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WPATH medical guidelines plagued by conflicts of interest 

Transgender medicine for minors is a lucrative industry. Credit: Getty

October 18, 2024 - 3:00pm

The World Professional Association for Transgender Health (WPATH) creates widely-cited standards of care for cross-sex medical treatments. Yet many of the medical professionals who create those guidelines have financial or personal conflicts of interest, according to newly unsealed court documents.

WPATH President Marci Bowers said in a deposition that she made more than $1 million last year from work that primarily consisted of gender-related surgeries. Despite concerns over conflicts of interest, she also said it was “absolutely” important for those involved in creating the medical guidelines to be advocates for the procedures.

The statements came during her deposition in Boe v. Marshall, a lawsuit brought against Alabama over a state law restricting cross-sex medical treatments for minors. There are no federal laws limiting cross-sex treatments for minors in the US, though about half of states have such restrictions. Court testimony and internal communications between WPATH members were collected as part of the case, and revealed that these members were aware of concerns about the safety of trans medical interventions. In some cases, members shared those concerns themselves, but nonetheless endorsed such procedures with no minimum age restrictions in 2022.

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.


is UnHerd’s US correspondent.

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UnHerd Reader
UnHerd Reader
18 days ago

I encourage all of you to research the WPATH Files. These are private memos, emails and zoom calls between members of the organization that were leaked. What struck me was a zoom call involving seven to nine members. One doctor complained that 13 and 14-year-old girls and boys were not able to consent to transitioning, because they don’t understand what is involved, and they can’t process the the implications of chemical and physical changes. Yet, they all support the transitioning of children. Dr. Marci Bower, who specializes in vagioplasties, has admitted to performing the surgery on 16 and 17-year-old boys. Yet, in a speech at Duke University, she admitted that all of her patients were incapable of having an o****im. Children don’t understand the fact that they never enjoy s**. The most current standards of care includes eunuchs, both boys and men, and their needs. Dancing around the edges, hoping to join WPATH, are MAPS—minor attracted people, aka ped****les. Sorry, but these people are mentally ill—in a really sick way.

Seb Dakin
Seb Dakin
17 days ago
Reply to  UnHerd Reader

The whole thing is appalling, and that there is no federal law preventing or even controlling it is scandalous, an utter dereliction of duty on the part of legislators.

Talia Perkins
Talia Perkins
17 days ago
Reply to  Seb Dakin

Uhuh. The fact there are lawsuits against medical caregivers participating in gender affirming medicine for doing so, proves there is nothing lacking in the actions of the legislators. The fact there are so few such lawsuits goes far to prove me correct in what else I have said here.

S Wilkinson
S Wilkinson
17 days ago
Reply to  UnHerd Reader

I encourage everybody to download Alabama’s amicus brief to the Supreme Court re WPATH – click on the ‘submitted’ link in the final paragraph to get the pdf file.
It’s very readable (ignore the lengthy evidence listing at the beginning) and gives an excellent picture of WPATH’s protagonists, motivations, political interference and the lack of an evidence base for their so called Standards of Care.

Talia Perkins
Talia Perkins
17 days ago
Reply to  S Wilkinson

That amicus supported and somewhat comprised of the claims of those paid testiliars referred to by other courts as, “obvious charaltans”. That one?

Talia Perkins
Talia Perkins
17 days ago
Reply to  UnHerd Reader

No, anonymous and fake physician . . .

“One doctor complained that 13 and 14-year-old girls and boys were not able to consent to transitioning, because they don’t understand what is involved, and they can’t process the the implications of chemical and physical changes.”

. . . There are no such substantive complaints. After all, we have no trouble with presumably cisgender children progressing with their lives happily — but how do they know they are really cisgender? Perhaps a child with cancer only needs surgery, and sterilizing chemotherapy will be regretted! How can we permit such cancer treatments!

“Dr. Marci Bower, who specializes in vagioplasties, has admitted to performing the surgery on 16 and 17-year-old boys.”

No, anonymous child abuser, on girls who did not want to have a p***s.

“Dancing around the edges, hoping to join WPATH, are MAPS—minor attracted people, aka ped****les.”

So what? They are all around the whole of society, and are accepted not at all — your mention of them is only a deceitful scare tactic, because you have no facts excusing your real agenda.

Talia Perkins
Talia Perkins
17 days ago
Reply to  UnHerd Reader

I love how The Herd has already removed my first reply to you, they are so terrified of their Herd being spooked by true unacceptable things. I presume it will show up eventually.
***
The more hysterical thing even than that is it popping up for a few minutes and then disappearing again!
You can tell when, even if you can see a comment of yours, it is being shadowbanned, because the count of up/down votes is not visible. You are all at The Herd such vile, cowardly child abusers.

David Morley
David Morley
17 days ago

Practitioners in the field — many of whom were  div > p > a”>involved in drafting WPATH’s standards of care — have a financial interest in legitimising the practice in the eyes of the public. 

Wouldn’t it often be the case that experts in an area of medicine would also be making money within that area, or have careers linked to it? I was expecting to see links to big pharma revealed in this article.

Talia Perkins
Talia Perkins
17 days ago
Reply to  David Morley

“I was expecting to see links to big pharma revealed in this article.”

I have already observed you are only a mealymouthed, equivocating transphobic bigot.

“Wouldn’t it often be the case that experts in an area of medicine would also be making money within that area, or have careers linked to it?”

Ooooh! Ooh ! You’re so close to a complete, objective, conclusive and unambiguous, rational thought on the topic!

So close!

Duggan is a factless, bigoted, transphobic activist, and nothing more. You can say what is real, I believe in you!

UnHerd Reader
UnHerd Reader
13 days ago
Reply to  David Morley

I suspect it’s more acute in this area than many others. It’s not just about making money, but the extent to which the money is made on a handful of (controversial) procedures. If you had a professional standards body on, let’s say, cardiology or podiatry, there isn’t any one issue in which most of those people are going to have a major stake, especially an ideologically charged one. Cardiologists worldwide aren’t going to be out-of-the-job if recommendations on stents change, nor would podiatrists if people get surgery for recurring ingrown toenails less often.
For gender surgeons, the question of how accessible surgical transition ought to be is intrinsically linked to their entire practice.

Sphen Oid
Sphen Oid
17 days ago

Well surprise surprise who would thought!

Talia Perkins
Talia Perkins
9 days ago
Reply to  Sphen Oid

You gender critical never think, you substitute your bigoted emotions for facts and logic both.

Talia Perkins
Talia Perkins
17 days ago

What vapidity! There is no such thing as any practicing doctor who has no financial interest in medicine — and — para inter pares, no leading practitioners who should not be the standards of care writing experts.

“There are no federal laws limiting cross-sex treatments for minors in the US,”

And there should be none anywhere, because the only thing such laws accomplish is the monstrous abuse about 99 people for any one person they save from the same.

“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.”

And because of her obvious commission of fraud, she should be. So should Ken Zucker and Paul McHugh, and for the same reason.

Either there is a free market for medical care — or — to the extent there is not someone is being enslaved to the degree they are forced to perform at less than the recompense they willingly accept.

That doctors make money and should while providing medical care is a trivialty.

Duggan’s piece is an example of colorably pro communist enslavement, where it is not definitely a propagandistic set of lurid deceits and the performative hysterics of the moral panic paying her bills.

Until you Social Conservatives have something factual to say to the contrary of these factual statements:

1) Gender is sexually dimorphic neural anatomy between the ears.
2) Sex is sexually dimorphic reproductive anatomy between the legs.
3) The brain is the whole of the person — the body can be functioning, but if the brain can not the person is 100% gone. The brain is what is supposed to be in charge of a person’s life and is in fact what is their life.
4) Similarly to how a fraction of humanity fully deserving of respected inherent individual human rights will be born with atypical sexual dimorphism between the legs, some are born with atypical sexual dimorphism between the ears, and, with respect to their gender and their sex.
5) When such atypicalness occurs in an individual, medical care may be legitimately sought, provided, and paid for in the manner typical to the day.
6) Such medical care should be available to those who seek it when they seek it as empirically arrived at medical practice such as the WPATH standards of care indicate — including medical transition for people under age 18.
7) Anything else in the way of #6 that prohibits that is respectively forcing 99 boys to grow up with breasts and periods, and, girls to grow up with beards and deep voices. All for the sake of saving 1 from the same.

Until and unless you Social Conservatives manage to find some actual facts to the contrary of those statements — not that merely that you do not like reality, but that what I have said is factually incorrect in some substantial way — all you can do is vainly fume that the grotesque abuse of transgender people which you want for us children included, is in fact all we are fit for … and so you convict yourself of being people wanting to abuse transgender people and children and with your own words.

Supporting but far from exhaustive facts to be found here.

https://taliaperkinssspace.quora.com/People-are-born-transgender-they-are-not-mentally-ill-it-is-no-paraphilia-it-is-a-physical-birth-defect-no-more-a-men

Talia Perkins
Talia Perkins
17 days ago
Reply to  Talia Perkins

I will not hold my breath awaiting a substantive, fact based reply, I know already from long experience — 40+ years of it — that you Social Conservative bigots have none.

You are faith based only, like that fraud of a doctor in ACPeds who went along with an effort to raise the dead by the power of prayer.

B Emery
B Emery
14 days ago
Reply to  Talia Perkins

‘And there should be none anywhere, because the only thing such laws accomplish is the monstrous abuse about 99 people for any one person they save from the same.

Either there is a free market for medical care — or — to the extent there is not someone is being enslaved to the degree they are forced to perform at less than the recompense they willingly accept.’

I think your free market argument is actually reasonably fair, so is the argument for not outlawing certain types of medical care.
Your concern that transgenderism is/ could be treated by some as a mental illness is valid too I think, I don’t personally think it it should be classed as that. Classifying people as mentally ill because they don’t fit others social norms is very dangerous.

‘The brain is what is supposed to be in charge of a person’s life and is in fact what is their life.’

Don’t you think that based on that, a child’s brain should be fully developed before they are allowed access to treatment though?

‘That doctors make money and should while providing medical care is a trivialty.’

This is fair enough, but it should be subject to scrutiny especially where children are involved and especially where they are making such a big decisions.

Talia Perkins
Talia Perkins
9 days ago
Reply to  B Emery

“Don’t you think that based on that, a child’s brain should be fully developed before they are allowed access to treatment though?”

Not when before the development completes is when the worst and hardest to fix damage is done, and, the detection of the likelihood of that damage is so accurate.

Consider 4,500,000 people (and please keep in mind even with such a large numbers there are repeating decimals and I can’t typographically make a bar over them to signal that repeat, so totals may not appear to be 100.00%. I’ll use ellipsis to indicate some sort of repeating decimal or pattern). I’ll try to break it down to all fractions (percentages) which I have good reason to believe are correct.

4,470,000 are almost definitely cisgender, they’ve heard all about transgender people one way or another and nothing about it has made them consider seriously they could be transgender, and I mean they won’t even anonymously claim it. 149 out of 150 are in this category, 99.3…%

20,000 state they meet the criteria for being transgender per the WPATHSoC/DSM5 other than that they do not state a desire to transiton medically at this time, and do not anticipate seeking medical transition. 1 in 225, 0.4…% are in this category.

6,666 meet the criteria for being transgender per the WPATHSoC/DSM5, and get the prescriptions and letters, and eventually surgeries. [as an aside, in the US at least, about 93% of those who transition socially when young don’t have any surgery until after age 18]. They transition medically with whatever surgeries suit them and never detransition at all. They have no regrets. 1 in 675, or 0.14813…% .

3,034 Meet the criteria for being transgender per the WPATHSoC/DSM5, and get the prescriptions and letters, and at some point eventually the surgeries as suits them. But they detransition for some time strategically, never regretting their decision as though it were an error altogether, but just that they can’t make transition work for them at the moment — and they transition quite happily later. They have no regrets. 1 in ~1483, 0.06742…%

200 Meet the criteria for being transgender per the WPATHSoC/DSM5, and get the prescriptions and letters, and at some point the eventually surgeries as suits them at the time. But they detransition feeling they just can’t make transition work for them at all, and they detransition for life with regret at the fact they feel they have to detransition. They do not claim they were diagnosed in error, they wish transition had worked for them — if they have a regret, that is it. 1 in 22,500, 0.004…% (that’s about 2% of who transitions mediclaly)

99 Detransition and claim transitioning was always a mistake and they should not have done it at all, they had a wrong diagnosis with respect to F.64. In diagnostic statistics parlance, they are false positives. 1 in ~45454, 0.002…% I’m going with 1%, (99 in 10,000 of who transitions medically) because I just don’t have the time to weight 15 different study’s values below or near 1% by participant count. But they seem not to have the feeling they can sue, like if it in retrospect was always an error, they can see how the error was made honestly and that they had a substantial or entire hand in it.

1 Detransitions and claims transitioning was always a mistake and they should not have done it at all, they had a wrong diagnosis with respect to F.64. In diagnostic statistics parlance, they are false positives — and — they sue their caregivers over the false positive. That’s 1 in 4,500,000 of the general population, 1 in 10,000 of whom transition medically per WPATHSoC/DSM5. Percent of general population is real small here at 0.00002…%, 1 in 4,500,000. That’s 1 in 10,000 of those who transition medically per WPATHSoC/DSM5.

The thing about that very last category is it’s very notional and likely over representing that contingent. Florida has 22+ million people, they should have 5 people who are false positives suing their caregivers over a regretted gender transition — but the groups agitating to ban medical transition couldn’t apparently find and get any of them to testify, and they had to import such people from out of state to testify. Let alone that, there should be just shy of 500 people in Florida able to testify their transition was all wrong in the first place, and they couldn’t round up anyone to do that either — and these groups are paying for example Chloe Cole $200k per year to testify for them.

None of this addresses people who transition by informed consent alone either as adults or as youth where they are emancipated formally or defacto by running away from home. The informed consent model is not the gender affirming care model. Informed consent is a part of the gender affirming care model, but, gender affirming care presumes therapy/counseling along with informed consent, and that therapy/counseling is done per WPATHSoC/DSM5 compliant standards meaning duration and stability of reported dysphoria is observed, characterized, and noted. Informed consent is literally just signing the papers and you get the shots, and is usually only available to adults, and usually only for HRT not surgery. When informed consent alone is occurring for youth, it is almost always done with adults signing on the youth’s behalf such as parents or guardians. Informed consent care is generally not available to youth themselves from any provider. Most providers and near all surgeons will not use informed consent alone towards surgery even for adults. One way or another some insurance is usually paying for medical transition in large measure, and most insurers require WPATHSoC/DSM5 criteria be met before they pre-authorize payments towards prescriptions and surgeries, and people actually writing/filling Rx’s and doing surgeries want to see that preauthorization.

Those who have used informed consent alone one way or another are drastically over-represented among those who claim they are false positives or that there is any “social contagion”.  That they transititioned on their own by informed consent alone means their experience is no comment at all on those who transition per DSM5/WPATH SoC criteria, which criteria they simply ignored and avoided.

I profess there could well be 10% slop to any of those numbers, but nothing moves the needle at that scale of error — to amount to one whole person at this scale, that 4,500,000 has to become a LOT larger number — they are correct for all rational purposes, sufficient on the basis of which to make law and policy..

Also, one way or another some insurance is usually paying for medical transition in large measure, and most insurers require WPATHSoC/DSM5 criteria be met before they pre-authorize payments towards prescriptions and surgeries, and people actually writing/filling Rx’s and doing surgeries want to see that preauthorization.

There’s just no slop in the system as would permit what the gender critical claims is true to be true. They are literally claiming there are many hundreds of thousands if not over a million of false positive medically transitioned detransitioners — regretters — out there who refuse to make themselves known. They have no even possible credibility at all.

Talia Perkins
Talia Perkins
8 days ago
Reply to  B Emery

I have made a long reply which has vanished into censorship. I will follow this up with a few links to information which to the sane and informed prove what I say. That reply with links will also vanish into censorship.

Michael Clarke
Michael Clarke
16 days ago

Good and important piece.

Talia Perkins
Talia Perkins
9 days ago
Reply to  Michael Clarke

It is meaningless vapidity. One deceitful special pleading after another.