38 - WPATH, Part III - Lack of Research

In this third part of our series on WPATH, we’re going to highlight a few more points brought up in “Suing Over Medical Transition: The Case Against Considering Wpath as a Competent, Reasonable Body of Expert Opinion” by Peter Jenkins, posted on Genspect Dec. 10, 2022. Here Jenkins continues to compare WPATH’s Standards of Care to those of the UK’s NICE:[1]

The UK National Institute for Clinical and Health Excellence (NICE) issues clinical practice guidelines on a wide range of specific topics, based on the best available evidence, usually randomised controlled trials. Randomised controlled trials are specifically designed to identify causal factors which produce change, such as the impact of therapy in reducing symptoms of clinical depression.

…In contrast, the Standards of Care rely crucially on patient self-diagnosis. This process derives from a pre-scientific paradigm, based on patient self-attribution of causal factors, which are not open to objective testing and verification. There are no agreed criteria for identifying a gender identity. The clinician is largely bound to accept (or, more rarely, reject) the patient’s perception of their lived experience, i.e. their personal sense of truth, as the key determinant for accessing treatment. The overall treatment goal is to “to better align their body with their gender identity” (Coleman et al, 2022: 31) via appropriate medication and surgery. In practice, this can mean facilitating the patient’s progression along a treatment pathway, which may lead to medication and surgery. Randomised controlled trials are rare, with a reliance on less authoritative observational cohort studies. Observational studies can identify changes over time, or between different groups, such as levels of satisfaction with interventions, but cannot isolate the causal mechanisms producing such changes. There may be also less emphasis on audit, evaluation and follow-up, so assessing rates of attrition or detransition may be correspondingly more difficult.

The NICE is significant because their independent study, which included a systemic review of the research, was key in closing the Gender Identity Development Service (GIDS) gender clinic at the National Health Service’s Tavistock and Portman NHS Trust in Great Britain.

Again we see parallels to sexual orientation ideology. In Creating Space for Professional Christian Counselors – Part 2 Difficulties with Psychological Research R4R Dec. 11, 2020, we read about the same reliance on self-report and the lack of an agreed-upon definition of sexual orientation:

The difficulties in measurement of sexual orientation are well-documented... They include the lack of a direct physical measurement tool, the reliance on self-report, and the inability of researchers to come to consensus about what elements of sexuality form the construct of sexual orientation. ...should sexual orientation be defined by attractions only; by behavior, fantasies, and identification; or by some combination of these factors?[2]

We cannot scientifically measure and study what is not defined. There is also a similar lack of randomized controlled trials comparing the results of different therapeutic approaches when it comes to experiencing attractions to the same sex:

“...whereas therapy models should ideally be based on empirical research showing the likely results of a therapeutic approach, none of the approaches for therapy in this realm – whether SOCE, GAT, or client-affirmative/sexual identity approaches like SIT – have been evaluated with extensive research on outcomes.”[3]

Jenkins continues to point out problems with a glaring lack of evidence-based research in WPATH’s recommendations in his article, noting their lack of carrying out randomized controlled trials, and negligence in conducting a systematic review of the research which has been done to date:

WPATH thus appears to be reluctant to carry out randomised controlled trials in the field of transgender healthcare, preferring the less authoritative research provided by observational cohort studies. It has also signally failed to carry out a systematic review of treatment and outcomes for adolescents, citing a lack of available research studies. However, two other professional bodies, NICE and SBU[4], have both carried out their own reviews within the recent period and have then acted on the findings to advise extreme caution with regard to medical interventions for young people with gender dysphoria. WPATH was aware of and had access to 21 out of the 38 studies cited in the SBU survey, and 14 out of the 19 studies cited in the two NICE surveys. WPATH clearly possessed the resources and capacity to carry out its own systematic review, but did not do so, at a time of intense international debate over best practice in transgender healthcare. It has also failed to cite the NICE and SBU surveys in its own SOC 8 references, suggesting a worrying tendency not to highlight unfavourable analyses. These failings would suggest that WPATH should not be considered to be a reasonable or competent body of expert professional opinion.

Again, all of this is stunning in light of the authority WPATH is claiming to recommend medical and surgical interventions on adults as well as children. We will look more closely at the bizarre recommendations in WPATH’s most recent Standards of Care 8, released in Sept. of 2022, in the next part of this series.

[1] Bonus points to those who, like me, are reminded of the N.I.C.E. (National Institute
of Co-ordinated Experiments) from C.S. Lewis’ That Hideous Strength whenever reading
this acronym.

[2] Sexual Identity and Faith, Dr. Mark Yarhouse, pg 189-190

[3] Sexual Identity and Faith, pg 53 (SOCE = Sexual Orientation Change E_orts, GAT =
Gay A`rmation Therapy, SIT = Sexual Identity Therapy.). See also pg 45 and 195.

[4] Swedish Agency for Health Technology Assessment and Assessment of Social Services