Dr. Rachel Levine Denies Having Pressured WPATH to Remove Age Limits on Minors' Gender Treatments
Subpoenaed records indicate that the former Biden health official, once the highest-ranking openly transgender member of government, did indeed do this, and explicitly for political reasons.
Dr. Rachel Levine, who as a Biden administration health official was the highest-ranking openly transgender member of the federal government, has denied that she sought to pressure a major transgender health group into removing age limits on gender-transition interventions.
She has additionally claimed that the evidence backing the field of pediatric gender medicine is “strong.”
Both of these claims, which Dr. Levine made in an interview yesterday with The Advocate, are refuted by considerable evidence.
Dr. Levine, a pediatrician by training, served as the assistant secretary for health throughout President Biden’s term.
Alabama’s attorney general, Steve Marshall, in defense of his state’s ban on prescribing puberty blockers and cross-sex hormones to minors with gender dysphoria, subpoenaed a raft of records from the World Professional Association for Transgender Health. WPATH is an activist-medical organization that publishes what are known as the Standards of Care, which are guidelines for the care and treatment of transgender people, including minors. In particular, Mr. Marshall sought internal records on the drafting of the Standards of Care’s 8th edition, or SoC 8, which was published to considerable fanfare—and controversy—in September 2022.
A federal court began to unseal these records in June 2024. Among the damning findings were emails indicating that Dr. Levine had obtained a draft of the SoC 8 and, in mid-2022, began pressuring WPATH leadership to remove the age restrictions for gender-transition treatments, in particular for surgeries.
In Alabama’s amicus brief to the Supreme Court in U.S. v Skrmetti, the case that ultimately upheld the constitutionality of Tennessee’s ban of pediatric gender-transition treatment, the state documented what the subpoenas had uncovered about Dr. Levine’s involvement in the SoC 8 development process:
After reviewing the draft, Admiral Levine’s office contacted WPATH at the beginning of July with a political concern: that the listing of “specific minimum ages for treatment,” “under 18, will result in devastating legislation for trans care.” Admiral Levine’s chief of staff suggested that WPATH hide the recommendations by removing the age limits from SOC-8 and creating an “adjunct document” that could be “published or distributed in a way that is less visible.” WPATH leaders met with Levine and HHS officials to discuss the age recommendations. According to a WPATH participant, Levine “was very concerned that having ages (mainly for surgery) will affect access to health care for trans youth … and she and the Biden administration worried that having ages in the document will make matters worse.” Levine’s solution was simple: “She asked us to remove them.”
And yet, in an article about yesterday’s Federal Trade Commission workshop scrutinizing pediatric gender medicine, The Advocate just reported:
Conservatives at the FTC workshop repeatedly named Levine, accusing her of pressuring WPATH in 2024 to remove age requirements from its updated standards of care for political reasons. Levine rejected those claims outright. “I’ve never considered myself political. I’ve always been involved with medicine and public health,” she told The Advocate. Levine explained that WPATH publicly circulated a draft of its guidelines and solicited feedback, to which her office submitted comments like any other entity.
"We gave a comment. Many different organizations put out comments, and we did too,” she said.
WPATH did not comply with Dr. Levine’s wishes—at first. But then, at the 11th hour, the American Academy of Pediatrics, subpoenaed records show, threatened that they would not only not endorse the SoC 8 if the age restrictions remained in the guidelines, they would explicitly come out against the document. WPATH then caved and complied with the shared wishes of Dr. Levine and the AAP. WPATH’s then-president Dr. Marci Bowers coordinated with her fellow leaders at the organization for a cover story about why they had removed the age restrictions.
Last year, in what appeared to be a continued vote of confidence in Dr. Levine, the AAP invited the health official to serve as the keynote speaker at its annual conference. An activist disrupted her speech by shouting, “Stop transing gay kids!”
The Advocate also reported that Dr. Levine said, in reference to the field of pediatric gender medicine, “It has been made a political and ideological issue.” She further emphasized that “the evidence base is strong for the safety and efficacy of these treatments.” Paraphrasing her words, The Advocate further reported that she noted that “with all areas of medicine, research should continue to evolve.”
Dr. Levine’s claim about the strength of the evidence behind these medical interventions is contradicted by a raft of systematic literature reviews—the gold standard of scientific evidence—that have found that the relevant research findings are weak and inconclusive. I reported in January for The New York Sun on a pair of recent such reviews about prescribing puberty blockers and cross-sex hormones to minors with gender dysphoria, which included a meta-analysis:
Dr. [Gordon] Guyatt [who is considered the godfather of evidence-based medicine] and his colleagues concluded in both papers that there is “considerable uncertainty regarding the effects” of each intervention, given that the available research almost entirely yielded evidence of “very low certainty.” Regarding hormone treatment in particular, the authors concluded that “we cannot exclude the possibility of benefit or harm.” The only research finding they considered to be of “high certainty” was that a small percentage of people who started cross-sex hormones subsequently experienced cardiovascular health events.
Dr. Levine has a history of making bold, unsubstantiated claims about pediatric gender medicine. In 2022, she asserted in a video: “Gender-affirming care is life saving” and “medically necessary.”
The Alabama amicus brief detailed how WPATH put the term “medically necessary” in its chapter on treating adolescents with gender dysphoria not because the research on blockers and hormones warranted it, but to garner insurance coverage and to help win lawsuits.
As for the claim that these treatments prevent suicide death, only one study has ever directly assessed whether prescribing cross-sex hormones to youths attending gender clinics is associated with an independent, statistically significant difference in the suicide death rate. The study, an analysis of robust national data in Finland, was published in Feb. 2024. It found no such association. It did find that while such deaths were elevated in this population compared with age-matched peers, they were nevertheless rare.
And yet, as recently as February of this year, Dr. Levine continued to claim that these treatments save lives. “Let’s be specific: Gender-affirming care is essential healthcare. It serves as mental health support, acts as suicide prevention, improves quality of life and literally saves lives,” she said in an address at the University of Michigan.
During the oral arguments for the Skrmetti case in December, ACLU litigator Chase Strangio admitted that there is no evidence to back the claim that these treatments prevent suicide death. He nevertheless asserted that studies have shown that this treatment demonstrates a reduction in suicidality.
On June 29, Mr. Strangio asserted on Bluesky, in reference to his words before the Supreme Court about the suicide question:“The way this has been taken out of context and distorted… [ellipsis his] Completed suicide is also not the only way to die from lack of access to medical care.”
It remains unclear what Mr. Strangio meant by this and how prescribing blockers and hormones to minors with gender dysphoria might prevent death by some other means than suicide.
"Insidious": The ACLU's Chase Strangio Slams The New York Times In Leaked Audio
ACLU litigator Chase Strangio on Saturday issued full-throated criticism of The New York Times’ coverage of transgender issues, calling it “insidious” and “absolutely terrible.” Mr. Strangio, who is a trans man, said that the paper is led by “this idea that they can situate us as a people to be hated.”
I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News and The New York Sun. I have also written for theWashington Post, The Atlantic and The Nation. Follow me on Twitter: @benryanwriter and Bluesky: @benryanwriter.bsky.social. Visit my website: benryan.net
He and the AAP are quite guilty of these charges. The motive- simple. To indemnify those who did sex change operations on youth. By having no age where it was impermissible, everything became permissible. Shame on all of them.
Well, what did you expect from Admiral Rachel? The advocates of sex change treatments for minors are well-practiced in lying. Although shocking, it isn't surprising.