Leaked files reveal confusion in ranks of gender medicine

Medical professionals who push transgender interventions acknowledge that they base many of their practices on limited and low-quality research, according to leaked files from a group that bills itself as a leading authority on gender identity disorders.

The documents from the World Professional Association for Transgender Health reveal disturbing discussions in which doctors were encouraged to proceed with hormone treatments and risky surgeries on young children and mentally unstable people even as internal debates continued over whether these vulnerable patients could give informed consent.

Environmental Progress, an American conservationist nonprofit that states its goal is “solving big problems, without regard for ideology,” released the files in a 241-page report last Monday. It documents discussions from a private online forum and an 82-minute video of a virtual meeting between members, but it redacts most of the names of the people mentioned.

WORLD reviewed the report, which was written by Environmental Progress researcher Mia Hughes. The group’s leader, Michael Shellenberger, said on the social media platform X, formerly known as Twitter, that “one or more” unnamed people gave him access to the files. Shellenberger, also a journalist, said he initially planned to release the files through a series of articles, but instead shifted the entire project to staff at his nonprofit.

The files contain excerpts from conversations initiated by doctors seeking guidance for patients with the most vexing problems. In one case, two doctors expressed hesitation over whether to write letters endorsing cosmetic surgeries on the sex organs of clients with autism, bipolar disorder, and schizoaffective disorder. One doctor argues that the surgery is just as important to the patient’s well-being as getting treatment for the mental illness, asking, “What will happen to these patients if they do NOT undergo their affirmative treatment, which is also a medical necessity?”

On another discussion thread, another doctor admitted he was “struggling internally” about whether to prescribe cross-sex hormones requested by a patient with post-traumatic stress disorder, depression, and other clear signs of mental illness. Dr. Dan Karasic, a California psychiatrist, responded, “I’m missing why you are perplexed. Does the mental illness impair ability to give informed consent?”

In the leaked forum messages, the tone remained professional and serious, regardless of what scenarios the commenters addressed. One doctor said that for patients with dissociative identity disorder, in which a person adopts multiple personalities, he recommended getting consent from each of the patient’s alter egos.

The files revealed that patient outcomes varied widely. Medical professionals said some patients were pleased with the results of medication and surgery, but others regretted the procedures or suffered serious complications. In the discussion forum, one doctor asked whether he should stop giving testosterone injections to a woman with tumors in her liver. In response, another commenter said he believed the testosterone was to blame, mentioning a female colleague who spent years on testosterone and later died of advanced liver cancer.

In her summary report, researcher Hughes writes that patients have died as a direct result of transgender procedures, including an 18-year-old male who died of necrotizing fasciitis—a flesh-eating bacterial infection—after surgeons tried to construct a pseudo-vagina out of the teenager’s intestines.

Association experts speaking in the video of a May 2022 workshop acknowledged that children often didn’t comprehend the consequences of transgender procedures on their bodies. But the speakers still argued children should be allowed to undergo the procedures.

“It’s out of [minors’] developmental range sometimes to understand the extent to which some of these interventions are impacting them,” Dianne Berg said in a video quoted in the report. Berg is a licensed psychologist and associate professor at the University of Minnesota Medical School’s Institute for Sexual and Gender Health. “What really disturbs me is when the parents can’t tell me what they need to know about a medical intervention that apparently they signed off for,” she said.

In the video, Berg and her colleagues admitted it can be challenging to obtain informed consent from children and their parents. Berg said psychologists should conduct in-depth discussions with patients about medical interventions to make sure they and their guardians understand exactly how hormones or surgeries would affect them.

The panelists on the call also discussed the difficulties associated with helping children understand how medical interventions could change their fertility.

“The thing you have to remember about kids is that we’re often explaining these sorts of things to people who haven’t had biology in high school yet,” said Dr. Daniel Metzger, a pediatric endocrinologist at BC Children’s Hospital in Vancouver, British Columbia, Canada. “It’s always a good theory that you talk about fertility preservation with a 14-year-old, but I know I’m talking to a blank wall.”

During the meeting, Metzger and other panelists said medical providers need to be sure their patients understand the effects of cross-sex hormones, puberty blockers, and other interventions before moving forward.

In September 2022, about four months after the recorded meeting, WPATH released its Standards of Care 8 that included a chapter specifically dedicated to adolescents. The previous standards had combined children and adolescents into one chapter. The new version also removed a minimum age limit for prescribing cross-sex hormones, though it still recommends that patients delay taking medications until they start natural puberty.

WPATH president Dr. Marci Bowers, a male who identifies as female, is cited in the report as acknowledging that some patients who undergo transgender procedures may suffer lifelong sexual dysfunction. But Bowers did not pin that blame on doctors or the industry. “Patients need to own and take active responsibility for medical decisions, especially those that have potentially permanent effects,” Bowers wrote.

Yet the association president denies the existence of detransitioners.

“Acknowledgement that detransition exists to even a minor extent is off-limits for many in our community,” wrote Bowers in another post, according to the report.

Bowers issued a short statement on Tuesday, saying the organization “stands opposed to individuals who misrepresent and de-legitimize the diverse identities and complex needs of this population through scare tactics.” The statement neither confirmed nor denied the legitimacy of the files in the report.

Transgender journalists offered swift critiques of the Environmental Progress report. Writing for the pro-LGBTQ news site Assigned Media, transgender journalist Evan Urquhart said the report is unreliable because members of the online forum do not have to work in the medical field to join. According to Urquhart, “anyone willing to pay $225 can participate in the members-only forum and gain access to its posts.” Urquhart added that since most of the names of forum participants have been redacted, it was impossible to verify the accuracy of the messages, or the cases being discussed.

Urquhart argued that the files demonstrate that medical personnel do carefully consider if and when to offer transgender interventions to children. Transgender journalist Erin Reed also wrote a rebuttal to the WPATH Files, arguing that the documents actually show that people who identify as transgender are largely happy with their interventions and only rarely regret undergoing surgeries or cross-sex hormones.

Meanwhile, nearly all major professional medical associations have remained silent about the report. Now a week after its release, no public statements or press releases regarding WPATH have been issued from the American Medical Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, or the American Psychiatric Association. 

Only one group, the American College of Pediatricians, a professional association representing roughly 600 members, spoke out. “As suspected, children are being gravely injured,” said the group’s president, Michael Artigues, in a news release. “This is tantamount to abuse and it must be stopped immediately.”