WPATH in the UK

Analysis

These organisations were writing about the World Professional Association of Transgender Health (WPATH) before the leak of WPATH files and include useful introductions to what WPATH is and what it does. See also our recent blog post about the leaked WPATH files and why they matter.

Reduxx

In May 2022, the independent feminist news outlet Reduxx published an exposé of the SOC8 chapter on “eunuch identified people”, showing how it drew extensively on research collected from the Eunuch Archives, a hardcore fetish site featuring child sexual exploitation fantasies centred around stopping little boys from going through puberty.

Critical Therapy Antidote

In November 2022 Peter Jenkins of Thoughtful Therapists wrote for Critical Therapy Antidote, a broad-based collective whose members are committed to maintaining the clinical therapeutic space as functionally apolitical, a fascinating article on the influence of WPATH on gender medicine in the UK, both in the NHS and in private clinics. Jenkins is a counsellor, trainer, researcher and author of Professional Practice in Counselling and Psychotherapy: Ethics and the Law (Sage, 2017).

CAN-SG

This collective of British clinicians campaigning for evidence-based approaches to gender distress describes WPATH’s influence in the UK as extensive in its FAQs: 

“In the UK, activism calling for widespread adoption of SOCv7 influenced the creation of NHS policies on transgender health (Gender Identity Research and Education Society, no date), such as guidance produced by the Royal College of Psychiatrists (Wylie et al., 2014).”

WPATH’s influence on the NHS

NHS training and guidance

In 2013, an NHS guide for GPs and other healthcare staff on gender-dysphoria services (archived version) was “informed by the seventh edition of the World Professional Association of Transgender Health (WPATH) Standards of Care”. This marked a clear shift towards WPATH’s “affirmative” model of care, which redefined the role of therapists and clinicians as facilitators of transition without question rather than providers of objective, neutral healthcare and support.

GIDs treatment protocols

The House of Commons Women and Equalities Committee’s discussion of transgender equality in 2015 reveals how influential WPATH was in shaping the treatment approach of the NHS’s Gender Identity Development Service at the Tavistock clinic in London. The shift away from defining gender dysphoria as a psychiatric condition in need of compassionate mental health support and towards defining it as a normal healthy variation of human existence in need of affirmation and medical intervention is in line with WPATH’s “depsychopathologization” campaign of the early 2010s.

Relevant extracts from the committee’s first report of its 2015–16 session:

191. GIRES explained to us that homosexuality was once classified as a disease, until its removal from the World Health Organization (WHO) International Classification of Diseases (ICD) in 1992. Attitudes in respect of gender identity are now likewise shifting. Under the ICD, “transsexualism” has been, and still is, classified under “Mental and Behavioural Disorders”. Consequently, “treatment in the UK has, typically, been led by psychiatry.” However, the WHO is expected to revise the ICD accordingly. The “psychopathological model” of trans identity will be “abandoned, in favour of a model that reflects current scientific evidence and best practice”. This will accord with the Standards of Care promulgated by the World Professional Association for Transgender Health (WPATH), which describe trans identity as “a common and culturally diverse human phenomenon that should not be judged as inherently pathological or negative”.

200. A number of witnesses argued for the “informed-consent model”, which is said to be used by some private providers of gender-reassignment / confirmation treatment in the USA. This entails imposing a minimum of clinical preconditions for treatment, on the basis that if the patient is able to give informed consent their wishes should be treated as Paramount.

201. Counter-arguments to this approach focus on: the requirement on clinicians to observe established clinical, professional and ethical standards (including those set by WPATH); and the need to ensure that finite NHS resources are spent appropriately and effectively. In addition, the informed-consent only model is not used in any other area of practice within the NHS.

203. We subsequently received a further written submission from NHS England explaining that the current clinical protocols are in accordance with UK Intercollegiate Good Practice Guidelines and WPATH clinical standards. 

244. Bernadette Wren, Head of Psychology and Associate Director at the Tavistock Clinic, told us that its treatment protocols are based on WPATH guidelines which are almost universally observed in Europe.

Read the full House of Commons report.

The NHS’s Standard Contract for Gender Identity Development Service for Children and Adolescents in 2017 (for the period 2016–2020) – its specification for what the service will deliver – repeatedly refers to the seventh version of WPATH’s Standards of care (SOC7).

NHS gender clinics referred to WPATH as recently as 2019.

A document from the Tavistock clinic which applies to the period between December 2022 and September 2024 says that clinical practice in the gender identity clinic (GIC) follows a “modified version of the WPATH Standards of Care v7”.

Two NHS Foundation Trusts – Nottinghamshire Healthcare and Cumbria, Northumberland, Tyne and Wear – currently link healthcare professionals, including GPs, to the current version of Standards of care.

The Scottish Government’s gender-medicine protocol

In 2012 the Scottish Government wrote a Chief Executive Letter (which had to be followed) to health boards with the Gender Reassignment Protocol for Scotland:

“The protocol incorporates recommendations from the 7th edition of The World Professional Association for Transgender Health (WPATH) Standards of Care, September 2011. The protocol sets out those procedures which may be provided on the NHS; procedures exclusive to gender reassignment should be accessed via this protocol.” 

In 2021, the update to the protocol advised the use of WPATH’s guidelines as a reference point.

“The updated GRP should also take into account relevant international guidance including the World Professional Association of Transgender Health (WPATH) Guidelines.

“The NGICNS may wish to consider the following when establishing a programme of work to undertake a review and complete an update of the GRP: Ensuring an updated GRP is consistent with relevant WPATH guidelines.”

In 2022, the Scottish government planned to update the protocol in line with the latest version of Standards of care (SOC8). 

“The review will be based on principles of human rights and person centred care.

It will take into account in relation to gender identity healthcare:

Advances in evidence including World Professional Association of Transgender Health (WPATH) Standards of Care.”

Campaign groups urged the Scottish Government to abandon SOC8, but their concerns were dismissed. Plans to implement SOC8 were dropped only after the media reported on SOC8 controversies.

Instead, the new government guidance on endocrine and fertility preservation – which refers to WPATH – was published later in 2022. This is the current guidance for Scotland.

“The recommendations below are therefore based largely on national and international guidelines (e.g. WPATH).”

NHS Scotland

According to current documents from the Sandyford NHS Gender Clinic, its practice is still based on WPATH SOC7.

Sandyford Gender Identity Services booklet (adult services):

“Your treatment will be monitored and run in accordance with the guidelines set out in the ‘Standards of Care’ as laid down by the World Professional Association for Transgender Health (WPATH) ( www.wpath.org ) – and in the Gender Protocol for Scotland.”

The Young People’s Gender Service booklet does not refer to WPATH but follows its SOC7. 

Wales

The LGBTQ+ Independent Expert Panel commissioned by the Welsh Government wrote recommendations in a March 2021 report in which WPATH is cited several times. In one of these, it is described as the source of “authoritative international clinical guidelines” that “support the use of puberty blockers for trans youth, as one component of a holistic model of care”. In another, its 2010 De-pathologization statement is cited as the authority for the panel’s claim that regarding gender distress as requiring specialist psychiatric diagnosis “is now recognised as an inaccurate, stigmatising, and outdated approach to trans identities, which are a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative.” Many of the panel’s recommendations were carried through to the Welsh Government’s 2023 LGBTQ+ action plan. 

Health Education and Improvement Wales provides continuing professional development modules for GPs working in Wales. These are open-access and available online. WPATH’s Standards of care version 7 is recommended in the “Resources” section of the module on Gender Diversity. 

The Welsh Health Specialised Services Committee is responsible for commissioning gender identity services in Wales. Its Specialised Services  Commissioning Policy: CP182a Policy Gender Identity Service for Adults (Non-Surgical) says the policy should be read “in conjunction with” WPATH SOC7 and cites WPATH as a source in its “evidence” section.

WPATH’s influence on UK medical organisations

British Medical Association 

The BMA guide Inclusive care of trans and non-binary patients recommends an affirming approach to patient care, as outlined by WPATH. The document links directly to WPATH’s SOC7. The document was last updated in March 2022.

General Medical Council

The GMC’s web page on professional standards for trans healthcare directs its members to WPATH’s Standards of care version 8 (SOC8).

The Royal College of Psychiatrists

In its 2013 Good practice guidelines for the assessment and treatment of adults with gender dysphoria, the Royal College of Psychiatrists referred to WPATH’s standards of care as an example of the sorts of “good clinical practice” that “have informed these UK standards of care”.

“The World Professional Association for Transgender Health’s (WPATH) standards of care for transsexual, transgender and gender non-conforming people have informed these UK standards of care (World Professional Association for Transgender Health, 2011). The endorsement by several medical Royal Colleges, allied medical professional societies and service user groups sends a strong signal for the adoption of these guidelines across the UK and beyond.”

(These guidelines were due to be reviewed in 2018, which does not appear to have happened. The document says that as of April 2023 a review is underway.) 

WPATH’s influence on private gender clinics

Gender Plus states that its practice is guided by WPATH (World Professional Association for Transgender Health) Standards of Care. Two team members, Drs Aidan Kelly and Lyndsey Moon, are WPATH members, and Sarah Favier has presented to WPATH members.

Gender GP states on its website that “its doctors follow the peer-reviewed, published International Guidance from the WPATH”. The private clinic follows WPATH’s criteria for assessing surgical readiness, and boasts that its “medications are prescribed in line with international standards of best practice, like the WPATH Standards of Care”.

Activist groups pushing WPATH’s approach to gender medicine

Gender Identity Research and Education Society (GIRES)

GIRES, a charity founded in 1997 by the parents of a trans-identified young person, sought the adoption of WPATH’s Standards of care in the UK by serving on the intercollegiate committee that published the Good Practice Guidelines and the two NHS England clinical reference groups that developed the specifications for gender identity services, respectively for adults and young people. 

GIRES also funded the translation of WPATH’s SOC7 (2012) into 17 foreign languages, thus spreading its influence beyond the Anglosphere.

“WPATH gratefully acknowledges the generous support of GIRES (Gender Identity Research and Education Society) of the UK, which has made our SOC translation efforts possible.”

Stonewall 

In July 2023 Stonewall released a statement on NHS England’s revised interim service specification produced after the interim report of the Cass Review of Gender Identity Services for Children and Young People, saying that it welcomed “the specification being more clearly aligned with relevant international clinical standards, in particular WPATH Standards of Care 8”.

Mermaids

Mermaids is probably the most influential of the various organisations pressing for gender services in the UK to align with WPATH. It repeatedly refers to WPATH as an authority when lobbying to lower the age at which children can be prescribed puberty blockers and hormones by NHS gender services. In its FAQs, it argues for early provision of puberty blockers, citing “the globally recognised Standards of Care V8 from WPATH”.

In a document that predates the publication of SOC8, Mermaids describes WPATH as “the leading authority” in gender medicine and says that the development of SOC8 is being carrying out by “world-leading experts in transgender care, including Mermaids CEO, Susie Green, who is a contributing member for the Children’s Chapter”.

In a public response to the NHS England consultation on changes to youth gender services, it says that a child’s gender “may be fluid and develop over time,” but that according to “international best practice”, this is “not sufficient justification to negate or deter social transition”. The authority it cites for these claims is SOC8. 

In the guidance it produced for the general public on how to respond to the consultation, it urged members of the public to mention WPATH in their responses, again describing its standards of care as “international best practice”.

Press For Change

This lobby group, one of the oldest in the UK (it was founded in 1992), describes itself as the leading expert in transgender law. It has been closely aligned with WPATH for decades. In 2007 one of its co-founders, Stephen Whittle, became the first non-medical professional and first trans-identifying person to serve as WPATH’s president. In the same year, Press For Change welcomed the change of name to WPATH (from the Harry Benjamin International Gender Dysphoria Association) as signalling a shift away from a “built-in pathology-based vision” of gender medicine towards a “more client-centred emphasis”. 

TransActual

This ‘by and for’ trans-identifying people lobby group welcomed the initial draft of SOC8 in the main, but was disappointed that the new guidance still retained any elements of caution. It complained about the chapter on adolescence, in particular, saying that it was:

“bizarre for the editors to have left any references to the widely debunked theories of ‘social contagion’ and ‘rapid onset gender dysphoria’ within the text, as the critique of them renders the references entirely irrelevant and unnecessary.”

(These theories have not in fact been debunked, and evidence supporting them continues to mount up.)

Scottish Trans

This lobby group has played a key role in encouraging the Scottish National Party and the devolved SNP government in Holyrood to introduce legal gender self-identification and to move from sex-based rules in areas such as prison allocation towards gender-based ones. Its vision is explicitly aligned with WPATH. In 2015, responding to a statement by WPATH in support of legal gender self-identification, it described WPATH as “long regarded as the world’s foremost authority on the medical treatment of transgender people”. 

LGBT Foundation

In this national charity’s response to the interim service specification, it urges NHS England to move away from “gender dysphoria” – a clinical term that conceptualises gender distress as a condition in need of treatment – to “gender incongruence”, which sees trans identification as a natural human variation, with medical treatment understood as being simply what the person wants. It describes the newer concept as “WPATH-approved”, as well as “more up-to-date and aligned with international clinical best practice”.

Gendered Intelligence

This charity, founded in 2008, lobbies for legal gender self-identification and the removal of gatekeeping in gender medicine. It offers a variety of training courses for individuals and organisations, in which it cites WPATH as an overarching authority on everything to do with trans people, from gender self-ID to medical approaches. For example, in a course on “Working Alongside Trans, Gender Diverse and Questioning People” aimed at therapists and counsellors, one of the topics covered is “The WPATH (The world Professional Association for Transgender Health) Standards of care for the Health of Transsexual, Transgender, and Gender Nonconforming People and how they inform good practice”.