Editorial – Urgent Call for Comments on WHO Announcement of Guideline on Transgender Health

The World Health Organization (WHO) announced on December 18, 2023 that it is going to develop a guideline on the health of “trans and gender diverse” [sic] people.

The WHO announcement states:

“The guideline is supposed to focus on 5 areas: provision of gender-affirming care, including hormones; health workers education and training for the provision of gender-inclusive care; provision of health care for trans and gender diverse people who suffered interpersonal violence based in their needs; health policies that support gender-inclusive care, and legal recognition of self-determined gender identity.”

For this, WHO has assembled a guideline development group (GDG). The GDG is composed of 21 members. The GDG consists of researchers with relevant technical expertise, among end-users (programme managers and health workers) and among representatives of “trans and gender diverse” [sic] community organisations. The WHO announcement has also published the biographies of the GDG members.

All of this is open for public comment till January 8, 2024. You can email your comments to hiv-aids@who.int

In the following piece, we point out some problems with the above mentioned propositions, why it matters and what you can do about it.

“Gender-affirming care”–what do they mean when they say that?

The WHO announcement defines “gender-affirming care” as a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity” when it conflicts with their sex. Behavioral intervention means behaving in ways that the society considers typical of the supposed gender identity of the individual. This is not harmful if a man or woman decides to break gender stereotypes and behaves in ways previously considered typical of the other gender. On the contrary, as a feminist, we support breaking gender norms. But when it comes to “gender-affirming care,” major questions arise:

Why is it that a trans-identifying man feels more feminine by wearing dresses and makeup? Who decides what kind of behavior is masculine and what kind of behavior is feminine?

The answer is easy: thousands of years of patriarchy that has created a system where certain behavior is considered feminine and others masculine. Through “gender-affirming care,” when a health professional recommends a trans-identifying man to act more feminine in order to conform to his “gender identity,” the health care professional is reinforcing these stereotypes created by patriarchy. Both patriarchy and “gender-affirming care” state that, if you are a particular gender, you have to perform in ways stereotypical to that gender in order to be happy. The only difference between the two is that patriarchy bases your gender on your sex (a biological reality), whereas “gender-affirming care” bases your gender in your gender identity (a psychological feeling that is in turn based on the social construct of gender).

Psychological intervention in a “gender-affirming care” is one that validates the client’s gender dysphoria. It does not challenge the dysphoria in any way. While validation might, on the surface, seem a compassionate response (and it is for a lot of situations), it is not an appropriate one in many situations. For example, an anorexic client believes she is fat, even when her body is dying out of a lack of nutrition. If a therapist tried to “validate” her feelings of being fat, he would (quite rightly) be questioned on the ethics of his action. The same goes for body dysmorphic disorder, where a person is obsessed with a part of her body being “abnormal” or “not right” that it affects her daily functioning. There’s also body integrity identity disorder, where a person believes that he cannot be his real self unless he destroys a specific part of his body and opts for voluntary mutilation. How would you feel about a psychologist who would validate a person’s desire to mutilate his body and assist in the process? Here’s a video of a woman who claims to have voluntarily poured toilet cleaner in her eyes in order to blind herself.

Is gender dysphoria like body dysmorphic disorder and anorexia nervosa, i.e. arising out of a deep-rooted hatred for one’s body, that needs to be challenged ethically, or is it like a condition that needs to be accepted?

There are differing opinions on this. Yet, there is one thing that cannot be discredited by anyone. It is that most people suffering from gender dysphoria have a history of childhood trauma and other problems, as confirmed by a whitsleblower of a so-called gender-affirming service. When a person suffers from that kind of trauma, feeling a hatred or disgust with one’s body, or even dissociation from one’s body, is a common response. Talk to anyone who has been sexually assaulted, or molested about the immediate response of her body. Psychologists or psychotherapists know this. Yet, under “gender-affirming care”, they conveniently overlook this. Under “gender-affirming care,” you cannot talk about the childhood trauma, because anything that mildly challenges their dysphoria is considered (in an Orwellian twist of language) malpractice. In reality, not dealing with trauma should be dealt as an unethical conduct for a psychologist.

Medical intervention in “gender-affirming care” involves the use of puberty blockers, hormone replacement therapy (HRT) and sex reassignment surgeries (SRS). Puberty blockers are used in prepubescenct children to stop puberty, because, we (as a culture) finally decided that a prepubescent child can have the right to make life-altering decisions. GnRH, a category of drugs used as puberty blocker, suppresses the release of testosterone in male and estradiol in female, thus stopping the development of primary and secondary sex characteristics. If taken for a long time, it permanently affects the body’s production of follicle stimulating hormone (FSH), lutenizing hormone (LH), testosterone and estradiol – all of which are related to a normal reproductive and sexual functioning. And, this is a decision a child is making before puberty, before the child has even had a chance to see himself as a sexual and/or reproductive being. Lupron is also the drug that is used to chemically castrate male sex offenders. However, it is recommended to be reserved for offenders with “highest risk of sexual offending due to its extensive side-effects“.

Simply put, the drug that is too harmful for a person with a low to medium risk of sexual offending, is promoted by “gender-affirming care” to children without a fully developed prefrontal cortex (i.e. without the ability to fully comprehend consequences of one’s actions).

HRT and SRS are not better either. There are many who regret these interventions for the impact that they had, and mainly because they were never given the actual intervention that they needed: trauma healing. A pioneer study looked into the lived experiences of 237 detransitioners on their regret, medical complications, and even, the vitriol they face from trans-rights activists.

For a well-written account of a detransitioner, read Kiera Bell’s story. Her tireless activism and legal lawsuit was what brought in stricter regulation for medical intervention in the UK.

Self-identified gender identity

Self-identified gender identity or Self-ID (as it is commonly known) means the ability of a person to be able to change one’s sex legally without the need for any medical intervention or for any form of psychological assessment. Trans rights activists have been pushing for self-ID in many countries, claiming that it would help with gender dysphoria. After all, treating a person in the way that they desire to be treated should not have been a problem. Unfortunately, it turned out to be. It meant rapists immediately after conviction claiming to be women and then being housed in women’s prisons, where they get access to vulnerable women. It meant men claiming to be a woman getting into seats reserved for a woman. It meant mediocre male athletes claiming to be women and playing in women’s sports, where due to their biological advantage, they easily win the competitions. It meant pedophiles claiming to be women to get lighter sentences. For countries where law does not recognize a woman raping woman, it could mean no sentence for a rapist claiming to be a woman. For more on how self-ID has been misused by sex offenders, read this open letter by Derrick, Lierre and Max.

Self-ID is an issue where the demands of the trans rights movement directly clash with the hard-fought rights of women for centuries. Sadly, many have chosen to forego of women’s rights in order to validate men’s feelings.

Why it matters?

WHO is a leading body on health related information throughout the world. Although WHO guidelines are not binding (i.e. no country is forced to comply by its standards), it does have high influence in creating standards across many countries. This is especially true for low and middle income countries (LMIC). LMIC lack the resources and expertise to develop guidelines of their own. As a result, they have a greater reliance on WHO guidelines for health related issues. Regardless of the economic status of the countries, WHO is an authority body when it comes to health related matters globally. It is bound to have a great influence in the policies of all nations.

What can you do?

• Submit your comments to hiv-aids@who.int The deadline for submitting comments on the WHO announcement is January 8, 2024.
• Sign this petition by Who Decides It explains many issues with the announcement that may not have been covered in the above piece.
• Find women and men around you and organize to defend these hard-fought rights in your locality.

Photo by Alexander Grey on Unsplash