WPATH: It’s Just Our Opinion, Judge

The World Professional Association for Transgender Health (WPATH) now claims that its “standards of care” are merely one opinion in a debate over youth gender medicine. This marks a dramatic change for WPATH, which spent years promoting its approach as the only ethical one to help youth and adults who experience distress associated with their sexual embodiment.

WPATH makes this claim in a legal filing submitted in a lawsuit brought against it by the Federal Trade Commission (FTC). The federal agency alleges that WPATH has engaged in consumer fraud, specifically listing ten “deceptive claims” made by the defendant about the benefits and safety of medical interventions. According to WPATH, however, the claims in question “are non-actionable opinions about subjects on which there is medical and scientific uncertainty,” and as such protected under the First Amendment and not subject to FTC jurisdiction.

Assuming the FTC overcomes WPATH’s First Amendment defense, it has ample evidence to support its fraud allegation, much of it drawn from internal WPATH emails subpoenaed by the state of Alabama and published in 2024.

When developing its eighth and latest “Standards of Care” (SOC-8), WPATH commissioned systematic evidence reviews but then prevented their publication after learning that the results were disappointing. The published SOC-8 guideline asserts, however, that a systematic review for adolescent outcomes is “not possible.” WPATH also eliminated age minimums for hormones and surgeries for political reasons, ignored conflicts of interest among guideline authors, and admitted that its recommendations were designed to secure insurance coverage for expensive procedures and win lawsuits. (See Chapter 10 of the U.S. Department of Health and Human Services report, of which I was a coauthor.)

The group’s decision to call its recommendations “Standards of Care” was likely no accident, either. In the American context, “standard of care” is a medical-legal concept defined in court, typically in the context of medical malpractice cases. In essence, the standard of care is how a reasonable clinician would act in similar circumstances. WPATH intended for its recommendations to be viewed as the ultimate authority to which judges, policymakers, insurers, and medical providers defer.

In April 2022, five months before WPATH published SOC-8, Admiral Rachel Levine, the Biden administration’s assistant secretary for health, told NPR that “there is no argument among medical professionals . . . about the value and the importance of gender-affirming care.” Noting that other groups also make recommendations on this front, Levine emphasized that the “evidence-based standard of care . . . is set by the World Professional Association for Transgender Health, or WPATH.”

Major medical and mental-health groups have deferred to WPATH as the authority in the field, and SOC-8 has shaped health care at nearly every level in the United States. Oregon adopted SOC-8 as the minimal basis of Medicaid coverage in the state, and major commercial insurers, including Kaiser, Aetna, Cigna, and UnitedHealthcare, rely on its recommendations for determining coverage benefits.

WPATH’s new framing, that SOC-8 is merely one perspective in a debate marked by “scientific and medical uncertainty,” implies that it has always seen debate over the medical pathway as legitimate and has been willing to engage with, or at least tolerate, critics. Nothing could be further from the truth. WPATH has long maintained that puberty blockers, cross-sex hormones, and surgeries constitute “medically necessary” and even “life-saving” care for some (and potentially “most”) kids with gender dysphoria. For years, WPATH and its allies went to great lengths to tarnish the reputation of critics—external and internal—while aggressively maintaining that the “science is settled” on the necessity of medical interventions.

WPATH has relied heavily on bona fide medical groups to launder its own credibility and enforce its dogmas. As recently reported in The Free Press, when Karla Solheim, a doctor who served as chair of the Iowa section of the American College of Obstetricians and Gynecologists, raised concerns about the trustworthiness of WPATH SOC-8 to ACOG’s leadership, the organization’s vice president called her in for a meeting and told her that she must either be silent on the matter or resign from her position. (She resigned.)

WPATH’s shifting attitude toward the U.K.’s Cass Review is especially revealing. In the new legal filing, WPATH frames its engagement with the Cass Review as one of good faith debate. “WPATH is on one side of that debate and provides guidelines on how to best provide transgender healthcare. Others, such as Dr. Hilary Cass . . . fall on the other side of the debate and disagree with how to, or if one should, provide transgender healthcare to adolescents.”

But when the Cass Review came out, WPATH issued a fiery denunciation, insisting that Cass and the NHS were bringing about “a devastating situation for transgender youth and their families, whose rights are breached as they are being denied medically necessary care.” WPATH’s peer-reviewed journal published an article titled “The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children,” which accused the Cass Review of harboring “anti-trans prejudice” (by “adopt[ing] a position where all views are welcomed and valued”), “cisnormative bias,” a “pathologizing” attitude toward trans identity, and a “double standard” in the assessment of evidence.

Interestingly, in acknowledging “medical and scientific uncertainty” in youth gender medicine, WPATH cites United States v. Skrmetti, a lawsuit filed by gender-medicine advocates that unsuccessfully challenged Tennessee’s age minimum law on constitutional grounds. The Biden administration, which intervened in that case on behalf of plaintiffs, explicitly cited WPATH SOC-8 when claiming that Tennessee was depriving youth of “medically necessary” care. The Biden DOJ did not frame SOC-8 as merely one opinion in a debate. Instead, it claimed, falsely, that “[t]he SOC 8 is based upon a rigorous and methodological evidence-based approach. Its recommendations are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options, as well as expert consensus.”

WPATH also cites Chiles v. Salazer (2026), in which the Supreme Court held in an 8–1 ruling (Justice Ketanji Jackson dissenting) that states could not ban talk therapy by classifying it as “conversion therapy.” As the Court reasoned, the fact that state authorities consider such talk therapy outside the “standard of care” (which WPATH has helped define) does not authorize them to violate a therapist’s First Amendment rights. Citing Chiles, WPATH now argues that the FTC’s “disagreement with WPATH’s speech does not make it ‘deceptive.’ The Supreme Court has recently rejected the proposition that state governments can prohibit professional medical speech they regard as ‘substandard care.’”

For years, skeptics of youth gender medicine within the medical and scientific community have had their viewpoints silenced when they challenged WPATH’s approach. In presenting itself now as the victim of speech suppression, WPATH is giving a masterclass in DARVO (Deny, Attack, and Reverse Victim and Offender).

For example, it asserts, “The government does not get to silence one half of a scientific debate,” adding, “If the government wishes to refute the science underlying WPATH’s Standards of Care, its remedy must be more speech, not censorship.” More speech! And where previously WPATH and its allies stood athwart state efforts to regulate medicine in the area, insisting that politicians should not practice medicine, WPATH now emphasizes “the need for [state] legislative flexibility,’ not FTC action that seeks to usurp states’ longstanding authority.” Federalism!

Doctors, of course, always bear individual responsibility for their patients and cannot claim to have been forced to treat patients according to some group’s recommendations. But WPATH now seems to want to shift responsibility even more to doctors, and away from itself. “The current version of those Standards of Care (‘SOC-8’) has a sixty-nine-page bibliography citing over 1,500 scientific studies to support its guidance,” WPATH writes in its filing. “The fundamental premise of Plaintiffs’ lawsuit is that doctors cannot review this evidence for themselves.”