For the past two years, it has been a matter of public record that in 2022, when leaders at the World Professional Association for Transgender Health were finalizing the eagerly-awaited revisions to their transgender-care guidelines, they caved to pressure from outside entities to remove the age limits on almost all gender-transition interventions. This revelation came from internal records the Alabama attorney general, Steve Marshall, subpoenaed from WPATH as a part of his defense in the Boe v. Marshall lawsuit against the state’s ban on gender-transition interventions for minors.
In particular, the records showed that Dr. Rachel Levine, a high-ranking health official in the Biden administration and a transgender woman herself, pressured WPATH to remove the age limits, citing political reasons. Leaders within the organization resisted and balked internally, according to internal emails.
But on Aug. 5, 2022, someone from the organization—the name was redacted in the subpoenaed records released in 2024—sent someone else an email that suggested that WPATH had taken into consideration the email recipient’s “constructive comments” about the pending Standards of Care, Version 8, or SoC 8, as the guidelines are called. Following internal discussions, including with the authors of the adolescent chapter and with the leaders of the SoC 8 revision—those names were also redacted—this person said that WPATH was going to shift from having age limits be a “recommendation” to merely suggesting “minimal ages as long as the adolescent fulfils” various criteria.
I have now obtained an unredacted copy of this email. So I can report for the first time that it was written by Dr. Walter Bouman, a trans-care specialist at the University of Nottingham who was then WPATH’s president, and addressed to Dr. Levine. It was routed through staffers at the U.S. Department of Health and Human Services, where Dr. Levine was the assistant secretary for health—the highest-ranking openly transgender federal official in history. This included Sarah Boateng, Dr. Levine’s then-chief of staff. Also cc’d was Blaine Vella, WPATH’s executive director.
Below are the two versions of the email. The first—the redacted copy—can be found on page 18 of this PDF, published in the Boe v. Marshall materials. The second is the original that I have received.
The Boe v. Marshall records also show that in September 2022, the American Academy of Pediatrics insisted that WPATH remove the age limits. If they did not, the AAP threatened not only not to support the SoC 8 upon its publication, but to come out actively against it. (The Trevor Project, an LGBTQ-youth-suicide prevention nonprofit, also pressured WPATH to remove the age limits.)
WPATH subsequently—and, once this became public knowledge, notoriously—caved. They published the SoC 8 later that month, with the age limits still in the adolescent chapter. But then, that same day, they took the guidelines offline and republished them a few hours later. The age limits were then mysteriously gone.
Only days later, at WPATH’s conference in Montreal, Ohio child psychiatrist Dr. Scott Leibowitz, who led the adolescent chapter revision for the SoC 8, presented the revised chapter to his colleagues. In his presentation—as I have previously reported based on the video of the conference session, which I also obtained, along with hundreds of others like it—Dr. Leibowitz claimed that everything in the chapter had gone through a systematic process called Delphi by which the authors collectively reached consensus.
But evidence from Boe v. Marshall indicates that the age limit removal did not go through Delphi.
Now that the names are unredacted in the Aug. 5, 2022 email, we can see that Dr. Bouman told Dr. Levine that “we heard your comments regarding the minimal age criteria for transgender healthcare adolescents; and the potential negative outcome of these minimal ages as recommendations in the US; and we have taken this very seriously. We have discussed this amongst ourselves, including the whole Working Group of the adolescent chapters plus their Leaders Dr Annelou de Vries and Dr Scott Leibowitz and with the SOC8 Chair Eli Coleman and Co-Chairs Dr Asa Radix and Dr Jon Arcelus.”
This provides yet another piece of evidence indicating what Dr. Leibowitz knew about why the age limits removed and whether the removal was run through Delphi.
Dr. Levine has previously denied pressuring WPATH to remove the age limits.
No one else mentioned in this Substack returned a request for comment. I asked the WPATH crew to route my email seeking comment to Dr. Levine but did not hear back from her either.
Dr. Bouman is notorious for, in a June 14, 2022 email revealed via the subpoena, throwing a tantrum to his WPATH colleagues, after the American Medical Association declined to endorse the SoC 8 (the AMA said that such endorsements were not something the organization engaged in). Dr. Bouman, awkwardly appropriating classist American derogatory language, insisted that people at the AMA were “probably some white cisgender heterosexual hillbillies from nowhere.…… (please delete this quote).……..”
In his email to Dr. Levine the following August, Dr. Bouman signed off:
“With warm wishes,
“In servitude
“Walter.”
I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, NBC News, The Free Press, UnHerd and The New York Sun. I have also written for the Washington Post, The Atlantic, The Guardian and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net
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