Doctors fear White House opposition to surgeries for transgender youth will slow gender-affirming care

The Biden administration appears to have changed its thinking on gender affirming surgeries for transgender and non-binary youth, raising concerns among doctors and 2SLGBTQ+ rights groups who have already been pushing back against a flood of anti-trans legislation across the country.

In recent media statements, the White House has spoken out against such surgeries for minors, which are rare, despite the fact that it has voiced support for protecting access to gender-affirming care for minors and preventing discrimination in health care.

“These are deeply personal decisions and we believe these surgeries should be limited to adults,” a White House spokesman said in a statement this week. The 19tha website that reports on gender politics and policy.

This followed an earlier statement to The New York Times following reports that government health officials had pushed to remove the age limit for gender confirmation surgery from transgender care guidelines provided to medical professionals around the world.

Advocates fear the comments will fuel anti-transgender movements and conservative lawmakers who want to restrict access to all forms of gender-affirming care for young transgender and non-binary people, despite several medical associations stressing that such care is essential.

According to Dr. Meredithe McNamara, an assistant professor at Yale School of Medicine and a physician specializing in adolescent medicine, a one-size-fits-all approach to the problem doesn’t help patients who are better off with care negotiated on a case-by-case basis with their families and medical professionals.

“It is very difficult to tell someone that you need, want and otherwise qualify for this care, but a piece of paper says you are not old enough yet.”

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Doctor justifies harmful medical care

The New York Times Report The report that fueled the White House comments was published last week. It described how Department of Health and Human Services Assistant Secretary Dr. Rachel Levine urged the World Professional Association for Transgender Health (WPATH) to remove age limits for surgeries from the standards of care guidelines it publishes and distributes to health care providers around the world.

Levine, the highest-ranking openly transgender U.S. government official, worried that imposing age limits on certain surgeries could have negative consequences when it comes to anti-transgender laws and access to care, the Times reported.

McNamara said that in the past, doctors were not required to justify any form of medical care to government agencies, and that having to do so in these cases is harmful.

“It scares our patients. It keeps them from coming in for care.”

Joe Biden, dressed in a navy suit, stands behind a blue podium with the presidential seal. There is a blue background behind him with the words "Stonewall National Monument Visitor Center" in white letters.
U.S. President Joe Biden speaks at the grand opening ceremony of the Stonewall National Monument Visitor Center in New York City on June 28, marking 2SLGBTQ+ Pride and the 55th anniversary of the Stonewall Riots. That same day, The New York Times published an article stating that the Biden administration opposed gender-affirming surgeries for minors. (Evan Vucci/The Associated Press)

CBC News reached out to the White House and the Department of Health and Human Services but did not receive a response.

In recent years, the US has seen a wave of bills introduced aimed at transgender rights and gender-affirming care for minors.

The American Civil Liberties Union has tracked the following 527 anti-2SLGBTQ+ bills have been implemented so far in 2023. Of those, 78 relate to health care restrictions. Many face lawsuits.

The Supreme Court will also take up the issue in its next hearing, which will consider whether to ban access to puberty blockers and hormone therapy for transgender and non-binary youth. are constitutional.

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Surgery not common among transgender youth

Gender Confirmation Surgical Procedures may include feminization/masculinization of the face, removal of breast tissue, breast enlargement, and genital transformation and reconstruction surgeries.

These procedures are not the first step, McNamara says, and are certainly not necessary or desirable for all patients — whether in adolescence or adulthood — nor are they easily accessible to most people.

Social transition and non-surgical medical treatments, such as prescribing medications that block puberty or hormone treatmentsis perhaps the furthest some are willing to go when it comes to their transition, she explained.

McNamara told CBC News that providing access to reversible nonsurgical treatments like puberty blockers often limits a patient’s need or desire for surgery later in life. She says those treatments are being singled out, banned and criminalized.

Advocates for restricting gender-affirming care for young people argue that there is not enough research on the outcomes and risks of such treatments and claim that medications such as puberty blockers and hormone therapy are irreversible. They also say that adolescents are making decisions about surgeries without understanding the consequences.

Portrait of a woman in a cream-colored turtleneck sweater with a long, dark coat over her shoulders.
Meredithe McNamara, an assistant professor at Yale School of Medicine and a pediatrician, says a one-size-fits-all approach to gender-affirming care and surgery doesn’t help patients who are better off with care determined on a case-by-case basis in consultation with their families and medical professionals. (Submitted/Yale School of Medicine)

There is little reliable data on how many people under the age of 18 have undergone gender confirmation surgery.

According to the Cleveland Clinic25 to 35 percent of transgender and non-binary people in the US choose gender confirmation surgery.

a Study 2023 A study led by Columbia University found that of the more than 48,000 patients who underwent gender confirmation surgery between 2016 and 2020, 7.7 percent (3,678) were between the ages of 12 and 18. Breast or thoracic surgeries made up the vast majority of procedures.

That’s a small fraction of the approximately 1.6 million transgender people ages 13 and older in the U.S., according to an estimate by the Williams Institute at the University of California-Los Angeles Law School.

McNamara says that of the thousands of adolescent patients she treats, very few are transgender and even fewer – she can count on her hands – have expressed interest in gender-affirming pharmaceutical therapies, let alone surgery.

She says she has only heard of one person under the age of 18 in her entire career who has undergone surgery, and it was someone with “extreme dysphoria coupled with chest discomfort” and rib fractures from years of breast binding.

According to McNamara, cisgender children are undergoing far more gender-affirming surgeries, such as the removal of excess male breast tissue due to a condition called gynecomastia.

She also notes that cosmetic procedures unrelated to gender-affirming care are much more common for trans youth and have no government-imposed age limit.

“The number of pre-operative approvals for breast augmentation and Brazilian butt lifts in adolescents that I have performed far exceeds the number of times my practice reports gender confirmation surgeries for transgender individuals.”

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2SLGBTQ+ groups critical of White House statement

McNamara is concerned that misinformation about gender identity and gender-affirming care has informed the Biden administration’s position on gender-affirming surgeries for minors.

CBC News reached out to several U.S. transgender and 2SLGBTQ+ organizations but did not receive a response.

However, several groups have criticized the White House statement, calling it damaging and ill-informed.

Transgender Equality Advocates Executive Director Rodrigo Heng-Lehtinen said in a statement that trans youth and their families rely on their doctors and medical research to make the right decisions about health care, and that the government should stay out of it.

“Unfortunately, the Biden administration has chosen to put politics over science, and that mistake empowers the bullies, amplifies the misinformation of extremists, and puts lives at risk,” the statement said.

“It’s wrong on the science and it’s wrong on the content,” said Kelley Robinson, president of the Human Rights Campaign. on the group’s websitewhich also noted that the White House statement is inconsistent with the administration’s previous commitments to protect transgender health care.

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