Biden Admin Now Opposes Access to Surgery for Trans Youth
The shift, which took place under pressure from the New York Times, represents a crumbling of one of the last bulwarks of protection for the tiny number of families whose children need such care.
by Evan Urquhart
According to stories in the New York Times and Fox News last week, the Biden administration announced a change in policy towards transgender healthcare, opposing all surgeries for trans youth under 18.
The change comes in the wake of a misleading story in the New York Times on June 25 that implied the Biden administration had pressed to make surgeries available for youth at younger ages. The NYT’s story on Friday printed a clarification from Biden’s Assistant Secretary for Health, Adm. Rachel Levine, saying that she had opposed a plan by WPATH to lower the minimum ages for treatments such as cross-sex hormones and surgeries for youth. A second statement, sourced to the White House and quoted in full by Fox News, stated, “The Administration does not support surgery for minors."
In the midst of an intensifying political focus on gender-affirming care for youth there remains widespread confusion over what is meant by gender-affirming surgeries, how common they are, and whether they are a necessary aspect of a gender transition from male to female or female to male.
Members of the public often assume surgery for gender transition means genital surgery such as a vaginoplasty or phalloplasty. However, less complicated surgeries, such as breast augmentation or chest masculinization, are far more common for trans people at any age. Genital surgeries in particular are vanishingly rare for youth under 18, however chest masculinization surgeries are slightly more common for adolescent transgender boys. Some anti-trans activists have further confused the issue by describing the implantation of a puberty-blocking implant using local anesthesia as “transgender surgery.” This framing has been used as a means of increasing pressure on lawmakers to ban the use of these reversible drugs.
The decision to get surgery is an individualized treatment choice made by a trans person in consultation with their doctor and other healthcare providers, and it is based on the person’s unique medical needs. A survey using representative sampling methods conducted by the Washington Post in 2022 found only 16 percent of adults who identify as transgender have undergone a gender-affirming surgery or surgery to change their physical appearance, and it is far rarer for adolescents than it is for adults. There are no surgeries needed, recommended, or allowed for children before the onset of puberty.
Most estimates point towards only a few hundred such procedures a year, primarily chest masculinization surgeries for adolescent trans boys who were unable to access puberty blockers in time to stop significant breast growth. (One known benefit of puberty blockers is that they reduce the need for surgery among trans boys.)
Though it’s rare, sometimes the family and healthcare team involved in treating a transgender adolescent for gender dysphoria determine surgery is necessary. Families, most of whom are afraid to speak openly about this topic out of the fear of being targeted for violence or political persecution, have spoken with Assigned in the past about the dramatic positive transformations their sons experienced after accessing top surgery. They spoke of teenage trans boys who were socially isolated gaining new confidence and making friends at school, teenagers with deep depression and suicide attempts returning to full mental health, and young men who struggled with hygiene starting to take showers again. (Assigned avoids sharing any potentially identifying details to protect such family’s safety, as the rarity of these surgeries increase the risk that identifying these families might be possible, even with such vague details as the child’s age or home state.)
The Biden Administration’s policy shift represents the crumbling of one of the last bulwarks that has protected families like these. Activists have seized on the news to renew calls for a national ban on the treatments.
Reached via text, one parent whose trans son accessed chest masculinization in adolescence had this to say: “The Biden Administration’s decision represents a failure of Democrats to recognize the medical necessity of surgical interventions for a small segment of trans youth. The statement demonstrates the performative allyship of Democrats and their willingness to follow Republicans in pathologizing trans people, criminalize their healthcare, and legislate all aspects of their lives. Either you support the right of trans people to access all the care that they may require, or you don’t. Politicians need to leave trans people and their families alone.”
Assigned Media reached out to the Department of Health and Human Services seeking comment on the change in policy by the Biden administration on surgery for transgender youth. They did not respond by the time this story went to press. We will update our story if we receive any official comment from HHS.
Evan Urquhart is the founder of Assigned Media.