On 18 December 2023, the World Health Organisation’s (WHO) Department of Gender, Rights and Equity – Diversity, Equity and Inclusion (GRE-DEI) announced the development of a WHO guideline on the health of trans and gender diverse people and the membership of a guideline development group (GDG).
The focus of the guideline is to be on the provision of ‘gender affirming care’ and ‘legal recognition of self-determined gender identity’.
This is despite an increasing number of European countries, including Finland, Sweden, Norway and the UK moving away from the medical transition of minors (via hormones and surgeries), as evidence emerges showing that these treatments are producing poor outcomes for patients. It also ignores the harmful public health consequences of ‘self-determined gender identity’, including the harms to vulnerable women and girls when trans-identified males are allowed to claim access to female-only spaces and services.
While the WHO only made its announcement just before Christmas, public comment on the composition of the 21-person GDG is due by 8 January – a time period (over the Christmas holidays) which makes it impossible for genuine public consultation, and indeed appears intentionally designed to minimise it.
A similarly inappropriate consultation period was given for the first announcement of the project on 28 June 2023, which included biographies of the first 14 panel members.
The group itself is scheduled to meet at the WHO headquarters in Geneva, 19 - 21 February 2024, to evaluate and interpret the evidence, formulate guideline recommendations, and suggest implementation strategies.
As one commentator writes of the GDG composition, “many of them have significant personal, intellectual, and professional conflicts of interest that may interfere with their ability to evaluate and follow the evidence when that evidence leads to uncomfortable places. Conflicts of interest are unavoidable, but balance matters. One won’t find any critics, concerned clinicians, experts in child and adolescent development, specialists in neurodevelopment, or desisters and detransitioners in the WHO’s guideline development group.”
The process and the model for developing this health guideline have been evaluated by the Society for Evidence-Based Gender Medicine (SEGM), which has produced an excellent analysis of the concerning development of the guideline. SEGM raises concerns about:
- A biased guideline panel composition (i.e. the GDG membership)
- A constrained public comment period, and
- A rushed guideline development process overall.
Several other commentators have also written important critiques of the WHO’s biased and rushed guideline process.
Eliza Mondegreen, UnHerd, “WHO quietly announces controversial gender guidance”: “This panel of experts is heavily stocked with apparatchiks from the World Professional Association of Transgender Health (WPATH), including two former presidents; trans activists employed by the Global Action for Trans Equality network, or GATE; the parent of a trans-identifying child; and at least one member with strong ties to the pharmaceutical industry.
A few of the panellists have especially colourful public profiles, none more so than Florence Ashley, a “transfeminine jurist and bioethicist” whose preferred pronouns are “They/Them/That Bitch”. Ashley believes that “puberty blockers ought to be treated as the default option” for all youth, as opposed to “letting puberty runs its course”. The activist argues that letting this stage of human development progress uninterrupted “strongly favours cis embodiment by raising the psychological and medical toll of transitioning”.
Bernard Lane, Gender Clinic News, “The why of the WHO”: "The World Health Organisation’s new guideline project for transgender health has ignored the intense international debate about youth gender medicine and overlooked key reformist experts, according to the prominent American gender clinician Dr Erica Anderson. “[The WHO] seem to be oblivious to the issues with transgender healthcare, particularly as they are playing out in the developed world,” she told GCN, adding that the agency had failed to draw on the expertise of leading clinicians who come informed by systematic reviews of the evidence base."
JustDad7 (Canadian lawyer and advocate), Substack, “The WHO’s Stealth Campaign to Avoid Public Scrutiny on New Gender Guidelines”: “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)."
"There appears to be a sense of panic in this rushed process. WPATH and the affirming care model are facing increasing scrutiny. Countries like Finland, Sweden, Denmark, and Norway have all abandoned the WPATH Standard of Care. The upcoming Cass Review report, expected in early 2024, is likely to confirm a similar shift in the United Kingdom. Serious questions about the affirming care model are also emerging in France, Germany, the Netherlands, and Australia. New Zealand’s new government is also anticipated to initiate changes.”
Clinical Advisory Network on Sex and Gender, “CAN-SG statement on the proposed WHO guideline for the health of trans and gender diverse people”: “The WHO...appears to assume that gender-affirming care is a safe and effective management approach. This assumption is incorrect. Amongst clinicians and policy makers globally, there is growing concern about the long-term efficacy and safety of these interventions. People who have received these interventions and experienced harmful effects, or who have subsequently de-transitioned, are speaking out. We are concerned that this announcement gives the appearance that WHO has taken a policy position on this without critically appraising the evidence.”
“There are consequences for society when people claim access to the rights of the opposite sex. This is multi-faceted, and places the highest burden on the most vulnerable women and girls, challenging their human rights. This includes women in prisons, in hospitals, in care, in mental health settings, women accessing services following domestic or sexual violence, and those that are dependent on other people for intimate care. These are all people whose healthcare WHO should be championing, particularly noting WHO’s vision for healthcare systems that “leave no-one behind”. There are also profound implications for health systems and research, particularly with regard to data collection and resource allocation.”
Petition, “WHO should Go Back to the Drawing Board on its Transgender Health Guidelines”: “We call on the World Health Organization (WHO) to participate in, rather than preempt, an open and transparent dialogue about the scientific and societal implications of gender dysphoria treatments, the importance of biological sex, and the best way to protect trans-identified individuals without sacrificing protections for other vulnerable groups including women and children. Such a dialogue requires that a diversity of perspectives from experts and stakeholders be heard, that the public be given sufficient time to weigh in, and that the guideline development group (GDG) take the time and care necessary to understand all the risks, benefits, and unknowns involved, rather than arriving in Geneva with their minds already made up.”
Women’s Forum Australia joins these and other concerned groups and individuals in calling on the WHO to:
- Address the many conflicts of interest in the current panel, and appoint a balanced guideline development group with transparency on how members are selected and full disclosure of any conflicts of interest.
- Extend the period for public comment to ensure all voices have an opportunity to be heard.
- Cancel the upcoming February Geneva meeting until the above issues are addressed.
Given the current debate taking place within our own country both federally and at the state level around the gender affirming model of care (see for example, here, here, here, here, and here), we also call on the Australian Government to raise concerns with the WHO about its rushed and biased guideline process (we have specifically written to Prime Minister Anthony Albanese and Federal Health Minister Mark Butler in this regard). It will be critical for vulnerable Australians that this flawed process by the WHO does not complicate our own consideration of the issue.
**Update: After international pressure calling out the rushed and biased process around the development of its guideline, the WHO has taken some positive steps. Read more.**
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