The World Professional Association for Transgender Health (WPATH) is the leading authority in the field of gender medicine. Its guidance is routinely used by top medical associations in the U.S. and abroad, while its standards of care inform insurance companies’ approach to coverage policies.
But behind closed doors, top WPATH doctors discussed, and at times seemed to challenge, the organization’s own published guidelines for sex change procedures and acknowledged pushing experimental medical interventions that can have devastating and irreversible complications, according to exclusive footage obtained by the Daily Caller News Foundation.
WPATH published highly influential clinical guidance called “Standards of Care for the Health of Transgender and Gender Diverse People, Version 8” (SOC 8), which recommends the use of invasive medical interventions such as puberty blockers, cross-sex hormones and sex change surgeries, calling them “safe and effective.”
The DCNF filed a series of public records requests to WPATH SOC 8 co-authors who are employed at taxpayer-funded institutions, making their emails subject to open records laws. Buried in more than 100 pages of responsive records from the University of Nevada was a series of emails between prominent WPATH members and leaders, including WPATH Global Education Institute (GEI) Co-Chair Gail Knudson, that were sent in 2022. In one email, Knudson sent a colleague the link to a folder containing nearly 30 hours of recordings from WPATH’s GEI summit in September 2022 in Montreal, Canada, which included sessions on mental health, puberty blockers, cross-sex hormones and sex change surgery.
These sessions provided WPATH members with in-depth education on the clinical application of topics addressed in the SOC 8 treatment guidelines. However, the footage reveals WPATH-affiliated doctors advocating for children to undergo risky sex change procedures and even pushing for these treatments for patients struggling with severe mental health issues. Several sessions were dedicated exclusively to treating children and included recommendations for minors to receive puberty blockers, cross-sex hormones and surgeries.
For instance, WPATH guidance recommends addressing a patient’s mental health issues before giving them sex change medical interventions. However, in one recorded session, a WPATH faculty member and gender doctor claimed that mental health issues don’t necessarily affect a patient’s ability to receive cross-sex hormones.
In another video, a doctor told attendees children should be informed that cross-sex hormones will likely make them infertile but admitted that he will prescribe them anyway if a child says they want the treatment, regardless of the future consequences.
A surgeon euphemistically referred to a phalloplasty procedure, a surgical series that includes obliterating the vaginal cavity and creating a fake penis with harvested tissue, as an “adventure” for young people. He did this despite later admitting that those same procedures will “definitely” have “complications,” such as permanent issues with bladder function and tissue death.
One physician called the entire field of cross-sex hormones “off-label,” referring to the concept of drugs being used for alternative purposes than what they were approved for. The doctor went on to say that female patients might actually appreciate drug side effects that cause them to lose hair, because they’d look “more like men.”
The Food and Drug Administration says that when it approves a drug, healthcare providers generally may prescribe that drug for an unapproved use, or off-label, when “they judge that it is medically appropriate for their patient.”
In several other videos, doctors argued in favor of transitioning patients who experience psychotic episodes. One admitted that some of his patients with schizophrenia have to be careful how much cross-sex hormones they take or they can’t “keep the voices down.”
The DCNF consulted medical professionals from respected organizations, such as Do No Harm, who all argued that the comments from WPATH-affiliated doctors show that the transgender medical industry does not have patients’ best interests at heart.
While the average person, nationally and internationally, likely has never heard of WPATH, the modern medical industry is deeply tied to the organization and relies on it to dictate the standards of care for transgender medicine. WPATH’s guidelines are cited as criteria for obtaining insurance coverage by both private insurance companies and tax-funded insurance plans, positioning them as a lynchpin of the sex reassignment industry.
Additionally, their guidelines help inform policy statements from major medical and professional organizations, such as the American Academy of Pediatrics (AAP), the American Psychological Association and the Endocrine Society. The AAP is currently being sued by Isabelle Ayala, a former patient who was medically transitioned as a child, for allegedly rushing her through sex change medical procedures.
There’s been an explosion in the number of young people, including children, being put on hormones and puberty blockers and getting sex change surgeries, according to a study published in August 2023 by the JAMA Network. This surge has been fueled, in part, by groups like Planned Parenthood, which distributes cross-sex hormones to patients as young as 16. Planned Parenthood saw a roughly 125% jump in the number of transgender services it provided between 2020 and 2022.
Twenty-three states, however, have enacted legislation preventing doctors from performing sex change surgeries on minors amid backlash from concerned parents and doctors who don’t subscribe to the WPATH-endorsed “gender-affirming care” model. Gender-affirming care is another euphemism used by medical professionals to describe the idea that doctors should affirm a patient’s wish to live as the opposite biological sex through social transitioning, hormone therapy and even surgery.
The SOC 8 was released just days ahead of the 2022 symposium and contained several significant changes to how doctors and medical institutions implemented transgender medical treatment. For instance, WPATH removed minimum age requirements criteria that established when a child can or should receive transgender medical services such as puberty blockers, cross-sex hormones, and sex reassignment surgeries.
WPATH’s previous guidelines recommended that hormone therapy be given once a patient was over the age of 16, but the updated version removed this barrier and suggests hormone therapy begin at the first signs of sexual maturity.
The videos obtained by the DCNF give the first glimpse at how doctors and mental health professionals discussed implementing the new guidelines. To highlight the most significant portions of the content obtained in the records requests, the DCNF has decided to publish a series of articles collectively called “The WPATH Tapes.”
Following this release, the DCNF intends to publish all of the videos in their entirety in order to provide the public with necessary information about WPATH’s approach to medical care and shine a light on an influential organization that has largely remained anonymous until now.
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The FDA old guard criticized the new leadership in a Dec. 3 New England Journal of Medicine (NEJM) letter over a higher regulatory bar for vaccines, namely the expectation that most new vaccine approvals will require randomized clinical trials, arguing it could hamper the market.
“Insisting on long, expensive outcomes studies for every updated formulation would delay the arrival of better-matched vaccines when new outbreaks emerge or when additional groups of patients could benefit,” the former commissioners wrote. “Abandoning the existing methods won’t ‘elevate vaccine science’ … It will subject vaccines to a substantially higher and more subjective approval bar.”
But while the former commissioners disclosed their conflicts of interest to the medical journal — per standard practice in scientific publishing — reporters didn’t relay them to the broader public in reports in the Washington Post, STAT News and CNN.
The headlines about a bipartisan rebuke from former occupants of FDA’s highest office give the impression that the Trump administration is contravening established science, but closer inspection reveals a revolving door between pharmaceutical corporations and the agencies overseeing them.
Three of the signatories have received payments totaling $6 million from manufacturers or former manufacturers of COVID vaccines.
Scott Gottlieb has received $2.1 million in cash and stock from his position on the Pfizer board of directors, where he has advised on ethics and regulatory compliance since 2019, according to company filings to the Securities and Exchange Commission. Stephen Ostroff has received $752,310 from Pfizer in consulting fees since 2020, according to OpenPayments.
Gottlieb and McClellan did not respond to requests for comment. Ostroff could not be reached for comment.
FDA Center for Biologics Evaluation and Research Director Vinay Prasad outlined the higher standards and shared the results of an internal analysis validating 10 reports of children’s deaths following the COVID-19 vaccine in a Nov. 28 memo to staff. He called for introspection and reform at the agency.
The NEJM letter criticizes Prasad for cracking down on a practice called “immunobridging” that infers vaccine efficacy from laboratory tests rather than assessing it through real-world reductions in disease or death. The FDA under the Biden administration expanded COVID vaccines to children using this “immunobridging” technique, extrapolating vaccine efficacy from adults to children based on antibody levels.
Norman Sharpless — who in addition to previously serving as acting FDA commissioner also served as the head of the National Institutes of Health’s National Cancer Institute — consults for Tempus, a company that collaborates with COVID vaccine maker BioNTech. He has helped steer $70 million in investments in biotech through a venture capital firm he founded in November 2024. Sharpless also disclosed $26,180 in payments in 2024 from Chugai Pharmaceutical, a Japanese pharmaceutical company that markets mRNA technology among other drugs, on OpenPayments.
“I was grateful for the opportunity to serve as NCI Director and Acting FDA Commissioner in the first Trump Administration, and strongly support many of the things President Trump is trying to do in the current Administration,” Sharpless said in an email.
Margaret Hamburg, another former FDA commissioner and signatory of the NEJM letter, has since 2020 earned $2.8 million as a member of the board of Alnylam Pharmaceuticals, which markets RNA interference (RNAi) technology.
Hamburg did not respond to a message on LinkedIn.
Most signatories disclosed income from biotech companies testing experimental cancer treatments. These products could face tighter scrutiny under Prasad, a hematologist-oncologist long wary of rubberstamping pricey oncology drugs — which Prasad points out often cause some toxicity — without plausible evidence of an improvement in quality of life or survival.
The former FDA commissioners disclosed ties to Sermonix Pharmaceuticals Inc.; OncoNano Medicine; incyclix; Nucleus Radiopharma; and N-Power, a contractor that runs oncology clinical trials.
Andrew von Eschenbach, who like Sharpless formerly served both as FDA commissioner and the head of the National Cancer Institute, disclosed stock in HistoSonics, a company with investments from Bezos Expeditions and Thiel Bio seeking FDA approval for ultrasound technology targeted at tumors.
Some FDA commissioners who signed onto the letter opposing changes to vaccine approvals have ties to biotechnology investment firms, namely McClellan, who consults Arsenal Capital; Janet Woodcock, who consults RA Capital Management; and Robert Califf, who owns stock in Population Health Partners.
Califf did not respond to an email requesting comment. Woodcock did not respond to requests for comment sent to two medical research advocacy groups with Woodcock on the board. Eschenbach did not respond to a LinkedIn message.
The two signatories without pharmaceutical ties may find their judgement challenged by the FDA investigation into COVID-19 vaccine deaths, having either implemented or formally defended the Biden administration’s headlong expansion of vaccines and boosters to healthy adults and children.
David Kessler executed Biden’s vaccination policy as chief science officer at the Department of Health and Human Services, helping to secure deals for shotswith Pfizer and Moderna.
Meanwhile Jane Henney chaired a National Academies of Sciences, Engineering, and Medicine report published in October 2025 that praised the performance of FDA and Centers for Disease Control and Prevention (CDC) vaccine surveillance during the pandemic — underwritten with CDC funding.
That assessment clashes with that of a Senate report, citing internal documents from FDA, finding that CDC never updated its vaccine surveillance tool “V-Safe” to include cardiac symptoms, despite naming myocarditis as a potential adverse event by October 2020, and that top officials in the Biden administration delayed warning pediatricians and other providers about the risk of myocarditis after their approval in some children in May 2021, months after Israeli health officials first detected it in February 2021. The Senate investigation named Woodcock, a signatory of the NEJM letter, as one of the FDA officials who slow-walked the warning.
HHS is also working to “reverse the Biden administration’s attempt” to classify gender dysphoria as a type of disability.
The U.S. Department of Health and Human Services unveiled a multi-pronged regulatory effort Thursday to curtail gender-affirming care for minors, including gender transition procedures at hospitals.
The Centers for Medicare & Medicaid Services has drafted a rule that would prohibit pharmaceutical or surgical gender reassignment procedures from receiving federal Medicaid or Children’s Health Insurance Program funding. It’s also proposing a rule that would allow it to withdraw Medicare and Medicaid funding from hospitals that perform such surgeries on minors. HHS is also working to “reverse the Biden administration’s attempt” to classify gender dysphoria as a type of disability. If gender dysphoria were to be defined as a disability, then health care providers who don’t want to perform what the department has dubbed “sex-rejecting” procedures could be in danger of violating anti-discrimination laws.
Health and Human Services Secretary Robert Kennedy, Jr., described gender affirming procedures as “unsafe” and “irreversible,” and framed the administration’s actions as “[protecting] America’s most vulnerable.”
“Our children deserve better – and we are delivering on that promise,” Kennedy told reporters Thursday.
The department is acting on directives from an executive order from President Donald Trump’s first few weeks in office. The Jan. 28 order called on government agencies to “[defund] chemical and surgical mutilation” of children, seemingly in the manner that HHS has proposed, as well as “rescind or amend all policies” relying on guidance from the World Professional Association for Transgender Health.
The Food and Drug Administration is also taking regulatory action against some organizations that market breast binders to minors.
“Illegal marketing of these products for children is alarming, and the FDA will take further enforcement action such as import alerts, seizures, and injunctions if it continues,” said Food and Drug Commissioner Marty Makary.
Kennedy signed a declaration Thursday that gender affirming procedures for minors “do not meet professionally recognized standards of health care” and the Assistant Secretary for Health and Head of the United States Public Health Service Commissioned Corps, Admiral Brian Christine, signed a public health message stating the same.
“Evidence shows sex-rejecting puberty blockers, cross-sex hormones, and surgeries are dangerous. Providers have an obligation to offer care grounded in evidence and to avoid interventions that expose young people to a lifetime of harm,” Christine said.
The House of Representatives passed a bill Wednesday that would criminalize the act of providing gender affirming care to minors.
