Statement 6.12h was intended to be part of the World Professional Association for Transgender Health (WPATH) Standards of Care version 8 (SOC8).
The WPATH SOC8 was eventually published on September 15, 2022 but endured an extensive debate in the summer of 2022 over whether or not to include statement 6.12h as shown above.
Its cause for omission in the ultimate publication was explained through documents publicized during a constitutional challenge to the state of Alabama’s Vulnerable Child Compassion and Protection Act that prohibits the mutilation of children in the name of gender dysphoria (United States District Court Middle District of Alabama Northern Division BRIANNA BOE, et al., Plaintiffs, v. STEVE MARSHALL, et al., Defendants).
Ultimately, the reason why this statement was left out was not a result of changed views on the appropriate ages for these surgeries, but was instead, politically motivated.
In a string of emails from the spring and summer of 2022, that were disclosed in document 560-36 – Defendants’ Summary Judgment Exhibit 186 of the Alabama Constitutional Challenge, Rachel Levine, his Chief of Staff Sarah Boateng, and Sam Ames from The Trevor Project managed to convince those at WPATH to omit the table shown above that provided details regarding appropriate ages for various transgender procedures.
After reviewing the most recent standards of care publication by WPATH, it appears as if they were successful as the original 6.12h table did not make the cut.
As per this string of emails, the information within is quite telling of how politics and subjective medicine can so easily mesh.
An email was sent on July 1, 2022 from an unknown sender who wrote to the elected Chairs, SOC8 Co-Chairs and the Adolescent Chapter Leads at WPATH, to tell them that Sarah Boateng, Levine’s chief of staff, “wanted to convey a concern she has, as Sarah, not as an official response/review of the office.”
The unknown writer attached statement 6.12h to the email and explained,
She [Sarah Boateng] 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.
On July 29, 2022, another email from an unknown person was sent to WPATH employees that lays out a zoom meeting the writer had with Admiral Levine, at which time he expressed “concern that having ages (mainly for surgery) will affect access to health care for trans youth and maybe adults too.”
The unknown emailer and WPATH employees to whom it was sent, engaged in replies that included comments such as:
You may remember that ages in the document were a “suggestion” not a “recommendation” as we had no evidence to recommend that, but in the document it has become a “recommendation” as it is part of the criteria.
A few days later an email was sent to WPATH chairs from Scott Leibowitz (Child and Adolescent Psychiatrist at Nationwide Children’s Hospital, Columbus, OH) that included a conversation transcription that occurred between the SOC8 Adolescent Workgroup members.
The email with the transcript attached was marked: CONFIDENTIAL – SUBJECT TO PROTECTIVE ORDER after which Leibowitz wrote,
Some of the comments in the transcript are as follows:
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I was never committed to ages, so I’m fine with adjustments to de-emphasize them. However, I don’t know how I feel about allowing US politics to dictate international professional clinical guidelines that went through Delphi.
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My sense is that the US, along with many other countries, is moving toward putting restrictions on youth seeking medical interventions and making the age requirement MUCH older. If our concern is with legislation (which I don’t think it should be – we should be basing this on science and expert consensus if we’re being ethical) wouldn’t including the ages be helpful? ie, it will be harder for states/countries to enact laws that go against the SOC. Plus, aren’t the ages just a recommendation with room for adjusting in unique circumstances? I need someone to explain to me how taking out the ages will help in the fight against the conservative anti trans agenda. Maybe I’m missing something.
The conservatives will only hone in on the ages and say that WPATH is supporting “cutting off healthy girl breasts at 15 years old” for example. They will not talk about the rest of the guidelines, except for the ages, and then it will create misguided fear and legislation will pass.
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How does taking the ages out help? We’re still recommending medical interventions for minors. So they’ll just say that.
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It doesn’t give them the headline. Less direct focus on age. I mean, we have a very high up politician telling us that having the ages specified front and center would politically lead to more attacks and legislative efforts. I see no reason not to trust that assessment is accurate.
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I’m already a bit worried about the change from “several years” for this reason. I do see your point about the headlines though, Scott. I see how it could cause more uproar among the general public. However I’m not sure how much that actually matters when the laws are being made. I’m also curious how the group feels about us making changes based on current US politics. Not trying to be difficult here! Just want to be sure we’re thinking this through carefully.
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But. On the flip side, for all our work to be thrown down the drain because we know it will be used to further efforts to ban our work….. if being strategic by putting that in an Appendix, or changing to “suggest,” we shouldn’t be outright dismissive of workarounds. I think it’s important that we all get our thoughts out now though.
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My understanding is that the suggestion from the chairs is to leave the ages in but have them as suggestions and not criteria/recommendations for start of treatment? That seems like an ok compromise to me.
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Maybe there’s something I’m missing but I think the conservatives are going to react negatively to age “suggestions” as well. Still a headline. I’m concerned about the headline: SOC8 changes at last minute at request of USA official.
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Rumors are already spread about us caving to activist pressure when we made the “several years” change. It seems like it’s not going to be pretty, whatever we do.
The email that followed a couple days later on August 5, 2022, from an unknown sender to Rachel Levine and his staff which noted:
The emailer goes on to write that:
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Ages for surgical intervention within the document cannot be removed because they are consensus-based. The compromise is in how the ages are presented, which includes no longer referring to them as recommendations but instead as “suggestions.”
Less than a month later, Sam Ames, from the Charitable organization The Trevor Project sent an email espousing the same concerns expressed by Rachel Levine and his Chief of Staff. The email included comments such as:
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My name is Sam Ames, and I’m the Director of Advocacy & Government Affairs at The Trevor Project. My primary portfolio is supporting trans youth and fighting the anti-trans healthcare legislation and policy sweeping the country right now. I know you’re likely quite busy leading up to the symposium in a few weeks, but I’m hoping we can talk sooner rather than later.
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If what we’re hearing is correct – and it’s entirely possible it isn’t – we’re extremely concerned about the age minimums I believe are in the new SOC8 standards. If what we’ve seen is accurate, this could have disastrous consequences for the work to protect basic healthcare for transgender youth. I promise I wouldn’t be emailing you at such a busy time if I thought this was anything but an emergency
On September 15, 2022, the WPATH Standards of Care, version 8 was published without the 6.12h table, thus without specified ages.
For a better understanding of the surgeries mentioned in Statement 6.12h, I’ve included links to various websites that explain them further:
In the published version, surgeries specifically noted in Appendix D under Adolescent Summary of Criteria are, breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery.
