Influential transgender health doctors and activists successfully helped shape NHS policies for more than a decade, it can be revealed.
Standards of Care documents, produced by the World Professional Association for Transgender Health, have been used as a basis for guidance to medical practitioners across the NHS.
Such was the level of WPATH’s influence it saw a director of the Tavistock and Portman NHS Trust tell a committee of MPs its treatment protocols were based on the organisation’s guidelines.
It was previously reported hormones blocking the onset of puberty were given to almost every child referred to specialists by the Tavistock clinic.
The NHS gender identity service’s own data showed 96 per cent of children sent for assessment to endocrinology clinics were given puberty blockers – 98 per cent then went on to be given cross-sex hormones.
Such was the level of WPATH’s influence it saw a director of the Tavistock and Portman NHS Trust tell a committee of MPs its treatment protocols were based on the organisation’s guidelines
This aligns with the seventh version of WPATH’s Standard’s of Care – relied on by the NHS and others – calling for trans people to have ‘gender-affirming care’, including treatments such as hormones, surgeries and puberty suppression.
Its eighth version, which was published to widespread criticism, included an entire chapter on Eunuchs and advocated for medical professionals to 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 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 earmarked for closure, to be replaced by regional hubs, this year.
NHS guidance documents for staff, published in 2013, repeatedly make reference to WPATH and state they are ‘informed’ by the organisation’s seventh edition of its guidance.
Contracts for NHS England’s Gender Identity Development Service, covering 2016-2020, state services ‘will be delivered in line with… relevant national and international guidelines for the care of children and adolescents with GD such as the World Professional Association for Transgender Health Standards Of Care’.
The document goes on to cite the seventh version of WPATH’s standards of care.
It states: ‘When assessing children and adolescents who present with GD, the service’s mental health professionals will broadly conform to the following guidelines taken from the WPATH SOC v7.’
WPATH has since updated its Standards of Care document, with a ‘version eight’.
These are still signposted to as guidance for professionals by some trusts in NHS England.
WPATH’s Standards of Care document has been criticised for pushing a model where clinicians facilitate patients’ transitioning, rather than providing objective healthcare.
The organisation refers to its Standards of Care as ‘internationally accepted guidelines’ and discusses at length medical interventions for children and adolescents.
Professional medical bodies have also published guidance either endorsing or signposting their members to WPATH’s guidance.
The GMC and BMA have directed their members to WPATH’s standards of care, while the BMA cited them in its ‘core principles of supportive care’.
The Royal College of Psychiatrists made repeated reference to WPATH’s Standards of Care in its ‘Good Practice Guidelines’ report in October 2013. A review of the document was planned in April 2023, although it is unclear when it was due by.
The Scottish Government recommended the adoption of Standards of Care in 2012 and in 2021 advised the guidance should be updated.
In 2022 it reviewed whether to implement the eighth version of WPATH’s Standards of Care, but stopped short following a backlash.
Last year, Dr Hilary Cass submitted her interim review to NHS England on gender identity services for children and young people.
The Cass review criticised the Tavistock clinic – the sole provider of specialist care in England – as ‘not a safe or viable long-term option’.
WPATH’s Standards of Care document has been criticised for pushing a model where clinicians facilitate patients’ transitioning, rather than providing objective healthcare (stock image)
Her review noted the Tavistock adopted a ‘predominantly an affirmative, non-exploratory approach’, to treating patients and advised a more cautious approach.
Hundreds of messages by WPATH members – who include surgeons, GPs and therapists – were published this week after being sent to American activist Michael Shellenberger, who previously published bombshell leaks from Twitter staff.
The material also includes a recording of an internal panel discussion held in May 2022 which featured a lengthy discussion of how to deal with gender-questioning teenagers who want to be prescribed puberty-blocking drugs or cross-sex hormones yet do not understand the consequences for their fertility.
Dan Metzger, a hormone specialist at a children’s hospital in Canada, told the meeting: ‘I think the thing you have to remember about kids is that we’re often explaining these sorts of things to people who haven’t even had biology in high school yet.’
He later said: ‘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.
‘We try to talk about it, but most of the kids are nowhere in any kind of a brain space to really talk about it in a serious way. That’s always bothered me, but we still want the kids to be happy, happier in the moment, right?’
Dr Metzger did not respond to requests for comment.
In one exchange on its messageboard, 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 ‘schizoid typical traits’.
Dr Dan Karasic, who helped write the mental health chapter of WPATH’s latest guidelines, replied: ‘I’m missing why you are perplexed. The mere presence of psychiatric illness should not block a person’s ability to start hormones if they have persistent gender dysphoria, capacity to consent, and the benefits of starting hormones outweigh the risks.’
He insisted when approached by the Mail: ‘Treatment is only prescribed when the patient has capacity to give informed consent and the medical provider and patient agree that the benefits of treatment outweigh the risks.’
President Dr Marci Bowers, who is transgender, said following the publication of the messages: ‘WPATH is and has always been a science- and evidence-based organization whose recommendations are widely endorsed by major medical organizations around the world.
‘We are the professionals who best know the medical needs of trans and gender diverse individuals—and stand opposed to individuals who misrepresent and de-legitimize the diverse identities and complex needs of this population through scare tactics.
‘The world is not flat. Gender, like genitalia, is represented by diversity. The small percentage of the population that is trans or gender diverse deserves healthcare 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 of Transgender Health (WPATH). Specific questions related to its 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 wide evidence base helps inform the delivery of NHS gender identity services in Scotland.’
A GMC spokesman said: ‘As the regulator for individual doctors in the UK, we do not set clinical guidance. The guidance we provide is high-level and our Trans healthcare ethical hub shows ways in which our professional standards can be applied and signposts to resources.’
A spokesperson for the Royal College of Psychiatrists said: ‘All our position statements are informed by a wide variety of sources, as well as our own member’s professional expertise, and are not dictated by any single 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 children’s gender identity services, in line with the Cass Review recommendations, and moved away from WPATH guidelines more than 5 years ago.
‘The Tavistock clinic will close at the end of March and the new services will open in April, with robust safeguarding processes in place and staffed by experts in paediatric safeguarding.’
An NHS England spokesperson said: ‘The NHS has well-established methods and processes in place to enable the development of policies and specifications for NHS gender services in line with clinical evidence and expertise.
‘While we are aware of WPATH standards, we are clear that these do not determine NHS policy.’
The BMA was approached for comment.
