Actually Nothing: The Non-Starter Non-Story of the WPATH Files

Assigned Media analyzed hundreds of forum posts by WPATH members under a microscope. We found that WPATH members created hundreds of boring forum posts.

Analysis, by Evan Urquhart

The WPATH files is a report consisting primarily of forum posts between members of WPATH, the main professional organization for specialists in transgender healthcare. The report was released on March 4, with great fanfare, by Environmental Progress, which is a non-profit founded by public relations specialist and author Michael Shellenberger. Environmental Progress’ main focus is advocating in favor of industry and against the idea that climate change should be a source of alarm. In a note included at the beginning of the report, Shellenberger explained the rationale for his organization releasing a report on WPATH’s forum discussions writing, “we are pro-human environmentalists, and our mission is to incubate ideas, leaders, and movements for nature, peace, and freedom for all. We thus work on a wide range of issues…”

The report itself was authored by Mia Hughes, who is listed as a staff member of Environmental Progress under the name Mia Ashton. She has previously written anti-trans stories for the far-right Post Millennial.

The full report is 242 pages long. After the introduction by Shellenberger there are 66 pages of Hughes’ analysis of a collection of source material referred to as “the WPATH Files.” The Files themselves are included in the report on pages 73 through 242. For this story, Assigned skipped Hughes’ analysis and went directly to the source documents, the WPATH Files themselves, in order to perform our own independent, unbiased analysis of what they actually contain.

The bulk of the Files consists of 140 pages of posts from WPATH’s members-only forum. On their website, WPATH states that membership costs $225 (with a discount for members in the developing world). Full membership is open to “professionals working in disciplines such as medicine, psychology, law, social work, counseling, psychotherapy, nursing, family studies, sociology, anthropology, speech and voice therapy and sexology.” However, non-voting supporting membership is open to “individuals who do not work in the professional disciplines listed above, but still have an interest in being an active member of the organization.” 

In other words, anyone willing to pay $225 can participate in the members-only forum and gain access to its posts.

While a small number of the posts include the unredacted name of a prominent WPATH member, the vast majority of names are redacted, meaning it is not possible to verify who is posting or what, if any, qualifications they possess.

In addition to forum posts, 31 additional pages consist of a transcript of a video where senior members of WPATH participated in a panel discussion of best practices around informed consent. The video includes discussions of anecdotes from panel members where they felt the informed consent process had broken down, resulting in patients or parents who lacked a full understanding of what treatment would entail. These anecdotes where the process broke down are used as a teaching aid to explain the importance of checking to be sure that patients and parents fully understood what the clinician had explained.

The forum posts consist of photographs of paper print-outs (often with highlighted or underlined phrases) as well as screenshots of forum posts. In all, there are approximately* 340 individual posts that range from a single word (ex. “Exactly” or “YES”) to extensive paragraphs of text.

In other words, they’re forum posts.

screenshot from page 130 of the WPATH FIles

Eight individuals’ names are included unredacted. These include surgeons Christine McGinn, Marci Bowers, Thomas Satterwhite, Daniel Dugi, and Rajveer Purohit, as well as psychiatrist Dan Karasic, sexologist Eli Coleman, and psychologist Christina Richards. Posts from these named individuals constitute fewer than two dozen of the 340* posts.

The report organizes the forum posts into 21 categories, though it can be misleading to look over the table of contents alone because several, such as “Gender Affirming Surgery for Minors” and “DOD Spending on Transgender Healthcare,” consist of a single post, or one post with a small handful of replies.

The nature of the presentation makes it impossible to ascertain if all of the replies to a given post have been included. In some cases the top post seems to have been left off, making the discussion more difficult to parse. In one case a post about topical testosterone creams appears two seperate times, on pages 95 and 99. In context, it seems likely that the post was mistakenly added to a section on vaginal dryness/atrophy in transgender men (page 95), when it correctly belonged in a discussion of pain on ejaculation reported by trans women on estrogen (page 99).

There is no way to know whether the source who leaked the forum posts to Environmental Progress was also a participant in some of the discussions.

Overall, the posts are very dull. For example, pages 120-127 are labeled “DOD Spending on Transgender Healthcare” and consist of a top post describing a release of information from the U. S. Department of Defense describing the number of transgender people in the military and how much the military estimates their healthcare will cost and its replies. Forum participants discuss whether the DOD’s estimate is correct, with some arguing it likely exaggerates the costs of care and others disagreeing. Participants discuss their personal experiences treating members of the military, and how a large number of service members they had treated wound up paying out of pocket.

A discussion of Lisa Littman’s survey of 100 detransitioners on pages 105-115 is similar, containing a cordial discussion of the paper, with many expressing a positive response to the paper, and one member writing a lengthy but polite critique of the survey’s methods. Marci Bowers is a participant in this discussion, saying that she sees discussion of detransition as something of a distraction because “all surgeries and all medical treatments have regret rates that are typically much higher than what we see for gender transition.”

In many of the posts a member brings a question or dilemma relating to patient care. Details of individual patients are typically fairly scanty, although it is not impossible that personally identifying information might be present here. Replies to these dilemmas typically seek to guide the questioner toward resources that could help, such as research papers, presentations, even in one case an online philosophy class, or else describe the best practices from a provider’s clinical experience, such as the proper creams to prescribe for transmascs experiencing vaginal dryness, bleeding, or atrophy (on pages 93-94).

One notable inclusion mentions a benign form of liver tumor, called a hepatic adenoma, which the poster believes may be linked to testosterone therapy in a 16-year-old. The only reply to this included in the Files states, “I have one transition friend/colleague who, after about 9-10 years of T, developed hepatocarcinomas. To the best of my knowledge it was linked to his hormonal treatment. He was in his midlife. Unfortunately I don’t have much more details since it was so advanced that he opted for palliative care and died a couple months after.”

This brief statement about a “friend/colleague” by a person of unknown qualifications has been falsely reported in Newsweek and the Telegraph as evidence that testosterone causes cancer. An epidemiological survey of cancer in transgender patients did not identify liver cancer in transmasculine patients as an area of concern. Instead, while describing the overall evidence as inconclusive, the study identified an increase risk of anal cancer due to HPV virus and concerns about breast screenings for transgender women on estrogen as two main areas of concern.

screenshot from the Telegraph

Assigned did not identify anything in the WPATH Files that stood out as being particularly notable, defined as anything outside of what would be expected from a professional forum for specialists in a healthcare field. Discussions universally maintained a professional tone, and disagreements seemed to be freely, but mildly, expressed. The only potential area for concern we were able to identify would be in the area of patient privacy, with vague but potentially identifying case details being shared in an online forum that could be accessed by anyone with $225, however it is not possible to say whether patient privacy was actually compromised in any particular case.

*In a few cases posts are duplicated or partially duplicated, making a precise count impossible.