A version of the letter below has been sent to editors and journalists in New Zealand regarding the latest Cass Review and the WPATH developments. A similar letter, sent to Health Minister Dr Shane Reti is available here on the Genspect substack
Kia ora [Journalist],
I write to you on the topic of transgender health. There are two under-reported stories with direct and important relevance to NZ and your readership.
1. A number of European clinical societies have endorsed the NHS’s independent Cass Review or made declarations consistent with its findings. Advice from the Cass Review has led to the NHS ending the routine use of puberty blockers for gender-questioning adolescents.
2. Organisations promoting medical interventions on minors such as the World Professional Association of Transgender Health (WPATH) have come under increasing legal scrutiny. Revelations from unsealed court documents in the USA confirm that WPATH is primarily an activist organisation rather than the scientific organisation it claims to be.
These stories will be of interest to NZ readers because the local chapter of WPATH is the Professional Association of Transgender Health Aotearoa (PATHA). PATHA has the contract to create the new “national gender affirming care” guidelines and the commissioning document from Health NZ states that the new national guidelines are to be drafted in line with the 2022 WPATH “Standards of Care” version 8 (SOC-8). Some members of PATHA are also members of WPATH – notably former PATHA President and current executive board member Dr Jamie Veale, who is also the current Secretary of WPATH and is listed as an author of SOC-8.
With policy on medical interventions on minors now diverging dramatically internationally, the basis for current permissive policy settings in New Zealand deserves scrutiny. Slightly over 400 adolescents were being treated with puberty blockers in 2022 –approximately 10x the recent England and Wales per capita treatment rate.
1. Regarding the clinical society endorsements :
– The UK’s Royal College of Psychiatrists have welcomed the Cass review:
“[the report] offers a roadmap toward more effective, compassionate, and evidence-based care for transgender and gender-questioning children and young people”
– The UK’s Royal College of GP’s issued a statement with advice “[t]o fully implement the provisions of the Cass review in England and adoption of the principles it identifies across the nations of the UK”.
–The Association of Clinical Psychologists UK responded to the Cass review positively: “It has employed the highest clinical and research standards available at this time. We particularly commend the extensive consultation with a range of stakeholders and, most importantly, the young people who use services and their families.”
– The European Society of Child and Adolescent Psychiatry –an umbrella group of 36 national-level child and adolescent psychiatry societies published a statement calling on psychiatrists “not to promote experimental and unnecessarily invasive treatments with unproven psycho-social effects and, therefore, to adhere to the 'primum-nil-nocere' (first, do no harm) principle.” The group pointed to the "poor reliability and instability of a gender dysphoria diagnosis in a specific child over time" and the "possible effects of the decisions to block puberty or preventing medical transitioning on a child's psychosocial development."
– The 2024 German Medical Assembly, a convention with delegates from 17 medical societies, passed a resolution to restrict medical interventions on gender-questioning minors to research settings. Votes were overwhelmingly in favour (120 for, 47 against, and 13 abstentions).
– The UK Council for Psychotherapy published a statement quoting the Cass Review and reiterating that “[e]xploratory psychotherapy must not be conflated with conversion therapy”; while noting the legal protections to which ‘gender-critical’ therapists are entitled (i.e. therapists who are sceptical of the proposition that a gender identity is an intrinsic quality of a person).
These statements are in addition to the national health bodies of Finland, Sweden, Denmark, Scotland, Chile, and authorities in Alberta, Canada and 25 US States restricting or halting puberty blockers for adolescents; authorities in Italy, Norway, the Netherlands, and France initiating reviews; the Editor-in-Chief of the British Medical Journal endorsing the Cass Review; and the World Health Organisation deciding not to pursue guidelines for children and adolescents because “the evidence base for children and adolescents is limited and variable regarding the longer-term outcomes of gender affirming care…”.
Restrictions and bans have occurred or continued under left-wing governments (e.g. Finland, Chile, Denmark and the newly elected UK Labour government). The issue’s prominence does not appear to be tied to a socially conservative political perspective. In many cases it has been initiated by politically independent health authorities concerned about the lack of evidence supporting medical interventions.
Prolific prescriber of puberty blockers Dame Sue Bagshaw has framed restrictions of puberty blockers as a “moral panic”. However, the vector of moral panics is not usually weighty independent reviews passing through dozens of expert hands under intense public scrutiny; and Bagshaw may not be aware of the breadth and depth of those who have subsequently supported the Cass Review’s recommendations. When we look at the actual motivations of those advocating restrictions on blockers it is often a concern that same-sex attracted young people have mistaken a tendency to not conform to sex stereotypes for an innate gender identity. This position is now supported by the Cass Review.
2. Regarding the WPATH revelations
In addition, recent unsealed court [1] documents [2] in the USA, reported in the New York Times, NYT Opinion, The Economist, the Washington Post, the New York Sun and The Hill, confirm that WPATH is primarily an activist organisation rather than the scientific organisation it claims to be. WPATH produces guidelines and research to advance political goals and provide legal cover for the controversial medical practices of WPATH members and has little understanding of evidence-based medicine.
The court documents, obtained through legal discovery, include internal communications between WPATH members and reveal several concerning issues:
1. Lack of consensus and evidence: Guideline authors expressed concerns about the lack of consensus and evidence for SOC-8 recommendations. One WPATH member stated,
“My understanding is that a global consensus on ‘puberty blockers’ does not exist.” [1] When WPATH President Dr Marci Bowers was asked under deposition “whether reasonable people could conclude that there is not enough evidence to support the safety or clinical effectiveness of puberty blockers.” Bowers replied “There's not enough high level evidence. Yes, you can – you can – you can say that”. [2]
2. Loosening standards: SOC-8 Authors worried that they had "loosened standards and lost some control." Some clinicians were providing "treatment on demand," and SOC-8 would further "open that up." [1]
3. Influence of social factors: Authors noted that "social factors" and immature decision-making could lead young people to mistakenly believe they are transgender. However, there was "no assessment tool" to differentiate between genuine and mistaken transgender status. [1]
4. Subservient to political and legal objectives: Guideline authors lobbied to tailor the language to influence courts and legislatures, even at the expense of scientific accuracy. One WPATH member admitted, "Our concerns…is [sic] that evidence-based review reveals little or no evidence and puts us in an untenable position in terms of affecting policy or winning lawsuits." [2]
5. Conflicts of interest: The lead guideline author, Dr Coleman, agreed with the statement that “most participants in the SOC-8 process had financial and/or nonfinancial conflicts of interest. Dr. Bowers admitted to making "more than a million dollars" in revenue from sex trait modification surgeries the previous year but found it “absurd” to disclose this while authoring a guideline recommending such surgeries. SOC-8 readers were misled to believe that "no conflicts of interest among the authors were deemed significant or consequential." [2]. In the USA puberty blockers can cost “tens of thousands of dollars a year” per child. Guidelines that recommend the routine use of puberty blockers could therefore be a lucrative marketing tool for providers.
6. Suppression of systematic reviews: Guideline authors suppressed the publication of, or avoided commissioning, systematic reviews as reviews that found "little to no evidence"[3] would undermine WPATH’s political objectives. The lead author of the mental health chapter testified that instead of relying on systematic reviews, they "used authors we were familiar with." Another author highlighted concerns about language indicating "insufficient evidence" or "limited data" as it would “empower” groups “trying to claim that gender-affirming interventions are experimental.” [2]
7. Political interference: In the final days before SOC-8 publication, age minimums for adolescent hormonal treatments and surgeries were removed due to external political pressure. WPATH had shared a draft with the Assistant Secretary for Health, Admiral Levine, who identifies as a woman. Levine argued that age minimums would undermine the administration's political goals. The American Academy of Pediatrics (AAP) also threatened to publicly oppose SOC-8 unless age minimums were removed. Despite their low regard for the AAP, WPATH complied, contradicting the wishes of some guideline authors and the WPATH’s own formalised consensus process. WPATH later falsely claimed that the removal was due to a renewed focus on "individualized care." [2]
I have outlined how the Cass Review's recommendations align with a broad section of the international scientific and medical community, potentially including New Zealand. Indeed, high-ranking New Zealand health officials removed the description of puberty blockers as "safe and fully reversible" from the Ministry of Health's website in 2022, diverging from PATHA's stance.
Unfortunately, large sections of the NZ Media have taken an unsustainable narrative, framing critics of medical interventions as fringe voices. Stuff’s 2022/23 position argued that puberty blockers were supported by “accepted science”, and that people who question the scientific basis of puberty blocker benefits are akin to climate change deniers. It is doubtful that a New Zealand audience that reads overseas coverage of the issue will continue to be led by this style of reporting.
Coinciding with notable decreases in public trust in the media, many journalists now seem to see their role defending ‘accepted science’ and ‘vulnerable communities’. Reporting ‘both sides’ is out and ‘countering harmful misinformation’ is in. This has made often poorly resourced journalists vulnerable to savvy PR. If one side of a debate presents itself as representatives of a vulnerable community and silences critics with accusations of transphobia then quite flaky organisations with their own agendas can gain influence.
Organisations endorsing the Cass Review typically have exclusively clinical/medical professional membership. In contrast, WPATH and PATHA allow non-clinical members who support their political goals of expanding publicly funded surgeries and hormonal treatments. Notably, PATHA's past and current presidents lack medical qualifications or clinical experience relevant to authoring clinical guidelines. In the photo below the past and current PATHA presidents are respectively Dr Veale: back row far right; and Jennifer Shields: far right.
In 2022 current PATHA president Shields gave the following bio:
“....an artist, advocate, web developer and event producer…interested in alternate spiritualities…a tarot reader and a party witch.” .
PATHA claimed that the Cass Review discarded “101 out of 103 studies” –a misleading statement also spread by UK Labour MP Dawn Butler, who later apologised in the House of Commons. PATHA president Shields called the nearly 4-year and 388 page Cass review final report “trash” the day after its release. Shields also made an unsubstantiated claim that “decades and decades” of evidence shows that a non-medical approach to gender-questioning adolescents leads to “deaths”[3]. Additionally, Shields spread claims that UK restrictions on puberty blockers have lead to a “huge increase” in adolescent suicides alledgedly covered up by the NHS. These claims have been refuted in an independent review by Professor Louis Appleby, a suicide prevention advisor.
Organisations that promote medical interventions do include well-meaning medical professionals, but many will also have conflicts of interest due to their careers built on the medical intervention model. Higlighting this, the AAP faces a lawsuit from a detransitioner alleging civil conspiracy and deceptive practices. In response, medical malpractice insurers are raising premiums or refusing coverage for clinics performing interventions on minors, potentially affecting long-term viability of such practices in the USA.
New Zealand journalists have noted inconsistencies in the Ministry of Health’s position. This inconsistency may result from competing perspectives within the public service: those with a scientific, evidence-based medicine approach versus those aligned with PATHA. The outcome of this conflict will impact potentially hundreds of children and adolescents who, due to “social factors” (as one WPATH author put it), feel out of place with gender roles and seek medical solutions. The media can perform a public service by covering this issue in a balanced way.
Best wishes,
Simon Tegg
Endnotes and Citations
[1] Boe v. Marshall - Exhibit 24: Appendix A to Supplemental Expert Report of
James Cantor, Ph.D. https://storage.courtlistener.com/recap/gov.uscourts.almd.77755/gov.uscourts.almd.77755.591.24.pdf
[2] Boe v. Marshall: Defendant’s Motion for Summary Judgement
and Brief in Support https://storage.courtlistener.com/recap/gov.uscourts.almd.77755/gov.uscourts.almd.77755.619.0.pdf
[3] On the 1st of May Shields appeared on the 1 of 200 podcast to discuss the Cass review and made the following statement about the non-medical approach to gender “watchful waiting”:
“And we have, you know, decades and decades of proof that watchful waiting doesn't work, that watchful waiting leads into poor mental health outcomes, and in the deaths of trans people, we've got so much evidence that that doesn't work, thoroughly more evidence than we have of any potential harm that blockers might have.”
It's perfect, Simon.
This is so timely, your thorough review of the status quo is much needed. Thank you !
Any chance you can let us know who you’ve sent it to? Katy, LKBK