A message apparently sent to Levin from WPATH read, “We have heard your comments regarding the minimum age criteria. … Accordingly, we have changed the way the minimum age is worded in our documentation.”
Taken together, these messages suggest that Levin does not understand the ethical requirements of his job.
I reached out to HHS to see if anything had been lost in translation, and it turned out the evidence I was looking at consisted of fragmented, decontextualized conversations purportedly paraphrased by anonymous WPATH members, and the court evidence presented was compiled by expert witnesses critical of these treatments.
Surely a top HHS official wouldn’t have asked a group of experts to rewrite the experts’ recommendations for political purposes?
Surely Levin, a pediatrician and transgender woman herself, was proposing to lower guardrails designed to protect vulnerable adolescents from potentially lifelong complications?
But had Admiral Levine not done these things, surely the administration could have come up with something stronger than the tepid non-denial stance that was pointed out to me in a follow-up New York Times article: “Admiral Levine shared with his staff the view that publicly announcing a proposal to lower the age for sex-reassignment surgery was not supported by science or research and could lead to an onslaught against the transgender community.”
The Times article also included a new announcement, made shortly after the Levine case was published: The White House now opposes sex-reassignment surgery for minors.
This is too little: the allegations against Levine need to be investigated and, if true, she needs to be replaced — not only because she puts children at risk, but also to send a message that politics will not take precedence over science when it comes to determining appropriate medical care for children.
Much of the debate on this subject has focused on legal, political, and philosophical questions, and less on the most important empirical questions: For example, will most children who receive these treatments benefit? If so, to what extent? And if only some children benefit, how can others be identified before they begin life-altering treatments such as hormones and surgery?
As this story unfolds, the Supreme Court has agreed to hear a Tennessee challenge to its ban on sex-reassignment care for minors. The justices will assemble in robes this fall to hear solemn arguments from lawyers and then, in June or July of next year, rule on whether the ban violates the Equal Protection Clause of the 14th Amendment.
But this makes no sense until we have better information about how effective treatments are. If medical intervention can help gender dysphoric children live longer, happier lives, states should allow it because it’s the right thing to do, not because refusing it might be discriminatory. If the intervention doesn’t help children, or doesn’t help enough children, and it’s impossible to identify with any certainty which interventions would be beneficial, then clearly children should not be harmed in the name of gender equality.
You probably think you already know these answers – that, as we so often hear, sex reassignment treatment for children is “medically necessary,” “evidence-based,” and “life-saving.” But such judgments are expressions of our hopes, not dispassionate assessments of the available research. Several European health authorities have conducted systematic reviews of the evidence on the use of puberty suppressants and hormones to treat gender dysphoria in young people, and all have come to the same basic conclusion: the evidence is too weak to know how effective the treatments are.
We urgently need better evidence. Unfortunately, it is becoming harder to trust the institutions in charge of collecting it.
Last week, The Economist reported that other documents uncovered in the Alabama lawsuit suggest something was amiss with WPATH itself. WPATH reportedly asked Johns Hopkins University to review the evidence and then tried to interfere with its findings. Internal communications suggested the study needed to be “thoroughly vetted to ensure that its publication would not negatively impact the delivery of transgender health care broadly.” Now, assuming this is true, WPATH must have sincerely believed it was doing the best it could for gender dysphoric kids. But interference like this makes it hard to tell whether the group is right.
The fact is, nearly everyone involved in this issue, from Republican state legislators who think they’re saving young people from unnecessary and harmful treatments to Department of Health and Human Services officials who think they’re saving those same kids from being trapped in the wrong bodies, certainly thinks they’re doing what’s best for kids. But they can’t all be right. The two sides can hold such opposing views in good faith precisely because this issue is being treated as a political and legal dispute, rather than a new empirical question that we have yet to fully answer. The only way to resolve the issue is to set aside politics and replace it with professionalism, passion with reason, and opinion with facts.
