The development process of the World Health Organization’s guideline on the health of trans and gender diverse individuals represents a significant missed opportunity. There’s a clear need for a reliable international guideline, especially considering the increasing global scrutiny of the affirming care model endorsed by the World Professional Association for Transgender Health (WPATH). In several countries, notably the United States, this debate has become entangled in partisan politics. Ideally, an international organization like the WHO would help steer this debate towards evidence-based medicine.

However, WHO’s approach to developing this guideline reveals a concerning disregard for the principles of evidence-based guideline development, a problem that is particularly acute in gender medicine. The final membership of the WHO’s guideline development group was announced on December 18, 2023, with public comment open until January 8, 2024. The group is scheduled to meet from February 19 to 21, 2024. The hurried nature of this process appears intentionally designed to minimize public input. Even more concerning is the clear bias in the group’s composition that favors the medical model of “gender-affirming care.”

Clinical guidelines aim to help clinicians navigate the vast amount of research on different treatments, enabling them to make decisions based on the best available evidence. Managing conflicts of interest is a critical aspect of developing these guidelines. Medical professionals, despite their best intentions, can develop biases toward specific treatment types. This bias can lead to a preference for studies that support their favored care model and a dismissal of contradictory evidence.