The purportedly “evidence-based” medical standards that helped score gender activists a few short-term legal victories may soon be their undoing.

Internal communications contained in unsealed documents from an Alabama lawsuit, along with prior leaks and a four-year review of transgender medical studies, have exposed the oft-cited standards published by go-to authority for gender medicine, the World Professional Association for Transgender Health’s (WPATH), as being driven by political and activist agendas rather than scientific evidence about what’s best for patients.

As evidence undermining WPATH’s standards mounts, those working closely on litigation against transgender activist groups believe it will prove too much for courts to overlook.

“We now understand it is not legitimate science dictating the standards of care, but a true conspiracy involving non-medical personnel [who] are activists for transgender agenda,” Alabama Attorney General Steve Marshall told the Daily Caller News Foundation during an interview.

Documents recently unsealed in a case challenging Alabama’s law banning child sex change procedures revealed the reality behind WPATH’s Standards of Care Version 8 (SoC 8) guidelines — not only was there no internal consensus, but the recommendations were apparently not evidence-based despite being advertised as such.

Marshall told the DCNF it was at one point an “effective” strategy to be able to point to medical organizations, like WPATH. Now that strategy appears to be falling apart.

“One of the things litigation has done is bring transparency to what many have contended for a long time, which is that we are engaging in experimentation on kids,” Marshall said. “The idea of informed consent doesn’t exist around the concept of gender affirming care.”

“Gender-affirming care” is a euphemism often used by activists that refers to medical interventions, including life-altering and potentially harmful ones such as cross-sex hormones, puberty blockers and genital surgeries.

WPATH defended the guidelines in a statement to the DCNF, but said it is not a party to the lawsuits and would not comment on the ongoing litigation.

“WPATH could not and did not prohibit the evidence-based review team from publishing,” the group said in a statement. “Furthermore, SOCv8 is evidence-based – and while WPATH is not a party to the Alabama case (or any other case), we are confident the legal process will confirm the quality of SOCv8 and the process through which it was developed.”

WPATH claims its SOC8 are “evidence-based standards for safe and effective gender affirming health care and represent the most expert, in-depth, and evidence-based and consensus-based guidelines internationally.”

But court documents revealed how WPATH suppressed the publication of evidence reviews that undermined their recommendations, or chose not to seek them at all so they could avoid reporting the results. WPATH’s decision was driven, at least in part, by “social justice lawyers” who suggested evidence-based reviews would put them “in an untenable position in terms of affecting policy or winning lawsuits.”

In an expert report submitted in the case, Canadian sex researcher James Cantor wrote that WPATH viewed “evidence-based” medicine as a threat to its “policy goals” and allowed its guidelines to be influenced by “political pressure, litigation and legislative advocacy strategy, and the financial self-interest of WPATH members.” Internal communications included in Cantor’s report show members of WPATH’s Guideline Development Group acknowledged there was “no consensus” on the use of puberty blockers.

WPATH also appeared to cave to political pressure from the Biden administration.

Assistant Secretary for Health Rachel Levine was “very eager” for the release of SOC 8 to “ensure integration in the US health policies of the Biden government,” according to internal communications included in the court documents. Levine’s pressure also prompted WPATH to remove minimum age recommendations, documents show.

When WPATH released SOC 8 in September 2022, it removed age limits for procedures like cross-sex hormones and surgeries.

‘Weak Evidence’

Opponents to state child sex change bans have cited WPATH’s guidelines to support their legal challenges, and some judges have similarly done so in rulings favoring activists.

In June, District Court Judge Robert Hinkle, a Clinton-appointee, struck down Florida’s law banning transgender procedures for minors, pointing to two “well-established standards of care for treatment of gender dysphoria” published by the Endocrine Society and WPATH. (RELATED: THE WPATH TAPES: Behind-The-Scenes Recordings Reveal What Top Gender Doctors Really Think About Sex Change Procedures)

“Gender identity is real,” Hinkle wrote. “Those whose gender identity does not match their natal sex often suffer gender dysphoria. The widely accepted standard of care calls for appropriate evaluation and treatment.”

Likewise, the Biden administration often cites WPATH guidelines in court filings challenging state pediatric sex change bans, including in its challenge to Tennessee’s law banning child sex changes, United States v. Skrmetti, which the Supreme Court recently agreed to hear. The case considers whether bans like Tennessee’s and Alabama’s, which have been passed in 25 states, violate the Equal Protection Clause of the Fourteenth Amendment.

In its petition for certiorari, the Biden administration claimed that “overwhelming evidence establishes that appropriate gender-affirming treatment with puberty blockers and hormones directly and substantially improves the physical and psychological wellbeing of transgender adolescents with gender dysphoria.”

In April, however, a comprehensive review commissioned by the National Health Service (NHS) England and conducted by Dr. Hilary Cass found “weak evidence” for offering puberty blockers to children, raising crucial questions about WPATH’s guidance. The review also found “no clear evidence that social transition in childhood has any positive or negative mental health outcomes.”

Separately, video footage of a closed-door WPATH education session obtained by the DCNF shows Dr. Gail Knudson, co-chair of WPATH’s Education Institute, admitting a systemic review commissioned by the group found the “strength of significance was low” when measuring if “gender hormone therapy” improved mental health outcomes. However, WPATH’s guidelines cite this study as “strong evidence” for “gender-affirming care” improving outcomes for trans patients.

‘Damage Control’

After the Supreme Court agreed to hear the case out of Tennessee, the DOJ moved to halt proceedings in the Alabama case pending the ruling. (RELATED: ‘Social Justice Lawyers’ Told WPATH To Avoid ‘Evidence-Based Review’ Of Sex-Change Guidelines For Minors, Docs Reveal)

Alabama accused the federal government of trying to shield information about the administration’s involvement in developing the WPATH standards from reaching the justices. Marshall’s office wrote that “the Supreme Court deserves to know the full story, but the United States seems intent on telling just a piece of it.”

Given what documents revealed in the case, they argued “it is no wonder the United States rushed to the Supreme Court with a case without a robust evidentiary record—and then immediately tried to shut this case down.”

A district court judge agreed to pause proceedings in Alabama’s case early July.

“There’s no doubt that there is an effort to engage in damage control by trying to stop the facilitation of the release of other records,” Marshall told the DCNF.

THE WPATH TAPES: Behind-The-Scenes Recordings Reveal What Top Gender Doctors Really Think About Sex Change Procedures

From: @MegEBrock and @kliseanderson https://t.co/Dsvdc22vZx pic.twitter.com/1Eli4kuw9B

— Daily Caller (@DailyCaller) May 14, 2024

Alliance Defending Freedom senior counsel Roger Brooks said the revelations about WPATH likely would influence United States v. Skrmetti, though the documents are not yet in the formal record.

“I have no doubt that the most important revelations from the WPATH internal emails will be called to the Supreme Court’s attention through one or more Amicus briefs as well as more generally through media coverage,” Brooks told the DCNF, noting it would be “entirely appropriate for the State of Tennessee itself to call the Court’s attention to these internal emails, if only in footnotes.”

‘A Duty Of Care’

The WPATH revelations could also fuel offensive litigation pushing back on gender activists, bolstering malpractice lawsuits against doctors who offer such procedures to children and even exposing the associations pushing the guidelines to legal consequences.

Brooks said the erosion of WPATH’s credibility “will have very serious implications on future malpractice claims based on surgeries or prescriptions inflicted on minors now and in the future.”

“No longer can any doctor credibly defend him or herself by saying ‘Well, I was just relying on the widely accepted WPATH Standard of Care,'” he told the DCNF.

Josh Payne, who co-founded the firm Campbell Miller Payne to provide legal representation for detransitioners, likewise told the DCNF the revelation that activists influenced the development of WPATH’s recommendations “are relevant to the medical malpractice cases brought on behalf of detransitioners.”

One of Payne’s clients, Prisha Mosley, is suing the healthcare professionals that started her on a course towards medical transitioning at just 16 years old, offering her testosterone injections at 17 years old and the removal of her breasts at 18 years old.

Another detransitioner client of Payne’s firm, Isabelle Ayala, sued the doctors who pushed her towards transitioning as a teenager, along with the the American Academy of Pediatrics (AAP), which published a “policy statement” authored by those same doctors backing the “gender-affirming” treatment model used on her.

AAP members plotted ways to circumvent state laws banning child sex changes, including Tennessee’s, emails obtained by the DCNF in June revealed.

Ayala’s lawsuit alleges individuals, like Dr. Jason Rafferty and Dr. Michelle Forcier, tested their “no-questions-asked ‘affirming'” approach on patients like her.

“At the most fundamental level, medical professionals owe a duty of care to their patients,” Payne told the DCNF. “The recently unsealed documents show that members of the healthcare community knew, or should have known, that the drugs and procedures they were prescribing were not supported by sufficient evidence. Failing to disclose that lack of evidence to patients, and prescribing those drugs and procedures anyway, is a breach of the duty of care owed to patients.”

Though Alabama can’t move forward at this point with more discovery, Marshall said he hopes other states engaging in litigation will explore paths to expose other medical associations pushing the transgender agenda.

“Just as we’ve been able to shine the light on WPATH, similarly, I think we’ll see records that are equally disturbing of medical organizations in our country — who I want to believe were trying to look out for kids — but instead, either were willfully ignorant of what was going on, or had their own agenda that was driven by money, which I think is another factor here that people aren’t talking about enough, or their own personal philosophy, ” he said.

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