This is a shameful document, by any standard. Any illusion that the issuing body, the World Professional Association for Transgender Health (WPATH), is in any way a credible professional body, with patient wellbeing at its heart, should be dispelled by the task of reading through the 180 pages of this guidance.
A surprising addition to the lengthening list of gender identities is that of eunuch, listed here with reference to a peer-support website, the Eunuch Archive. This has been exposed by Gluck (2022) as a repository of child pornography, specialising in fantasies of self- or child-mutilation. The inclusion of eunuch as a legitimate gender identity captures the process at work, where declassifying paraphilia (formerly Scoptic syndrome in DSM-4) seems intended to normalise fetishistic behaviour for a wider professional audience. The close nexus between social media, pornography and bodily mutilation (in the strict medico-legal sense) which is inherent within the concept of gender identity could not be made any clearer.
The crucial barrier to care of age limits is also dispensable within these guidelines (S66). The unspoken dynamic driving the process is clearly a bias towards the presumption of treatment, rather than of non-treatment (Soh, in Lane, 2022).
This persistent motif, namely of trading high risk of physiological damage in exchange for claimed psychological benefit, is a central and recurring feature of these guidelines, and, perhaps, of gender identity affirming care more generally.
However, the harm reduction model applied here is simply aspirational, namely based largely on value judgements, but without hard evidence of its efficacy in the form of randomised controlled trials (RCT). This is clearly the case with puberty blockers, where the desired effect of delaying an unwanted puberty is supposed to minimise the claimed harm of psychological distress. However, there are no RCTs at present in relation to puberty blockers.
This all points to a major structural problem with the guidelines, namely the profound weakness of their research and evidence base.
Requiring psychological therapists to follow these guidelines means imposing major constraints their professional autonomy to practise according to their own preferred modality and established ethical precepts.
Finally, the rush to expedite medical transition ultimately makes therapy completely optional, if not totally dispensable, within this end-driven process. The value of therapy is briefly acknowledged, but then modified and brushed aside by WPATH.
In greasing the slipway towards medical transition, the WPATH 8 Standards of Care thus present a direct threat to the continued independence and autonomy of the psychotherapeutic professions.