How Long, WPATH?

For WPATH to insist that their SOC is protected by the First Amendment, as something more akin to an opinion than scientific consensus, is absurd. In fact, they have benefited from the reputation as the scientific consensus and the legitimate source of knowledge on transgender care for many years.

There’s a reason we refer to the “transition pipeline.” A recent article by Leor Sapir published in The Wall Street Journal highlights the findings of a new study on Oregon’s rate of transgender youth. Between the years of 2016—2023, 1 in 240 17-year-old girls received cross-sex hormones, and 1 in 630 17-year-old boys.

Such a ubiquitous system is not perpetuated by bad actors alone—it takes an army of well-meaning volunteers. It is absolutely despicable for WPATH to squeal on their own soldiers. In fact, their argument—that they can’t be held accountable for damages caused by doctors acting on their advice—is self-incriminating. They have admitted, in not-so-many words, that their advice was bad to begin with.

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And it is despicable that they would throw their own adherents under the bus. Of course, there are some bad actors on the individual level. But in my experience, the majority of clinicians involved in GAC truly care for their patients and believe they are on the right side of history. When they heard of my regret and my detransition, some of my former care team were callous and defensive; others were open to dialogue. At least one was devastated. I believe she is a victim as well, who has suffered morally due to bad advice.

It is also important to note that WPATH’s influence isn’t confined to the SOC. Significant changes to the diagnostic criteria in the DSM-5 (May 2013) can be traced back to WPATH’s advocacy and the official DSM Consensus Building Process.

“The World Professional Association for Transgender Health (WPATH) is recognized as the leading authority in the field of transgender health, through a membership that encompasses experts in this field and transgender community representatives. WPATH therefore is in an excellent position to give input on the DSM 5 section on gender identity disorders.”
—Knudson et al., 2010

These changes—replacing the nominal Gender Identity Disorder with Gender Dysphoria, removing it from the sexual-disorders chapter, and eliminating the sexual-orientation-specifier—effectively defanged the process of psychological scrutiny, which should have prevented widespread regret among a young and vulnerable generation, raised on pornographic digital media. Most remarkably, the American Psychological Association’s (APA) own DSM-5 work group later acknowledged that objections from WPATH members helped prompt its decision to replace its proposed term “Gender Incongruence” with “Gender Dysphoria.”

Will the APA plead the same as WPATH, that adherents to the DSM-5 should have known better than to unthinkingly follow its guidelines?

There’s no shortage of evidence of WPATH’s sway over the medical profession. In the 2021 article “Guiding the conversation—types of regret after gender-affirming surgery and their associated etiologies” (Narayan et al.), 154 surgeons were contacted via the registrations for the 2016 WPATH and 2017 USPATH conferences in a tenuous effort to extend the purview of WPATH SOC to include detransition. The tacit authority of WPATH’s SOC was presumed in the methods of the survey.

“We limited the questions to breast and genital procedures only. Facial surgery was excluded as there are no associated WPATH criteria, so there is less standardization of patient selection for surgery. Thus, we did not feel that those patients should be pooled with those who were subject to WPATH criteria in our calculation for prevalence of regret. We did not define the term “regret” in order to capture a wide range of responses.”
—Narayan et al., 2021

The defense is hiding behind words because they know they are wrong. Behind the pedantry lies a truly cynical gaze. They are grasping, clinging to whatever partisan favors they might find in the judiciary. But they know they are wrong. Truth is a force of nature, and there’s no escaping it. So for all that’s Holy, WPATH, get a grip. Show some dignity, like Cicero, and stick your neck out.

Forrest Smith spent five years living openly as a trans woman before detransitioning in the fall of 2020. Facing institutional resistance in Portland, Oregon, he turned toward family, faith, and writing to chart a path to recovery and reflection. He is the author of a recently completed memoir manuscript and writes long-form reflections on Substack.

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