‘Gold Standard’ Transgender Health Org Releases Disturbing New Guidelines For Minors

Written by K. Walker on September 16, 2022

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Parents should be concerned, but frankly, we should ALL be concerned.

The World Professional Association for Transgender Health (WPATH) is the leading transgender health association and its recommendations are widely used in hospitals and clinics across the U.S., Canada, and the U.K. in the treatment of individuals suffering from gender dysphoria.

On September 6, 2022, WPATH issued its Standards of Care 8th Edition in the International Journal of Transgender Health, but just a few days later, on September 15, issued a correction that removed sections related to “minimal ages for gender-affirming medical and surgical treatment for adolescents.”

While those sections have been removed, a close reading finds that there are still some age suggestions for some procedures included in the text.

The new published recommendations are almost identical to the December 2021 draft that was available for public review — the minimum age for minors to seek “gender-affirming” medical treatment including surgery has been lowered by at least a year. But that’s only if you read the document closely. The summary has no age recommendations at all.

WPATH suggests that both puberty blockers and cross-sex hormones may be administered when a child shows the first signs of puberty, which is called “Tanner Stage 2.” In practical terms, this means between the ages of 9-11 for girls, and around age 11 for boys, but the WPATH document gives no minimum age.

But from the close reading, the age to obtain cross-sex hormones — which cause permanent changes to the body — dropped two years from age 16 to 14. The same is true with surgeries — irreversible “chest masculinization” surgery, (also known as a double mastectomy,) is now recommended at age 15; facial feminization surgery dropped to age 16; and male-to-female genital surgeries are now given the nod at age 17 instead of 18.

But these are only recommendations, not hard and fast rules.

When discussing vaginoplasties, which is creating a pseudo-vagina using the patient’s male genital tissue, the guidance suggests that this can be done before the age of 18.

“While the sample sizes are small, these studies suggest there may be a benefit for some adolescents to having these procedures performed before the age of 18,” states WPATH. Another statement in the document admits that this is already being done, “A 2017 study of 20 WPATH-affiliated surgeons in the US reported slightly more than half had performed vaginoplasty in minors.”

The one surgery that WPATH is not recommending to minors is a phalloplasty, which is the creation of a penis-like phallus from skin grafts taken from the arm, thigh, or elsewhere on the body.

“Given the complexity of phalloplasty, and current high rates of complications in comparison to other gender-affirming surgical treatments, it is not recommended this surgery be considered in youth under 18 at this time,” states the document.

Disturbingly, in place of minimal age recommendations for any of the medical interventions — puberty blockers, cross-sex hormones, and surgeries — the adolescent criteria states, “Demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.” Chapter 6 of the document explains what WPATH means by cognitive maturity, “the ability to reason hypothetical situations enables a young person to conceptualize implications regarding a particular decision.”

The appendix to the document titled, “Summary Criteria for Adolescents,” doesn’t indicate minimum ages for surgeries, but instead recommends: “At least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated.”

We are now seeing more and more people who are de-transitioning and speaking out about how they were rushed into transition before they understood the repercussions of their actions.

Not to mention that a disproportionate number of these gender-confused children suffer from other mental health issues that range from anxiety and depression to autism. That doesn’t seem to be considered in the calculation very often.

Besides, how can a minor be able to provide “informed consent” about removing their breasts at age 15 or turning their penis into a vagina at age 17? Their brains haven’t even fully developed yet.

And what kind of slippery slope is this if we as a society accept that a minor can give “informed consent” to these medical procedures that affect their sexual organs?

This leads to very, very bad places.

Another disturbing change in the guidance leaves room for intervention by the state if parents refuse to get on board with the “gender-affirming” care.

WPATH’s new guidance states that while parental consent for minors to obtain medical treatments are recommended, they are not required and state powers may intervene if a parent does not affirm their child’s chosen identity.

Chapter 6 of the document deals with minors. Section 6.11 is pretty clear that parental consent is preferable, but not necessary.

“Helping youth and parent(s)/caregiver(s) work together on important gender care decisions is a primary goal. However, in some cases, parent(s)/caregiver(s) may be too rejecting of their adolescent child and their child’s gender needs to be part of the clinical evaluation process. In these situations, youth may require the engagement of larger systems of advocacy and support to move forward with the necessary support and care (Dubin et al., 2020).” (Emphasis added)

“We recommend when gender-affirming medical or surgical treatments are indicated for adolescents, health care professionals working with transgender and gender diverse adolescents involve parent(s)/guardian(s) in the assessment and treatment process, unless their involvement is determined to be harmful to the adolescent or not feasible.” (Emphasis added)

The Appendix reiterates the position, “Involvement of parent(s)/guardian(s) in the assessment process, unless their involvement is determined to be harmful to the adolescent or not feasible.”(Emphasis added)

The Society for Evidence-Based Gender Medicine (SEGM), an international group of over 100 clinicians and researchers, critiqued the WPATH 8th Edition draft in January 2022.

SEGM did applaud WPATH for acknowledging the “profound shift in the incidence of gender dysphoria/gender incongruence and its presentation among youth, and the acknowledgment of the risk of inappropriate medical transition of youth.”

They also commended the slightly stronger focus on psychotherapy assessments in the document “since gender incongruence in youth can arise from multiple causes and may have multiple paths to resolution.”

SEGM cited the potential for harm to patients with WPATH’s “significant methodological limitations.”

The document lays out where the methodological flaws are:

These are most evident in the reporting of the guideline recommendations. The recommendation statements are not always clear and actionable. There is no strength of recommendation or certainty of evidence attached to them. There is no justification about the balance of desirable and undesirable consequences for each of the recommendations. There is no evidence synthesis attached to each of the recommendations. Values and preferences, which shape the recommendations, are not articulated. These reporting issues will make it difficult for clinicians to follow the recommendations, or to be confident that following them will result in more good than harm for any given patient.

The group also took umbrage with the use of the term “Standards of Care” which they called “misleading.” They explained that a standard of care is a “treatment approach that all reasonable providers would use in a particular clinical situation.” SEGM uses the example of penicillin or amoxicillin to treat Strep throat.

But they wrote that that doesn’t exist in transgender care.

No such consensus exists for how to care for the growing numbers of youth with increasingly varied gender identity presentations. In fact, leading health systems and hospitals worldwide, including those that pioneered the practice of pediatric medical transition, such as the Karolinska—the home of the Nobel Prize in Medicine—have revised, or are currently revising their treatment protocols because of concerns about very low-quality evidence for the medical and surgical gender dysphoria interventions and their potential for harm.

They wrote that with the increase in youth “self-expressing gender variant identities” which would make them eligible for medical interventions, “an evidence-based treatment guideline is urgently needed.”

SEGM says that although WPATH claims that their recommendations are “evidence-based”, they appear to come from flawed, cherry-picked studies that support their conclusions. “The current description of the literature betrays a strong bias toward studies promoting social and medical transition,” says SEGM.

“A true evidence-based practice guideline that prioritizes the long-term mental and physical health of gender-dysphoric and gender incongruent youth,” wrote SEGM.

As a reminder, the WPATH guidelines are seen as the “gold standard” and are used as a template in gender clinics and hospitals to treat gender dysphoria in minors.

The left will tell you that it’s not “compassionate” to allow minors to transition and go down a path of medicalization for the rest of their lives.

But some of these “gender-affirming” clinics are rushing kids onto puberty blockers and hormone therapy after one short visit.

How many more of these de-transition regret videos will we have to see?

That is truly heartbreaking.

Mutilating and sterilizing minors because of a neo-Gnostic belief that how they “feel” isn’t in line with their physical body is the real cruelty.

ClashDaily's Associate Editor since August 2016. Self-described political junkie, anti-Third Wave Feminist, and a nightmare to the 'intersectional' crowd. Mrs. Walker has taken a stand against 'white privilege' education in public schools. She's also an amateur Playwright, former Drama teacher, and staunch defender of the Oxford comma. Follow her humble musings on Twitter: @TheMrsKnowItAll and on Gettr @KarenWalker