Breaking News: What Future for WPATH as Membership Plummets?

Detail of photo: Pexels from Alexander Grey

The future for gender affirming healthcare at a global level now looks rather uncertain. Until recently, WPATH (World Professional Association for Transgender Health) looked and behaved as though it had “seen the future and it works’” to paraphrase Lincoln Steffens, on returning from the Soviet Union in 1919. WPATH trumpeted the publication of its new Standards of Care (Version 8) only twelve months ago. These aimed to simplify and streamline the process of social and medical transition for children, adolescents and adults, in order to “better align their body with their gender identity” (Coleman et al, 2022: S31). WPATH also simply announced its discovery of the existence of a new eunuch gender identity, which seemed to require no further justification or discussion. Senior WPATH members were active and highly successful, particularly in the US courts, in arguing for the adoption of its Standards of Care and research findings, in order to promote its gender medicine pathways as the new professional consensus.

So it probably comes as a surprise for most observers to note that WPATH individual membership figures appear to have suffered a sharp fall over the past year (see: Figure 1: WPATH individual membership 2023-24.)

Figure 1: WPATH individual membership 2023-24.
Source: https://www.wpath.org/member/search

WPATH global membership stood at 4,119 in January 2023. As of 4th January 2024, it stood at 1,590. US membership was 3,104 in January 2023, compared with 1,234 in January 2024, i.e. currently comprising 78% of WPATH global membership. UK membership is minimal in comparison with 2% of total membership, although it appears to have experienced a similar proportionate decline, from 93 members in January 2023 to 34 in January 2024 (NB: membership figures fluctuate daily on the membership search portal: https://www.wpath.org/member/search). If taken as correct, the figures represent a massive fall in global WPATH membership in the order of a 60% drop within the space of a year. This seems to be an important development, the full causes and significance of which remain yet to be clarified.

So why is WPATH now on the back foot?

WPATH has experienced a number of major setbacks to its professional standing and credibility during the past year. The so-called ‘Dutch Protocol’ providing the rationale for prescribing puberty blockers off-label to forestall the onset of naturally-occurring sexual maturation in children and adolescents has been comprehensively critiqued and found wanting (Biggs, 2022). There has been a raft of systematic reviews across Europe and also from the US state of Florida, which have found little evidence of benefit and some evidence of potential harm from prescribing puberty blockers for this patient group. The voice of detransitioners, long ignored and dismissed, has continued to become louder and more insistent. The flagship media coverage of a teenager undergoing medical transition in the US (“I am Jazz”) seems to have lost its early triumphalism and now appears to have foundered, with the emergence of ever-more complex family dynamics and the incipient mental health concerns of its star patient. WPATH’s unrivalled status as expert legal opinion has been summarily rejected in a key case heard at the 6th Circuit Appeal Court in the US, which may well now proceed to the US Supreme Court for further resolution (Jenkins, 2023). In the UK, the Interim Cass Review (2022) has found against the Tavistock Gender Identity Development Service model of care, which was arguably closely influenced by and aligned with WPATH Standards of Care.

So, all in all, WPATH may well have glimpsed the future, but things are clearly not going according to plan just at present.

References

Biggs, M. (2022) The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence, Journal of Sex & Marital Therapy. DOI: 10.1080/0092623X.2022.2121238
https://doi.org/10.1080/0092623X.2022.2121238

Cass Review (2022) Independent review of gender identity services for children and young people: Interim report. https://cass.independent-review.uk/publications/interim-report/

Coleman, E. et al. (2022) Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health. 23:sup1, S1-S259. DOI: 10.1080/26895269.2022.2100644 https://www.wpath.org/publications/soc

Jenkins, P. (2023) Suing for medical transition The case against considering WPATH as a competent reasonable body of expert opinion. Genspect. https://genspect.org/suing-over-medical-transition-the-case-against-considering-wpath-as-a-competent-reasonable-body-of-expert-opinion/