White House says gender-affirming surgeries should be limited to adults

The Biden administration said it opposes gender-affirming surgery for transgender minors, deviating from past statements that broadly support gender-affirming health care for youth and angering LGBTQ groups that have backed President Biden in the race against former President Trump.

A White House spokesperson told The Hill in an email that while the administration supports gender-affirming care for minors, which represents a continuum of care, it believes gender-affirming surgical care, specifically, should be reserved for adults.

The administration’s statement, which was first reported by The 19th News, drew swift criticism from influential LGBTQ organizations and figures who accused the administration of abandoning its commitment to transgender youth and going back on a promise not to insert politics into private medical decisions. 

“The Biden administration is flat wrong on this,” said Kelley Robinson, president of the Human Rights Campaign, which has endorsed Biden and poured millions into his reelection. “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.” 

Allison Scott, director of impact and innovation at the Campaign for Southern Equality, a nonprofit organization supporting LGBTQ people in the South, called the administration’s statement “cowardly.” 

“It is a troubling concession to the right-wing assault on transgender Americans, falling for their false narratives about surgical care and betraying a commitment to equality and trust in the medical community,” Scott said in a statement. “Let’s be very, very clear: Government has no business inserting itself into private medical decisions that should be exclusively between patients, their providers, and the patients’ parent or guardian.” 

“It is dangerous to begin endorsing categorical bans or limits on healthcare, and there is no justification for restricting transgender youth’s access to the very same care that many cisgender youth receive every year – that’s literally the definition of discrimination,” she said. “We demand the Biden Administration retract this thoughtless statement and work to undo its damage.” 

The White House did not respond to requests for comment on the backlash. 

The Biden administration first expressed some skepticism to gender-affirming surgeries for minors last week in a New York Times report, which came in response to another Times report that the staff of Adm. Rachel Levine, an assistant secretary at the Department of Health and Human Services (HHS), had urged the World Professional Association for Transgender Health (WPATH), an organization devoted to researching transgender health care, to remove age minimums for gender-affirming medical care from its guidelines for minors. 

The draft guidelines, released in late 2021, recommended lowering the age minimums to 14 for hormone treatments, 15 for mastectomies, 16 for breast augmentation or facial surgeries and 17 for surgeries on genitals or reproductive organs. Gender-affirming medical care of any kind, however, was only to be recommended to minors with a “well documented” history of gender incongruence and who demonstrate “the emotional and cognitive maturity” needed to provide informed consent for treatment, according to the draft guidelines. 

The final WPATH guidelines, released in 2022, removed minimum age requirements altogether, including for surgery. The group said that change, among others, will “eliminate unnecessary barriers to care” and foster a more individualized approach.

Other medical organizations and health care professionals have said maturity and social support are better indicators of whether gender-affirming care is appropriate than age minimums. The Endocrine Society, a nonprofit organization that focuses on endocrinology and hormone research, recommends waiting until 18 for genital, or “bottom,” surgery, and such a procedure being done on minors is exceedingly rare. 

In a statement to the Times, a spokesperson for HHS said Levine, who is transgender, “shared her view with her staff that publishing the proposed lower ages for gender transition surgeries was not supported by science or research, and could lead to an onslaught of attacks on the transgender community.” 

HHS did not respond to questions from The Hill about the Biden administration’s stance on gender-affirming surgery for minors. A spokesperson for WPATH did not immediately return a request for comment. 

The administration’s latest statement on surgery for transgender minors is a departure from the president's speeches, public statements and executive actions that express unequivocal support for gender-affirming care and denounce state laws meant to restrict or ban treatment, primarily for youth.

Twenty-five Republican-led states since 2021 have adopted laws that bar transgender minors from accessing gender-affirming health care, which major professional medical organizations say is medically necessary. In some cases, state law limits care for trans adults, in addition to minors.

In Arizona, surgeries — but not other care — are banned for transgender youth under 18. Access to other treatments, including puberty blockers and hormones, is protected under an executive order signed last year by the state’s Democratic governor, Katie Hobbs. 

In Ohio, a state Health Department rule similarly bars minors from undergoing gender-affirming surgery, though Ohio Gov. Mike DeWine, a Republican, has called the claim that doctors are performing surgeries on minors in the state “a fallacy.”  

In April, a federal judge blocked an Ohio law banning gender-affirming medical care more generally for minors, and enforcement of a similar Montana law was halted last fall. In June, a federal judge struck down a Florida law barring access to gender-affirming health care for minors and some adults, and Arkansas's first-in-the-nation ban was ruled unconstitutional last year.

At the urging of the Biden administration, the Supreme Court late last month said it will decide during its next term whether bans on gender-affirming medical care for minors are constitutional.