1 Adolescent Chapter

The section "Gender Identity Development in Adolescence" legitimizes the debunked hypothesis of “social contagion” causing people to identify as trans (p4,) and gives lip service to the entirely debunked junk science of “Rapid Onset Gender Dysphoria."

Statement 3 advocates for extensive gatekeeping of any and all trans adolescents prior to beginning HRT p11-12. This statement also propagates a recently-coined euphemism for anti-trans conversion therapy: “gender exploratory therapy” (top of p15.) This term is used by numerous conversion therapists and by transphobic hate groups [1] [2] which refuse to affirm the identities of trans people & oppose the ability of trans adolescents to access any kind of gender-affirming medical treatment (puberty blockers, HRT, and surgeries.)

Statement 11 legitimizes unfounded “concerns” of transphobic parents regarding alleged social contagion & perceived “very recent and/or sudden self-awareness of gender deiversity” (p20.)

Statement 12B (p22-23) requires “several years” of well-documented “gender incongruence or gender diversity” prior to the initiation of HRT.

Statement 12D (p24-26) advocates for further gatekeeping of autistic trans adolescents prior to initiation of HRT.

The problems within this chapter both legitimize debunked, entirely unevidenced junk science, and deny the fundamental right of bodily autonomy to trans adolescents. Restricting trans adolescents’ rights to agency & bodily autonomy is reprehensible and profoundly harmful. In addition, the entire chapter caters to the tiny percentage of people who eventually detransition due to a change in gender identity, at the direct expense of trans adolescents needing medical care.

2 Child Chapter

The major problem is in the discussion of Statement 14, (p13) where the so-called “risks” (“locking in” an individual to a gender expression even if they want to detransition in the future) of social transition for pre-adolescent children are exaggerated, speculative & hypothetical. Given the proven benefits of social transition for trans children, Statement 14 must take a stronger stance in support of this if the child desires it.

3 Hormone Therapy Chapter

In the "Introduction" section, there’s an omission of an important medication in the suggested hormone regimens for trans women & girls: Progesterone (p1) due to claimed “insufficient evidence.” But in fact, there IS evidence that progesterone can be very beneficial for trans women. Refusing to include it in the new SOC may make it much more difficult for trans people to access it through insurance.

The "No fucking idea" section also should have mentioned the inefficacy of 5α-reductase inhibitors (eg Finasteride or Dutasteride) as a primary testosterone blocker. It simply isn’t how those meds work: they work by blocking the conversion of testosterone to the more potent dihydrotestosterone, not by suppressing testosterone nor its effects. They can be effective in reversing hair loss, but not as a general purpose androgen blocker. Unfortunately, 5-ARIs are still commonly prescribed for the latter in a variety of places. [1] [2]

4 Intersex Chapter

Intersex Chapter While the new WPATH has taken a big step forward by officially recommending against non-medically necessary surgeries on intersex infants & young children, the committee is not nearly as firm about this as it should be.

In addition, the discussion section under Statement 9 (p11-12) contains a reprehensible statement including potential “parental distress” over the genitals of intersex people as a factor in the decision as to whether or not perform surgery on nonconsenting infants or young children. It must be made clear that the priority is the bodily autonomy of intersex people, not the comfort of their parents.

5 General Feedback

Severely compounding the problems in the new SOC, a transphobic clinician has a spot on both the Adolescent & Child committees of the new Standards of Care, and has very clearly influenced both. This clinician, Laura Edwards-Leeper, has a long history of gatekeeping trans adolescents for lengthy periods of time, and has repeatedly adovcated for all other clinicians to do the same. Several weeks ago, she wrote this abhorrent article and she has contributed major quotes to other transphobic pieces in the same vein [1] [2] Apart from all this, her personal bias is very clear. She follows & interacts with dozens of prominent transphobes on twitter, along with multiple transphobic hate groups (“Transgender Trend,” “4th Wave Now,” and “Genspect.”) See her account for yourself

Here’s a sampling of some of her recent tweets from the past couple months – unfortunately, she deleted all of her tweets from before then:

-Supporting this comment against people fighting for trans equality -Claiming that parental & professional involvement should "usually" happen prior to schools allowing students to social transition at school: [1] [2]

-Fallaciously linking the formation of trans identity with viewing porn

-Associating gender stereotypes with the formation of trans identity

-Endorsing junk science like “ROGD” & paying a hate group to watch their webinar on it

-Refusal to refer to any trans children as trans: [1] [2] [3]

-This nonsense

-Liking a tweet gloating about how transphobic rhetoric made it into the new WPATH guidelines

This is not someone who should have any say in the direction of healthcare for trans people.

Additionally, you can directly contact WPATH via their general contact form here, for issues besides the content of the new guidelines: https://www.wpath.org/contact