Metro Weekly

White House Opposes Surgeries for Trans Youth

The Biden administration has come out explicitly against allowing surgical intervention for transgender minors.

Image by Todd Franson

The Biden administration has come out explicitly against allowing minors to undergo gender-affirming surgical procedures.

Though extremely rare, the surgeries have become an obsessive focus of anti-transgender movements, which claim that advocates for transgender rights are seeking to “mutilate” youth.

Last week, The New York Times published an article claiming that staff in the office of Adm. Rachel Levine, the assistant secretary of health at the U.S. Department of Health and Human Services, had urged an influential international transgender health organization, WPATH, to remove age minimums for surgery from its treatment guidelines for transgender minors.

Levine, who is herself transgender, feared that listing age minimums for certain medical interventions — part of a larger effort by WPATH to update its guidelines — would spark backlash and empower opponents of transgender rights in arguing for across-the-board bans on gender-affirming care. 

A draft version of the update to the care guidelines, obtained by The Associated Press, recommended that gender-affirming medical interventions could be started at earlier ages than those set forth by a previous version of the guidelines.

Under the draft version, for instance, hormone replacement therapy could be recommended for individuals as young as 14, two years earlier than previously recommended.

The draft guidelines also recommended that puberty blockers, which inhibit the development of secondary sex characteristics, could be started for individuals assigned female at birth from ages 8 to 13, and for individuals assigned male at birth from age 10 to 15.

When the final WPATH “Standards of Care” were issued in 2022, they contained no specific age recommendations. In a “Frequently Asked Questions” document, WPATH claimed that the age recommendations were removed to “reflect the fact that one-size-fits-all health care models, especially transgender care, are not accurate or appropriate for every individual person.”

The Times piece, and another published by Fox News, claimed that Levine’s staff pressured WPATH to drop age-specific recommendations.

This sparked outrage from anti-LGBTQ outlets, which cast the lobbying by HHS officials as part of a sinister plot to lift all restrictions on gender-affirming care and force children as young as elementary school age to undergo surgical transition.

In response to the swirl of misinformation, the White House released a statement to the Times, clarifying that it opposes surgical interventions for minors.

The statement marked a departure from the Biden administration’s earlier, less-defined position, which generally opposed government intervention into private medical decisions.

An HHS spokesperson clarified that Levine had “shared the view with her staff that publishing the proposed lower ages for gender transition surgeries was not supported by science or research, and could lead to an onslaught of attacks on the transgender community.”

On July 2, a Biden administration spokesperson provided more details.

“These are deeply personal decisions and we believe these surgeries should be limited to adults,” a White House spokesperson told the independent news outlet The 19th.

The spokesperson sought to balance the White House’s opposition to surgery with support for allowing minors — with parental permission and their doctors’ consent — to access other forms of gender-affirming care.

“We continue to support gender-affirming care for minors, which represents a continuum of care, and respect the role of parents, families, and doctors in these decisions,” the spokesperson said.

The Campaign for Southern Equality demanded that the Biden administration reverse its position on the issue. 

“This is…a troubling concession to the right-wing assault on transgender Americans, falling for their false narratives about surgical care and betraying a commitment to equality and trust in the medical community,” the organization’s Allison Scott said in a statement.

In reality, transgender surgical interventions for minors are exceedingly rare.

For those assigned female at birth, “top surgery,” or male chest reconstruction, is often the only surgery that most physicians will even consider for minors, and usually only in their late teens, depending on the individual patient’s physical development, emotional maturity, and length of time that they have consistently identified as transgender.

Yet, misinformation spread by opponents of gender-affirming care routinely claims that genital surgeries are being performed on transgender youth en masse.

LGBTQ advocates criticized the White House, accusing it of caving to political expediency and ceding ground to intellectual arguments promoted by right-wing and anti-transgender activists.

For many activists, any broad-based restriction on access to care is unacceptable because it fails to take into account a patient’s individual circumstances.

“Health care decisions for young people belong between a patient, their family, and their health care provider. Trans youth are no exception,” Kelley Robinson, the president of the Human Rights Campaign, said in a statement.

“The Biden administration is flat wrong on this. It’s wrong on the science and wrong on the substance. It’s also inconsistent with other steps the administration has taken to support transgender youth. The Biden administration, and every elected official, need to leave these decisions to families, doctors and patients — where they belong.”

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