Physicians Must Demand Answers from WPATH
It is high time for medical organizations to confront WPATH about manipulating its own research
In July of this year, the United States Federal Trade Commission conducted a daylong hearing during which its Chairman, Andrew Ferguson, laid out a fairly cogent case for possible fraud in the field of youth gender medicine. They day ended with a call for action – the FTC requested patients and their parents who feel they may have been misled during their experiences accessing youth gender medicine to submit comments that may guide a future further investigation into medical fraud. The full recording is here. I reported on the first 6 or so hours. The public comments on the possible investigation are available on the FTC’s website.
As a physician with excellent training in medical research methods, I was most disturbed by what I heard about the WPATH. The World Professional Association for Transgender Health has positioned itself as a group of expert clinician-scientists. However, within the last two years, evidence has increasingly come to light that suggests its leadership engaged in a profoundly unethical manipulation of data to support the recommendations – broad medical and surgical interventions for gender dysphoric youth – that they wished the evidence to support.
Before the FTC hearing, I had been working on the assumption that the field of youth gender medicine simply suffered from a lack of long-term follow-up data, and that well-meaning clinicians somewhat naively became over-enthusiastic about treatments (puberty blockers, cross-sex hormones, and surgeries for minors) that didn’t have the data behind them to be ready for prime time.
However, Leor Sapir, a research fellow at the Manhattan Institute who spoke during the FTC hearings, described behavior on the part of WPATH that goes beyond naivete. If what Sapir states is true, we in the medical community have been frankly misled by this organization. It seems that WPATH’s leadership are not well-trained physician scientists with a deep understanding of research methodology, but instead highly influenced by non-scientist activists and, either subconsciously or consciously, changing their research post hoc to reflect what they wish the data would show. In my opinion, the allegations are credible. The WPATH has lost my trust, and I am embarrassed that my own specialty’s professional organization, the ACOG, has based any of its own recommendations on their guidelines.
A Brief History of Youth Gender Medicine and WPATH Guidelines
Youth gender medicine is the most visibly controversial area of WPATH’s domain. Although there is hardly more evidence for adult gender medicine, we as a society generally allow adults to do what they wish to their bodies, for better or for worse. By contrast, we have the expectation that minors will be protected from unwarranted medical interventions. The bar for doing no harm is higher for children.
The first United States gender medicine clinic for children opened in 2007, affiliated with Boston Children’s Hospital and was called GeMS. At that time, the WPATH was named the Harry Benjamin International Gender Dysphoria Association. Its Standards of Care (SOC) Version 6 , published in 2001, had guided the care of gender dysphoric minors. “Only a few gender variant youths become transsexual, although many eventually develop a homosexual orientation,” this document notes. The SOC 6 takes care to emphasize that irreversible interventions for minors must be very well thought out, as gender identity is subject to change. “Identity beliefs in adolescents may become firmly held and strongly expressed, giving a false impression of irreversibility; more fluidity may return at a later stage. For these reasons, irreversible physical interventions should be delayed as long as is clinically appropriate.” According to the SOC 6, while puberty blockers may be given to adolescents at Tanner stage 2, cross-sex hormones should be delayed until age 16, and surgery should be delayed until age 18. No citations are given in this document. It is presented as simple expert opinion.
The state of the evidence behind youth gender medicine when GeMS opened in 2007 was meagre. The initial landmark “Dutch Study” that followed 70 gender dysphoric adolescents who received puberty blockers and cross-sex hormones was still accruing subjects and would not be published until 2011. Essentially, the children at GeMS were being given an experimental treatment regimen – but they were not followed to track their outcomes; they were not part of a study; there was no IRB involvement. They were just given an experimental treatment that would change their lives forever in an unknown way.
A new iteration of the guidelines, the SOC 7, was published in 2012. The Harry Benjamin Association had rebranded to WPATH (World Professional Association for Transgender Health). The 22-page citationless document from 2001 had grown to 120 pages and included a number of academic references. The SOC 7 still noted that of prepubertal boys referred to gender clinics for dysphoria, only 6-23% had dysphoria persisting into adulthood. For girls, this was 12-27%. The SOC 7 asserted that for adolescents, the rate of persistence “appear[ed] to be much higher”; however, the only citation to support this claim was the Dutch study of 70 adolescents recruited from 2000 – 2008, none of whom had detransitioned as of 2010. A major change of the SOC 7 was the removal of any discussion of lower age limits for cross-sex hormones. In addition, mastectomy in minors is permitted under these guidelines. “Chest surgery in FtM patients could be carried out earlier [than age of majority], preferably after ample time of living in the desired gender role and after one year of testosterone treatment.”
The number of youth gender clinics in the United States had exploded soon after the SOC 7 were published. From GeMS opening in 2007 to 40 clinics nationwide by 2017, as well as a substantial number of independent practitioners who were comfortable providing youth gender medicine via their private practices.
WPATH Seeks Better Evidence for Its Recommendations
However, as is clear from the sparse citations in the SOC 7 document, the quality of research supporting the liberalized guidelines for youth gender medicine was far scantier than similar recommendations from other specialty societies. According to Leor Sapir of the Manhattan Institute, who spoke at the FTC hearing, WPATH leaders wished for their upcoming SOC 8 to have the credibility of being backed by stronger evidence, and so they decided to commission systematic reviews on specific questions in the field of youth gender medicine.
Now we are going to get nerdy. For my fellow Ob/Gyns, you will have noticed that every ACOG Practice Bulletin contains a box with the description of the GRADE system for grading evidence. For example, Practice Bulletin #222, “Gestational Hypertension and Preeclampsia,” contains recommendations supported by evidence ranging from Grade A (women with gestational hypertension or preeclampsia at or beyond 37 0/7 weeks gestation should be delivered) to Grade C (Epidural or spinal anesthesia is considered acceptable for women with platelet counts of 70,000 or higher). Grade A is the best, but even Grade C recommendations are pretty solid in the world of medicine, and we tend to follow them when ACOG makes them.
None of the recommendations in the SOC 7 came with a GRADE. As Sapir tells it, this was a problem for WPATH, even as gender medicine was becoming mainstream and, crucially, being covered by insurance. Insurers even covered pediatric gender transition. Typically, insurers look for treatments that they cover to be evidence-based, particularly if they are controversial and/or expensive. Youth gender medicine is both.
We know that, in 2017-2018, the WPATH commissioned the Johns Hopkins University’s Evidence-Based Practice Center to conduct a series of systematic reviews on their behalf. The intention was for the SOC 8 to be more evidence based than the SOC 7. WPATH hoped to cite these systematic reviews in their upcoming revised guidelines, the SOC 8, in order for the recommendations to get an evidence grade and thereby be more credible. After all, many small studies had been conducted here and there about various aspects of gender medicine. I assume the leaders of WPATH sincerely believed that when these studies were aggregated by experts, they would show a benefit to gender medicine for both adults and youth.
WPATH did not make this process of commissioning systematic reviews transparent or public. However, we have a fair amount of information about it, because the State of Alabama was able to obtain it in legal discovery. After Alabama passed a ban on youth gender medicine in 2022, transgender-rights organizations such as GLAAD filed a lawsuit against the state, successfully obtaining an injunction against the State of Alabama so that it could not enforce the law.
As Edmund LaCour, the Solicitor General of Alabama, told it at the FTC hearings, the plaintiffs argued that transgender-identifying youth were in immediate danger if not allowed to pursue medical transition. The plaintiffs argued that they were at risk of death by suicide. They argued that the WPATH guidelines recommending medical and surgical transition for minors were backed by solid science. LaCour says that this was a successful strategy with judges, who tend to defer to the expertise of medical organizations. However, he suspected that there was not strong science behind WPATH’s guidelines, nor that the risk of suicide could be alleviated via gender affirming medicalization. So he sought emails and other internal communications from WPATH and the federal government in the course of legal discovery. He ended up with a treasure trove of information about the, in my opinion, secretive and quite un-scientific process that resulted in the publication of the WPATH SOC 8. The numerous documents may be found on the State of Alabama’s website.
As a disclaimer, I am a liberal, pro-choice lesbian Ob/Gyn. I would not have ever imagined agreeing with the Solicitor General of Alabama on anything. Indeed, there is very little that I otherwise agree with Mr. LaCour about. But this is a very clever legal strategy, and he seems to have a good grasp on WPATH’s motivations. It is this discovery by the State of Alabama that has made publicly available information into WPATH’s actions in suppressing the systematic reviews it commissioned from Johns Hopkins.
(Overall these documents are grim and depressing, but there is also the part where WPATH’s [British] then-president got upset at the AMA for refusing to endorse the SOC 8 – since the AMA is not in the business of endorsing specialty society guidelines – and said via email that the AMA is “probably” run by “white cisgender heterosexual hillbillies from nowhere.” That is a truly poetic statement. I am also a white cisgender hillbilly from nowhere, so we probably have some common interests.)
We know that the lead on the team for the systematic reviews commissioned by WPATH was Dr. Karen Robinson, PhD, Director of the Johns Hopkins Evidence-Based Practice Center. She was eminently qualified to lead this effort. According to a proposal made to WPATH in early 2017: “The proposed PI (Karen A. Robinson, PhD) is Director of the AHRQ-designated Johns Hopkins University Evidence-based Practice Center (EPC) and has been a leader in the Cochrane Collaboration for more than 20 years.” From her biography, she seems to be a queen of evidence-based medicine and systematic reviews.
Dr. Robinson has not spoken out about her experience with the systematic reviews she performed for WPATH. She also very sensibly did not respond to my request for an interview for this article.
Although her team conducted dozens of systematic reviews on various topics, according to this report in the British Medical Journal, WPATH would not allow the majority of them to be published. . I wanted to see the primary sources of this article, so I went to the Alabama Attorney General’s website to flesh out the story.
In fall 2017, Dr. Robinson became concerned that WPATH, in hiring her team, wanted unusual language in the contract that would prevent her from publishing her findings without their approval. “The board wants it to be clear that the data cannot be used without WPATH approval in each instance so they have some control over the context it is being used in,” the WPATH contact stated.
“In general, my understanding is that the university will not sign off on a contract that allows a sponsor to stop an academic publication,” Dr. Robinson replied. She continued to be polite but firm in her emails to WPATH:
“I am happy to have a call with you and/or board members to discuss the contract language. Briefly, I cannot and Hopkins will not, sign off on a contract with the proposed language from WPATH mandating approval of any publications of research we conduct. There are two reasons for this:
1. First, Hopkins as an academic institution, and I as a faculty member therein, will not sign something that limits academic freedom in this manner. In other words, a sponsor cannot change or suppress publication of research.
2. Second, I will not sign off on language that goes against current standards in systematic reviews and in guideline development. It was my understanding that WPATH wanted to move toward the current standards for guideline development. To do so, the review team needs to be independent. (see IOM standards: http://www.nationalacademies.org/hmd/Reports/2011/Finding-What-Works-in-HealthCare-Standards-for-Systematic-Reviews/Standards.aspx and http://www.nationalacademies.org/hmd/Reports/2011/Clinical-Practice-Guidelines-We-CanTrust/Standards.aspx).”
However, Dr. Robinson’s concerns were overruled. The contract was ultimately signed for WPATH to pay the Johns Hopkins Evidence-Based Practice Center $196,307 for performing a series of systematic reviews on the field of gender medicine, in order to support the creation of the SOC 8. The contract ultimately stated, “Prior to the publication of the Project Data or any part thereof by the JHU evidence review team, WPATH shall have thirty (30) days in which to review and comment on the proposed publication. The JHU evidence review team will give due regard to WPATH’s comments. WPATH has the right to request the deletion of any Confidential Information.” This is identical language to that in the original fall 2017 contract that worried Dr. Robinson.
An early bump in the road: conflict of interest disclosures
The collaboration between Dr. Robinson and WPATH seems to have gotten off to a somewhat rocky start. Dr. Robinson first had to explain to the WPATH group that, in general, individuals with a vested interest how medical guidelines are written should not participate in writing them. This is called a conflict of interest and is taken very seriously by the National Academies of Science, Engineering, and Medicine. Up until this point, everyone agreed that Dr. Robinson and WPATH would abide by the process of the National Academies in creating their guidelines, so that their Standards of Care would be legitimate.
However, checking for conflicts of interest is actually supposed to be done before a guideline development group (GDG) is even assembled. According to the National Academies, individuals with a conflict of interest (COI) should not participate in GDGs. The Academies document states, “Experts who have unique knowledge about the topic under consideration—but who have COIs—can share their expertise with the GDG as consultants and as reviewers of GDG products, but generally should not serve as members of the GDG.”
Under the most extreme circumstances, where there is no option but to have conflicted people on the GDG due to their special expertise, the Academies document states:
“In some circumstances, a GDG may not be able to perform its work without members who have COIs, such as relevant clinical specialists who receive a substantial portion of their incomes from services pertinent to the CPG. Members with COIs should represent not more than a minority of the GDG.”
-National Academies of Sciences, Engineering, and Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press.
Thus, in December 2018, Dr. Robinson emailed the WPATH team, asking them to disclose any conflict of interest they have. She wrote: “We would expect many, if not most, SOC8 members to have competing interests. Disclosure, and any necessary management of potential conflicts, should take place prior to the selection of guideline members. Unfortunately, this was not done here but the decision was made to adhere as much as possible to best practice for guideline development. To that end, disclosures are being collected now from SOC8 members.”
A meltdown ensued among the WPATH members.
Dr. Jamie Feldman replied: “Who developed this form? I would need to describe my entire practice, academic and advocacy history and anticipated future history in order to fill out this form.” Since Dr. Feldman was the most strenuously offended by the conflict of interest disclosure, I took a look at Dr. Feldman’s biography, and indeed, this individual’s entire career seems to represent a conflict of interest with being on the WPATH SOC 8 committee.
Jamison Green from WPATH, a transgender man with a PhD in equalities law, chimed in: “I agree; the form was difficult for me, as well, and as I worked on it, I actually thought the only reason I was able to summarize my potential conflicts was that I am NOT a clinician.” Of note, Green, who is not a physician nor trained as a clinician in any way, was president of WPATH, purportedly a medical organization, in 2011.
Dr. Robinson referred the objecting WPATH members to the IOM Standards for guidelines and replied:
“As noted in the methodology document, disclosures or conflicts of interest should be collected from all involved. Typically this is done as members are nominated as potential conflicts may cause some to be not selected as members. Collection early also facilitates ensuring that there is a balance amongst the group. I didn’t see anything in the document you attached about conflicts and it does not contain any disclosures of (potential) conflicts. It also seems to be limited to Leads. All Chapter Members, the Chairs, and I should complete the COI/DOI.”
Developing the Systematic Reviews
In fall 2018, Dr. Robinson and the WPATH team worked together to finalize a list of questions to be answered by systematic reviews, which would support many of the recommendations made in the SOC 7.
A systemic review protocol dated 10/17/2018 was included in the legal discovery documents, which included the following questions:
· For transgender adolescent, what are the long term effect of GnRH agonists compared to no treatment, in terms of surrogate outcomes, clinical outcomes, and harms?
· For transgender adolescent, what are the effects of suppressing puberty with GnRH agonists on quality of life?
A protocol for the “surgery chapter” dated 11/15/2018 included the following question:
· How does age affect the benefits and risks of top surgery for transmasculine individuals and gender-nonconforming individuals assigned female at birth, particularly for those under age 18?
These are basic questions that gender clinicians should know the answers to – and know how strong the supporting evidence is.
Dr. Robinson’s team continued its work on the systematic reviews that WPATH commissioned.
The Reviews Are Buried
However, in June 2020, over two years after the contract was signed, WPATH updated its policy for approving the publication of Dr. Robinson’s work. “Approval is granted to author(s) for publication by majority vote,” read the policy, of the Chair and Co-Chairs of the SOC8 and the WPATH Board of Directors.
Then, in August 2020, WPATH notified Dr. Robinson that 2 of her proposed publications were met with “many concerns noted regarding these papers.” WPATH alleged that Dr. Robinson should have involved WPATH leaders more in the “design … drafting, and … final approval” of the research articles.
In October 2020, then-president of WPATH Dr. Vin Tangpricha emailed the members of the SOC 8 team : “One paper from the John Hopkins University Team has recently been published online in the International Journal of Transgender Health, whilst two papers have not received the green light to be published. It is paramount that any publication based on the WPATH SOC8 data is thoroughly scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender healthcare in the broadest sense.”
Essentially, according to this logic, Dr. Robinson’s team would only be allowed to publish their research if it found the desired conclusions of WPATH. If they found otherwise, it would indeed “negatively affect the provision of transgender healthcare in the broadest sense,” and therefore publication would not be allowed.
Dr. Robinson fired back:
“I am concerned about this message sent to the members of SOC8 Working Group Members as it suggests that there continues to be incorrect interpretation regarding data ownership and publications. WPATH approval for our publications is not required under the terms of the agreement, the WPATH policy was not incorporated into the executed agreement so it is not binding on us, and the JHU institution policies on academic freedom and intellectual property prohibit such restrictions/approvals regarding publication.”
Dr. Robinson was not happy that she, one of the world’s leading experts in research methods, guideline development, and systematic reviews, was told to bury the results of her team’s hard work.
Ultimately, just two of the initial “dozens” of systematic reviews that Johns Hopkins conducted passed WPATH’s tests and were published. One considered the impact of hormones on mental health, and one described prolactin levels in trans women taking estrogen. The systematic reviews on the long-term effects of hormone therapy and mastectomy for adolescents were killed for publication by the WPATH team.
Dr. Robinson tried to fight for her work to see the light of day. The BMJ reports she wrote to WPATH, “We have the right to publish and any [Johns Hopkins University] publications arising out of the work conducted as part of this contract are not subject to approval by WPATH nor subject to any policy of WPATH. I feel like I have made these statements several times in email and phone conversations, beginning when the contract was being negotiated in 2018.”
Dr. Robinson lost her battle. The remainder of the systematic reviews were never published. The Economist published additional information about the dispute between Dr. Robinson and the WPATH here. “Our concerns, echoed by the social justice lawyers we spoke with, is that evidence based review reveals little or no evidence and puts us in an untenable position in terms of affecting policy or winning lawsuits,” wrote one SOC 8 chapter author.
The SOC 8 were published in 2022 and contained the following statement: “Despite the slowly growing body of evidence supporting the effectiveness of early medical intervention, the number of studies is still low, and there are few outcome studies that follow youth into adulthood. Therefore, a systematic review regarding outcomes of treatment in adolescents is not possible.”
The BMJ adds this for context: “Carl Heneghan, director of the University of Oxford’s Centre for Evidence-Based Medicine, says, “There’s no such thing as ‘not enough evidence to do a systematic review,’ because what you do is set out a question and try to find all the available evidence.” If a review finds only low certainty evidence, he says, the recommendation should be to “pursue treatment in the context of a research study addressing the uncertainties”—otherwise, patients will continue to have limited evidence to inform their decisions.”
WPATH Misrepresents Its Guidelines to Other Medical Organizations
The SOC 8 was published by WPATH in 2022.
WPATH leaders immediately began contacting leaders of other medical organizations to garner support for their updated guidelines. In an email to the president of the American Psychiatric Association (APA), a WPATH leader wrote, “Recommendation statements were developed following independent systematic literature reviews, where available, background reviews and experts’ opinions. Grading of recommendations were based on available evidence supporting interventions, a discussion of risks and harms, as well as feasibility and acceptability within different contexts and country settings.” As we have seen previously, this is not true. The recommendation statements were developed based on WPATH members’ desires, and Dr. Robinson’s independent systematic reviews were buried by WPATH. The assertion that “grading of recommendations” took place is laughable as anyone with eyes can access the Standards of Care 8 and see that no recommendations are given a GRADE, unlike any other medical guidelines that I have encountered in the past 20 years.
The Methods section of the Standards of Care 8 is similarly incorrect about the document’s actual methods and repeats the false statement above and goes on to say:
“The process for development of the SOC-8 incorporated the recommendations on clinical practice guideline development set forth by the National Academies of Medicine and the World Health Organization, which addressed transparency, conflict-of-interest policy, committee composition, and group process.
A guideline methodologist assisted with the planning and development of questions and systematic reviews with additional input provided by an international advisory committee and during the public comment period.”
As we can see from the legal discovery documents made public by the State of Alabama, this is not actually what happened. WPATH actually elected not follow the National Academies of Medicine conflict-of-interest policy. Furthermore, literally, no recommendation in the entire SOC 8 is given a grade.
The Final Assessment
To sum up a fairly technical process buried deep within legal discovery, Freedom of Information Act requests, and medical journals, 1) WPATH encountered roadblocks because their recommendations, particularly for minors, were based on poor evidence. 2) they hired Johns Hopkins to conduct a series of systematic reviews, which is the standard for widely-accepted medical society guidelines. 3) Johns Hopkins conducted the systematic reviews, which did not produce the expected results. 4) WPATH used its funding power to prevent the researchers from publishing their work. 5) WPATH stated in its SOC 8 that a systematic review of youth gender medicine was “not possible.”
WPATH published the Standards of Care 8 in the International Journal of Transgender Health. This is a case of academic fraud that has gone largely unreported on and unacknowledged in the medical community. It is clear WPATH claimed that they used a rigorous approach to crafting its SOC 8, including relying on systematic reviews and gold-standard conflict-of-interest review, when they did neither of these things. They also misrepresented their research methods to their colleagues in other medical organizations.
You can hear the way WPATH leaders dismiss the fundamental tenets of evidence-based medicine with your own ears if you like. On “The Protocol,” a New York Times podcast about youth gender medicine, Dr. Marci Bowers gives an absolutely bonkers interview in Episode 5. Dr. Bowers is a gender affirming surgeon and the current president of WPATH. She is also a transgender woman herself.
Then she, the president of an allegedly scientific medical organization, blithely disavows the founding principles of evidence-based medicine. “After the Hopkins [gender clinic] closure of 1979, trans care continued… in the hands of private practitioners like Stanley Biber, my predecessor… And he didn’t look at studies, he didn’t look at guidelines or data, because there was none. He treated the patient first.” Bowers laments the expectation that the field be subject to a framework of guidelines, data, or any outcome other than immediate patient satisfaction.
Meanwhile, in Episode Four, we hear Jamie Reed, former case worker at a gender clinic turned whistle blower, patiently explain the concept of evidence-based medicine to Azeen Ghorayshi, science reporter for the New York Times, and her producer, Austin Mitchell. Jamie responds to their statements that many youth and their families are happy with their medical transitions. “Is that really what we want medicine to be?” Reed asks. “At the end of the day, is it actually just about patient satisfaction?” And then Mitchell follows up with, “May I ask, what is the other option besides satisfaction that you’re pushing for?” as if he had never considered that objective measures of health and well being could exist. Reed is so floored herself that she is a bit flustered as she answers, “Actual evidence-based care. Care that meets a gold standard of what evidence is.”
We, the medical community, have been badly deceived by WPATH.
At the very least, children and their parents have been deceived about the risks and benefits of medicalized gender transition. They have been told that their risk of death by suicide if they do not undergo these interventions is high. This false claim has been repeated so many times that it has become a truism, although it is supported by no evidence. The ACLU’s very attorney arguing against Tennessee’s ban on youth gender medicine before the Supreme Court, Chase Strangio, was forced to admit this: “There is no evidence in some—in the studies that this treatment reduces completed suicide. And the reason for that is completed suicide, thankfully and admittedly, is rare and we’re talking about a very small population of individuals with studies that don’t necessarily have completed suicides within them.”
It is most likely that, on the whole, children have suffered and perhaps lost their lives due to the Wild West of youth gender medicine. (I cannot say this definitively, because – again – the evidence is so poor.) Dr. Johanna Olson-Kennedy, the current president of USPATH, recently published the results of a clinical trial of adolescents given puberty blockers. Of 315 young people enrolled in this study, 2 died by suicide.
I believe that there are members of WPATH who have practiced youth gender medicine in good faith, who have been deceived by their leaders into believing the protocols they were taught were based on solid evidence.
Our credibility as physicians has been tarnished, and we have been made to look like fools.
It is time for all medical organizations who base any guidelines on the WPATH Standards of Care to re-evaluate these guidelines based on their own clinical expertise, since that of WPATH can no longer be trusted.
On a personal note, I know why this is a difficult discussion to have. At the academic medical institutions where the great and good make the guidelines the rest of us follow, the climate is different. In this, the year 2025, everybody has multiple friends and colleagues who identify as nonbinary or transgender, or who have a transgender-identifying child. I have noticed that many of these individuals find the criticism of gender medicine to be an existential threat. I am sympathetic to this. As gays and lesbians, we have a lot of remembered trauma. It wasn’t that long ago that Ronald Reagan callously let an entire generation of gay men die of AIDS.
Furthermore, the political Right is skeptical of gender medicine as well. The political Right, of all people! Yes, the same people who once believed that we could transplant ectopic pregnancies from the fallopian tube into the uterus. I agree that this political wing has very little credibility on medical issues in general – but like a stopped clock, they are right twice a day.
In the liberal blue bubbles, it is taken as a fact that those who are skeptical of gender medicine want transgender people dead. To me, this is obviously not true. A few absolutely insane and loud voices on Twitter (the cesspool of the Internet) notwithstanding, most skeptical voices wish for gender nonconforming people to live full and happy lives as their authentic selves but see a medical scandal / trainwreck unfolding and cannot remain silent. Somehow in the academic bubble this has been translated to widespread malevolence.
I wanted to be part of that climate once. I had a promising research career as a medical student and published posters and papers with some of the leaders in the field of maternal-fetal medicine, or high-risk obstetrics. I dreamed of being an MFM attending at a research institution and contributing to the field. I thought that was my path.
I matched to a prestigious academic residency in my beloved Midwest and started my Ob/Gyn training in 2011. I found that key leaders in the MFM division were actually quite religiously conservative. As an out lesbian, I did not fit in the culture. When I mentioned I was getting married the upcoming weekend to my attending on rounds one morning in 2013, he frowned and asked me, “What do your parents think about that?” Of note, I was 34 years old at the time.
It was clear that I would not match in an MFM fellowship at my home institution, and I had no appetite at that point in my life to put my wife (and hopefully future children) through another match process and then inevitably one more move to our final home. I decided to get off the academic carousel and become the bread-and-butter community Ob/Gyn I am today. It’s been a great journey, and I certainly have no regrets.
Dr. Karla Solheim, MD, FACOG