Even as they publicly insist the science is settled, gender clinicians privately acknowledged performing irreversible hormonal and surgical interventions on teens whose requests, mental-health histories, and long-term prospects fall far outside anything supported by research.
The footage comes from closed-door conferences of the World Professional Association for Transgender Health (WPATH) and its U.S. chapter. It was released after a federal district court allowed Alabama to disclose discovery materials from a lawsuit challenging the scientific basis of WPATH’s guidelines. As part of that case, the state subpoenaed hundreds of internal conference recordings — materials the organization had attempted to keep confidential and, at times, destroy. The Free Press reviewed the footage and published it Dec. 3 in a report titled “‘We’re All Just Winging It’: What the Gender Doctors Say in Private.”
Journalist Leor Sapir writes that in these private settings, clinicians “allowed themselves to speak freely,” describing practices that do not resemble their public claims of rigorous psychological evaluation and evidence-based oversight.
Across the recordings, clinicians repeatedly acknowledged that mental-health evaluations are often sidelined. As Sapir reports, many “freely and proudly proclaim that they conduct no assessments, either of mental health or even of gender identity, and base treatment considerations on an individual’s cosmetic ‘goals.’”
One video shows Amy Penkin, a social worker with Oregon Health & Science University’s (OHSU) Transgender Health Program, describing an 18-year-old patient she called Sky, who requested complete genital nullification to resemble “a Barbie down there.” Penkin said Sky identified as asexual, had never had sex, and “did not want to feel any pleasurable sensation and hope[d] removal of all erogenous tissue [would] be possible.”
She (Penkin) told colleagues that current standards were “not enough to meet the needs of our patients” and argued the field needed to “take it to the next level to really think about how we evolve and match the needs of our patients as their needs are being expressed to us.” Sky ultimately obtained the required letters for castration.
The same session included discussion of adolescents seeking “penile-preserving vaginoplasty” or full genital removal despite not identifying as male or female. Penkin noted these ‘nonbinary’ requests were “growing in number” and said the field remained too tethered to traditional male-female categories, emphasizing the need for more experimental approaches. Multiple presenters framed these extreme body-modification goals — including the removal of sexual function — as valid expressions of identity rather than psychological red flags.
Another session addressed fulfilling patients’ “embodiment goals.” Pediatric endocrinologist Hayley Baines of OHSU’s Doernbecher Children’s Hospital presented a composite case of a 13-year-old “nonbinary” boy whose stated aims were “‘I want tits,’ and ‘I want my parts to still work.’”
Baines said that the child and the child’s ‘nonbinary’ parent were “surprised” to learn hormones could impair fertility and sexual function and that the parent cried upon hearing this. She explained that the clinical team’s role was to reconcile such risks with the teen’s stated goals.
Meanwhile, psychologist Mair Marsiglio argued that clinicians should support surgeries even for patients with severe psychiatric disorders.
“It’s important to reframe the role of the mental health person or the psychologist as a collaborator rather than a gatekeeper,” Marsiglio said.
She added that this applied even to patients with “multiple personalities” or “psychosis,” warning colleagues not to let their own discomfort limit access to surgery.
The footage also shows WPATH contributors acknowledging that many procedures lack meaningful research. During a panel on “nonbinary” surgeries, British endocrinology consultant Leighton Seal said, “We are doing procedures here where we don’t have outcome data.” He described such operations as “on the edge of the field of medicine” and said multidisciplinary backing was needed so clinicians would be less “vulnerable.”
Some clinicians responded with blunt acceptance of the field’s experimental nature. A provider from Utah said she no longer knew what to offer the influx of “nonbinary” patients, explaining, “Because I feel like we’re all just winging it, you know? And which is okay, you’re winging it too. But maybe we can just, like, wing it together.”
Sapir writes that the recordings expose “how gender clinicians, when they think outsiders aren’t listening, speak differently to each other from what they tell the wider medical community and the public at large.”
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