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How influential trans doctors and activists have been secretly shaping NHS policy for more than a decade

Influential transgender doctors and activists have successfully shaped NHS policy 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 for doctors across the NHS.

Such was the influence of WPATH that a director of the Tavistock and Portman NHS Trust told a committee of MPs that its treatment protocols were based on the organisation’s guidelines.

It was previously reported that almost every child referred to specialists by the Tavistock clinic was given hormones that blocked the onset of puberty.

The NHS Gender Identity Service’s own data showed that 96 percent of children sent to endocrinology clinics for tests were given puberty blockers – 98 percent were subsequently given cross-sex hormones.

Such was the influence of WPATH that a director of the Tavistock and Portman NHS Trust told a committee of MPs that its treatment protocols were based on the organisation’s guidelines.

This is in line with the seventh version of WPATH’s Standard’s of Care – which the NHS and others rely on – which calls for transgender people to receive ‘gender-affirming care’, including treatments such as hormones, surgery and puberty suppression.

The eighth version, published amid much criticism, included an entire chapter on eunuchs and advocated that medical professionals consider whether to castrate a person who identified as such.

Former Tavistock director Dr Bernadette Wren told the Women and Equality Commission in 2015 that the clinic’s protocols were ‘based on WPATH guidelines which are almost universally adhered to in Europe’.

At the time, Tavistock was the largest provider of transgender services in England – it is currently earmarked for closure and will be replaced by regional hubs this year.

NHS staffing guidelines, published in 2013, repeatedly refer to WPATH and state that they are ‘informed’ by the seventh edition of the organisation’s guidelines.

Contracts for NHS England’s Gender Identity Development Service, for the period 2016-2020, government services ‘will be delivered in accordance with… relevant national and international guidance for the care of children and adolescents with GD, such as the World Professional Association for Transgender Health Standards Of Care’.

The document then cites the seventh version of WPATH’s standards of care.

It says: ‘When assessing children and adolescents presenting with GD, the service’s mental health professionals will broadly adhere to the following guidelines from the WPATH SOC v7.’

WPATH has since updated its Standards of Care document with a ‘version eight’.

These are still indicated by some trusts in NHS England as guidance for professionals.

WPATH’s Standards of Care document has been criticized for encouraging a model in which physicians facilitate patient transitions, rather than providing objective health care.

The organization calls its Standards of Care “internationally accepted guidelines” and extensively discusses medical interventions for children and adolescents.

Professional medical bodies have also published guidelines that their members endorse or refer to WPATH guidelines.

The GMC and BMA have made their members aware of WPATH’s standards of care, while the BMA included these in its ‘core principles of supportive care’.

The Royal College of Psychiatrists repeatedly referred to WPATH’s standards of care in its ‘Good Practice Guidelines’ report in October 2013. A review of the document was scheduled for April 2023, although it is unclear when this would take place.

The Scottish Government recommended the adoption of standards of care in 2012 and advised in 2021 that the guidelines should be updated.

In 2022, it assessed whether to implement the eighth version of WPATH’s Standards of Care, but stopped doing so after a backlash.

Last year, Dr Hilary Cass submitted her mid-term review to NHS England on gender identity services for children and young people.

The Cass review criticized the Tavistock clinic – the only provider of specialist care in England – as ‘not a safe or viable long-term option’.

WPATH's Standards of Care document has been criticized for encouraging a model in which physicians facilitate patient transitions, rather than providing objective healthcare (stock image)

WPATH’s Standards of Care document has been criticized for encouraging a model in which physicians facilitate patient transitions, rather than providing objective healthcare (stock image)

Its review noted that the Tavistock took a ‘predominantly confirmatory, non-exploratory approach’ to treating patients and recommended a more cautious approach.

Hundreds of messages from WPATH members – including surgeons, GPs and therapists – were published this week after being sent to US 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 that featured a lengthy discussion about how to deal with gender-questioning teens who want to be prescribed puberty-blocking drugs or cross-sex hormones but don’t understand the consequences. their fertility.

Dan Metzger, a hormone specialist at a children’s hospital in Canada, told the meeting, “I think the thing to remember about kids is that we often explain this stuff to people who haven’t even taken biology in high school. not yet at school.’

He later said: ‘It’s always a good theory to talk to a fourteen-year-old about fertility preservation, but I know I’m talking to a blank wall.

“We try to talk about it, but most kids don’t have any brain space to actually talk about it in a serious way. That’s always bothered me, but we still want the kids to be happy, happier right now, right?’

Dr. Metzger did not respond to requests for comment.

In a message board conversation, a nurse asked what was the right thing to do with a patient who wanted to start hormone treatment but had been diagnosed with depression, post-traumatic stress disorder and “typical schizoid features.”

Dr. Dan Karasic, who helped write the mental health chapter of WPATH’s latest guidelines, responded: “I don’t understand why you’re perplexed. The mere presence of a psychiatric illness should not block a person’s ability to start hormones if he or she has persistent gender dysphoria, the capacity to consent, and the benefits of starting hormones outweigh the risks. ‘

When contacted by post, he insisted: ‘Treatment is only prescribed if the patient is capable of giving informed consent and the medical provider and the patient agree that the benefits of treatment outweigh the risks.’

President Dr. Marci Bowers, who is transgender, said after the release 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 against individuals who misrepresent and delegitimize 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 threaten the global gender binary.”

A Scottish Government spokesperson said: ‘The Scottish Government and NHS Scotland have no working relationship with the World Professional Association of Transgender Health (WPATH). Specific questions regarding the standards or their development should be directed to WPATH.

‘It is not correct to say that NHS Gender Identity Services in Scotland follow the WPATH V8 guidelines; a broad evidence base helps inform the delivery of NHS gender identity services in Scotland.”

A GMC spokesperson said: ‘As the regulator for individual doctors in Britain we do not set clinical guidelines. The guidance we provide is of a high standard and our trans care ethics 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 views are based on a wide variety of sources, as well as the professional expertise of our own members, 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 spokesperson for the Department of Health and Social Care said: ‘NHS England is transforming gender identity services for children, in line with the recommendations of the Cass Review, and moved away from the WPATH guidelines more than five years ago.

‘The Tavistock clinic will close at the end of March and the new services will open in April, with robust security processes in place and staffed by pediatric safeguarding experts.’

An NHS England spokesperson said: ‘The NHS has established methods and processes to enable the development of policies and specifications for NHS gender services in line with clinical evidence and expertise.

‘While we are aware of the WPATH standards, we are clear that they do not determine NHS policy.’

The BMA was contacted for comment.