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Notes -
WPATH Files
Hey guys have you heard about the WPATH Files? Well, you did, they were already brought up earlier this week, but unlike our resident doomers, I think they're worthy of a top level thread.
No, this isn't about the Eunuch Archive story breaking containment (although Genevieve Gluck is striking the iron while it's hot). Long story short someone on the inside of WPATH contancted Micheal Schelenberger and released some of their internal discussions. So what's all the hubbub about? At a cursory glance might even look like the WPATH members are urging additional caution. Well, let's take a step back.
To avoid going full-Putin, I'll start at Abigail Shrier's Irreversible Damage. A lot of the arguments presented in the book aren't new, but it's a convenient compilation - transition is serious shit with huge health implications, kids don't know what they hell they're talking about and shouldn't be taken at face value with regards to such a serious decision, past research shows most of would-be trans youth desist after puberty, new research indicates there might be a social contagion component to the recent increase in trans kids, puberty blockers themselves might be pushing kids further down the trans rabbit hole, etc., therefore we should hit the breaks on the whole thing.
A lot of the counter-arguments are also conveniently compiled in critical reviews of the book, or critical responses to positive reviews, for instance:
The message is clear: We know what we're doing. We have strict standards that filter out those that might not benefit from transition. We have scientific consensus and studies, all you have is speculation and anecdotes. It is the departure from this deadpan, "we know what we're doing" discourse, delivered with iron confidence that I commented on earlier this year, and which is a useful lens to look at the WPATH Files through, given that it's one of the explicitly named organizations responsible for setting these supposedly strict standards.
Part of the Files is a video of the "Identity Evolution Workshop" held on Zoom by the WPATH, a significant portion of it is devoted to the question of informed consent:
(these are slightly edited for the removal of awkward speech patterns)
So there's a few ways to look at it charitably. One that comes to mind is "they aren't talking about issues with the current state of gender affirming care, they're describing the sort of problems a clinician will run into, and how to handle them". The problem with that is that they themselves would disagree with that interpretation:
One of the reasons for this state of affairs that they brought up is a simple lack of resources - "backlog of therapists", "20 minute medical appointments" - which is consistent with info that got out of the Tavistock or through whistleblowers like Jaime Reed. The other way to look at it is @gattsuru's "urging additional caution", which they are indeed doing throughout various excerpts of the Files, but if additional caution needs to be urged, because patients, or even their parents, don't understand what they're signing up for, that paints a very different picture than the one that Jack Turban painted in his review. This is a lot less "we know what we're doing" and a lot more "this is all new, and we're still figuring it out", the difference is portrayed in this analogy:
The reason for the discrepancy in the level of understanding that is expected, is acutally later explained by Jamison Green:
The issue brought up in the second part of the quote, that patients might not want to read, talk about, or ask questions about their treatment because they're afraid this will result in them not getting it, is brought up later in the conversation, but this is where things go from bad to worse:
(...)
(...)
Ok, simply put: you can't tell me how you have it all figured out, how you have strict standards that filter out people who might change their mind later, and how rare it is for trans youth to change their identity, and how all the concerns raised are invalid precisely because you have it all figured out so much, only to turn around to talk about patients' shifting identitties, how they were hiding their motivations, or didn't want to ask questions because they were afraid tripping that filter stemming from those supposedly strict standards, and then for your response to be "don't worry about it, we'll give you the treatment no matter what".
This already got quite long, and I already got one or two other angles to approach this topic from, so I think this will become a series*. My general conclusion is: contrary to Jack Turban, and the general pre-2022-ish pro-trans discourse, gender affirming care, especially it's pediatric variant, is not uncontroversial within medicine, it's not The Science, it's an experiment. There is, of course, room for those within medicine, psychiatry and/or psychology, but rule #1 of ethical experimantation is that you tell people they're participating in an experiment. You don't tell them things like "would you rather have a happy daughter, or a dead son", you don't dismiss critics because you don't like their politics, and you don't try to push through bizarre social reforms on the back of The Science that just isn't there.
As always, time will tell if my conclusion is correct, I'm not going to pretend I'm not biased, and it's only natural for someone biased in the other way to come to a different conclusion, especially that a lot of people in these WPATH Files comments and transcripts come off as quite sympathetic. But before signing off, I'll allow myself a bit of speculation: this is either the tip of the iceberg, and/or WPATH members themselves think the organization is no longer credible, as WPATH membership dropped from 4119 to 1590 from January 2023 to 2024. This is after the Files were announced, but way before they were released, but it's hard not to get a "fleeing a sinking ship" impression from it, and in fact such a sudden departure of so many members might even be the cause of the Files being leaked (out of many disgruntled people, some decided to leak stuff), and the effect is yet to come.
*) Hey mods, are we still doing the "Culture War goes into the Culture War Thread" thing? I would really rather have these as standalone posts.
Yup, CW in the CW thread.
We do appreciate the level of effort you’ve put into this breakdown.
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I suppose it might be relevant to bring up my own n=1 anecdotal experience with a voluntary surgical procedure. About a year, maybe a year and a half ago, an acquaintance-of-an-acquaintance posted on twitter that they were seeking a kidney, as they had begun to enter renal failure and while thanks to modern medicine they were stable, their lifespan had changed from an easy seventy or eighty years to about forty without a transplant. So I figured hey, this guy needs a kidney, and whadya know I've got this spare lying around not really doing anything. Let's see about getting rid of it.
First I had to figure out if I was compatible. I was. What followed was a surprisingly rigorous battery of examinations, questionnaires, interviews, pre-recorded educational modules, and re-interviews. Was I absolutely sure I wanted to give this guy a kidney? Did I know the potential surgical side-effects? Was I absolutely sure I wanted to give this guy a kidney? What about the possibility of complications? Was I absolutely sure I wanted to give this guy a kidney? What was my support structure? Was I absolutely sure I wanted to give this guy a kidney? Did I live in a building with an elevator? Was I absolutely sure I wanted to give this guy a kidney? Could I get groceries without physically lifting more than 20lbs? Was I absolutely sure I wanted to give this guy a kidney? You get the gist. Once I had managed to convince my donor liaison (appointed by the hospital as my advocate) that I knew the risks, that I knew I could withdraw consent right up until they gassed me (my words not theirs), that I was of sound mental health, then came the actual tests.
I am something of a connoisseur of hospital blood draws - for whatever reason the vagaries of life have resulted in my giving a significant percentage of my blood to various medical apparatchiks - and let me tell you the blood tests they ran on me were exhaustive. I think they filled about twenty of those little blood vials in one sitting. Then were more tests. Looking back at my records about thirty in all, from an EKG to a full metabolic panel. Then after all these tests were done, I sat down with a nephrologist (kidney doctor). The nephrologist, a very nice woman, looked at all my tests, and politely told me that she was declining to move forward with my donation. She thought that (1) at 26 I was too young, and (2) one of my kidney function tests was not perfectly centered in the "normal" function range. She was very clear that it was mostly a function of age, and that had I come to her when I was 30 she probably would have given me the green light, or at least been willing to take a closer look at what was causing the slight abnormality in that one test.
And that was that.
I can't help but contrast this, a potentially life-saving surgery with very minimal long-term knock on effects (kidney donors do not have a decreased life span or at most lose half a year to a year, various foundations and the recipient's insurance cover all medical and associated bills including transportation and recovery fees, the total hospital stay is one to two days, with full recovery in 3-4 months) with what are ultimately cosmetic surgeries with largely unknown long-term effects, and the difference in treatment a transitioning teenager receives (full endorsement and full surgery at 18) versus my own. I'm not upset with my treatment mind you, if the kidney doctor says no then the kidney doctor says no, and she probably knows best. It's just... an odd juxtaposition.
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In the interests of stirring the pot, I'll link to this person's attempt at a fisking of the WPATH files, pointing out examples of factual inaccuracies, things taken out of context or similar. Without having read the WPATH files I can't speak as to whether their characterisation is accurate.
Still gets me that the word "fisking" - a word invented by online warbloggers for their supposed eviscerations of Robert Fisk articles and which, insofar as I remember it, often devolved to just laying the article out sentence by sentence and replying to individual sentences with "Oh come on!" and "Surely no-one can believe this!" -style fare - continues to live, even though most people would in fact probably agree that Fisk was more correct about whether Iraq War was a proper decision or not than the warbloggers.
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I saw that scrolling by recently, though haven't read the whole thing. I'll add it to the reading list, and say what I think when I'm through it, but I'm putting high odds on it being cope. For one, the argument I made in the post doesn't rest on anything being taken out of context. The other files are comments on some sort of internal discussion platform they're using, I didn't see anything there being taken out of context or misrepresented either.
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I think the only take away from that is to ignore all the editorializing and only look at the actual pictures. I agree that the people who wrote the files are pushing an agenda and playing fast and loose with the facts, but the stuff in the actual WPATH communications is just as crazy.
This mostly seems like an attempt by the author to get people to avoid looking at the actually damning stuff.
I can understand the agenda bit, though I'm not sure how much agree (worst case scenario they're about as ideologically biased as WPATH itself), but what made you think they're playing fast and loose with the facts?
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1: Why should people who don't understand the different sexes and how they're supposed to work together ever come up with the best course of action for legitimately transgender individuals (i.e. not just men with a terminal case of "it's ma'am")?
The flipside of not being able to have a proper answer to the question of what a woman is means that you don't have a good answer for what a man is. Which I believe is a pretty scorching indictment for an organization, an entire "scientific" field, and to a point the Tribe backing it that claims to have an answer to whether a man should become a woman- if the distinction between genders is meaningless, then dysphoria shouldn't exist (and thus shouldn't even be acknowledged), right?
An organization that's supposed to support transgender health first and foremost needs to understand, and understand properly (as in, the good-faith scientific distinction and not the common definitions), what gender even is in the first place (and communicate that definition coherently). If they don't understand it, or have definitions that are first and foremost self-serving (perhaps if their salaries depends on them intentionally misunderstanding it), then they have no business telling men when and when not to become women and vice versa.
I'd argue that rejecting the bimodal distribution of gendered behaviors, or trying to push men further and further into being women (for various reasons, ranging from a simple failure of preventing the male biological niche from getting destroyed by market forces to the actively malicious gender supremacy movements) is one of the reasons we even have an explosion of ex-men in the first place. The collapse of a positive, approachable masculinity also creates ex-women, since the tolerance of tomboyishness as a subgenre of "woman" collapsed with it (and without a positive, approachable masculinity, femininity had nothing to constrain it from becoming toxic).
2: Why should people who don't have a healthy sense of pro-social adult sexuality be able to come up with a solid answer for when trans is and isn't a fetish (or to have any hope of understanding what productive development/expressions of child sexuality should be)?
"I spend a bunch of time writing online about how great it would be if basically every boy on the planet was castrated" is not the mark of someone who has a well-rounded view of what co-operative/productive sexual expression looks like. The elephant in the room on the Blue side is that this way of thinking, and everything they do to express power, is itself some shade of castration; men with a healthier (as in, less internalized androphobia) understanding of how the sexes interact have quite accurately noticed this tendency, it's why the memes specify a ball-busting bitch.
The problem is squaring the circle between "patholotical androphobia" and "children are sexual beings". How are we supposed to expect that an answer that depends specifically on getting the latter right is going to be correct when the minds of everyone working on that answer are utterly consumed by the former? I'm pretty sure Boku no Pico is a healthier and more productive treatise on male sexuality than anything high-ranking WPATH personnel will ever come up with.
(As an aside, it's probably worth noting that the main difference between adult sexuality and child sexuality seems to have something to do with the presence/absence of biological impulse to play power games with sex- so expecting someone whose entire sexuality is nothing but explicitly malicious power games to try and make things better for people who inherently lack the understanding/biological drive to do them is so, so much worse. "It's ma'am" is the model transperson to people like this, and it is those power games that lend themselves to the bad faith consequences: suppressing de-transitioner literature, placing ex-men in women's prisons, and so on.)
3: Given the above, why would a movement whose entire motivation is some abstract form of "fuck you, Dad" ever be able to ask the "are you doing this out of spite?" question and be able to engage productively with the fact that the response is sometimes 'yes'?
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First, this is utterly predictable. Patients won't read 10 pages of medspeak, especially when they've already made up their minds.
I want to zero in on that last bit; I'm pretty sure everyone who shows up at a gender clinic in 2024 AD knows what they want, when they want it. Parents who aren't sure about transitioning their kid won't take them to a gender clinic. Everyone knows the outcome of stepping into that building. And doctors know it too, and they also know that saying "no" just means the patient gets hormones anyways, just from an abortion doctor instead because planned parenthood can't resist jumping into something left coded for any reason, ever. I'm not sure what exactly that means here; I'm 100% sure that trans isn't real and the medical treatment these people need is for mental illness, but the idea that the medical system can self-regulate in a culture war heavy topic is also risible.
Second, this is utterly predictable. "The experts" tm being firmly on the left of the culture war for anything controversial and willing to misrepresent their theoretical area of expertise if not outright lie about it shouldn't be a shock to anyone who lived through Covid. Trans is pretty central to the culture war.
Third, and going for variety here, this shouldn't be a shock to anyone. Everything we know about trans people should point to them being difficult patients at the best of times; they disproportionately have additional mental illnesses, lots of them don't trust non-trans people, high percentages of them are unemployed/underemployed people who get on poorly with their families and thus have insurance difficulties which make everything more complicated, and most of them are literal teenagers who probably have a higher rate of lying to begin with. In that environment of course it's going to cause this type of problem.
WPATH is confirming things we already knew. It's a valuable confirmation, but there's not a lot of new information there other than that WPATH knew about the obvious problems and was choosing not to say anything, which was already my assumption- they're ideologically motivated, not stupid.
What's the working definition of real here? Do you believe that mental illness is real?
I think that the median case of, at the very least, depression, ADHD, and most anxiety disorders are just med-seeking or munchausens, yes, and I think all three of those things have a closer correspondence to reality than the claims trans adherents make about themselves.
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This may be an exercise in throwing stones in glass houses, but you need to log off. Plenty of people know next to nothing on the issue, and when their kid says they're trans they just go "welp, better make an appointment with the psych / doctor". Funnier still, even psychologists and family doctors tend to know next to nothing on the issue, and just refer.
It was also my assumption, but I wouldn't describe it as "what we already knew". "Suspected", yes, and only for a given value of "we". And other than the confirmation being valuable, it also shows that, like I keep insisting, the vibe has shifted on this issue.
Or they are pushed to go by the kid's school.
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Trans is a hot topic. Everyone in America in the 2020’s has an idea of what it is which at least rounds to trans.
There are people who don’t think they know how to respond to it, sure, but those types know full well that the medical system will respond with transition, everyone knows that. Maybe not the finer details, but once you add on that ‘trans kids’ pretty much all come from well off blue tribe families- ‘non-affirming’ parents or parents who have a willingness to be skeptical of the official narrative do not seek medical treatment for their trans kid, they pull the kid’s pants down and say ‘look at how God made you and get used to it’.
+1 to Jiro's "no they don't". I'll add that even in the event they actually have an opinion on trans care, paradoxically it's the "allies" that may be to most vulnerable here, because they will tend to assume that the talk of lack of guardrails is a right-wing moral panic. But the majority simply have not followed any of the back and forth.
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No they don't. They may think "well, I don't know if trans is correct for my kid, I'm sure the doctor can figure it out". They'll assume that the doctor would act like a professional and diagnose based on objective standards that might say yes, but might say no.
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I think you may be typical-minding. Countless people on Maury have denied fathering a child for absurd reasons like “we only had sex one time.”
There’s plenty of people sleepwalking through life seemingly without ever making an informed decision. “I didn’t know I couldn’t orgasm after removing my penis” sounds absurd but I would be more surprised if it didn’t happen.
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This has been a general problem with mental health disorders in general and especially ones that you get a prescription for. The difference between someone who’s sad and someone who’s depressed is ten minutes with a psychiatrist. And adhd tends to work this way as well. If you’re seeking help for something that doesn’t leave physical evidence, the way to get what you want is to insist that it be given.
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I'd be more careful with absolutes.
My burning hatred for presentism and general displeasure towards technocrats and their solutions to human problems can't be overstated; but they do all have a point in that the phenomenon behind "trans" is a real thing that has existed for pretty much all of history in some form or another.
The present obsession with it and its political implications helps nobody, but let's not pretend the problem doesn't exist. It's not just a symptom of other mental illnesses.
Call it its own type of mental illness if you will, we certainly used to, but it's real and we don't really understand the cause of it.
It is this ignorance that's the fertile ground for would be experts to push convenient solutions they swear have no drawbacks. The way out isn't more willfull ignorance. The flawed frame of understanding that is leading to the present problems must be replaced with the truth, whatever that may be. Not a different sort of convenient lie.
FWIW I agree with both @hydroacetylene and you here, and I expect that he'd agree with you too. What I would mean, and what I expect he means, by "trans isn't real" is that none of the people being classified as "trans" are "born into the wrong body" or "assigned" the wrong gender, nor are they "really" (in some sense) the opposite sex -- that it's not just a matter of overdiagnosis and a classification of some people as "trans" who aren't, while there is still some smaller subset who are "really trans" and where that the most appropriate treatment is the constellation of "gender-affirming" (what a euphemism!) treatments of hormones/surgery/social transition/etc.
I do agree that there is a separate mental illness (probably more than one) which correspond to "trans" -- that it's not just depression or anxiety or whatever that causes boys/men to want to be girls/women (or vice-versa), or to be unhappy because they aren't, or to (at times) convince themselves that they "really are" what they want to be. And I get that there are some people who don't believe that and think that the entirety of "trans" is just some current-day-cultural nonsense. But I do think that there is a meaningful and important sense in which "trans isn't real" is true, and I think that's what he's getting at.
Yes I doubt we all disagree very much, but some things deserve to be stated at least inasmuch as it allows us to map things out.
The story we've all been told (i.e.: there are people born with brains that correspond to the other sex and bringing their bodies in line with their brain heals them) has many problems, not least of which the fact that it has incredibly little to no evidence supporting it. In this at least, "trans isn't real". But the problem is the alternatives, like Blanchardism, are really no better on that front.
There's a deep irony in the fact that learning more would require pretty wild experimentation that would and has been suppressed by a political movement that is hell bent on large scale experimentation but only of a very specific kind.
If there's one thing we ought to learn from this it is that building identities around specific medical treatments is a terrible idea. And it's a mistake we keep making. See the weirder parts of the deaf community for another example.
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My own personal experience is that scientists and people with genuine expertise in a subject are way more softly spoken and uncertain about the topics they hold expertise in, particularly in friendly company and in private, than political activism would like. From personal experience, to keep things vague since the topic is niche, I actually had to tone down a claim that I already thought was already very modest about whether [some human activity] would increase levels of [some dust], even if it was the best way to link research to real-world impacts. Climate change is the obvious one, where IPCC reports are incredibly modest compared to claims made by activists, to the point they might as well be speaking different languages. And to bang my usual drum, claims about "The Science" for covid restrictions often didn't exist at all in literature, or were contradicted by it. Even something like lab leaks will see surveys reported as Virologists and epidemiologists back natural origin for COVID-19 when actually the survey findings was that said experts averaged 77% probability of zoonosis and 23% of lab leak, and only 25% of scientists reporting to be near certain that it was zoonosis, hardly a consensus.
As for this topic in particular, doctors who are inclined to cooperate and not "gatekeep" due to political pressure, and patients who are told to defect by lying to "gatekeepers" and get the drugs faster, is going to lead to disaster. Even if you're trying to implement standards in good faith here, they're just going to get instantly eroded.
There are definetly plenty of those with more mixed feelings. Experience shows that whenever there is an opportunity for scientific authoritarianism that gives scientists special status, whether with covid, climate change, or scientific marxism, plenty of them are willing to jump along. And they don't need to be all of them or even a majority, to be highly influential.
Calling something a science, and censor opposition as unscientific, are strong elements of modernity's fundamentalism. In a way that is convincing of plenty of scientists. Another possibility is those in charge to say that certain views are scientific truth and exclude from journals those who aren't going along.
Trained in a culture of peer science and trusting authority of the scientific clique, many are going to go along with it. Especially if they already have pro left wing biases.
This means that being a good scientist and doing science effectively is different and can in fact be opposite with the class of scientists and people called scientists, and their prejudices and preferences, which can show group think, and unwillingness to examine their conclusions.
It is the courtier phenomenon. Where power goes, there are always some people who go along with it. Another aspect of this can be that the media and people who belong in factions promoting group think have a benefit in associating science/scientists with particular views, and fostering a divide between them and then those who raise objections or oppose certain policies. Another facet of this are some edgier and more fantastical objections to claims on political charged issues that are focused upon over more substantive disagreements. For example
microchips
vs
Origin of covid. Lockdowns. Vaccine effectiveness.
Add to that censorship of dissent, and it would be a mistake to expect the people we have given the title scientists, or rational, to succeed in opposing this, any more an ideology given the title scientific will succeed at being scientific, just because it claims to be that, or to aspire to that.
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Jack Turban, Steven Novella, and David Gorsky - the authors of the two reviews I linked - are all doctors and scientists. Turban specializes in trans care, Novella and Gorsky don't, but their entire claim to fame (such as it is) is being part of the Skeptic movement, and the entire point of their blog is to inform the public of the actual state of evidence, not to repeat the activist line. If they talk differently in friendly company and in private, that means they're deliberately misleading the public.
Maybe none of this should be surprising, but the system that exists today wouldn't survive, if any significant number of people internalized that.
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I really don't understand any of the lines you're drawing between excerpts here.
On the one hand, we have statistical data about low desistance and high satisfaction. On the other hand, we have anecdotes about patients trusting their doctors and not being medical experts themselves (scandal!) and anecdotes about patients angling for the care they want instead of giving the doctor extra information because they are correctly scared of political manipulations interfering with their care.
And your claim is that the latter somehow disputes the former? How so?
If you think Turban's citation is valid statistical data, it's your funeral, but before we continue this line of debate I would like you to comlnfirm that you looked into the argument and this is, in fact, what you are saying.
Have you...have you read my post? I really don't know how else to respond other than to repeat what I said there. These doctors are explicitly saying they aren't putting barriers to entry to treatment, saying this is all new and not a known problem like diabetes, and that the patients are not informed enough to give informed consent, and that they are currently falling short of ethical standards. It's explicitly contradicting several of Turban's claims.
Are you saying this is all fine? Can you elaborate on why? Do you think we know enough on gender affirming care that doctors can confidently prescribe treatment knowing it will improve the condition the patients were diagnosed with, like they do with diabetes? Why do you think they themselves disagree with that?
I mean, yes, abuse of trust is pretty scandalous. Doctors shouldn't fake confidence in front of the public, and talk about how they're winging it behind closed doors.
Well, if you want to say "there are no rigorous guardrails on the process, and that's a good thing", say it with your chest. The problem is that if you claim guardrails do exist when responding to critics, you are showing yourself to be deceptive.
This is a category error. It's like dismissing a confession to murder because it's just an anecdote.
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Great post, thanks.
Can anyone give some context on where WPATH fits into the broader ecosystem of such organizations? I assume there are other organizations that give guidelines or do research - is WPATH bigger/smaller, newer/older, more/less funded, etc?
I haven't heard of anyone trying to map it out this way. My guess is that WPATH is probably the biggest and oldest one focused on the subject. Their closest competitors would be Genspect, and SEGM, but they are just now finding their footing, and they've been mostly founded simply as a reaction to the current state of affairs. Other than that you're going have organizations devoted to wider branches of medicine / psychology, like the ones listed by Turban at the beginning of my post. Each country has their own, and not all of them are pro gender affirming care (and I don't mean something predictable like Saudi Arabia being against - Europe seems to be leaning anti-trans-care, at least for kids).
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