The FTC Suit Against WPATH Isn't Just Another Example of Fealty to Trump

It's an example of responding to the sordid history of WPATH, and bad science

In Bob Ostertag’s seminal 2016 book Sex Science Self, he describes Harry Benjamin, the endocrinologist most responsible for promoting cross-sex hormone treatments for what was once called gender identity disorder and is now called gender dysphoria. “Benjamin began his career as a self-described ‘disciple’ of Eugen Steinach, an Austrian doctor who became rich and famous claiming that he could rejuvenate aging men by performing vasectomies on them,” Ostertag writes. Benjamin went on to found the Life Extension Institute in New York City, “for performing Steinach’s bogus rejuvenation surgeries.” Since “he continued to champion those procedures long after everyone else had rejected them,” Benjamin “became something of a medical laughingstock.”

Benjamin—friend of the German sexologist Magnus Hirschfeld, who had coined the term transvestite—had found a powerful supply, in the form of hormones, and was constantly trying to drum up demand. That demand finally came after the media debut of Christine Jorgensen, the ex-GI who became a “Blonde Beauty,” in the words of The Daily News.

It was from Ostertag’s book, which I read in 2017, that I learned that what is now called the World Professional Association for Transgender Health—an official-sounding name that evokes science and expertise—was first called the Harry Benjamin International Gender Dysphoria Association (HBIGDA). That is, the group that bills itself as the premier creator of standards of care to treat this condition—or to affirm gender identity, as has become the goal—was named for, essentially, a snake oil salesman.

It’s this group that the Federal Trade Commission, along with Alaska, Iowa, Nebraska and Texas, is suing, as they announced yesterday. The group’s recommendations for treating trans kids, or kids with gender dysphoria, “misled parents and children about the medical consensus and medical necessity, as well as the safety and effectiveness, of such services, in violation of the FTC Act,” per a press release.

The New York Times positions the suit as an example of the FTC’s rejecting “the agency’s traditional independence from the White House, taking actions that wade into culture war issues while testing the boundaries of the commission’s legal authority.” That is, they see it as the FTC doing Trump’s bidding on niche issues.

While that certainly seems to be the case in other areas of government, the FTC has plenty of standing when it claims that WPATH misled parents and children. Those families whose children are socially or medically transitioning, or considering it—they’re the ones, above all others, who need to understand the merits of this suit.

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HBIGDA rebranded as WPATH in 2006, and the next year installed as its first president a transgender man named Stephen Whittle, rather than a clinician. Whatever pretense of science they’d carried over the years was discarded in favor of activism. In 2010, they called for the “de-psychopathologisation of gender variance worldwide.” They wanted “disorder” removed from the diagnosis, but still wanted an entry in the DSM, so that a billing code for insurance would remain.

At the time, there wasn’t much research, especially on youth. The two famous Dutch studies that eventually created a surge in the gender medicine industry weren’t published until 2011 and 2014, respectively, though pediatric gender clinics were starting to trickle open anyway. WPATH put out their 7th “Standards of Care” (SOC-7) in 2011, with 11 pages about adolescents. The document acknowledged what’s known as the “desistance literature”—a body of long-term studies that suggest most cases of childhood-onset gender dysphoria resolve by the end of puberty, and the bulk of the kids grow up to be gay. “Boys in these studies were more likely to identify as gay in adulthood than as transgender,” the authors wrote.

As for adolescents, “the persistence of gender dysphoria into adulthood appears to be much higher for adolescents,” they wrote. But this was an assumption. They admitted: “No formal prospective studies exist.”

By the time WPATH released its long-awaited eighth “Standards of Care for the Health of Transgender and Gender Diverse People” (SOC-8) in 2022—with 24 pages on adolescents and an entire chapter on children—some formal studies did exist, or were in the works (including one that would eventually reveal that two out of 315 young people took their own lives after gender-affirming care). By then, health care agencies in England, Sweden and Finland had conducted systematic reviews, to evaluate the quality of the studies that American medical associations, advocacy groups, and WPATH continued to claim as proving the safety, efficacy, and medical necessity of puberty blockers, cross-sex hormones, and surgeries on secondary sex traits—the stuff of gender affirming care.

These reviews all came to the same conclusion: the quality of the evidence was very low. Even if the data seemed to show that kids fared better after these interventions, there was no way to tell if that was actually true, or, if it was, that the interventions caused the improvement.

Yet SOC-8 claimed that, due to a paucity of studies, “a systematic review regarding outcomes of treatment in adolescents is not possible.” Instead, WPATH offered a “short narrative review,” which observed that “the data consistently demonstrate improved or stable psychological functioning, body image, and treatment satisfaction.” That is, they summarized the positive conclusions of studies, without noting that they were of such poor quality that they shouldn’t be relied upon.

That wasn’t the most scandalous aspect of the new SOC.

The initial draft of SOC-8, released in December 2021, had included minimum age recommendations for interventions: fourteen for estrogen or testosterone (as opposed to sixteen in previous SOCs); fifteen for mastectomies (or “chest-masculinization surgery”); seventeen for vaginoplasty, metoidioplasty (lengthening the clitoris and threading through the urethra, to mimic a penis), and orchidectomy (removal of testicles); and eighteen for phalloplasty. This despite repeated claims that minors didn’t get gender-affirming surgeries.

When WPATH officially released the final guidelines, those age requirements remained. But a few hours later, they disappeared from the website. A notice appeared that they had been published in error. There were no longer any minimum ages for gender surgery. At the time, no one knew why.

Meanwhile, the draft chapter on ethics had been removed from the final, but a new chapter had been added on “eunuch gender identity.” “As with other gender diverse individuals, eunuchs may also seek castration to better align their bodies with their gender identity,” it read.

When a lawsuit against Tennessee’s ban on gender-affirming care made it to the Supreme Court as US v. Skrmetti, an Amicus brief filed in the case (with evidence, from a different case, Boe v. Marshall in Alabama) revealed what had happened.

WPATH had contracted Johns Hopkins’ Center for Evidence-Based Practice to conduct systematic reviews, and then pressured Hopkins employees to suppress them. SOC-8’s assertion that there wasn’t enough evidence for an SR appeared to be an outright lie—one that guided parents and patients in what would likely be the most important medical decision of their lives.

The brief also solved the mystery of the disappearing age minimums. HHS Assistant Secretary of Health, pediatrician Dr. Rachel Levine, a male who transitioned and identifies as a woman, had urged WPATH to remove the age limits—not because of evidence but because of politics. Levine worried they would “result in devastating legislation for trans care.” Age limits would add fuel to the bans’ fire. The AAP piled on, threatening “to oppose SOC-8 if WPATH did not remove the age minimums.”

WPATH leadership ultimately caved to please Levine and secure the AAP’s approval, “without being presented any new science,” as one author noted. These guidelines were crafted to respond to politics, not evidence—a key point that anyone considering transition needs to understand. WPATH president Dr. Marci Bowers insisted they all keep mum, submitting to a “centralized authority” to appear united, as opposed to appearing politicized. Bowers wrote: “it is a balancing act between what i feel to be true and what we need to say.”

But members of WPATH had already said plenty. The lead author of the child chapter, Dr. Amy Tishelman, had said at a WPATH conference: “We were thinking, and it was scary for me, about the potential uses of the chapter for legal and insurance contexts…What we didn’t want to do was create a chapter that would make it more likely that practitioners would be sued because they weren’t following exactly what we said.” In one video, Dr. Scott Leibowitz, an author of the adolescent chapter, insists the age limits were removed not because of pressure but to provide “individualized” care, which was also not true. Another provider told the audience that they should consider using the threat of Child Protective Services to push reluctant parents toward affirming.

The New York Times covered Levine’s pressure to remove age limits, but despite having access to the emails between WPATH and Hopkins about suppressing research, they chose not to cover them. They made no mention of The WPATH Files, a report by journalist Mia Hughes that exposed even more concerning internal communications by WPATH members, and which little of the media and medical establishment that extolled WPATH bothered to engage with.

Long after the scandal of WPATH suppressing evidence had been exposed, Oregon Democrats tried to enshrine WPATH’s SOC-8 as the “accepted standards of care,” and pass a law prohibiting health insurers from “denying or limiting coverage for medically necessary gender-affirming treatment that is prescribed in accordance” with it. Its name is now synonymous with these deceptive statements, which have led to the medicating of thousands of teenagers under false pretenses. WPATH and its defenders continued to champion this evidence long after other credible agencies around the world had rejected them, replicating what happened with WPATH’s founding father.

WPATH’s statement paints the FTC as “acting out of pure retaliation as part of the federal government's relentless and targeted campaign to undermine gender-affirming care.” Well, they do want to undermine it. But that’s because it’s worthy of undermining. Anyone transitioning, anyone parenting someone transitioning, should understand the science—and that WPATH is not a credible source of information about it.

It’s unclear how viable this suit is. Though the authors of WPATH’s SOC-8 profit from providing these treatments, WPATH itself isn’t selling anything more than membership. They claim this isn’t about commerce, but about free speech, and some pundits agree.

The stronger the lie, the more powerful the denial. WPATH “envisions a world wherein people of all gender identities and gender expressions have access to evidence-based health care, social services, justice, and equality,” they wrote in SOC-8. And yet, WPATH has stood in the way of providing evidence-based health care.