WPATH Standards of Care Version 8
What does Gender Affirming Care really mean + entail?
The Institute of Medicine defines clinical practice guidelines as “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances.” (1990) Evidence-based medicine is a coherent approach to clinical decision making. The Institute of Medicine defines evidence-based medicine as the “integration of best researched evidence and clinical expertise with patient values.” (Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press).Well-developed guidelines have the potential to enhance the appropriateness of clinical practice, improve the quality of cardiovascular care, lead to better patient outcomes, improve cost effectiveness, and identify areas of further research needs.
— American Heart Association, Methodology Manual and Policies From the ACCF/AHA Task Force on Practice Guidelines, (2010)1
I decided to take a look at the source of the all misery — WPATH SOC, World Professional Association of Transgender Health Standards of Care.2
To understand why we cannot take WPATH seriously as a professional clinical organisation creating serious standards of care we need to know the origin story of WPATH. Formerly the Harry Benjamin International Gender Dysphoria Association, WPATH has a historical commitment to the most invasive modality of care for individuals experiencing dysphoria3 related to their reproductive class, euphemistically called Gender Dysphoria in the diagnostic jargon of Gender Medicine. Harry Benjamin’s entire schtick revolved around changing the individual’s body to match his mind. So, a society founded in Benjamin’s honour to carry on his work would do so espousing his clinical values—primarily change the body to meet the mind. That’s really what Gender Affirmation means when strip away rhetoric and get real with our language.
What is gender? A feeling we have about our reproductive class? How do we measure it objectively to know when it’s broken and needs us to fix affirm it? Do we have markers we can measure in the blood? Why is there a serious contingent of intelligent human beings out there who think that the answer to feeling disgusted or uncomfortable with one’s own reproductive class would involve distorting one’s body with medically unnecessary (off label use) chemicals and medically unnecessary (experimental) surgery so they resemble members of the reproductive class to which they do not + cannot + will never belong?
How have we a serious contingent of clinical people thinking that self diagnosis for a condition requiring irreversible treatment meets the standard of Do No Harm? How have we clinical people who think self identification a valid or reliable diagnostic process when the treatment most certainly results in permanent sterility and loss of sexual function? Why do we think some mental health patients can determine their own course of treatment without question, whilst we deny others’ claims to know their condition, physically tying them up or down and applying heavy restraint force and jabbing them with powerful sedatives and/or forcing ridiculous psychiatric horse pills into them on pain of isolation or restraint or social punishment of some kind? Why is the answer to unpleasant emotions and psychological distress always locking humans up — either in their pre-pubescent bodies or in a horrible institutional space created to slowly drain the vibrance from feisty suffering people?
When menopause came and the physical debilitation of estrogen withdrawal became too severe to live with I required blood testing of my hormone levels so the doctor could determine the lowest possible dose to provide the replacement I needed to function. My friend, a heavy smoker, was denied HRT because she had too many risk factors. Despite her struggle with debilitating side effects. If we called receiving HRT affirmation, then she was not affirmed and I was affirmed. See how silly that sounds?
Also it’s a lie because she was affirmed - denying a heavy smoker HRT seems life affirming. Stroke sucks dude. Her kids kinda want her around. Her husband too. So, maybe choosing the clinically safest—ie least invasive with least side effects—treatment would be the most affirming. Because destroying the body to affirm a fixed distorted thought in the mind seems like taking a wrecking ball to your apartment because a ghost told you they hate that load-bearing wall being there. Go ahead and remove that load bearing wall … the engineer will cringe but you can affirm your delusion that your home will feel nicer if you remove that wall.
What kind of due process happens when docs are making these clinical decisions for adolescents? How can you even speak of replacing a hormone you aren’t meant to have at that high level? How come menopausal women get more rigorous care than adolescents presenting with angst over their changing bodies?
Why aren’t people asking these very basic common sense questions? Are you all okay?
What if someone had it in their head they identified an insulin dependent diabetic and the clinician thought it would be harmful to the patient to challenge that self diagnosis because it might increase their risk of suicide to invalidate their identity as a diabetic who requires insulin? Are we going to give the insulin, a hormone, to affirm a questionable belief of an unskilled person presenting for care? Ok, this sounds like DIY restaurants, just cook that sh1t yourself, it’s affirming shut up.
Also, if you as the prescribing clinician really believe the patient will self harm should you make a sound clinical decision to deny her the treatment modality of her choice, then maybe you have a larger issue to deal with on-the-ground. Affirmation = not giving the tantruming sick person the unreasonable thing they demand because if you give it to them you could kill them. We don’t fcuk with the endocrine system to make someone feel better, that’s nonsense. That’s like short circuiting your home wiring because you feel sad and thinking you will feel better after distorting your home electrical system. Dude, are you okay?
You know what happens if I give insulin to a patient who doesn’t need it? I kill them. Hormones are not identity validation baubles. So, I want to ask everyone — what do you think is going on when we shove kids with normal puberty and childhood stress angst through an experimental regime that Mengele himself could feel great about dreaming up it’s so cruel? Like, seriously? Who thinks a 4 year old can give anyone instructions on how to parent? Are we going to have special mechanical equipment installed in the car so they can drive too, even when they can’t reach the pedals? Why not let a 4 year old drive if you let them change sex? They want to drive it seems unaffirming to deny them.
So, I’m going to leave it there today. I will continue this discussion cuz I ain’t done, Ise jest gettin started, boo! I don’t intend to duplicate the work that’s been done on analysis of the WPATH SOC 8. I will continue to give you my own smart-ass + sweary interpretation of relevant sections and the document as a whole.
I’ll end today by reminding us all that WPATH has done what all successful propaganda ministries do — mislead their audience to very passionately support a doctrinal position replete with fatal contradictions and lacking coherence and an explanation of or anchor to biological or rational material reality. This is not Standards of Care, rather it’s Catechism. WPATH promotes a body modification suicide cult not a serious body of clinical work to assist in the care and healing of humans afflicted with reproductive class dysphoria.
Definitions :: know the difference -
Standards of Care — Set the tone + quality + rigour of care, high in authority and limited in application.
Practise Guidelines - Specific, address treatment algorithm + criteria, less authoritative, wider application
Evidence-Based - Ethical, judicious + thorough, uses best + most recent results of patient outcomes to help formulate care decisions that have low invasiveness and high success rates for individual patients
Examples :: know the difference -
Standard of Care - Do No Harm
Guideline - Take the patient’s blood glucose reading prior to administering the insulin and use a sliding scale to determine the dosage and use a tuberline syringe with the prescribed insulin prepared by pharmacy
Evidence-based - giving a patient unnecessary insulin has been shown to bottom out their blood glucose level and send them into shock
italicized because they aren’t standards and they don’t provide care
from the Greek meaning hard to bear … well who thought it would be easy? 🙄