Several prominent LGBTQ+ advocates and a dozen transgender lawmakers have criticized the Biden administration for its recent statement that gender-affirming surgeries should only be allowed for transgender adults.
“These are deeply personal decisions and we believe these surgeries should be limited to adults,” a White House spokesperson said in an email to The 19th last week. “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 statement came days after The New York Times and Fox News reported on the administration’s opposition to surgery for minors — a stark departure from the White House’s strong support for gender-affirming care and efforts to protect LGBTQ+ rights more broadly.
The White House did not immediately respond to HuffPost’s requests for comment.
Three years ago, during his first joint address to Congress, President Joe Biden sent a clear message to the trans community: “To all transgender Americans watching at home, especially young people … I want you to know that your president has your back.”
Most recently, the Biden administration has sided with transgender youth and their families in a legal challenge to Tennessee’s ban on gender-affirming care for youth, which is heading to the Supreme Court this fall. The court agreed to take up the case, which will determine whether bans on transition care violate the Constitution and could have ripple effects on similar bans nationwide.
“As President Biden has repeatedly said, ‘It’s wrong that extreme officials are pushing hateful bills targeting transgender children, terrifying families, and criminalizing doctors. These are kids. These are our neighbors. It’s cruel and it’s callous,’” the White House spokesperson said to The 19th, repeating remarks Biden gave last summer when he announced a series of initiatives to protect the LGBTQ+ community.
In a letter addressed to Biden last week, 12 transgender lawmakers wrote that the administration’s opposition to surgeries for minors is a “repudiation of that promise” and its statement about care for trans youth is “a betrayal.”
“By stating that some forms of healthcare for transgender people should be limited solely to adults, the administration is surrendering the health care of young transgender people as something to be negotiated in the political domain, rather than something that needs to be carefully considered and decided by the medical community, by the parents of transgender youth, and by the youth themselves,” the letter reads.
Montana state Rep. Zooey Zephyr — who was censured from speaking on the House floor in her state last year after telling colleagues they would have “blood” on their hands if they supported a ban on gender-affirming care for youth — was among the state legislators who signed the letter. She was joined by lawmakers from Oklahoma, Michigan, Minnesota, New Hampshire, Pennsylvania and Colorado.
Several LGBTQ+ advocacy organizations, including the Human Rights Campaign, Advocates for Transgender Equality and GLMA: Health Professionals Advancing LGBTQ+ Equality, also released statements condemning the administration’s 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,” Kelley Robinson, the president of the Human Rights Campaign, wrote in a statement.
“The administration is surrendering the health care of young transgender people as something to be negotiated in the political domain.”
– Letter from transgender lawmakers to President Joe Biden
Trans youth typically start by receiving puberty blockers before the onset of puberty, which causes bodily changes that may become sources of gender dysphoria in the future. Later in adolescence, patients may consider beginning hormone replacement therapy.
Gender-affirming surgery for minors is rare. The most common procedure is top surgery, or a masculinizing chest surgery that patients would only undergo after years of receiving medical care. Patients who have gotten top surgery have reported very low rates of regret.
“Opposing something as rare and necessary as surgery for trans youth is like banning care only for rare but severe allergies – targeting a seldom-needed but crucial intervention and stigmatizing those who need it the most,” Alex Sheldon, the executive director of GLMA, said in a statement. “This move by the Biden Administration is perilous, as it continues on the dangerous trend of inserting the government into private medical decisions that should remain between young individuals, their caregivers, and their providers.”
As Republican politicians have rallied to curtail access to gender-affirming care and have spread hateful rhetoric against LGBTQ+ people over the last few years, many conservative news outlets and pundits have spread misinformation about the types of care being provided to transgender youth.
Social media accounts like LibsOfTikTok and conservative media figures like Matt Walsh and Christopher Rufo have made posts mischaracterizing gender-affirming care for minors as “castration” and “mutilation.” This kind of misinformation has fueled Republican attorneys general and state legislators to investigate children’s hospitals in Tennessee, Texas and Missouri, and to use their authority to obtain sensitive patient medical records.
The first reports of the White House’s opposition to surgery for trans youth came after the Times and Fox News published articles describing conversations between the World Professional Association for Transgender Health and staff for Dr. Rachel Levine, the assistant secretary of the Department of Health and Human Services.
The Times reported in late June that Levine “pressed” WPATH to remove its proposed age limits for adolescent surgeries in its guidelines, which it releases periodically, because she was concerned about political backlash in the U.S.
WPATH, which is a global organization, had proposed lowering recommendations for top surgeries to 15 years old and to 17 years old for genital surgeries. The final standards of care, however, did not include specific age recommendations for surgeries for trans youth. The organization said it removed age recommendations to reflect the fact that “one-size-fits-all health care models, especially transgender care, are not accurate or appropriate for every individual person.”
Email correspondence between Levine and WPATH first became public through a deposition from James Cantor, a Canadian psychologist who was testifying in support of Alabama’s ban on gender-affirming care for minors.
Cantor, who was removed from Florida’s roster of medical experts in 2022 after linking being gay to pedophilia, said in his deposition that he has not directly been involved in the prescription or assessment of puberty blockers or hormone therapy for transgender youth.
The Department of Health and Human Services did not respond to HuffPost’s request for comment.
The agency told The 19th last week that in response to WPATH’s request for feedback on its standard of care, “Adm. Levine shared her 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.”
One-third of transgender youth now live in a state where they are not allowed to access gender-affirming care due to a state ban — despite numerous medical associations noting that such care is “medically necessary” and grounded in science.
Over the last few months, the Biden administration has strengthened protections for LGBTQ+ people in health care and education. In April, the Department of Education issued new guidance for Title IX, a federal law that protects against sex-based discrimination, to include discrimination on the basis of gender identity and sexual orientation. Similarly, the administration issued a final rule on Section 1557 of the Affordable Care Act to ensure that transgender people can be protected from discrimination in health care.
Both sets of rules have been challenged by Republican attorneys general, with over 20 GOP-led states suing the Biden administration for expanding discrimination protections to LGBTQ+ students. Last week, a Republican federal district court judge issued a nationwide injunction on Biden’s Section 1557 rule banning sex discrimination in health care.