Dear Editor
We have read with significant interest the article by Jennifer Block, titled “Dispute arises over World Professional Association for Transgender Health’s involvement in WHO’s trans health guideline.” The topic of transgender health is critical, especially in countries such as China where social challenges, financial strain, and organizational pressures make quality healthcare for transgender individuals particularly difficult. The reported concerns regarding the transparency and credibility of the guideline development process are not only valid but also crucial for the global transgender community.
The core issues raised by this article — the alleged lack of ideological diversity in the guideline development group, concerns about potential biases favoring a “gender-affirming” approach, and the involvement of WPATH — all point towards a need for a more robust, evidence-driven, and transparent development process. For transgender individuals in China, access to healthcare that is both affirming and evidence-based is of paramount importance. Therefore, the involvement of organizations like WPATH, which have faced criticism for a lack of transparency, could undermine the perceived legitimacy and acceptance of the guidelines among the local medical community.
We would like to highlight several specific areas where the study could be improved to ensure broader acceptance and applicability.
Firstly, it is essential to clarify the evidence review process and provide comprehensive details about the systematic reviews undertaken. Without explicitly demonstrating the thoroughness of the evidence evaluation, the credibility of the guidelines is at risk. In particular, addressing the concerns regarding the potential suppression of adverse outcomes, such as detransition, regret, or hormone-related side effects, is imperative. In China, where many transgender individuals are already facing significant challenges in accessing healthcare, guidelines that do not account for possible adverse outcomes can lead to a lack of trust in medical authorities and hesitance to seek necessary care.
Secondly, we recommend including a broader range of expert perspectives in the guideline panel. Including medical professionals who have first-hand experience with patients who have detransitioned, or who have faced adverse outcomes from hormonal treatments, will provide a more balanced viewpoint. This diversity is crucial for countries like China, where transgender care is still in a nascent stage and public sentiment can be influenced by perceived risks and sensationalized narratives. Providing a balanced guideline that reflects both the benefits and risks of gender-affirming interventions will help practitioners in China feel more confident in offering these services.
Lastly, we hope WHO to provide clearer definitions and evidence of how the guidelines will protect patient rights without compromising the quality and safety of care. Advocacy for liberalized access to healthcare interventions must be balanced with rigorous, unbiased research into their long-term effects. As an academic worker with over 10 years of experience in the field and as someone who has devoted 80% of my efforts to establishing and operating transgender drop-in centers in Wuhan and Shenzhen, I have observed the significant harm caused by guidelines that overlook the diverse needs and vulnerabilities of minority communities, such as transgender individuals.
We hope that our observations will help guide a more transparent and inclusive approach to guideline development, ultimately benefiting transgender people not only globally but also in China, where the need for reliable and safe healthcare access is particularly acute.
Correspondence on ‘Dispute arises over World Professional Association for Transgender Health’s involvement in WHO’s trans health guideline’ by Jennifer Block