In 2023, Tennessee passed a bipartisan law protecting children from being subjected to puberty blockers, cross-sex hormones, and surgeries. Since these drugs and surgeries can inflict harmful, lifelong, and often irreversible consequences, Tennessee has a vested interest in prohibiting their use on children and adolescents who are struggling with their sex.
But rather than allowing Tennessee to protect children, the ACLU filed a lawsuit, seeking to force the state to allow these harmful procedures.
Despite growing evidence that these drugs and surgeries do not improve the mental health of these distressed young people in the long term, the ACLU (and the Biden administration, which joined the lawsuit) have relied on deeply flawed guidelines from the World Professional Association for Transgender Health (WPATH) to support their tenuous position. In December, attorneys from the office of Tennessee Attorney General Skrmetti will defend Tennessee’s law before the U.S. Supreme Court.
‘A medical, legal, and political scandal’
Like Tennessee, Alabama passed a law protecting children experiencing discomfort with their sex from harmful drugs and surgeries. While defending its law against challenges from both the Biden administration and other private parties, Alabama uncovered what it calls “a medical, legal, and political scandal that will be studied for decades to come.”
WPATH claims that its Standards of Care 8 (SOC-8) represent evidence-based treatment guidelines for children experiencing discomfort with their gender. But in an amicus brief filed in support of Tennessee’s law in United States of America v. Skrmetti, Alabama explained that WPATH has prioritized politics over evidence and ethics.
It is now clear that, from the beginning, WPATH’s central goal was to justify prescribing dangerous drugs and surgeries to children. Dr. Marci Bowers, a surgeon and former WPATH president, helped oversee the development and publication of SOC-8.
Usually, authors of such guidelines would be asked to approach the project from a neutral perspective, allowing the evidence to dictate the recommendations. But in this case, Dr. Bowers said it was “important” for each author “to be an advocate for [transitioning] treatments before the guidelines were created.” All 119 authors of SOC-8 were already WPATH members.
When WPATH hired Johns Hopkins University to research life-altering drugs and surgeries for people experiencing discomfort with their gender, the researchers “found little to no evidence” about their effects on children. Rather than letting this conclusion guide its decision-making, WPATH buried most of the reviews. Some authors of SOC-8 did not even conduct any systematic evidence reviews for fear they would “reveal[] little or no evidence and put[] us in an untenable position in terms of affecting policy or winning lawsuits,” as one author put it.
If WPATH were truly seeking the best way to help children experiencing discomfort with their gender, it would want to gather all the evidence it could get. Instead, the organization was interested only in furthering these harmful drugs and surgeries—even if it came at the expense of medical norms.
SOC-8 was designed as a legal tool
Even though WPATH publicly describes SOC-8 as providing “clinical guidance for healthcare professionals,” one author privately described the need for SOC-8 to be “a tool for our attorneys to use” to defend the use of puberty blockers and cross-sex hormones.
Another author told his colleagues that “[m]edical necessity is at the center of dozens of lawsuits in the US right now.” He added that he “cannot overstate the importance of SOC 8 getting this right at this important time.”
So WPATH authors inserted the term “medically necessary” throughout SOC-8 even though they had no reliable evidence to support the claim. In some instances, the authors even seemed to contradict themselves.
The chapter about adolescents, for example, states that “[a] key challenge in adolescent transgender care is the quality of evidence evaluating the effectiveness of medically necessary gender-affirming medical and surgical treatments.” In the very same sentence, the authors question the evidence for these harmful drugs and surgeries while also calling them “medically necessary.”
The Biden administration participates in the scheme
While challenging laws like those of Tennessee and Alabama in court, the Biden administration has claimed that SOC-8 is “evidence-based.” But as Alabama detailed in its amicus brief, the Johns Hopkins evidence review team told the Biden administration well before these arguments that it “found little to no evidence about children and adolescents” and that WPATH was “trying to restrict [its] ability to publish” the findings of their independent evidence review.
An official from the Department of Health and Human Services (HHS) responded, saying that “[k]nowing that there is little/no evidence about children and adolescents is helpful.” But in court, the administration ignored this fact and falsely argued that giving puberty blockers and hormones to children who experience discomfort with their gender was supported by “overwhelming evidence.”
Perhaps even worse, Biden administration officials actively influenced the content of SOC-8. Rachel Levine, the Assistant Secretary for Health at HHS, reviewed SOC-8 in its entirety a few months before it was set to be published and demanded changes to serve political goals.
The most shocking change advocated by Levine—a man who identifies as a woman—was in the category of age recommendations for life-changing drugs and surgeries. Originally, SOC-8 contained minimum age recommendations—already shockingly as low as 14 for some surgeries. But Levine said that listing any minimum age recommendations would “result in devastating legislation” and asked WPATH to remove them.
Some authors raised concerns about allowing a government official to dictate what were supposed to be medical guidelines, and WPATH initially told Levine that it could not remove the age recommendations. But after the American Academy of Pediatricians also threatened to oppose SOC-8 if WPATH did not take out the age recommendations, WPATH chose to remove them.
Children experiencing discomfort with their gender deserve real, evidence-based care. Instead, WPATH is advocating for dangerous, life-altering drugs and surgeries—and allowing politics and pre-determined conclusions to drive its recommendations. WPATH’s advocacy isn’t helping young people; it’s harming them.
Tennessee has the right and responsibility to protect its children, and the Supreme Court should acknowledge this fact by upholding the state’s law.
