Trans Activist Truths on Post-Operative Misery

Leaked Files should discredit the World Professional Association for Transgender Health and its professional associates.

Since its inception in 2007, the World Professional Association for Transgender Health (WPATH) has been perceived by activists, therapists, medical organisations and various legislatures as an authority on the diagnosis and management of children, adolescents and adults who identify with a gender incongruent with their chromosomes. WPATH has formalised the social, hormonal and surgical procedures that comprise the process of “affirmation” of body to mind, while (at least indirectly) underpinning various legislatures that have criminalised attempts for “reconciliation” between mind and body as destined by chromosomes. Few legislatures have criminalised “reconciliation” more aggressively than in Australia, with Victoria’s Change and Suppression (Conversion) Practices Act of 2021 leading the pack. The gender clinic in the Royal Children’s Hospital in Melbourne proclaims “official affiliation” with WPATH and leadership in the abolition of age limits in the process of “affirmation”. Of six Australian “centres of excellence” linked in authorship with WPATH’s recent Standards of Care, five are in Victoria[1].

What ought to be a major problem for WPATH and its affiliates is that, on March 4 this year, files were released of screen shots of “semi-private conversations” exchanged, from 2021 to 2023, between WPATH members and leaders on an “internal on-line forum for discussing specific medical cases”, and during an “Identity Evolution Workshop” on May 6, 2022.

The files were leaked to Michael Shellenberger and published on the website Environmental Progress along with an extensive commentary by a freelance journalist, Mia Hughes. Hughes’s “Executive Summary” concluded that “gender medicine is neither science nor medicine”: just an “experiment” in which “members demonstrate a lack of consideration for long-term patient outcomes despite being aware of the debilitating and potentially fatal side effects of cross-sex hormones and other treatments”. WPATH “advocates for many arbitrary medical practices including hormonal and surgical experimentation on minors and vulnerable adults. Its approach to medicines is consumer driven and pseudoscientific and its members appear to be engaged in political activism, not science.”

I concur, differing only in the definition of experimentation, which normally implies biological plausibility, expectation of benefit but with full explanation of alternatives and risks, regulation of method, comparison with controls, blinded application and interpretation, equally based on the four principles of beneficence, non-maleficence, justice and autonomy, culminating in provision of “fully informed consent” by a comprehending brain. Thus, the word experimentation is inappropriate for WPATH’s activities, which are more logically seen as imposition of a utopian ideology or Gnostic religion upon the immature brains of young people. The leaked files should discredit WPATH and severely embarrass its associates.

Overview of WPATH’s stages of “affirmation”.

Review of WPATH’s stages of “affirmation” of young people towards incongruent chromosomes will emphasise the importance of the leaked files. But, first, it must be emphasised that studies have long shown that most gender-confused children will revert to an identity congruent with chromosomes with the help of traditional (but now criminalised) psychotherapy, psychiatric and social care.[2][3][4][5][6][7] The outcome of the recent epidemic of gender-confused adolescent females is, however, unknown. Paradoxically, the files contain many declarations that gender identity can “shift” (including back to congruence with chromosomes). Why then are WPATH and affiliates, including politicians, welded to life-long “affirmation”?

The first stage of “affirmation” of children involves social change towards the opposite sex, including names, pronouns, dressing, celebration by peers and validation by authority figures. Given immaturity, and co-morbid mental and familial dysfunction, “social affirmation” is not a neutral act, more likely an iatrogenic strengthening of disparity between vulnerable mind and chromosomal directives.

The second stage involves blocking the process of puberty which normally begins deep in the brain to be effected by a cascade of hormones of which one member, gonadotrophic releasing hormone (GnRH), is manufactured in the hypothalamus to be conveyed to the nearby pituitary gland where it stimulates the next phase. But GnRH is also distributed to neurons throughout the brain,[8][9] confirming both “reproductive” and “non-reproductive” roles[10].

In its reproductive role, GnRH stimulates the release of Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) from the pituitary into the bloodstream to the distant gonads where they stimulate and maintain production of eggs and sperm, and the sex hormones oestrogen and testosterone, which evoke the physical (including cerebral) characteristics of biological sex, as directed by two X chromosomes in females or one X and one Y in males.

As well as its “vertical” role in reproduction from pituitary to gonads, GnRH also exerts a “horizontal” role by stimulating various centres for sexualisation within the brain. For example, GnRH-based centres in the mid-brain were demonstrated, decades ago, to precipitate sexual behaviour in rodents[11][12][13][14], and to exert a “socio-sexual” effect (the “ram” or “male” effect) in which merely “social” exposure to a ram will induce ovulation in ewes[15].

A “non-reproductive” role of GnRH in the maintenance of nerve cells in the brain and elsewhere in the body has also been known for decades: “blocking” the action of GnRH in peri-pubertal sheep results in hypertrophy of the limbic system[16] which normally integrates cognition, memory, emotions and sexuality, and inspires appropriate “executive function”. Molecular studies on hypertrophied limbic tissue have revealed dysregulation of multiple genes[17] resulting in sustained disorder in behaviour, increased emotional lability, interruption of memory and, apparently based on fearfulness, preference for “executive decisions” that favour the status quo, the familiar over the novel.[18][19][20] Studies on humans receiving blockers to reduce the pathological effects of the sex hormones (for example, testosterone in prostate cancer) have also revealed disordered executive function.[21][22][23][24] And research has revealed marked reduction of nerve cells in the intestines of women administered “blockers” for endometriosis.[25]

Moreover, recent studies reveal that progressive cerebral deterioration in rodents and humans with Down Syndrome is linked to reduced production of GnRH, mitigated by replacement.[26] Studies have also shown that the emotional and cognitive effects of deposition of amyloid in Alzheimer’s-like disease may be reduced by administration of GnRH,[27] raising the suggestion its lack may be associated with other neuronal degenerations, from ageing to Parkinson’s disease.[28]

“Blockers” are pharmaceutical compounds similar to GnRH but with a minor structural difference that “blocks” its function. According to proponents for “affirmation”, blocking the process of puberty grants time for greater understanding of sexuality, gender identity and fertility, but this argument lacks biological plausibility.

First, how can a child consider sexuality when all of nature’s directives have been neutered: from the GnRH-based sexualising midbrain centres, to the “socio-sexual” effects revealed in sheep but paralleled in humans “falling in love (or lust) at first sight”, to the driving and orientating forces of sex hormones from the gonads?

Second, how can children, even as young as nine, make mature decisions of life-long importance given discordance in maturation between the emotional immediacy of the limbic system and the rational control of the pre-frontal cortex? This youthful discordance is the reason tattoos are banned, alcohol prohibited, driving illegal, and membership in the armed forces unthinkable for children. Things can only be worse when the limbic system itself is disrupted.

Third, can a child “think straight” when “blockers” have demonstrated adverse effects on neurons in laboratory dishes,[29] on brain development in a young human[30] (as well as the aforementioned effects on maintenance of neuronal integrity)?

Fourth, can young people appreciate the life-long implications of “affirmation” when afflicted with co-morbid mental and family disturbance?[31][32][33][1][34]

Fifth, the observation that “blocked” animals prefer the “familiar” over the “novel” provides a biological explanation for the fact that almost all “blocked” children proceed to the next phase of “affirmation”, receipt of cross-sex hormones. When they are on “blockers”, the “familiar” has become the adopted persona of the opposite sex, fortified by authority figures including parents, teachers, peers, web “friends” and even God Himself in the form of an “affirming” religious school. The avoided “novel” would be the rejection of those influences in pursuit of “reconciliation” with chromosomes.

The third stage is the administration of cross-sex hormones: female hormones to a natal male, or testosterone to a female. Here, WPATH and its associates warn of side effects on the cardiovascular system but are silent on reports that the male brain exposed to oestrogen shrinks at a rate much faster than ageing, presumably due to cell death[35][36][37]. On testosterone, cells in the adult female brain hypertrophy. But no studies are available on their effects on the growing brains of adolescents—funding has been denied. The leaked private WPATH files report an association of cross-sex hormones and hepatic cancer, but there is no evidence this is discussed publicly.

The fourth stage comprises surgical modification of the body towards that of a sex contrary to chromosomes. In females it may begin with mastectomies but, ultimately, in both sexes it implies reconstruction of genitalia with inherent castration.

In natal males, surgery may involve removal of the testes and the penile shaft, associated with the creation of a cavity anterior to the anus into which remaining penile skin from that from the scrotum is inverted to form a “vagina” whose depth, for penetrative sex, may need to be augmented with a segment of intestine. The glans is re-positioned anterior to the vagina to function as clitoris. Ersatz breasts may be implanted in the chest wall if oestrogenic stimulation is insufficient.

In natal females the process is even more complicated: the vagina, uterus, tubes and ovaries are removed, and the cavity closed. A phallus may be constructed from a rectangular shaft of skin from the forearm, rolled into a tube, and grafted beneath the pubis. For sexual sensation, the clitoris may be positioned on the neo-phallus. To urinate while standing, an internal tube will need to be fashioned within the neo-phallus. Testicular models may be inserted in remaining labia vagina. A length of Eve’s rib may be inserted within the phallus to stiffen it for penetrative sex, and breasts removed for Adam’s chest.

The fifth stage may be defined as disillusion with the results, confirmed by the increasing number of “desisters” who “regret” their “affirmation”. Sadly, “desisting” may result in suicide which, in transgendered adults, may occur at rate nineteen times that of the general population[38]. WPATH protests that “regret” is rare, and that suicides result from “minority stress” induced by a non-accepting public, minimising the role of co-morbid psychiatric disease, the iatrogenic effect of hormones on the brain, and the final absence of any gold at the end of the rainbow.

 

The leaked files

1. The new definition of “informed consent”.

Aping Alice’s Humpty Dumpty, who declared, “when I use a word … it means just what I choose it to mean”, WPATH has subjugated the traditional bases of “informed consent” to dominance by one of the pillars of ethics: “autonomy”. In this distortion, WPATH reduces the traditional role of patient and therapist to the mechanical level of consumer and provider: the patient “informs” the doctor as to which gender identity and body modifications are desired, and the doctor “consents” to their manufacture.

In the files, endocrinologist Dan Metzger reveals this absurdity in describing his management of even thirteen-year-old gender-confused children. He explains to them, “This is like a journey and you’re going to take us … we are coming along for the ride. I am going to ask you what you want to do with your hormones. Are you happy where they are?”

He declares, “The kids need space to know … they are in charge … and have permission to go backwards (in dosage), stay where they are, go forwards, to whatever degree.” He emphasises, “I just think you have got to let kids have … permission to do that.”[39]

But despite these grand protestations of respect for the wisdom and autonomy of children, earlier Metzger, in self-contradiction, revealed he did not really believe in such bespoke gender embodiment. He had warned: “the thing you have to remember about kids is that we’re often explaining these sorts of things to people who haven’t even had biology in high school … it is important to know … people want this [effect] … but don’t want this [effect] from a hormone … and I am like, you know, you can’t get a deeper voice without probably a bit of beard”. Regarding hormonal action, Metzger explained, “it’s going to act on a receptor [and they are] everywhere … and it is hard to pick and choose the effects you want … that is something that kids wouldn’t normally understand … nor would “a lot of adults”[40].

• Can children comprehend?

Publicly, WPATH and affiliates proclaim that great care is taken to fully inform (in the traditional sense) and ensure comprehension by children, adolescents and involved parents. But do WPATH leaders really believe this? The answer is “No”.

Like Metzger, another leader and contributor to WPATH guidelines, psychologist Dianne Berg, explained that young people could not be expected to understand the process of “affirmation” because it is “out of their developmental range to understand the extent to which some of these medical procedures are impacting them … But what really disturbs me is when the parents can’t tell me what they need to know about a medical intervention that apparently they signed off for … they’ll say they understand but then they’ll say something else that makes you think, Oh, they didn’t really understand … Oh, they didn’t get that point, but they’ll say they totally get it.” Berg declared she could ask clients and parents what they had learned after an hour’s discussion with an endocrinologist only to be told, “We have no idea what they were talking about.”[41]

In reference to WPATH guidelines where “it’s encouraged and ethical to talk about fertility preservation options” because puberty blockers followed by cross-sex hormones “will eliminate the development of their gonads producing sperm and eggs”, Metzger added, “It’s always a good theory that you talk about fertility preservation with a fourteen-year-old, but I know I am talking to a brick wall.”

When another member admitted that the challenge of explaining sterilisation had her “stumped”, the loquacious Metzger concurred: “Most of the kids are nowhere in any kind of a brain space to really talk about it in a serious way.”

• What about the effect of co-morbid mental disorders?

WPATH members discount challenges to comprehension posed by co-morbid mental disorder. In one case, a nurse practitioner declared she was “perplexed” about the ability of a patient to make a rational decision for “affirmation”, given he was suffering from a combination of PTSD, major depression, observed dissociations and schizoid traits. In reply, an author of WPATH’s most recent “Standard of Care” declared, “I am missing why you are perplexed … the mere presence of psychiatric illness should not block a person’s ability to start hormones [if] the benefits … outweigh the risks.” Thus, demands for bodily modifications (autonomy) trump suggestions they may not have arisen in a stable mind.

The issue of “dissociations” should be clarified: they pertain to “dissociative identity disorder” (DID), once known as “multiple personality disorder”, in which the mind of a sufferer may (supposedly) be composed of two or more separate personalities. DID seems to lack widespread validation in current psychiatric circles, being more of “social contagion” engendered, in the 1950s, by such movies as The Three Faces of Eve.

Nevertheless, classical DID survives in the realms of WPATH, threatening therapists. A psychologist warns that “it is imperative to get all the alters [as the individual personalities are called] who would be affected by HRT [hormone therapy] to be aware and consent to the changes … Ethically, if you do not get consent from all alters you have not really received consent and you may be open to being sued later, if they decide HRT or surgery was not in their best interests.” As to how the alters could be mustered for consensus was not explained, but one member suggested apps might be useful.

Ultimately, WPATH’s guidance for the “perplexed” rested on the paramountcy of “autonomy” for body modification, with objections rejected as intrusive “gate keeping”. One leader boasted that his patients with DID, major depressive disorder, bipolar and schizophrenia “do just fine” on hormones, recounting that castration of one disturbed homeless man made a “huge difference” to his life.

Is information fully shared?

Perhaps the most astonishing leak concerns the effects of “blockers” on sexuality, fertility, and the ability to experience orgasm. Publicly, WPATH and affiliates speak positively about preservation of fertility by collection of eggs and sperm for future artificial insemination. Publicly, it seems easy. Privately, it is not.

On January 14, 2022, WPATH’s President, Marci Bowers, declared, “We do not fully understand the onset of orgasmic response, and blockers make this a major question. Fertility and more problematic surgical outcomes in adulthood are also concerns.” One week later, she repeated, “The fertility question has no research that I’m aware of as puberty onset allows for fertility options while blockers preclude those opportunities … The orgasmic response question is thornier and observational based largely upon the growing cohort of puberty blocked individuals seeking gender affirming surgical care years later …To date, I’m unaware of an individual claiming ability to orgasm when they were blocked at Tanner 2.”[42] No one disagreed.

Here, Bowers is referring to the five stages of puberty described by a British physician, James Tanner. Stage 2 corresponds with development of breast buds in girls and testicular enlargement in boys, around nine years of age. Stage 4 corresponds, a few years later, with production of eggs and sperm.

Confirming “affirmation” is not evidential, Bowers explained, “Clearly this number [of infertile and anorgasmic children] needs documentation and the long-term sexual health of these individuals needs to be tracked. Again, puberty blockade is in its infancy … observational reports are commonly the nidus for future study, as will likely be the case here. I do hope to tabulate some of our experiences for this year’s WPATH presentations.”

Despite Bowers’s claims, the use of “blockers” is not in its infancy: they have been integral to the “Dutch protocol” for management of gender-dysphoric children for over thirty years[43], involving thousands of children in many countries.

In May 2022, at the “Evolution of Identity” conference, WPATH leader, Ren Massey, encouraged discussion on the effects of blockers on reproduction, confirming the issue was far from resolved and certainly not made public. She declared that “one important thing is to make sure we address fertility preservation … even for youth who are going on puberty blockers because many of those youth”—and here Massey thanks the audience for nodding heads in agreement—“will go directly onto affirming hormone therapies which may eliminate, or will eliminate … the development of their gonads producing sperm or eggs that are going to be usable if they want to be partners with somebody else later in contributing genetic material for reproduction.”[44]

Two years later, WPATH and its affiliates, however, continue to assert that “blockers” are “safe and entirely reversible”, and yet another Australian state, New South Wales, has proscribed alternative therapy for gender dysphoria, obliging the use of blockers. How many Australian boys have been deprived of orgasms and fertility remains to be seen.

In refusal to acknowledge all reproductive and non-reproductive side-effects of blockers and cross-sex hormones, WPATH’s Australian affiliates continue to ignore the mandate of the High Court in Rogers v Whitaker[45] which declares a medical practitioner has a duty to warn a patient of a risk “if … a reasonable person in the patient’s position, if warned of the risk, would be likely to attach significance to it”. In the Whitaker case, the risk of side effects was around one in 14,000. Regarding “blockers” administered to natal males in early puberty, according to WPATH files, the risk of sterility and anorgasmia was one in one.

 

• Blockers and surgery.

Administered at Stage 2, as is not uncommon, blockers will not only stop the production of eggs, sperm, oestrogen and testosterone, but also the growth of genitalia and sex-specific features such as breasts and beards. Proponents for “affirmation” approve this blocking because it delays sexualisation of the body, allegedly granting more time for consideration of identity. In girls, inhibition of breast development might be of psychological advantage to their possessor but would also make life easier for a surgeon: a breast bud being much easier to excise than a developed organ. In boys, however, restriction of genital growth is likely to mean the eunuchoid genitalia do not have sufficient penile and scrotal skin for the creation of a neo-vagina of sufficient depth for penetrative sex, necessitating augmentation with a length of intestine, increasing complications.

In both sexes, the neutering effect of GnRH on the growth of genitalia is likely to involve the neuronal and vascular innervation of the glans and clitoris resulting in reduced sexual sensation especially if grafted to an abnormal site. The biological reason no one in the WPATH discussions was able to report orgasm and fertility in natal males “blocked” soon after the onset of puberty might indicate they were administered earlier and maintained longer in order to prevent the development of a male physique and beard, facilitating the later “passing” as a female.

In both sexes (as aforementioned), blockers will neuter sexualisation by interruption of cerebral centres and the gonadal production of sex hormones, refuting the allegation they provide time for its mature consideration. Perhaps unwittingly, endocrinologist Metzger concurs: “I am sure putting a kid on a blocker at age nine and then letting them get to the age of whatever, when they’re developing a sexual identity … cannot be great … we are to a degree robbing these kids of that sort of early to mid-pubertal stuff that’s happening with their cisgender peers. That’s not happening because we’ve got one loop running and their … brains are just not thinking that way. They’re getting older and smarter about … math, but they’re not learning know their body works … [Regarding masturbation] they don’t have the urge to do that, right? And, all of a sudden they’re … many years behind their peers trying to figure their sex stuff out.”[46]

The extent of destruction of healthy tissue, the extravagance of attempts to attempt similitude with the opposite sex, and the prevalence of complications do not feature in promotional literature for “affirmation” or in much media coverage where “sex change” would appear a simple matter. The leaked files, however, reveal a litany of post-operative miseries: pain, discharge, incontinence, stenosis, infection and malfunction.

Of note are complications associated with a neo-vagina in a natal male in which 71 per cent of those administered puberty blockers needed the “riskier”, intestinal augmentation of vaginal depth. Of these, 25 per cent required follow-up surgery[47]. Moreover, the neo-vagina has such a proclivity to stenose (close down) it demands insertion of a dilator for up to two hours every day or more, until healing and then once a week for life: a challenge for the most balanced of minds, let alone those disturbed by mental co-morbidities and adolescent immaturity. Stenosis has been reported in 15 per cent of patients, of whom 73.5 per cent had been unable to adhere to their dilating schedule.[48]

According to the files, inflammation, associated with pain and discharge, is a common complication of neo-vaginas in natal males, as well as the natural variety in natal females who were being “affirmed” by deprivation of oestrogen and administration of testosterone. Therapy for “atrophy with persistent yellow discharge we often see as a result” involved “experimental” combinations of locally applied hormones.

Pain during intercourse is a major challenge for both sexes. One WPATH member, a natal female trans activist lawyer, recounted a personal story of “splits in the skin which bled and were excruciating” after some years of “affirmation” with testosterone. Another reported “bleeding after penetrative sex” and painful orgasms. The Executive Summary reported “genital pain or discomfort in sexual activity” in over 60 per cent of natal females receiving testosterone[49].

Natal males receiving oestrogen also suffered coital pain. One said it was “like broken glass”. Another declared he tried to “avoid having them [erections] … they were physically uncomfortable and not pleasurable”. Another reported he solved his problem by penectomy.

Other problems included failure to obliterate natural tubing during the cross-sex constructions: one gynaecologist sought advice regarding continued leaking into the neo-vagina of fluid from seminal vesicles and prostate which had not been removed in reconstructive surgery on a natal male. As fluid from these organs contributes to ejaculate, a nursing lecturer opined that the sufferer should be encouraged to “enjoy the ride … it’s the ultimate physical sign of orgasm … what’s not to like”.

• WPATH’s recent “Standards of Care 8” proclaim that “regret” and “desisting” from “affirmation” are rare. In private, its members declare otherwise: in the transcript of WPATH’s Identity Evolution Workshop, held on May 6, 2022, endocrinologist Metzger referred to a recent presentation by Dutch researchers “who gave some data about … young adults who had transitioned and reproductive regret … it’s there”.

Having admitted, “I know I am talking to a blank wall”, when trying to explain the effect of “affirmation” on fertility, Metzger confirmed the reality of regret: “now that I follow a lot of kids into their mid-twenties, I’m always like, Oh the dog isn’t doing it for you anymore, right?”, explaining “Yeah, they’re like … I just found this, you know, wonderful partner …”[50]

According to Shellenberger, the presentation to which Metzger referred occurred in a WPATH symposium in Montreal and reported that of the 50.3 per cent who responded to a questionnaire, 27 per cent of young people who had received puberty blockers followed by cross-sex hormones and surgical removal of their testes or ovaries, at thirty-two years of age, “find their infertility troublesome”. Another 11 per cent are unsure, while 44 per cent of natal females and 35 per cent of males would attempt to “preserve fertility” if they could retrace their steps[51].

In the files, psychologist Ren Massey, co-author of the chapter on adolescence in the latest WPATH Standards of Care, admits “we don’t have data” on the phenomenon but “it looks like a lot of folks are looking for support and I would say we need to normalize their exploration just as we would normalize people considering transition to a gender different than what they were assigned at birth”.[52]

Members were instructed, more than once, that gender identity “is fluid”, can “change”, and “shift”, and were advised to be accepting of those who left the pathway of “affirmation” and sought reconciliation between mind and chromosomes as part of their journey to self-realisation. Thus, practitioners of “affirmation” were themselves affirmed: despite the side-effects of inflicted hormones and surgery, they had respected their clients’ autonomy and facilitated their self-discovery.

Considering the reasons for “regret” by a young person who had suffered prior sexual abuse, Metzger denied the case represented a “system problem”, explaining “to me, this is not an untypical story” in which a young person has “significant mental health stuff that they need to deal with. It sounds like they had an unfortunate sexual, traumatic event” which led to commencement of now regretted “affirmation”.[53]

Associated discussion concurred that the “kid was not fully supported”, confessing the need for “getting as much of the picture as you possibly can” by exploring “behavioural health, mental health”. It was lamented that “oftentimes mental health can get a really bad rap”.

Nevertheless, Metzger concluded, “I may obviously feel sorry for the kid, but to me, this is not de-transitioning. This is just a kid working through crap … and is not like something that should hit the news as, you know, a system problem.”[54] How much “affirmation” the “kid” had received was not declared but, in conclusion, Metzger repeated, “To me, this is like, not an untypical story. Um, and with a happy ending. So yay.”[55]

Psychologist Massey sympathised with the difficulty of helping young people “distinguish between the assault and their gender identity” when they “don’t disclose some type of sexually, coercive or unpleasant experience”. Given even adults may not disclose such things, Massey declared, “it’s a high bar … to try to catch everything that may be affecting somebody’s view of themselves”.[56]

Perhaps failures in exploratory psychotherapy can be attributed to perfunctoriness: despite WPATH’s public assurances, privately, one member declared that “even the good hormone docs in my area don’t always take the time”. Another worried about “twenty-minute medical appointments”, explaining “the way the medical system works is there is often very little time”. Yet another complained about the scarcity of trained people[57].

Ultimately, the WPATH discussion was, again, self-affirming. The “system problem” lay not in limited attempts for psychotherapeutic exploration but in the victims’ failure of disclosure: with the “kid” who “didn’t disclose some of the bullying and the traumatic sexual event until a year later”. Too bad about the hormones and the scalpel.

 

• Guilt by association.

Revelations in the files should discredit WPATH and severely embarrass all who have fallen under its thrall, especially those continuing to proclaim professional association, as does the Gender Clinic of the Royal Children’s Hospital (RCH) in Melbourne, whose leaders also proclaim that their “Australian Standards of Care and Treatment Guidelines” are based “primarily” on those of WPATH, while being self-acclaimed for abolition of age restrictions.

According to “A history of trans health care in Australia”, published in 2022 and available on the RCH website, the Melbourne clinic “has consistently worked with any children and young people under the age of seventeen” and had concluded, contrary to WPATH’s restriction of prescription of cross-sex hormones before the age of sixteen, that such “delays could cause unnecessary stress … particularly as peers went through puberty”.

Consequently, the “Australian Guidelines” abandoned age restrictions, and, soon after, WPATH Standards of Care followed. Now, puberty blockers may be given when the therapist observes “significant distress” in a child entering puberty, and subsequent administration of cross-sex hormones “depends on the individual seeking treatment and their unique circumstances”.

According to the Australian Guidelines, the best time for “chest reconstructive surgery” (mastectomy) is in “alignment” with WPATH guidelines, which report the procedure “is performed across the world in countries where the age of majority for medical procedures is sixteen years”. Declaring that genital surgery “performed before the age of eighteen years remains relatively uncommon internationally”, Melbourne advises delay until “adulthood”.

Reality behind this verbiage is revealed in the leaked files. One US surgeon declared she had performed “about 20 vaginoplasties in patients under 18 over the past 17 years” and lamenting that hospitals “are preventing it”, apparently in fear of litigation. As to whether a fourteen-year-old trans female should undergo such an operation, while “rejecting that consent is impossible”, the surgeon considered “dilation” of the neo-vagina more likely to be pursued when seventeen. Marci Bowers agreed: “tissues too immature … dilation routine too critical” but said she had performed that procedure on a sixteen-year-old. No one in the WPATH gatherings suggested that the brain of a fourteen-year-old was too immature for such a critical intervention. No one in Australian transgendering circles has sought dissociation from any of the revelations of the files.

In Australia, since the Family Court, in re Imogen, in 2020[58], finally abrogated its “gate keeping” role for “affirmation” of young people and since state health departments are franchising “affirmation” from major hospitals to unaccountable private practitioners, no one knows what is happening to whom in private hospitals.

Conclusion. While it is probably unrealistic to believe that the leaked WPATH files, by themselves, will curb enthusiasm for “affirmation” by gender clinics or reduce political opposition to “reconciliation” in Australia, they may have an effect through the courts. Indeed, one WPATH member worried that disillusioned graduates of “affirmation” might one day complain, “You never told us”. Given a significant number of Australian boys may have been chemically castrated and rendered “anorgasmic” under the reassurance that blockers are “safe and reversible”, there should be a time of legal accounting. Publication of the WPATH files should warn its affiliates, while encouraging lawyers, that the “truth is out”. 

[1] List of authors. Standards of care for the health of transgender and gender diverse people, Version 8.Int J Transgender Health. 2022.23. Supp1, S1-5259. DOI:10.1080/26895269.2022,2100644.

[2] Zucker KJ, Wood H, Singh MA, Bradley SJ. A Developmental, biopsychosocial model for the treatment of children with gender identity disorder. J Homosexual. 2012. 59 (3): 369-397.

[3] Rekers GA, Kilgus M, Rosen A. Long term effects of treatment for gender identity disorder of childhood. Human Sexuality. 1991;3(2):121-153.

[4] Zuger B. Effeminate behaviour present in boys from childhood: ten additional years of follow up. Comprehensive Psychiatry. 1978;19(4) (July-August): 363-369.

[5] DSM-5. 2013, Op. cit., pg. 452.

[6] Kosky RJ. Gender disordered children:does inpatient treatment help? MJA. 1987.146 (11):565-569.

[7] Singh D, Bradley S, Zucker K. Follow-up studies of Boys with Gender Identity Disorder. Front Psychiatry. 2021. Mar 29:12:632784. doi: 10.3389/fpsyt.2021.632784. eCollection 2021.

[8] Jennes L, Conn P. Gonadotropin releasing hormone and its receptors in the rat brain. Frontiers in neuroendocrinology. 1994. 15:51-77.

[9] Stopa EG,Koh ET,Svendsen CN, Rogers WT, SchwaberJS and King JC 1991 Computer-assisted mapping of immunoreactive mammalian gonadotropin-releasing hormone in adult human basal forebrain and amygdala. Endocrinology 128:3199–3207.

[10] Wickramasuriya N, Hawkins R, Atwood C, Butler T. The roles of GnRH in the Human Central Nervous System. Hormones and Behaviour. 2022.145,105230. https://www.sciencedirect.com/science/article/pii/S0018506X22001246.

[11] Moss R MCann S. Induction of mating behavior in rats by luteinizing hormone releasing factor Science. 1973. 181:177-179Riskind P, Moss R. Midbrain Central Gray:LHRH infusion enhances lordotic behavior in estrogen primed ovariectomised Rats. Brain Research Bulletin. 1979. 4:203-205.

[12] Pfaff D, Luteinising hormone releasing factor potentiates lordosis behavior in hypophysectomised ovariectomised female rats. Science. 1973. 182:1148-1149.

[13]Pfaff D, Lewis C, Diakow C et al. Neurophysiological analysis of mating behavior responses as hormone sensitive reflexes. Prog Physiol Psychol. 1973;5:253-297.

[14] Bentley G, Jensen J, Kaur G et al. Rapid inhibition of female sexual behavior by gonadotropin-releasing hormone (GnIH). Hormones and Behaviour. 2006.49:550-555.

[15] Hawken P, Martin G. Sociosexual stimuli and gonadotropin releasing hormone/luteinizing hormone secretion in sheep and goats. Domestic animal endocrinology. 2012.43:85-94.

[16] Nuruddin, S., Bruchhage, M., Ropstad, E., Krogenaes, A., Evans, N. P., Robinson, J. E., et al. (2013a). Effects of peripubertal gonadotropin-releasing hormone agonist on brain development in sheep-A magnetic resonance imaging study. Psychoneuroendocrinology 38, 1994–2002. doi: 10.1016/j.psyneuen.2013.03.009

[17] Nuruddin S, Krogenaes A, Brynildsrud et al. Peri-pubertal gonadotropin-releasing hormone agonist treatment affects hippocampus gene expression without changing spatial orientation in young sheep. Behav Brain Res. 2012; 242: 9-16.

[18] Robinson, J. E., Evans, N. P., Dumbell, R., Solbakk, A. K., Ropstad, E., and Haraldsen, I. R. (2014). Effects of inhibition of gonadotropin releasing hormone secretion on the response to novel objects in young male and female sheep. Psychoneuroendocrinology 40, 130–139. doi: 10.1016/j.psyneuen.2013. 11.005

[19] Anacker C, Sydnor E, Briana K et al. Behavioral and neurobiological effects of GnRH agonist treatment in mice—potential implications for puberty suppression in transgender individuals. Neuropsychopharmacology (2021) 46:882 – 890 

[20] Evans N, Robinson J, Erhard H et al. Development of psycophysiological motoric reactivity is influenced by peripubertal pharmacological inhibition of GnRH action-results of an ovine model. Psychoneuroendocrinology. 2012; 37:1876-1884.

[21] Craig MC et al. Gonadotropin hormone releasing hormone agonists alter prefrontal function during verbal encoding in young women. Psychoneuroendocrinology. 2007;32(8-10):116-1127. Doi 10.1016/j.psyneuen.2007.09.009

 [23] Grigorova M, Sherwin BB, Tulandi T. Effects of treatment with leuprolide acetate depot on working memory and executive functions in young premenopausal women. Psychoneuroendocrinology. 2006 Sept; 31 (8): 935-947.

[24] Nelson CJ, Lee JS, Gamboa MC, Roth AJ. Cognitive effects of hormone therapy in men with prostate cancer: a review. Cancer. 2008 Sep 1; 113 (5): 1097-106.

[25] Ohlsson B. Gonadotrophin_releasing hormone and its physiological and pathophysiological roles in relation to the structure and function of the gastro-intestinal tract. European Surgical Research. 2016;57:22-33

[26] Manfredi_Lozano M, Leysen V, Adamo M et al. GnRh rescues cognition in Down Syndrome. Science. 2022;377:eabq4515.

 [27] Marbouti L, Zahmatkesh M, Riahi E et al. GnRH protective effects against amyloid B-induced cognitive decline: a potential role of the 17 B oestradiol. Mollecular and Cellular Endocrinology. 2020. 518.110985.

[28] Leysen V. The role of GnRH in the age-related cognitive decline in some disorders including Down syndrome. Human health and pathology. Université de Lille, 2019.

[29] Quintanar JL, Calderón-Vallejo D, Hernández-Jasso I. Effects of GnRH on Neurite Outgrowth, Neurofilament and Spinophilin Proteins Expression in Cultured Spinal Cord Neurons of Rat Embryos.Neurochem Res. 2016 Oct;41(10):2693-2698.

[30] Schneider MA, Spritzer PM, Soll BM et al. Brain maturation, cognition and voice pattern in a gender dysphoria case under pubertal suppression. Front Hum Neurosci. 2017;11:528. Doi:10.3389/fnhum.2017.00528

[31] Holt V, Skagerberg E, Dunsford M. Young people with features of gender dyshoria: demographics and associated difficulties. Clin Child Psychol Psychiatry. 2016;164:108-118.

[32] Wallien MS ,Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adol Psych. 2007;46:1307-1314.

[33] Becerra-Culqui T, Liu Y, Nash R et al. Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers. Pediatrics 2018. 141(5). DOI:10.1542/peds.2017-3845.

[34] Kozlowska K, Chudleigh C, McClure G et al, Attachment patterns in children and adolescents with gender dysphoria. Front psych. 2021.11. https://doi.org/10.3389/fpsyg.2020.582688

 

[35] Pol H, Cohen-Kettenis PT, van Haren N et al. Changing your sex changes your brain: influences of testosterone on adult human brain structure. European J Endocrinol. 2006;155: S107-S114.

[36] Zubiaurre-Elorza L, Junque C, Gomez-Gil C et al. Effects of hormone treatment on cortical thickness in transsexual individuals. J Sex Med. 2014;11(5):1248-1261.

 

[37] Fuss J, Hellweg R, Caenegem E et al. Cross-sex hormone treatment in male to female transsexual persons reduces serum brain-derived neurotrophic factor (BNDF). European Neuropsychopharmacology. 2015;25(1):95-99.

[38] Dhejne C, Lichtenstein P, Boman M et al. Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLOS 1. 2011;6 (2): e16885.

[39] Files: 210.

[40] Files: 185.

[41] Files:186-187.

[42] Files: 181

[43] De Vries ALC, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: the Dutch approach. J Homosexual. 2012;59(3):301-320. DOI:10.1080/00918369.2012.653300

[44] Files: 192.

[45] Re Rogers v Whitaker (1992] 175 CLR 479

[46] Files: 213.

[47] Waal H et al. Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. Euro J Endocrin. 2006. https://doi.org/10.1097/prs.0000000000002549.

[48]Kozato M et al. Vaginal stenosis of the neo-vagina in Transfeminine patients after Gender-Affirming vaginoplasty surgery. Plastic and reconstructive surgery. Global open 9.108. 2021. https://journals.lww.com/prago/fulltext/2021/1001/vaginal_stenosis_of_the_neovagina_in_transfeminin.103.aspx.

[49] Tordoff D et al. Testosterone use and sexual function among transgender men and gender diverse people assigned female at birth. Am J Obstet Gynecol. (Sept 9 2023). https://doi.org/10.1016/j.ajog.2023.08.035.

[50] Files: 194.

[51] Files 13, from Steensma TD, de Rooy FB, van der Meulen et al. Transgender Care over the years. First long term follow up studies and sex ration in the Amsterdam Child and Adolescent Gender Clinic (Conference presentation. WPATH Symposium. Montreal. September 2022.

[52] Files: 215.

[53] Files 197-198

[54] Files: 197.

[55] Files: 197.

[56] Files: 198.

[57] Files:186-7.

[58] Re Imogen (No. 6) [2020] FamCA 761