WPATH & the Biden HHS on transgender medical interventions guidelines
by Pauline Park, Ph.D.
Transgender identity is in many ways the new same-sex marriage; back in 2004, Karl Rove — known widely as ‘Bush’s brain’ — persuaded George W. Bush to use opposition to marriage equality to win Ohio and re-election; 20 years later, the majority of Americans in favor of marriage equality is so overwhelming that even Republicans will not talk about same-sex marriage except privately in right-wing circles and even then just pay lip service to what they (misleadingly) call ‘traditional marriage.’ The truth is, ‘gay marriage’ (never a fully accurate moniker) just doesn’t work anymore for Republicans and the religious right and their confederates have turned instead to transgender community members as the new bogeymen (‘bogeypersons’?) of the American body politic: that is the best and really the only persuasive explanation for the bizarre little controversy that exploded earlier in the year that got the attention even of the august — and increasingly transphobic — New York Times.
“Health officials in the Biden administration pressed an international group of medical experts to remove age limits for adolescent surgeries from guidelines for care of transgender minors, according to newly unsealed court documents. Age minimums, officials feared, could fuel growing political opposition to such treatments,” Azeen Ghorayshi reported in June 2024, alleging that Joe Biden’s highest transgender-identified appointee Admiral Rachel Levine, MD pushed the World Professional Association for Transgender Health (WPATH) to eliminate age limits for sex reassignment surgery (SRS, also called ‘gender reassignment surgery,’ ‘gender confirmation surgery’ and ‘gender affirmation surgery’) (Azeen Ghorayshi, “Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show,” New York Times, 25 June 2024). “The draft guidelines, released in late 2021, recommended lowering the age minimums to 14 for hormonal treatments, 15 for mastectomies, 16 for breast augmentation or facial surgeries, and 17 for genital surgeries or hysterectomies,” added Ghorayshi.
Joe Biden appointed Levine an assistant secretary for health in the Department of Health & Human Services (HHS) in 2001, making her the most senior trans-identified appointee in Biden’s administration and indeed in any presidential administration to date; significantly, she has declined to respond to media inquiries from the New York Times and other media outlets over the allegation that she tried to use her position to influence WPATH to try to forestall controversy. An unnamed WPATH staff member was quoted by the Times as writing in an e-mail message of Sarah Boateng, then serving as Admiral Levine’s chief of staff: “She 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” and the same WPATH staffer wrote in another e-mail message that Boateng had said that 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 and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them.”
In response from obviously transphobic critics, Dr. Marci Bowers told the Times, “It wasn’t political, the politics were already evident. WPATH doesn’t look at politics when making a decision.”
Nonetheless, Republicans in the House of Representatives tried to make hay of the controversy, even going so far as to open an investigation into the matter (Gabrielle M. Etzel, “House investigates Biden official over pressure to lower age limits for gender-transition surgeries,” Washington Examiner, 27 August 2024).
There are five questions that anyone wishing to understand this tempest in a teacup should try to answer:
First, how did this whole thing start and who is behind the controversy and what agendas are being pursued?
Second are these US HHS guidelines legally binding and if not, why are they important?
Third, what kinds of medical interventions are legal minors currently able to access in the US and what are the real life consequences for transgendered people and especially for trans youth of the denial of care?
Fourth, is there another way to frame this than in terms of ‘medically necessary treatment’?
Fifth, what would a progressive intersectional feminist analysis suggest about the relationship between this controversy and the pursuit of a progressive agenda of social justice and social change…?
Pauline Park is a member of the Out-FM collective that produces LGBTQ-relevant programming for WBAI at 99.5 FM; she led the campaign for the transgender rights law enacted by the New York City Council in April 2002 and became the first openly transgendered grand marshal of the New York City LGBT Pride March in June 2002. Park did her M.Sc. in European studies at the London School of Economics & Political Science and her Ph.D in political science at the University of Illinois at Urbana-Champaign. Pauline Park is a member of the Out-FM collective that produces LGBTQ-relevant programming for WBAI at 99.5 FM. She did her M.Sc. in European studies at the London School of Economics & Political Science and her Ph.D in political science at the University of Illinois at Urbana-Champaign.
