Fact Check: 216 Instances Of Factual Errors Found In Right-Wing "WPATH Files" Document

On Monday, anti-trans groups released a set of highly editorialized and decontextualized leaks dubbed the "WPATH Files." A fact check reveals 216 errors, misrepresentations, and faulty citations.

On Monday evening, prominent right-wing activist Michael Shellenberger, known for pushing anti-scientific views, released what he dubbed "the WPATH files." In this highly editorialized document, select decontextualized images of forum posts from the World Professional Association for Transgender Health were made public. The document, replete with 37,569 words of editorial commentary before even presenting the so-called leaks, leans heavily into opinion and pseudoscience, urging readers to view it as a "groundbreaking scandal." However, a closer inspection of the actual messages, achievable only after wading through the equivalent of a novella's worth of editorial content, reveals rather mundane and often almost dull exchanges between doctors, psychologists, and therapists. These professionals are seen asking about edge cases and seeking advice from colleagues on patient circumstances. Despite attempts to cast the messages in a negative light, the report significantly misses the mark. In a thorough fact-check of the document, I have uncovered 216 instances of factual inaccuracies, erroneous citations, misinterpretations of what is “leaked,” and purposeful omissions contradicting the authors central editorialized claims.

The files were quickly shared by nearly every major anti-trans organization and journalists aligned with them. Genspect described it as “one of the worst medical scandals in history.” Riley Gaines claimed it unveiled “one of the most profitable yet destructive social experiments in history.” The Alliance Defending Freedom termed it a “deep-rooted medical scandal.” Given the rapid pace at which news stories emerged from these and other organizations, it likely was the result of a coordinated and organized embargo campaign, leaving those in support of care with scant time to review the voluminous documents and respond. In anticipation of such a response, the right-wing, Edelman-funded anti-trans organization FAIR in Medicine even published a fake screenshot of their own analysis of the report, labeling it “true” in a "fact check" with a big red bar—a direct nod to the fact checks presented in my own reports.

See here:

FAIR In Medicine “fact checks” the anti-trans report as “true” (notably, no such fact check was presented by the organization)

The factual inaccuracies, incorrect citations, and misrepresentations of both the literature and the "leaks" in the report are pervasive, affecting every section. In many instances, the authors reference their "leaks," which are not searchable without optical character recognition (OCR) processing, presumably banking on the assumption that readers will not verify the context, thus missing the misrepresentations. The editorial section serves as a prime example of a "Gish gallop"—a tactic where numerous errors are thrown at once to overwhelm those attempting to critically respond, a strategy first attributed to creationist debater Duane Gish. Given the sheer volume of errors, it is impractical for a single fact-check to address each one comprehensively. Instead, this fact-check will highlight clear examples of each type of error to illustrate the wide chasm between the documented evidence and the report's exaggerated claims.

Misrepresented Citations

The editorialized report relies heavily on citations that are misrepresented, either in terms of what the citations actually claim, their quality, or whether the arguments in the citations support the point being made by the author. For example, one section claims that the WPATH Standards of Care 8th revision “sent shockwaves through the medical profession,” and “provided the catalyst for the Beyond WPATH declaration, now signed by over 2,000 concerned individuals, many of whom are clinicians working with gender diverse young people.” A closer examination of the “Beyond WPATH” letter itself reveals signatories such as “John Howard - DJ” and “Collin Wynter, yoga instructor.” A majority of the signatories appear to be from non-relevant categories, and a significant chunk are not medical providers at all, such as “concerned grandparent” or “parent.” While the report presents the “declaration” as a document of primarily medical professionals, it omits that it is essentially a freely available online petition form.

A small sample of the signatories of the “Beyond WPATH” letter.

When addressing supposedly "scientific" citations, the report's performance is equally lacking. For example, in the editorialized section, the report asserts that transgender individuals who undergo gender reassignment surgery "do not show positive outcomes," citing four references to support its claim. These citations include a 2004 article from The Guardian, an article from a conservative site called "The New Atlantis," which self-describes not as an academic journal but as a "public journal of ideas," the frequently misquoted "Swedish Study" whose author has expressly corrected misinterpretations by anti-trans organizations, and a quality of life study that is 15 years old, evaluating surgeries performed 30 years ago, when social discrimination likely significantly influenced the outcomes. This contrasts sharply with much newer research from peer-reviewed articles that demonstrate a substantial improvement in the quality of life for transgender individuals.

Another claim was that a study supported a “2% fatality rate” for gender affirming surgery for those who have a sigmoid vaginoplasty, of which the report states “This one death represents an almost 2% fatality rate. In any other field of medicine, such a high fatality rate would result in the experiment instantly being halted and carefully studied to investigate what went wrong.” A review of the citation reveals a single case report of a death which occurred from a wound infection, a potential complication for any surgery. What the report leaves out, however, are that there are many recent studies designed to look at surgical complication rates, including a much newer study with a sample size of 366 patients and only 2 who experienced “major complications,” with no deaths.

All of these and many more misrepresented citations are then used to frame various portions of the “leaks” as scandalous or negative. For instance, they follow the incorrect claim that citations “do not show positive outcomes” with a discussion between WPATH members centering best practices on the ability transgender people to orgasm after puberty blockers, presumably to highlight the aforementioned “no positive outcomes.” To ensure factual accuracy, studies have shown that those who took puberty blockers are capable of orgasm and are satisfied with their sex lives, with 84% reporting orgasm capability and 12% not trying, similar to cisgender rates of anorgasmia. (Update: some critical responses have only read the sentence stating “female sexual function scores are low.” The FSF questionnaire measures include things like “lubrication” and the study is critical of the use of FSF in measuring transgender women’s sexual health. The study argues that instead of relying on FSF, other measures should be used. The study notes high satisfaction and indicates the vast majority of trans women can orgasm after surgery even with puberty suppression).

Errors About Trans Care

In numerous cases, the report not only misrepresents citations but also commits outright factual errors about trans care. For instance, it incorrectly conflates gender identity and sexuality, claiming that gender-affirming care is “a new form of conversion therapy” that “sterilizes lesbians and gays.” Gender identity and sexuality are fundamentally distinct. Regarding the claim of transition being a form of “conversion therapy,” evidence indicates that the vast majority of transgender individuals do not identify as straight after transitioning. Therefore, if transition were meant to serve as “conversion therapy,” it is notably ineffective in such an endeavor.

Similarly, the report claims that “the majority of gender dysphoric children would naturally desist and reconcile with their birth sex after puberty” if “not affirmed.” The studies cited all point to the same two sources continually used to make this claim - Kenneth Zucker’s research from the 1990s, which uses outdated diagnostic criteria for "gender identity disorder" that misclassified feminine gay men as "disordered," and Steensma’s studies from 2011/2013, known for similar methodological shortcomings. They utilize old criteria which did not require a “desire or insistence to be the other sex,” and purposefully included in the disorder feminine boys who parents wished were more masculine. Modern studies show desistance rates of only 2.5%, with 97.5% of patients continuing to identify as transgender after social transition. The report claims that social transition prevents this “natural” desistance, a hypothesis that has not been validated, and instead seemingly advocates that trans youth should be disallowed social transition, which consists haircuts, clothing, pronouns, and names.

Old criteria vs. new criteria

The report also states that “hormone therapy places an enormous medical burden on the body and impairs sexual function.” This is a claim made in multiple instances in the article, implying that sexual functionality is low and poor. In some sections, the authors lament that sexual function will be so poor, “the ability to form long-term sexual relationships is drastically compromised.” Research shows, however, that 65% of post op transgender women see an improvement in sexual satisfaction, with the majority rating their experiences with their body parts as “satisfying” or “very satisfying.” One review concluded, “We find that the most well-established changes associated with [hormone therapy] are initial changes to libido and increased sexual satisfaction.” Low sexual satisfaction is not supported by research.

These factual errors would be enough by themselves to discredit a report like this. In this report, however, it is compounded by using it to make innocuous and important discussions between clinicians seem nefarious. For example, the report uses the claims of low sexual satisfaction to then paint a discussion between clinicians about teenagers understanding trans care as harmful and evidence of wrongdoing, even though the claim is both incorrect and completely decontextualized from the actual discussion.

Misrepresentations of “Leaked Material”

One of the most prevalent tactics used by the document is the misrepresentation of "leaked material," frequently obscuring the actual statements (which are relegated to the end of the document) with an editorialized interpretation. For instance, an editorialized description of an exchange in the WPATH forums suggests that "a patient was leaking prostate secretions through the urethra after vaginoplasty and found it bothersome." However, upon examining the actual exchange, it is revealed that the patient was actually "noticing an ejaculate with orgasm through her urethra," which significantly alters the context - directly contradicting the editorialized assertions made earlier that transgender individuals are often incapable of orgasm.

Editorialized claim states that “prostate fluids leak after vaginoplasty.” Actual “leak” shows this is due to orgasm.

Another misrepresentation of the leaked material states, “There is talk about detransition being just another step in a patient’s “gender journey.” The document mentions detransition 54 times, suggesting it is a frequent occurrence among transgender individuals. However, a closer examination of the actual WPATH leak reveals that it was not a clinician but the detransitioner themselves who described their experience as part of a "gender journey," specifically noting they were detransitioning without regret - something that harms the editorialized report’s portrayal of regret among trans people. Additionally, it is disclosed that one doctor has encountered only four detransition cases in their practice across 25 years and 600 patients. This information is not directly presented in the editorialized report but is instead interpreted in a way that precludes readers from forming their own conclusions, which would contradict the report's assertions.

Editorialized claim stating that providers treat detransition as a “gender journey.” The actual leak reveals this was language used by the patient to indicate no regret.

Another portion of the editorialized assertions includes a patient discovering "two liver masses" identified as hepatic adenomas, with doctors suggesting "the likely offending agents are the hormones." However, this claim omits the fact that the patient was also taking "oral contraceptives," and it fails to mention that hepatic adenomas are benign. These tumors are more commonly observed in individuals who use birth control pills and are described as "rare but benign epithelial tumors of the liver frequently associated with oral contraceptive pill use." This omission likely explains why the phrase "and/or oral contraceptives" was excluded from the editorialized claim. Furthermore, this information, alongside a solitary post about a transgender individual developing cancer, has been inaccurately used to assert that WPATH privately considers hormone therapy a cause of cancer.

The editorialized claim mentions hepatic adenomas without mentioning they are benign and associated with birth control. The actual leak reveals “and/or oral contraceptives,” a phrase left out of the editorialized claim.

Conclusion

It is evident that numerous anti-trans organizations contributed to the creation of the report, laden with misinformation. According to one post, Stella O'Malley from Genspect, an organization which has previously teased a young trans girl testifying in front of a school board, played a role in its development. Similarly, Carrie Mendoza of FAIR In Medicine, which has received significant funding from anti-trans billionaire Joseph Edelman to combat trans healthcare, appears to have been involved as well. The report, editorialized to transform relatively innocuous discussions among clinicians about best practices and specific cases into a purported major medical scandal, relies on factually incorrect assertions and misrepresentations to build its case. This approach, however, is unconvincing upon closer scrutiny. Instead of uncovering wrongdoing, the report inadvertently highlights the actions of an organization engaging in what is a standard procedure for medical entities: remaining engaged with ethical care discussions and seeking collaborative advice for emerging questions.

Updates: I previously included a quality of life study whose limitations make the results non-generalizable in similar ways to the criticized QOL studies of the author, and so I have removed it. I have replaced it with another one, as there are many to draw from.