So the Biden administration removed age limits for trans surgery
Excerpts from emails from Wpath members tell how the staff of flagship Rachel Levine managed to change the guidelines for political purposes without relying on scientific data

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While the Democrats panicked after the debate with Trump, in which Biden faltered several times giving everyone the impression of not being at his best, it turns out that some health officials in the Biden administration pushed to eliminate age limits for surgery on transgender minors from the guidelines. Officials feared that the age limit could fuel growing political opposition to transgender medicine.
Excerpts from emails from WPATH members tell how the staff of flagship Rachel Levine, secretary of the Department of Health and a transgender woman, urged them to eliminate the limits proposed by the guidelines and apparently succeeded.

In the United States, the definition of age limits has always been controversial.
The draft guidelines, published in late 2021, recommended lowering the minimum age to 14 for hormone treatments, 15 for mastectomies, 16 for breast augmentation or facial surgery, and 17 years for genital surgeries or hysterectomies. The limits were eliminated in the final guidelines, raising concerns within the international group and external experts on the reason for this cancellation.
Email excerpts released this week highlight Flagship Levine's role as the point person for transgender issues in the Biden administration. The documents, just published, are part of a federal lawsuit challenging Alabama's ban on gender-affirming care.
In one excerpt, an anonymous WPATH insider recalls a conversation with Sarah Boateng, Admiral Levine's chief of staff at the time:

“She believes, based on what she hears in Washington, that these limits on under-18s will lead to devastating legislation for trans care. We ask that specific ages be eliminated."

Another email states that Admiral Levine “was very concerned that the presence of the age limit (especially for surgery) would affect access to care for trans youth and perhaps even for adults." Apparently the situation in the United States is terrible (…) He asked us to remove it.”

The excerpts were deposited by James Cantor, psychologist and critic of gender-based treatment of minors, who used them as evidence that WPATH established guidelines based on politics rather than science. The emails from Admiral Levine's staff were not disclosed. The prosecution is trying to block Dr. Cantor from testifying in the case, arguing that he has no experience and that his opinions are irrelevant.
Flagship Levine and the Department of Health did not respond to requests for comment, citing the ongoing litigation.

Cantor said he filed the report to expose the contents of the group's internal emails.

“What is said in the public is totally different from WPATH's discussions in private,” he says.

Dr. Marci Bowers, a gynecologic and reconstructive surgeon and president of WPATH, disputed the claim.

«WPATH does not look at politics when making decisions»

In other emails released this week, some WPATH members express their disagreement with the proposed changes. “If our concern is legislation (and I don't think it should because we should rely on science and expert consensus) wouldn't it be useful to include age?” writes one member. «I need someone to explain to me how eliminating ageism can help in the fight against the conservative anti-trans agenda."
In the eighth edition of the standards of care, published in September 2022 WPATH finally eliminated the minimum age. The new edition included for the first time a chapter dedicated to the treatment of transgender adolescents.
The field of gender transition care for adolescents is relatively new, and evidence on long-term outcomes is scarce.
However, as the number of young people seeking such treatments increases, leading doctors around the world are at odds over issues such as the ideal timing and criteria for medical interventions. Several European countries, including Sweden and Britain, have recently placed new restrictions. In these countries' health systems, surgeries are only available to patients over the age of 18.
The emails were made public by the United States District Court for the Middle District of Alabama, as part of an appeal of Alabama's ban filed by civil rights groups, including the National Center for Lesbian Rights and the Southern Poverty Law Center, on behalf of five transgender teenagers and their families.
Transgender rights groups they turned to the courts to block the laws, like Alabama's, which have been approved in more than 20 Republican-controlled states as of 2021, but courts have ruled differently each time.
The Supreme Court announced Monday that it would hear an appeal against the ban on gender medicine for youth in Tennessee, that makes it a crime for doctors to provide any gender-related treatment to minors, including puberty blockers, hormones and surgery. The petition, filed by the Department of Justice, cites the WPATH guidelines as among the primary “evidence-based practice guidelines for the treatment of gender dysphoria.”
Additional emails cited in the new court documents suggest that the American Academy of Pediatrics also warned WPATH that it would not approve the group's recommendations if the guidelines set the new minimum age.
In a statement Tuesday, Mark Del Monte, CEO of the American Academy of Pediatrics, stressed that the group, which represents 67,000 U.S. pediatricians, had not endorsed the international guidelines because it already had its own.
He said the AAP has tried to change the age limits in the guidelines.
Last summer, the AAP reaffirmed its guidelines, published in 2018, but said it was commissioning an external review of the evidence for the first time.
The numbers of gender-related medical interventions for adolescents are constantly increasing. A Reuters analysis based on insurance data estimated that approx 4,200 American adolescents started estrogen or testosterone therapy in 2021, more than double compared to four years earlier. Surgeries are rarer, and most are mastectomies or breast surgeries. Reuters estimated that 282 teenagers had mastectomy surgeries paid for by insurance in 2021.
Azeen Ghorayshi for the New York Times


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