UN envoy criticises ‘one sided’ WHO approach to trans health guidelines

The UN special rapporteur on violence against women and girls has accused the World Health Organization of taking a “one sided” pro medicalising approach to trans healthcare in its development of new guidelines. Reem Alsalem has stepped into a developing row over the composition of a recently announced WHO committee, which will work to develop the organisation’s first global guidelines on adult transgender care.

The UN health agency last month published biographies of 21 experts who have been invited to help formulate guidelines. The committee’s composition triggered concern from a number of women’s rights and LGBTQ+ organisations, flagging a lack of diversity of views. Alsalem, who has previously intervened in the debate over Scotland’s gender recognition reform bill, wrote to the WHO’s director general to say she believed the committee’s composition contained “significant unmanaged conflicts of interest”.

She added: “Stakeholders whose views differ from those held by transgender activist organisations do not appear to have been invited. Such stakeholders include experts from European public health authorities who have taken the lead on developing an evidence based and consequently cautious approach to youth gender transitions (eg England, Sweden and Finland).” Most committee members had “strong, one sided views in favour of promoting hormonal gender transition and legal recognition of self asserted gender”, she wrote, adding that of the 21 committee members “not one appears to represent a voice of caution for medicalising youth with gender dysphoria or the protection of female only spaces”.

The role of UN special rapporteur is an independent position, given to human rights experts who offer expertise in specialist areas to UN bodies. The WHO says the new guidelines will provide “guidance on health sector interventions aimed at increasing access and utilisation of quality and respectful health services by trans and gender diverse people”.

The guidelines will focus on five areas including the “provision of gender affirming care, including hormones” and “health policies that support gender inclusive care, and legal recognition of self determined gender identity”. Organisations that have expressed concern over the composition and the goals of the WHO committee have complained that the UN organisation has taken both legal recognition of self ID and the benefits of gender affirming care as accepted starting points, despite those positions being the subject of continuing debate in many countries.

How quickly the stated gender of young people with gender dysphoria should be affirmed is at the centre of discussions over NHS policy on trans healthcare. Alsalem said it was a “significant omission” that the committee contained no representatives who are experts in adolescent development, as “the vast majority of individuals contacting gender related services worldwide are now adolescents and young adults who had no prior history of gender related distress”.

She also raised concern that the WHO’s three week consultation period for offering feedback on the committee’s makeup had fallen over a holiday period, and ended on Monday. The committee is due to meet in February at the WHO headquarters in Geneva to examine the proposed guidelines. Alsalem said she hoped the meeting would be postponed until all concerns over the committee had been addressed.

She said she had yet to receive any response from the WHO to her letter sent on 4 January. The Clinical Advisory Network on Sex and Gender, a network of clinicians mainly in the UK and Ireland looking at the debate over sex and gender on healthcare, questioned why the WHO appeared to be promoting gender affirming care as always the best approach.

“There are no robust randomised controlled trials supporting gender affirming medical and surgical interventions, and therefore there are no studies which tell us about the efficacy of these interventions, in children or adults,” the organisation said in a statement. The WHO said it encouraged stakeholders to provide feedback, adding: “WHO guidelines are always based on balancing of available evidence, human rights principles, consideration of harms and benefits and inputs of end users and beneficiaries.”.