This is the second 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.
A leader of the world’s most prominent transgender medical organization argued at a 2022 symposium that patients diagnosed with varying degrees of schizophrenia can consent to transgender hormone therapy and sex change surgeries, according to videos exclusively obtained by the Daily Caller News Foundation through a public records request.
Psychiatrist Dr. Gail Knudson made the remarks during the September 2022 World Professional Association for Transgender Health (WPATH) symposium, which followed the release of the group’s updated treatment guidelines. Knudson, the president of WPATH’s Executive Committee, argued that “people with diagnoses on the schizophrenia spectrum” have the capacity to consent to hormone therapy and surgery.
The event was an opportunity for gender medicine professionals to discuss and present various findings and research to their colleagues, and, crucially, also served to help “launch” WPATH’s updated Standards of Care (SOC). The symposium aimed at developing “best practices” in gender medicine related to the SOC, which plays a major role in influencing gender medicine.
During one training put on by WPATH’s Global Education Institute (GEI), Knudson said that while it varies “case by case,” schizophrenic patients can consent to cross-sex procedures.
“It’s a bit different though when people who are on the schizophrenia spectrum, whereas when they have a long-term illness in many cases, [after] following them for a long period of time and [becoming] well known to the team, they do have a capacity to consent for treatment, for hormones, for surgery, and, of course, [that] is depending case by case,” Knudson said.
Knudson, who is also a faculty member at the University of British Columbia (UBC), said that for some patients there are concerns about “mild psychotic symptoms” persisting despite treatment. She suggested that psychotic patients be placed in a psychiatric ward instead of a surgical ward for patients who have undergone sex change treatments.
“Consider admission to a psychiatric ward unit instead of a surgical ward for extra psychological assistance, post-operatively, after a person has had surgery and is stable,” Knudson said. “It’s actually putting a lot of wrap-around care in place.”
A spokesperson for UBC’s Department of Psychiatry told the DCNF that requests for comment had been forwarded to Knudson, who did not respond.
Research published in the journal Schizophrenia Research and Treatment has shown that schizophrenia diagnoses may be higher in transgender patients than in the general population. One well-cited study published in 2023 found that transgender individuals were significantly more likely to be schizophrenic, citing research that found transgender youth between 10 and 17 were 22 to 50 times more likely to be on the “schizophrenia spectrum.”
WPATH’s SOC Version 8 does not directly mention schizophrenia, but it encourages doctors to rule out the possibility of gender dysphoria manifesting from an “acute psychotic episode.” The standards further state that if a patient’s gender dysphoria continues after a psychotic episode, hormone therapy and surgeries can be “considered.”
According to the Cleveland Clinic, “psychiatrists once referred to different types of schizophrenia, like paranoid schizophrenia and catatonic schizophrenia.” But, according to the clinic, “the types weren’t very useful in diagnosing or treating schizophrenia. Instead, experts now view schizophrenia as a spectrum of conditions, including: Schizotypal personality disorder (which also falls under the category of personality disorders); Delusional disorder; Brief psychotic disorder; Schizophreniform disorder, and Schizoaffective disorder.”
While the American Psychiatric Association recognizes the “complexity” of schizophrenia, its definitions do not refer to any “spectrum.”
Dr. Carrie Mendoza, director of Genspect USA, told the DCNF that no “high quality, longitudinal evidence” exists that shows cross-sex hormones improve the mental health of transgender patients “over a sustained period of time.”
Founded in 2021, Genspect is made up of medical and mental health professionals, “detransitioners” and parental rights advocates who do not support hormone therapy or transgender surgeries for minors or young adults dealing with gender dysphoria.
‘No Underlying Therapeutic Rationale’
WPATH discussions and resources obtained by the DCNF shed additional light on how some WPATH members and gender medicine doctors are approaching the critical issue of consent. Many WPATH doctors largely believe that children could consent to gender transitions, and often downplay the role of parents in their child’s decision.
In a series of notes for a presentation on the topic, Dr. Luke Allen, a psychologist and WPATH member, claimed that parents cannot consent to transgender procedures for their children.
“Because informed consent describes a process where an individual understands and makes a decision for themselves, a parent cannot logically provide informed consent for their child,” Allen’s notes read. “Only the child/individual could do that, but the parent can provide parental permission.”
Allen wrote that for children younger than seven, it is unlikely that they have the capacity to consent and that arguments can be made for or against children younger than 14 having the ability to consent. Allen argued that children at the age of 14 and up are presumed to have the capacity to consent to transgender treatments and can be treated “without parental consent.”
Allen explained to the DCNF that “my views and comments are personal and do not represent any official stance of WPATH” and that the presentation does not “convey to attendees that physicians can treat minors without parental permission” except under certain circumstances.
“The presentation did not advocate for the treatment of minors without parental permission across the board,” Allen said. “Rather, it outlined existing legal and medical practices where, under certain jurisdictions and specific circumstances (such as the “mature minor doctrine“), minors might have the capacity to consent to medical treatments. This description was meant to provide a factual account of existing practices without suggesting any departure from standard legal and ethical frameworks that require parental permission, except where explicitly allowed by state law.”
Dr. Daniel Metzger, a WPATH-certified pediatric endocrinologist at British Columbia Children’s Hospital, made a similar claim in a presentation titled “Foundations in Gender Affirming Hormone Therapy: Adults and Adolescents.” Metzger explained that WPATH’s updated standards of care recommended that children as young as 14 could go on cross-sex hormones.
“Standards Of Care 8 says to think about treating at age 14 with hormones unless there are significant reasons not to do that or to do it earlier. Honestly, 13-and-a-half, 14, is where I think many places feel comfortable to do that,” said Metzger, who did not respond to requests for comment.
British Columbia Children’s Hospital also did not respond to the DCNF’s requests for comment.
Many individuals who have later reversed their gender transition, also known as “detransitioners,” have argued that they were not old enough to understand the consequences of transgender hormones or sex change surgery. Detransitioner Isabelle Ayala told conservative commentator Megyn Kelly in a March interview that her doctor diagnosed her with gender dysphoria at 14 after a 45-minute conversation and began putting her on hormones, which she reversed three years later.
For a patient to truly be able to consent, a physician must be able to “rationally explain the logic of his treatment,” according to Dr. Eithan Haim, a general surgeon and gender clinic whistleblower from Texas, who spoke to the DCNF.
In the case of gender dysphoria, Haim explained that medical professionals have been unable to provide “a concrete definition that is reliably tied to human biology, anatomy, or physiology” and instead they have turned to “amateurishly constructed circular definitions and forceful intimidation to obscure the nature of this failure.”
“A patient cannot give informed consent if the doctor is misinformed on the therapeutic rationale underlying the proposed intervention,” Haim said. “This would be the same if a general surgeon was proposing doing an appendectomy for depression. The patient can be informed of the risks, but it would not be considered an informed consent if the doctor falsely believes an appendectomy — treatment of the body — can be used to treat depression — a problem of the mind. Because there is no underlying therapeutic rationale for the intervention, an informed consent cannot be properly given.”
Haim, who is opposed to transgender ideology, is well known for exposing the fact that Texas Children’s Hospital – the largest children’s hospital in the world – was “lying to the public about the existence of their transgender program.” Haim said that after the investigation was released, two federal agents showed up to his apartment “in a highly atypical, unexpected, and aggressive show of force.”
Haim said, “Despite their best attempt at launching a surprise interview, I insisted on having an attorney present. Before leaving, however, I was given a target letter signed by a federal prosecutor that stated I was being criminally investigated for a case regarding “medical records.”
‘Call Out For The Autism Spectrum Kids’
Detransitioners have also warned that doctors overlook other psychiatric diagnoses, like autism and attention-deficit/hyperactivity disorder (ADHD), to push them into transgender medical procedures.
Notably, Dr. Ren Massey, a licensed psychologist and the co-chair for WPATH’s GEI, told conference attendees that it is important to get specific training because nearly one-third of their transgender patients are likely to be neurodivergent or on the autism spectrum.
“I think it’s really significant to notice that 30% identify as neurodivergent. If you are new to the field, that’s a thing. It’s really important, but that’s all that I’m going to say at the moment,” Massey, who did not respond to requests for comment, said in video footage obtained by the DCNF.
Worldwide, only one out of every 100 children in the world has been diagnosed with autism, according to the World Health Organization. In the U.S. the number is higher at one out of every 36 children, with it being four times as likely for boys as opposed to girls.
A study from 2020 that surveyed over 600,000 “transgender and gender-diverse individuals” found that those who identify as transgender were three to six times more likely to be autistic. Other studies reported that 6%-26% of transgender individuals were on the autism spectrum, according to the Autism Research Institute.
At WPATH’s 2022 conference, Dr. Chris Booth, a child and adolescent psychiatrist and faculty member at the University of British Columbia, gave a presentation titled “Foundations in Mental Health.” Booth discussed the process of diagnosing patients with gender dysphoria and mentioned how, in the past, autism immediately excluded someone from being diagnosed.
“I see many people on the autism spectrum,” Booth said. “It used to be without a doubt anyone with autism spectrum disorder was considered not a candidate for diagnosis. It was considered a preoccupation, you know, an obsessive interest, and they wouldn’t qualify, but now we know that there are persons with autism who have genuine gender dysphoria and can respond to treatment.”
Booth explained to the audience that he has only “seen a small slice of cases” where a person with autism claiming to have “transient interest,” or expressed interest in transitioning to the opposite gender, didn’t also have gender dysphoria.
“The case that I’m thinking of, in particular, was somebody who was extremely fascinated with certain personalities and would watch videos of a certain personality incessantly and would mimic them and dress like them, and this went on for quite some time until they dropped that interest and that personality and moved on to something else, but that’s unusual,” Booth said. “It is our job as a mental health clinician to try to sort these things out. I’ve seen many, many, many more people on the spectrum who’ve done well with supportive treatment.”
Booth declined to comment when contacted by the DCNF.
Dr. Scott Leibowitz, a psychologist at Nationwide Children’s Hospital in Ohio and a member of WPATH, said that doctors should learn how to be “neurodiverse-friendly” to autistic children, who identify as transgender, and make sure medical professionals “speak in ways that they can understand.”
“We always need to call out for the autism spectrum kids,” Leibowitz said. “We don’t believe autism or neurodiverse presentation or experience should prevent someone from transitioning, but we need to understand how to be neurodiverse-friendly to them and speak in ways that they can understand and that’s really important to help them process their own goals.”
A spokesperson for Nationwide Children’s Hospital told the DCNF they were declining an “interview request” for Leibowitz.
In another video, Dr. Wallace Wong, a psychiatrist who regularly treats patients as young as three years old, said that in his practice, he finds that transgender kids are “six to nine times more likely” to also have high-functioning autism. He noted that “assigned females at birth” are often very good at “masking” symptoms of autism, such as struggling with eye contact or lacking verbal skills.
“But when they come to the office when you put the pieces together, and we do the assessment for the autism, many of them … are diagnosed on the spectrum,” Wong says in the video. “So now the new guidelines tell us if you see the [female] kids, if you notice them, don’t just look [for] the typical signs like the boys do. They will not have any acting out behavior. They will have very strong verbal skills, they have eye contact, but their social skills and then the way they [have] very black and white thinking and all the sensory things. Those are better indicators for you to say, ‘Hey, you know what, this is what research telling us let’s look into this and many parents are open to this.’”
Wong co-leads WPATH’s GEI Diversity, Inclusion and Community Engagement committee, which is designed to “find creative ways to include marginalized or under-utilized contributors to the curriculum development and/or course delivery in every topic area,” according to its website.
Neither WPATH nor Wong responded to requests for comment.
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