The FTC and four states allege WPATH misled families, suppressed contrary evidence, and removed age limits under outside pressure, all while helping expand a lucrative market for gender-transition treatments for children.
No organization has done more to fuel the dramatic rise in transgender identification and gender-transition surgeries than the World Professional Association for Transgender Health (WPATH), the medical organization that developed the Standards of Care (SOCs) for gender-affirming treatments. Doctors, insurance companies, activists, politicians, and even judges have all cited and deferred to those SOCs as justification for prescribing puberty blockers, cross-sex hormones, and surgeries to children.
WPATH even popularized the line “Would you rather have a dead daughter or a live son?” to manipulate parents into acquiescing to the euphemistically named “gender affirming care.”
Journalist Michael Shellenberger first exposed the organization in his “WPATH files,” which revealed the organization’s leaders to be ideologues rather than medical experts. The files, released in early 2024, showed that WPATH officials ignored evidence contradicting their claims that the treatments were safe and effective and pushed forward in advancing mutilating surgeries, even on young adolescents.
Two years later, the organization is finally set to face a reckoning. A lawsuit filed in mid-June by the Federal Trade Commission (FTC), and joined by the attorneys general of Texas, Alaska, Iowa, and Nebraska, alleges that WPATH’s rot goes much deeper, that, in fact, the impetus for its work and lies wasn’t primarily ideology but cold hard cash. Worse for WPATH, an attempt to get the case moved out of Texas has since been rejected.
In other words, this case is going to trial, and WPATH officials will now have to turn over internal communications and documents and, under oath, answer some very hard questions about their “evidence” justifying the medical mutilation of children.
Following are just some of the charges the FTC makes in its lawsuit against WPATH.
WPATH Created Fraudulent Standards of Care
WPATH was created from the ashes of the first “Gender Identity Clinic” at Johns Hopkins University, which closed in 1979 after researchers determined that gender transitions provided little to no benefit to adult patients. But a growing and lucrative industry had already emerged, and the clinic’s closure threatened that industry.
Enter WPATH. That same year, it published its first Standards of Care, establishing guidelines for diagnosing and treating patients experiencing distress regarding their sex. WPATH has since revised its SOCs seven times, culminating in SOC-8, which was published in 2022. Those standards are the benchmark for treating patients with gender dysphoria.
In its first SOC, WPATH admitted that “[h]ormonal and surgical sex reassignment is extensive in its effects, is invasive to the integrity of the human body, has effects and consequences which are not, or are not readily, reversible, and may be requested by persons experiencing short-termed delusions or beliefs which may later be changed and reversed.” It also noted that potential patients often underestimated those risks and that “published and unpublished case histories” showed patients regretted these treatments and found the final results “to be psychologically dehabilitating [sic].”
At that time, WPATH recommended that gender transitions never be performed on minors. However, during the 1980s, Dr. Peggy Cohen-Kettenis presented research to WPATH claiming that puberty blockers were fully reversible — despite having no studies to support that claim. Her research was funded by the pharmaceutical industry.
Cohen-Kettenis joined WPATH’s board in 1995. In 2001, WPATH issued SOC-6, which advocated giving puberty blockers to children as soon as puberty began. The only evidence cited was a single patient of Cohen-Kettenis who gave “slightly improved” responses on a psychological evaluation following gender transition.
SOC-7, released in 2012, allowed patients to self-identify as gender dysphoric; removed the “Real-Life Test” that required patients to spend a year socially transitioning before starting cross-sex hormones; and established the very first gender-affirming care protocols for females who believed themselves to be male.
In SOC-8, WPATH removed all age restrictions for gender transition surgeries.
WPATH Ignored and Even Invited Conflicts of Interest
In direct contradiction to accepted medical guidelines, the FTC claims that WPATH intentionally and exclusively chose those who had already publicly supported child gender transitions and were “well-recognized advocate[s] for WPATH and the SOC” to serve on its SOC-8 Revision Committee.
Many committee members stood to gain financially from altering the SOCs, including former WPATH president and current board member Dr. Marci Bowers, who made more than $1 million in a single year performing transition surgeries. Another member, Dr. Eli Coleman, testified in a deposition that “most participants in the SOC-8 process had financial and/or nonfinancial conflicts of interest.”
WPATH Manipulated and Hid Evidence
While WPATH presented SOC-8 as guidelines supported by strong evidence, its drafters admitted behind closed doors that they had no basis for their assertions. Coleman wrote in a memo to other drafters, “[a]ll of us are painfully aware that there are many gaps in research to back up our recommendations.”
Dr. Amy Tishelman, the lead drafter of SOC-8’s Children chapter, said in an interview with NPR, “[W]e’re talking about assessments [prior to transitioning a child], but we really don’t have research on what assessments are effective. Right now, we don’t have a research basis for making those decisions.”
Tishelman confirmed that WPATH lacked sufficient evidence to determine the best course of treatment for gender dysphoric children.
Drafters also admitted there was no international agreement among pediatric endocrinologists regarding the use of puberty blockers; in fact, they were fully aware that there had been many European studies that concluded otherwise — conclusions that caused the U.K. and several other countries to ban gender treatments in minors.
But WPATH wasn’t merely aware of studies showing that gender transitions weren’t beneficial. The authors of SOC-8 commissioned their own study from researchers at Johns Hopkins University (who submitted their findings in 2020), but they mandated that the researchers “use the Data for the benefit of advancing transgender health in a positive manner” and “involve at least one member of the transgender community in the design, drafting of the article, and the final approval of the article.” When the researchers reviewed numerous gender transition interventions and found no evidence that they benefitted patients, WPATH rejected multiple drafts and then refused to publish the final review.
What’s more, a study that had been used as a basis for WPATH guidance involved two patients who committed suicide during the study; these deaths were not disclosed with the SOC-8 publication that claimed pediatric gender transitions improved psychological well-being.
WPATH Caved to External Political Pressure in Removing Age Limits
The FTC argues that WPATH faced and gave in to outside pressure in its decision to remove all age limits from SOC-8. Some of this pressure came from former Assistant Secretary for Health at the U.S. Department of Health and Human Services, Admiral “Rachel” Levine, a man who identifies as a woman. Levine was “extremely supportive of the SOC-8” and “very eager for its release—so to ensure integration in the US health policies of the Biden government.”
When the new SOC standards were still being drafted, Levine’s office contacted WPATH to express fear that including age limits on gender transition surgeries would “result in devastating legislation” to limit those surgeries. Admiral Levine’s Chief of Staff wondered “if the specific ages can be taken out.”
WPATH members admitted that “politics” was a factor in SOC-8’s recommendations, but it wasn’t the only one. The American Academy of Pediatrics also threatened to publicly oppose SOC-8 if WPATH did not remove all age limits.
Then-WPATH president Dr. Walter Pierre Bouman voiced “surprise[] that a ‘reputable’ association” like “the AAP [wa]s so thin on scientific evidence” and “struggle[d] to find any sound evidence-based argument(s) underpinning.” One WPATH drafter noted that it was “the most strange experience” to see WPATH change the age limits at the “last minute” after discussion showed “nobody [on the committee] wanted to [eliminate] them, and personally not agreeing with the change.”
WPATH Considers Nearly Every Gender Treatment and Surgery To Be “Medically Necessary”
The suit argues that WPATH had long faced the challenge of getting insurance companies to pay for gender transitions because insurance executives considered them cosmetic. So in 2008, WPATH began claiming that gender transition interventions were “medically necessary.”
HHS defines “medically necessary” as “[h]ealth care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.” Insurance companies use this definition to help determine whether or not they will pay to cover a treatment.
When SOC-7 was released, WPATH declared that hormones and transition surgeries were medically necessary. SOC-8 insists that approximately 30 different gender-affirming procedures are medically necessary, including voice surgery, counseling, and hair removal. WPATH also encourages what it calls “embodiment goals,” which mean that doctors can administer hormones to a patient who isn’t necessarily gender dysphoric but simply wants to look “different.”
The only gender transition procedure that WPATH does not consider medically necessary is phalloplasty on minor females. According to the FTC, this position was most likely taken because the procedure, which removes the clitoris and replaces it with something akin to a penis using tissue cut from the patient’s forearm or thigh, violates laws against female genital mutilation.
The FTC argues that WPATH’s “medical necessity” designations are created to guarantee maximum payouts and profits for its members.
WPATH Launched “Education” Campaigns to Create Demand
The lawsuit also contends that WPATH uses public relations firm BerlinRosen to increase its public image credibility. WPATH and its members were coached by BerlinRosen on what to say in interviews, including the claim that gender transition “is safe and effective and endorsed by all leading medical associations,” and as a result, it has received major media coverage.
WPATH also launched “education” campaigns in schools, hospitals, medical associations, and other entities in order to increase the number of children seeking gender transitions.
The FTC charges WPATH with intentionally targeting children, providing training that tells pediatricians to ask children about their gender identities. Dr. Scott Leibowitz, one of the drafters of SOC-8, argued that gender transition doctors should “ensure that gender is the fabric of all healthcare for all kids” claiming “[t]hat will help … pediatricians be able to ally with those parents who wouldn’t even consider coming to a clinic that we provide.”
A St. Louis transition clinic used these methods, training doctors who specialize in cystic fibrosis and sickle cell anemia. Within three months, the clinic received its first referrals for children who were being treated for sickle cell anemia and cystic fibrosis.
Several WPATH members also co-authored a paper titled “Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents” that instructed doctors to screen autistic children and ask them probing questions that could show “gender concerns” and lead to a “referral…to an appropriate gender specialist.” It has been shown in numerous studies that autistic children are diagnosed with gender dysphoria at a much higher rate than their peers.
Not surprisingly, the FTC says that WPATH urges clinicians to ignore a patient’s comorbidities such as autism, mental health issues, and trauma and to instead immediately begin gender transition treatments.
It Was All for Profit, Not Patients
The FTC claims that WPATH’s ultimate goal in everything was to enrich itself and its members. And it’s hard to argue with the results. Since WPATH began claiming children would kill themselves without expensive gender transitions, the number of clinics and the number of those pursuing transition have risen drastically. And so too have the profits.
Doctors across the world have clung to WPATH’s SOCs as though they were infallible religious texts and parroted WPATH’s false claims. Doctors have lied in order to convince parents that their child will commit suicide if they don’t sign off on gender-affirming treatments. They lied when they said puberty blockers are reversible. They lied when they insisted transitions are safe and worry-free. They ignored mental health issues and trauma in favor of quickly rushing minor patients into permanently mutilating and medicalizing their healthy bodies.
And now the evidence is increasingly clear that WPATH knew it was all a lie and didn’t care. If the allegations are proven by a propensity of the evidence in a court of law, WPATH must be punished and dismantled for what it is: a criminal organization that conspired to destroy children’s bodies and minds for a quick buck. And the doctors who blindly followed or who saw an opportunity to boost their own bank accounts must also be held to account.
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