WPATH unmasked: the WPATH Files


There can be no doubt that WPATH, the World Professional Association of Transgender Health, has had a profound and malign influence on gender healthcare worldwide. This power is wielded through their Standards of Care, guidelines for the diagnosis and treatment of gender dysphoria in adults and children, which WPATH claims are evidence-based and best practice. But the recently released WPATH Files reveal an organisation run by activists and ideologues who in private chat forums admit knowing of the harms caused by cross-sex hormones and surgery.

These chillingly candid discussions show that WPATH members are aware that puberty blockers are not reversible as they almost invariably lead to cross-sex hormones, that children will be frozen in an adolescent state, infertile, anorgasmic, and at risk of life-threatening medical conditions. The online chats reveal a cynical lack of compassion for young people who experience acute problems post genital surgery. The WPATH Files include this example: “a gynecologist in the WPATH forum described a patient who, after penile inversion vaginoplasty, was leaking prostate secretions through the urethra and was finding it bothersome. The replies inform the gynocologist that there is no remedy, but one nursing lecturer, who self-described as a “woman of trans experience,” suggested telling the distressed patient to “enjoy the ride,” adding, “It’s the ultimate physical sign of orgasm…what’s not to like?””

The chats reveal positive approaches to performing vaginoplasties on boys under 18, to prescribing hormones for patients suffering from severe mental health problems such as schizophrenia, to treating severely depressed or autistic people with drugs and surgery. They acknowledge that two female patients developed liver cancer caused by testosterone. One of these young women subsequently died. The plight of detransitioners is seen as a problem to be ‘framed’ rather than investigated.

Transgender Trend has documented the harms of medical transition since its inception in 2015, but it is still shocking to read that clinicians know about them and want to keep them secret from their patients and the public.

WPATH and the NHS

GIDS was closely aligned with WPATH Standards of Care v7 2012 during the period of its unfettered growth and adoption of an ideological, affirmative approach to gender-distressed children. The success of the Keira Bell judicial review in exposing the experimental practices at GIDS, and the lack of evidence for puberty blockers was a worldwide wake-up call to re-examine WPATH’s claims to authority. Following the Cass Review’s Interim Report in 2022 and NICE reports on the low evidence base for the safety and efficacy of puberty blockers and cross-sex hormones, the GIDS is being closed down. New medical hubs and clinics will follow new service specifications for child and adolescent services. The intention is that children referred with gender-related distress will be treated like any other paediatric patient with a mental health condition. The NHS made it clear during a consultation on puberty blockers that WPATH has no place in children’s services.

“On alignment to WPATH standards; NHS England commissions treatment based on evidence of clinical effectiveness, cost effectiveness and safety. WPATH standards of care do not determine clinical commissioning decisions for the NHS.”

But it’s a pity the NHS didn’t take the opportunity to make this their position over the whole of NHS gender services. WPATH is still embedded in many parts of the NHS in England. Adult gender clinics follow different service specifications. For non-surgical procedures it cites WPATH saying:

“Good practice for engaging in psychological interventions with transgender people has been published”


“The recommending medical practitioner will assess the risks, benefits and limitations of pharmacological interventions for the individual, and will ensure that that the individual meets the relevant eligibility criteria set out in the World Professional Association for Transgender Health Standards of Care (2011)”

So we now have the anomalous situation where once a teenager turns 17 they will be referred to adult services. There they could be given a prescription for cross-sex hormones after just two appointments, with no psychiatric oversight or investigation into co-morbidities.

UK based WPATH activism

Four senior UK clinicians are listed in the list of authors for WPATH SOC v8, the most activist and extreme version of the Standards of Care to date. They are all employed in NHS gender clinics.

Dr Walter Bouman is a senior consultant in trans healthcare at the Nottingham Centre for Transgender Health. He’s also a past President of WPATH and now sits on their executive committee. He’s listed as one of the UK authors of WPATH’s SOC v8.

Bouman gave evidence at the GMC hearing on behalf of the disgraced GP Dr Helen Webberley where he was asked if a 12-year-old would need a full examination and diagnosis before being prescribed hormones. He replied that psychological tests weren’t necessary as a transgender doctor knows when a person is trans.

He told the hearing that he favoured a lower age for starting cross-sex hormones, saying the global consensus was 14, but it was stage as well as age that is important in pubertal development and that in some cases they could start at 12.

Also working at the Nottingham clinic is Professor Jon Arcelus, the co-chair of WPATH’s Standards of Care v8. Nottingham’s website says he works “closely” with trans organisations, including Mermaids and Gendered Intelligence.

Endocrinologist Leighton Seal works at the Tavistock and Portman NHS Trust and privately. In 2022 Seal signed off on a protocol for GPs to share the prescribing of female hormones to trans identifying men citing a modified version of WPATH SOC v7 as the authority.

Dr Christina Richards works at the Gender Identity Clinic at Charing Cross Hospital. Richards was at the forefront of the British Psychological Society’s push towards a political affirmative approach to gender distress within the BPS. Christina Richards appears in the WPATH private chat forums discussing the pushback in various European countries against gender affirming treatments. One member says “This is a very dangerous development in the medical care of trans children and adolescents. I find the political interference in medical issues extremely questionable.” Richards chimes in “Gender care is, of course, vital for TGD youth and it is appalling that it is being limited.”

In the topsy-turvy world of gender ideology, WPATH members see democratic oversight as “political interference” and evidence-based research as “appalling.”     

In addition to the clinicians the UK, authors include trans activists Susie Green, at the time still CEO of Mermaids, Terry Reed of Gender Identity Research and Education Society (GIRES), Ben Vincent of the Trans Learning Partnership and Katherine Johnson, a sociologist. The UK contingent is a fifty fifty split between activist clinicians and activists, in line with the findings of the WPATH Files about the make-up of the WPATH membership.

The influence of Mermaids at the GIDS is well-known, but the extent of that influence was revealed only last year when it was reported that CEO Susie Green had been part of a task group reviewing the NHS service specification for the GIDS. But the organisation that applied the most pressure early on to use WPATH guidelines within NHSE was GIRES, who worked on two NHSE Clinical Reference Groups to revise service specifications for both child and adult services. GIRES funded the translation of the WPATH SOC into various languages, including Chinese and Russian.

The links between trans activist organisations and WPATH-aligned clinicians will need to be unpicked if gender healthcare for young adults is to be reformed along the lines of the Cass Review. In her book on the scandal at GIDS, Time To Think, Hannah Barnes describes the undue influence of Gendered Intelligence at the clinic. Although the Cass Review and closure have put a stop to that, Gendered Intelligence has found a way back into the NHS via adult gender clinics. The trans lobby group now runs Helpline services at four clinics, Nottingham Centre for Transgender Health, Sheffield Porterbrook Clinic, East of England Gender Clinic and the Laurels Exeter, paid for by NHSE. These adult clinics are completely compromised both by NHS service specifications and activists working within them.

For obvious reasons, private gender clinics are more likely to follow the lucrative, affirmative WPATH Standards of Care rather than NHS guidelines. Gender Plus, set up by ex GIDS staff, the London Transgender Clinic, The Gender Clinic and the Harley Street Clinic all align with WPATH. The Centre for Surgery, another private clinic, requires a letter from WPATH before ‘gender reassignment surgery.’

Patients with gender distress going down the private route may be under the illusion that WPATH is some sort of quality assurance. Nothing could be further from the truth especially for children, adolescents and vulnerable adults, the most likely victims of this ideologically driven craze to treat mental distress with experimental drug and surgeries.

WPATH in professional bodies

Despite the many criticisms of the activist approach of WPATH’s SOC v8 in 2022 both the  British Medical Association and the General Medical Council continue to  recommend WPATH as good practice when treating patients with transgender related conditions.           

The main professional bodies regulating therapists, psychologists and psychiatrists are also in thrall to WPATH. They are already signed up to the Memorandum of Understanding on Conversion Therapy v2 which commits their members to an affirmative approach to gender identity.

The British Psychological Society’s LGBT+ network reject the findings of the Cass Review and the call for caution in diagnosing children as ‘transgender’ and promote WPATH instead.

“The UK clinical pathway for transgender healthcare is extended and disengaged from best global psychological practice available through agencies like the World Professional Association for Transgender Health (WPATH), and more recently the evolving European PATH agency. Recognition and promotion of WPATH practices by BPS practitioners could likely benefit psychological treatments in the UK.”

WPATH is quoted as best practice by members of the British Association for Counselling and Psychotherapy. There are WPATH members within the BACP who are active in promoting WPATH’s queer theory based approach to working with clients.

The Royal College of Psychiatrists has abandoned evidence and critical thinking by signing the MoU v2 and endorsing WPATH as recently as 2018 as its standard of good practice.

“the College concurs with the views of many international professional organisations, such as the World Professional Association for Transgender Health (WPATH)….. that psychological treatments to suppress or ‘revert’ gender-diverse behaviours are unscientific and unethical.”

The Tavistock has had a long relationship with WPATH. They attended the first biennial conference of the European WPATH (EPATH) in 2015; Polly Carmichael presented the first results of the Tavistock’s puberty blockers trial at the WPATH symposium in Amsterdam in 2016 (which can be viewed on YouTube) and Tavistock clinicians gave presentations at EPATH 2017 and 2019.

WPATH symposium
Polly Carmichael at the WPATH symposium 2016

Presenting at conferences does not in itself imply adherence to WPATH principles, but as WPATH has become more and more an extremist activist lobby, association becomes more difficult to justify for a medical service like the GIDS. The debacle at the 2017 WPATH-sponsored USPATH symposium was a turning point in the credibility of WPATH, who unceremoniously dropped distinguished expert Dr Kenneth Zucker from the programme after angry protests from trans activist attendees. The conference Chair Dan Karasic admitted later that USPATH had stacked the conference schedule with practitioners of the “trans affirmative” approach and that Zucker was invited merely as a gesture of tolerance.

WPATH is firmly embedded in clinical practice in Scotland. The Sandyford gender identity service in Glasgow has resolutely closed its ears to the Cass Review and is ‘modelled and informed by’ WPATH guidelines. Wales is currently developing its own service but given the influence of Stonewall Cymru it is likely that WPATH will be promoted there as ‘international best practice.’ Will the WPATH files make a difference?

In 2018, as new services were being developed in Ireland, consultant endocrinologist Donal O’Shea had this to say “We don’t intend to run the service in line with WPATH guidelines. Aligning with them would result in significant harm accruing to those with gender confusion.” Dr Paul Moran, a liaison psychiatrist, said that the WPATH guidelines “as they apply to assessment and treatment recommendation, are not part of our model of care, are clinically unsafe, and unsuitable for use in a public healthcare gender clinic.”

Until we hear such clarity of assessment from NHSE, the influence of WPATH-affiliated clinicians on child and adolescent services in England may not be over. At the EPATH conference in Killarney last year Professor Gary Butler, an endocrinologist and clinical lead at the GIDS, questioned the need to reform the service at all. He told the conference that Cass’s recommendations were “slightly unusual” and the new proposals were “exactly what we’re doing at the present time and what the Gids is doing.” Professor Butler has been given a key role in implementing training for the new gender hubs due to open this year.

This Post Has One Comment

  1. Ian Court

    The surgical and chemical treatment protocols have always been about physician assisted self harm for cosmetic effect, in pursuit of an impossible goal – albeit one which is protected in law. Doctors, surgeons, endocrinologists know and have always known, that they are harming vulnerable, mentally ill and distressed children and adults – but they do it anyway. I think Genevieve Gluck was pointing this out quite some time ago ? WPATH’s support for eunuch gender and ‘nullification’, the removal of healthy breasts from children as young as 12, infants as young as 2 years of age being socially transitioned… it has all been on public display for years. I am not sure if any of these recent ‘revelations’ will make any difference to the steam roller of sex denialism – this is a Neo religion of the managerial and media elite managed by medics drunk on their own hubris. As Helen Joyce said – it is the banality of evil. It will collapse but only when the weight of the terrible harm it is causing proves unsupportable. One can only hope it is soon but those who self harm have a habit of doing so enthusiastically and those who facilitate it are convinced of their righteousness.

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