House Investigates HHS Role in Removing Age Minimums from WPATH Gender Transition Guidelines

The House Oversight Subcommittee on Health Care and Financial Services is investigating the Biden-Harris administration’s role in shaping guidelines for the provision of gender transition procedures to both adults and minors. In June, The New York Times reported that Health and Human Services (HHS) officials in 2022 lobbied the World Professional Association for Transgender Health (WPATH) to remove age minimums for gender transition procedures in new guidelines. “We are concerned that HHS officials, acting in their official capacity, inappropriately applied pressure for change to international pediatric medical standards,” Chairwoman Lisa McClain (R-Mich.) wrote Tuesday.

The report cited Admiral Rachel Levine, assistant secretary for health at the Department of Health and Human Services, and his then-chief-of-staff, Sarah Boateng, as the key actors involved in pressuring WPATH to change its guidelines, according to WPATH email records disclosed in a court filing. Daily Signal Managing Editor Tyler O’Neil characterized WPATH as “a transgender activist group masquerading as a health organization.”

In 2021, WPATH released a draft version for the eighth edition of its “Standards of Care” (SOC-8) for gender transition procedures. The draft recommended lowering the minimum age requirements for various transgender procedures. According to the draft guidelines, minors can be given cross-sex hormones beginning at 14, mastectomies at 15, breast augmentation or facial surgeries at 16, and genital surgeries or hysterectomies at 17.

Levine and Boateng asked WPATH to remove the specific age minimums not for medical reasons but for political ones, according to the WPATH emails. According to one email, Boateng “is confident, based on the rhetoric she is hearing in D.C., and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out.”

According to another, Levine “was very concerned that having ages (mainly for surgery) will affect access to care for trans youth and maybe adults, too. Apparently the situation in the U.S.A. is terrible and she [sic] and the Biden administration worried that having ages in the document will make matters worse. She [sic] asked us to remove them.”

“The final version of SOC-8 published in September 2022 entirely removed these age minimums, despite WPATH directly informing Admiral Levine that it was not possible to remove the age recommendations,” McClain’s letter notes.

In 2023, transgender activists used WPATH’s SOC-8 — and other medical organization recommendations based on it — to lobby against proposed state legislation to protect minors from gender transition procedures. They argued that gender transition procedures were provided in accordance with WPATH’s standards of care, often implying that this meant that gender transition surgeries were not being carried out on minors.

The publication of these emails provoked criticism at the Biden-Harris administration’s apparent political interference in medical recommendations. According to a nationwide study, in 2022 nearly 80% of Americans opposed gender transition procedures for minors.

“The Biden Administration’s advocacy for expanding the pool of vulnerable children subjected to life-altering procedures they may later regret is reprehensible,” wrote McClain. “Emails indicating that this advocacy was done for political advantage — possible to satisfy extremist elements of its base — is [sic] even more outrageous.”

In response to the backlash, the White House distributed a statement reaffirming its support for gender transition procedures for minors, with the caveat that “surgeries should be limited to adults.”

This statement made the transgender lobby furious. After days of attacks from transgender activist groups and trans-identifying politicians, the White House issued another statement, pledging to “fight state and national bans of gender affirming care, which represents a continuum of care, and respect the role of parents, families, and doctors — not politicians — in these decisions. This statement stopped short of opposing gender transition surgeries for minors, saying instead, “Gender-affirming surgeries are typically reserved for adults, and we believe they should be.” Transgender activists welcomed this revised statement as “good news.”

While the previously revealed emails only uncovered WPATH records, the House Subcommittee aims to fill in the picture by obtaining HHS records as well. The Subcommittee demanded that HHS turn over relevant documents and communications with WPATH, with other medical organizations, with the White House, and within HHS “not later than September 10, 2024.” It also demanded a record of calendar entries, briefings, and phone calls and other non-written communications with WPATH.

“The Committee expects your full cooperation with these requests,” the letter warned. “Under your purview, HHS has not cooperated in good faith with the Committee’s oversight of HHS and its subagencies. … HHS and its subagencies have been recalcitrant in responding and producing documents …. It is unacceptable for HHS to interfere with congressional investigations by refusing and delaying cooperation with the Committee’s oversight.”

“Considering the Biden Administration’s recently concocted defense that ‘The Administration does not support surgery for minors,’ it is alarming that HHS would advocate for these polices in its communications with WPATH,” the letter stated. “Admiral Levine and Boateng’s clear, concise instructions to remove age recommendations from SOC-8 led to their ultimate removal, notwithstanding the Biden Administration’s now public statement that it opposes providing such surgeries to minors.”