Dr Eli Coleman, lead author of WPATH’s SOC-8 guidelines, said conflicts of interest were ubiquitous among those involved. During his deposition, when asked whether “it was your understanding at the time that at least most participants in the SOC-8 [Standards of Care Version 8] process had financial and/or non-financial conflicts of interest”, he responded: “Yes.”

WPATH’s SOC-8 is one of the most widely-read and clinically recognised endorsements of cross-sex treatments for minors. It recommends the use of puberty blockers, hormones and surgeries. The guidelines create a perception of expert medical consensus and were a key component of a brief that was filed in support of cross-sex treatments for children in a pending Supreme Court case over the same issue.

The eighth version of WPATH’s guidelines, released a decade after SOC-7, removed recommended age minimums for cross-sex medical treatments. Internal communications show that WPATH members considered the impact their recommendations could have on the legality of child medical transitions as well as insurance companies’ decisions on which procedures to cover, a major financial consideration for medical practitioners.

In a debate over the merits of removing WPATH’s age guidelines for cross-sex procedures, a co-lead of the adolescent chapter wrote: “I really think the main argument for [age guidelines] is access/insurance. So the irony is that the fear is that [age guidelines] will spark political attacks on access. I don’t know how I feel about allowing US politics to dictate international professional clinical guidelines.”

In his deposition, Coleman said he did not recall any instance in which SOC-8’s language was changed at the behest of someone currently serving as an expert witness on the same subject, and claimed there was a “rigorous methodology” for determining the guidelines which focused on scientific evidence. However, he said there were no rules preventing such witnesses from serving on chapter committees directly related to those cases.

In one case, a member of WPATH did express concern about a conflict of interest. One message suggested that Lisa Littman, a gender-critical physician who was a pioneer of rapid-onset gender dysphoria research, should be excluded from a USPATH task force assessing trans issues. “We will need to engage impartial experts […] with no history of conflict of interest,” the member wrote. “For example, I would not consider Lisa Littman to be impartial given her recent appearance with Megyn Kelly.”

Transgender medicine for minors is a lucrative industry, with top providers bringing in millions of dollars annually in billings. Practitioners in the field — many of whom were involved in drafting WPATH’s standards of care — have a financial interest in legitimising the practice in the eyes of the public. But non-financial conflicts within WPATH, including ideological commitments, are also points of contention.

While WPATH’s recommendations have been used in court to defend paediatric gender medicine, the release of its internal communications casts doubt on the objectivity of those guidelines. This could undermine the legal defence of cross-sex treatments for children. Those communications were submitted to the Supreme Court earlier this week in what will likely be a landmark case to be decided in the coming spring.

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is UnHerd’s US correspondent.

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