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US trans medical lobby deeply divided behind closed doors

The Biden administration influenced medical guidelines. Credit: Getty

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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Anthony Roe
Anthony Roe
21 days ago

Take them for every last cent, then lock them up.

El Uro
El Uro
21 days ago
Reply to  Anthony Roe

Gallows is the only thing they deserve

Susan Grabston
Susan Grabston
21 days ago

Lawsuits incoming. Usually focuses American minds. Pity the collateral damage – all avoidable.

Graham Bennett
Graham Bennett
21 days ago

These sick ideologues call themselves medical professionals. Josef Mengele was a doctor too. History (and justice) will catch up with them, as it did him.

Talia Perkins
Talia Perkins
20 days ago
Reply to  Graham Bennett

Fascinating how you bigots never clue to the fact the dearth of such lawsuits shows the drastic degree of the erroneousness of your beliefs.

Pedro the Exile
Pedro the Exile
20 days ago
Reply to  Talia Perkins

what a spectacularly clumsy statement-class actions are notoriously slow initially but when they achieve momentum they don’t half concentrate the mind of the defendants.Its also one of the most effective policy correction measures in a litigious democracy like the USA.Once the dam breaks just watch these child mutilators run for cover and start dobbing each other in and plea bargaining.It won’t be pretty and it won’t be cheap.

Talia Perkins
Talia Perkins
20 days ago

No, it is a simply correct observation there are no impediments to such suits, and nevertheless the “backlash” predicted for decades about this still has not happened. There is no dam to break.

Mark Phillips
Mark Phillips
20 days ago

All are bigots except the rude and ignorant arch-bigot herself.

Talia Perkins
Talia Perkins
19 days ago
Reply to  Mark Phillips

No, Rowling does not believe that, or act like it.

Utter
Utter
19 days ago
Reply to  Talia Perkins

I posted to you a series of links reporting such lawsuits – but it mysteriously disappeared. I had thought there was just one or two, but I there are many more – thank you for drawing my attention to that. Notably, the sueful regretters are/were all f-to-m – fits it with the theory that much of the activism, and the huge increase in girls wanting to be boys, has a core of misogyny (and homophobia, as Andrew Sullivan and other prominent LGBs have claimed).

Talia Perkins
Talia Perkins
19 days ago
Reply to  Utter

Uhuh, sure. In a population the size of the UK’s there would need to be almost 1,500 such plaintiffs for even the <1% currently regretting transition at the known acknowledged rate to be suing. Did you have 1,500 plaintiffs counted?

Utter
Utter
19 days ago
Reply to  Talia Perkins

You have a shakey sense of these things – for example, how many, what percentage of smokers sued big tobacco, and how long was it before the first cases came to court?

“Be yourself, everyone else is taken.”

Major elective surgery & life-long powerful medications is not being yourself. Only in extreme and rare situations is this likely to be answer, and then only for adults after years of consideration. And not at the cost of women’s rights. Finally, research needs to have a settled position – clear and consistent findings – it has not. Worse than that, political activists are aggressively gaslighting people into thinking the trans issues are essentially similar to gay liberation. They are not. I work in a mental health field – the only people I have come across in 25 years are a transwoman of 20+ years who regretted the surgery and felt that she’d been manipulated into it by the surgeon; several gay men & women who felt sure they’d have trans-ed as young ones if they’d had today’s options – and were horrified by the thought; and a host of troubled and confused teens whose gender dysphoria resolved, and/or turned out to be adolescent confusion, with/without autism, trauma etc.

Of course there many genuine cases of life-long gender dysphoria, presumably underpinned by structural endocrine, neuropsychological matters.

Talia Perkins
Talia Perkins
17 days ago
Reply to  Utter

You have no sense of this whatsoever.

“Major elective surgery & life-long powerful medications is not being yourself.” <– Says you about you, and no one else. Feel free to refuse medical care for any diagnosis you may have or receive.

“Only in extreme and rare situations is this likely to be answer, and then only for adults after years of consideration.” <– Except 1 in 150 turns out to be transgender and 1 in 3 seek medical transition of their apparent sex and gender.

“And not at the cost of women’s rights” <– There is no such cost.

“Finally, research needs to have a settled position – clear and consistent findings – it has not.” <– Yes, it has a clear settled position. It is a political lie, propaganda, to claim it does not.

“Worse than that, political activists are aggressively gaslighting people into thinking the trans issues are essentially similar to gay liberation. They are not.” <– Yes, they are.

“I work in a mental health field – the only people I have come across in 25 years are a transwoman of 20+ years who regretted the surgery and felt that she’d been manipulated into it by the surgeon; several gay men & women who felt sure they’d have trans-ed as young ones if they’d had today’s options – and were horrified by the thought; and a host of troubled and confused teens whose gender dysphoria resolved, and/or turned out to be adolescent confusion, with/without autism, trauma etc.” <– Then you have made it a point to avoid them — and — are permitting the anecdote of one person to overrule the examples of hundreds of thousands of contrary data points.

“Of course there many genuine cases of life-long gender dysphoria, presumably underpinned by structural endocrine, neuropsychological matters.” <– Who number apparently no less than 1 in 450, and why should this variance in sexual dimorphism be so less common than others, let alone the far more rare than that which you think for no reason you can give that it must be?

Tyler Durden
Tyler Durden
20 days ago

Arguably Biden and his mob’s greatest sin, this direct attack on children’s health, outweighing even the neocon meat grinder in the Ukraine and the wilful destruction of a liberal order for women Afghanistan.

Julian Farrows
Julian Farrows
20 days ago

They don’t want to protect trans-children. They want physical and emotional access. Any ideology that needs to be taught behind the backs of parents is nothing more than child-grooming.

William Brand
William Brand
19 days ago

A commercial in which a woman looks at the clothes she wore as a teenager comes to mind “what was I thinking”. Teen girls are hypersensitive to fads and fashion. Changing sex is a fad. So are tattoos and piercings. When they grow up, they want their face untattooed and their body detransioned. It is harder to replace breasts than a facial tattoo. It is even harder to replace ovaries.

Utter
Utter
18 days ago

When are the missing 13 comments going to come back?

Talia Perkins
Talia Perkins
18 days ago
Reply to  Utter

Probably not at all. The Herd here must be protected from facts.
This is not a place for free thinkers, but for propaganda of which the editorial staff approves.

A J
A J
17 days ago

Rachel Levine, of course, is a natal male who started living as a woman late in life, after a successful career in the military, and being married and gathering children. Levine wants to remove all ages restrictions on child transition, condemning those children to a life of infertility.

Children can only go through the puberty of their birth sex. If that is blocked, they will never reach sexual maturity or fertility. They will be anorgasmic and unable to procreate. Their adulthood will merely be a number of years lived; they will in effect be perpetual children, since it is puberty that marks the transition from childhood to adulthood.

Ask yourself why Levine is so keen to stop children from maturing?