Private communications from key figures in transgender healthcare have highlighted how ideology and consensus, rather than scientific evidence, have fueled the rapid expansion of the child sex-change industry. These emails came to light through a Freedom of Information Act request.
As gender clinics saw a surge in patients, University of California, San Francisco (UCSF) Medical Director Maddie Deutsch and Stephen Rosenthal shared concerns about the support for children’s sex changes being considered “cold” and recognized as contributing to “predatory practices.” These revelations were contained in the emails.
Deutsch and Rosenthal, both prominent figures in gender medicine and co-authors of the World Professional Association for Transgender Health (WPATH) Care Standards Version 8, significantly shape clinical practices worldwide. Records indicate that the UCSF Gender Center was dealing with a substantial backlog of 230 new patients in late 2022. Rosenthal noted that their team was stretched thin, which raises issues about accessibility for a diverse range of young individuals.
Following a denial by the University of California for public email records regarding Deutsch and Rosenthal, Judicial Watch filed a lawsuit to gain access to these communications.
As a result of this legal action, a trove of 2,491 pages was released. Among the findings was that UCSF had administered puberty blockers to 9-year-old children—treatment not approved by the FDA for gender dysphoria.
Judicial Watch’s Tom Fitton remarked, “There’s something rotten in California,” drawing attention to the implications of these practices.
Tangled Research
A May 2022 email criticized Rosenthal and his colleagues for endorsing what was termed “annoying research.” This referred to various studies opposing legislative bans on child sex changes, including a notably criticized study by Diana Tordoff that claimed puberty blockers and hormonal treatments alleviated depression and suicidal thoughts among youth.
Despite the claims of benefits in Tordoff’s study, Rosenthal acknowledged in emails that it had “significant methodological concerns.” The correspondence expressed that the evidence from this research didn’t appear robust, pointing to a pattern of reliance on flawed studies in decision-making processes.
Reflecting on their own ongoing research, Rosenthal mentioned they were delving into the effects of gender-affirming care but recognized the need for more long-term studies.
By September 2022, Tordoff’s study had been referenced in WPATH’s SOC 8 to support child sex change practices. Rosenthal, in collaboration with Dr. Johanna Olson Kennedy, had been involved with a longer-term NIH study assessing mental health impacts related to pubertal blockers—though some of those findings remain debated.
WPATH, Deutsch, and Rosenthal did not respond to requests for comments on these issues.
Assessing Risks
Rosenthal addressed in a November 2022 email to Deutsch the risks associated with administering puberty blockers solely as monotherapy for teens over 14, which could jeopardize bone health.
He noted there was no supporting data for using these treatments without additional hormonal therapies and emphasized that WPATH’s SOC 8 guidelines did not endorse risky medical practices.
Rosenthal also expressed the Delphi process used by WPATH to shape clinical guidance was problematic if primarily ideologically homogeneous experts defined expertise. The outcome, he warned, risked becoming more about agreement than evidence-based science.
Concerns About Practices
Deutsch criticized WPATH for having an overly loose approach to surgical standards within SOC 8, cautioning the guidelines suggested only six months of hormonal therapy before irreversible surgeries, which may inadvertently promote opportunistic practices among some surgeons.
She raised alarms about a system that could enable “on-demand surgeries,” where qualifications for performing assessments could be diluted. After the release of SOC 8, Deutsch indicated UCSF Clinics would adopt these new criteria, eliminating the necessity for mental health evaluations.
