Summary

WPATH's Standards of Care 8 (2022) is the world's most influential guideline for transgender healthcare. In this study, eight trained raters, doctors and therapists from several fields plus two experienced guideline experts, scored six chapters relevant to young people using the standard checklist for judging how well guidelines are made. The chapters scored poorly on rigour (how evidence was searched for, chosen and linked to advice), on practical usefulness and on independence from funders and conflicts. Overall quality was rated about 3.5 to 4 out of 7. Raters split evenly between recommending the chapters, recommending them with changes, and rejecting them. The findings echo the Cass Review's earlier rating. The study was funded by SEGM, and only eight raters took part.

Key findings

• 8名の評価者（小児内分泌医、形成外科医、小児科医、家庭医、心理士、精神科医、ガイドライン専門家2名）が、WPATHガイドラインの6章をそれぞれ独立して採点した。
• 推奨策の開発プロセスは全章で39〜47%、エビデンスの検索と選択方法は7点満点中わずか1.5〜2.5点と評価された。
• 実用性は28〜40%で最も低く、実践での効果を検証する計画は7点満点中1〜1.5点と評価された。
• 資金提供者の影響や利益相反の扱いが不明確なため、独立性は43〜44%と評価された。
• 全章（思春期、小児期、ホルモン療法、メンタルヘルス、家庭医療、手術）の総合評価は、7点満点中約3.5〜4点であった。
• 8名の評価者のうち、変更なしで推奨するとしたのは2名のみで、3名は変更を条件に推奨、3名は推奨しないと回答した。
• 資金源：本研究はSEGMの資金提供を受けたが、研究デザイン、分析、論文執筆に関与はなかったと著者は述べている。筆頭著者はSEGMのコンサルタントを務め、各臨床評価者には30〜40時間の作業に対し1,500米ドルが支払われた。その他の資金源は宣言されていない。

Abstract

In 2022, the World Professional Association for Transgender Health (WPATH) released their guidelines, Standards of Care Version 8 (SOC8), which have been regarded as establishing standards for the management of transgender patients. To conduct a quality assessment of the WPATH's SOC8 using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, we recruited a diverse group of international health professionals as assessors, including six clinicians and two guideline methodologists, who were trained in the AGREE II tool and underwent a calibration exercise. They independently assessed six SOC8 chapters: adolescents, children, hormone therapy, mental health, primary care, and surgery. We summarized the ratings across assessors for all items to present the strengths and limitations of the guidelines. The evaluations identified that the SOC8 chapters had limitations in the AGREE II domains of applicability (ranging from 28% to 40% across chapters), editorial independence (ranging from 43% to 44% across chapters), and rigor of development (ranging from 39% to 47% across chapters). On a scale of 1 to 7 (7 = highest quality), the median overall quality score was 3.5 to 4 for all chapters. Two of eight assessors recommended using the guideline chapters, while three recommended use with modification, and three recommended not to use the reviewed guideline chapters due to methodological concerns. Evidence-based guidelines addressing the needs of transidentified people are urgently needed, but it is imperative that healthcare providers, researchers, and policymakers recognize and address the limitations present in these six SOC8 chapters.

Conclusion

The assessment found that WPATH's SOC8 guidelines have limitations in scientific and methodological rigour, applicability, and transparency in managing competing interests. Evidence-based guidelines addressing the needs of trans-identified children and adolescents are urgently needed, but uncritical adoption or endorsement of WPATH's guidelines may result in a disservice or even harm to this vulnerable population. Healthcare providers, researchers and policymakers should recognise and address the limitations of SOC8.