New standards of transgender health care raise eyebrows

As if more drama were needed in the gender wars, the public launch of the latest standards of care by the World Professional Association for Transgender Health (wpath) on September 15th was a mess. Known as soc8, they originally included a list of minimum ages for treatments—14 for cross-sex hormones, 15 for removal of breasts, 17 for testicles. Hours later, a “correction” eliminated the age limits. The head of the drafting committee, Eli Coleman, said the publisher went ahead “without approval” before final changes were made.

This only intensified concerns about the document’s “gender-affirming” approach that supports self-diagnosis by adolescents and children. wpath, based in Illinois, has been the main transgender-health organisation that is looked to for guidance across the world. Since its views count, critics worry about soc8 saying hormones and surgery should be allowed at even younger ages. They think this medicalises too many teens who need neither, just therapy. soc8 also says puberty blockers are reversible, a contested claim.

The document does try to find some middle ground. It accepts that other mental-health issues must be dealt with. But it insists that a systematic review of evidence of outcomes in youth transitioning, called for by critics, is not possible, even though Britain did one (the findings contributed to the decision to close the Tavistock youth clinic that also promoted gender affirmation).

wpath has been taken over by activists,” says Julia Mason, a paediatrician in Oregon. Mr Coleman responds that such criticism is wide of the mark: “This is a professional organisation of people who all adhere to the Hippocratic oath.”

The most controversial chapter is on eunuchs, who “may seek castration to better align their bodies with their gender identity”. It refers to a website which hosts stories about castrating boys against their will. Stella O’Malley, an Irish psychotherapist who heads Genspect, a group questioning “affirmation”, says there is a danger of “a new sacred ideology emerging that you cannot criticise”. As with the Catholic church, she says, “this will inevitably attract some bad-faith actors”.

Until now, transitioning has been justified by the hope that it could ease distress. Though some studies have found short-term improvements in mental health, these disappear in long-term studies. soc8 shows wpath has now changed this aim, to helping trans people achieve “lasting personal comfort”, points out Will Malone of the Society for Evidence-based Gender Medicine, an advocacy group. “Distress was clinical. Now it’s about cosmetic procedures to achieve personal comfort.”

Worried parents, many of them on the political left, point to the growing number of detransitioners. Sweden and Finland, meanwhile, have ignored wpath, done systematic reviews—and restricted hormones and surgeries for adolescents.

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