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The World Professional Association for Transgender Health (WPATH) has outsize influence on the medical care offered to children distressed about their gender. It shouldn’t. It’s not a medical or scientific organization, it’s an advocacy group. And in 2022, when it released its long-awaited revision of its treatment guidelines, including those for minors, the recommendations came as a shock. At the last minute, the group eliminated virtually all minimum age restrictions for receiving these life-altering medical and surgical interventions—interventions that, for example, could render patients sterile. How and why did such a thing happen? 

Now we know. 

A high-ranking Biden administration official, Assistant Secretary for Health Dr. Rachel Levine, directly interfered with these supposedly evidence-based WPATH recommendations.

Levine, we learned this week from internal WPATH documents that are part of a civil suit, lobbied WPATH to eliminate age minimums for treatments—including surgeries. The documents, from a report by expert witness Dr. James Cantor, show that Levine’s chief of staff met with WPATH representatives, who reported that Levine was very concerned that “specific minimum ages for treatment” “based on the rhetoric she is hearing in D.C.” “will result in devastating legislation for trans care. She wonders if the specific ages can be taken out. . . ” (Cantor’s report also shows the American Academy of Pediatrics similarly pressured WPATH to remove minimum age recommendations.)

The documents, as reported by Jesse Singal, show WPATH officials acknowledged Levine’s request and said they would act accordingly. Levine, a transgender woman who transitioned in middle age, was also worried about bans and backlash that were coming regarding transitioning young people. So, as the documents show, she pressured WPATH to hurry and release the new standards of care, to get them out soon for the administration’s political advantage: “I have just spoken to Admiral Levine today, who—as always is extremely supportive of the [Standards of Care 8], but also very eager for its release—so to ensure integration in the US health policies of the Biden government. So, let’s crack on with the job!!!”

Levine frequently describes gender transition of young people as “lifesaving” and “medically necessary.” Now we see how she used her political influence to interfere in what was supposed to be an evidence-based undertaking. But she also hasn’t been consistent. Levine said that she’s grateful that transition was not available when she was a teenager. “If I had transitioned when I was young, then I wouldn’t have my children,” Levine said at a 2019 meeting of the Society for Adolescent Health and Medicine. “I can’t imagine a life without my children.”

Lisa Selin Davis is a journalist and author of Tomboy. Read her piece “How Therapists Became Social Justice Warriors,” and follow her on Twitter @LisaSelinDavis.

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