Scott’s presentation came from a batch of nearly 500 videos of conferences held by WPATH that I recently obtained. It’s a motherlode of material on pediatric gender care that the secretive activist medical organization had long fought to keep from the public. The tapes, subpoenaed by the Alabama attorney general in response to a federal lawsuit, covered a pivotal period from 2021 to 2023, when pediatric gender medicine first began to face political backlash. In addition to egregious lapses in judgment on the part of WPATH, the videos are a case study in the excesses of peak woke, neatly preserved, as if in a time capsule. 

During a long winter of dyspepsia, I digested well more than 100 hours of the academic faithful checking their privilege and preaching about “centering lived experience.” And I can now report that there are few subcultures more slavishly faithful to the woke religion than WPATH was during the post-Racial Reckoning micro-era. 

According to sociologist Musa al-Gharbi’s landmark 2024 book, We Have Never Been Woke: The Cultural Contradictions of a New Elite, the term woke, in its original, early-20th-century definition, referred to “an awareness of social injustices and a commitment to rectifying them.” Today, it is typically used pejoratively for anything Left-coded that might “seem ridiculous,” as al-Gharbi observed. And not always unjustly: at its peak, the philosophy amounted to a form of egalitarian signaling by cultural elites that purported to serve the needs of the marginalized — mostly by hewing to politically correct positions on gender, sexuality, race and identity issues — but in fact mostly served their own needs for status and legitimacy. 

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I observed all these tendencies at the WPATH conferences, which were held virtually during Covid times, and then in hotel conference rooms in Montreal and Denver, and featured the titans of transgender medical care. One could only expect such discourse given the cast of characters. There were LGBTQ identities (and allies). There were overly educated cultural elites. There were activists. And there were guilty white people — overwhelmingly and blindingly white people — who sought to compensate for their inadequate melanization through promises to diversify WPATH and promote equity across the land.

These defenders of the marginalized were fluent in the academic-elite lingua franca of critical theory, intersectionality, and social justice, hewing to conformity at the expense of content, common sense, or even their own supposed mission to help gender-distressed children and adolescents. They stayed ahead of what Steven Pinker coined the “euphemism treadmill,” rattling off all the latest identity-politics jargon — deftly observing the imperative to shift from “transgender,” to “gender diverse,” to “gender expansive”; and from “Latino,” to “Latinx,” to “Latine.” They doled out trigger warnings for bread-and-butter medical subjects — to audiences of doctors and psychologists. 

In one session, which concerned the informed-consent model for providing gender surgeries, attendees were instructed to “please feel free to leave or take a break if need be. We want you to prioritize your own well-being above the content that we are sharing here.” 

They succumbed to concept creep, with one presenter defining trauma as “an experience or series of experiences that negatively affect someone’s interactions and experiences of moving through the world” — a definition so diffuse it could apply to anything from the Holocaust to a hangnail. And they undermined their own authority, responsibility, and legitimacy as care providers endowed with doctorates, as they conveyed that their young patients’ narratives were more important than diagnostic and scientific precision and the core principles of medical ethics.

Were there pronoun declarations? But of course. In fact, a WPATH conference is the rare setting where this performance might be useful. However, the vast majority of presenters, sometimes to their own professed chagrin, were not transgender. Most were straight women and gay men; the latter rarely admitted such a jejune and déclassé sexual identity, opting instead for obliquely declaring themselves “a member of the LGBTQ+ community.” 

The presenters didn’t stop with simply professing themselves a they/them. They routinely introduced themselves according to their sexual, racial, and class-based identities, making a point of self-flagellating should their oppression score prove subpar. One typical throat clearing was: “I’m a cisgender white woman who comes from a lot of privilege.” Another team declared: “We are white providers,” who, when caring for patients, took into consideration “the soup we all swim in, which is the dominant white Western ideas of what gender is, can be, should be.” Presenters displayed performative guilt and — with no sense of irony — apologized for their status as central players in a power structure that they were eagerly leveraging to promote the medicalization transgender identity in minors, even as they denounced that system as woefully damaged and damaging. 

Overall, the conference sessions placed a disquieting emphasis on correct-signaling over evidence-based medicine. If the presenters genuinely hoped to win over the public and other medical skeptics and establish gender-transition treatments and surgeries as a settled practice in pediatrics, one might have expected them to observe exacting caution and engage in scientific testing sufficiently rigorous to defend the ethics of providing irreversible, life-changing body alterations to highly distressed and impressionable minors. Alas, no.

Conference attendees were treated, for example, to a short sermon by Florence Ashley (they/them), a Canadian “transfeminine” legal scholar and author of Gender/Fucking: The Pleasures and Politics of Living in a Gendered Body. Ashley, a biological male who claims a loosely designated feminine identity, preached that erecting “gatekeeping” around gender-transition interventions for patients of all ages was “illegitimate by default.” 

There was also a session on experimental medical interventions for patients who identify as nonbinary. Dr. Walter Bouman, a British transgender-care specialist and WPATH leader, acknowledged working in the dark in this particular discipline. “We simply don’t have the evidence,” he admitted. And yet he and other care providers claimed it an imperative to provide mix-and-match sets of sex characteristics based on patients’ demands.

Such blind devotion to patients’ body-modification impulses extended even to minors and their “embodiment goals.” Dr. Johanna Olson-Kennedy, a top pediatric gender doctor practicing in California, confessed at the conference in 2023 that determining whether patients are “really trans” is “actually not the discussion I’m interested in participating in.” Instead, she wanted to talk about “giving the very best possible care to trans young people.” Nowhere in this astonishing confession was there room for determining whether a child’s gender confusion could  prove only temporary— and thus there was no consideration of whether the youth might later regret the medical intervention. 

Instead of caution we got hyperbolic warnings about white supremacy. Presenters such as policy wonk Kellan Baker and ACLU litigator Chase Strangio claimed, with no evidence, that objections to pediatric gender medicine, or to biological males participating in girls and women’s sports, were rooted in racist attitudes. Meanwhile, the conference sessions repeatedly called rueful attention to the fact that, despite everyone’s better efforts at recruitment, the organization’s leadership and its members were overwhelmingly white, as were their pediatric patients, as were youths participating in their studies. 

Such laments were paired with commitments to the equitable provision of medical interventions to nonwhite populations. White presenters ritually groveled over their racial or cispatriarchal supremacy. One, Dr. Carl Streed, a WPATH leader — a white gay man and primary-care physician at Boston Medical Center — heartily agreed to an observation that men of his persuasion controlled trans research and should voluntarily “step down” from leadership positions. 

These scenes highlight the intrinsically unstable nature of the woke belief system, which has always displayed contradiction and paradox. For example: race is a mere arbitrary social construct best dismissed and yet should be a source of monomania given that it is the architecture upon which all of society is built. Or this: given the overwhelmingly white makeup of WPATH and the field’s population of minor patients, perhaps pediatric gender medicine itself is fundamentally white. Where is the respect for marginalized cultures, when one of the chief professed goals is to impose what amounts to a glaringly white undertaking onto black and brown children?

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The only black trans woman I saw in all the WPATH videos I observed was Dr. Elle Lett, an activist-oriented statistician-epidemiologist (and insufferable gadfly on social media). Dr. Lett was still in training at the University of Pennsylvania when she gave a ramblingly woke plenary address to the 2021 conference. “Medicine,” she claimed, was “nested in the system of oppression,” and statistical methods “develop[ed] out of eugenics.” She called on attendees to “reject the notion of sample size and validity” in favor of messier science, provided it gave voice to the voiceless. The most mind-scrambling scenes came from sessions in which presenters preached the imperative to provide gender-transition treatment to Native Americans of all ages. 

I have no doubt that the WPATH conference presenters genuinely approach their medical mission with compassion. They routinely and emphatically expressed concern for their pediatric patient population, with apparent sincerity. But the quasi-religious zealotry I observed provides a weak foundation for a medical movement that seeks to care for a population of psychically unwell teenagers by subjecting them to drastic and permanent physical alterations. And it’s hardly possible to dispassionately weigh the risk versus benefits of these medical interventions when an unfalsifiable mode of new-age spirituality is pressing its finger on the scale. 

But a blindness to one’s own hypocrisy has always been the defining feature of the woke movement. So it’s no surprise that these medical radicals have proved incapable of self-correction, and that external political forces have stepped in to smash the precious temple they’ve built.