Biden administration opposes surgeries for transgender minors

The Biden administration this week said it opposes gender confirmation surgery for minors, the most explicit statement on the topic yet from a president who has championed transgender rights.

The White House announcement was sent to The New York Times on Wednesday in response to an article that reported that staff in the office of Admiral Rachel Levine, an assistant secretary at the Department of Health and Human Services, had urged an influential international transgender health organization to remove age minimums for surgeries from its treatment guidelines for minors.

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

“Adm. Levine 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,” an HHS spokesperson said in a statement Friday night.

Federal officials did not elaborate on the administration’s position on the scientific research or on Adm. Levine’s role in eliminating the minimum ages.

The government, which supports gender-affirming care for transgender youth, only opposed surgeries for minors, not other treatments. The procedures are usually irreversible, critics say.

Medical care for transgender adolescents has become a hot-button issue in many states, especially in conservative political circles. The Texas Supreme Court on Friday upheld a state law banning all gender-affirming medical treatments for minors.

The Supreme Court on Monday agreed to hear a challenge — filed in part by the Biden administration — to a Tennessee law that bans treatments including puberty blockers, hormone therapy and surgery for transgender minors. It’s the first time the justices have ruled on the constitutionality of such statewide bans.

Previous Biden administration statements on gender-affirming care for minors never explicitly rejected surgery.

a Two-page explanation of frequently cited gender-affirming care Federal officials said gender confirmation surgeries were “typically used in adulthood or on a case-by-case basis in adolescence,” leaving the door open in some cases for surgeries on minors.

Other gender-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 adolescence and beyond,” the report said.

Despite the enormous attention the issue receives, it is rare for minors to undergo gender confirmation surgery in the United States.

Procedures include “top” surgeries to remove or enlarge the breasts, “bottom” surgeries on the genitals and reproductive organs, and other surgeries to change facial features.

Breast reductions or mastectomies for transgender men and nonbinary individuals 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 puberty and breasts are so visible that menopausal teens go to extreme lengths to hide them, often binding their chests.

But even though the number of minors undergoing these operations has increased in recent years, it remains extremely unusual.

The number of annual breast surgeries for minors who are insured in the United States is estimated to be in the hundreds. Although there are no official statistics, a national analysis Hospital data from 2016 to 2020 show that approximately 3,600 patients aged 12 to 18 years underwent gender confirmation surgery.

The vast majority involved breast surgeries, a procedure that is becoming increasingly common among transgender teens.

An analysis of one hospital Data showed that the number of gender-affirming mastectomies among insured people The number of teenagers has risen from five cases in 2013 to 70 in 2019. But genital surgeries among minors are “extremely rare,” doctors say.

The administration has been a strong supporter of 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 care 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 laws in 2023 targeting transgender residents, including measures that would ban gender-affirming care for minors and restrict transgender athletes from joining certain sports teams, Biden said he found the efforts “appalling.”

He did not specify what specific policies he disagreed with. In contrast, Donald J. Trump, the presumptive Republican nominee for president, announced in a video posted to Truth Social in 2023 a plan to pass a federal law banning all gender-affirming care for minors, which he described as ‘sexual mutilation of children. ”

He also said hospitals that perform the treatment are not eligible for Medicaid and Medicare funds under this policy.

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