Are Democrats Dropping WPATH?

Last week, the Senate Committee on Health, Education, Labor, and Pensions (HELP) held a hearing titled “Protecting Our Children: Exposing the Dangers of Irreversible Gender Transition Procedures on Minors.”

The hearing proceeded in predictable ways. Republicans and their invited expert witnesses—Kurt Miceli, a psychiatrist and medical director of Do No Harm, and Chloe Cole, a detransitioner—spoke about the harms of puberty blockers, cross-sex hormones, and surgeries; the lack of evidence for benefits; and how the international consensus has changed to a more cautious stance on “gender transition” procedures. Democrats and their witness—Shannon Minter, a lawyer at the National Center for LGBTQ Rights—stressed the benefits of “gender-affirming care,” insisted that it rested on a solid evidence base, and accused Republicans of launching politically motivated attacks on marginalized people.

Perhaps the most remarkable thing about the hearing, however, was what was absent. Not once did Minter (in oral or written testimony), Ranking Member Bernie Sanders, or Senator Ed Markey mention the group reputed to be the leading U.S. authority in transgender medicine: the World Professional Association for Transgender Health, or WPATH.

Minter and the Democratic senators have cited WPATH as an authority in the past, so we can reasonably assume that they or their staffers are familiar with the organization. Minter cited WPATH’s Standards of Care, v. 8 (SOC-8) in written testimony in 2023, at a hearing before the House Judiciary Committee on the same topic. Markey cited WPATH in his Transgender Bill of Rights, which Senator Sanders co-sponsored, in 2023 and again in 2026. Markey also appealed to the authority of WPATH in his 2025 Transgender Health Care Access Act.

The likely reason for the omission of WPATH from last week’s hearing was provided by Miceli, the Republicans’ expert witness. After describing WPATH’s centrality to the field of gender medicine, Miceli reminded the committee of the scandals that have embroiled WPATH, and which have laid bare its nature as an activist group with a medical guise. The evidence for scandal comes primarily from internal WPATH communications successfully subpoenaed by the state of Alabama in Boe v. Marshall, a lawsuit challenging the state’s ban on hormonal and surgical transgender procedures for minors, and made public in 2024.

The most disturbing revelation: WPATH had commissioned and then suppressed evidence reviews after learning that they would not support its preferred medical approach to treatment of adolescents. WPATH leaders said in a private email that they “were caught on the wrong foot” by the findings of the reviews, conducted by experts in evidence evaluation at Johns Hopkins University. WPATH went on to claim in the published version of SOC-8 (2022) that a systematic review of evidence for adolescent outcomes is “not possible”—a claim its leaders knew was false.

Court documents from Boe also revealed that, under pressure from Biden administration Assistant Secretary for Health Rachel Levine and the American Academy of Pediatrics, WPATH had, within hours of SOC-8’s publication, eliminated age minimums for nearly all hormonal and surgical procedures. WPATH wrote in SOC-8 that its no-age-minimum recommendations achieved consensus among guideline authors, but SOC-8’s lead author, Eli Coleman, admitted in a deposition that this was not true.

Scott Leibowitz, a psychiatrist who co-led the adolescent section of SOC-8, later told fellow WPATH members that the decision to exclude age minimums did go through the consensus process, and that the issue “was thought through a lot, and there was a lot of discussion about it.” But email exchanges between Leibowitz and WPATH colleagues show that he was in fact aware that WPATH took out age minimums due to pressure from outside entities and helped the group’s leaders with talking points about how to present the matter to the public.

WPATH also failed to manage conflicts of interest (some authors stood to gain financially from their own recommendations), implemented ideological litmus tests for participation in the guideline process, and admitted privately to including “medical necessity” statements for purposes of insurance coverage and legal defense. (For a useful guide to the legal documents from Boe, see Alabama’s motion for summary judgment in that case.)

News of WPATH’s misconduct appeared in prominent liberal outlets as well as conservative media. The New York Times reported on Levine’s pressure campaign for age minimum removal. The Economist reported on the suppression of evidence reviews under the headline, “Research into trans medicine has been manipulated.” The Washington Post editorial board noted WPATH’s misconduct, as did The Atlantic, in an aptly titled article, “The Liberal Misinformation Bubble About Youth Gender Medicine.”

Earlier that year, Environmental Progress published “The WPATH Files,” a report authored by Mia Hughes based on leaked communications from an internal WPATH listserv. Among other troubling revelations, a WPATH doctor admitted that talking to a 14-year-old about the fertility effects of hormonal interventions is like “talking to a blank wall.” Yet this posed no barrier to offering fertility-compromising medications.

It’s possible that the failure to mention WPATH at last week’s hearing was just an oversight, but it’s more likely that the organization has become a liability for transgender advocacy groups (like Minter’s National Center for LGBTQ Rights) and their allies in the Democratic Party.

This is not, as some might think, merely fixing a citation error. In the U.S., WPATH’s authority over the field of gender medicine is all but undisputed. (For a summary, see Chapter 10 of the U.S. Department of Health and Human Services’ report on pediatric gender medicine, of which I was a coauthor.) WPATH’s guidelines and trainings define the field and are incorporated into hospital practice, insurance schemes, medical education, and malpractice litigation. It’s recommendations, as the Cass Review, the landmark British review of pediatric gender medicine, noted, are laundered through endorsement by other, more eminent and well-known medical groups, especially the Endocrine Society. The American Academy of Pediatrics’ policy statement of 2018 defers to WPATH and the Endocrine Society for medical recommendations.

In short, when advocates of gender medicine mention a consensus of medical groups, they are really reciting WPATH’s extensive influence network. As Do No Harm’s Miceli put it in the Senate hearing, “in the United States pediatric gender medicine is WPATH, and WPATH is pediatric gender medicine.”

That’s why it was stunning to watch Shannon Minter say, with a straight face, that surgeries are not the standard of care for minors. Minter was sitting next to Chloe Cole, who had her breasts removed at age 15. There is documented evidence that thousands of American teen girls had their breasts removed as young as 12 or 13 and dozens of teen boys had genital surgery at age 17. Some detransitioners are now suing their doctors and hospitals for malpractice, and the defendants in these cases are arguing that they were operating within the standard of care. It is pure gaslighting to assert, as Minter does, that surgeries are not part of the standard of care when WPATH’s SOC-8 contains no age minimums for any surgery except for phalloplasty.

Minter, who played a key role on behalf of plaintiffs in Boe v. Marshall (and who was later sanctioned by the court for “judge-shopping”), surely knows all this. Minter’s statement was thus either a thinly veiled legalistic evasion or a deliberate misstatement.

WPATH’s name was not the only notable omission on the Democratic side of last week’s hearing. Another was the American Society of Plastic Surgeons—albeit for different reasons. Senator Markey’s 2023 Transgender Bill of Rights, which sought to enshrine access to medical interventions for adults and minors, cited the ASPS in its list of medical authorities recommending these procedures. But the 2026 version of the same bill contains no mention of the ASPS. The most likely reason: in February, the ASPS changed course, publishing a position statement (covered by the New York Times) recommending against surgeries in adolescents and warning that the evidence base for the safety and efficacy of puberty blockers and cross-sex hormones is worryingly weak. The ASPS cited the existing systematic reviews of evidence in the field, practice reversals in Europe, and foundational principles of medical ethics.

Lawmakers with sincere concern for children’s health would not refurbish their citation list in this way. They would express genuine interest in why names at the top of that list have suddenly disappeared, and they would, inevitably, acknowledge the broken chain of trust in medicine. That, however, is very unlikely to happen, as the sides in this debate are dug in, and any admission of error is likely to have calamitous political consequences.