The Biden administration said this week that it opposes gender reassignment surgery for minors, the clearest statement yet on the issue by a president who has been a strong supporter of transgender rights.
The White House announcement was sent to The New York Times on Wednesday in response to a story reporting that staff in the office of Admiral Rachel Levin, assistant secretary for Health and Human Services, had asked an influential international transgender medical organization to remove the minimum age for surgery from its treatment guidelines for minors.
The draft guidelines would have lowered the minimum age to 14 for hormone treatment, 15 for mastectomy, 16 for breast implants or facial surgery, and 17 for genital surgery or hysterectomy. The final guidelines, released in 2022, removed the age-based recommendations entirely.
“Admiral Levine shared with her staff her view that publicly announcing a proposal to lower the age for gender reassignment surgery is not supported by science or research and could lead to violent attacks against the transgender community,” a Health and Human Services spokesperson said in a statement Friday night.
Federal officials did not provide further details about the administration's position on scientific research or Admiral Levine's role in lifting the age limit.
The administration has supported gender-reassignment treatment for transgender youth, but has only voiced opposition to surgery on minors, not other medical procedures, which critics say are typically irreversible.
Medical care for transgender youth has become a hot topic in many states, especially in conservative political circles. On Friday, the Texas Supreme Court upheld a state law banning all gender-affirming medical care for minors.
The Supreme Court on Monday agreed to hear a challenge, brought in part by the Biden administration, to a Tennessee law that bans puberty-suppressing drugs, hormone therapy, surgery and other treatments for transgender minors, marking the first time the court has ruled on the constitutionality of such a statewide ban.
The Biden administration has not previously explicitly opposed the surgery in statements about gender-reassignment care for minors.
A two-page instruction manual on gender reassignment treatment frequently cited by federal officials says that sex-reassignment surgery “is typically performed in adulthood or adolescence on a case-by-case basis,” leaving open the possibility of surgery on minors in some cases.
Other gender-affirming treatments, such as reversible puberty suppressants, are also used during puberty, the explainer noted. Partially irreversible estrogen- or testosterone-based hormone treatments are used “from early puberty onwards,” the explainer said.
Despite the attention the issue has received, minors in the United States rarely undergo gender reassignment surgery.
Surgeries include “top” procedures to remove or augment breasts, “bottom” procedures on the genitals and reproductive organs, and other procedures to modify facial features.
Breast reduction and mastectomy are the most common surgeries performed on transgender men and non-binary people. Because breast development begins early in puberty and breasts are so visible, teens undergoing gender transition go to great lengths to hide them, often binding them, leading some doctors to argue that minors should be able to undergo breast surgery by the age of 18.
But despite an increase in the number of minors undergoing such procedures in recent years, the situation remains extremely rare.
It's estimated that hundreds of insured chest surgeries on minors are performed annually in the U.S. Although there are no official statistics, a national analysis of hospital data from 2016 to 2020 identified approximately 3,600 patients ages 12 to 18 who underwent gender-reassignment surgery.
The majority of the surgeries involved the chest, a procedure that is becoming increasingly common among transgender teens.
An analysis of data from one hospital found that the number of sex-affirming mastectomies performed among insured patients was Genital surgeries on teenagers rose from five in 2013 to 70 in 2019, but doctors report that genital surgery on minors is “extremely rare.”
The Administration has been a strong supporter of transgender people, recognizing an individual's right to receive gender-affirming care, highlighting federal provisions that protect transgender Americans from discrimination, and emphasizing the importance of mental health services for transgender youth.
The Biden administration has denounced state laws that target transgender people, and the administration has taken steps to combat violence against transgender people by allowing passport holders to use “X” to indicate their gender.
After Florida proposed several bills in 2023 that would target transgender residents, including banning gender-affirming medical care for minors and restricting transgender athletes from participating on certain sports teams, Biden called the efforts “egregious.”
He did not provide specifics about the policies he opposes. In contrast, presumptive Republican presidential nominee Donald J. Trump announced in a Truth Social video in 2023 that he plans to pass federal legislation banning all gender-affirming care for minors, which he described as “child sexual mutilation.”
He also said that under the policy, hospitals that perform the procedure would be ineligible for Medicaid and Medicare funding.