Shortly after releasing the updated version of its Standards of Care, the World Professional Association for Transgender Health issued a correction without any explanation. The updated Standards of Care were initially published on Sept. 6, and the correction was published roughly a week later. What’s going on?
Well, WPATH’s guidelines are considered the leading document in transgender healthcare. They inform practitioners working with gender dysphoric patients, including adults, adolescents, and children, in the United States and globally. For the first time, the latest edition includes a chapter dedicated to adolescents presenting with gender issues, separate from the chapter dedicated to children. This was due, in part, to the sharp increase in referrals of adolescents to gender clinics and the “unique developmental and gender-affirming care issues” of this population.
Puberty-blocking treatment is recommended at the beginning of puberty. Surgery, including breast augmentation, vaginoplasty (creation of a vagina), hysterectomy, and phalloplasty (creation of a penis), is recommended after a minimum of 12 months of hormonal therapy in adolescents. Another chapter, regarding “nonbinary” people, describes third-gender identities as legitimate entities, including bigender, agender, neutrois, polygender, demiboy, demigirl, and gender fluid.
As for the correction, it consisted of alterations to several sections of text, including the removal of minimum age guidelines for cross-sex hormones and surgeries. The recommended age for cross-sex hormones was 14, and mastectomy and breast augmentation were recommended at 15 and 16, respectively. Genital surgery, including vaginoplasty and removal of the testes, was recommended at 17 and phalloplasty at 18.
As it stands, treatment decisions will be left to the adolescent and presumably his or her care team. This will surely make any clear-thinking person’s head spin. As we saw with the desire for “sanctuary states” for minors seeking transition, the direction we are moving in prioritizes a child’s wishes over those of parents and guardians. The new guidelines mention that adolescents may need “the engagement of larger systems of advocacy and support to move forward with the necessary support and care.”
With the explosion of children identifying beneath the so-called trans umbrella, along with the acceptance of “gender-affirming care” as the professional norm and the removal of safeguarding barriers that previously stood in a minor’s way, once the final source of resistance, parents, is removed from the equation, who will prevent a child from potentially making a mistake?
Dr. Debra Soh is a sex neuroscientist, the host of The Dr. Debra Soh Podcast, and the author of The End of Gender: Debunking the Myths About Sex and Identity in Our Society.
