This is the third 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.
Several top doctors advocated for patients, including children, to remain on hormone treatments despite having serious mental health issues, according to footage from a 2022 conference exclusively obtained by the Daily Caller News Foundation.
The World Professional Association for Transgender Health (WPATH), an international organization that creates medical guidelines for transgender procedures, hosted an educational series in September 2022 in Montreal, Canada. The DCNF obtained roughly 30 hours of video recordings from the 2022 conference through a public records request.
During one recorded session, Dr. Chris Booth, a child and adolescent psychiatrist at the University of British Columbia, said that psychotic symptoms should not necessarily prevent a patient from being on hormone therapy. He also discussed dealing with psychiatrists who want to end hormone treatments for patients undergoing psychotic episodes. (RELATED: EXCLUSIVE: Top Gender Doctor Bemoans How ‘White’ The Sex Change Industry Is In Unearthed Video)
“I’ve had trans masculine individuals who’ve come in [to the hospital] with psychotic symptoms, and then the treating psychiatrist wants to stop their hormones” over concerns these drugs were exacerbating the patients’ mental health problems, Booth said. “I try to explain to them that having them resume menses would likely be a much greater detriment than having them remain on their hormone therapy.”
According to the National Institutes of Health (NIH), people suffering from psychosis “typically experience delusions (false beliefs, for example, that people on television are sending them special messages or that others are trying to hurt them) and hallucinations (seeing or hearing things that others do not, such as hearing voices telling them to do something or criticizing them).”
The NIH also says psychosis “may be a symptom of a mental illness, such as schizophrenia, bipolar disorder, or severe depression” and often begins in a person’s late teens to mid-20s.
Booth said, in the past, it would take years to put young people on the path to sex changes, and criticized doctors who would seek to delay young patients’ “access to care.”
“I see young people and they are trembling when they see me because they’ve read about how things go, and often, it’s very hard for them to talk to me openly because they’re thinking if they say the wrong thing, that I’m going to be finding an excuse to not allow them to get access to care,” Booth said. “And it used to be that way. People would have to go through this step-wise, laborious, years-long process before they could get care, then we would, you know, anoint them, and then they would go forward. That’s not how it should be, and that’s not how it is. Anyone who wants it to be that way [when] they practice they shouldn’t really be in the business.”
WPATH’s Standards of Care Version 8 (SOC 8), which sets treatment guidelines across the medical industry, recommends health practitioners “not make it mandatory for transgender and gender diverse people to undergo psychotherapy prior to the initiation of gender-affirming treatment.” SOC 8 also doesn’t consider being transgender a mental illness.
“The second thing is stigma,” Booth said. “Suggesting that you need psychotherapy for being gender-diverse is implying that there is a mental disorder and there’s the implication about the gate-keeping that used to exist.”
According to the American Psychiatric Association (APA), “some people who are transgender will experience ‘gender dysphoria,’ which refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.” The APA adds that “not all transgender or gender diverse people experience gender dysphoria.”
Booth told the DCNF that he was “advised to not provide a comment” when asked about his presentation.
‘Kids With Schizophrenia’
In a separate panel session, Dr. Daniel Metzger, a pediatric endocrinologist at British Columbia Children’s Hospital and WPATH member, explained how he had several schizophrenic patients who said they felt like testosterone treatments made their psychosis “a little bit worse.”
“I have had a few kids with schizophrenia who do notice that if they push their testosterone too much that it seems to them that it makes things a little bit worse,” Metzger said. “So, the patients who have schizophrenia are doing well on their meds. So, they will sometimes moderate their dose a little bit just to keep the voices down or whatever the bad symptom is.”
Metzger went on to say hormone treatments might “cloud the picture” in terms of treating kids suffering from eating disorders “with suicidality where they’re in the hospital every two weeks.” He said he is “very mindful of the fact that if things get worse” they might have to delay or reduce hormones to help “keep the kids on track.”
Metzger and British Columbia Children’s Hospital did not respond to the DCNF’s requests for comment.
During the same panel discussion, Dr. Marshall Dahl, a WPATH member and the head of the University of British Columbia’s Division of Endocrinology, was asked if there was a bad time in terms of mental health to prescribe cross-sex hormones to patients.
“So my personal opinion is that this is not a thing, for either hormone,” Dahl said. “I think I would frame it [as] ‘Are they mentally stable enough to go to a wisdom tooth extraction right now?’ An elective surgery thing or something where they can both give consent and can cope with an unexpected event that took place … I think that’s where I’d frame that. I don’t think it’s a hormone thing, again most people get happier, which is why we are doing that which tends to be helpful for mental health.”
Dahl did not respond to requests for comment but a spokesperson for UBC told the DCNF that if “Dr. Dahl has not responded to your outreach, then we must assume that he is unavailable or does not wish to be interviewed.”
‘Insufficient/Inconsistent Evidence’
SOC 8 recommends addressing mental conditions that can interfere with a patient’s ability to provide informed consent before initiating “gender-affirming treatment,” noting conditions, such as an underlying psychosis, that may interfere with a patient’s ability to provide informed consent.
The term “gender-affirming care” is often used by physicians to refer to cross-sex hormone therapy, puberty blockers, and sex change surgeries.
Many transgender individuals also suffer from mental illnesses, such as depression, bipolar disorder, anxiety, and even schizophrenia, according to the Cleveland Clinic. A 2019 study published in the journal Transgender Health found that 58% of the transgender population had at least one psychiatric diagnosis compared to 13.6% of non-transgender individuals, with major depressive and generalized anxiety disorders being the most common at 31% and 12%, respectively.
The 2015 US Transgender Survey reported that 40% of respondents have attempted suicide in their lifetime — nearly nine times the attempted suicide rate in the U.S. population (4.6%).
Transgender activists often argue that mental health issues among the transgender population can be alleviated with social interventions, hormones, or surgeries. Several recent studies, however, have challenged this assertion, finding that sex change procedures may worsen individuals’ mental health.
The recently published Cass Review, led by former Royal College of Pediatrics and Child Health President Dr. Hilary Cass, found “insufficient/inconsistent evidence” that puberty blockers — drugs used to suppress puberty development in gender-confused kids — actually improved patients’ mental health.
“The systematic review undertaken by the University of York found multiple studies demonstrating that puberty blockers exert their intended effect in suppressing puberty, and also that bone density is compromised during puberty suppression,” the review reads. “However, no changes in gender dysphoria or body satisfaction were demonstrated. There was insufficient/inconsistent evidence about the effects of puberty suppression on psychological or psychosocial well-being, cognitive development, cardio-metabolic risk or fertility.”
WPATH did not respond to the DCNF’s requests for comment.
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