The Biden administration said it opposes gender-affirming surgeries for transgender minors, a departure from previous statements that broadly supported gender-affirming health care for young people, drawing the ire of LGBTQ groups that supported President Biden in the race against former President Trump.
A White House spokesperson told The Hill in an email on Wednesday that while the administration supports gender-affirming care for minors, which represents a continuum of care, it believes gender-affirming surgical care should be reserved specifically for adults.
The government's statement, which was first reported from The 19th News, drew widespread criticism from influential LGBTQ organizations and figures who accused the administration of abandoning its commitment to transgender youth and failing to honor its promise of non-political interference in private health care decisions.
“The Biden administration has got this completely wrong,” said Kelley Robinson, president of the Human Rights Campaign, which endorsed Biden and poured millions into his reelection. “It’s wrong on the science and the substance. It’s also inconsistent with other steps the administration has taken to support transgender youth.”
Allison Scott of the Campaign for South Equality, a nonprofit that supports LGBTQ people in the South, called the administration's statement “cowardly.”
“It is a disturbing concession to the right-wing attack on transgender Americans, who buy into their false narratives about surgical care and betray a commitment to equality and trust in the medical community,” Scott said in a statement. “Let us be very, very clear: The government has no business interfering in private medical decisions that should be solely between patients, their health care providers, and the patient’s parent or guardian.”
“It is dangerous to support categorical bans or restrictions on health care, and there is no justification for restricting transgender youth’s access to the exact same care that many cisgender youth receive every year — that is literally the definition of discrimination,” she said. “We demand that the Biden administration retract this thoughtless declaration and work to undo the harm.”
The White House did not respond to requests for comment on the negative reactions.
The Biden administration last week for the first time expressed some skepticism about gender confirmation surgeries for minors in a New York Times reportwhich was a response to another Times report that the staff of Adm. Rachel Levine, an assistant secretary at the Department of Health and Human Services (HHS), had urged the World Professional Association for Transgender Health (WPATH), an organization focused on research into transgender health care, to remove the minimum age for gender-affirming medical care from its guidelines for minors.
The draft guidelines, released in late 2021, recommended lowering the minimum age to 14 for hormone treatments, 15 for mastectomies, 16 for breast augmentation or facial surgery, and 17 for genital or reproductive surgery. However, gender-affirming medical care of any kind should only be recommended to minors with a “well-documented” history of gender incongruence and who demonstrate “the emotional and cognitive maturity” necessary to give informed consent to treatment, the draft guidelines said.
The final WPATH guidelines, released in 2022, removed minimum age requirements entirely, including for surgeries. The group said this change will, among other things, “remove unnecessary barriers to care” and promote a more individualized approach.
Other medical organizations and health care professionals have said that maturity and social support are better indicators of whether gender-affirming care is appropriate than minimum ages. The Endocrine Society, a nonprofit focused on endocrinology and hormone research, recommends waiting until age 18 for genital or “buttock” surgery, and such a procedure being performed on minors is exceedingly rare.
In a statement to the Times, an HHS spokesperson said that Levine, who is transgender, “shared with her staff her belief that publishing the proposed lower ages for gender reassignment surgery was not supported by science or research, and could lead to an onslaught of attacks on the transgender community.”
HHS did not respond to questions from The Hill about the Biden administration’s position on gender-affirming surgery for minors. A spokesperson for WPATH did not immediately respond to a request for comment.
The administration's most recent statement on surgeries for transgender minors is a departure from the president's speeches, public statements and executive actions, in which he has unequivocally expressed support for gender-affirming care and condemned state laws that restrict or ban treatments, primarily for young people.
Since 2021, twenty-five Republican-led states have passed laws barring transgender minors from accessing gender-affirming health care, which major professional medical organizations say it is medically necessaryIn some cases, the state law restrictions on care for trans adultsnext to minors.
In Arizona, only surgeries are banned for transgender youth under 18. Access to other treatments, including puberty blockers and hormones, is protected by an executive order signed last year by the state's Democratic governor, Katie Hobbs.
In Ohio, a Department of Health and Human Services rule also bans minors from undergoing gender confirmation surgeries, though Ohio Gov. Mike DeWine, a Republican, has called the claim that doctors are performing surgeries on minors in the state “a fallacy.”
In April, a federal judge blocked an Ohio law that generally banned gender-affirming medical care for minors, and enforcement of a similar law in Montana was halted last fall. In June, a federal judge struck down a Florida law that barred minors and some adults from accessing gender-affirming health care, and the nation’s first ban in Arkansas was ruled unconstitutional last year.
At the urging of the Biden administration, the Supreme Court indicated late last month that it will decide during its next term whether bans on gender-affirming medical care for minors are constitutional.
