The World Professional Association for Transgender Health (WPATH) is a non-profit medical advocacy group made up of of doctors that standardizes medical practices concerning treatments for gender dysphoria, which the organization previously termed gender identity disorder. WPATH’s recommendations, as most recently updated in 2022’s Eighth Edition of the Standards of Care for the Health of Transgender and Gender Diverse People, is highly influential on the guidelines followed by the U.S. Department of Defense, major hospitals across the United States, ¹ the Canadian Mental Health Association, ² the United Kingdom’s National Health Service (NHS), ³ the British Medical Association, the General Medical Council, the Royal College of Psychiatrists, and other major medical institutions ⁴ As of 2024, WPATH claims around 2,000 members. ⁵

WPATH has been criticized for misrepresenting its nature by portraying itself as a professional association rather than as an advocacy group. The Guardian called it “neither solely a professional body – a significant proportion of its membership are activists – nor does it represent the ‘world’ view on how to care for this group of people.” ⁶

In March 2024, Environmental Progress released the “WPATH Files,” an analysis of a collection of leaked documents that indicated that many WPATH members practiced a more liberal standard of care than the official WPATH guidelines. Critics, primarily right-leaning, have pointed to the WPATH guidelines as evidence of medical malpractice across the United States, particularly regarding treatments given to transgender-identified minors.

History

The Harry Benjamin International Gender Dysphoria Association was established in 1978 by gerontologist and endocrinologist Harry Benjamin and a group of medical colleagues to develop standardized medical treatments for gender dysphoria. Benjamin was one of the most prominent practitioners of gender dysphoria treatments in the United States and subscribed to the notion that his patients were “born in the wrong body.” ^{7 8}

In 1979, the Association published the First Edition of Standards of Care for Gender Identity Disorders. The First Edition recommended withholding treatments on the grounds of mental instability and recommended only providing treatments to individuals who would likely be able to “pass” as their chosen gender after treatments. The First Edition was written exclusively by cisgender doctors. Since then, according to the New York Times, transgender advocates have increasingly gained influence on WPATH. Seven updated editions have been published through 2022, with the most recent edition being titled Standards of Care for the Health of Transgender and Gender Diverse People. The Editions have tended to be more liberal in their recommendations over time, though many transgender activists still consider them to be overly restrictive. ^{9 10 11 12}

In 2006, the Association was renamed to the World Professional Association for Transgender Health to “eliminate the term ‘gender dysphoria’ and to put an emphasis on overall health and well-being instead of illness.” ¹³

Standards of Care for the Health of Transgender and Gender Diverse People, Eighth Edition

In 2022, World Professional Association for Transgender Health published the Eighth Edition of the Standards of Care for the Health of Transgender and Gender Diverse People, which describes standards for medical treatment for “transgender and gender diverse” individuals as well as “Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments.” ^{14 15} In an FAQ for the Eighth Edition, WPATH asserts that “gender affirming health care is a human right.” ¹⁶

Positions

The Eighth Edition is significantly more liberal in its treatment recommendations than the Seventh Edition. For instance, the Seventh Edition called the practice of social transition in early childhood “controversial” and was co-written by Chris Zucker, a Canadian researcher who argued that most trans-identifying young children grow out of their dysphoria naturally. In 2015, Zucker’s clinic was shut down due to pressure from transgender activists, and in 2017, Zucker’s appearance at a WPATH conference was canceled due to pressure. The Eighth Edition is almost entirely free of Zucker’s influence. ¹⁷

The Eighth Edition “[modifies] the criteria for medical interventions from previous versions to eliminate unnecessary barriers to care,” including “removing minimum age requirements” and “removing requirements for living in desired gender role.” ¹⁸ The advised minimum age for taking hormone treatments was lowered from 16 in the Seventh Edition to 14. The advised minimum age for mastectomies was set to 15. While previous editions required that trans-identifying individuals live as their chosen genders for at least one year prior to receiving genital surgery, the Eighth Edition has removed this provision. ¹⁹

The Eighth Edition includes new recommendations for “people who are nonbinary” and “eunuchs or eunuch-identified people.” ²⁰ The Eighth Edition advises that “eunuchs may also seek castration to better align their bodies with their gender identity.” ²¹

The Eighth Edition does not support surgical treatments for transgender children. The FAQ states, “the only form of gender-affirming care for children before puberty is social support, such as allowing a child to choose clothing, hairstyles, or use of a different name that more closely aligns with their gender identity.” However, the guidelines recommend the use of puberty blockers for non-gender-conforming adolescents. The guidelines recommend surgery as a possible treatment when a child reaches adulthood. ²² In a 2023 interview, WPATH president Marci Bowers stated, “Surgery really is not done under the age of 18, except in severe cases.” However, she emphasized, “care is individualized. And so age isn’t really the issue.” ²³

The Eighth Edition FAQ asks: “Are there more adolescents seeking gender affirming treatments because of social influences?” and answers that the rise in the transgender population is likely due to greater tolerance in the modern age making transgender individuals feel more comfortable in coming out. ²⁴ Bowers echoed this sentiment in a 2023 interview, but stated that the rate of transgenderism was unlikely to pass 3%. ²⁵ In the documentary, What is a Woman?, Bowers added that possible social contagion constitutes a “teeny-tiny” factor in the increase in the transgender population. ²⁶

The Eighth Edition FAQ states that the “risk of regret” for gender dysphoria treatment is “uncommon and statistically lower than for other medical or surgical interventions.” ²⁷

Criticisms

Do No Harm chairman Stanley Goldfarb has criticized the Eighth Edition for being overly subjective and based on low-quality research: “The general problem with WPATH guidelines is that they are primarily based on opinion and not on high quality research. That judgment has been affirmed by structured reviews, carried out in the United Kingdom, Norway, and Denmark. The current protocols used in many if not most American clinics fail to adhere to the original studies conducted in the Netherlands. And even those studies have been harshly criticized for failure to adequately assess outcomes of transition.” ²⁸

Leor Sapir of the Manhattan Institute for Policy Research has criticized the Eighth Edition for allegedly being misleading about the nature of transgender care in Europe and the United States. According to the Eighth Edition, transgender care is consistent on both sides of the Atlantic with a strong consensus on the efficacy of such treatments as puberty blockers. Sapir disputes this depiction, noting that the medical establishments of the United Kingdom, Sweden, and Finland have all determined that the risks of puberty blockers outweigh the benefits and have therefore placed significant restrictions on their usage. Sapir also disputes that the American medical establishment is universally supportive of WPATH’s transgender medical treatments. ^{29 30}

Thoughtful Therapists member Peter Jenkins has criticized the Eighth and Seventh Editions for being overly reliant on “patient self-diagnosis” over objective criteria for diagnosing and treating gender-non-conforming individuals. Jenkins considers this approach to be based on maximizing legal protection for clinicians rather than optimizing patient care: “WPATH and its Standards of care are likely to provide the key reference point for medical practitioners facing such negligence action for medical transition in the UK and elsewhere.” ³¹

Jenkins has also criticized the Eighth Edition for weak research standards and possible conflicts of interest. He has pointed out that the Eighth Edition’s key sources are observational studies rather than randomized control trials. Some key sources were written by members of WPATH, including the current president-elect Asa Radix. ³²

Sex Matters, an organization that is critical of numerous aspects of modern transgender activism, criticized the Eighth Edition for using “ideologically driven language,” such as “gender-affirming health care” instead of “irreversible medical and surgical interventions,” or “chest masculinization surgery” instead of “double mastectomies.” ³³

Sex Matters criticized the Eighth Edition for removing minimum age limits in advising medical treatments, particularly regarding irreversible treatments such as most surgeries. Sex Matters points out that the guidelines don’t even recommend mandatory therapy for children before undergoing treatments. ³⁴

Sex Matters criticized the Eighth Edition for encouraging harsh treatments like “chest binding” and “genital tucking” to children without sufficient regard for their physical discomforts. ³⁵

Sex Matters criticized the Eighth Edition for encouraging transgender children to “challenge” parents that don’t sufficiently support transgender children in their treatment. ³⁶

Sex Matters considers the Eighth Edition “deeply concerning” “from an ethical and therapeutic standpoint” due to its inclusion of treatment guidelines for eunuchs. ³⁷

WPATH Files

In March 2024, Environmental Progress (EP), an advocacy group led by Michael Shellenberger, published the “WPATH Files,” a summary of leaked internal files in which the World Professional Association for Transgender Health’s members are shown to operate outside generally accepted practices regarding transgender treatment. Many members expressed privately that they disagreed with or disregarded WPATH’s official guidelines. EP characterized WPATH as “neither scientific nor advocating for ethical medical care,” and as “engaging in an unregulated experiment on some of the most vulnerable individuals in society.” ³⁸

According to EP’s summary, WPATH’s members expressed private concerns about the adverse effects of gender-reassignment surgery while supporting WPATH’s claims that such practices are extremely safe. WPATH members reported patients with symptoms including painful orgasms, bleeding after sex, and “[erections] feeling like broken glass.” ³⁹

WPATH members reported conducting surgeries on patients to create customized bodies that mix and match gender components through “non-standard procedures.” For instance, doctors have performed “top surgeries without nipples,” “phallus-preserving vaginoplasties,” and “nullification procedures” (ie. castrations). Recently, these surgeries have been requested by a “wave” of non-binary patients, including those who identify as agender or eunuchs. ⁴⁰

EP’s report finds that WPATH follows “an unethical approach to consent among adults.” WPATH members found that adults seeking gender dysmorphia treatment for themselves or their children were often uninformed about the risks of the procedures. Many members stated that diagnosed mental illnesses, including depression, anxiety, and PTSD, were not sufficient to make consent impossible. One doctor reported attaining consent from all of the “alters,” or alternate personalities, of an adult with dissociative identity disorder. ⁴¹

WPATH members reported acknowledging that recipients of gender-reassignment surgery and hormone replacement therapy were sometimes too young to understand the ramifications of such treatments. One doctor stated that he found himself attempting to explain side effects to “people who haven’t even had biology in high school yet.” Another said that trying to describe fertility preservation to some young patients was like “talking to a blank wall.” WPATH members admitted to performing gender-reassignment surgery on patients as young as 14. ⁴²

WPATH members admit to refusing to notify patients that detransitioning is a risk for transgender individuals. On researcher stated that “the idea of detransitioning… reinforces transness as a pathology.” ⁴³

EP concluded the report by calling for the U.S. government to launch an inquiry into WPATH and its members for medical malpractice. ⁴⁴

While media attention for the WPATH files mostly came from right-of-center news sources, left-of-center media outlets also criticized WPATH. An op-ed in the Guardian called the leaked messages “disturbing.” ⁴⁵

Funding

In 2024, the World Professional Association for Transgender Health reported $2,554,088 in revenue. Membership fees provided 70% of the funding, while most of the remaining sum came from donations. ⁴⁶

Leadership

Marci Bowers has been the president of the board of the World Professional Association for Transgender Health since 2020 and has been on the board since 2018. She is a practicing physician at the Children’s Hospital Los Angeles and sits on the board of the Trevor Project, a group that advocates for LGBT acceptance. She is a former board member of the Transgender Law Center and GLAAD. ⁴⁷

According to a report from Fox News, during a speech to Mount Sinai Health in June 2021, Bowers expressed concerns that prescribing puberty blockers to children could weaken the development of sexual organs and diminish or eliminate the potential for orgasms. Bowers also stated that she had been attacked by left-of-center organizations for expressing this view. Fox News pointed out that Bowers later endorsed WPATH’s Eighth Edition of the Standards of Care for the Health of Transgender and Gender Diverse People which was released the following year and promotes the usage of puberty blockers in children. Bowers denied that her views had ever changed regarding puberty blockers, stating “they are safe and reversible.” ⁴⁸

As of March 2024, Asa Radix is the president-elect of WPATH and co-wrote WPATH’s Eighth Edition of its Standard of Care. Radix is an infectious disease and HIV specialist at the Callen-Lorde Community Health Center in New York City and an associate professor of clinical epidemiology in the Department of Epidemiology. ⁴⁹

In October 2022, Radix and Alex Keuroghlian wrote a paper arguing that “defamation, sensationalist transphobia, [and] intimidation” are often directed at practitioners of transgender medicine. ^{50 51}

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