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

• 八位評審者（包括一名兒童激素醫生、整形外科醫生、兒科醫生、家庭醫生、心理學家、精神科醫生及兩位指南專家）分別對WPATH指南的六個章節進行獨立評分。
• 指南建議制定過程的嚴謹度在各章節中得分為39–47%；證據搜尋與篩選方法僅獲7分制中的1.5–2.5分。
• 實際應用性得分最低（28–40%），其中對建議的實踐檢驗計劃評分僅為7分制中的1–1.5分。
• 獨立性得分43–44%，因資金方影響力與利益衝突處理方式不明確。
• 所有章節（青少年、兒童、激素治療、心理健康、基層醫療與手術）總體質量評分約為7分制中的3.5–4分。
• 八位評審中僅兩人推薦直接採用章節內容；三人建議修改後採用，三人不予推薦。
• 資金聲明：本研究由SEGM資助，作者聲明資助方未參與研究設計、分析與撰寫。第一作者曾擔任SEGM顧問，每位臨床評審者因30–40小時工作量獲1,500美元報酬。無其他資金來源聲明。

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.