Talking about the WPATH Files with Leftists

I wrote about the WPATH Files on Medium, hoping to reach a left-leaning audience. I got suspended instead.

Last week, I published a piece on Medium highlighting some of the more horrific findings of the WPATH Files. My aim was to reach the platform’s largely progressive readership and hopefully raise a few red flags. I wanted them to slow down, reflect, and reconsider what they were cosigning every time they advocated for “gender affirming care”. If nothing else, I wanted them to know what they were defending.

I published the piece, received a dismissive comment insinuating that the commenter had not even read what I had to say—let alone the files themselves—and was promptly suspended.

It’s worth noting that Medium is an exceptionally pro-trans platform. A trans-identified male who wrote an article in which he wears leggings displaying his “bulge” and castigates a woman at a coffee shop for being uncomfortable received thousands of likes. Meanwhile, an article questioning the ethics of pseudo-medical organization WPATH got me suspended.

Here is that article now. Hopefully, I can reach a few more people here than on Medium. If I change even one person’s mind I’ll consider it worth it.

We Need to Talk About the WPATH Files

On Monday, March 4th, non-profit organization Environmental Progress released the WPATH Files. The files were leaked by an anonymous source[s] and include a report by journalist and researcher Mia Hughes. From Environmental Progress’ powerpoint on the files:

“The WPATH Files is newly released files from WPATH’s internal messaging forum, as well as a leaked internal panel discussion, demonstrating that the world-leading transgender healthcare group is neither scientific nor advocating for ethical medical care. These internal communications reveal that WPATH advocates for arbitrary medical practices, including hormonal and surgical experimentation on minors and vulnerable adults.”

“We received the WPATH Files from a source or sources who contacted us because they had seen Michael Shellenberger’s work on the Twitter Files.”

The files reveal nothing new about WPATH or about the gender affirming care model as a whole — but they do cast the harsh light of day onto them. And since mainstream media has largely ignored them since release, I’ve decided to join other independent writers and journalists in calling urgent attention to them here.

What the Files Show: 3 Main Areas of Concern

I understand that many of you will not read the WPATH Files because it conflicts with what you believe about how to care for people experiencing real distress about their bodies. I know that you take this position out of genuine care and compassion for them, and that you may even count yourself or someone you love among them. If this is you, I urge you to read on.

1. Consent

One of the most striking things the report alleges and the files bear out is that WPATH members are failing to obtain proper informed consent from both adult and underage patients. Since debate and uncertainty already cloud so much of the conversation around gender-affirming care for minors, we’ll start by looking at the adult patients.

The files allege that WPATH has carried out an unethical approach to obtaining consent among adults with comorbidities. Patients with severe mental health issues are being treated with life-altering and irreversible hormonal and surgical interventions with no attempt to address underlying mental distress first — or ever. In many cases, the patients undergoing treatment suffer from mental health conditions so severe that consent is impossible to ethically obtain, including DID (dissociative identity disorder), major depressive disorder, PTSD, cPTSD, and schizoid typical traits.

From the files:

“I have operated on three DID patients in the past. 2 of the three were self-diagnosed with the stamp of a therapist and one was more serious/obvious. 2 were vulvavaginoplasties and one was mastectomy (more serious case).”

— Dr. Christine McGuinn, plastic surgeon and WPATH member

“I have several trans clients with serious mental illness. For example, bipolar disorder and autism or schizoaffective disorder…What criteria do other people use to determine whether or not they can write a letter supporting surgical transition for this population?”

— Unnamed WPATH member

“I have a number of cases of folks with significant mental health issues (with various markers of “stability” including Autism Spectrum, PTSD/C-PTSD, Psychosis…”

— Unnamed WPATH member

“Someone can have schizophrenia and be ready for surgery…it is just a matter of what you see concerns are…”

— Unnamed WPATH member

“One client who had [dissociative identity disorder], we worked on all alters giving consent to HRT before it was started. They had alters who were both male and female gender and it was imperative to get all the alters who would be affected by HRT to be aware and consent to the changes. Ethically, if you do not get consent from all alters you have not really received consent and you could be sued later, if they decide HRT or surgery was not in their best interest.”

— Gender therapist, WPATH member

In reply to a nurse practitioner who is struggling with how to handle a patient with PTSD, major depressive disorder, observed dissociations, and schizoid typical traits who wishes to go on hormone therapy:

“I’m missing why you are perplexed… The mere presence of psychiatric illness should not block a person’s ability to start hormones if they have persistent gender dysphoria, capacity to consent, and the benefits of starting hormones outweigh the risks…So why the internal struggle as to ‘the right thing to do?’”

— Dr. Dan Karasic, lead author of WPATH Standards of Care 8 mental health chapter

In one case, a homeless patient suffering from depression and cPTSD was referred for an orchiectomy. Consent aside (if it can indeed be put aside) a patient without a fixed home is in no condition to properly care for themselves following major genital surgery, while lack of a permanent address makes followup nearly impossible. In another case, an unnamed WPATH therapist admits to having denied only one patient a letter in 15 years of practice — as the patient was in active psychosis and hallucinated during the assessment session.

Minors

When it comes to minors, opinions vary as to if and when they can consent to medical interventions like puberty blockers, cross-sex hormones, and surgery. At the same time, many proponents of this care argue that such medical interventions aren’t happening. The WPATH files prove that they are. One plastic surgeon alone, Dr. Christine McGinn, reports performing 20 neovaginoplasties on patients under 18 over a 17-year period.

The files also show that consent is dubious at best. In video footage of an internal WPATH panel held on May 6th, 2022, panel members openly discuss how impossible it is to obtain informed consent from young patients. Dr. Daniel Metzger, a Canadian endocrinologist, describes patients requesting certain effects of HRT while asking not to experience others, as if hormonal treatment were a yogurt shop where patients can pick and choose toppings. This may sound unbelievable — until you remember that these treatments are being explained to patients so young they “haven’t even had biology in high school yet.”

From the files:

“It’s hard to kind of pick and choose the effects that you want. That’s something that kids wouldn’t normally understand because they haven’t had biology yet, but I think a lot of adults as well are hoping to be able to get X without getting Y, and that’s not always possible.”

“[You] may not be binary, but hormones are binary. You can’t get a deeper voice without probably a bit of a beard, and you can’t get estrogen to feel more feminine without some breast development.”

— Dr. Dr. Daniel Metzger, endocrinologist and WPATH member

“[It is] out of their developmental range to understand the extent to which some of these medical interventions are impacting them.”

“They’ll say they understand, but then they’ll say something else that makes you think, oh, they didn’t really understand that they are going to have facial hair.”

— Dr. Dianne Berg, child psychologist and co-author of the child chapter of WPATH’s SOC8

In one exchange, a clinician asks for advice about a 13 year old nonbinary patient requesting testosterone therapy. Another clinician responds by informing the initial poster that the WPATH’s SOC8 “removed the age requirement all together” and advises that the age of consent will be different from person to person. This is after the original poster revealed that the patient proposing to go on testosterone has likely restricted their eating to achieve an androgynous look.

While shocking, this only covers short-term physical changes, to say nothing of the irreversible effects to patients’ fertility. WPATH’s SOC8 requires that doctors inform patients of “the potential loss of fertility and available options to preserve fertility.” However, it’s safe to say that if patients do not even understand the physical effects of sex-trait modification interventions, they are nowhere near able to understand or consent to the prospect of giving up their fertility for life — and WPATH members know this.

From the files:

“It’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,” adding, “they’d be like, ew, kids, babies, gross.”

“Or, the usual answer is, ‘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.’”

“I think now that I follow a lot of kids into their mid-twenties, I’m like, ‘Oh, the dog isn’t doing it for you, is it?’ They’re like, ‘No, I just found this wonderful partner, and now want kids’ and da da da. So I think, you know, it doesn’t surprise me.”

“Most of the kids are nowhere in any kind of a brain space to really talk about [fertility preservation] in a serious way.”

— Dr. Daniel Metzger

In medicine, outside of life-threatening cancer diagnoses, disorders of sexual development, and other rare conditions, offering fertility preservation treatments to children is virtually unheard of. Gender-affirming care offers a new avenue of iatrogenic fertility loss with which young patients and their families must now contend.

2. Experimentation

The WPATH files reveal that members have knowingly conducted “an unregulated experiment on some of the most vulnerable people in society.” First and most urgently, this section covers experimental procedures which should not be performed on anyone — regardless of whether consent is obtained or not. These procedures can only be described as extreme body modifications without medical justification and modeled after nothing found in nature. These include:

Gender nullification: SOC8 contains a chapter on nonbinary medical interventions including gender nullification procedures, defined as “procedures resulting in an absence of external primary sexual characteristics.” WPATH’s SOC8 permits surgeons to amputate healthy, functioning genitalia to create smooth, sexless genital regions similar to those of a barbie doll — without a second thought as to the possible trauma or underlying mental health conditions that might cause a patient to seek this treatment. One male patient was allowed this procedure despite suffering from bipolar disorder and alcohol use disorder.

From the files:

“I have worked with clients who identify as nonbinary, agender and Eunuchs who have wanted atypical surgical procedures, many of which either don’t exist in nature or represent the first of their kind — and therefore probably have few examples of best practices…”

— Unnamed WPATH member

“This is an uncommon but a very important topic (in my opinion). I found it really important to discuss with patients exactly what they want — e.g. orgasms or not, sitting to urinate, etc.”

— Dr. Rajveer S. Purohit, WPATH member

Eunuch as identity: Even more disturbing, the WPATH’s SOC8 seeks to retrieve the category of the eunuch — men forcibly castrated to serve as harem guards — from the dark annals of history and reassert it as a self-declared sexual identity. SOC8 defines eunuchs as “individuals assigned male at birth (AMAB) [that] wish to eliminate masculine physical features, masculine genitals, or genital functioning.” The document asserts that “[a]s with other gender diverse individuals, eunuchs may also seek castration to better align their bodies with their gender identity. As such, eunuch individuals are gender nonconforming individuals who have needs requiring medically necessary gender-affirming care.”

From Youtube:

Dr. Jame, medical doctor, psychiatrist, and WPATH member explains to us what a eunuch is. (Yes I disliked the video.)

A patient describes themselves as having been “neutered” at age 23. They expressly thank WPATH’s SOC8 for making this possible.

Double mastectomy without nipples: By now, I’m sure many of you have seen TikTok posts of young people proudly displaying “top surgery scars.” Increasingly, more of them are choosing to have these procedures done without nipples. Many of WPATH’s members support and even encourage such extreme body modifications, with one unnamed professor and WPATH member citing “creative transfiguration” as a reason to seek out HRT and advocating for the body to be seen as “a gendered art piece” in a paper.

From the files:

“Are the current pre-op guidelines not sufficient? I know that for masculinizing top surgery procedures, these guidelines do not state whether or not someone should have nipples…”

— Unnamed WPATH member

“Trans health is about bodily autonomy, not normalizing bodies. “We didn’t reject the idea that you can’t change your gender only to double down on the idea that gender is binary and defined by genitals.”

— Unnamed professor and WPATH member

“If adult patients have body autonomy, what is the issue with having top surgery without nipples, for example? Surgical tattoos can help if the patient changes their mind later.”

— Unnamed therapist addressing WPATH panel

Bi-genital surgeries: As its name suggests, these procedures seek to create the genitalia of the opposite sex while preserving the original. These take the form of phallus-preserving vaginoplasties or vagina-perserving phalloplasties. In the SOC8, these are referred to as “individually customized surgeries”. While SCO8 does recommend that surgeons consult “a comprehensive, multidisciplinary team of professionals in the field of transgender health when eligible,” it is doubtful if these types of surgeries are ever advisable. As the WPATH Files report states, these surgeries “do not even meet the definition of experimental, as they are not being studied in any controlled manner.”

From the report:

“When Dr. Thomas Satterwhite, a renowned California surgeon, asks for the group’s input for “non-standard” procedures such as “top surgery without nipples, nullification, and phallus-preserving vaginoplasty,” no one raised any ethical questions about the destruction of perfectly healthy reproductive organs to fulfill customized body modification desires. Instead, members of the group policed Satterwhite’s language, with one therapist arguing that such procedures could also be “selected by those with binary gender identities;” another therapist who identifies as non-binary agreed and called his language “cisgenderist,” and a med school student stressed the importance of “de-gendering” sex-trait modification procedures.”

Non-standard neovaginoplasties: When an AMAB (assigned male at birth) patient has their puberty suppressed from tanner stage 2 of puberty, not enough penile tissue develops to perform a traditional neovaginoplasty, which involves surgically inverting the penis to create a neovagina. With more and more youth put on puberty suppressing drugs, surgeons must scramble to come up with alternative methods to create the desired genitalia. These include using tissue harvested from the patient’s colon, the lining of the abdominal cavity, or even tilapia fish skin. One study revealed that most patients with significant pubertal suppression — 70% — had to opt for intestinal vaginoplasty, while another found that a quarter of patients undergoing this riskier method required corrective surgery. This same study also notes that intestinal vaginoplasty is “a feasible gender-confirming surgical technique with good functional outcomes” for patients with insufficient penile tissue, while also noting that one patient died “as a result of an extended-spectrum beta-lactamase-positive necrotizing fasciitis leading to septic shock, with multiorgan failure.”

This cohort of patients is also completely stripped of sexual function and is anorgasmic — as WPATH notes. In a talk titled “Trans and & Gender Diverse Policies, Care, Practices, & Wellbeing” at Duke University, Dr. Bowers commented on an observation that “every single child who was truly blocked at Tanner stage 2 has never experienced orgasm. I mean, it’s really about zero.”

WPATH President Dr. Marci Bowers addressing panel on “Trans and Gender Diverse Care”

From the files:

“[The] fertility question has no research. Unless pre-pubertal dysphoria is enormous, allowing for a small amount of puberty before blockers might be preferable in the long run.”

“Clearly, this number needs documentation, and the long-term sexual health of these individuals needs to be tracked.”

— Dr. Marci Bowers, surgeon, WPATH president

But who, if not WPATH, should be responsible for tracking them?

Cross-sex Hormones

For transgender people seeking medical transition, HRT (hormone replacement therapy) is typically the first line of treatment. In trans men, HRT can bring about desired changes such as deepening of the voice, facial hair growth, and more masculine muscular development. In trans women, HRT can soften skin, redistribute fat, reduce body hair, and help develop breast tissue. However, the potentially harmful side effects of synthetic hormones are rarely discussed.

The files show that WPATH members continue to prescribe synthetic testosterone to patients despite severe side effects including liver cancer, vaginal atrophy, Pelvic Inflammatory Disease (PID), pelvic floor dysfunction, painful orgasms, bleeding after sex, and uterine atrophy.

From the files:

“Atrophy with the persistent yellow discharge we often see as a result.”

— Nurse, WPATH member

“Pt found to have two liver masses (hepatic adenomas) — 11x11cm and 7x7cm — and the oncologist and surgeon both have indicated that the likely offending agent(s) are the hormones.”

— Doctor and WPATH member speaking about a 16 year old patient

“I used to have bleeding after penetrative sex. It would hurt to have an orgasm… My uterus atrophied also.”

— Patient

From the report:

“Another doctor replied to this with an anecdote about a female colleague who, after about 8–10 years of taking testosterone, developed hepatocarcinome [liver cancer]. ‘To the best of my knowledge, it was linked to his hormone treatment,’ said the doctor, who had no more details because the cancer was so advanced that her colleague died a couple of months later.”

For patients on synthetic estrogen, members report similar negative effects on sexual functioning, describing painful erections like “broken glass”. Research bears out further potential harm including increased risk of blood clots, heart attack, and stroke, with increased risk the longer a patient continues hormones. A systematic review of available evidence on the safety and efficacy of HRT for transgender women had this to say:

“Despite more than four decades of ongoing efforts to improve the quality of hormone therapy for women in transition, we found that no RCTs or suitable cohort studies have yet been conducted to investigate the efficacy and safety of hormonal treatment approaches for transgender women in transition. The evidence is very incomplete, demonstrating a gap between current clinical practice and clinical research.”

A 2021 review summarizing what is known about the effects of HRT noted that “vaginal pain, bleeding, atrophy, and non-Lactobacillus-dominated vaginal microbiota are common” for patients on testosterone therapy, and that further research is needed.

Despite the lack of research and potential serious side effects, WPATH members continue to prescribe cross-sex hormones to adult and underage patients. More of the files reveal that despite — or perhaps because of — this paucity of research, doctors are essentially experimenting on patients and improvising care as they go. The files show discussion threads of members guessworking, giving anecdotal advice, and making vague, baseless recommendations. As the report notes, “anecdotes are not science, and no one in the forum provided links to actual scientific literature providing evidence-based recommendations for managing these painful iatrogenic symptoms.”

From the files:

“[The estrogen cream] appears to have stopped working. Has anyone had luck with estrace tablets vs cream?”

— Nurse

“My guess (and it’s just a guess, I’m not a medical person) would be that the pain is related to erectile tissue in [the] penis and that the removal of that tissue during vaginoplasty addresses the problem.”

— Counselor

“I had a non-binary patient assigned female at birth requesting masculinizing hormone therapy who had questions regarding the use of finasteride to prevent bottom (clitorial) growth. I was not aware that it had any affect [sic] on this area…”

“Thanks for posting this question! I have not had this request, but in recent discussion on this board it was noted that the use of 5ARIs in transM people can block specific components for virilization incl hair and clitoral growth. Whether the med should be used proactively for this purpose — this I don’t know but I’m looking forward to the potential response.”

“I have had a similar patient who is requesting finasteride to prevent bottom growth while starting testosterone…It has been difficult to give them a definitive answer. Any resources, evidence or advice would be appreciated.”

— Exchange between unnamed WPATH members

3. Detransition

Perhaps thorniest of all in the conversation around gender medicine is the question of detransition. As the president of WPATH admits, “acknowledgement that de-transition exists to even a minor extent is considered off limits”. Yet the taboo nature of the topic does not make it any less real or prevalent.

The prevailing belief among providers seems to be that rates of detransition and regret are low — but the true number remains unknown due to lack of long-term studies. Research on the subject notes that following up with patients only in the short term will likely not produce accurate data, as regret and desistance can emerge years or even decades after treatment.

Some members have pointed to a recent systematic review suggesting regret rates to be less than 1% for trans men and less than 2% for trans women. This sounds promising on the surface, yet numerous flaws within the studies contained in the review cast doubt on its conclusions, namely high loss to follow-up, short follow-up periods, and narrow definitions of regret and detransition. The authors of the study themselves note that “there is an unknown percentage of transgender and gender non-conforming individuals who undergo gender-affirmation surgeries (GAS) that experience regret.”

The reality is we simply don’t have the facts on how many young people have or will detransition, and trying to minimize concerns about detransition as fringe or miniscule isn’t serving anyone, especially the vulnerable patients whose fertility and well-being are on the line.

From the files:

“We have a patient, 17yrs FtM, that just graduated from high school and has decided to de-transition. We have seen him for years, followed all the guidelines, he’s legally changed his name and gender and has been on testosterone for 2+ years. He is very distraught and angry. He reports that he feels he was brainwashed and is upset by the permanent changes to his body.”

— Unnamed WPATH member

“I worked with a 16 year old who detransitioned after being on T for more than 2 years and having top surgery. She was very angry and actively engaged in anti-trans online groups. In her case, as well as with the 20 year old I am currently working with, they believe their issue was really body dysmorphia rather than gender dysphoria, and both had presented as being very appropriate for hormones and surgery.”

— Unnamed WPATH member

“Ten years ago, I had about 8–10 trans adult patients (all natal males) in my general practice…I now have had about the same number of patients (a different and a younger cohort) mostly natal females who are expressing regret and seeking help for related issues…it’s remarkable how my tiny sample looks so much like what is being described in the UK. I am in Canada.”

— Unnamed WPATH member

I hope what I’ve shared here has helped shed light onto what the WPATH is doing. I understand that many of these clinicians, if not most, simply want to do right by their patients. Yet good intentions aren’t always enough. However pure their intentions may have been, the results have been disastrous — and undeniable. Wherever you fall on the debate surrounding gender affirming care, I hope this perspective on the WPATH Files I’ve provided has at least raised a few red flags for you, caused you to slow down, or reminded you to proceed with caution. Because for so many, it’s already too late.

Thank you for reading.