A few weeks ago Michael Shellenberger, writer and founder of the think tank Enviromental progress, published on his website a weighty investigation with murky contours regarding public health and societal development: gender transition pathways for the most fragile groups, minors and psychiatric patients.
The activist published leaks from chats inside an organization for the study and medical and psychological care of the trans world, WPATH (World Professional Association Of Transgender Health), considered the world's foremost authority on "gender" medicine.
The published material includes different types of information, a substantial body of screenshots of forum posts, videos, and excerpts of exchanges between professionals, spanning from 2021 to 2024. All the names of those involved have been blacked out except for Dr. Marci Bowers, American gynecologist and president of WPATH, and Canadian endocrinologist Dr. Daniel Metzger.
"Gender" medicine theorists claim that it is based on scientific qualitative and quantitative standards, just like other branches of medicine. This investigation shows that this is not exactly the case but that the professionals involved proceed with unstable protocols, modified on a case-by-case basis, orienting themselves by "trial and error."
In the files, members of the organization show little concern for the long-term consequences of hormone treatments for gender dysphoria, despite being aware of highly probable side effects such as infertility, sexual dysfunction and possible cancer.
A scandal that adds to the one that led to the shutdown of the infamous British clinic Tavistock.
Gender transition: a story from afar
The first scholar to address gender transition was German sexologist Magnus Hirschfeld, who in the early 1900s coined the term "transvestite" and oversaw the first sex "reassignment" surgery. Today, requests for gender change pathways have increased exponentially. In February 2019, the Italian Drug Agency (AIFA) had extended the prescription and reimbursability of tryptorelin as a pubertal blocker for the treatment of adolescents with gender dysphoria. Since the 1980s, sex hormone blockers have been routinely used, especially to treat certain cancers (e.g., prostate or breast) and other hormone-sensitive conditions (endometriosis or uterine fibroids); but also to treat girls and boys who have central precocious puberty (CPP).
The scientist myth in Medicine
One of the most frequently used arguments by liberals in recent years to substantiate their theses is that of the infallibility of Science (spelled not surprisingly capitalized to paint the sacred totem view that some have of it). Whether concerning policies in pandemic times or LGBT theories, those who do not support them are not (in whole or in part) ignorant and anti-scientific people who do not believe in positivism and the words of scientists, who have now risen to the role of "secular clergy" in the midst of a world of laymen.
Technicism then has obvious limitations, very few issues are sectorial and reserved for experts only, most of the issues of interest to the citizen have to do with political and value issues. Moreover, philosophers of science as early as the 1900s warned against judging the scientific method as aseptic; rather, they proposed seeing it as immersed in the society from which it draws context and legitimacy.
The philosopher Kuhn spoke of a "paradigm" which denotes "universally recognized scientific achievements which, over a period of time, provide a model of problems and solutions acceptable to those practicing a certain field of research." Even in the case of gender medicine, we are immersed in a paradigm that establishes the contours of what is legitimate or not to be defined as ethical, just and scientific.
A Pandora's box opened...
In the messaging exchanges published in full by the think tank, the participants wonder about various issues pertaining to their clinical practice, the most relevant being the long-term consequences of hormone therapies, surgery in under-18s, the issue of active and participatory consent to treatments in patients with gender dysphoria and psychiatric illnesses, and cases of "detransition," that is, people who after a course of "gender reaffirmation" want to stop with therapies.
What is also of concern is a question of age; the published report points out to us the absence of an age limit for the start of hormone treatments, a limit that existed in the association's guidelines until 2012 (SOC, Standard Of Care, progressively expanded and modified in an arbitrary perspective and aimed at protecting professionals from litigation).
This is in line with the idea that it is right for the protection of the subject to start as early as possible the gender transition pathway in children with dysphoric tendencies or with doubts about their "gender" belonging. A trend that is questionable not only ethically (in terms of manipulating subjects in whom identity and self-determination is undeveloped), but which is wrong scientifically, since the literature states that most adolescents with gender dysphoria "make peace" with their sex and only a portion are genuinely motivated to go ahead with surgical "reassignment."
The topics discussed in the chats are diverse, the first discussion reported refers to a doctor's question about whether it is right to operate on a 14-year-old who has already begun the transition process, the answers are varied, one professional shyly points out that tissues at that age are immature, but that in any case the choice is subjective and each case must be evaluated for itself, a colleague states that he has performed about 20 vaginoplasties in under-18 patients and adds that "we need to proceed compactly" as a scientific society since "attacks from the aggressive right wing" have somewhat put some surgeons off their medical work.
Another topic covered conspicuously in the various chats is the overlap between patients with psychiatric diagnoses who are simultaneously undergoing transition. One practitioner states that he has "an internal struggle within himself" because he does not know whether to proceed with hormone therapy on a patient with severe traits of psychopathology. To this question, Dr. H. Karasic replies that he does not fully understand the doubt since even in psychiatric patients it is possible to obtain frank consent as in all other patients and that the mere presence of pathology does not prevent hormone therapies if the benefits from them exceed the risks.
Correct. Just the cost-benefit calculation. Sounds familiar? An argument that rational people and organizations make when they have to make important and diriment decisions. In fact, one topic of the chats is precisely the presence of major side effects following progressive hormone replacement therapies (HRT). In the back-and-forth between speakers, there is a lack of follow-up over time to understand the sustainability and long-term consequences of using such drugs. In a forum posting dated December 2021, a doctor describes the case of a 16-year-old patient who developed hepatocarcinoma after taking a treatment to suppress her menstruation, a condition that she admits is most likely related to past therapies.
The most common risks of hormone therapies are infertility and cancers. Regarding the first point, in a discussion of informed consent, Dr. Dianne Berg admits that adolescents are told about the effects of the protocol, but that often neither they nor their parents have the personal maturity and biological knowledge to fully understand.
Brainwashing patients
Another discussion relates to cases of "detransition," i.e., patients who want to discontinue the "gender transition" path or even regret it altogether. This phenomenon has been relegated in the common vernacular to a marginal event, relegated to about 1-2% of total cases or even defined as the cause of the social stigma that transgender people experience. In reality, the issue is much more complex; some patients do not expressly show remorse as much as they do depressive episodes, difficulty maintaining long-term relationships, and shame about the appearance of sexual organs. This underestimation may stem from the understandable suffering a patient experiences and thus from the "cognitive dissonance" mechanism that leads him or her to fail to acknowledge error and repentance. In a discussion thread, a practitioner recounts the case of a patient who is "angry" because he perceives that he has been "brainwashed," to which someone responds to him that he also considers detransition as a stage in the "gender journey" that the person is going through.
The report described deserves the in-depth study and attention of those who believe that medicine should be at the head of technology and not its slave, of all those who believe that ideology and activism should not dominate science, since as in many events in History it is the weaker segments of the population who will pay the price.
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