Biden administration retreats from sex-change surgeries for minors, still backs other interventions

The Progress Pride flag is shown above (center flag) at a White House “Pride” celebration on June 10, 2023. / The White House, public domain, via Wikimedia Commons

Washington, D.C. Newsroom, Jul 5, 2024 / 18:00 pm (CNA).

U.S. President Joe Biden’s administration is backing away from its previous support of sex-change surgeries for minors who identify as transgender but is maintaining its support for other medical interventions to facilitate gender transitions for those under the age of 18.

In a statement first reported by The 19th News this week, a White House spokesperson said the administration believes that gender-transition surgeries “should be limited to adults.” However, the statement emphasized that the administration still supports other interventions to facilitate gender transitions for minors without specifying what it supports.

A study published in August 2023 estimated that patients aged 12 through 18 accounted for nearly 8% of transgender surgeries between 2016 and 2020 in the United States — about 3,678 surgeries in total. This included more than 3,200 chest surgeries and more than 400 genital surgeries to facilitate a sex change. It is legal to perform these surgeries on minors in more than half of the states in the country.

The statement added, however, that the administration continues “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,” without getting specific.

Other forms of medical interventions used to facilitate gender transitions for minors include puberty-blocking drugs, which prevent the body from going through its natural developments during puberty, and hormone therapy, which increases estrogen and reduces testosterone in boys and increases testosterone and reduces estrogen in girls. This is also legal in more than half of the states in the country.

The shift comes about one week after court documents revealed that the Biden administration’s assistant secretary for Health and Human Services, Adm. Rachel Levine, pressured at least one health care association to remove proposed guidelines that would have discouraged doctors from providing sex-change drugs and surgeries to young children.

According to emails included in the court documents, the World Professional Association for Transgender Health (WPATH) removed its age-based recommendations after Levine — who identifies as transgender — asked them to eliminate those suggestions. Internal emails from WPATH also revealed that the association does not have evidence to support the efficacy of gender transitions for minors: “We are painfully aware of the gaps in the literature and the kinds of research that are needed to support our recommendations.”

Prior to the recent White House statements, the administration has consistently criticized state laws that prohibit doctors from performing sex-change surgeries on minors. 

In 2022, a letter sent by the U.S. Department of Justice to states enacting these restrictions claimed that the laws were discriminatory toward people who identify as transgender and might violate the equal protection clause. That same year, Biden also signed executive orders meant to expand access to transgender medical interventions for minors. In a statement, the White House referred to lawmakers who imposed the restrictions as “bullies targeting LGBTQI+ people.” 

The administration’s shift has angered some of its allies, such as the Human Rights Campaign (HRC), which supports the legality of sex-change surgeries for minors.

“The Biden administration is flat wrong on this,” HRC President Kelley Robinson said. “It’s wrong on the science and wrong on the substance. It’s also inconsistent with other steps the administration has taken to support transgender youth.”

The administration’s shift also did not appease critics on the political right. 

“They want it to sound like they oppose procedures that perhaps 80% of the public also opposes,” Jay Richards, the director of the Heritage Foundation’s DeVos Center for Life, Religion, and Family, said in a post on X. 

“At the same time they spent the last three and a half years doing what the rabid gender ideologues demand, and that includes gender surgery on minors,” he added. “Now they have a square to circle.”

In recent years, about two dozen Republican-led states have enacted laws that prohibit doctors from performing sex-change surgeries on minors — many of those states also banned gender transition drugs for minors as well. Several Democrat-led states have gone in the opposite direction, passing laws to expand access to such surgeries and drugs for minors.