Biden Administration Opposes Surgery for Transgender Minors

The Biden administration said this week that it opposes gender reaffirmation surgeries for minors, the most explicit statement yet on the topic from a president who has always been a staunch supporter of transgender rights.

The White House announcement was sent to the New York Times on Wednesday in response to an article reporting that staff in the office of Adm. Rachel Levine, assistant secretary of the Department of Health and Human Services, had solicited an influential organization International Transgender Health Committee to remove age minimums for surgery from its guidelines for the treatment of 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 eliminating the 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 that bans all gender-fixing 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 bans at the state level.

The Biden administration's previous statements on gender-affirming child care have not explicitly opposed the surgery in the past.

A two-page explanatory document on gender-affirming treatments, often cited by federal officials, states that gender-affirming surgeries were “typically performed in adulthood or on a case-by-case basis in adolescence,” leaving the door open in some cases to perform the surgery on 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,” she said.

Despite the enormous attention the issue has received, minors in the United States rarely undergo gender reaffirmation surgery.

Procedures include “upper” surgeries to remove or augment the breasts, “lower” surgeries on the genitals and reproductive organs, and other operations to change 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 although the number of minors undergoing these operations has increased in recent years, they continue to be extremely rare.

The number of annual thoracic procedures for minors covered by insurance 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 between the ages of 12 and 18 who had undergone gender-affirming surgery.

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

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

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 that targets transgender people. It allowed passport holders to use an “X” to describe their gender and took steps to combat violence against transgender people.

After Florida proposed a series of laws 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 “terrible” efforts.

He did not specify the specific policies with which he disagrees. In contrast, Donald J. Trump, the presumptive Republican nominee for president, announced in a 2023 video posted on Truth Social a plan to pass a federal law banning all gender-affirming care 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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