The Biden administration on Tuesday afternoon provided more details about its opposition to gender-affirming surgery for transgender minors, a position at odds with its previously broad support for gender-affirming care — and one taken by a presidential administration that has closely aligned itself with LGBTQ+ advocates.
“These are deeply personal decisions and we believe these surgeries should be limited to adults,” a White House spokesperson said over email. “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.”
Notably, the Biden administration has taken its support for gender-affirming care for trans youth all the way to the Supreme Court . The court has agreed to take up the question of whether gender-affirming care bans for trans youth are unconstitutional, in response to the Biden administration petitioning on behalf of trans youth and their families. The administration’s stance against laws that ban gender-affirming care for trans youth — which includes bans on surgeries — appears to remain the same.
“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 our kids. These are our neighbors. It’s cruel and it’s callous,’” the spokesperson said, quoting a statement that Biden made last summer in response to rising anti-LGBTQ+ legislation.
“Transgender children have been the victims of unacceptable bullying, hate and partisan laws that target them for who they are,” the spokesperson said.
Most transgender youth receiving gender-affirming care will not undergo surgery as a minor . Trans youth who, along with their parents, elect to begin gender-affirming medical care as they enter adolescence due to persistent gender dysphoria will typically receive puberty blockers. This treatment intervenes before puberty causes bodily changes that may require surgery in the future. Puberty blockers are typically used until patients get to an age where they can consider taking hormone replacement therapy.
Of the surgeries that a small number of trans adolescents undergo after receiving years of medical care, top surgery — or male chest reconstruction — is the most common. At some gender clinics, that is the only surgery ever considered for a trans minor. However, misinformation spread by opponents of gender-affirming care portrays genital surgery as a common procedure done on trans youth. Such a procedure being done on trans minors is exceedingly rare.
The White House cited the American Academy of Pediatrics (AAP) in its opposition to gender-affirming surgery for trans youth. The AAP, which endorses providing trans youth with gender-affirming care and opposes laws banning such care, has stated that gender-affirming surgeries are typically given to adults, which the White House echoed.
The White House provided its comment to The 19th following reports in The New York Times and Fox News that the Biden administration opposed gender-affirming surgery for trans youth.
According to reports from the Times and Fox News, the White House gave a brief response in opposition to surgery for trans youth following news articles detailing conversations between the World Professional Association for Transgender Health (WPATH) 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’s staff pressed WPATH to remove its proposed lower age limits for adolescent surgeries out of concern of political backlash, as WPATH updated its longstanding guidelines on transgender health care for medical professionals. WPATH had proposed lowering age recommendations for masculinizing top surgeries to 15 years old, and lowering the recommended age for genital surgeries to 17 years old.
In the final WPATH guidelines published in 2022, no age recommendations were given for surgeries for trans youth.
WPATH said that it removed those minimum ages for providing gender-affirming care “to reflect that one-size-fits-all health care models, especially transgender care, are not accurate or appropriate for every individual person.” WPATH said that medical professionals had expressed concern “that the listing of ages would lead to further limitations to care by creating or reinforcing arbitrary boundaries to care and/or by ignoring possible contributing health factors including mental health, family support, or other individual health needs.”
“In response to WPATH’s request for HHS feedback on a draft of its forthcoming 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,” the HHS said in an emailed statement. Levine, a four-star admiral in the U.S. Public Health Service Commissioned Corps, is the highest-ranking transgender official in the Biden administration.
The HHS did not respond specifically to questions regarding the White House signaling its opposition to gender-affirming surgery for trans youth.
The Biden administration has previously put out multiple statements in support of gender-affirming care for trans youth. The White House has stated that “transgender children have the right to access gender-affirming health care” and has promoted resources on gender-affirming care for trans youth, including an explainer written by the HHS that discusses when and how puberty blockers, hormone therapy, and surgeries are received by minors.
“To all transgender Americans watching at home, especially the young people, you’re so brave,” Biden said in 2021 to a joint session of Congress . “I want you to know your president has your back.” Biden again echoed that message in his 2024 State of the Union address .
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