The Biden administration said this week it opposes gender-affirmation surgery for minors, the most outspoken statement yet on the issue from a president who has been an outspoken supporter of transgender rights.
The White House announcement was sent to The New York Times on Wednesday in response to an article that said staff in the office of Adm. Rachel Levine, assistant secretary at the Department of Health and Human Services, had urged an international transgender health organization. remove minimum age limits for surgery from treatment guidelines for minors;
The draft guidelines would lower the minimum age to 14 for hormone treatments, 15 for mastectomies, 16 for breast augmentation or facial surgery and 17 for genital surgery or hysterectomy. The final guidelines, released in 2022, removed age-based recommendations entirely.
“Admin. Levine shared her view with her staff that publishing the recommended younger ages for gender reassignment surgery was not supported by science or research and could lead to an onslaught of attacks on the transgender community,” an HHS spokesperson said in a statement Friday night.
Federal officials did not elaborate further on the administration’s position on the scientific inquiry or on Admiral Levine’s role in repealing the minimum ages.
The administration, which has supported gender-affirming care for transgender youth, has expressed opposition only to surgeries for minors, not other treatments. The procedures are usually irreversible, critics said.
Medical care for transgender teenagers has become a hot-button issue in many states, particularly in conservative political circles. The Texas Supreme Court on Friday upheld a state law banning all gender-affirming medical treatment for minors.
The Supreme Court agreed Monday to hear a challenge — brought in part by the Biden administration — to a Tennessee law that bans treatments including puberty blockers, hormone therapy and surgery for transgender minors. This will be the first time the justices have ruled on the constitutionality of such statewide bans.
The Biden administration’s previous statements about gender-affirming care for minors have not been explicitly opposed to the surgery in the past.
A two-page explanation of gender-affirming care, often cited by federal officials, said gender-affirming surgeries “were typically used in adulthood or occasionally in adolescence,” leaving the door open to surgery for minors in some cases .
Other sex-affirming treatments, such as reversible puberty blockers, are used during puberty, the explainer noted. Hormone treatments with estrogen or testosterone, which are partially irreversible, are used in “early puberty and beyond,” he said.
Despite the tremendous attention the issue has received, it is rare for minors in the United States to undergo gender-affirming surgeries.
Procedures include “top” surgeries to remove or augment the breasts, “down” surgeries on the genitals and reproductive organs, and other procedures to modify facial features.
Breast reduction or mastectomy for transgender men and non-binary people are the most commonly performed procedures. Some doctors have argued that minors should have access to breast surgery before the age of 18 because breast development occurs early in adolescence and breasts are so visible that transitioning teens make every effort to attempt to hide them, often binding their breasts.
But although the number of minors undergoing these operations has increased in recent years, they remain extremely uncommon.
The number of annual breast surgeries for minors covered by insurance in the United States is estimated to be in the hundreds. Although there are no official statistics, a national analysis of hospital data from 2016 to 2020 found about 3,600 patients aged 12 to 18 who underwent gender reassignment surgery.
The vast majority were breast-related, an increasingly common procedure among transgender teenagers.
An analysis of one hospital’s data found that the number of sex-affirming mastectomies among policyholders Teenagers rose from five cases in 2013 to 70 in 2019. However, genital surgery among minors is “exceedingly rare”, doctors said.
The administration has been an outspoken advocate for transgender people, affirming individual rights to gender-affirming care, emphasizing federal provisions that protect transgender Americans from discrimination, and stressing the importance of mental health services for transgender youth.
The Biden administration has condemned state legislation targeting transgender people. It has allowed passport holders to use an “X” to describe their gender and has taken steps to combat violence against transgender people.
After Florida proposed several laws targeting transgender residents in 2023, including measures that would ban gender-affirming care for minors and restrict transgender athletes from participating on certain sports teams, Mr. Biden said he considered the “terrible” efforts.
He did not specify the specific policies he took issue with. In contrast, Donald J. Trump, the presumptive Republican presidential nominee, announced a plan in a 2023 video posted on Truth Social to pass a federal law banning all gender-affirming care for minors, which he described as “sexual mutilation of children. “
He also said that all hospitals that perform the treatment would be ineligible for Medicaid and Medicare funds under this policy.
