A Cautious Mainstream Trans Organization Comes Through
WPATH is often criticized by trans people for its medicalized, cautious approach to setting standards for gender affirming care, but their response to the new conversion-therapy tinged NHS guidelines is careful, methodical, scientifically sound, and an absolute banger.
by Evan Urquhart
England’s restrictive new NHS guidelines on treatment for gender dysphoria in youth are an endorsement of conversion therapy and Orwellian coercion tactics towards loving families from a country in the throes of an anti-scientific moral panic… but you don’t have to take my word for it. The mainstream medical organization responsible for setting the standards for doctors and other providers, WPATH, and all subsidiary organizations (USPATH, ASIAPATH, EPATH, and PATHA), have released a meticulously sourced statement explaining the research in detail, and laying out how the NHS strayed from the data to endorse an outdated psychiatric model of treatment that simply doesn’t work.
WPATH has been routinely criticized by trans people for its medicalized and small-c conservative approach to transgender healthcare. The organization serves doctors, hospitals, and insurance companies first and foremost, providing carefully vetted guidelines describing when and how patients should be allowed to access transition-related medical care. Many trans people believe that this approach puts up excessive financial, emotional, and wait-time barriers to something that ought to be a matter of individual choice. Although treatment for youth is widely agreed to be a lot more complicated, trans people tend to stress that any “damage” that comes from going through the wrong puberty is the exact same for a trans child who is not allowed to access medical transition as a misdiagnosed cisgender child who is given cross sex hormones in error. WPATH takes the risk of misdiagnosis much more seriously, and is therefore quite cautious in its recommendations on youth care.
That’s why it is so notable that, in the case of changing policy for treatment of gender dysphoric youth by England’s NHS, WPATH and trans people are largely speaking in one voice. The NHS guidelines are a huge step back, to a time when transgender identity was seen as primarily a mental disorder that could be cured by talk therapy or waited out.
Many cis people (and almost all transphobes) find the older psychiatric model of transgender identiy intuitive. It feels right that trans people would be mistaken about our genders and ought to be helped (or forced), with talk therapy (and sometimes threats of institutionalization), to accept ourselves the way we are, and not allowed to change our bodies to match our sense of self. This has always been so intuitive to cisgender people, in fact, that this very approach was tried for decades, unsuccessfully, until gradually in the face of that failure other options began to be explored. It may be uncomfortable and unintuitive for some cis folks, but it’s a straightforward medical fact that psychiatric approaches don’t improve trans people’s lives, but medical transition does.
To understand the medical picture you would be hard pressed to find a better starting place than the WPATH document, but in order to accept it you have to allow the possibility that what I’ve said is true. That talk therapy has been tried. That it doesn’t work. That medical interventions have been studied (for many years). And that these do, in fact, work. The psychological burden of accepting this as a possibility is too high for many transphobes, who will insist that the medical evidence referenced in the WPATH statement does not exist, that the real evidence says something it does not say, or (at the furthest extreme) that there’s a conspiracy of doctors and drug companies to fake the evidence and suppress what they feel must be the truth.
Conspiracy theorists are too far gone to reach, but anyone else should take the WPATH statement for what it is: A cautious organization, one whose priority is evidence-based standards of care, explaining in meticulous detail how the NHS in particular, and other efforts to restrict or ban treatment for gender dysphoria in general, are misguided, biased, and based solely on misinformation and prejudice. If instituted they will cause trans people great harm.
