SECTION 6 (part a & b)
Controversies around the GAC guidelines and practices of WPATH & Endocrine Society
The presenter referenced WPATH (World Professional Association for Transgender Health) as the authority in healthcare for the transgender diverse. WPATH is a voluntary organisation and sees itself as not merely a scientific organisation but an advocacy organisation (p.18) of gender affirmative care. It has a few members of the medical profession and has trans individuals who are not licensed professionals who attend the organisations biennial meetings, who have influenced outcomes. It is therefore known as an advocacy organisation.
WPATH has been severely criticised for it is most recent Standards of Care (version 8) and the recommendations to the Endocrine Society’s Clinical Practice Guidelines in 2017 its members contributed, are based on low or very low quality of evidence.
WPATH Standards of Care version 8 Controversy
Even though WPATH has named their treatment guidelines "Standards of Care" also known as "SOC." In a recent court case, WPATH clarified that despite the misleading name, their practice guidelines are indeed treatment recommendations and not a "standard of care."
Ultimately only the courts can determine whether clinicians who provide “gender-affirming” interventions can successfully invoke the standard of care argument when sued by a patient alleging harm. Those who will argue for it will point out that currently a number of medical organizations have embraced the practice of “gender affirmation” following WPATH's treatment recommendations. However, such an argument may not withstand scrutiny due to two key facts: the evidence base for "gender-affirming" interventions, as well as the WPATH guidelines themselves are recognized to be of very low quality; and a growing number of healthcare systems in the Western world recently diverged from WPATH recommendations, sharply limiting paediatric gender transitions to a few exceptional cases.
The latest Standards of Care have been deemed unreliable and unethical by a group of organizations, physicians, research scientists, mental health professionals, and other signatories to an online Declaration who support alternatives to the WPATH Standards. These health professionals encourage the use of up-to-date, science-based guidelines that minimize the risk of harm and respect the limitations of our current scientific evidence base. The Declaration aims to highlight concerns regarding the WPATH Standards of Care and to encourage healthcare professionals to utilize alternative resources that are available.
They maintain that the World Professional Association for Transgender Health (WPATH) has lost its standing as the leading authority on healthcare for gender-questioning youth with the release of its Standards of Care, 8th Edition. The following factors contribute to its loss of authority and trustworthiness:
The Standards continue to promote the affirmative care model, which involves widespread medical treatments (drugs and surgery) for trans-identified youth despite rising scientific scepticism that has led Sweden, Finland, France, and the United Kingdom to abandon this approach.
While other countries now prioritize psychosocial support as the first line of treatment, delaying drugs and surgery until the age of majority is reached in most cases, WPATH endorses early medicalization as fundamental.
WPATH failed to meet basic child-safeguarding norms by removing nearly all lower age limits for suggested medical and surgical interventions in a correction issued after the release of the Standards.
Abdicating ethical responsibility, WPATH eliminated a chapter on ethics that had appeared in earlier drafts.
Without convincing evidence, WPATH included "Eunuch" as a new gender identity (not necessarily a physical condition) and linked to an external site that depicts graphic and sexual fantasy stories portraying the castration of adolescent males.
WPATH's definition of "detransition" fundamentally mischaracterizes it, disregards the traumatic experiences of those who feel harmed by gender-related medical interventions and subsequently return to living as their biological sex, and offers no guidance on how to support individuals coping with the grief and pain of detransition.
Despite being presented as evidence-based, the Standards of Care fail to acknowledge that independent systematic reviews have deemed the evidence for gender-affirming treatments in youth to be of very low quality, subject to confounding and bias, and rendering any conclusions uncertain.
For these reasons and others, these health professionals no longer consider WPATH a reliable source of clinical guidance in the transgender field. WPATH and its Standards are outliers on the international stage and are deaf to the alarms being sounded within the scientific community regarding the use of experimental treatments on children.
b) Endocrine Society’s Clinical Practice Guidelines in 2017 ‘based on low or very low quality of evidence.’
The ECRI Guidelines Trust® an organisation that advances safe and effective patient care provide a “Trust Scorecard” that rates the quality of the guidelines, based on evidence strength and the measures taken to reduce bias in the recommendations. In 2019 a curious journalist searched the ECRI database for transgender care guidelines, the only guideline posted was the “Endocrine Society Clinical Practice Guidelines of Gender-Dysphoric/Gender-Incongruent Persons, 2017”. It was not given a Trust Scorecard rating. When ECRI was contacted by the journalist and asked why the Endocrine Society guidelines did not have a scorecard rating, they responded in an email, saying that the reason the Endocrine Society guidelines did not meet inclusion criteria to be rated was because “Only a few of their recommendations were supported by the systematic review; the majority were not.”
Note, nine out of 10 of the people who created the Clinical Practice Guidelines of 2017 belong to WPATH they have in their document a disclaimer that very clearly states at p. 3895 that this does not establish a standard of care.
“If you hear it's a Standard of care the Endocrine Society said it isn't the standard of care. If you look at the grading for of evidence, it's either low very low quality or there's no evidence for what they're doing” Dr Michael Laidlaw
is a board certified Endocrinologist with an MD in Endocrinology from USC, on February 21, 2023 he gave evidence to the Health and Human Services committee on the "Medical Dangers of Gender Affirmative Therapy”
At that session Dr Michael Laidlaw discussed some of the medical consequences of gender affirmative therapy, some of his points were:
Left alone the majority of children with gender dysphoria grow out of it by adulthood.
Even though there is no definitive physical evidence of gender identity, yet these youth with gender affirmative therapy are subject to the negative consequences of puberty blockers and high hormone levels that can cause potential risks, including infertility, cardiovascular disease, liver dysfunction, high blood pressure, manic mood swings, depression and high probabilities of cancer risks. Surgeries, that can produce loss of sexual function, high probability of urethra infections with phalloplasty, massive scaring, damage to nerves and loss of erotic feeling.
A long-term study from Sweden showed that individuals who underwent hormone therapy and surgery for transition had higher rates of mortality, inpatient psychiatric care, and completed suicide 19 times higher than the general population.