The thing is, the mainstream media and medical associations have already digested and accepted the new equation—gender dysphoria causes other mental health problems due to minority stress. They view social and medical transition not as invasive treatment with iffy evidence, but as a human right. Thus, as they ask in the WPATH files, why should only mentally healthy children access the evidence-based and life-saving care that modifying secondary sex characteristics offers?
If you have already closed your mind to the idea that there’s something wrong with the science, it’ll be hard for you to open it to the science’s misapplication. If you believe that this is evidence-based, life-saving care—that it’s suicide prevention—then these clinicians are saying just what you’d expect: give me affirmation or give me death. No admission of uncertainty by the supposed experts can dislodge some people’s certainty.
Although, on the other hand, journalists shouldn’t be certain. Journalists should be skeptical, and asking themselves over and over if they’re wrong.
But off-ramps: we need them desperately. So I am curious to hear if anyone has shared the files, or the articles about them, and if it’s sparked discussion or allowed anyone to shift. Please let me know in the comments!
I watched the Gender A Wider Lens live broadcast and was struck by the analogy drawn by the one MD on the panel, Dr. Carrie Mendoza of FAIR, that she is seeing "end stage" symptoms in these WPATH files analogous to stages in other medical scandals like the opiod over-prescription scandal and I don't know if she intended it, but I commented that she might be saying this is like a disease process that has to run its course and we are at a critical stage of the disease with all the hallmarks of that. She also said what I have been thinking, that this ends when everyone knows someone personally who has been harmed, just like when we all knew someone who had lost a family member or child to overdose after starting with prescription medicine and then moving on to street drugs including fentanyl.
I also recall having a client who at the time the opiod over-prescribing scandal was coming to light who was suffering with chronic pain associated with a host of medical problems and was losing access to his prescription for fentanyl, and that many pain patients were scared they would also lose access due to the scandal--I think this will happen here too, and I've said many times to colleagues who are worried about the latest round of legislative actions banning access to gender care that they are only setting this up to be a problem by not reigning in access to people who shouldn't have access.
I’m also skeptical that true believers in the trans cult will have their views changed by this. It may help to influence some who were on the fence. To me, it all boils down to whether you believe every person has an unmeasurable , unobservable, inborn characteristic called “gender identity” that might be incongruent with their physical body. If you believe this, everything the activists say and do makes sense. Of course you would want to identify people with this condition as young as possible and give them medical treatment to relieve their distress. Of course someone having depression or other mental health issues is likely a result of this condition and shouldn’t preclude them from treatment. Of course treatment should be covered by insurance.
But I, and likely everyone reading a comment on this Substack, question that premise. And there is lots of evidence that it’s nonsense. Unlike other “internal” characteristics such as handedness or sexual orientation, you can’t test for, or even coherently define, gender identity. Other internal characteristics don’t require medical treatment - they are simply characteristics of a person that only impact that person’s behaviors. Inborn characteristics don’t change their rate of occurrence or demographics dramatically over a short period of time - so where are the thousands of women of my generation, and every previous generation, who are “actually men” and just never knew it? Could I be one? Did they all commit suicide? If so, why are suicide rates so much higher now that being transgender is so much more accepted? Why are suicide rates higher in post-transition transgender people than the general population? Why have the demographics of people seeking gender transition shifted from almost exclusively born male to heavily weighted to born females? Could I have internal versions of other physical traits that don’t match my body? Could I be a tall person in a short person’s body? A black person in a white body? Do I have a predefined internal number of tattoos that I must get to avoid the distress of “tattoo dysphoria”?
To me, this is the root of the argument that we must attack if we are to make any headway with the general public. As long as activists can convince people that gender identity is an inborn characteristic, it will be easy to make the argument that we are just bigots. But if we can get people to question that premise, the whole house of cards comes down.