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Biden Administration Pressured WPATH to Be Even More Radical

AP Photo/Matt Slocum

Suppose you thought, as I did, that WPATH represented the radical fringe of transgender ideology. In that case, I have news for you: "Admiral" Rachel Levine successfully pressured the organization to make Standards of Care Version 8 far more radical than they were when formulated. 

The World Professional Association of Transgender Healthcare sets the standards by which thousands of doctors and hospitals provide "gender-affirming care" to gender-confused children and adults. Recently--less than two years ago--the organization published its latest standards (version 8), purporting to lay out the expert "consensus" on how patients should be treated. 

It was supposed to be a medical document, but by now, we all know that it was primarily an ideological document dressed up as medical recommendations. 

We did not know until now, as revealed in discovery documents from a lawsuit against WPATH, that the recommendation's timing and contents were shaped by pressure from the Biden Administration

When the World Professional Association for Transgender Health’s Standards of Care Version 8 was released in September 2022, a very strange thing happened: WPATH removed references to minimum age requirements for various medical interventions, describing the change as a “correction” in a notice that now reads, weirdly: “This correction notice has been removed as it referred to a previous version of the article, which was published in error.” Whatever happened, exactly, it’s clear that until late in the game the document did have age minimums until, suddenly, it did not.

The SoC 8 was supposed to have been created via something called the Delphi process. As the document itself explains: “Consensus on the final recommendations was attained using the Delphi process that included all members of the guidelines committee and required that recommendation statements were approved by at least 75% of members.” Suffice it to say that making a sudden, major change so late in the game calls into question whether that process was fully adhered to.

Thanks to a rather remarkable document just unsealed as part of Boe v. Marshall, one of the many American lawsuits over youth gender medicine, we now have a potential explanation for why the age guidelines were removed: direct pressure from assistant secretary for health of the Department of Health and Human Services Admiral Rachel Levine (who is a trans woman herself) and the American Academy of Pediatrics.

This is how healthcare is now done in the United States of America. It is as if patient safety and health are, at best, secondary or tertiary considerations. 

Levine's pressure to WPATH stemmed from his efforts to change federal recommendations and standards for the treatment of gender-confused individuals, and he needed "expert" justification for standards that he had already developed. The goal was to provide backing for policies the administration wanted to implement, not to develop standards that would reflect even the more radical doctors in the transgender mafia. 

More worryingly, Cantor charges that “Assistant Secretary Levine also attempted to and did influence the substantive content of SOC-8, based on political goals rather than science. Specifically, Assistant Secretary Levine, though [sic] a staff member, pressured WPATH to remove recommended minimum ages for medical transition treatments from SOC-8.”

Here, too, he has evidence from anonymized emails written by those involved in the SoC 8:

Sarah Boateng, who is Adm. Levine’s chief of staff [said the] biggest concern is the section below in the Adolescent Chapter that lists specific minimum ages for treatment, she is confident, based on the rhetoric she is hearing in DC, and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out and perhaps an adjunct document could be created that is published or distributed in a way that is less visible than the SOC8, is the way to go. 


The issue of ages and treatment has been quite controversial (mainly for surgery) and it has come up again. We sent the document to Admiral Levine. . . She like [sic] the SOC-8 very much but she was very concerned that having ages (mainly for surgery) will affect access to health care for trans youth and maybe adults too. Apparently the situation in the USA is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them. We have the WPATH executive committee in this meeting and we explained to her that we could not just remove them at this stage. 


[W]e heard your [Dr. Levine’s] comments regarding the minimal age criteria for transgender healthcare adolescents; the potential negative outcome of these minimal ages as recommendations in the US [. . . ] Consequently, we have changes to the SOC 8 in this respect. Given that the recommendations for minimal ages for the various gender affirming medical and surgical intervention are consensus-based, we could not remove them from the document. Therefore, we have made changes as to how the minimal ages are presented in the documents. [Note: “your” may well refer to an aide of Levine’s rather than the Secretary herself, though it’s unclear.] 

WPATH, it turns out, had produced a draft document that explicitly endorsed restricting transgender healthcare and much more extensive pre-treatment screening and counseling, but the Biden Administration through Levine wanted the broadest possible recommendations in order to promote its own ideological agenda. 

Medicine had nothing whatsoever to do with the final recommendations because they had been screened and changed by the Biden Administration without the agreement of the doctors who had formulated the standards, and in violation of the process by which the standards had been developed. 

Even doctors who were fully committed to the medicalization of gender dysphoria and skeptical of psychological and psychiatric treatments objected to the standards as propagated. 

That's amazing. Some of the most radical alphabet ideology promoters were skeptics regarding how radical the WPATH guidelines turned out to be and questioned the process by which they were developed. 

Few of us are surprised that the WPATH guidelines have been developed with ideology in mind--the entire discipline is guided by ideological assumptions--but it is shocking to find that one political appointee can dictate the medical standards of an entire discipline for explicitly political reasons. 

Well, it would have been shocking before COVID, anyway. 

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David Strom 2:30 PM | July 14, 2024
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