We’ve been waiting for this shoe to drop since Michael Shellenberger released “the WPATH Files” in 2024, and we should be grateful to Florida for dropping it.
WPATH stands for the World Professional Association for Transgender Health, a new name adopted in 2007 by the Harry Benjamin International Gender Dysphoria Association, originally formed in 1979.
It was around 2010 that WPATH took the position that gender identity dysphoria should be depathologized — that is, no longer viewed as a mental illness requiring treatment designed to reconcile an individual to their biological sex. Instead, “gender identity” was to be validated and the appropriate treatment was to provide “gender-affirming” care to modify the physical body to lessen distress. This might include puberty blockers, cross-sex hormones, elective mastectomies, and phalloplasty/vaginoplasty, among other procedures.
But to get this approach actually adopted by the medical community, there would have to be a medical professional association that published “standards of care.” Such standards of care, or SOC, are the basis upon which clinical practice, medical education, insurance billability and avoidance of medical malpractice lawsuits rely. If a treatment was questioned, by a critic or an insurance company or in court, the magic words would be “it’s the standard of care” and the case would then be closed.
Enter WPATH. Claiming to be the world’s expert professional association on transgender health, the group got the ball rolling by lobbying the American Psychiatric Association to turn “gender identity disorder” into “gender dysphoria” in their diagnostic manual; they succeeded in 2013. No longer a pathology or a disorder, the diagnosis now was a diagnosis of distress.
WPATH standards of care would then be positioned to become the expert advice on how to treat the distress, and they were presumably established through rigorous empirical studies. The 7th and 8th standard of care guidelines (issued in 2011 and 2022) changed the clinical picture radically for individuals with gender dysphoria. “Gender-affirming care” was in, and psychotherapy to reconcile the individual with their physical body was out — even viewed as a form of noxious “conversion therapy,” which was outlawed in some states. SOC 8 even eliminated age-based restrictions on such care.
The final step needed was for other medical professional associations to legitimate WPATH SOCs by publishing similar guidelines for clinical practice by their members. In the United States, the Endocrine Society in 2017 and the American Academy of Pediatrics in 2018 did just that. The guidelines were produced by small groups from within the organizations, most with ties to WPATH. This was a more controversial step, as many members of both organizations dissented vehemently, and no member-wide votes on the issue were allowed in these associations. In response, some members felt they were forced to create new professional organizations to fight what they saw as the politicization of their professional associations: the Society for Evidence-Based Gender Medicine (SEGM) is but one example.
We can debate when this carefully laid foundation of justification was first shaken, but by 2023, the shaking had become obvious. The “rigorous empirical evidence” just was not there; in fact, studies began to show no benefit, or even harm to children undergoing such care. Countries such as Sweden, Finland, Denmark, Norway, France and Italy U-turned on this care in a pediatric setting. Even the Netherlands —home of the famous "Dutch Protocol“ that originally led to the use of puberty blockers and cross-sex hormones in children — greatly restricted the use of such care in children.
But it was in 2024 that the hammer fell, with the publication of the results of the UK’s "Cass Review." Appointed by the government to synthesize the existing knowledge on the evidence base for “gender-affirming” care, Dr. Hilary Cass discovered that the evidence base was seriously weak or even absent entirely. Furthermore, tropes that had been repeated for years, such as that such care lowered suicidality in gender dysphoric youth, turned out to be simply not true. As a result, the UK joined the list of countries that severely restricted this sort of care for children.
And then came the revelations of the “WPATH Files.” In early 2024, journalist Michael Shellenberger was contacted by members of WPATH with access to conversations on its internal online discussion forum. Shellenberger’s 241-page report makes for chilling reading, with gender health care experts admitting amongst themselves that they knew informed consent was not possible for children, that oftentimes the clinicians were just making up care as they went along, that the regret rates were much higher than reported, and the negative side effects much more dire. I urge you to read the report for yourself, for it is damning.
Even more troubling is that when WPATH hired researchers at Johns Hopkins University to conduct systematic reviews of the literature to provide a justification for SOC 8, it squashed the resulting reports that did not show any real positive benefit. The New York Times summarizes:
The foundation for “gender-affirming” care was, in essence, a house of cards. The SOCs were political, not empirical. For example, it was at the request of President Joe Biden’s deputy HHS secretary, Admiral Rachel Levine, that WPATH dropped age minimums from its SOC 8. In other words, if you actually “followed the science,” the science would not support WPATH’s position.
Now Florida has charged these three professional organizations with breaking two laws: the Florida Deceptive and Unfair Trades Practices Act (FDUTPA) and the Florida RICO Act (racketeering). Under the first, Florida claims that the three organizations — WPATH, the Endocrine Society and the American Academy of Pediatrics — knowingly deceived parents and clinicians about the evidence base for the treatments stipulated in the SOCs. The penalty is $10,000 per instance of transmission of the deceptive material.
Under the RICO Act, Florida claims that the knowingly deceptive SOCs in effect coerced others to undertake behaviors — in this instance, “gender-affirming care,” which led to the enrichment of members of the three organizations through payments for such care. The penalty is $1 million, plus a court plan to restrict, dissolve, and/or de-license the organizations.
This is the American way of justice: hit them where it hurts, in the wallet.
In this case, it’s not just the fines that will hit the wallets of the three organizations. If Florida wins, the current WPATH/ES/AAP standard of care falls. That means insurance companies can cite the ruling and refuse to pay for such care. In addition, clinicians who are sued by their patients for providing such care will find no cover from the SOC unless they in turn sue the three organizations for lying to them about the SOC.
WPATH, the Endocrine Society and the AAP deserve everything that’s coming to them from the state of Florida — and you can be sure other states will follow in Florida’s footsteps. Robert F. Kennedy Jr.’s announcement this week that the federal government is stepping in to ban hospitals performing gender-affirming care for minors from receiving any federal dollars at all is the next logical step. As he put it, “This is not medicine, it is malpractice,” adding: “We’re done with junk science driven by ideological pursuits, not the wellbeing of children.”
Sir Walter Scott was prescient when he wrote: Oh, what a tangled web we weave when first we practice to deceive.