On December 18, 2023 The World Health Organisation (WHO) announced the establishment of a panel tasked with developing national guidelines for countries on how to best treat transgender and gender diverse people (gender dysphoria). Referred to as providing “gender-inclusive care”, the panel’s emphasis is on promoting the access to hormone replacement therapy, such as puberty blockers and gender reassignment surgery. Researching possible external environmental factors which may be having an influence on the incidence of gender dysphoria, appears to be outside the panel’s area of responsibility and at this time does not appear to be an area of scientific inquiry with the WHO.
To quote from the WHO press release:
This new guideline will provide evidence and implementation guidance on health sector interventions aimed at increasing access and utilization of quality and respectful health services by trans and gender diverse people. The guideline will focus in 5 areas: provision of gender-affirming care, including hormones; health workers’ education and training for the provision of gender-inclusive care; provision of health care for trans and gender diverse people who suffered interpersonal violence based on their needs; health policies that support gender-inclusive care, and legal recognition of self-determined gender identity.[1]
Although these are laudable efforts to help people currently dealing with gender issues nothing is said by the WHO departments responsible for the implementation of the guidelines [2] about a need to address possible contributing factors, such as widespread environmental exposure to endocrine disruptive chemicals (EDCs). Despite the WHO’s expert panel’s apparent avoidance of perhaps an inconvenient area of inquiry, evidence clearly indicates that EDC exposures in-utero and in young children are a significant risk to health, leading to a range of adverse biological effects, including gender identity. This represents a significant health risk for exposed populations, which one could argue is the majority of the world’s population. Consider this brief sampling of evidence for adverse biological effects of EDCs:
In a 2022 global overview of EDCs these chemicals were found to be universal in the environment, and low concentrations (µg/L to ng/L) could severely impact human health and wildlife due to transgenerational and multigenerational effects [3]
In a scientific statement by the Endocrine Society in 2009 the authors presented evidence that EDCs have effects on male and female reproduction, breast development and various cancers. They report that results from animal models, human clinical observations and epidemiological studies implicate EDCs as a significant concern to public health. The authors made a number of recommendations, including increased basic and clinical research and the involvement of individual and scientific society stakeholders in communicating and implementing changes in public policy and awareness [4]
In March 2023 The Minderoo-Monaco Commission on Plastics and Human Health published a comprehensive review which examined plastics’ impacts across their life cycle on: (1) human health and well-being; (2) the global environment, especially the ocean; (3) the economy; and (4) vulnerable populations-the poor, minorities, and the world’s children. On the basis of this examination, the Commission has come up with science-based recommendations designed to support development of a Global Plastics Treaty designed to protect human health and save lives. In relation to children in-utero and exposures after birth the Commission’s review found the following:[5]
Infants in the womb and young children are two populations at particularly high risk of plastic-related health effects. Because of the exquisite sensitivity of early development to hazardous chemicals and children’s unique patterns of exposure, plastic-associated exposures are linked to increased risks of prematurity, stillbirth, low birth weight, birth defects of the reproductive organs, neurodevelopmental impairment, impaired lung growth, and childhood cancer. Early-life exposures to plastic-associated chemicals also increase the risk of multiple non-communicable diseases later in life.
For the WHO to enter the issue in 2023 with its new expert panel, which avoids the possible role of EDCs as a contributing factor in the increasing incidence of gender dysphoria, despite available evidence to the contrary, is of no use in the development of the United Nations Global Plastics Treaty.[6] Considering the evidence, this avoidance on part of the WHO expert panel, seems somewhat disingenuous.
The danger inherent in the WHO’s panel developing guidelines is that they give an impression that trans and gender diverse identity are exclusively natural human conditions needing only societal intervention. This is unfortunate as it discourages scientific research examining possible environmental contributing factors, such as the increasing levels of EDCs and other artificial chemicals widely used in today’s world.
For women planning on having children in the future and families with young children, being aware of, and avoiding unnessary exposures to plastic items containing EDCs, needs wider discussion and awareness as advocated by the United Nations Global Plastics Treaty. Allowing the Who’s expert panel on gender dysphoria to have some sort of final say essentially lets the plastics industry ‘off the hook’ ( its not us!) and is the worst of science, if one could even call it that.
************************************
[1] WHO press release: WHO announces the development of a guideline on the health of trans and gender diverse people, 18 december 2023,
[2] WHO departments of Gender, Rights and Equity-Diversity, Equity and Inclusion ( GRE-DEI), Global HIV, Hepatitis and Sexually Transmitted Infections Programmes (HHS), and Sexual and Reproductive Health and Research (SRH).
[3] Puri, M., Gandhi, K. & Suresh Kumar, M. A global overview of endocrine disrupting chemicals in the environment: occurrence, effects, and treatment methods. Int. J. Environ. Sci. Technol. Vol. 20, pp. 12875–12902 (2023).
[4] Diamanti-Kandarakis E,, Bourguignon J-P., Giudice L., Hauser R., Prins G., SotoA., Gore A., “Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement”, Endocrine Review, Vol 30, no.4, pp.293-342, June 2009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726844/
[5] Landrigan PJ, et al., The Minderoo-Monaco Commission on Plastics and Human Health, Annuals of Global Health. Mar 21;89(1):23. 2023. https://pubmed.ncbi.nlm.nih.gov/36969097/
[6] Resolution adopted by the United Nations Environment Assembly on 2 March 2022, https://www.un.org/en/climatechange/nations-agree-end-plastic-pollution
