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WPATH Files (2024): lobbying and conflicts of interest

WPATH presents itself as a scientific professional association. In March 2024 the think tank Environmental Progress published the WPATH Files: leaked messages from an internal WPATH forum and a video of an internal panel discussion (source). According to Environmental Progress, WPATH does not meet the standards of evidence-based medicine; that is the reading of the think tank, which calls the care pseudoscientific in the title of the report.

What are the WPATH Files?

On 4 March 2024 Michael Shellenberger's Environmental Progress published the report The WPATH Files, with an analysis by journalist Mia Hughes. It contains screenshots of messages on WPATH's internal forum from 2021 to 2024 and a video of an internal panel discussion (source).

Main findings

According to Environmental Progress, the messages show that members know children and young people cannot oversee the lifelong consequences of treatment. Of the members contacted, one person confirmed their own statements and another disputed the interpretation (source).

Separately from the Files, The BMJ (31 October 2024) reported that Johns Hopkins University researchers carrying out systematic reviews for WPATH wrote that the client tried to restrict their ability to publish; WPATH denied having banned publication (source). See Cass Review.

Shortly after SOC8 was published (see WPATH SOC versions), a correction of 15 September 2022 removed the proposed minimum ages for hormone treatment and surgery in adolescents; the correction gives no reason. According to The New York Times, which later described court documents, the staff of Rachel Levine, then Assistant Secretary for Health, urged WPATH to remove age limits for surgery in minors. SOC8 also contains a chapter on eunuchs (source).

Cass on the quality of the WPATH guideline

The Cass Review had international guidelines assessed with the AGREE II instrument. On rigour of development WPATH 2022 scored 35%, against 71% for the Swedish and 51% for the Finnish guideline; only those two are judged recommendable for practice. Cass also writes that WPATH 8 overstates the strength of the evidence (source). SBU (2022), NICE (2020) and COHERE Finland likewise rated the evidence for hormonal treatment of young people as weak.

Interests and influence

Environmental Progress points out that influential organisations such as the American Academy of Pediatrics and the Endocrine Society base their policies on the WPATH Standards of Care (source). An analysis of conflicts of interest on the WPATH board looks in more detail at who holds which interests.

For the broader international context, see the Yogyakarta Principles, the DSM evolution and the ICD evolution.

What this means for the Netherlands

Dutch care providers work with international guidelines, including WPATH. The Dutch Health Council judged on 30 June 2026 that Dutch care for young people is carefully organised, and rated the strength of the evidence for the effects found as low to very low (source). See also the Dutch rollout and the criticism of the Dutch Protocol.