Biden Administration Pressured International Group to Remove Age Limits for Transgender Youth Surgeries
Newly unsealed court documents have revealed that Health officials in the Biden administration pressured the World Professional Association for Transgender Health (WPATH) to remove age limits from their guidelines for the care of transgender minors. The administration feared that age minimums could fuel growing political opposition to such treatments. Emails from members of WPATH recount how staff for Admiral Rachel Levine, assistant secretary for health at the Department of Health and Human Services and herself a transgender woman, urged them to drop the proposed limits.
Key Takeaways:
- The Biden administration, concerned about political backlash, pressured WPATH to remove age limits for transgender youth surgeries.
- WPATH members expressed concerns that removing age limits could be detrimental to transgender youth, potentially leading to worse legislation.
- The controversy highlights the ongoing debate surrounding the appropriate age for transgender medical interventions.
The debate around transgender medical care for adolescents has become increasingly polarized, with opponents arguing that teenagers are too young to make such decisions, while supporters, including an array of medical experts, argue that young people with gender dysphoria face depression and worsening distress if their issues go unaddressed.
The original draft of the WPATH guidelines, released in late 2021, outlined age minimums for different procedures: 14 for hormonal treatments, 15 for mastectomies, 16 for breast augmentation or facial surgeries, and 17 for genital surgeries or hysterectomies. However, these proposed age limits were ultimately removed from the final guidelines, prompting questions and concerns about the reasons behind the change.
The emails released this week provide context to this decision, highlighting the role of the Biden administration in influencing the development of these international standards. One email excerpt describes a conversation between a WPATH member and Sarah Boateng, then serving as Admiral Levine’s chief of staff: "She is confident, based on the rhetoric she is hearing in D.C., and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out."
Another email states that Admiral Levine "was very concerned that having ages (mainly for surgery) will affect access to care for trans youth and maybe adults, too. Apparently the situation in the U.S.A. is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them."
These emails were submitted by Dr. James Cantor, a psychologist and vocal critic of gender treatments for minors, as evidence in a federal lawsuit challenging Alabama’s ban on gender-affirming care. Dr. Cantor believes that these private conversations reveal WPATH’s decision-making process was heavily influenced by political considerations rather than scientific evidence.
While Dr. Cantor maintains that WPATH misrepresented its decision-making process to the public, WPATH President Dr. Marci Bowers strongly refutes this claim, stating that the removal of age limits was not driven by political motivations. She argues that the political climate surrounding transgender care was already evident, and that WPATH’s focus remained solely on scientific and expert consensus.
However, other WPATH members expressed concern about the potential negative consequences of removing the age limits. One member wrote: "If our concern is with legislation (which I don’t think it should be — we should be basing this on science and expert consensus if we’re being ethical) wouldn’t including the ages be helpful?" Another member questioned the strategy: “I need someone to explain to me how taking out the ages will help in the fight against the conservative anti-trans agenda.”
This internal debate within WPATH reflects the larger controversy surrounding the appropriate age for transgender medical interventions. While the field of gender transition care for adolescents is relatively new and the long-term effects of treatment are not yet fully understood, the removal of age limits from the WPATH guidelines has fueled criticisms that potential risks are being disregarded in favor of political expediency.
The controversy surrounding transgender care for minors has intensified in recent years, particularly in the United States. While the majority of transgender adolescents receiving medical interventions are prescribed puberty-blocking drugs or hormones, more recent years have seen a significant increase in the number of young people seeking such care, including surgery.
Several countries in Europe recently placed new restrictions on gender medications for adolescents following reviews of the scientific evidence. These restrictions primarily stem from the lack of robust long-term data on the potential effects of such treatments.
The United States has also seen a growing wave of legislation attempting to restrict access to gender-affirming care for minors. More than 20 Republican-controlled states have passed laws broadly restricting such care, and the Supreme Court recently announced that it would hear a challenge to Tennessee’s ban on youth gender medicine. This ban, which makes it a felony for doctors to provide any gender-related treatment to minors, including puberty blockers, hormones, and surgeries, has been fiercely challenged by transgender rights groups.
While the WPATH guidelines state that distress about breast development in particular has been associated with higher rates of depression, anxiety, and distress in transgender teenagers, and advocate that the potential negative health consequences of delaying treatment should be considered, the ongoing debate over the appropriate age for transgender medical interventions reflects the complex intersection of scientific understanding, societal attitudes, and individual rights.
