At WPATH’s 2018 annual conference in Buenos Aires, Marci Bowers delivered a speech to the Standards of Care 8 committees, urging members to “Be bold!” when drawing up the guidelines. The four-minute video provides another glimpse into WPATH’s unsettling parallel world, where trans activism dictates reality, the Hippocratic Oath is absent, and none of the rules of child and adolescent development apply.
What Bowers meant by “bold” was for the committee members to go forth from the rousing speech and dismantle as many safeguards surrounding extreme body modification surgeries as possible. Bowers encouraged the SOC8 committee members to craft the upcoming guidelines in a way that would allow adolescents to have earlier access to surgeries, including genital surgeries, and for the committee to abolish the requirement for a psychological evaluation before the removal of healthy reproductive organs.
“A rewrite of the standards of care means progress, and we deserve progress,” declared the celebrity gender surgeon, who was destined to be at the helm of WPATH as its reputation sank from globally respected to widely discredited and condemned.
Noting that children and adolescents are being socially transitioned at younger ages than ever before, Bowers argues that there should be “no impediment” for a teenage girl who is under 18 to access a (medically unnecessary) bilateral mastectomy.
What’s more, Bowers doesn’t even attempt to disguise the main objective of WPATH’s SOC8, which is to secure insurance coverage for as many experimental body modification procedures as possible. Setting a minimum age requirement of 18 “in the standards of care means insurance companies pick these standards up, and therefore deny care to these families,” explains Bowers. “They deserve that care.”
Not content with removing what little safeguarding there was in place to protect teenage girls from sacrificing their breasts before they’ve even had a chance to experience womanhood, Bowers also encouraged the committee to permit adolescent boys as young as 17 to undergo the surgical inversion of their penises. The justification given for this was that “these kids that are coming out at four or five years old.”
Only someone who has forgotten everything known about early childhood development could ever think that a four-year-old can “come out” as trans. These little effeminate boys are almost certainly future homosexuals who have the misfortune to be growing up in an era that tells them their gender nonconformity means they are girls. In truth, no child can “come out” as transgender because no child can understand the lifelong social and medical implications of adopting this identity.
This speech must be preserved as a historical artifact for future historians, who will undoubtedly study it with a mixture of disbelief and horror, asking: How did society allow this group to exist? How could a professional association so detached from reality, with so little understanding of child and adolescent development, have been permitted to influence an entire field of paediatric medicine? Where were the ethics boards? Where were the child safeguarding experts?
Apples to Oranges
A further indication that Bowers and the committee members live in an alternate universe, where even the most rudimentary understanding of medical ethics is absent, comes with the suggestion that it is discrimination to require a psychological evaluation and letter of recommendation before “the removal of reproductive organs like the testes or a uterus.”
“This is nothing more than a hoop from the lens of discrimination. It is not done for cisgender people seeking vasectomies or tubal ligations,” says Bowers, triggering an enthusiastic round of applause from the assembled crowd.
Yet, this is clearly comparing apples to oranges. Firstly, vasectomies and tubal ligation are minor procedures that preserve the overall function of the reproductive and endocrine systems. On the other hand, the surgical removal of the testes leaves a man permanently unable to produce sex hormones. This procedure also carries significant health risks, including a higher likelihood of heart disease, stroke, and metabolic syndrome.
Similarly, a hysterectomy is major surgery that can lead to pelvic organ prolapse, urinary dysfunction, and hormone imbalances due to decreased blood flow to the ovaries. If the ovaries are also removed, the woman is put into menopause, which comes with an increased risk of certain cancers, cardiovascular disease, and osteoporosis.
What’s more, vasectomies and tubal ligation are performed for a clear purpose—birth control—and the procedures are known to be safe, effective, and evidence-based. The same cannot be said for the surgeries in the field of gender medicine. The surgical removal of testes, ovaries, and uteruses in gender clinics is done as a treatment for a poorly defined psychiatric disorder based on a person’s self-declared transgender identity with the misguided aim of transforming the patient into a member of the opposite sex. To make matters worse, there is no good-quality evidence to show that these surgeries are safe or beneficial or that the perceived benefits outweigh the numerous known risks.
However, Bowers choosing to compare gender-related surgeries to vasectomies and tubal ligation does highlight an interesting contrast. Outside the field of gender medicine, doctors are typically reluctant to perform sterilization procedures on anyone under 30, recognizing that adolescents and young adults often change their minds about parenthood. It is well-documented that young people often strenuously insist that they will never want children, only for that to change dramatically as they grow older.
Therefore, contrary to Bowers’s claim, there are actually more guardrails placed around vasectomies and tubal ligation compared to WPATH’s transition-on-demand approach to gender medicine, even though the procedures are considerably less invasive and damaging to a person’s health.
Safeguarding is Bigotry!
Towards the end of the speech, Bowers makes a very telling comment. Still on the subject of the requirement for a psychological assessment, Bowers tells the group he has been “informally polling members, particularly of the trans community, and no one can see a reason for this letter or this evaluation by psychologists who perpetuate psychopathology.”
This comment strikes at the very heart of what has gone wrong inside WPATH. This is an organization that allows itself to be guided by trans-identified people who hold the political belief that being transgender is healthy and natural, and therefore reject psychotherapy aimed at aligning body and mind as being equivalent to conversion therapy. In this worldview, on-demand access to hormones and surgeries is a human right, and safeguarding is considered transphobic “gatekeeping.”
It wasn’t always this way. When the organization first began as the Harry Benjamin Gender Dysphoria Association (HBIGDA), its board had just one trans-identified member—a trans-identified female named Jude Patton. It wasn’t until the 1990s, when trans activism took a radical turn, that activists started to pressure HBIGDA to include more trans-identified people in the group while demanding that the group’s guidelines reduce barriers to care.
It was this same militant branch of trans activism that also pressured the American Psychiatric Association (APA) to change the diagnosis from gender identity disorder to gender dysphoria, thereby shifting the focus of the disorder from the cross-sex identity to the distress felt because mind and body are not aligned.
Activist and trans-identified male Kelley Winters summed up the goal of this depsychopathologization campaign succinctly in 2005. “By labeling a person’s identity, which is discordant with her or his natal sex, as disordered, [gender identity disorder] implies that identity and not the body is that which needs to be fixed,” said Winters. “By its title and diagnostic criteria, the diagnosis contradicts treatment goals that correct the body.”
This approach of prioritizing immediate medicalization over caution and psychotherapy would undoubtedly have resulted in harm even if the patient cohort had remained stable with just autogynephilic men and a tiny number of gender-nonconforming homosexuals seeking hormones and surgeries.
However, in a devastating perfect storm moment, just as trans activists succeeded in framing trans as natural and healthy and extreme body modification as a human right, the enormous surge in adolescents identifying as transgender began. While arguably no one benefits from WPATH’s free-for-all approach to gender medicine, the people who are harmed the most by it are the legions of confused youth who are misinterpreting the struggles of adolescence for a sign that they are transgender.
In the wake of the Cass Report, PATHA, the New Zealand branch of WPATH, issued a statement criticising the review for not including trans-identified people as key decision-makers. However, if there is one lesson to be learned from the scandal of gender medicine under WPATH, it is that transgender people with extremist political views, who consider caution and guardrails to be transphobic gatekeeping, have no business contributing to the discussion about how best to manage the vulnerable young people swept up in today’s cultural storm.
When the history books are written about this medical scandal, the "Be Bold" speech will be cited as clear evidence of the dangers of letting ideologues drive medical practice and allowing medical organizations to fall prey to groupthink at the cost of scientific integrity. Let this tragedy be a lesson, and may we never again allow young lives to be destroyed in the name of ideology.
Mia Hughes is the director of Genspect Canada and co-host of the Beyond Gender Podcast
Share this post