Letter to the WHO: re-evaluate the makeup of your trans health committee

We wrote a letter to the World Health Organization, protesting that the committee they’ve formed to develop transgender policy is composed almost exclusively of activists, and appears to be deliberately evading input from medical and scientific professionals. We’ve urged them to show down the process and to re-evaluate the makeup of the committee.

The letter reads as follows:

Dr. Meg Doherty
Director Global HIV, Hepatitis, and STI Programmes
World Health Organization

Dear Dr. Doherty,

I write today on behalf of LGB (Lesbian, Gay & Bisexual) Alliance Canada, an organization that seeks to promote the interests of same-sex attracted persons, both adults and minors. 

We are deeply concerned about the manner in which the World Health Organization is developing its guidelines on transgender health. Those responsible for this process, which is being undertaken in alarming haste, have ignored the fact that there is a heated international debate underway concerning the medical protocols related to gender medicine. As such, they have overlooked potential contributions by key reformist experts.

The debate on this matter is split into two camps, one focused on ideology and activism, heavily influenced by identity politics, and the other focused on an evidence-based approach to the treatment of gender dysphoria and those identifying as transgender, particularly young people. The former camp is intensely hostile to the latter, and has a record of seeking to suppress arguments based on objective scientific findings. This appears to be happening here.

Bernard Lane, writing in Gender Clinic News, cites Dr. Erica Anderson, a noted gender clinician, who has said the WHO seems “to be oblivious to the issues with transgender healthcare, particularly as they are playing out in the developed world,” adding that the agency has failed to draw on the expertise of leading clinicians who are informed by systematic reviews of the evidence. For instance, none of the twenty-one panel members chosen by the WHO to develop the new guideline seems qualified to address social influence as an apparent factor in the explosion of trans and non-binary identities.

Indeed, the new committee is composed largely of individuals from within the activist camp, easily identifiable by their public affiliations and explicitly stated activities. Moreover, we argue that the guideline development is being rushed deliberately in order to evade contributions from the many clinical professionals who urge caution, and who dissent from the activist camp’s views, represented by the members of your committee.

There is a growing contingent of ‘de-transitioners’ who are emerging with grievances about being promptly prescribed hormones, even if their dysphoria might have some other source, such as an eating disorder, being on the autism spectrum, or having experienced sexual trauma. Countries that have been at the vanguard of what is benignly called ‘gender-affirming therapy,’ including Finland, Sweden, Norway and the UK, have taken a sharp turn away from a medicalized approach for those with gender dysphoria to one that centers on psychological support.

In ignoring all of this the WHO is not following its own policies regarding the composition of the committee, nor is it appropriately managing the conflicts of interests in order to reduce bias.

Chapter six of the WHO’s Handbook for Guideline Development defines an intellectual conflict of interest as “academic activities that create the potential for an attachment to a specific point of view that could unduly affect an individual’s judgment about a specific recommendation” and notes that such conflicts “can undermine the credibility of specific recommendations, the entire published guideline, and WHO as a global leader in normative and other work.”

The chapter also highlights examples of roles or positions that might interfere with the objective assessment of a body of evidence, including “prior public declaration of a firm opinion or position, as in public testimony during a regulatory or judicial process, or in an editorial in a journal; or professional or personal affiliation with an organization advocating for products or services related to the subject of the guideline.”

Regarding  the composition of the guideline development group, the WHO’s Handbook notes that the aim is to have a diverse group that includes relevant technical experts; those who will adopt, adapt, and implement the guideline; representatives of groups most affected by the recommendations, such as representatives of disadvantaged groups; and other technical experts such as an expert on equity, human rights and gender.

How can the WHO claim that the committee is diverse when experts who are skeptical of the gender affirming model and favour an evidence-based model in its place; detransitioners or members of their families, and LGB individuals who have experienced gender dysphoria and incongruence are not represented?

Further, given that the committee is also tasked to develop guidelines regarding self-ID (which itself is a topic of more concern to areas of social policy and identity politics rather than medical health; its inclusion is perhaps further evidence of the bias in the committee’s makeup and mandate), those who may be impacted by such a broad-reaching, society-wide social policy should also be represented, such as members of women’s rights groups.

We would like to remind you of the WHO’s past failures—which had grievous consequences—that occurred as a result of the ideological corruption of establishing health guidelines: the use of drastic psychosurgery to treat psychiatric disorders (the lobotomy scandal); and the flawed recommendations regarding breast-feeding amidst the HIV epidemic are two notable examples. Theodore Brown, co-author of “The World Health Organization: A History” (Cambridge University Press, 2019) attributes such failures in the WHO’s past to the fact that it “allowed itself to become so politicized. I expected there to be political contamination or intrusion, but I didn’t expect it to be so pervasive.”

We are confident that there is no wish to risk similar destructive outcomes in the matter of many thousands of young people, especially in Western countries, who are struggling with gender confusion.

Therefore, in the interests of vulnerable young people, many of whom are same-sex attracted, we urge you in the strongest possible terms to pause this process and to radically re-evaluate the makeup of the committee.

We offer as alternative candidates these highly qualified Canadians with strong reputations for commitment to evidence-based medicine: Dr. Ken Zucker; Aaron Kimberly, RN; Dr. Ray Blanchard; Dr. Gordon Guyatt; and Dr. Susan Bradley. 

Respectfully submitted,

Arty Morty
Co-founder, LGB Alliance Canada