Health
Private Footage Reveals Leading Medical Org’s Efforts To ‘Normalize’ Gender Ideology
From the Daily Caller News Foundation
By MEGAN BROCK AND KATE ANDERSON
I have developed a part of my brain that’s very fluid around with some of my folks asking them each week, what name are you going by? What pronouns are we using today? So it keeps us flexible to be doing this work.
This is the seventh 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.
Members of the world’s most prominent transgender medical organization encouraged fellow doctors to push transgender ideology beyond the healthcare field into schools and their communities, according to internal recordings obtained by the Daily Caller News Foundation.
In September 2022, the World Professional Association of Transgender Health (WPATH) Global Education Institute (GEI) hosted an event that included a series of education sessions for certification in transgender medicine. The event coincided with the release of WPATH’s updated medical guidance, called the Standards of Care Version 8 (SOC 8), and provided additional insights on its clinical applications.
During the sessions WPATH members were encouraged to “normalize” preferred pronoun use as a way to “create societal change” and behave in a way that “affirms” their patients’ gender identity, such as by asking female patients if they have a penis.
Psychologist Ren Massey, the co-chair of WPATH GEI, said clinicians should be ready to act as advocates for “gender diversity” in school settings. Massey earned a Ph.D. in clinical psychology from University of South Florida and is not a physician.
“We want to have the skills to negotiate multiple roles,” Massey said. “Because I have both had to be the therapist and then go talk to the school and be an advocate, or do a talk to the whole community of a school. So, I’m in multiple hats that we get to navigate, if we are advocating and helping and supporting our trans and gender diverse folks we are working with.”
Massey did not respond to requests for comment, and neither did Massey’s psychology practice.
Transgender ideology includes the belief that a person’s sex can be different from their “gender identity,” which SOC 8 defines as “a person’s deeply felt, internal, intrinsic sense of their own gender.” It’s a rejection of long-established scientific understanding of biology that there are only two sexes based on the fact there are only two types of reproductive cells — sperm and ova.
The term “gender identity” was popularized in the 1960s by controversial sexologist John Money, who’s most high-profile experiment involved advising parents of a boy whose penis was damaged in a botched circumcision to cut the rest of it off and raise him as a girl. At age 15, the boy — who was raised as “Brenda” — discovered the truth and rejected further hormone treatments. He eventually committed suicide at age 38.
The very concept of “gender identity” creates the possibility of changing one’s sex — a biological impossibility — through medical interventions, therefore creating a demand for medical sex reassignment interventions.
SOC 8 recommends that gender dysphoric minors be given the opportunity to “change” their sex through medical interventions. The guidance has been used to inform government regulations, insurance policies, and recommendations by numerous medical organizations, increasing minors access to sex reassignment procedures.
‘We Will Facilitate Changes’
The call for clinicians to be involved in local schools was echoed by WPATH-affiliated psychologist Dr. Wallace Wong in a presentation titled “Foundations in Gender Affirming Mental Health Care in Childhood and Adolescence.” Wong explained how therapists can play a pivotal role in facilitating change by helping schools embrace transgenderism and explained that schools need to embrace the use of preferred pronouns.
“A lot of time we will facilitate changes. It’s not unusual that you will go to the school with the parents together and educate the school what to do,” said Wong. “A lot of the times, some school they say, ‘we don’t know what to do.’ You say, ‘that doesn’t fly, I will teach you how to do,’” Wong said.
Wong did not respond to requests for comment, and the Diversity and Emotional Wellness Centre, where Wong works, provided additional contact information but did not provide comment.
SOC 8 recommends that “health care professionals work with families, schools, and other relevant settings to promote acceptance of gender diverse expressions of behavior and identities of the adolescent.”
“Using different pronouns for children is a step towards their social transition. It is now well established that social transition leads to the medicalization of their care,” Dr. Stanley Goldfarb of Do No Harm, a watchdog organization focused on keeping identity politics out of healthcare and medical schools, told the DCNF.
“It is inappropriate for anyone to advocate gender transition in gender dysphoric children unless they have had extensive psychological counseling and are part of some formal research protocol,” Goldfarb said. “This is the new policy in the United Kingdom and in multiple European countries.”
Without naming a specific doctor, Goldfarb said that “for a physician to speak to untrained personnel given the psychological difficulties that these children often experience along with their gender dysphoria, is bordering on malpractice.”
‘The Face Of The Enemy’
As European nations such as Norway, Sweden, Denmark, and the U.K. have restricted or halted the use of cross-sex hormones and puberty blockers in minors, WPATH has rallied against similar bans in the United States.
The WPATH GEI educational event dedicated an entire session to transgender legal and policy issues. Paula Neira, a biological man who identifies as a woman and is program director of LGBTQ Equity & Education at Johns Hopkins Medicine, gave a presentation titled “Legal Issues & Policy.” During the talk, Neira criticized legislative efforts aimed at stopping child sex changes and protecting women’s sports.
“Numerous states have either engaged in having litigation and legislation proposed or the government has taken actions that are targeting the LGBTQ+ community broadly, and then at least half of these bills are specifically targeting transgender people, particularly transgender youth. The way that these bills are being played out is, one is attempts to ban gender affirming care,” Neira said.
“In Alabama they’re trying to criminalize, by making it a felony, to provide gender-affirming care to transgender youth. The bill is called the “Alabama Child Compassion and Protection Act” so the height of cynicism and hypocrisy,” Neira said.
Neira ended the session by calling on WPATH members to band together and stand firm against “attacks” on the transgender community.
“Being defiant in the face of the enemy is not something that’s unfamiliar to me,” Neria said. “It’s going to take a lot of resolve. It’s going take a lot of resilience. It’s going take a lot of mutual support, to stand firm under these attacks. And that’s what we have to do. And we have to do it with a clear strategic eye. And that means banding together. It means being strategic in how we challenge policy, how we advocate and make persuasive arguments.”
“And together we’re gonna get back to making progress no matter how bleak it looks now, as long as we never give in. And we never surrender,” Neira told the audience, prompting applause.
Neira did not respond to requests for comment. Johns Hopkins Medicine, where Neira works, responded but did not provide comment.
‘Helps All Humans’
Throughout the 30 hours of WPATH GEI recordings reviewed by the DCNF, speakers cast a vision of moving gender ideology beyond sex change procedures and promoting it in other domains such as schools, communities and public policy.
Dr. Scott Leibowitz, a WPATH board member and SOC 8 co-author, said it “helps all humans” to promote the acceptance of transgender ideology in a diversity of settings.
“We recommend health care professionals who work with families. They should work with families, schools, and other relevant settings to promote acceptance of gender diverse expressions of behavior and identities of the adolescent,” Leibowitz said.
“Notice, we don’t say: ‘work with these settings to promote acceptance of transgender people,’” Leibowitz told the audience. “We actually think it’s broader than that because by helping promote acceptance of gender diversity as a whole, we believe that helps all humans, including trans people. It doesn’t reinforce the notion of boxes, which is what we’re trying to move away from.”
Leibowitz declined an interview request through a Nationwide Children’s Hospitals spokesperson.
WPATH’s commitment to social change is captured in its own guidelines.
“WPATH recognizes that health is not only dependent upon high-quality clinical care but also relies on social and political climates that ensure social tolerance, equality, and the full rights of citizenship,” the guidelines read. “Health is promoted through public policies and legal reforms that advance tolerance and equity for gender diversity and that eliminate prejudice, discrimination, and stigma. WPATH is committed to advocacy for these policy and legal changes.”
‘Creating Change By Using Different Language’
WPATH members were also encouraged to use preferred pronouns in healthcare practices, with Massey describing the use of preferred pronouns as a way to create social change.
“I would encourage you in your practices to have universal approaches to correct pronouns. So, training your staff so they’re aware and have good interaction skills. Maybe even have role plays with them,” Massey said.
“We are creating change by using different language,” said Massey.
Massey, who maintains an active psychology practice, said it’s “good clinical practice” to let clients dictate terminology used to describe their sex and gender.
“I’ve had folks that within the same day or within the same week may shift from feeling masculine, feminine, both, neither,” Massey said.
“And so that’s a thing like I have developed a part of my brain that’s very fluid around with some of my folks asking them each week, what name are you going by? What pronouns are we using today? So it keeps us flexible to be doing this work. There is so much evolution and so much exciting work developing.”
SOC 8 recommends that healthcare professionals use the “language or terminology” preferred by the patient.
‘Normalize It’
Dr. Jennifer Slovis, the medical director of the Oakland Kaiser Permanente Gender Clinic, promoted the use of an electronic medical database that collects sexual orientation and gender identity information for all patients. On the form, healthcare providers were expected to indicate a patient’s preferred pronouns and gender identity, as well as take an “organ inventory” for the patient.
The organ inventory asks both men and women to indicate their reproductive organs on a list that includes the cervix, breasts, uterus, vagina, testes, prostate and penis. Clinicians were also asked to indicate which organs were present at birth, had been surgically constructed, or developed by hormones.
Slovis explained that to “normalize” the organ inventory, this data needs to be collected for all patients, including “cisgender” patients.
“Cisgender people too, we should be doing this for everybody. That’s the only way we’re going to normalize it, if we do it for everybody,” said Slovis.
Slovis did not respond to requests for comment, and neither did Kaiser Permanente, where Slovis works.
In a presentation titled “Foundations in Primary Care,” Dr. Erika Sullivan said organ inventories needed to be constantly taken because patients’ organs “change.”
“One of the things I always like to illustrate with this is that you don’t just ask this question once, right? Because this changes. And so sexual practices change, pronouns change, organs change,” said Sullivan.
“You kind of have to constantly take that inventory to find out like, what’s what, what’s where, what are we doing?” Sullivan said.
WPATH’s SOC 8 supports the use of organ inventories.
“In electronic health records, organ/anatomical inventories can be standardly used to inform appropriate clinical care, rather than relying solely on assigned sex at birth and/ or gender identity designations,” the guidelines read.
Sullivan also explained the importance of using preferred pronouns and not assuming a patient’s pronouns based on outward appearance.
“I should be asking this of everybody and introducing myself this way, ‘Hi, I’m Erica, I use she/her pronouns,’” Sullivan said. “Because I think if we are going by sort of presentation, we are taking so much bias and so much judgment into that space. It’s really important to just wipe that away. So asking everyone’s pronouns is important because really, ultimately, you have to question your assumptions.”
Sullivan did not respond to requests for comment, and neither did the University of Utah, where Sullivan works.
Goldfarb said doctors should focus on patient care, not promoting gender ideology.
“It is not the job of physicians to create a culture of gender ideology. The job of physicians is to care for ill people,” Goldfarb said. “The proper care for children with gender dysphoria is intensive psychological treatment. The idea that all this should be normalized represents pure ideology and is not based on hard science or valid clinical research.”
WPATH did not respond to multiple requests for comment.
When it comes to addressing the national overdose crisis, the Canadian public seems ideologically split: some groups prioritize recovery and abstinence, while others lean heavily into “harm reduction” and destigmatization. In most cases, we would defer to the experts—but they are similarly divided here.
This factionalism was evident at the Canadian Society of Addiction Medicine’s (CSAM) annual scientific conference this year, which is the country’s largest gathering of addiction medicine practitioners (e.g., physicians, nurses, psychiatrists). Throughout the event, speakers alluded to the field’s disunity and the need to bridge political gaps through collaborative, not adversarial, dialogue.
This was a major shift from previous conferences, which largely ignored the long-brewing battles among addiction experts, and reflected a wider societal rethink of the harm reduction movement, which was politically hegemonic until very recently.
Recovery-oriented care versus harm reductionism
For decades, most Canadian addiction experts focused on shepherding patients towards recovery and encouraging drug abstinence. However, in the 2000s, this began to shift with the rise of harm reductionism, which took a more tolerant view of drug use.
On the surface, harm reductionists advocated for pragmatically minimizing the negative consequences of risky use—for example, through needle exchanges and supervised consumption sites. Additionally, though, many of them also claimed that drug consumption is not inherently wrong or shameful, and that associated harms are primarily caused not by drugs themselves but by the stigmatization and criminalization of their use. In their view, if all hard drugs were legalized and destigmatized, then they would eventually become as banal as alcohol and tobacco.
The harm reductionists gained significant traction in the 2010s thanks to the popularization of street fentanyl. The drug’s incredible potency caused an explosion of deaths and left users with formidable opioid tolerances that rendered traditional addiction medications, such as methadone, less effective. Amid this crisis, policymakers embraced harm reduction out of an immediate need to make drug use slightly less lethal. This typically meant supervising consumption, providing sterile drug paraphernalia, and offering “cleaner” substances for addicts to use.
Many abstinence-oriented addiction experts supported some aspects of harm reduction. They valued interventions that could demonstrably save lives without significant tradeoffs, and saw them as both transitional and as part of a larger public health toolkit. Distributing clean needles and Naloxone, an overdose-reversal medication, proved particularly popular. “People can’t recover if they’re dead,” went a popular mantra from the time.
Saving lives or enabling addiction?
However, many of these addiction experts were also uncomfortable with the broader political ideologies animating the movement and did not believe that drug use should be normalized. Many felt that some experimental harm reduction interventions in Canada were either conceptually flawed or that their implementation had deviated from what had originally been promised.
Some argued, not unreasonably, that the country’s supervised consumption sites are being mismanaged and failing to connect vulnerable addicts to recovery-oriented care. Most of their ire, however, was directed at “safer supply”—a novel strategy wherein addicts are given free drugs, predominantly hydromorphone (a heroin-strength opioid), without any real supervision.
While safer supply was meant to dissuade recipients from using riskier street drugs, addiction physicians widely reported that patients were selling their free hydromorphone to buy stronger illicit fentanyl, thereby flooding communities with diverted opioids and exacerbating the addiction crisis. They also noted that the “evidence base” behind safer supply was exceptionally poor and would not meet normal health-care standards.
Yet, critics of safer supply, and harm reduction radicalism more broadly, were often afraid to voice their opinions. The harm reductionists were institutionally and culturally dominant in the late 2010s and early 2020s, and opponents often faced activist harassment, aggressive gaslighting, and professional marginalization. A culture of self-censorship formed, giving both the public and influential policymakers a false impression of scientific consensus where none actually existed.
The resurgence in recovery-oriented strategies
Things changed in the mid-2020s. British Columbia’s failed drug decriminalization experiment eroded public trust in harm reductionism, and the scandalous failures of safer supply—and supervised consumption sites, too—were widely publicized in the national media.1
Whereas harm reductionism was once so powerful that opponents were dismissed as anti-scientific, there is now a resurgent interest in alternative, recovery-oriented strategies.
These cultural shifts have fuelled a more fractious, but intellectually honest, national debate about how to tackle the overdose crisis. This has ruptured the institutional dominance enjoyed by harm reductionists in the addiction medicine world and allowed their previously silenced opponents to speak up.
When I first attended CSAM’s annual scientific conference two years ago, recovery-oriented critics of radical harm reductionism were not given any platforms, with the exception of one minor presentation on safer supply diversion. Their beliefs seemed clandestine and iconoclastic, despite seemingly having wide buy-in from the addiction medicine community.
While vigorous criticism of harm reductionism was not a major feature of this year’s conference, there was open recognition that legitimate opposition to the movement existed. One major presentation, given by Dr. Didier Jutras-Aswad, explicitly cited safer supply and involuntary treatment as two foci of contention, and encouraged harm reductionists and recovery-oriented experts to grab coffee with one another so that they might foster some sense of mutual understanding.2
Is this change enough?
While CSAM should be commended for encouraging cross-ideological dialogue, its efforts, in this respect, were also superficial and vague. They chose to play it safe, and much was left unsaid and unexplored.
Two addiction medicine doctors I spoke with at the conference—both of whom were critics of safer supply and asked for anonymity—were nonplussed. “You can feel the tension in the air,” said one, who likened the conference to an awkward family dinner where everyone has tacitly agreed to ignore a recent feud. “Reconciliation requires truth,” said the other.
One could also argue that the organization has taken an inconsistent approach to encouraging respectful dialogue. When recovery-oriented experts were being bullied for their views a few years ago, they were largely left on their own. Now that their side is ascendant, and harm reductionists are politically vulnerable, mutual respect is in fashion again.
When I asked to interview the organization about navigating dissension, they sent a short, unspecific statement that emphasized “evidence-based practices” and the “benefits of exploring a variety of viewpoints, and the need to constantly challenge or re-evaluate our own positions based on the available science.”
But one cannot simply appeal to “evidence-based practices” when research is contentious and vulnerable to ideological meddling or misrepresentation.
Compared to other medical disciplines, addiction medicine is highly political. Grappling with larger, non-empirical questions about the role of drug use in society has always necessitated taking a philosophical stance on social norms, and this has been especially true since harm reductionists began emphasizing the structural forces that shape and fuel drug use.
Until Canada’s addiction medicine community facilitates a more robust and open conversation about the politicization of research, and the divided—and inescapably political—nature of their work, the national debate on the overdose crisis will be shambolic. This will have negative downstream impacts on policymaking and, ultimately, people’s lives.
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Any single suicide is an unspeakable tragedy. But public health officials should be especially alarmed when the numbers of suicides among a particular population spike. Between 2019 and 2023, the suicide rate across Canada fell from 12.3 per 100,000 to 9.5 per 100,000. U.S. numbers aren’t that different (although they’re heading in the other direction).
Holding public officials and institutions accountable using data-driven investigative journalism.
Against this context, the suicide rate among active Canadian military personnel is truly alarming. Data included in a 2021 Report on Suicide Mortality in the Canadian Armed Forces (CAF) showed that the three year moving average annual rate for suicides in all services of the CAF was 23.38 per 100,000 – around twice the national rate. Which, of course, is not to ignore the equally shocking suicide rates among military veterans.
This isn’t specific to Canada. All modern military communities have to worry about numbers like those. Officials in the Israel Defense Force – now hopefully emerging from their longest and, by some measures, costliest war ever – are struggling to address their own suicide crisis. But there’s a significant difference that’s probably worth exploring.
Through 2024, 21 active duty IDF soldiers took their own lives. This dark number has justifiably inspired a great deal of soul searching and, naturally (it being Israel), finger pointing. But the real surprise here is how low that number is.
It’s reasonable to estimate that there were 170,000 active duty soldiers in the IDF during 2024 and another 300,000 active reservists. If you count all of those together, the actual suicide rate is just 4.5 per 100,000 – which is less than half of the typical civilian suicide rate in Western countries!
Tragic. But hardly an epidemic. Those soldiers have all lost friends and faced battlefield conditions that I, for one, find impossible to even comprehend. And those 300,000 reservists? They’ve been torn away from their families, businesses, and normal lives for many months. Many have suffered devastating financial, social, and marital pressures. And still: we’re losing them at lower rates than most civilian populations!
Is there any lesson here that could help inform CAF policy?
One obvious difference is sense of purpose: IDF members are fighting for the very existence of their people. They all saw and felt the horrors of the October 7 massacres and know that there are countless thousands of adversaries who would be happy do it again in a heartbeat¹. And having a general population that overwhelmingly supports their mission can only help that sense.
But there are some other factors that could be worth noting:
- The IDF is unusual in that it subjects all potential conscripts to mandatory psychological screening – resulting in many exemptions.
- Small, stable units are intentionally kept together for years. In fact, units are often formed from groups who have known each other since their early school years. This cohesion also helps with post-service integration.
- Every IDF battalion has a dedicated officer trained in brief interventions and utilization rates are high.
Is there anything here that CAF officials could learn from?
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