June 27, 2024 - 8:00pm

Advocates for youth gender transitions in the US have long claimed that there is a consensus among the medical establishment on the subject. Now, however, unearthed emails reveal conflicts over medical recommendations even between organisations that ardently support the procedures.

Communications released as part of an ongoing legal case showed intense disagreement between WPATH and the American Academy of Pediatrics over the former’s 2022 guidelines for medical transitions. WPATH members complained in internal messages that “very, very junior” clinicians at the AAP were urging them to change their guidelines ahead of publication.

WPATH has claimed its standards of care guidelines are “determined by consensus of [its] committee members”, yet these communications show not only disagreement within WPATH over the guidelines but also a high level of outside influence from the AAP and the Biden administration, both of which pushed to make youth access to cross-sex treatments easier. Several WPATH members viewed the AAP as being too lax and affirming in its approach to youth transitions, with one expressing concern that the latter organisation’s recommendations would be “very affirming but not so well underpinned”. Several other messages accused the AAP of promoting guidelines with sparse scientific evidence to back them up.

WPATH’s president complained that AAP members “annoyed the hell out of [him]”, calling them “white cisgender heterosexual hillbillies from nowhere… (please delete this quote)” in one email.

The findings also show the considerable influence external organisations have had on WPATH’s guidelines. While the AAP and the Biden administration cite WPATH’s guidelines to justify their own support for youth gender transitions, they themselves influenced those guidelines behind the scenes. Rachel Levine, assistant secretary for health of the Department of Health and Human Services, pressured WPATH to rush out its guidelines to help the Biden administration politically, and Levine successfully pushed to remove age limits for cross-sex medical treatments, including surgeries, from the guidelines.

Leor Sapir, a Manhattan Institute fellow who reports on transgender medicine, told UnHerd that the purported medical consensus on child transitions is in fact merely deference toward WPATH from medical organisations. These medical associations, such as the AAP, claim to represent thousands of physician members, but in reality make no real effort to survey most of their members on the issue, according to Sapir. Even the AAP’s guidelines on the issue defer to WPATH.

“The whole point of that consensus is to make it look as if these medical groups did their own research and came to the same conclusion in unison. But it’s actually just WPATH,” he said.

In internal emails, WPATH members repeatedly acknowledged that there is no consensus on child gender transitions. “I think there is no agreement on this within paediatric endocrinologists, what is significant risk especially balanced against the benefits of e.g. thinking time which can be very important for a 14 year old,” one message read.

“I’m not clear on which ‘agreement regarding the value of blockers’ is required to be espoused by a WPATH member/mentor. My understanding is that a global consensus on ‘puberty blockers’ does not exist,” read another.

Members of WPATH’s guideline development group disagreed with several assertions that the AAP asked be included in WPATH guidelines, including that gender identity “always appears at childhood”. One message expressed concern that the AAP guidelines “have a very weak methodology, written by few friends who think the same”.

Agreement between medical organisations in support of youth gender transitions has been a key point in the case against legal restrictions on the procedures, including in a potential landmark Supreme Court case. In US v. Skrmetti, the Department of Justice claims there is an “overwhelming consensus of the medical community” supporting cross-sex medical treatments for children.

“All of the Nation’s major medical and mental health organizations recognize [WPATH] guidelines as reflecting the consensus of the medical communities on the appropriate treatment for gender dysphoria,” their petition to the court reads.

Charles LiMandri, an attorney who represents detransitioners suing medical providers for cross-sex treatments they underwent as minors, told UnHerd that growing evidence of the lack of consensus on the issue could help upend the practice of youth transitions.

“There is no true consensus in the medical community on transgender treatment for minors because the transgender agenda is driven by political ideology and not science or medicine,” he said. “Consequently, the facade of legitimacy of this harmful practice is collapsing.”


is UnHerd’s US correspondent.

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