Biden administration opposes surgery for transgender minors

The Biden administration said this week that it opposes gender-affirming surgery on minors, the most outspoken statement yet on the issue from a president who has been a vocal supporter of transgender rights.

The White House announcement was sent to the New York Times on Wednesday in response to a report that staff in the office of Adm. Rachel Levine, assistant secretary of the Department of Health and Human Services, had solicited an influential international organization to Transgender health remove minimum age for surgery from treatment guidelines for minors.

The interim guidelines would have lowered the minimum age limits to 14 for hormone treatments, 15 for mastectomies, 16 for breast augmentation or facial surgery, and 17 for genital surgery or hysterectomies. The final guidelines, released in 2022, removed the age-based recommendations altogether.

“The admin. Levine shared with his staff his view that publishing the proposed lower ages for gender transition surgeries is not supported by science or research and could lead to an onslaught of attacks against the transgender community,” an HHS spokesperson said in a statement Friday evening.

Federal officials did not elaborate further on the administration's position on scientific research or Admiral Levine's role in abolishing minimum age limits.

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 have said.

Medical care for transgender teens 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-diagnosing medical treatments for minors.

The Supreme Court on Monday agreed 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 state-level bans.

Previous Biden administration statements on gender-affirming child care have not explicitly opposed surgery in the past.

A two-page explanation of gender-affirming treatments, often cited by federal officials, said that gender-affirming surgeries were “typically used in adulthood or on a case-by-case basis in adolescence,” leaving the door open in some cases to surgery for minors.

Other gender-affirming treatments such as puberty blockers are used during puberty, the explainer noted. Hormone treatments with estrogen or testosterone, which are partly irreversible, are used in “early adolescence and beyond,” it said.

Despite the enormous attention the issue has attracted, it is rare for minors in the United States to undergo gender-affirming surgeries.

Procedures include “upper” surgeries to remove or augment the breasts, “lower” surgeries on the genitals and reproductive organs, and other operations to alter facial features.

Breast reductions or mastectomies for transgender men and nonbinary individuals are the most common procedures performed. Some doctors have argued that minors should have access to breast surgery before the age of 18 because breast development occurs at the onset of puberty and breasts are so visible that transitioning teens go to great lengths to hide them, often by binding their chests.

But even though the number of minors undergoing these surgeries has increased in recent years, they continue to be extremely rare.

The number of thoracic surgeries performed annually on insured minors in the United States is estimated to be in the hundreds. While there are no official statistics, a national analysis of hospital data from 2016 to 2020 identified approximately 3,600 patients ages 12 to 18 who underwent gender-affirming surgery.

The vast majority were chest-tied, an increasingly common procedure among transgender teens.

An analysis of hospital data found that the number of gender-affirming mastectomies among insured Cases in adolescents have increased from five cases in 2013 to 70 in 2019. But genital surgeries among minors are “extremely rare,” doctors said.

The administration has been a strong advocate for transgender people, affirming individual rights to gender-affirming care, highlighting federal provisions that protect transgender Americans from discrimination, and emphasizing 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 a series of bills targeting transgender residents in 2023, including measures that would ban gender-affirming child care and bar transgender athletes from joining certain sports teams, Biden said he found the efforts “appalling.”

He did not specify the particular policies with which he disagrees. In contrast, Donald J. Trump, the presumptive Republican nominee for president, announced in a video posted in 2023 on Truth Social a plan to pass a federal law banning all gender-affirming treatment for minors, which he described as “child sexual mutilation”. “

He also said that any hospital performing the treatment will not be eligible for Medicaid and Medicare funds under this policy.

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