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Gender transition side effects include death, patients have severe mental illness: leaked convos

World Professional Association for Transgender Health members swap candid stories, seek advice in private forum, panel discussion. Testosterone wreaks havoc on women's bodies over time. WPATH dismisses "scare tactics."

Published: March 5, 2024 11:45pm

The Twitter Files helped expose how federal officials, from the White House on down, coordinated with and pressured tech platforms to remove challenges to preferred narratives on COVID-19, particularly the safety and effectiveness of vaccines.

A tranche of internal discussions among leaders and practitioners in the so-called gender-affirming-care industry stands to amplify concerns about the safety and effectiveness of puberty blockers, cross-sex hormones and genital surgeries on children with gender dysphoria.

They show members of the World Professional Association for Transgender Health admitting that some young patients or colleagues developed life-threatening medical conditions or even died after years of treatment.

These are more serious than the sexual dysfunction and developmental problems, such as sterilization, inability to orgasm, weaker bones and sudden spikes in brain pressure, already reflected in research and even federal guidance on gender affirming care.

"The WPATH Files" came from "one or more" people with access to the organization's member discussion forum, whose conversations confirm that "transgender medicine is neither scientific nor medical," Twitter Files journalist and contrarian environmentalist Michael Shellenberger wrote in a lengthy X thread Monday night.

Shellenberger's Environmental Progress research group summarized and posted the leaked communications, which appear to have been copied from printouts based on the skewed orientation, squished spacing and degradation of forum pages. 

"WPATH serves no purpose, contributes nothing beneficial to the field of gender medicine, and leads medical and mental health professionals astray," says the report, written by journalist Mia Hughes. "Several European nations have already abandoned the group’s guidelines, indicating the extent to which WPATH has become obsolete."

A 16-year-old patient developed "two liver masses" after several years on a menstrual-suppression drug and one year of testosterone, "and the oncologist and surgeon both have indicated that the likely offending agent(s) are the hormones," a doctor wrote in the forum.

Another responded that a female colleague who identified as a man died of liver cancer, which "[t]o the best of my knowledge … was linked" to taking testosterone for nearly a decade.

Three years of testosterone gave a young woman pelvic inflammatory disease, with vaginal atrophy typical of postmenopausal women and "a persistent yellow discharge we often see as a result" of treatment, a nurse practitioner wrote. Hughes said PID's fatal risks include ectopic pregnancy and "spread of infection to other body parts."

The report states the names of members were redacted "except in the case of the WPATH president, surgeons, and other prominent members" and did not edit the files.

Only one WPATH member answered a request for comment, with "legal threats," and an email obtained by Environmental Progress showed "WPATH advising against replying and informing the recipients that WPATH was seeking legal counsel," the report says.

"WPATH is and has always been a science- and evidence-based organization whose recommendations are widely endorsed by major medical organizations around the world," President Marci Bowers said in a statement the group gave Just the News.

"We are the professionals who best know the medical needs of trans and gender diverse individuals – and stand opposed to individuals who misrepresent and de-legitimize the diverse identities and complex needs of this population through scare tactics," Bowers wrote. 

"The world is not flat. Gender, like genitalia, is represented by diversity. The small percentage of the population that is trans or gender diverse deserves healthcare and will never be a threat to the global gender binary," the statement concludes.

WPATH member discussions are important stateside because of the group's outsized influence in American medicine, including recommendations by the American Academy of Pediatrics, American Psychiatric Association, American Medical Association and Endocrine Society.

The eighth version of WPATH's Standards of Care (SOC8), published in 2022, drew mainstream attention for ditching planned age minimums for breast removal and hormone therapy for fear of malpractice lawsuits against practitioners and insurance hurdles for patients.

The forum messages also show members discussing negative lifestyle experiences from treatment — erections that "feel like broken glass," painful orgasms and "excruciating" bleeding from split skin — and asking each other for recommendations on treating the side effects.

"No one in the forum provided links to actual scientific literature providing evidence-based recommendations for managing these painful iatrogenic symptoms," because "there is no reliable science to consult," Hughes wrote in the report.

Members were often left guessing, as when a Seattle psychologist found "conflicting information" on whether a 10-year-old premenstrual patient who identified as a boy could take puberty blockers without stunting her growth. 

A pediatric endocrinologist recommended supplementing the blockers with a low dose of testosterone and gradually increasing the dose, to ensure the growth plates stay open without preempting the growth spurt.

Members also discussed patients' mental health problems, with a Canadian nurse practitioner saying she was "perplexed" whether a patient with post-traumatic stress disorder and dissociative identities could give informed consent. 

SOC8 mental health chapter author Dan Karasic told her to just evaluate whether the patient has "persistent gender dysphoria, capacity to consent, and the benefits of starting hormones outweigh the risks.”

Karasic has previously said WPATH members should not reject transition for "plural" identities.

Others said they must get consent from all of the "alters" exhibited by their dissociative patients or risk litigation. One admitted to hiding dissociative diagnoses in referral letters, calling it "complicated PTSD" so gender-affirming surgeons wouldn't question it.

"My comments in any forum on the care of transgender adults with co-occurring mental health conditions are consistent with my belief in the importance of mental health care in these patients, which is the work I've done for decades," Karasic wrote in an email.

While he hasn't reviewed the report "in its entirety, as it was just released," Karasic said he saw a "quote attributed to me" that was "was edited from my actual comments, and I've seen in the past that excerpts of statements I've made are sometimes presented to try to assert that I am making a point that is opposite to the one I made."

The leak included internal video from a May 6, 2022 "Identity Evolution Workshop," also made public by Shellenberger's group, and the report includes a 30-page transcript.

Canadian endocrinologist Daniel Metzger explained that young patients and even some adults don't understand that they cannot "pick and choose the effects of hormone therapy," such as taking estrogen without developing breasts or testosterone without facial hair.

Other panelists smiled when Metzger said young patients are a "blank wall" when he warns them about the likelihood of sterility from treatment and say they'll just adopt if they want kids, believing they can go to "the orphanage" and get a baby.

Child psychologist Dianne Berg, author of SOC8's child chapter, said she was "stumped" on how to make a 9-year-old "who's starting puberty suppression" appreciate the fertility consequences.

She said many patients had started "medical intervention" before mental health treatment because of a "backlog of therapists," and that she is frustrated by parents who "can’t tell me what they need to know about a medical intervention that apparently they signed off for."

Former WPATH president Jamison Green told the panel that some patients can "get their hormones prescribed through their primary care provider," who is not an expert. Report author Hughes says this contradicts WPATH's official statement that "a team of medical and mental health professionals carefully evaluates young patients."

Green also said patients for hormones and surgeries tend to skim or even ignore the potential complications and consequences on the consent form because their mentality is "this is my moment, I gotta grab it."

Metzger, Berg and Green did not respond to queries about their comments and portrayal in the report.

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