39 - WPATH, Part IV - Bizarre Recommendations

In this edition of our series on WPATH, we take a closer look at the bizarre recommendations being made by this organization, impacting clinicians, social workers, prisoners, athletes, crisis shelters[1], lawmakers, parents, etc. along with adults and children experiencing gender dysphoria.

Removal of Ethics Chapter

Stella O’Malley in her interview with Benjamin Boyce[2] sheds more light on the background of WPATH’s most recently released Standards of Care 8 (SOC8):

…they let out a draft last Christmas last December January of SOC8. It was kind of a draft tester…kind of waving the kite to the public saying, “What do you think of this?” …and we were all invited to comment. …And in that draft they had an Ethics chapter. OK - well done. The clinicians were making their voice [heard]. We should we should consider ethics. And in the SOC8 that they released last week they took out the chapter in ethics, which says it all. It's like, “Oh, yeah, we were thinking about ethics - but nah, not so important.”

You put in something that obviously when you're talking about transgender health, where there's so much money to be made. Where there's so much destruction if you got it wrong - there needs a very robust ethics chapter. Because some people will just want to make money and they will do whatever somebody else wants so that they can make money. That's their prerogative. And the prerogative of clinicians and doctors is to remember you're in a position of responsibility. You did get trained, you are very well paid, and your job is to make sure you do no harm. And so you abide by ethics. That's what we are meant to be doing and the removal of the ethics chapter kind of blew my head off as a representation of activists have taken over this entire organization and this entire document is ran by activists.

It's so it's such an important part of transgender health, ethics is. And…there's no mention of safeguarding in that document. There's no mention of child protection in that document now.

So the SOC8 – the self-proclaimed “standard of care for the health of transgender and gender diverse people,” has chosen to remove their chapter on ethics. Astounding.

Addition of Eunuchs as a Gender Identity Classiffication

Stella continues in the interview:

Stella O’Malley: And then the kind of infamous addition of the chapter on eunuchs.

Benjamin Boyce: Was the eunuch chapter in the draft?

Stella O’Malley: It was! I didn't think it would make… …The draft came out…10 months ago and we all read it. I know everybody went, “Look, sorry, eunuchs? Eunuchs? And I honestly thought there is no way WPATH are seriously going to release a chapter on eunuchs. They're not going to do it. It's a bridge too [far]. I know that they're very arrogant, I know that they own the whole field, but they're not going to do this.

And they did. Which is I think a demonstration of their utter arrogance and disconnection with the with the world that they have created an identity: “the gender dysphoric eunuch.” And they think it's appropriate to suggest that this is something that the world needs to get their head around.

And in their SOC8 - so there's an awful lot of references so it looks at first glance…. It's clearly an awful lot of money went into this and in SOC8 they have obviously, they've got loads of references. And the references to the eunuch linked to websites with pornography on child eunuchs. It's like, okay, you've completely and utterly
discredited yourself.

…And what we need to do as clinicians is speak the truth to that and say this document is not an appropriate document for doctors, governments, schools, gender clinics to use as a serious document.

I wish Stella was exaggerating here, but she isn’t. On Sept. 23rd of 2022, the transcript and audio of the WPATH symposium on eunuch identity was posted online.[3] Here we find the following slide from the presentation of Chapter 9. Eunuchs (Page No. 888), of the WPATH 27th Scientific Symposium, Sept.20, 2022, with Thomas W. Johnson, PhD; Michael S. Irwig, MD:

Who Seeks Voluntary Castration?

1. Biological men with extreme gender dysphoria. They desire to be not male, but do not wish to be female either. They have a Male-to-Eunuch Gender Dysphoria that is now in the SoC, v8.

2. Others have an oppressive feeling that their genitals are not a proper part of their body. They fit a Body Integrity Dysphoria (BID) diagnosis. (Also now in the SoC, v.8.)

3. An extreme fetish or paraphilic disorder. There are a wide variety, but most common is religion-based. (NOT in the SoC, v.8). [Emphasis theirs.]

So, not only have they created a new category of gender identity with these three subtypes, they’ve tossed off those with “extreme fetish or paraphilias” into a “most commonly religion-based” bin. Thanks.

To clarify, Dr. Johnson refers to eunuchs as a type of gender (on par with transgender, or nonbinary, which also has a chapter) in his talk[4], and this is an excerpt from the Eunuch chapter in the SOC8:

Eunuch individuals will present themselves clinically in various ways. They wish for a body that is compatible with their eunuch identity—a body that does not have fully functional male genitalia. Some other eunuch individuals feel acute discomfort with their male genitals and need to have them removed to feel comfortable in their bodies…

Like other gender diverse individuals, eunuch individuals may be aware of their identity in childhood or adolescence. Due to the lack of research into the treatment of children who may identify as eunuchs, we refrain from making specific suggestions.[5]

Elaborating on this third subgroup in his lecture, Dr. Johnson stated:

“Or they have an extreme fetish or paraphilic disorder, of which there's a wide variety, and they're not in the SOC8. That's something separate, most of that is religious based. In the Western world, it tends to be based onMatthew 19:12, where Jesus talks about the three types of eunuchs: those who “made themselves eunuchs for heaven's sake.” There are quite a number of those as well, but they don't fall under our purview here.”

In an article responding to this chapter of SOC8 by World Magazine, we read Alasdair Groves comment on Matthew 19:12:

But Alasdair Groves, executive director of the Christian Counseling and Education Foundation, argues that Jesus is speaking figuratively here to legitimize celibacy. An individual’s identity should not be shaped by “the absence of body parts,” he said in an email.

As a counselor, Groves said he would “universally and always discourage anyone from pursuing castration.” But he’s sympathetic to those who feel uncomfortable in their bodies. “Any time you feel like your body is awkward and fighting you, much less at odds with who you think of yourself to be, there is a pain in that,” he said.

This contrasts with the WPATH guidelines, which say “chemical or surgical castration may be experienced as a source of distress to cis men with prostate cancer,” but add that “the same treatment may be affirming and a source of comfort for eunuch individuals.”[6]

During the Q&A segment of the WPATH symposium, co-presenter Dr. Michael Irwig shared the aspirations of including this chapter:

Michael Irwig: So I think having this in the SOC is so huge, because it's now in the official guidelines. And a lot of doctors and surgeons, you know, they don't want to be seen as, you know, being rogue, and doing things that are—may get them into trouble, or that they may get their licenses pulled on. So now that there's a chapter in the SOC8 saying, here's this population, here are the services that they're looking for, this is an appropriate, you know, management— it helps alleviate some of their concerns, I think. And it also will lead to, I think, more education. You know, now, I think maybe at the urology meetings across the country, and surgery meetings, you know, there can be sessions on this, and more symposiums. The more sessions like this we have, the more educated people will get, and then we'll get more people like you to be able to do this.

While this edition of R4R is rather long and contains disturbing information, it is crucial for us to understand what is being passed along as expertise. Sasha Ayad, M.Ed., LPC, wrote the following on Twitter after this WPATH presentation:

If you hope that Johnson explained what depths of pain or psychopathology might induce someone to voluntarily remove sex organs, you’ll be disappointed. Instead, the presentation proceeded to destigmatize and validate the experience of males who want these surgical interventions, and to provide guidance for clinicians & surgeons for remaining “open minded” about such cases. 9:38 AM · Sep 23, 2022

And Peter Jenkins of Genspect offers further clarity on what is at stake[7]:

It is well known that the SOC 8 chapter on ethics was removed from the draft version. It is not clear how far its inclusion would have resolved concerns about WPATH’s ethical stance. What was notable was the inclusion of chapter on eunuchs as a gender identity. This follows on from the declassiccation of skoptic syndrome as a paraphilia in the DSM5. Hence in SOC 8, “eunuchs may also seek castration to better align their bodies with their gender identity” (Coleman et al, 2022: 88). As discussed above, WPATH medical practice is governed by the goal of bodily alignment, given “a high risk that withholding treatment will cause individuals harm through self-surgery, surgery by unqualiced practitioners, or unsupervised use of medications that affect hormones.” (Coleman et al, 2022: 90: PJ: emphasis added).

In terms of medical practice, the inclusion of eunuch raises a number of concerns. It is clear from its inclusion that there are no objective, vericable criteria for this, or indeed, for any gender identity, other than those decided by people identifying as trans. Surgery to remove both testicles i.e. healthy, functioning tissue, is mandated here on the basis of a patient belief system, and justiced by an untested model of harm reduction. The contrast with orthodox medicine could not be more marked, where deontological (i.e. rule-based) ethical principles still hold some sway, namely ‘First, do no harm’. Within evidence-based medical care, removal of testicles would only follow on from a specific diagnosis of testicular cancer, based on signs, symptoms and history-taking. Diagnosis would explore the least invasive treatment, based on research findings with regard to likely outcomes. Removal of both testicles is apparently rarely required in the case of testicular cancer (NHS UK, 2022). In contrast, WPATH displays a consistent bias towards medical intervention, in this case castration as an extreme form of radical cosmetic surgery, in order to comply with a patient’s sexual fetish. WPATH, of course, would deny any charge that such an operation would constitute cosmetic surgery, arguing that it would only be carried out as a medical necessity. However, all medical interventions within transgender healthcare must be categorised as a medical necessity, even in the relative absence of evidence of epcacy, simply in order to qualify for payment under the US healthcare insurance system: “Medical necessity is central to payment, subsidy, and/or reimbursement…” (Coleman et al, 20220: 17). Medical necessity and financial imperative seem to bleed together to form a single catch-all category at this precise point.

[1] This impacts prisons due to men who identify as women being housed in women’s prisons. (I wish I was joking, but it is happening in the US and in Europe.) Athletes are being impacted as men who identify as women are being allowed to compete in women’s sports. And women’s crisis shelters are being forced to house men who identify as women in their midst in the US and in Europe as well.


[2]


[3]

[4] “Eunuchs today, though, are mostly an invisible gender. There's no real way to present as eunuch in the Western world. Most present publicly as male. They're indistinguishable from anyone else you see on the street. Sometimes they try to appear androgynous, but there is really no way they demonstrate publicly that they are other than male. And we estimate there are eight to ten thousand self-identiced voluntary
eunuchs in North America today.”

[5] https://andrewsullivan.substack.com/p/the-gender-identity-of-eunuchs-d4d

[6] Also in this article, we are reminded of the role eunuchs played in being put in charge of harems: “Christians will be more familiar with the eunuchs of Biblical times, which were very different from the eunuchs of today. Tom Hobson, former chair of Biblical studies at Morthland College, said eunuchs of the past were often used as royal officials. Many were sterilized to give a king subservient employees with little ambition. With a man’s infertility assured, a eunuch could safely guard women and not threaten the king’s succession. ‘No one was using it to disidentify with being male,’ he said.”

[7] “Suing Over Medical Transition: The Case Against Considering Wpath as a Competent, Reasonable Body of Expert Opinion” by Peter Jenkins, Genspect Dec. 10, 2022.