World Professional Association of Transgender Health (WPATH) members demonstrate a lack of consideration for long-term patient outcomes despite being aware of the debilitating and potentially fatal side effects of cross-sex hormones and other treatments
Presented by Magali PIGNARD
Since the early 2010s, minors have been able to access puberty blockers and opposite-sex hormones, following the results of an innovative Dutch experiment known as the “Dutch Protocol.” This treatment quickly entered general clinical practice worldwide. However, the supposed robust and long-term psychological benefits of this “innovative practice” have not been replicated in other research settings, resulting in an “uncontrolled spread” without the rigorous clinical research needed to demonstrate that the benefits outweigh the risks.
To reverse this uncontrolled spread, which accelerated with the explosion of cases starting in 2015, pioneering countries such as England, Sweden, and Finland sounded the alarm, commissioning systematic reviews of the evidence on the effects of puberty blockers and cross-sex hormones on minors. These reviews concluded that the practice of pediatric gender transition is based on low to very low-quality evidence. As a result, these countries developed new guidelines prioritizing non-invasive psychosocial interventions.
This awareness had no impact on American medical organizations.
In 2022, the World Professional Association for Transgender Health (WPATH) updated its “Standards of Care,” aligning with the Dutch experience (with some differences): gender affirmation, comprehensive “biopsychosocial evaluation” for adolescents, and providing patients with a range of “gender-affirming care” options à la carte, without age limits.
Scientifically, the trans-affirmative approach is not universally accepted and is no longer in effect in countries like England (2023), Finland (2020), Sweden (2022), Denmark, and likely soon in Norway.
In France, practice generally follows WPATH's standards of care, and the HAS (French National Authority for Health) is currently developing best practice recommendations concerning the transition process for transgender individuals.
WPATH recommends affirming gender and initially offering “gender-affirming care” (i.e., physical appearance aligned with one’s internal sense of gender), which consists of:
Social transition (changing one’s name, wearing clothes typically associated with the opposite sex): possible from age 6.
Medical transition:
Puberty blockers (PB) for preteens (from age 11-12): these suppress the development of sexual organs and secondary sexual characteristics (breasts, voice, body hair) and stop the production of sex hormones (similar to chemical castration).
Gender-affirming hormones from age 16, with parental consent; also known as opposite-sex hormones or cross-sex hormones.
Reassignment surgeries: surgeries on the face, torso, chest, and internal and external genitalia.
One chapter is dedicated to a new gender identity: eunuchs (Chapter 8): “Like other transgender and gender-diverse (TGD) individuals, eunuchs need access to affirming care [castration] to feel comfortable with their gender identity.”
WPATH removed a chapter on ethics that was included in the draft version of these Standards of Care, version 8.
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