The World Professional Association for Transgender Health (WPATH) recently released new guidelines for children in their new “Standards of Care.”
The Daily Wire previously reported on the WPATH’s decision to remove the minimum age recommendations for minors to receive medical interventions that permanently alter the body. A new live-streamed session from WPATH’s annual conference on Sunday reveals why they made this change from previous editions: so that doctors wouldn’t face malpractice lawsuits.
“We were thinking, and it was scary for me, about the potential uses of the chapter for legal and insurance contexts,” said Amy Tishelman, who introduced herself as the lead author of the Child chapter in WPATH’s new guidelines. “What we didn’t want to do was create a chapter that would make it more likely that practitioners would be sued because they weren’t following exactly what we said.”
Tishelman previously held the position of the Director of Clinical Research at the Gender Multispecialty Service (GeMS) program at Boston Children’s Hospital. The GeMs program welcomes “gender diverse” patients as young as 3 years old and offers a “full suite of surgical options for transgender teens,” according to their website.
“We wanted there to be some clinician judgment without being at risk for being held in court for not sticking completely to these standards,” continued Tishelman. “So we did write them in a way I think so that there is leeway, that we recommend things, but we suggest that clinicians use their judgment about what to do in therapy situations and assessment situations so that they can use individualized clinical judgment and not face malpractice suits.”
While WPATH previously used explicitly stated minimum age recommendations for minors to obtain puberty blockers, cross-sex hormones, and surgeries, the “leading” transgender health association made the decision to forgo age recommendations in the latest edition of their guidelines.
WPATH published its Standards of Care 8th Edition in International Journal of Transgender Health on September 6, 2022. A correction was published in the same journal on September 15, which removed sections pertaining to “minimal ages for gender-affirming medical and surgical treatment for adolescents.”
“On the other hand we didn’t want it to be so loose that insurance wouldn’t cover things because they’ll say they’re not necessary,” Tishelman explains. “We tried to bridge those considerations. We didn’t want overly general standards that would dilute their meaning and importance.”
“There can be some confusion,” Tishelman said of determining whether a child is “gender diverse” or “cisgender.” “Gender diverse,” as Tishelman repeatedly alludes to, refers to simple gender noncomformity, or a rejection of sex-based stereotypes. Based on the WPATH guidelines, a tomboy — a girl who rejects feminine stereotypes through her preferences and behaviors — would be considered “gender diverse” and may warrant a visit to a pediatric gender clinic.
“One of the challenges for us in our chapter is that there is limited research,” Tishelman admitted. “So we drew on our strengths as clinicians as well as our knowledge of research in the area of gender development for gender diverse kids, as well as our knowledge of what all kids need as they develop.” Tishelman described the collaboration process between herself and the eight other authors as “unanimous.”
In lieu of age recommendations, WPATH now suggests that both puberty blockers and cross-sex hormones may be administered when a child reaches Tanner Stage 2, meaning at the first signs of puberty. For girls, puberty begins between ages 9-11, and for boys around age 11.
For surgeries, no indication of a minimal age is given in the guidelines, and instead it recommends: “At least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated.”