Jan Bergstra & Laurens Buijs
Amsterdam Gender Theory Research Team
Structure of this blog
1. Introduction
The world of gender and gender transition is somewhat in turmoil because of the bringing out of the so-called WPATH files by activist and journalist Mia Hughes. These are leaked files containing correspondence between members of WPATH about gender transition.
WPATH is a global leader in the medical aspects of gender and gender transition. But Mia Hughes’ work works strongly to suggest that there is considerable doubt within and behind closed doors among key WPATH figures about the defensibility of the guidelines issued by WPATH in their Standards of Care , particularly in the area of gender affirming treatment of minors. These guidelines are largely based on the famous Dutch protocol , which has been under heavy fire for several years.
The Dutch protocol regulates the medical diagnosis, hormonal treatment, psychological support, surgery and aftercare of transgender persons. One of the pillars of the protocol is its view of treatment for minors: puberty inhibitors and hormone treatments could, according to the protocol, function as a “pause button” to gain thinking time.
The Dutch protocol has always been considered a leading guideline in the field of transgender care. Developed in the 1990s by Dutch health professionals, it was originally published as a guide to the treatment of gender dysphoria. In recent years, however, the protocol has come under increasing scrutiny. The WPATH files even put the protocol down as fraudulent, even though such strong terms are not used. In any case, its evidence base is qualified as totally inadequate.
It is likely that the WPATH files will cause great reputational damage to the WPATH. Those who want to know the details of this must read the texts themselves, which cannot be summarized in a few sentences. Clearly, in the eyes of Mia Hughes, the Dutch protocol is completely inadequate, and the leaked documents show that there is no open debate about that within WPATH.
2. The Dutch protocol is under fire internationally
Hughes is not alone in her criticism. Dutch protocol has been receiving increasing criticism since the Tavistock scandal. Tavistock is the British gender clinic in London and Leeds that came under serious scrutiny in 2020 when it was found to have provided inadequate follow-up care, missing statistics and overly careless decisions in the transition process for a large number of minors. Internally, there was a heavy oppressive culture that suppressed critical dissent, so psychiatrist David Bell eventually decided to come forward as a whistleblower. The BBC subsequently made a series of broadcasts about the abuses on its Newsnight program.
That led to a chain reaction. First, professionals in Finland and Sweden stepped on the brakes and issued all sorts of warnings about Dutch protocol. In January 2023, U.S. professor Stephen Levine also published a critical analysis of the protocol, stating that it lacks a scientific basis and warning of its potentially negative effects among vulnerable youth.
Criticism of the protocol also arose in Belgium that year, when professor of family medicine Patrik Vankrunkelsven severely questioned the claim that it would help young people. In the Netherlands, the following were among the topics discussed Zembla and de Volkskrant paid attention to the fuss. The fact that now even in our progressive country where the protocol originated it is being increasingly doubted is being followed with great interest internationally.
Read more about doubts raised about gender transitions among medical professionals:
Science still struggles with gender, self-identification has limitations
In February of this year, published The New York Times a great article about the fuss over the Dutch protocol, which heavily criticized the pioneering study of the protocol in 2011: that study had problems with the sample, was full of methodological errors and shortcomings, could not support all statements with evidence, and did not follow up properly to participants who had dropped out. On Feb. 27, 2024, the House of Representatives passed a motion by Rosanne Hertzberger (NSC) to investigate the scientific quality of the model of care based on the Dutch protocol.
The WPATH files collected by Mia Hughes also show, in particular, a lack of compliance with the principles of evidence-based medicine in touting treatment prescriptions by WPATH, in which the Dutch protocol plays a major role. We assume that the irreversible interventions that WPATH considers acceptable in children will increasingly lose acceptance.
3. The future of transgender care
It is unfortunate that Mia Hughes leaves open whether she thinks gender transition and medical support for it is a reasonable thing in principle and is primarily critical of WPATH’s practices and integrity. Surely there is so much discussion about the principled sides of gender transition that it would strengthen Mia Hughes’ contribution if a clear statement were made in this area. Are there any potentially serious errors in the treatment of gender dysphoria? Or, according to Mia Hughes, does the issue lie deeper: gender transition does not exist and gender affirming medical health care is a misunderstanding?
We assume that the concepts of gender, gender transition, and transgender person are, in principle, rational and defensible, and that criticism of WPATH and the Dutch protocol is about how these issues are handled, and not about the underlying principles. That said, at the same time we see a need to bring the relationship between gender dysphoria, gender incongruence and gender identity into sharper focus. Recent research in Groningen shows that the desire to have a gender other than one’s physical gender is also a measurable quantity that can and should be examined, in addition to the idea of actually having a gender other than one’s physical gender. It is notable that terminology is still deficient.
Read more about the problems with the concept of gender identity:
The concept of gender identity still provides more questions than answers, but concept engineering offers perspective here as well
What is the correct word for a person who has gender A and gender identity B (unequal A)? Because this situation cannot exist according to co-essentialism (because gender identity then always determines gender), it has no name in gender theory of the past 25 years. Gender philosopher Elisabeth Barnes (University of Virginia) speaks of a discrepancy between gender categorization and gender identity. We propose to speak of incongruent gender identity. This is then sometimes a problem that can be solved by gender transition. The fundamental issues then are for WPATH:
- Under what conditions does a minor have an incongruent gender identity?
- When is it appropriate to “do something about it” with irreversible medical interventions?
- When can we see these interventions as preparations for gender transition that are also motivated by the perspective of gender transition?
4. Conclusion
The WPATH files give the impression that within WPATH, there is a lack of confidence in the answers that people bring out to these questions. It is particularly disappointing that, from progressive quarters and also from gender studies departments at universities in the Netherlands and abroad, there is no longer open discussion of the difficult phase in which transgender care finds itself, and that there is still mainly activism based on co-essentialism (see gender-theory.org/) seems to be practiced.
Digging in even further into one’s own ideological position and looking away from the great scientific and social debate that has erupted over the principles and sustainability of transgender care will obviously not solve the problems. Sooner or later, advocates of progressive transgender care and transgender empowerment will have to step out of their own bubble, face the obvious problems with the current view of gender and gender identity as highly malleable, and engage in argumentative discussions with critics. Only in this way can a new vision of transgender care be developed that goes beyond the trenches and polarization of the current gender wars.
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