The World Professional Association for Transgender Health (WPATH) has declared puberty blockers, cross-sex hormones and gender reassignment surgery to be “medically necessary” in an effort to get US insurers to cover the treatment, recently unsealed court documents show.
According to the Washington Free Beacon:
WPATH's standards of care, which guide clinical practice in the United States, were updated in 2022 to include language about the medical necessity of hormones and surgery, because the organization was frustrated with the U.S.'s “confusing and unsound health care 'insurance' system,” as one WPATH official said in an email.
The frustration has been simmering for some time. Knowing that most private insurers and state Medicaid plans would not cover elective procedures, WPATH issued a statement in 2016 arguing that the treatments it recommended were “medically necessary.” For example,
The medical procedures involved in gender reassignment surgery are not “cosmetic,” “elective,” or “for patient convenience.” These reconstructive surgeries are not optional in any meaningful sense, but are understood to be medically necessary to treat a diagnosed condition. In some cases, such surgeries are the only effective treatment for a condition, and for some, genital surgery is essential and life-saving. (emphasis in original)
Standard Transmission
When plaintiffs challenging Alabama's ban on gender-relevant therapies for minors repeatedly cited WPATH's 2022 Standards of Care (SOC-8), including the “medically necessary” language, the state subpoenaed documents related to the development of the standards. “What emerged was a picture of a political organization posing as a medical organization, claiming scientific authority to push activist agendas,” the Free Beacon wrote.
“We needed a tool that lawyers could use to defend access to care,” one WPATH official wrote in an email in January 2022. “The original medical necessity statement was specific to the United States because that's where we were experiencing the issues.”
That “tool” was SOC-8: “I have long wanted this (and many other policy statements) to become part of the (Standards of Care) because that would give it more power,” the official explained to a colleague.
They gladly obliged. When SOC-8, the first revision of health care standards in a decade, was released, it encouraged health systems to provide “medically necessary gender-affirming care.”
WPATH Deception
The wording on “gender reassignment treatment” was also adjusted during the drafting process to improve the public image of such procedures. Instead of saying that patients “want” to undergo a certain procedure, the document says that they “need” it because, in the words of one official, “wish makes a necessary procedure seem optional.” Meanwhile, procedures were renamed from “treatment” to “medical care,” to avoid the impression of fighting a “pathology,” according to another official.
WPATH officials acknowledged that making these changes to the standard of care would affect not only insurance companies but also doctors, who would now have the right to prescribe “gender-affirming care” to those who want, or even “need.” One official said the draft SOC-8 creates “very broad categories” that “any well-intentioned clinician could use for this purpose.”
“These documents show how one of the core claims of American gender medicine — that these treatments are 'medically necessary' and cannot be withheld without harm — has been shaped by legal and financial pressures that have nothing to do with medical evidence,” the Free Beacon wrote.
For example, the documents show that Biden's Under Secretary of Health Rachel Levin pressured WPATH to remove age restrictions on gender-affirming treatments, including gender-reassignment surgery, from its standards of care, and that WPATH silenced a team of Johns Hopkins researchers who concluded there was “little to no evidence” for such treatments, telling them they “could not independently publish their findings.”
WPATH denies that it acted unethically in updating SOC-8, telling the Free Beacon that it has “historically been solely interested in evidence-based medicine.”
Malicious influencers
The organization claims to be “evidence-based,” and its standards are accepted as absolute by hospitals, government agencies, insurance companies, and journalists. Conversely, any voice opposed to WPATH is denounced as “anti-science” and “transphobic.”
As in Alabama, plaintiffs challenging state restrictions on gender-specific treatment have taken on WPATH's mantle of scientific objectivity.
Unfortunately, courts often defer to these experts: In April, the Fourth Circuit Court of Appeals, citing WPATH's “authoritative” standard, ruled that all state health insurance must cover “gender-affirming care.”
WPATH terminology also influences public perceptions of gendered treatment.
“Despite the fact that 'medical necessity' is a technical term intended to affect insurance, the term has been widely adopted by legal circles,” Manhattan Institute researcher Leor Sapir told the Free Beacon. “Americans are now convinced that if they do not receive this type of care upon request and with minimal or no gatekeeping, they are at imminent risk of suicide.”
Ironically, the “medically necessary” phrase was primarily intended to appeal to the American mix of public and highly regulated private insurance that WPATH officials disliked. In Europe, where universal health care rules, governments have rolled back gender-specific insurance coverage, especially for minors. The Free Beacon noted that “the reason the group has wielded such influence in America is clearly due to WPATH's nemesis: the American health care system.”
