New evidence suggests that the White House is taking its marching orders on so-called gender-affirming care for kids from transgender interest groups. A messaging blunder last week revealed that the Biden administration likely knows that gender hormones and surgeries for kids are unpopular but fears that saying so will alienate the powerful organizations that support these controversial procedures.
In late June, documents released in Boe v. Marshall—a case challenging Alabama’s ban on sex-trait modification procedures for minors—revealed that the assistant secretary for health at the U.S. Department of Health and Human Services, Rachel Levine, pressured the World Professional Association of Transgender Health (WPATH) to eliminate age minimums from its latest “standards of care,” due to fear that specifying adolescent ages for surgeries would invite political backlash and result in legal restrictions on teen gender surgeries.
Even worse for a group that claims the mantle of medical science, internal emails reveal that WPATH suppressed the publication of evidence reviews that it had commissioned from researchers at Johns Hopkins University. As The Economist reported, WPATH also required the researchers to secure the organization’s approval before publishing their findings. And, according to a court document, WPATH forced the authors to add a disclaimer that they were “solely responsible for the content” of their published work.
Within days of the Alabama documents being unsealed, the White House told Fox News and the New York Times that it opposes gender surgeries for kids. It did so despite the administration’s longstanding, well-documented support for these very procedures. On July 2, 19th News, a progressive news site, published another statement that it had received from the White House. This one reiterated the Biden administration’s opposition to surgeries but added that the White House “continue[s] to support gender-affirming care for minors like mental health care and respect[s] the role of parents, families, and doctors in these decisions” (emphasis added). Notably absent was explicit support for puberty blockers and cross-sex hormones; the statement seemed to equate “gender-affirming care” with “mental health care.”
Transgender activists and advocacy groups were incensed. Some accused the White House of giving in to “far right” narratives and putting electoral priorities above the “health care” of “trans youth.” “The Biden administration is flat wrong on this,” wrote the Human Rights Campaign, the largest transgender lobby group and a powerful organization within the Democratic coalition.
Five hours later, 19th News edited the original story. “This article has been updated to clarify the nature of the White House’s response,” an editorial note explained. The White House statement was now amended to read: “We continue 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” (emphasis added).
Why did the White House suddenly change its tune? Why did it replace “mental health care” with “continuum of care”? The answer came the following day in a leaked email from the president of the Human Rights Campaign, Kelley Robinson, apparently sent to her organization’s listserv. After providing the text of the original and amended statements, Robinson wrote: “This is progress, but need [sic] to keep pushing. Pressure is working. This would not have happened without all of us.”
Replacing “mental health care” with “continuum of care” may leave an opening for hormonal interventions. The White House’s schizophrenic messaging around sex-modification procedures for kids, however, still needs explaining.
That explanation consists in the simple fact that all medical procedures for trans-identifying youth, whether hormonal or surgical, are unpopular and becoming increasingly so as Americans, including those in the medical profession, learn the details of this unfolding scandal. A YouGov poll found that only 19 percent of voters supported “allowing transgender youth access to puberty blockers.” Among Democrats, opinion was evenly split among those who support, oppose, and aren’t sure. Support went down as respondents’ age went up—a relevant finding considering that older voters turn out more frequently at the ballot box.
The White House has been impervious to these emerging realities. It has ignored the findings of the Cass Review, a nearly 400-page report commissioned by the National Health Service of England and the most comprehensive evaluation of youth gender medicine to date. The author of that report, a highly respected pediatrician in the U.K., wrote in the British Medical Journal that youth gender medicine is “built on shaky foundations.” She later told the New York Times that U.S. doctors and doctor groups that support hormonal and surgical procedures for kids are “out of date.”
Despite this emerging evidence, the Biden administration has preferred to rely on WPATH and on advocacy groups like Human Rights Campaign for its policy decisions on youth gender medicine. In 2022, for example, HHS’s Levine told NPR that “there is an evidence-based standard of care for the evaluation and treatment of trans individuals,” and “That standard is set by [WPATH].”
The White House’s statements over the past few days leave it unclear whether, or in what ways, it continues to support double mastectomies, castration, and endocrine manipulation, which carries significant risk of permanent sterility and lifelong sexual dysfunction. What recent days do make clear, however, is that the administration has finally recognized the deep unpopularity of these procedures. The question is whether the White House will continue to appease the powerful lobby groups that back these procedures, despite the voter sentiment and growing body of evidence opposing their use.
Democrats must stop allowing adult transgender activists to dictate their policies and start following principles of evidence-based medicine. The longer they wait to do so, the more they will lose the trust of Americans who care about science—and child welfare.
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