It can be revealed that influential doctors and transgender health activists successfully helped shape NHS policy for more than a decade.
Standards of care documents, produced by the World Professional Association for Transgender Health, have been used as a basis to guide medical professionals across the NHS.
Such was the level of influence of WPATH that a director of Tavistock and Portman NHS Trust told a committee of MPs that its treatment protocols were based on the organisation’s guidelines.
It was previously reported that almost all children referred to specialists at the Tavistock clinic were given hormones that blocked the onset of puberty.
The NHS gender identity service’s own data showed that 96 per cent of children sent for assessment to endocrinology clinics were given puberty blockers; 98 percent then received cross-sex hormones.
Such was the level of influence of WPATH that a director of Tavistock and Portman NHS Trust told a committee of MPs that its treatment protocols were based on the organisation’s guidelines.
This aligns with the seventh version of the WPATH Care Standards, which the NHS and others rely on, which require trans people to receive “gender-affirming care”, including treatments such as hormones, surgeries and breast suppression. puberty.
Its eighth version, which was published to widespread criticism, included an entire chapter on eunuchs and advocated that medical professionals consider whether they should castrate a person who identified as such.
Former Tavistock director Dr Bernadette Wren told the Women and Equalities Committee in 2015 that the clinic’s protocols were “based on WPATH guidelines which are almost universally observed in Europe”.
At the time, Tavistock was the largest provider of transgender services in England; It is currently scheduled to close, to be replaced by regional centers, this year.
NHS guidance documents for staff, published in 2013, repeatedly refer to WPATH and state that they are “informed” by the seventh edition of its guidance to the organisation.
Contracts for NHS England’s Gender Identity Development Service, covering the period 2016-2020, state services “will be provided in accordance with…relevant national and international guidelines for the care of children and adolescents with GD , such as the World Professional Association for Transgender Health Care Standards.” ‘.
The document goes on to cite the seventh version of the WPATH standards of care.
It says: “When assessing children and adolescents presenting with GD, service mental health professionals will broadly adhere to the following guidelines taken from WPATH SOC v7.”
WPATH has since updated its Standards of Care document, with a “version eight.”
Some NHS trusts in England still point to them as guidance for professionals.
WPATH’s Standards of Care document has been criticized for pushing a model in which physicians facilitate patients’ transitions, rather than providing objective medical care.
The organization refers to its Standards of Care as “internationally accepted guidelines” and discusses medical interventions for children and adolescents in detail.
Professional medical bodies have also published guidance supporting or directing their members to WPATH guidance.
The GMC and BMA have directed their members to the WPATH standards of care, while the BMA cited them in its “core principles of supportive care”.
The Royal College of Psychiatrists made repeated references to the WPATH Care Standards in their ‘Good Practice Guidelines’ report in October 2013. A review of the document was planned for April 2023, although it is unclear when this was due to take place.
The Scottish Government recommended the adoption of Care Standards in 2012 and in 2021 recommended that the guidance be updated.
In 2022, it reviewed the possibility of implementing the eighth version of the WPATH Standards of Care, but was stopped due to backlash.
Last year, Dr Hilary Cass submitted her interim review to NHS England into gender identity services for children and young people.
Cass’s review criticized the Tavistock clinic, the only provider of specialist care in England, saying it was “not a safe or viable long-term option”.
WPATH’s Standards of Care document has been criticized for promoting a model in which doctors facilitate patients’ transition, rather than providing objective medical care (file image)
Their review noted that Tavistock took a “predominantly affirmative and non-exploratory approach” to treating patients and recommended a more cautious approach.
Hundreds of messages from WPATH members, including surgeons, GPs and therapists, were published this week after being sent to US activist Michael Shellenberger, who previously published explosive leaks from Twitter staff.
The material also includes a recording of an internal roundtable discussion held in May 2022 that included a lengthy discussion on how to deal with adolescents who question their gender and want to be prescribed puberty-blocking or cross-hormone medications but do not understand the consequences of this. . their fertility.
Dan Metzger, a hormone specialist at a children’s hospital in Canada, said at the meeting: “I think the thing to remember about kids is that we often explain these kinds of things to people who haven’t even studied biology at a high level.” “. school yet.’
He later said, “It’s always a good theory when you talk about fertility preservation with a 14-year-old, but I know I’m talking to a blank wall.”
‘We try to talk about it, but most children don’t have any brain space to talk about it seriously. That’s always bothered me, but we still want kids to be happy, happier right now, right?
Dr. Metzger did not respond to requests for comment.
In an exchange on her forum, a nurse asked what the right thing to do was with a patient who wanted to start hormone treatment but had been diagnosed with depression, post-traumatic stress disorder, and “typical schizoid traits.”
Dr. Dan Karasic, who helped write the mental health chapter of the latest WPATH guidelines, responded: “I don’t understand why you are perplexed. The mere presence of a psychiatric illness should not block a person’s ability to begin to take hormones if you have persistent gender dysphoria, capacity to consent, and the benefits of starting hormones outweigh the risks.
When approached by the Mail, he insisted: “Treatment is only prescribed when the patient has the capacity to give informed consent and the medical provider and patient agree that the benefits of the treatment outweigh the risks.”
President Dr Marci Bowers, who is transgender, said after the posts were published: ‘WPATH is and always has been a science and evidence-based organization whose recommendations are widely supported by leading medical organizations in everyone.
‘We are the professionals who best know the medical needs of trans and gender diverse people, and we oppose people who misrepresent and delegitimize the diverse identities and complex needs of this population through scare tactics.
‘The world is not flat. Gender, like genitals, is represented by diversity. “The small percentage of the trans or gender diverse population deserves medical attention and will never be a threat to the global gender binary.”
A Scottish Government spokesperson said: ‘The Scottish Government and NHS Scotland do not have a working relationship with the World Professional Association for Transgender Health (WPATH). Specific questions related to your standards or their development should be directed to WPATH.
“It is not correct to say that NHS gender identity services in Scotland follow WPATH V8 guidelines – a broad evidence base helps inform the provision of NHS gender identity services in Scotland.”
A GMC spokesperson said: ‘As the regulator of individual doctors in the UK, we do not set clinical guidelines. The guidance we provide is at a high level and our ethical trans healthcare hub shows ways our professional standards can be applied and points to resources.’
A spokesperson for the Royal College of Psychiatrists said: “All our position statements are based on a wide variety of sources, as well as the professional experience of our own members, and are not dictated by any individual or organisation.” Our position paper on transgender health was written in 2013 and we will update it following the outcome of the Cass Review.’
A Department of Health and Social Care spokesperson said: ‘NHS England is transforming gender identity services for children, in line with Cass Review recommendations, and moved away from WPATH guidelines more than five years ago.
“The Tavistock clinic will close at the end of March and new services will open in April, with robust safeguarding processes in place and staffed by pediatric safeguarding experts.”
A spokesperson for NHS England said: ‘The NHS has well-established methods and processes to enable the development of policies and specifications for NHS gender services in line with evidence and clinical experience.
“While we are aware of the WPATH standards, we are clear that they do not determine NHS policy.”
The BMA has been contacted for comment.