The World Professional Association for Transgender Health (WPATH) has been lecturing the public for years to listen to their expert opinions on helping people transition to the opposite sex. Unfortunately for them, their behind-the-scenes conversations are now public, so finding out what they really think is possible. And it is alarming.

Following the release of the U.K.’s Cass Report, an extensive review of youth gender medicine that incorporates four years of assessment and multiple systematic reviews, and then also the whistleblower-released WPATH Files, now comes the publication of the WPATH Tapes. Resulting from a public records request, the WPATH Tapes highlight what’s being said by WPATH-affiliated endocrinologists behind closed doors during educational member symposiums. The Daily Caller News Foundation’s investigative series on the tapes features these endocrinologists contradicting WPATH’s “safe” and “effective” public propaganda. In private, they admit to routinely prescribing toxic drugs and promote a cavalier approach to administering hormone-altering, Lupron-like medications to patients.

Already in 2019, a retiring endocrinologist complained of the trend in “devaluing” expertise while pediatric endocrinologist and WPATH educator Dr. Kara J. Connelly was finishing six years of practice by recommending a gender specialty to endocrinology students. Training is highly desirable, and not just because the field casts highly inspirational stories. Oregon, where Connelly practices, covers all transgender-related medications and surgeries under state Medicaid. I’ll say, inspiring.

Patients often demand dramatic changes in appearance. This spurred WPATH endocrinologists to be obsessively preoccupied with visual outcomes despite their field’s traditional focus on treating diabetes and hyperthyroidism, which generally precludes cosmetic considerations. Summing up 2017 Endocrine Society (ES) guidelines, American endocrinologist Dr. William Malone recently observed that “gender dysphoria guidelines justified the use of puberty blockers for children just entering puberty by stating that appearance changes were more important than avoiding harm.” This is proven by the WPATH Tapes. For instance, when Canadian endocrinologist Dr. Marshall Dahl reviewed the effects of testosterone, he clearly gave more attention to cosmetic changes such as hair growth than medical risks such as extreme clitoral growth, fatty liver, and vaginal atrophy.

Patients come to endocrinologists under the impression that their identity distress is a detectable pathology like diabetes. For its part, ES has contributed to this kind of confusion by lumping identity distress in with physical conditions. However, Dr. Robert Garofalo, the Division Chief at Chicago’s Lurie Children’s Hospital, says there’s no lab test, scale, or even psychological assessment for identity. Yet WPATH-affiliated endocrinologists support quickly medicalizing patients who seek to transition in the misguided fear that they need to “pass” to survive discrimination as a minority. However, suicide in minority populations such as black Americans is relatively insignificant. Moreover, in long-term studies that are better able to track self-harm, suicide increased by 12 percent following surgery, echoing a Swedish study finding a 20 percent increase after “life-saving” gender medicine.

WPATH endocrinologists also minimize the dangers of taking off-label medications to block testosterone. Although they do not recommend bicalutamide, the lone dissenting voice against prescribing it is Dr. Asa Radix, an infectious disease specialist who warns that such medications are “incredibly dangerous.”

Spironolactone is similarly standard script in the tapes, despite patients complaining that it is too damaging in its effects. ES established spiro as the preferred option in the 90s, but it is now generally considered undesirable. Such toxic medications were initially deemed permissible as chemotherapy drugs and were only later marketed for OBGYNs and use in gender medicine. Dr. Dahl considers it viable because it’s inexpensive.

Endocrinologists have known at least since Lupron was released that blocking hormones is dangerous. Heck, even the FDA warned that it can cause brain swelling and vision loss. It is for good reason that hormone blockers are banned in the U.K., Alberta, and Florida, because they are linked, among other things, to a permanent loss of bone density and irreversible damage to organs, fertility, and brain function. So when Dr. Daniel Metzger, a WPATH-certified pediatric endocrinologist, characterized the effect of puberty blockers on brain development as “unknown,” that is disingenuous.

Blockers produce a multitude of adverse reactions with very little evidence of any benefit. For years, studies have demonstrated outcomes such as enlarged amygdalae, spatial memory impairment, and lowered IQ. It is worth considering, with Australian professor of pediatrics Dr. John Whitehall, whether these so-called experts are unable—or unwilling—to stay abreast of the relevant scientific literature. As medical professionals, don’t they owe it to their patients to be fully aware of the dangers instead of tallying drug revenue?

But perhaps the most obscene claim about blockers is that they are reversible. Though the public face of WPATH and its affiliated organizations produce a constant stream of blocker propaganda, the WPATH Tapes contradict this rhetoric. In contrast to their public-facing “standards,” WPATH endocrinologists clearly acknowledge that these medications are fraudulently promoted. They admit to the irreversible effects of such therapy, such as the phallus remaining at pre-puberty size. And despite Dr. Metzger maintaining that the effects of puberty suppression on the brain are unknown, section 6.12c of WPATH’s most recent standards admits that brain development is negatively affected. Metzger’s mere mention that blockers “rewire” the brain’s development gives the lie to WPATH dogma.

Dr. Scott Leibowitz, a member of WPATH’s Board of Directors, calls puberty suppressions “way more invasive” than people think: “There’s challenges with puberty suppression that we have to acknowledge and that’s why it’s ‘reversible asterisks.’” Asterisks give background details to clarify a point, so asterisks here go beyond the Cliffs Notes version WPATH serves the public. As Leibowitz says, “One cannot be on puberty suppression endlessly. You get to a place where physiologically we need hormones.” WPATH’s backstage asterisk thus outright contradicts their at the time just-published “standards.”

WPATH exists to assign authority to dodgy prescriptions with only nominal regard for particular cohorts. For instance, WPATH clinicians fail to fully discuss potential dangers to females even though testosterone package inserts specifically state they are “Not for use in women.” Since these drugs are not FDA approved for gender distraught individuals, inserts omit warnings for females. And even then, only a few inserts even mention the possible side effect of liver cancer. This doesn’t get called out because female patients believe they are really men, and besides, being under a doctor’s care makes risk negligible, right?

Witnessing one of the clearest documented cases of injury, whistleblower Jamie Reed, a former intake case manager at The Washington University Transgender Center at St. Louis Children’s Hospital, carefully tracked health effects experienced by a 15-year-old child, particularly noting bicalutamide liver toxicity. Pediatric Endocrinologist Dr. Christopher Lewis followed typical WPATH practice in prescribing bicalutamide to stop testosterone production. In a sworn affidavit to the state’s attorney general, Reed testified that the parents reported resulting liver damage:

Because of these risks and the lack of scientific studies, other centers that do gender transitions will not use Bicalutamide. The adult center affiliated with Washington University will not use this medication for this reason. But the Center treating children does.

Such off-label use of dangerous drugs calls attention both to WPATH’s lack of internal policing and their freewheeling approach to prescribing extremely dangerous medications. In fact, in the WPATH Tapes, Dahl laughed when accurately emphasizing the off-label character of the whole field of gender medicine, which is based around medications not approved by the FDA. While WPATH speakers say they’re helping patients meet specific “embodiment goals,” patients actually side with the U.K.’s Cass Report and recognize they are not being treated holistically as “complete and complex human beings.”

How do WPATH endocrinologists react to their own off-label use of bicalutamide-type drugs when messing about with healthy hormonal levels? They laugh. Co-author of both the WPATH and ES guideline Dr. Joshua Safer shared a chuckle with an audience when he admitted to calculating hormone doses based on a “best guess.”

Safer explained that hormones are jacked up beyond normal levels to simulate puberty, specifying that this is done primarily for cosmetic reasons—not for “health reasons.” Contra Dr. Safer, ignoring a patient’s health could have catastrophic consequences. A recent court case in the U.K. involves a 15-year-old-girl judged at risk of sudden death because a gender clinic administered double the adult male level of testosterone, a dangerously high dose that placed her at imminent risk of fatality. Dr. Safer is therefore not an outlier in treating the dispensing of dangerous medications like a crap shoot.

A February 24, 2022 post included in the WPATH Files features an anonymous doctor disclosing that a female friend developed liver cancer after “about 8-10 years” of testosterone use. “It was so advanced that [she] opted for palliative care and died a couple months later,” the doctor wrote. (A Newsweek article titled “Transgender Hormone Drugs Linked to Cancer” reviews this connection.) And even the producers of hormone products warn in their product labelling, “‘Cases of benign and malignant liver tumours have been reported in users of hormonal substances, such as androgen compounds.’” For women, the drug is “contraindicated”—meaning that it’s not to be used.

Following the release of the Cass Report, WPATH doubled down on its “listen to the experts” rhetoric, and ES has used similar boilerplate propaganda. No matter: the WPATH Tapes feature the “experts” in their own words in sheltered online enclaves. Epiphanies that began with the previous release of the WPATH Files are further reinforced by this new material, and public perception of WPATH and affiliated groups will hopefully be forever changed.

Will WPATH endocrinologists lose patients over online clinics and walk-in providers such as Planned Parenthood? Who knows. But WPATH cannot sustain the reputational blows coming. One after another, these conversations reveal the absence of the most basic standards of ethical medicine. As seems evident from their willingness to jeopardize patient safety that ES may collapse due to their failure to safeguard themselves from gender medicine. Or they may be brought under tighter regulation by Medicaid.

Of course, endocrinologists can be replaced altogether by family practice physicians or AI. After all, if AI can read X-rays more accurately than physicians, it can calculate gender medications, especially given the low bar for precision in prescribing them. As whistleblower Jamie Reed details, distraught females well past the window for puberty suppression came in demanding puberty be stopped and were not accurately screened for distress over menses but simply placed on testosterone.

The Endocrine Society, like WPATH, has a lot to answer for in the wake of the Cass Report. This is the Cass effect. After Cass and the WPATH Tapes, medical organizations like ES and WPATH will face increasing backlash—and will hopefully be shuttered for good.