WPATH Proposed Standards of Care Ignores Non Transitioners

Comments on the Draft WPATH SOC8

The proposed WPATH Standards of Care (SOC8) is out. It was released early this month but it ignores the needs for care of the vast majority of transgender people, in particular, those who do not want to transition. WPATH is the World Professional Association for Transgender Health and the SOC8 is intended to provide guidelines for providers to treat all transgender people but it generally ignores non-transitioners. It also disproportionately pathologizes non-transitioners by concluding that 19% of transgender women have contracted HIV. (The CDC estimates that .4% of the US population has HIV). Non-transitioners make up the majority (approximately 2/3) of transgender people. The proposed SOC is out for comment but it seems that WPATH does not really want comments so non-transitioners will probably not be adequately represented.

There are, of course, many non-transitioners who term themselves as “crossdressers” who do not want to transition and may only crossdress intermittently. WPATH seems to want to count non-transitioners as transgender in order to enhance its cultural reputation but does not seem to want to provide a Standard of Care that really applies to them. Many of these folks complain that providers assume that they want to transition and this has caused ill feelings, as well as breakups of marriages and families. Many of you know that I have been trying to get WPATH to pay more attention to this majority transgender group but WPATH leaders are focused on the transitioners.

Pointing these issues out to WPATH SOC8 committee would seem to be in order but it seems that WPATH does not actually want comments. The draft SOC8 was released for comment without warning on December 2, 2021 with an initial deadline for comments of December 16, 2021. Two weeks is clearly not enough time to review a long document of this importance. The SOC8 consists of 19 Chapters (for example Hormone Therapy, Surgery), each of which includes several overarching “statements”. For each of the statements the SOC8 committee provides explanatory material which the committee has approved. At the outset, the committee stated that they would not allow proposed changes to the “statements” by reviewers. There were many of us that burned the midnight oil to review the document and I was just returning from vacation so I only had 10 days. I tried to concentrate on the explanatory material underlying the most egregious issues, two of which concern non-transitioning transgender people.

After a hue and cry about the short comment period, the period has now been extended to January 16, 2021. Sure, interfere with holiday celebration! Again, they said that they would only accept comments about the explanatory material, and not the “statements” themselves.

Deletion of Lynn Conway Transgender Population Survey Studies

Lynne Conway

An important sign of WPATH ignoring the non-transitioning group, was the deletion of references to Lynn Conway’s excellent work (2000-2003) which estimated the number of transgender people. It also broke down the composition of transgender people into non-transitioners, transitioners (transsexuals) , and transitioners who had received transgender genital plastic surgery. Conway actually went out into the population and counted noses in support groups (including crossdressers) and used these to project the population. She made estimates of the frequency of transitioning and the “throughput capacity” of surgeons that offered transgender genital plastic surgery. She estimated the lower bound for trans women of 1% of the population, with the likelihood being 2%. At the time, there were not enough transgender men available to make population estimates.

Conway’s work has been ignored for years by WPATH but I thought the reason was that she was transgender, or not a professional provider, or because they did not understand the mathematical estimation models that she built. The most often cited current studies rely on CDC Risk Assessments but these assessments have flawed methodologies. They were made by calling random landlines (only 40% of households have landlines). These assessments are further flawed because not all states are polled and the transgender questions came at the end of a long survey interview. Because there were so many holes in the data, the surveyors projected transgender populations in drop out states according to demographics from the polled states.

But it now occurs to me that downplaying Conway’s studies may have been due to the inconvenient truth that non-transitioners make up most of the transgender population. This would require them to perform science or improve treatment of non-transitioners, preferring to deliver services to transitioners who professed transgender “gender identities” according to wokie RAPOMO philosophy (not the Star Wars Wookies). Many non-transitioning transgender people do not assert that they have a “transgender identity” but only that they feel the need to express their masculinity or femininity intermittently or full time. The obvious fix is to change the title of WPATH to the World Professional Association for Transsexual Health. WPATH evidently does not want to do this because only a small minority of the transgender population are transsexuals and perhaps, because the word transsexual is not politically correct.

Harry Benjamin

Going back into history, WPATH was formed by those who were concerned with transsexualism as the “Harry Benjamin International Gender Dysphoria Association” in honor of Harry Benjamin who was a champion of transsexual treatment. So, non-transitioners were never a concern of WPATH historically and it seems this continues today.

Misinterpretation of Transgender HIV Prevalence Study Results

The draft SOC8 continues the misinterpretation of transgender HIV prevalence studies that I discussed in a previous post. The basic misinterpretation is the projection of studies designed to assess prevalence in likely high prevalence geographical areas and clinical venues to project to the entire transgender population. From the studies, they selected an infection prevalence of 19% of all transgender women which is absurdly high. The geographical areas polled featured inner cities and the clinical venues featured free clinics and other facilities where one would expect higher prevalences (the word prevalence is appropriate here because it refers to a disease.) CDC studies were included which were conducted in major U.S. cities, including Atlanta. The purpose of such CDC studies was to identify localities which could use grant money for HIV treatment and housing, not to obtain an overall prevalence rate. I am familiar with these grant programs because I volunteer for the Ryan White HIV treatment task force and the HOPWA housing task force for the Atlanta area.

I believe it is a misinterpretation of the study results to conclude that 19% of all transgender women in the world have HIV, although I do not deny that HIV is a pernicious problem among transgender people that deserves attention. The clinicians performing these studies are myopic and can only see the patients that come into their clinics as being the only ones who are transgender. They don’t stop to consider the roughly 2/3 of transgender people that never grace their doorsteps. But I can see anti-transgender people reading the SOC8 and concluding that transgender people are morally corrupt or mentally deranged. They will use this faulty conclusion as a weapon against us. Since non-transitioners are the largest proportion of transgender people, they will accordingly be disproportionately pathologized.

So, I could pursue issues pertaining to non-transitioners with the American Psychological Association, of which I am also a member, but they have gone woke too. I conclude that non-transitioners must get their support and information from peer support groups because WPATH providers are not currently interested in them. They have been providing support since the 1970s and now is not the time to stop.

As I pointed out in my last blog post on cashing in by requiring extended counseling for trans kids, treating transgender people has become big business. But if a professional organization says they are providing mental health and medical guidelines to treat all transgender people, they need to live up to that commitment. If not, then non-transitioning transgender people must find another way, as they always have.

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Tags: featured, Standards of Care, Transgender

Category: Transgender Opinion, Transgender Science