Criticism of WPATH Standards of Care Version 8

The WPATH Standards of Care Version 8 (2022) is the international guideline for healthcare for transgender and gender-diverse people.

Contents of SOC-8

The WPATH Standards of Care Version 8 (2022) is the international guideline for healthcare for transgender and gender-diverse people. SOC-8 introduced, among other things, revisions to chapters on adolescents, eunuchs and non-binary people. The first version of the Standards of Care dates back to 1979.

Criticism of the methodology

The British Cass Review and subsequent systematic reviews concluded that the recommendations in SOC-8 are not always supported by evidence of sufficient quality. The methodological basis of the recommendations became the subject of litigation in the US; in 2024 internal WPATH documents came to light in the process.

WPATH Files (2024)

In March 2024, Environmental Progress published the WPATH Files: leaked internal messages and a video of WPATH members. In them, members expressed concerns about the evidence base, whether young people can understand what they are consenting to and patient safety. The political pressure to remove the age limits did not emerge from this leak, but from court documents; see below. WPATH rejected many interpretations of the documents. An explanation of the leak is available at transtijd.nl.

Age limits removed

SOC-8 was published in September 2022. On 15 September, a correction followed that removed the passages on minimum ages for medical and surgical treatment of adolescents. In 2024, documents from the US case Boe v. Marshall were made public, concerning Alabama's ban on hormonal and surgical treatment for minors. According to those documents, Rachel Levine, then assistant secretary for health, called for their removal. One cited email mentions fears that ages below eighteen would lead to 'devastating legislation'. The American Academy of Pediatrics was also said to have threatened not to support the guideline. This interpretation comes from an expert report submitted by the party defending the ban.

The underlying reviews

In 2018, WPATH commissioned Johns Hopkins University to conduct systematic reviews. According to the same court documents, reported on by The Economist among others, WPATH leadership interfered in their preparation and publication. The researchers from the University of York assessed 23 guidelines from the period 1998 to 2022 for the Cass Review using the AGREE II instrument. Only the Finnish and Swedish guidelines were recommended for use. SOC-8 and the Endocrine Society guideline received a low score.

What other bodies did

As early as June 2020, Finland deviated from the predecessor to SOC-8 and made psychotherapy the first-line treatment. In February 2022, the Swedish National Board of Health and Welfare concluded that the risks of hormonal treatment for minors currently outweigh the potential benefits. In 2024, the WHO limited its own guideline to adults because the evidence for children and adolescents is limited and mixed. Advocacy organisations such as ILGA-Europe and TGEU continue to cite the WPATH guideline as a medical consensus. In March 2026, in the United States, a section chair of the obstetricians' and gynaecologists' organisation ACOG resigned after criticising the WPATH guidelines. See also SOC-8 in the timeline, the Cass Review and the Endocrine Society guideline.

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