This is the fifth article in the “WPATH Tapes” series on the World Professional Association for Transgender Health and the gender medical industry. Read the overview of our investigation here.
Top doctors in the field of transgender medicine discussed the stark reality of infertility resulting from puberty blockers and cross-sex hormones at a 2022 industry conference, according to videos obtained through an open records request by the Daily Caller News Foundation.
The doctors discussed how children don’t fully grasp the consequences of potentially sterilizing drugs and medical procedures, and some acknowledged that the gender medical industry often rushes patients through the sex change process.
The 2022 conference was put on by the World Professional Association of Transgender Health (WPATH), an international organization that creates treatment guidelines for transgender medicine. Medical professionals from all areas of expertise gathered at WPATH’s 27th annual symposium in Montreal, Canada, in September 2022 to discuss the group’s recently-updated standards of care.
One doctor, Scott Leibowitz, a psychiatrist at Nationwide Children’s Hospital in Ohio, said that while it’s important to tell kids that puberty blockers, cross-sex hormones and surgery could make them infertile, doctors shouldn’t pump the brakes on these procedures.
Leibowitz argued that an “adolescent” patient who acknowledges they may regret undergoing sterilization and could want to have kids in the future is thereby capable of consent, according to a video of his presentation.
“An adolescent who says, ‘I don’t really care about [fertility] right now, but I realize I’m a teenager, maybe when I’m older I could change my mind, but I don’t think I will,’ that … adolescent is capable of understanding that they don’t know what their life may be like,” Leibowitz told attendees.
“That’s the type of young person [who] understands that [the] decisions they’re making now are impacting them and that they could be appropriate for their future or they might not be, and it’s not up to us to say, ‘if your thing is going to change in time, if your priorities are going to change in time well then we shouldn’t do this.’ No, it’s to say ‘great, you understand that, now let’s move forward with what you feel you need,’” Leibowitz said.
WPATH’s Standards of Care Version 8 (SOC 8) states that children who “think they have made up their minds concerning their reproductive capacity” can change their minds and it is the responsibility of their doctor to discuss this possibility in more depth with them.
A spokesperson for Nationwide Children’s Hospital told the DCNF that “Dr. Leibowitz is not available for an interview.” Leibowitz did not respond to requests to his own email address.
Dr. Alex Laungani, a clinician at Canada‘s Metropolitan Center Of Surgery, said that doctors should at least “mention” fertility preservation treatments when discussing a gonadectomy, the removal of the gonads that form either ovaries or testes, with a patient. He noted that doctors tend to “rush” these kinds of procedures despite the risk that patients may have regrets down the line.
“You have to discuss practical options when you’re doing gonadectomies of course,” Laungani said. “It’s a lot of things happening in one’s life at that moment, and we tend to rush things to that surgery, but there could be regrets afterward, saying, ‘well it could have been an option actually to freeze some of that,’ so I think that it’s important that we mention it at least.”
“There’s still financial issues to that because in Canada, for example, I think the five first years are covered, but then you would have to pay for storage after that, so if we are talking young individuals maybe they won’t have the money to do so but at least you have the conversation with them,” Laungani added.
Laungani and the Metropolitan Center Of Surgery did not respond to the DCNF’s requests for comment.
‘Kids Have Zero Idea About Their Fertility’
Detransitioners, individuals now living as their biological sex after previously transitioning genders, and some medical professionals have warned that children are unable to fully understand infertility risks when asked to consent to hormone therapy or surgeries.
Chloe Cole, who is suing her doctors for medical malpractice for transitioning her at age 13, told lawmakers in July 2023 that a huge part of her “future womanhood” had been taken away since she would never be able to breastfeed.
Another detransitioner named Isabelle Ayala is suing the American Academy of Pediatrics over its treatment of minors with gender dysphoria. Ayala says she was put on testosterone as a teenager after just one meeting with doctors, and now she’s unsure if she can have children. She claims in her lawsuit that she now has an autoimmune disease “that only the males in her family have a history of.”
Some WPATH doctors admitted during the 2022 symposium that children are largely unaware of the future ramifications of sex change treatments.
Dr. Daniel Metzger, a WPATH-certified pediatric endocrinologist who works at British Columbia Children’s Hospital, said in another video that “kids have zero idea about their fertility.” He explained that fertility-preserving procedures for girls who wish to transition to male are limited, and that the ones available are incredibly expensive.
“The options for assigned females are fewer when you’re talking about kids,” Metzger said. “You can, yes, you can put ovaries in the freezer, you can do other fancy things [but] it’s very, very expensive. It requires a surgical intervention and it’s just not really practically done in most places to my knowledge in youth at this point.”
During a question-and-answer session in the same video, an attendee asked whether eggs harvested from young girls just beginning puberty are even fertile. Metzger replied that young female cancer patients will have their eggs frozen for fertility purposes while admitting that not much “is known about that still for a 10-year-old assigned female.”
Metzger and British Columbia Children’s Hospital did not respond to the DCNF’s requests for comment.
When discussing fertility options, Dr. Michael Irwig, a specialist in endocrinology at the Beth Israel Deaconess Medical Center and an author of the SOC 8 chapter addressing eunuchs, said fertility concerns are usually raised by young patients’ parents.
“On a practical level, though, I can tell you because this is part of my standard template, I always ask patients, ‘are you interested in having a biological child?’ And I would say at least 80% to 90% will say no right out, and for the ones that are interested in having children, they’re often very happy with adopting. So, it’s actually very rare that I get a patient who said, ‘Yes, I want to have a biological child,’” Irwig told attendees.
“And it’s usually more if it’s a 19 or 20-year-old, the parents are in the room and it’s more of the parents’ concern than the 19 and 20-year-old, because usually having a child is not the first kind of thing for your average 19 or 20-year-olds,” said Irwig, who did not respond to the DCNF’s requests for comment.
The Beth Israel Deaconess Medical Center also did not respond to a request for comment.
Leibowitz noted during his presentation that a mastectomy is the most popular sex-change surgery for biological female adolescents because the risk of infertility from other surgeries is a “real sticking point” for patients and their families.
A 2023 study published in the Journal of the American Medical Association found that between 2016 and 2019 the number of sex change surgeries nearly tripled from 4,552 to 13,011 in patients 12 to 40 years old, with the most popular being breast and chest surgeries at 56.6% of operations.
‘Reversible, Asterisks’
Transgender activists and medical professionals have often claimed that the effects of drugs like puberty blockers are reversible. The SOC 8 claims puberty-blocking medication administered to children showing the first signs of “physical changes” is “fully reversible” and “regarded as an extended time for adolescents to explore their gender identity by means of an early social transition.”
WPATH also states in its guidelines that putting minors on puberty blockers will alleviate a large amount “of distress stemming from physical changes that occur when endogenous puberty begins.”
Leibowitz, however, explained during a WPATH presentation that puberty blockers are actually “‘reversible, asterisks.”
“One cannot be on puberty suppression endlessly,” he said. “You get to a place where physiologically we need hormones.”
There are also fertility risks to hormone therapies. For instance, Planned Parenthood, which offers hormone therapy for thousands of patients who identify as transgender, notes that females who get on testosterone are at risk of becoming infertile and should look into “family planning” options.
The National Health Service of England announced in March that it had banned the prescription of puberty blockers for minors based on the recommendations in a comprehensive review led by renowned pediatrician Dr. Hillary Cass.
The Cass Review, which was released to the public in April, found there was little evidence to support the claim that puberty blockers alleviate a patient’s gender dysphoria, further finding the drugs actually pushed patients to pursue more extreme measures.
Dr. Stephen B. Levine, an expert in gender dysphoria and a distinguished life fellow of the American Psychiatric Association, said in a deposition in August 2022 that multiple studies have shown that putting children on puberty blockers “virtually eliminates the possibility of desistance” — which is when a gender-confused person decides against transitioning or stops identifying as transgender altogether.
Levine further argued that the treatments often shift “children to a persistent transgender identity” and act as a “switch” to push them toward cross-sex hormones.
The Mayo Clinic released a report in April that found that puberty blockers were not reversible as many activists and doctors have claimed and could present a risk of infertility. Mayo’s website still claims, however, that the treatment “pause[s] puberty” without “permanent physical changes” and cites WPATH standards for transgender healthcare recommendations.
WPATH did not respond to the DCNF’s requests for comment.
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