UN envoy criticizes WHO’s ‘one-sided’ approach to transgender health guidelines | Transgender

The UN’s special rapporteur on violence against women and girls has accused the World Health Organization of taking a “one-sided” pro-medicalisation approach to transgender healthcare when developing new guidelines.

Reem Alsalem has weighed in on a developing controversy over the composition of the recently announced WHO committee that will work to develop the organization’s first global guidelines on care for transgender adults.

The UN health agency published biographies last month of 21 experts invited to help formulate guidelines. The commission’s composition has drawn concern from a number of women’s rights and LGBTQ+ organizations, noting the lack of diversity of viewpoints.

Alsalem, who previously intervened in the debate over Scotland’s gender recognition reform bill, wrote to the WHO director-general to say she believed the commission’s composition contained “significant unchecked conflicts of interest”.

She added: “Stakeholders whose views differ from those of transgender activist organizations do not appear to have been invited. Such stakeholders include experts from European public health authorities who have taken the lead in developing an evidence-based and therefore precautionary approach to young people’s gender transition (eg England, Sweden and Finland).”

Most committee members had “strong, one-sided views in favor of promoting hormonal gender transition and legal recognition of self-identified sex,” she wrote, adding that of the 21 committee members, “not one appeared to represent a voice of caution for medical treatment of youth with gender dysphoria or the protection of women-only spaces’.

The UN Special Rapporteur role is an independent position given to human rights experts who offer expertise in specialized areas to UN bodies.

The WHO says the new guidelines will provide “guidance for health sector interventions aimed at increasing access to and use of quality and respectful health services by transgender and intersex people”.

The guidelines will focus on five areas, including “providing gender-affirming care, including hormones” and “health policies that support gender-inclusive care and legal recognition of self-determined gender identity.”

Organizations that raised concerns about the composition and objectives of the WHO committee complained that the UN organization had taken both the legal recognition of self-identification and the benefits of gender-affirming care as accepted starting points, even though these positions were subject to an ongoing debate in many countries. How quickly the stated gender of young people with gender dysphoria should be confirmed is at the center of discussions about NHS policy on trans health care.

Alsalem said it was a “significant omission” that the commission did not include representatives who were experts in adolescent development, as “the majority of individuals contacting gender-related services around the world are now adolescents and young adults adults who have no prior history of gender-related adversity”.

She also expressed concern that the WHO’s three-week consultation period to provide feedback on the panel’s composition fell over a holiday period and ended on Monday.

The committee is due to meet in February at WHO headquarters in Geneva to consider the proposed guidelines. Alsalem said he hopes the meeting will be postponed until all concerns about the commission are addressed. She said she has yet to receive a response from the WHO to her letter sent on January 4.

The Sex and Gender Clinical Advisory Network, a network of clinicians mainly in the UK and Ireland looking at the sex and gender debate in health, has questioned why the WHO appears to be promoting gender-affirming care as always the best approach. “There are no robust randomized controlled trials supporting gender-affirming medical and surgical interventions, and therefore no studies to tell us about the efficacy of these interventions in children or adults,” the organization said in a statement.

The WHO said it encouraged stakeholders to provide feedback, adding: “WHO guidelines are always based on a balance of available evidence, human rights principles, consideration of harms and benefits, and the input of end users and beneficiaries.”

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